Psychiatric emergency units in Brazil: a cross-sectional study

SUMMARY OBJECTIVES: This study aimed to identify the infrastructure (e.g., availability, resources, and staff), basic metrics, and problems (e.g., network, overcrowding, resources, and infrastructure) of the psychiatric emergency services in Brazil. METHODS: This is a cross-sectional study assessing psychiatric services (n=29) listed by the Brazilian Psychiatric Association in 2019. RESULTS: Almost all the units reported 24 h/7-day availability having psychiatrists, nurses, and social workers, with 8.8 (SE=2.2) and 2.8 (SE=0.3) consultations and hospitalizations per day, respectively. Separated room for contention was reported by the minority of the services (38%). The most commonly reported problems were insufficient structure for child/adolescent care (83%), increasing patient demand (72%), housing referral for homeless (72%), excessive prescription demand (69%), short-term room overcrowding (59%), court orders for inpatient treatment (59%), lack of vacancies for inpatients hospitalization (59%), and referral to primary care (56%). CONCLUSIONS: Similar to the United States, the Brazilian psychiatric emergency units are decreasing and encompass the shortcomings of the Brazilian mental health care network.

Os desafios para o ensino de emergências de psiquiatria em desastres e conflitos armados / The challenges of Teaching Psychiatric Emergencies in situations of natural disasters and armed conflicts

Resumo: Introdução: A população moçambicana tem sido recorrentemente afectada por situações traumáticas devido a catástrofes naturais (ciclones, secas, inundações) ou provocadas pelo homem (conflitos armados), que podem levar ao desenvolvimento de perturbações mentais que, se não forem identificadas e tratadas, deixarão sequelas graves e causarão cronicidade. Objetivo: Este estudo teve como objetivo promover uma reflexão sobre a inclusão de temas psiquiátricos de emergência em desastres naturais e conflitos armados nas disciplinas ou módulos de psiquiatria, nos cursos de formação de graduação nas escolas médicas de Moçambique. Método: Trata-se de revisão narrativa da bibliografia, realizada entre abril e junho de 2021, com foco na pesquisa de artigos e documentos publicados nas plataformas virtuais Research4Life, PubMed, Hifa-pt e Google Scholar que abordam o tema desastres naturais e conflitos armados e seu ensino para estudantes de Medicina na disciplina de psiquiatria. Resultado: A inclusão das emergências psiquiátricas em desastres e conflitos armados no curso de Medicina pode proporcionar aos clínicos gerais que atuam na atenção primária à saúde conhecimentos e habilidades para que possam reconhecer emergências psiquiátricas causadas por desastres naturais e conflitos armados e trabalhar nelas, levando em consideração que o país atualmente tem poucos médicos especializados em psiquiatria. Conclusão: A adequada organização e assistência em emergências psiquiátricas à população exposta a desastres naturais e conflitos armados contribui para a resiliência e salvaguarda da saúde mental das comunidades. Neste ensaio, refletimos sobre o desafio de incorporar os temas das emergências psiquiátricas causadas pela exposição a desastres naturais e conflitos bélicos como contribuição para melhorar as habilidades dos médicos generalistas na resposta às demandas prementes de saúde mental dessa população vulnerável.

Abstract: Introduction: The Mozambican population has been recurrently affected by traumatic situations due to natural (cyclones, droughts, floods) or man-made (armed conflicts) catastrophes, which can lead to the development of mental disorders that, if not identified and treated, result in severe sequelae and cause chronicity. Objectives: To promote a reflection on the inclusion of emergency psychiatric topics in natural disasters and armed conflicts in the disciplines or modules of psychiatry in undergraduate medical school courses in Mozambique. Methods: Narrative literature review carried out between April and June 2021, focusing on the research of articles and documents published on the virtual platforms Research4life, PubMed, Hifa-PT, Google Scholar and that address the topics of natural disasters and armed conflicts and the teaching of these topics to medical students in the discipline of psychiatry. Results: The inclusion of psychiatric emergencies in situations of natural disasters and armed conflicts in the medical course can provide general practitioners who work in primary health care with knowledge and skills to recognize and act in psychiatric emergencies caused by natural disasters and armed conflicts, taking into account the fact that the country currently has few doctors specialized in psychiatry. Final considerations: The adequacy of the organization and assistance in psychiatric emergencies to the population exposed to natural disasters and armed conflicts contributes to the resilience and protection of the mental health of the communities. In this article, we reflect on the challenge of incorporating the topics of psychiatric emergencies caused by exposure to natural disasters and armed conflicts as a contribution to improving the skills of general practitioners in responding to the pressing mental health demands of this vulnerable population.

Mathematical modeling of the effects of atmospheric pressure on mosquito (Díptera: Culicidae) population density in Villa Clara, Cuba / Modelación matemática del efecto de la presión atmosférica sobre la densidad poblacional de los mosquitos (Diptera: Culicidae) en Villa Clara, Cuba

Abstract Introduction: Mosquitoes (Diptera: Culicidae) are considered one of the most versatile organisms in the world as they can breed in any pool of water, such as puddles or tanks. However, their reproduction is influenced by atmospheric variables that allow predicting their population density. Objective: To assess the impact of atmospheric pressure on mosquito population density in the province of Villa Clara, Cuba, by means of a mathematical model based on a regressive objective regression (ROR) methodology. Materials and methods: The development of the mathematical model to predict breeding sites was based on the number of breeding sites reported in the province of Villa Clara between 2000 and 2017, and the ROR model. Furthermore, a regression analysis was carried out using the IBM SPSS® version 19.0, which allowed obtaining models that explained 100% of the variance, with its corresponding standard error. Results: With respect to the number of breeding sites, an increasing trend was observed in the municipality of Cifuentes, while the trend was downward in Ranchuelo and Caibarién. The municipalities of Santa Clara and Encrucijada had the highest and lowest standard deviation (13.432 vs. 5.968, respectively), which demonstrates great variability among the data of each municipality. Conclusions: There is a close relationship between atmospheric pressure and mosquito population density since both total and specific larval densities increase as atmospheric pressure increases.

