Sensory remapping: a possible therapy option / Remapeamento sensorial: uma possível opção de terapia

The human sensory receptors are morphologically specialized to transduce specific stimuli into the brain. However, when an injury occurs, mainly in the spinal cord, which can be of traumatic or non-traumatic origin, it provokes various degrees of sensory deficits, autonomic, motor and sphincter dysfunction below the level of the injury. Based on this, a new therapeutic modality is being proposed by neuroscientist Miguel Nicolelis, which is based on the brain-machine interface, that is, using other pathways so that the information can reach the cerebral cortex and thus be consciously processed (AU).

Os receptores sensoriais humanos são morfologicamente especializados para realizar a transdução de estímulos específicos para o encéfalo. Entretanto, quando ocorre uma lesão, principalmente, na medula espinal, que pode ser de origem traumática e não traumática, provocam diversos graus de déficits sensoriais, disfunção autônoma, motora e esfincteriana, abaixo do nível da lesão. Com base nisso, uma nova modalidade terapêutica está sendo proposto pelo neurocientista Miguel Nicolelis, que tem como base a interface cérebro máquina, isto é, utilizar-se de outras vias para que as informações possam chegar no córtex cerebral e assim serem processadas conscientemente.Palavras-chave: Interfaces cérebro-computador, Neurociências, Órgãos dos sentidos (AU).

Social capital and possible bruxism during the COVID-19 pandemic among Brazilian undergraduates

Abstract This study investigated the prevalence of possible bruxism and its association with social capital among undergraduates during the coronavirus disease (COVID-19) pandemic. This cross-sectional study was conducted at a private university in Southern Brazil. Data were collected through a self-administered electronic questionnaire (Google Forms). Possible bruxism was measured using the following question: "Do you grind your teeth or clench your jaws?". Social capital was evaluated using individual social networks. Data on self-perceived oral health, anxiety, sociodemographics, and information related to university graduates were also collected. Adjusted logistic regression models with a hierarchical approach were used to evaluate associations. The results are presented as odds ratios (ORs) and 95% confidence intervals (95%CIs). Altogether, 345 undergraduates participated in the study, with a mean age of 21.8 years (standard deviation = 5.21). The prevalence of bruxism in the sample was 57.1%. Undergraduates with low social capital had 2.06 times greater odds of bruxism than their counterparts (OR 2.06; 95%CI 1.11-3.83). Female undergraduates (OR 2.40, 95%CI 1.39-4.12), those who were in the final year of university (OR 1.13, 95%CI 1.04-1.21), and those who perceived they needed dental treatment (OR 1.91; CI: 1.21-3.02) also had greater odds of possible bruxism. In conclusion, the prevalence of possible bruxism was high among undergraduate students during the COVID-19 pandemic and associated with lower social capital levels. Knowledge of these factors is important to identify risk groups and plan strategies to control bruxism in this population.

Food practices and nutritional status of university students who use the University Restaurant / Práticas alimentares e o estado nutricional entre estudantes universitários usuários do Restaurante-Escola

ABSTRACT Objective To evaluate the food practices and nutritional status of students who use the University Restaurant at a public university. Methods This is a cross-sectional study carried out with 958 university students. Data related to regular eating practices (≥5 times/week), routine food consumption and nutritional status were collected. The association between University Restaurant attendance and dietary practices and body mass index was reviewed by bivariate logistic regression model and multiple regression. Results Students who attended the University Restaurant three or more times a week were more likely to regularly consume beans (OR: 1.35, p=0.041) and fresh salad (OR: 1.77, p<0.001) and less likely to have afternoon snack (OR: 0.68; p=0.008). In addition, an association between soda consumption and overweight was observed. Conclusion Thus, the importance of strategies that seek to promote incentives for healthy eating and lifestyle practices in the university population become evident.

RESUMO Objetivo O objetivo do estudo foi avaliar as práticas alimentares e o estado nutricional de estudantes usuários do restaurante-escola em uma universidade pública. Métodos Trata-se de um estudo transversal realizado com 958 estudantes universitários. Foram coletados dados relacionados às práticas alimentares regulares (≥5 vezes/semana), à rotina alimentar e ao estado nutricional. A associação entre a frequência de ida ao restaurante-escola, práticas alimentares e índice de massa corporal foi analisada por modelo de regressão logística bivariada e regressão múltipla. Resultados Os estudantes que frequentaram o restaurante-escola 3 ou mais vezes por semana apresentaram maiores chances de consumir regularmente feijão (OR: 1,35, p=0,041) e salada crua (OR: 1,77, p<0,001) e menos chances de realizar o lanche da tarde (OR: 0,68; p=0,008). Além disso, foi observada associação entre o consumo de refrigerante e o excesso de peso. Conclusão Dessa forma, evidencia-se a importância de estratégias que busquem promover incentivos a práticas alimentares e de vida saudáveis na população universitária.

First report of putative Leishmania RNA virus 2 (LRV2) in Leishmania infantum strains from canine and human visceral leishmaniasis cases in the southeast of Brazil

BACKGROUND Leishmania RNA virus 1 (LRV1) is commonly found in South American Leishmania parasites belonging to the subgenus Viannia, whereas Leishmania RNA virus 2 (LRV2) was previously thought to be restricted to the Old-World pathogens of the subgenus Leishmania. OBJECTIVES In this study, we investigated the presence of LRV2 in strains of Leishmania (L.) infantum, the causative agent of visceral leishmaniasis (VL), originating from different hosts, clinical forms, and geographical regions. METHODS A total of seventy-one isolates were screened for LRV2 using semi-nested reverse transcription-polymerase chain reaction (RT-PCR) targeting the RNA-dependent RNA polymerase (RdRp) gene. FINDINGS We detected LRV2 in two L. infantum isolates (CUR268 and HP-EMO) from canine and human cases, respectively. MAIN CONCLUSIONS To the best of our knowledge, this is the first detection of LRV2 in the New World.