Resumen Introducción. Los mosquitos (Diptera: Culicidae) son uno de los organismos más versátiles del mundo, pues pueden reproducirse en cualquier depósito de agua, como charcos o tanques. Sin embargo, su reproducción está influenciada por variables atmosféricas que permiten predecir su densidad poblacional. Objetivo. Evaluar el impacto de la presión atmosférica en la densidad poblacional de mosquitos en la provincia de Villa Clara, Cuba, mediante el uso de modelos matemáticos basados en la metodología de regresión objetiva regresiva (ROR). Materiales y métodos. El desarrollo del modelo matemático de pronóstico de focos de reproducción se basó en el número de focos reportados en la provincia de Villa Clara entre 2000 y 2017, y en el modelo ROR. Además, se realizó un análisis de regresión mediante el programa IBM SPSS® versión 19.0, lo que permitió obtener modelos de regresión que explicaron el 100% de la varianza, con su error típico. Resultados. Respecto a la cantidad de focos, se observó una tendencia al aumento en el municipio de Cifuentes, mientras que en Ranchuelo y Caibarién la tendencia fue a la reducción. Los municipios de Santa Clara y Encrucijada tuvieron la desviación estándar más alta y más baja, respectivamente (134.32 vs. 5.968), lo que evidencia una gran variabilidad entre los datos de cada municipio. Conclusiones. Existe una estrecha relación entre la presión atmosférica y la densidad poblacional de mosquitos, ya que a medida que aumenta la presión atmosférica, aumentan las densidades larvales, tanto total como específicas.

Cephalometric assessment of Colombia's mestizo population aged 6 to 12 years / Evaluación cefalométrica de la población mestiza colombiana entre 6 a 12 años

ABSTRACT Introduction: over the years, populations have been studied by means of lateral cephalic x-rays in a variety of ethnicities, ages, and study types, setting standards for different groups. In Latin America, studies show cephalometric differences from standards based on Caucasian populations. Method: 1,627 cases of patients without prior treatment were analyzed; the sample included 855 males and 772 females aged 6 to 12 years. Lateral cephalic radiographs and specific tracing were taken. Descriptive analysis was done using mean, standard deviation, minimum, and maximum. Comparisons were made between male and female subjects and by age. Results: a greater size was found in all measurements in male subjects, being statistically significant in some measurements and ages. The ages with the most differences were 8 and 9 years, and the least difference occurred at the age of 10. Conclusion: there was variation in maxillary and mandibular size with age and gender, with the largest size in males and indications of vertical predominance.

RESUMEN Introducción: a través de los años se han estudiado poblaciones por medio de radiografías cefálicas laterales, en variedad de etnias, edades y tipos de estudio, lo que ha permitido establecer estándares para diferentes grupos. En Latinoamérica, los estudios demuestran diferencias cefalométricas respecto a las normas basadas en poblaciones caucásicas. Método: se analizaron 1.627 casos de pacientes sin tratamiento previo, 855 hombres y 772 mujeres entre 6 y 12 años. Se tomó radiografía cefálica lateral y un trazado específico. Se realizó análisis descriptivo utilizando media, desviación estándar, mínimo y máximo. Se hizo comparación entre los sujetos masculinos y femeninos y por edades. Resultados: se encontró mayor tamaño en todas las medidas en hombres, siendo estadísticamente significativas en algunas medidas y edades. La edad que mayor diferencia presenta es a los 8 y 9 años, y la de menor diferencia es a los 10 años. Conclusión: se presentó variación en el tamaño maxilar y mandibular con la edad y el género, con mayor tamaño en los hombres y con características de manifestaciones de predominio vertical.

A survey of tire-breeding mosquitoes (Diptera: Culicidae) in the Dominican Republic: Considerations about a pressing issue / Estudio de mosquitos (Diptera: Culicidae) que se desarrollan en neumáticos en República Dominicana: consideraciones sobre un problema acuciante

Introducción. Los neumáticos usados representan una grave amenaza para el medio ambiente y la salud pública, ya que tienen el potencial de albergar mosquitos (Diptera: Culicidae) vectores de enfermedades. Objetivo. Evaluar la importancia de los neumáticos usados como hábitats larvarios de mosquitos que colonizan estos recipientes artificiales en Jarabacoa, República Dominicana. Materiales y métodos. Se muestrearon mediante pipetas neumáticos usados en tiendas de venta y reparación y en vertederos entre junio y agosto de 2018. Resultados. Se muestrearon 396 neumáticos; 57 (índice de contenedor=14,4 %) albergaban estados inmaduros que contenían 2.400 especímenes de 11 especies y cuatro géneros (Anopheles, Aedes, Culex y Toxorhynchites). La especie más abundante fue Aedes albopictus (42,3 %) seguida de Aedes aegypti (34,3 %) y Culex quinquefasciatus(14,0 %), entre otras (9,4 %) de menor abundancia. El índice de contenedor varió significativamente según el tamaño del neumático (χ2=13,4; p≤0,05) y los mayores niveles de infestación se registraron en los neumáticos de mayor tamaño. Se observó una baja correlación positiva (r=0,38; n=396; p≤0,001) entre el tamaño de neumático y la prevalencia de estadios inmaduros. La presencia de materia orgánica tuvo un efecto positivo sobre los niveles de infestación de mosquitos (U=11430,0; p≤0,001). Conclusiones. Estos residuos de caucho, generalmente almacenados cerca de las poblaciones humanas, son propicios para la reproducción de vectores de arbovirus como el dengue, el chikungunya, el Zika y el West Nile.

Introduction: Discarded vehicle tires represent a serious threat both to the environment and to public health as they have the potential to harbor important mosquito (Diptera: Culicidae) vectors. Objective: To assess the importance of used vehicle tires as larval habitats for mosquito fauna that colonize these artificial reservoirs in Jarabacoa, Dominican Republic. Materials and methods: Used tires were sampled with pipettes at specialized tire fitting shops and scattered stockpiles of tires between June and August, 2018. Results: We sampled 396 tires; 57 (Container Index=14.4%) were positive for immature stages and contained 2,400 specimens, 11 species, and four genera (Anopheles, Aedes,Culex, and Toxorhynchites). The most abundant species was Aedes albopictus (42.3%) followed by Aedes aegypti (34.3%), and Culex quinquefasciatus (14.0%) while other species (9.4%) were less abundant. The container index varied significantly among the different tire sizes (χ2=13.4; p≤0.05). The highest infestation levels were found in the largest tires. A low positive correlation (r=0.38, n=396; p≤0.001) between the tire size and the prevalence of immature stages was recorded. The presence of organic matter had an overall positive effect on the infestation levels (U=11,430.0; p≤0.001). Conclusions: These rubber residues, usually located nearby human populations, represent suitable breeding sites for arboviruses vectors such as dengue, chikungunya, Zika, and West Nile.

Evaluación radiográfica de la estabilidad en medidas cefalométricas de pacientes Clase III sometidos a cirugía ortognática bimaxilar / Radiographic evaluation of stability in cephalometric measurements of Class III patients undergoing bimaxillary orthognathic surgery

Objetivo: evaluar, a través de medidas cefalométricas de los planos sagital y vertical, la estabilidad de pacientes con maloclusión clase III sometidos a cirugía ortognática bimaxilar. Métodos: se aplicó estudio longitudinal en 20 pacientes (11 mujeres), en un promedio de edad de 22.5 años y con diagnóstico de hipoplasia del tercio medio facial y prognatismo mandibular, tratados con ortodoncia y cirugía ortognática bimaxilar. Se realizaron tres radiografías cefálicas laterales por cada paciente: la primera, previa al procedimiento quirúrgico (T1), otra a los 8 meses posquirúrgicos (T2) y la tercera, a los 18 meses posquirúrgicos (T3). Posteriormente, se evaluaron los cambios en el plano X y Y en los tres tiempos realizando las pruebas estadísticas pertinentes con el fin de observar diferencias. Resultados: se encontraron medidas más estables en el maxilar superior en sentido vertical y sagital, y se observó que la mandíbula es menos estable a los movimientos quirúrgicos, principalmente en sentido vertical (diferencias estadís-ticamente significativas p<0.05). Conclusión: la cirugía ortognática bimaxilar en casos de clase III es muy estable (especialmente en el maxilar); dicha estabilidad fue definida solamente con medidas cefalométricas, sin tener en cuenta variables como la función o las características clínicas de los pacientes.

Objective: To evaluate cephalometric stability in the sagittal and vertical planes of class III malocclusion patients undergoing bimaxillary orthognathic surgery Class III skeletal malocclusion is reported as the most frequently dentofacial alteration treated in combination with orthodontics and orthognathic surgery. It is important to evaluate the stability or relapse of the surgical treatment performed on these patients. Methods: A longitudinal study were conducted in 20 patients (11 women), with an average of 22.5 years old, diagnosis of hypoplasia of the facial middle third and mandibular prognathism, treated with orthodontics and bimaxillary orthognathic surgery. Three lateral cephalic radiographs were taken for each patient: one prior to the surgical procedure (T1), another at 8 post-surgical months (T2) and finally at 18 post-surgical months (T3). The changes on the X and Y planes were evaluated the same three times, performing the relevant statistical tests in order to observe differences. Results: More stable measurements were found in the upper jaw in the vertical and sagittal direction, while the mandible is less stable to surgical movements, mainly in the vertical direction (statistically significant differences p<0.05). Conclusion: bimaxillary orthognathic surgery in class III malocclusion is very stable (especially in the maxilla). It is important to keep in mind the maxillary biomechanics in order to offer an accurate treatment to these patients. Further studies are required in order to investigate possible associated predictor factors.

Potencialidad de Pseudosuccinea columella (Say, 1817) (Molusca: Gastropoda: lymnaeidae) en la transmisión de la fascioliasis humana en República Dominicana / Potentiality of Pseudosuccinea columella (Say, 1817) (Molusca: Gastropoda: lymnaeidae) in the transmission of human fascioliasis in the Dominican Republic

Introducción: en el paisaje epidemiológico de la fascioliasis humana, dos aspectos son de fundamental importancia: a) presencia de hospederos definitivos (especialmente ganado bovino y humanos) parasitados con adultos del tremátodo y; b) presencia de hospederos intermediarios invertebrados, moluscos de la familia Lymnaeidae, en los que se desarrollan los estadios larvarios, además de plantas acuáticas de consumo humano. Material y métodos: con el objetivo de prevenir brotes de fascioliasis humana mediante la correcta identificación de aspectos de interés epidemiológico, un humedal fue seleccionado en el sector de Palo Blanco, municipio de Jarabacoa, provincia de La Vega, en el cual se realizó un estudio malacológico en octubre de 2016, en busca de especies de moluscos limneidos e hidrófitos asociados. En el laboratorio se obtuvieron los índices de infección natural y experimental a Fasciola hepatica. Resultados: se identificó el limneido Pseudosuccinea columella, en proporciones de 250 especímenes por persona/hora. El vegetal predominante fue el berro (Nasturtiun officinale), cultivado comercialmente en tres cuadrantes del humedal y en el otro cuadrante se observaron bovinos pastando. El índice de infección experimental de los moluscos fue de 94 % a la cepa simpátrica de F. hepatica de Dajabón; no se encontraron moluscos parasitados naturalmente. Conclusiones: Pseudosuccinea columella debe considerarse como un molusco de relevancia epidemiológica en la transmisión de la fascioliasis en República Dominicana, a tenor de su dispersión y elevado índice de infección experimental obtenido en el presente estudio