Escore de Valor em Saúde (EVS): Uma proposta para mensuração de valor dentro de um sistema de saúde / Value-based Health Care Score (EVS): A proposal for measuring value within a health system

Um sistema de saúde baseado em valor deverá entregar os melhores desfechos possíveis ao paciente, desfechos que realmente importam para ele, ao menor custo possível. O conceito é relativamente fácil de entender, mas a métrica para a sua demonstração tem sido um grande desafio dos sistemas de saúde. O presente artigo demostra a criação de um Escore de Valor em Saúde (EVS) utilizando Análise de Decisão por Multicritério, o qual pode ser aplicado em qualquer sistema de saúde para avaliar profissionais, serviços de saúde e linhas de cuidado de pacientes com condições clínicas específicas.

A value-based healthcare system must deliver the best possible patient outcomes, outcomes that really matter to the patient, at the lowest possible cost. The concept is relatively easy to understand, but the metric to demonstrate it has been a major challenge for healthcare systems. This article demonstrates the creation of a Health-Based Health Care Score (EVS) using Multi-Criteria Decision Analysis which can be applied in any health system to evaluate professionals, healthcare providers and care pathways for patients with a specific disease.

Homozygotes NAT2*5B slow acetylators are highly associated with hepatotoxicity induced by anti-tuberculosis drugs

BACKGROUND Distinct N-acetyltransferase 2 (NAT2) slow acetylators genotypes have been associated with a higher risk to develop anti-tuberculosis drug-induced hepatotoxicity (DIH). However, studies have not pointed the relevance of different acetylation phenotypes presented by homozygotes and compound heterozygotes slow acetylators on a clinical basis. OBJECTIVES This study aimed to investigate the association between NAT2 genotypes and the risk of developing DIH in Brazilian patients undergoing tuberculosis treatment, focusing on the discrimination of homozygotes and compound heterozygotes slow acetylators. METHODS/FINDINGS The frequency of NAT2 genotypes was analysed by DNA sequencing in 162 patients undergoing tuberculosis therapy. The mutation analyses revealed 15 variants, plus two new NAT2 mutations, that computational simulations predicted to cause structural perturbations in the protein. The multivariate statistical analysis revealed that carriers of NAT2*5/*5 slow acetylator genotype presented a higher risk of developing anti-tuberculosis DIH, on a clinical basis, when compared to the compound heterozygotes presenting NAT2*5 and any other slow acetylator haplotype [aOR 4.97, 95% confidence interval (CI) 1.47-16.82, p = 0.01]. CONCLUSION These findings suggest that patients with TB diagnosis who present the NAT2*5B/*5B genotype should be properly identified and more carefully monitored until treatment outcome in order to prevent the occurrence of anti-tuberculosis DIH.

Professoras negras na pós-graduação em saúde: entre o racismo estrutural e a feminização do cuidado / Black female professors in health postgraduate courses: between structural racism and the feminization of care

RESUMO A partir de referenciais do feminismo negro, da perspectiva interseccional e dos estudos étnicoraciais no Brasil, problematizam-se o racismo e o sexismo na academia brasileira com base na caracterização e análise da presença/ausência de professoras negras em programas de pós-graduação em ciências da saúde de duas universidades federais fluminenses, UFRJ e UFF. Utilizando informações de sites de 31 Programas de Pós-Graduação (PPG), reconstruíram-se quantitativamente os perfis de gênero e étnico-raciais por universidade e área de avaliação. Identificaram-se 23 professoras negras que ocupam 26 vagas docentes nos PPG analisados. Com base em informações da Plataforma Lattes, também se abordou longitudinalmente a dimensão de estudo. Os resultados assinalam que a presença de professoras negras é de 2% na UFRJ e de 6% na UFF; que ela é maior em áreas relativas aos cuidados e ínfima em áreas de maior prestígio científico e socioeconômico, como medicina. Constata-se o racismo como principal sistema de poder, operando no contexto institucional e disciplinar. Neste último, associado ao sexismo que determina as hierarquias de gênero nas áreas de saúde. Observa-se, também, que as desigualdades de raça se sobrepõem às de gênero no contexto desta pesquisa, confirmando as teses que apontam o epistemicídio dos saberes negros.

ABSTRACT Based on black feminism, intersectional perspective and Brazilian ethnic-racial studies, the paper problematized racism and sexism in the Brazilian academy. It characterizes and analyses the presence/ absence of black women professors in PhD programs in health sciences of two federal universities, UFRJ and UFF. Using information from the websites of 31 PhD programs, we reconstructed, quantitatively, the gender and ethnic-racial profiles of the PhD programs by university and evaluation area. Twentythree black women professors were identified in 26 teaching positions. Based on information from the Plataforma Lattes, we also addressed the study dimension longitudinally. The results indicate that the presence of black women professors is 2% at UFRJ and 6% at UFF. It is greater in areas related to care, and non-existent in areas of greater scientific and socio-economic prestige, such as Medicine. Racism is seen as the main power system, operating in the institutional and disciplinary context. In the latter, it is associated with sexism that determines gender hierarchies in health fields. It is also observed that race inequalities overlap with gender inequalities in the context of this research, confirming the theses that point to the epistemicide of black knowledge.