Introduction: in the epidemiological landscape of human fascioliasis, two aspects are of fundamental importance: a) presence of definite hosts (especially cattle and humans) parasitized with trematode adults and b) presence of invertebrate intermediate hosts, mollusks of the family Lymnaeidae, in which larval stages develop, in addition to aquatic plants for human consumption. Material and methods: in order to prevent outbreaks of human fascioliasis by correctly identifying aspects of epidemiological interest, a wetland was selected in the sector of Palo Blanco, municipality of Jarabacoa, province of La Vega, in which a malacological study was carried out in October 2016, in search of limneid mollusk species and associated hydrophytes. Natural and experimental infection rates to Fasciola hepaticawere obtained in the laboratory. Results: the lymnaeid Pseudosuccinea columella was identified, in proportions of 250 specimens collected per person/hour. The predominant vegetable was the watercress (Nasturtiun officinale), commercially cultivated in three quadrants of the wetland and in the other quadrant were observed cattle grazing. The rate of experimental infection of mollusks was 94 % to the sympatric strain of F. hepatica of Dajabón; no naturally parasitized mollusks were found. Conclusions: Pseudosuccinea columella should be considered as a mollusk of epidemiological relevance in the transmission of fascioliasis in the Dominican Republic, due to its dispersion and high rate of experimental infection obtained in the present study

Micro-environmental features associated to container-dwelling mosquitoes (Diptera: Culicidae) in an urban cemetery of the Dominican Republic / Variables microambientales asociadas a mosquitos (Diptera: Culicidae) que habitan en recipientes en un cementerio urbano de República Dominicana

Abstract Mosquitoes (Diptera: Culicidae) are important vectors of diverse pathogenic organisms, particularly arboviruses and protozoa. The immature stages of mosquitoes occur in a wide range of natural or human-made aquatic habitats. On this basis, some anthropogenic places such as cemeteries, usually serve as thrive and productive artificial-breeding habitats for mosquitoes. Despite being important foci for vector species, urban cemeteries are frequently overlooked in control and surveillance programs. This study evaluates the association of ecological variables and attributes (type of material, presence of flowers, water availability and height from the ground) of the breeding sites with the levels of infestation of mosquito immature stages. In 2017, an entire urban cemetery in Jarabacoa (Dominican Republic) was sampled at two different climatic periods (March: dry and August: rainy) for the characterization of the artificial breeding-sites, collection of immature stages of culicids and subsequent laboratory rearing for species identification. In total 968 containers were studied, containing 7 758 immature stages in 203 (21.0 %) water-filled containers which accounted for four species: Culex quinquefasciatus (50.5 %), Aedes aegypti (47.1 %), Aedes albopictus (1.9 %) and Culex nigripalpus (0.4 %). The mean of A. aegypti immatures in infested containers was roughly two times higher compared to C. quinquefasciatus and significantly lower compared to A. albopictus. The total Container Index (CI) was 20.9 %, and among the type of materials, those made from rock (cement, ceramic, and mud) and plastic had the highest CI = 25.9 % and 23.4 %, respectively. Almost 95 % of the total infested water-filled containers were made of plastic or rock. No association was found between the type of material of the containers and the density of mosquitoes. However, overall, greater densities of immature stages were found at ground than at higher levels. A weak positive correlation between water volume and density was found in some species of immature stages. Significantly higher number of C. quinquefasciatus were recorded in containers with flowers and large water volume. In contrast, A. aegypti immature stages were more frequent in containers without flowers. A weak negative association between water volume and infestations was found for A. albopictus immatures. As reflected of their opportunistic behaviour and broad ecological plasticity, Culex spp. and Aedes spp. mosquitoes were abundant pests in cemetery habitats where were able to breed in almost any kind of water-filled container regardless the type of material. However, our study showed that some ecological variables have critical impact for the development of the immature stages of some species. The health authorities and cemetery keepers can benefit from these results by focusing on the implementation of detailed plans and integrated strategies for the control and prevention of cemetery infestations by mosquitoes.(AU)

Resumen Los mosquitos (Diptera: Culicidae) son importantes vectores de diversos organismos patógenos, tales como arbovirus y protozoos. Los estadios inmaduros de los mosquitos pueden encontrarse en un amplio abanico de hábitats, tanto de origen natural como humano. Algunos lugares antrópicos, como los cementerios, sirven como prósperos hábitats artificiales para el desarrollo del ciclo de vida de los mosquitos. A pesar de constituir importantes focos para especies de interés vectorial, los cementerios urbanos son frecuentemente olvidados en los programas de vigilancia y control. Este estudio evaluó la asociación de algunas variables ecológicas (tipo de material, presencia de flores, disponibilidad de agua, y altura respecto al suelo) de los lugares de cría (recipientes) con los niveles de infestación de las fases preimarginales de los culícidos. En 2017, un cementerio urbano en Jarabacoa (República Dominicana) fue inspeccionado durante dos periodos climáticos (es decir: marzo: estación seca y agosto: estación húmeda) para: caracterizar los lugares de cría artificiales, captura de los estadios inmaduros de culícidos e identificación de los adultos emergidos a partir de las fases inmaduras. En total, 968 recipientes fueron examinados, conteniendo 7 758 inmaduros en 203 (21.0 %) recipientes con agua pertenecientes a cuatro especies, Culex quinquefasciatus (50.5 %), Aedes aegypti (47.1 %), Aedes albopictus (1.9 %) y Culex nigripalpus (0.4 %). El índice de recipiente (IR) fue del 20.9 %, y los recipientes fabricados a partir de roca (cemento, cerámica y barro) y plástico tuvieron el mayor IR = 25.9 y 23.4 %, respectivamente. Casi un 95 % de los recipientes con agua infectados estaban constituidos de materiales tipo plástico o roca. No se encontró asociación entre el tipo de material del recipiente y la densidad. En general, mayor densidad de estadios inmaduros fue observada a nivel del suelo que a alturas mayores. Se observó un incremento significativo del número de C. quinquefasciatus en recipientes con flores y grandes volúmenes de agua. Por el contrario, los estadios de A. aegypti fueron más frecuentes en recipientes sin flores. Como reflejo de su comportamiento oportunista y amplia plasticidad ecológica, los mosquitos Culex y Aedes fueron abundantes en los cementerios, siendo capaces de desarrollar su ciclo de vida acuático en cualquier tipo de recipiente, con independencia del material que lo constituya. Nuestro estudio, por tanto, mostró que algunas variables ecológicas tienen un impacto crítico sobre el desarrollo de los estadios inmaduros de algunas especies de mosquitos. Tanto las autoridades de salud pública como los cuidadores del cementerio pueden beneficiare de estos resultados centrándose en la implementación de planes detallados y estrategias integradoras para el control y prevención de mosquitos que infectan cementerios.(AU)

Modeling of Equivalent Effective Temperature and its possible incidence on larval density of Anopheles mosquitoes (Diptera: Culicidae) in Villa Clara province, Cuba / Modelación de la Temperatura Efectiva Equivalente y posible incidencia en la densidad larval de mosquitos Anopheles (Diptera: Culicidae) en la provincia Villa Clara, Cuba

AbstractThe wind chill or Equivalent Effective Temperature (EET) is the thermic sensation that a person feels when being exposed to a certain combination of temperature from the air, relative humidity and wind velocity. The objective of this investigation was directed to determine the possible incidence of the EET upon the larval density of Anopheles mosquitoes in Villa Clara province, Cuba. The Climatological data were compiled from the Yabú station in Santa Clara, and a total of 5 370 measurements were included in a database every three hours, using the aggregate function of the Statistical Package of Social Science software version 13 (SPSS), from January 1st, 2011 to September 30th, 2013. A long term forecast (1 year of advance) was made to obtain EET and the Anopheles larval density in the locality of Santo Domingo was modelled. These entomological data were taken at the same time but monthly, so the EET data were converted to monthly scale to be correlated with the monthly data of the larval density. The result was a 97.1 % of variance with a standard error (SE) of 3.57 °C for the model of the EET with a year of anticipation; therefore, the tendency in time was significant. The modeling also included the Anopheles larval density of mosquitoes in Santo Domingo, Villa Clara province, observing an increase of the EET, while the Anopheles mosquito larvae also increased. The most important variables in the model were the EET that were back in 1, 2, 3, 4, 7, 16, 24, 40 for the previous year; that is to say 2 920, 2 921, and so on, which explained a strong contagion among the data. EET correlation compared with itself in previous year was high; therefore, it may be used as a predictable variable. The anophelinic density in Santo Domingo explained the 66 % of the variance, with a SE of 0.66 larvae.m-2. The tendency of the Anopheles larval density was to diminish. In conclusion, EET has an important impact in larval density of Anopheles with EET increase associated with larval density decrease.

ResumenLa Temperatura Efectiva Equivalente (TEE) es la sensación térmica que siente una persona frente a una determinada combinación de temperatura del aire, humedad relativa y velocidad del viento. El objetivo de la investigación fue determinar la posible incidencia de la TEE sobre la densidad larval de mosquitos del género Anopheles en la provincia Villa Clara, Cuba. Una base de datos recogió medidas climatológicos cada tres horas durante el periodo comprendido entre el 1 de enero 2011 hasta el 30 de septiembre 2013, proveyendo un total de 5 370 medidas de la estación Yabú de Santa Clara. Se realizó un pronóstico a largo plazo (1 año) para obtener la TEE y se modeló la densidad larvaria total de mosquitos en la localidad de Santo Domingo. Los datos entomológicos fueron recogidos en el mismo lapso temporal pero con una periodicidad mensual, por lo que los datos de TEE fueron convertidos a escala mensual para poder ser empleados con los datos de densidad larvaria. Para la modelación se utilizó la Metodología de Regresión Objetiva Regresiva que explicó el 97.1 % de varianza con un error estándar (SE) de 3.57 ºC para el modelo de TEE con un año de antelación; la tendencia en el tiempo fue significativa al aumento. Además, al modelar la densidad larvaria anofelínica en el municipio Santo Domingo, se observó que a medida que aumenta la TEE, disminuye la densidad larval anofelínica. La variable más importante en el modelo fue la TEE regresada en 1, 2, 3, 4, 7, 16, 24, 40, pero del año anterior, es decir 2 920, 2 921, y así sucesivamente, explicando un contagio muy fuerte entre los datos. Ello fue debido a que la correlación de TEE con ella misma en años anteriores fue alta, por lo que puede ser utilizada como variable predictora. El modelo de densidad larval anofelínica en Santo Domingo explicó el 66 % de la varianza, con un SE de 0.06 larvas/m2. La tendencia de la DLA fue a la disminución. En conclusión, la TEE tuvo una incidencia directamente proporcional en la densidad larval anofelínica, ya que a medida que aumentaba este indicador, disminuyó la densidad larval anofelínica.