Perfil das manifestações musculoesqueléticas em esclerose sistêmica e associação com fator reumatoide / Profile of musculoskeletal manifestations in systemic sclerosis and association with rheumatoid factor

A esclerose sistêmica (ES) é doença sistêmica crônica e autoimune. Estima-se que dor musculoesquelética esteja presente entre 40-80% dos pacientes, sobretudo naqueles com doença difusa precoce. O objetivo deste trabalho foi estudar a prevalência de manifestações musculoesqueléticas em ES, verificar se sua presença altera o perfil clínico, qual a prevalência de fator reumatoide na ES e sua associação com manifestações musculoesqueléticas. É estudo retrospectivo envolvendo 48 pacientes com ES. Foram coletados dados sobre epidemiologia, manifestações clínicas e exames laboratoriais Coletou-se também o valor do HAQ. Em conclusão, manifestações articulares da ES estão associadas com pior funcionalidade e a miosite aparece nos mais jovens. Um quarto dos pacientes é positivo para fator reumatoide, mas ele não se associa com as manifestações musculoesqueléticas.

Systemic sclerosis (SSc) is a chronic and autoimmune systemic disease. It is estimated that musculoskeletal pain is present in 40-80% of patients, especially those with early diffuse disease. The objective of this work was to study the prevalence of musculoskeletal manifestations in SSc, verify if its presence alters the clinical profile, the prevalence of rheumatoid factor in SSc and its association with musculoskeletal manifestations. It is a retrospective study involving 48 patients with SSc. Data on epidemiology, clinical manifestations and laboratory tests were collected. The HAQ value was also collected. In conclusion, joint manifestations of SSc are associated with worse functionality and myositis appears in the youngest. A quarter of patients are positive for rheumatoid factor but it is not associated with musculoskeletal manifestations.

Who is going to turn on the ventilators? / Quem vai ligar os ventiladores?

ABSTRACT Objective To analyze the COVID-19 pandemic in Brazil, a continental-sized country, considered as an emerging economy but with several regional nuances, focusing on the availability of human resources, especially for intensive care units. Methods The database of the National Registry of Health Facilities was accessed. Healthcare professionals in the care of COVID-19 were georeferenced. We correlated the number of professionals with the parameters used by the World Health Organization. According to the Brazilian Intensive Care Medicine Association, we correlated the data for adult intensive care unit beds in each state with the number of professionals for each ten intensive care unit beds. The number of professionals, beds, and cases were then organized by state. Results The number of physicians per 100 thousand inhabitants followed the World Health Organization recommendations; however, the number of nurses did not. The number of intensivists, registered nurses, nurse technicians specialized in intensive care, and respiratory therapists, necessary for every ten intensive care beds, was not enough for any of these professional categories. A complete team of critical care specialists was available for 10% of intensive care unit beds in Brazil. Conclusion There is a shortage of professionals for intensive care unit, as we demonstrated for Brazil. Intensive care physical resources to be efficiently used require extremely specialized human resources; therefore, planning human resources is just as crucial as planning physical and structural resources.

RESUMO Objetivo Analisar a pandemia da COVID-19 no Brasil, um país de dimensões continentais, considerado uma economia emergente, mas com inúmeras diferenças regionais, abordando a disponibilidade de recursos humanos, especialmente para unidades de terapia intensiva. Métodos Foi acessado o banco de dados do Cadastro Nacional de Estabelecimentos de Saúde. Os profissionais de saúde que atuavam nos cuidados para COVID-19 foram georreferenciados. O número de profissionais foi correlacionado com os parâmetros utilizados pela Organização Mundial da Saúde. De acordo com a Associação de Medicina Intensiva Brasileira, correlacionaram-se os dados de leitos de terapia intensiva adulta em cada unidade federativa com o número de profissionais para cada dez leitos de terapia intensiva. Os números de profissionais, leitos e casos foram, então, organizados por unidade federativa. Resultados O número de médicos por 100 mil habitantes seguiu as recomendações da Organização Mundial da Saúde; mas não o número de enfermeiras. O número de intensivistas, enfermeiros, técnicos de enfermagem especializados em terapia intensiva e fisioterapeutas respiratórios, necessário a cada dez leitos de terapia intensiva, não foi suficiente para nenhuma dessas categorias profissionais. Uma equipe completa desses especialistas esteve disponível para 10% dos leitos de terapia intensiva do Brasil. Conclusão Há carência de profissionais para unidade de terapia intensiva, como demonstrado no Brasil. Os recursos físicos da terapia intensiva, para serem usados de forma eficiente, precisam de recursos humanos extremamente especializados; portanto, o planejamento de recursos humanos é tão crucial quanto o planejamento de recursos físicos e estruturais.

In situ cellular immune response in non-ulcerated skin lesions due to Leishmania (L) infantum chagasi infection

Skin lesions of patients affected by non-ulcerated cutaneous leishmaniasis (NUCL) caused by L. (L.) infantum chagasi are characterized by lymphohistiocytic inflammatory infiltrate associated with epithelioid granuloma and scarce parasitism. However, the in situ cellular immune response of these patients is unclear. Therefore, the aim of the present study was to characterize the cellular immune response in the skin lesions of patients affected by NUCL. Methods Twenty biopsies were processed by immunohistochemistry using primary antibodies to T lymphocytes (CD4, CD8), NK cells, B lymphocytes, macrophages, nitric oxide synthase and interferon-gamma. Results Immunohistochemistry revealed higher expression of all cellular types and molecules (IFN-γ, iNOS) in the dermis of diseased skin compared to the skin of healthy individuals (p < 0.05). Morphometric analysis performed in the skin lesions sections showed the predominance of CD8+ T lymphocytes in the mononuclear infiltrate, followed by macrophages, mostly iNOS+, a response that could be mediated by IFN-γ. Conclusion Our study improves knowledge of the cellular immune response in non-ulcerated or atypical cutaneous leishmaniasis caused by L. (L.) infantum chagasi in Central America and pointed to the pivotal participation of CD8+ T lymphocytes in the host defense mechanisms against the parasite in patients with NUCL.(AU)

Análise da velocidade e acurácia de movimentos em indivíduos após acidente vascular encefálico / Speed and accuracy of movement in individuals after stroke

The Stroke might cause alterations in movement control due to the sequels of this process. Objective: Analyze the speed-accuracy trade-off of upper limb movement in individuals with sequels of Stroke through a computer software. Method: It is about a cross-sectional study, the sample was composed of 46 individuals divided into two groups: individuals post-stroke, between the ages of 35 and 83 years old, in which 10 were women and 14 were men; and 22 healthy controls aligned by age and sex, in which 8 were women and 14 were men, evaluated through the instruments: Mini mental state examination, Orpington prognostic scale, Fugl-Meyer Assessment Scale, dynamometer, box of blocks and throught the software "Fitts Reciprocal Aiming Task v.2.0. (Horizontal)", that seeks to understand the motor control of the upper limb, verifying the speed and accuracy of movement through a computer task. Results: The individuals with sequels of Stroke showed a loss in the strength of the palmar grip and manual function. Besides, they showed a longer time in movement in all index of difficulty compared to Control group. However, they showed a similar behaviour to the healthy individuals throughout the execution of the index of difficulty. Conclusion: Thus, it can be concluded that the individuals with sequels of Stroke showed a deficit of the motor control of the upper limb, compared to the healthy individuals, however, these showed the same behavior, with a bigger deficit in the accuracy of movement

The Stroke might cause alterations in movement control due to the sequels of this process. Objective: Analyze the speed-accuracy trade-off of upper limb movement in individuals with sequels of Stroke through a computer software. Method: It is about a cross-sectional study, the sample was composed of 46 individuals divided into two groups: individuals post-stroke, between the ages of 35 and 83 years old, in which 10 were women and 14 were men; and 22 healthy controls aligned by age and sex, in which 8 were women and 14 were men, evaluated through the instruments: Mini mental state examination, Orpington prognostic scale, Fugl-Meyer Assessment Scale, dynamometer, box of blocks and throught the software "Fitts Reciprocal Aiming Task v.2.0. (Horizontal)", that seeks to understand the motor control of the upper limb, verifying the speed and accuracy of movement through a computer task. Results: The individuals with sequels of Stroke showed a loss in the strength of the palmar grip and manual function. Besides, they showed a longer time in movement in all index of difficulty compared to Control group. However, they showed a similar behaviour to the healthy individuals throughout the execution of the index of difficulty. Conclusion: Thus, it can be concluded that the individuals with sequels of Stroke showed a deficit of the motor control of the upper limb, compared to the healthy individuals, however, these showed the same behavior, with a bigger deficit in the accuracy of movement

Barreiras e estratégias no handover de enfermagem do doente crítico: revisão integrativa / Barriers and strategies in the nursing handover of critically ill patients: integrative review / Barreras y estrategias en el handover de enfermería de pacientes críticos: una revisión integradora

OBJETIVO: Verificar as principais barreiras e estratégias inerentes ao handover de Enfermagem ao paciente crítico na literatura científica. MÉTODOS: Trata-se de uma revisão integrativa da literatura, abordagem quantitativa, realizada entre 19 de outubro a 02 de novembro de 2018. Com seleção dos artigos publicados entre 2002 a 2018. RESULTADOS: 26 (100%) artigos identificados, todos publicados no âmbito internacional, desses 16 (62%) publicados nos últimos cinco anos. Dentre os artigos, 38% abordaram a barreiras e 27% as estratégias de handover, sendo 35% relacionados à segurança do paciente. DISCUSSÃO: a comunicação constitui-se instrumento básico para o cuidado em Enfermagem, no handover está torna-se indispensável, possibilitando a continuidade dos cuidados e minimizando os eventos adversos. CONCLUSÃO: Com os resultados desta revisão, é latente a necessidade emergente de desenvolver ferramentas e estratégias que auxiliem o Handover de Enfermagem no paciente crítico.

OBJECTIVE: To verify the main barriers and strategies inherent to the nursing handover of critically ill patients in the scientific literature. METHOD: This is an integrative review of the literature which used a quantitative approach and was conducted between October 19 to November 2, 2018. With the selection of article published between 2002 and 2018. RESULTS: 26 (100%) identified articles, all published internationally, among these 16 (62%) were published in the last five years. Among the articles, 38% addressed barriers and 27% handover strategies, 35% of which were related to patient safety. DISCUSSION: communication is a basic instrument for nursing care, and it is becoming indispensable in handover, enabling continuity of care and minimizing adverse events. CONCLUSION: The results of this review show the emerging need to develop tools and strategies to assist the Nursing Handover in critically ill patients.