Desempenho funcional de pacientes com deformidades visíveis na hanseníase / Functional performance of patients with visible deformities in leprosy

Esse estudo tem por objetivo avaliar a capacidade funcional da mão das pessoas atingidas pela hanseníase na realização das atividades básicas e instrumentais da vida diária. A amostra foi constituída por 50 pacientes, maiores de 18 anos, que estavam sendo acompanhados no ambulatório do Instituto Lauro de Souza Lima. Para avaliação das características sociodemográficas e clínicas foi elaborado um questionário próprio. As dificuldades manuais para realizar atividades nas áreas de vestuário, alimentação, higiene pessoal, cuidados com a casa, escrita e outros foram avaliados por meio da Avaliação Funcional das Mãos em Hanseníase. Os resultados demonstram que em todas as atividades houve algum grau de dificuldade, porém, a maioria dos pacientes as realiza com independência. As atividades consideradas mais difíceis de serem executadas pelos pacientes com garra ulnar foram: pegar objetos pequenos em superfície plana, abrir/fechar fecho de corrente e cortar unhas. Na população de pacientes com garra ulnar/mediano foram: pegar objetos pequenos em superfície plana, abotoar/desabotoar, dar laço/ amarrar cadarço e abrir/fechar fecho de corrente. As atividades são realizadas com algum grau de dificuldade, porém, com independência pela maioria dos indivíduos que tem ou tiveram hanseníase e apresentam deformidades visíveis. Muitas dessas dificuldades podem ser minimizadas por meio de transferências tendinosas ou pela indicação, confecção e uso de tecnologia assistiva(AU).

This study aims to assess the functional capacity of the hand of people affected by leprosy in carrying out basic and instrumental activities of daily living. The sample consisted of 50 patients, aged over 18, who were being followed up at the outpatient clinic of the Instituto Lauro de Souza Lima. A questionnaire was developed to assess sociodemographic and clinical characteristics. Manual difficulties in carrying out activities in the areas of clothing, food, personal hygiene, home care, writing and others were assessed through the Functional Hand Assessment in Leprosy. The results show that in all activities there was some degree of difficulty, however, most patients perform them independently. The activities considered most difficult to be performed by patients with an ulnar claw were: picking up small objects on a flat surface, opening / closing the chain clasp and cutting nails. In the population of patients with an ulnar / median claw were: picking up small objects on a flat surface, buttoning / unbuttoning, looping / tying shoelaces and opening / closing chain fastening. The activities are performed with some degree of difficulty, however, independently by the majority of individuals who have or have had leprosy and have visible deformities. Many of these difficulties can be minimized by means of tendon transfers or by the indication, preparation and use of assistive technology(AU).

Updated distribution of Aedes albopictus (Diptera: Culicidae) in Spain: new findings in the mainland Spanish Levante, 2013

In 2004, Aedes (Stegomyia) albopictus (Skuse, 1894) was observed for the first time in Catalonia, northeastern Spain. A decade later, it has spread throughout the eastern Mediterranean region of the country and the Balearic Islands. Framed within a national surveillance project, we present the results of monitoring in 2013 in the autonomous communities of the mainland Levante. The current study reveals a remarkable increase in the spread of the invasive mosquito in relation to results from 2012; the species was present and well-established in 48 municipalities, most of which were along the Mediterranean coastline from the Valencian Community to the Region of Murcia.

Controle de qualidade de monitores de diagnóstico por imagem e iluminância nos espaços de pós-processamento em serviços de imagiologia / Display quality control based on luminance measurements in post-processing units at imaging diagnosis centers

OBJETIVO: Avaliar a qualidade dos monitores de diagnóstico e tratamento de imagem digital em radiologia convencional (raios X) com base nos níveis de luminância. Fez-se a medição da iluminância dos postos de trabalho onde estavam os monitores. MATERIAIS E MÉTODOS: A medição da luminância foi realizada usando-se um detector Unfors Xi Light em cinco instituições, com 23 monitores primários e 22 secundários, sendo 6 usados em urgência, seguindo o método descrito no relatório TG18 da American Association of Physicists in Medicine (AAPM). O instrumento de medida utilizado foi o Delta Ohm HD 9221 luximeter. RESULTADOS: Para as recomendações da AAPM, tanto monitores primários como secundários cumpriram, no geral, os níveis de tolerância. No caso dos níveis de iluminância, nos locais de trabalho dos monitores primários encontravam-se ligeiramente acima do intervalo recomendado. Quanto às recomendações do The Royal College of Radiologists (RCR), os monitores que respeitaram os níveis recomendados estavam em minoria, embora as diferenças não fossem significativas. CONCLUSÃO: Em geral, os resultados foram satisfatórios, embora os monitores não fossem adequados para atingir as recomendações exigentes do RCR. Os níveis de referência entre os monitores primários e secundários deveriam aproximar-se, de modo a garantir a qualidade de imagem. Os monitores para visualização e diagnóstico de imagens médicas devem ser regularmente avaliados para manter um sistema com a qualidade exigida, dada a função que desempenham.

OBJECTIVE: To evaluate the quality of primary and secondary displays of conventional radiography systems based on luminance measurements. The level of ambient lighting within the rooms was also measured. MATERIALS AND METHODS: Luminance measurements were performed with an Unfors Xi Light Detector in 23 primary and 22 secondary displays (six of them utilized in emergency departments) at five different institutions, and according to the method described on the American Association of Physicists in Medicine (AAPM) TG18 report. The level of ambient lighting was measured with Delta Ohm HD 9221 lux meter. RESULTS: In general, both the primary and secondary the displays were compliant with the AAPM guidelines. As regards ambient lighting, the primary workstation rooms were slightly above the recommended levels. As far as The Royal College of Radiologists (RCR) recommendations are concerned, the number of compliant displays corresponded to a minority, with no significant difference, though. CONCLUSION: Although most of the displays could not meet the strict RCR guidelines, in general, the results were satisfactory. The level of agreement between primary and secondary displays should be as high as possible in order to guarantee the image quality. Considering the key role played by diagnostic imaging systems, medical imaging displays must be regularly evaluated to assure that the quality of the imaging system is maintained.