OBJETIVO: Verificar las principales barreras y estrategias inherentes al Handover de enfermería a pacientes críticos en la literatura científica.. MÉTODO: Esta es una revisión bibliográfica integradora, un enfoque cuantitativo, realizada entre el 19 de octubre y el 2 de noviembre de 2018. Con una selección de artículos publicados entre 2002 y 2018. RESULTADOS: 26 (100%) artículos identificados, todos publicados internacionalmente, de estos 16 (62%) publicados en los últimos cinco años. Entre los artículos, el 38% abordó las barreras y el 27% las estrategias de transferencia, el 35% relacionados con la seguridad del paciente. DISCUSSÃO: La comunicación es un instrumento básico para la atención de enfermería, el Handover se está volviendo indispensable, permitiendo la continuidad de la atención y minimizando los eventos adversos. CONCLUSIÓN: con los resultados de esta revisión, existe una necesidad latente de desarrollar herramientas y estrategias para ayudar a la handover de enfermería en pacientes críticos.

Dor e sofrimento na perspectiva do cuidado centrado no paciente / Pain and suffering from the perspective of patient-centered care / Dolor y sufrimiento desde la perspectiva de la atención centrada en el paciente

Resumo O objetivo desta reflexão é contribuir com a aplicação do cuidado centrado no paciente no manejo da dor em contexto hospitalar. Trata-se de estudo de natureza teórica que busca estimular a discussão sem esgotar os argumentos, considerando assuntos como as dimensões do sofrimento, a negligência da dor e suas consequências, a relevância da abordagem interprofissional e os direitos humanos do paciente. Conclui-se que é preciso haver equipe interprofissional para lidar com a dor e o sofrimento humano no contexto hospitalar, e que o planejamento da assistência deve considerar aspectos emocionais, econômicos e culturais, proporcionando bem-estar físico e mental. A proposta interprofissional caminha paralelamente à proposta do cuidado centrado no paciente.

Abstract This reflection aims to contribute to the application of patient-centered care in pain management in a hospital context. As a theoretical study, it seeks to stimulate discussion without exhausting arguments, considering issues such as the dimensions of suffering, pain neglect and its consequences, the relevance of the interprofessional approach, and the patient's human rights. An interprofessional team is essential for treating human pain and suffering, and care planning must consider emotional, economic and cultural aspects, providing physical and mental well-being. The interprofessional proposal goes hand in hand with patient-centered care.

Resumen El objetivo de esta reflexión es contribuir a la aplicación del cuidado centrado en el paciente en el tratamiento del dolor en un entorno hospitalario. Se trata de un estudio teórico que trata de estimular el debate sin agotar los argumentos, considerando cuestiones como las dimensiones del sufrimiento, la negligencia del dolor y sus consecuencias, la relevancia del abordaje interprofesional y los derechos humanos del paciente. Se concluye que es necesario contar con un equipo interprofesional que pueda lidiar con el dolor y el sufrimiento humano en el contexto de un hospital, considerando que la planificación de la asistencia debe tener en cuenta aspectos emocionales, económicos y culturales, proporcionando bienestar físico y mental. La propuesta interprofesional va de la mano con la propuesta de la atención centrada en el paciente.

The glyphosate controversy: an update / A controvérsia do glifosato: uma atualização

The demand for food in the world grows year after year due in part to population growth, but also to the improvement of emerging markets. Brazil is one of the largest food producers in the world. In 2017, its cereal, legume and oilseed crops totaled 238.6 million tons, 29.2% more than the year before. Much of the great increase in productivity is due to the incorporation of transgenic seeds, especially cotton, maize and soybean, which possess genes that will increase plant's adaptability to harsh soil and water conditions and, resistance to pests, but also tolerance to herbicides. Virtually, all transgenic soybeans planted in Brazil are resistant to glyphosate, the herbicide initially launched on the market by Monsanto in the 1970s under the trade name Roundup. Due to the existence of several transgenic crops tolerant to glyphosate, such as soy, wheat, corn and canola, this product is the most commercialized herbicide in the world. The use of glyphosate allows the sowing of transgenic crops immediately after application, making the planting and maintenance processes very practical. Soybeans, such as other transgenics, have biological safety already well defined, but the use of glyphosate is still an extremely controversial subject. This review presents some historical aspects of the binomial Roundup Ready soybean/glyphosate and discusses the most recent controversies about the use of glyphosate in Brazil and worldwide.(AU)

A demanda por alimentos no mundo cresce ano após ano devido em parte pelo aumento populacional, mas também pela melhoria dos mercados emergentes. O Brasil é um dos maiores produtores de alimentos do mundo. Em 2017, a safra nacional de cereais, leguminosas e oleaginosas totalizou 238,6 milhões de toneladas, 29,2% superior à obtida em 2016. Boa parte do grande aumento da produtividade se dá pela incorporação de sementes transgênicas, especialmente de algodão, milho e soja, que apresentam genes que conferem maior adaptabilidade da planta ao solo, pragas, condições hídricas, mas também conferem resistência a herbicidas. Praticamente toda a soja transgênica plantada no país é resistente ao glifosato, inicialmente lançado no mercado pela empresa Monsanto nos anos 1970 pelo nome comercial Roundup, que é hoje o herbicida mais utilizado no mundo, principalmente pela disseminação da soja e outros produtos transgênicos como trigo, milho e canola. A utilização do glifosato permite a semeadura de culturas transgênicas imediatamente após a aplicação, tornando o processo de plantio muito prático. A soja, como outros transgênicos, apresenta segurança biológica já definida, mas a utilização do glifosato ainda é um assunto extremamente controverso. Esta revisão apresenta alguns aspectos históricos do binômio soja transgênica Roundup Ready/glifosato e discute as controvérsias mais recentes sobre o uso do glifosato no Brasil e no mundo.(AU)