How to increase the population of a Phlebotomus perniciosus (Diptera: Psychodidae) colony: a new method

The sandfly Phlebotomus perniciosus is the most widespread vector of Leishmania infantum in Spain. Laboratory colonisation represents the most feasible source of information on the biology of these insects, but in conducting any study, the density of individuals in the colony may drop to such an extent that it is sometimes difficult to recover the initial population levels. A new technique was tested for the recovery of sandfly eggs in three different colonies; the recovery rate was studied by comparing the standard method of mass rearing with this new method of colony management. The results demonstrate a mean increase of 18.4 percent in adult production, a growth in colony productivity that justifies the inclusion of this process in the routine maintenance of any colony of sandflies.

Memorias para la historia de la medicina en Santafé de Bogotá: capítulos IV y V / Memories for the history of medicine in Santafé de Bogotá: chapters IV and V

Médicos y naturalistas ilustres que prestaron servi­cios a la causa de la independencia americana. -Funda el doctor Merizalde una Cátedra de Medici­na en el Colegio de San Bartolomé. -Epidemias de coqueluche y de viruela. - Providencias tomadas para contener la última. -Rapacidad de un Jefe es­pañol. Devolución del edificio y rentas del Colegio Mayor del Rosario. - Dictadura de don Juan Sámano. -El Médico Inspector del Ejército Expedi­cionario se radica en Santafé. -Primera Academia de Medicina que existió en esta ciudad. -Sus miem­bros. -Raras circunstancias que acompañaron su creación. Fin de la guerra de la independencia. -Diversos nombramientos. -Libros científicos que había en el país. -Introducción de nuevos textos.

Cambios en la vía aérea después de cirugía ortognática bimaxilar en pacientes con maloclusión clase III esquelética / Airway changes after bimaxillary orthognatic surgery in patients with skeletal class III malocclusion

Introducción: el objetivo fue determinar radiográficamente el porcentaje de estabilidad de la altura del reborde alveolar del maxilar superior e inferior en pacientes sometidos a cirugía preprotésica de aumento de reborde con implante de HA no reabsorbible. Métodos: el estudio se realizó en quince pacientes, en quienes se determinaron mediciones reproducibles. Para el maxilar superior: (A) desde espina nasal anterior; (B derecha-izquierda) desde el borde más inferior de las fosas nasales; (C derecha- izquierda) desde el borde más inferior de la órbita. Para el maxilar inferior: (E) desde el borde inferior de la mandíbula y pasando por la sínfisis; (F derecha-izquierda) pasando por el agujero mentoniano; (G derecha-izquierda) pasando 5 mm. atrás del agujero mentoniano; (H derecha-izquierda) pasando 10 mm posterior al agujero mentoniano. Todas las mediciones se realizaron en el prequirúrgico, en el posquirúrgico inmediato, y a los nueve meses. Resultados: se promediaron los diferentes puntos del maxilar superior (PPMXS) y se observó una pérdida de altura entre el 6,29 y un 33,6% con promedio del 17,36 %. En el maxilar inferior (PPMXI) se observó una variación desde ganancia del 6,31% hasta una disminución del 18,87%, con promedio del 2,54%. Conclusiones: el implante de HA permite restablecer adecuada altura del reborde alveolar. La altura del reborde alveolar obtenida inicialmente presenta un porcentaje de disminución de su altura en el maxilar superior del 17,36%, y en el maxilar inferior del 2,54 durante el seguimiento a nueve meses.

Introduction: the purpose of this study was to determine radiographically the percentage of stability of alveolar ridge height in the maxilla and the mandible in patients subjected to pre prosthetic surgery of ridge augmentation with non resorbable HA implants. Methods: the study was performed in 15 patients in whom reproducible measurements were taken. For the maxilla: (A) From Anterior Nasal Spine; (B right and left) from the lowest border of the nasal fossae; (C right and left) from the lowest border of the orbit. For the mandible: (E) from the lowest border of the mandible passing through symphysis; (F right and left) passing through the mental foramen; (G right and left) passing 5 mm posterior to the mental foramen; (H right and left) passing 10 mm posterior to mental foramen. All measurements were performed before surgery, immediately after and, nine months after surgery. Results: the different points of the maxilla were averaged (PPMXS) and a height loss between 6.29% and 33.6% was observed, with an average of 17.36%. For the mandible (PPMXL) variations ranging from 6.31% of augmentation to 18.8% loss were observed, with an average of 2.54%. Conclusions: HA implants allow reestablishment of adequate alveolar ridge height. The alveolar ridge height initially obtained presents a decrease percentage in height for the maxilla of 17.36% and 2.54% for the mandible after nine months follow up.

Estudio comparativo del efecto clínico producido por el first class y el péndulo en pacientes atendidos en la Facultad de Odontología de la Univesidad de Antioquia. Análisis radiográfico y de modelos / Comparative study of the clinical effect produced by the first class and the pendulum in patients trated at the College of Dentistry, University of Antioquia. A radiographic and model analysis

El propósito de este estudio fue establecer y comparar los resultados clínicos y radiográficos obtenidos con el del péndulo y del First class® durante cuatro meses de tratamiento, en relación con sus efectos craneofaciales, dentales y de tejidos blandos en pacientes que tuvieran indicado dentro de su plan de tratamiento la distalización de los primeros molares superiores. La muestra estuvo constituida por 27 sujetos entre los 12 y 17 años de edad: 19 experimentales (11 tratados con péndulo y 8 con First class®) y 8 controles, con los cuales se descartaron cambios debidos al crecimiento. Se obtuvieron radiografías panorámicas iniciales y cefálicas laterales iniciales y finales; fotografías estandarizadas 1:1 de modelos de estudio: al inicio, segundo y cuarto mes de tratamiento. Los resultados radiográficos muestran que no se presentan cambios significativos en las estructuras esqueléticas. A nivel dentoalveolar se observa distalización molar promedio con el péndulo de 4,68 ± 4,9 mm y con el First class® de 2,05 ± 4,06 mm acompañadas ambas de inclinación distal (12,2º con péndulo, 3,2º con First class®) e intrusión (0,55 y 0,037 mm respectivamente) con comportamiento asimétrico derecha-izquierda. Por cada milímetro de distalización molar se presentó un incremento en la labialización del incisivo de 0,9º con el péndulo y de 3,0º con el First class® que se acompaña de disminución del ángulo naso-labial (-5,45º con péndulo y -6,0º con First class®) y protrusión del labio superior (1,59 y 1,07 mm respectivamente). En los modelos se observó un cambio rotacional del molar con un comportamiento heterogéneo; tanto con péndulo como con First class®, se observan rotaciones en sentidos opuestos: distopalatinas (+) y distovestibulares (-) El promedio total fue positivo en ambos siendo mayor para el First class® (5,87°) que para el péndulo (4,3°), conservando un patrón asimétrico derecha-izquierda. Debe cuestionarse la efectividad del anclaje ofrecido por el botón de acríli...

The purpose of this research was to establish and compare the clinical and radiographic results obtained during the four month use of the pendulum and the First class® in relation with its craneofacial, dental, and soft tissue effects in patients who had indicated as part of their treatment plan, a distalization of their first upper molars. The sample consisted of 27 subjects between 12 and 17 years of age: 11 treated with pendulum, 8 treated with First class®, and 8 controls to discard any changes due to growth. All patients received inicial Panoramic X-rays, inicial and final lateral cephalograms; 1:1 standardized pictures of study casts at the beginning, second and fourth months of treatment. The radiographic results showed there were no significant changes in the skeletal structures. At the dento-alveolar level an average molar distalization of 4.68 ± 4.9 mm was observed with the pendulum and of 2.05 ± 4.06 mm with the First class® both of which were accompanied by distal inclination (12.2º pendulum, 3.2º First class®) and intrusion (0.55 and 0.037 mm respectively) with an assymetric right – left behavior. For each millimeter of molar distalization there was an increment in incisal labialization of 0.9º with the pendulum and 3.0º with the First class® accompanied by a decrease in the nasolabial angle (-5.45º with the pendulum and -6.0º with First class®) and an upper lip protrusion (1.59 and 1.07 mm respectively). The dental casts showed a rotational change in the molar with a heterogenous behavior; with both pendulum and First class®, rotations in opposite directions were observed: distopalatal (+) y distolabial (-). The total average was positive in both, being greater for the First class® (5.87°) than for the pendulum (4.3°), conserving a right-left asymmetric pattern. The effectiveness of the anchorage offered by the palatal acrylic button should be questioned, since there was evidence of anterior displacement of this structure...

Adeus à nossa professora: perde a Escola de Enfermagem Anna Nery/UFRJ / Goodbye to our teacher: lost to the Anna Nery School of Nursing/UFRJ

A Escola perde uma das professoras mais estimadas de seu corpo social. Em nome deste Corpo Social homenageamos sua dileta aluna, enfermeira, docente e amiga a Professora Assistente e Mestre em Enfermagem, Maria da Conceição Gonçalves. Ela era uma pessoa tímida e valente, excepcional e ética, provida dos mais profundos sentimentos, emoções e capacidade de doação à família, aos clientes, aos amigos, à Escola e à Universidade...

Implementación de métodos estadísticos para la clasificación de las relaciones máxilo-mandibulares clase I / Implementation of statistical methods for classification of maxillo-mandibular class I relationships

El propósito de este estudio fue aplicar herramientas estadísticas en la clasificación de la relación máxilo-mandibular clase I utilizando las variables del análisis de la radiografía cefálica lateral. La muestra estuvo conformada por un total 103 sujetos (51 hombres, 52 mujeres), entre los 18 y 29 años de edad, pertenecientes a la población estudiantil de la Universidad de Antioquia en Medellín, con relaciones oclusales molares y caninas bilaterales de clase I, sin apiñamiento evidente y buen balance facial. Las medidas cefalométricas tenidas en cuenta se dividieron en dos grupos: medidas esqueléticas y medidas dentoalveolares. Posteriormente los datos fueron procesados y se realizaron los diferentes análisis estadísticos: univariado, bivariado y multivariado. Los resultados mostraron gran dispersión de los datos y por ende comportamiento heterogéneo de la muestra.

Alteración dentofacial de una paciente clase III y su manejo ortodóncico quirúrgico: reporte de caso clínico / Dentofacial alteration in a class III patient and its surgical orthodontic management: report of a case

Se reporta el caso clínico de una paciente de quince años de edad con maloclusión dental clase III, con deficiencia maxilar y prognatismo mandibular. La paciente consultó a edad temprana, por lo cual, se decidió esperar a que terminara su crecimiento y desarrollo para luego iniciar el tratamiento de ortodoncia con prescripción de Alexander (Ormco) ® y hacer solamente cirugía mandibular (osteotomía oblicua de rama para retroceso), lográndose la adecuada relación oclusal y balance facial. Se siguió el protocolo de atención de ortodoncia y cirugía maxilofacial para los pacientes tratados en los posgrados de Odontología Integral del Adolescente y Ortodoncia y el posgrado de Cirugía Oral y Maxilofacial de la Facultad de Odontología de la Universidad de Antioquia.