Desempenho clínico de laminados cerâmicos em zircônia ultratranslúcida: ensaio clínico controlado e randomizado / Clinical performance of ultratranslucent zirconia ceramic laminates: randomized controlled clinical trial

Objetivo: Avaliar a sobrevida clínica de laminados cerâmicos em zircônia ultratranslúcida e os impactos desse tratamento na qualidade de vida do paciente. Materiais e métodos: O estudo é um ensaio clínico controlado e randomizado, duplo cego (paciente e avaliador) e de caráter longitudinal. A amostra foi de 82 laminados cerâmicos: 39 laminados em dissilicato de lítio para o grupo controle e 43 em zircônia ultratranslúcida para o grupo experimental. O tratamento restaurador foi realizado por cirurgiões-dentistas participantes do projeto de extensão "Próteses Fixas Metal-Free". A coleta de dados foi realizada por um único examinador nos períodos de avaliação de 1 mês (T1), 6 (T2), 12 (T3), 24 (T4), 36 (T5) e 48 (T6) meses. Quanto ao impacto na qualidade de vida, um questionário modificado OIDP (Oral Impact of Daily Performances) foi usado. A análise da longevidade clínica foi feita através dos critérios modificados de Ryge conferidos com espelho clínico e explorador. Os dados referentes a sobrevida dos laminados de diferentes materiais foram representados graficamente através da curva de Kaplan-Meier. Os escores dos critérios de Ryge, e impacto na qualidade de vida do paciente foram a analisados descritivamente. As espessuras médias para cada terço (cervical, medial e incisal) foram comparadas entre os diferentes materiais através do teste Anova 1 fator. Para análise estatística o nível de significância estabelecido foi de 5%. Resultados: A taxa de sobrevida clínica foi de 100% para os laminados de ambos os materiais. Apenas o critério descoloração marginal obteve uma classificação diferente de A. O escore B foi apresentado por 9 laminados de dissilicato de lítio e 2 de zircônia ultratranslúcida, Não houve nenhuma interferência negativa do tratamento na qualidade de vida dos indivíduos. Falar e relaxar foram as atividades em que o tratamento menos interferiu. Não houve diferença estatisticamente significante para as espessuras dos laminados entre os dois tipos de materiais. Conclusão: O tratamento com laminados confeccionados em zircônia ultratranslúcida apresenta desempenho clínico similar aos casos tratados em dissilicato de lítio (AU).

Objective: to evaluate the clinical survival of ceramic laminates in ultra-translucent zirconia and the impacts of this treatment on the patient's quality of life. Materials and methods: The study was analyzed as a controlled, randomized, double-blind (patient and evaluated) clinical trial with a longitudinal character. The sample studied was 82 ceramic laminates divided into two groups according to the type of material, 39 laminates in lithium disilicate for the control group and 43 in ultra-translucent zirconia for the experimental group. The restorative treatment was carried out by dentists participating in the extension project "Metal-Free Fixed Prostheses". Data collection was performed by a single examiner in the evaluation periods of 1, 6, 12, 24, 36 and 48 months. For the impact on quality of life, a modified OIDP (Oral Impact of Daily Performance) was used. An analysis of clinical longevity was performed using Ryge's modified criteria with a clinical mirror and explorer. The data on the survival of laminates of different materials were plotted using the Kaplan-Meier curve. The Ryge criteria scores and impact on the patient's quality of life were descriptively arranged. The thicknesses for cervical, medial and incisal were compared between the different materials using the ANOVA One-Way test. For statistical analysis, the level of significance was set at 5%. Results: The clinical survival rate was 100% for the laminates of both materials. Only the discoloration marginally criterion obtained from a classification other than A. The B score was presented by 9 laminates of lithium disilicate and 2 of ultra-translucent zirconia. There was no negative interference from treatment on the quality of life. Talking and relaxing were activities in which the treatment least interfered. No statistically significant difference for laminate thickness between the two materials. Conclusion: The treatment with laminates made of ultratranslucent zirconia has clinical performance similar to the cases treated with lithium disilicate (AU).

Effect of different surface treatments and multimode adhesive application on the Weibull characteristics, wettability, surface topography and adhesion to CAD/CAM lithium disilicate ceramic

Abstract This paper aims to evaluate the effect of different surface treatments on surface topography, wettability, and shear bond strength of resin cement to glass ceramic. Methodology: For SBS test, 32 blocks (7x7x2 mm) of lithium disilicate were obtained and randomly divided into eight groups (four blocks per group) according to each surface treatment (HF 20 s, 60 s, 120 s + silanization/S or Scotch Bond Universal/ SBU) and the Monobond Etch & Prime - MEP application followed or not by SBU. On each treated surface ceramic block, up to four dual-curing resin cement cylinders were prepared and light-cured for 40s (N=120/n=15). The specimens were thermocycled (10,000 cycles, 5-55°C, 30 s) and the SBS test (50KgF, 0.5 mm/min) was performed. Furthermore, failure analysis, wettability, AFM, and SEM were carried out. SBS data (MPa) were analyzed using Student's t-test, two-way ANOVA, Tukey's test (5%) and Weibull's analysis. Results: For HF experimental groups, two-way ANOVA presented the factors "etching time" and "bonding agent" as significant (p<0.05). After silane application, the HF groups presented similar bond strength. SBU application compromised the SBS, except for 120s etching time (HF120sS: 23.39ᵃ±6.48 MPa; HF120sSBU: 18.76ᵃ±8.81MPa). For MEP groups, SBU application did not significantly affect the results (p=0.41). The MEP group presented the highest Weibull modulus (4.08A) and they were statistically different exclusively from the HF20sSBU (0.58B). Conclusion: The HF 20s, 60s, 120 s followed by silane, promoted similar resin-bond strength to ceramic and the SBU application after HF or MEP did not increase the SBS.

Determinantes da violência sexual infantil no estado do Paraná - Brasil / Determinants of child sexual violence in the state of Paraná - Brasil

A violência sexual infantil configura-se como um fenômeno sociocultural, pautado em relações hierárquicas e desigualdades de gênero, étnico-raciais e geracionais. Nesta pesquisa, investigouse os determinantes da violência sexual infantil a partir dos casos notificados pelo SINAN no estado do Paraná entre 2011 e 2014, disponibilizados pelo DATASUS, por estudo descritivo, de base documental e abordagem quantitativa. No Paraná, totalizaram 2.446 casos no período. A Regional de Saúde com maior prevalência foi a de Foz do Iguaçu. Prevalece a faixa etária de 5 a 9 anos, meninas, raça negra e indígenas. Na tipologia, predominaram estupro e assédio sexual, por meio de força corporal. Os casos prevalentemente ocorreram na residência e o provável agressor era próximo da criança. Reconhecer os determinantes da violência sexual infantil é essencial para a implementação de ações de cuidado integral às vítimas.

Método fenotípico automatizado versus método manual na identificação de microorganismos isolados de hemoculturas: desfechos clínicos e microbiológicos / Automated phenotypic method versus manual method in the identification of microorganisms isolated from blood cultures: clinical and microbiological outcomes

INTRODUÇÃO: A automação laboratorial é cada vez mais utilizada em microbiologia, no entanto, poucos estudos avaliam desfechos clínicos em comparação aos métodos tradicionais. No Brasil, nenhum estudo com esse objetivo foi detectado. OBJETIVO: Analisar os impactos clínicos e microbiológicos após implantação de método fenotípico automatizado em um serviço de microbiologia. MÉTODOS: Realizamos estudo observacional e retrospectivo no laboratório de microbiologia referente a exame de hemocultura de pacientes da Unidade de Terapia Intensiva (UTI). Os dados foram coletados de pacientes internados entre janeiro/2014 a dezembro/2015. Analisou-se o tempo de internação, número de terapias empíricas, óbitos e dados relacionados ao isolamento microbiológico. A amostra foi obtida por conveniência. Para a comparação entre os desfechos foram empregados os testes t de Student e Qui-quadrado de Pearson. O programa empregado foi o Stata release, versão 11, sendo considerados significativos valores de p<0,05. RESULTADOS: Foram avaliados 472 pacientes. Não houve redução na prescrição empírica de antimicrobianos (54,7% vs 45,3%; p=0,33), tempo de internação na UTI (14,5 dias vs 15,8 dias p=0,78) e na taxa de óbitos (54,4% vs 45,6%; p=0,36). Similarmente, o perfil de agentes isolados em ambos os métodos não parece ser discrepante, no entanto, houve um aumento de 44,7% no número de isolados microbianos (76 vs 110) com melhor caracterização dos mesmos. CONCLUSÃO: A automação do laboratório de microbiologia não impactou no tempo de internação, mortalidade na UTI e no número de terapias empíricas. No entanto, a identificação e o isolamento de microrganismos melhoraram.

INTRODUCTION: Automation is increasingly used in microbiology laboratory, however, few studies assessed clinical outcomes compared to traditional methods. In Brazil, no studies with this objective were detected. OBJECTIVE: To analyze the clinical and microbiological impacts after implantation of an automated phenotypic method in a microbiology service. METHODS: Observational and retrospective study carried out on the microbiology laboratory involving blood culture test from intensive care unit (ICU) patients. Data were collected from hospitalized patients between January 2014 and December 2015. The length of hospitalization, number of empirical therapies, deaths and information related to microbiological isolation were analyzed. The sample was obtained by convenience. Pearson's Chisquare and Student's t-tests were used to compare outcomes. The program used was the Stata release, version 11, being considered significant values of p<0.05. RESULTS: A total of 472 patients were evaluated. There was no reduction in the empirical prescription of antimicrobials (54.7% vs 45.3%; p=0.33), ICU stay (14.5 days vs 15.8 days; p=0.78) and mortality (54.4% vs 45.6%; p=0.36). Similarly, profile of isolated agents in both methods did not appear to be discrepant, however, there was an increase of 44.7% in the number of microbial isolates (76 vs 110) and a better characterization of them. CONCLUSION: The microbiology laboratory automation did not modify the length of stay, ICU mortality and the number of empirical therapies. However, identification and isolation of microorganisms was improved.

Avaliação do treinamento mediado por tecnologias educacionais: revisão integrativa / Evaluation of training mediated by educational technologies: review integrative / Evaluación de la formación mediada por lastecnologías educativas: una revisión integradora

OBJETIVO: Identificar resultados da avaliação de treinamentos realizados por meio de educação continuada de enfermeiros mediados por tecnologias educacionais, em cenário de práticas. MÉTODO: Esta revisão integrativa incluiu artigos publicados entre 2012 a 2016, das bases LILACS, Scielo, Bdenf, Medline/PUBMED, CINAHL excluindo-se artigos relacionados à formação de graduandos/pós-graduandos e educação de pacientes. Utilizou-se Galvão como referencial metodológico e Abad como referencial teórico de análise. RESULTADOS: Foram selecionados 17 artigos publicados no idioma inglês. Entre eles estudos de coorte ou caso controles e relacionados a Simulação foram prevalentes. Todos avaliaram a aprendizagem e alguns também o impacto no trabalho, suporte para a transferência ou a reação. CONCLUSÃO: O treinamento de enfermeiros e a avaliação de impacto em cenário de campo precisam ser desenvolvidos no Brasil sistematicamente. Este processo de avaliação deve envolver o profissional treinado e ser realizado com ênfase no suporte para transferência e como uma política de recursos humanos.

Objective: To identify the results of the training evaluation performed by nurses through continued education mediated by educational technologies, at work.Method: This integrated revision included articles published between 2012 and 2016, from LILACS database, Scielo, Bdenf, Medline/PUBMED and CINAHL, excluding articles related toundergraduate or postgraduated students and patients education. It was adopted Galvão as the methodological reference and Abad as the theorical analyses reference. Results: There were selected 17 articles written in English.Among them cohort and case control study related to Simulation were prevalent. Some of them evaluated the jobs impact, the support to transfersor there action, but all of them evaluated the apprentice ship. Conclusion: The nurses training and the evalutation of the trainning impact at work scenario must be systematically developed in Brazil. This evaluation process must include the trained professional and be conducted emphasing the transfer support, and as a human resources policy.

Objetivo: Identificar los resultados de la evaluación de entrenamiento levada a cabo por enfermeras medianteeducación contínua a través de tecnologías educativas, em el trabajo.Método: Esta revisión integrada incluye artículospublicados entre 2012 y 2016, de la base de datos LILACS, Scielo, Bdenf, Medline/PUBMED y CINAHL, excluyendoartículos relacionados com estudiantes en carrera y graduados y educación de pacientes. Se tomó a Galvão comoreferencia metodológica y a Abad como referencia de análisis teóricos. Resultados: Fueron seleccionados 17 artículosescritos em inglés. Entre ellos, grupos y estudios de control de casos relacionados com Simulación fueron prevalientes.Algunos de ellos evaluaron los impactos Del trabajo, apoyo a lãs transferencias o lãs reacciones, pero todos evaluaronel aprendizaje. Conclusión: El entrenamiento de enfermeras y la evaluación del impacto del entrenamiento en unambiente de trabajo deben ser sistematicamente desarrollados en Brasil. Este proceso de evaluación debe incluir a umprofessional en trenado, y debe ser conducido haciendo énfasis em el soporte de transferencia, y como política derecursos humanos.

Cost-utility of quadrivalent versus trivalent influenza vaccine in Brazil - comparison of outcomes from different static model types

ABSTRACT Background: Influenza burden in Brazil is considerable with 4.2-6.4 million cases in 2008 and influenza-like-illness responsible for 16.9% of hospitalizations. Cost-effectiveness of influenza vaccination may be assessed by different types of models, with limitations due to data availability, assumptions, and modelling approach. Objective: To understand the impact of model complexity, the cost-utility of quadrivalent versus trivalent influenza vaccines in Brazil was estimated using three distinct models: a 1-year decision tree population model with three age groups (FLOU); a more detailed 1-year population model with five age groups (FLORA); and a more complex lifetime multi-cohort Markov model with nine age groups (FLORENCE). Methods: Analysis 1 (impact of model structure) compared each model using the same data inputs (i.e., best available data for FLOU). Analysis 2 (impact of increasing granularity) compared each model populated with the best available data for that model. Results: Using the best data for each model, the discounted cost-utility ratio of quadrivalent versus trivalent influenza vaccine was R$20,428 with FLOU, R$22,768 with FLORA (versus R$20,428 in Analysis 1), and, R$19,257 with FLORENCE (versus R$22,490 in Analysis 1) using a lifetime horizon. Conceptual differences between FLORA and FLORENCE meant the same assumption regarding increased all-cause mortality in at-risk individuals had an opposite effect on the incremental cost-effectiveness ratio in Analysis 2 versus 1, and a proportionally higher number of vaccinated elderly in FLORENCE reduced this ratio in Analysis 2. Discussion: FLOU provided adequate cost-effectiveness estimates with data in broad age groups. FLORA increased insights (e.g., in healthy versus at-risk, paediatric, respiratory/non-respiratory complications). FLORENCE provided greater insights and precision (e.g., in elderly, costs and complications, lifetime cost-effectiveness). Conclusion: All three models predicted a cost per quality-adjusted life year gained for quadrivalent versus trivalent influenza vaccine in the range of R$19,257 (FLORENCE) to R$22,768 (FLORA) with the best available data in Brazil (Appendix A).