Improving cardiovascular health in primary care in Saint Lucia through the HEARTS Initiative / Mejorar la salud cardiovascular en la atención primaria en Santa Lucía por medio de la iniciativa HEARTS / Melhorando a saúde cardiovascular na atenção primária em Santa Lúcia por meio da Iniciativa HEARTS

ABSTRACT Objective. To improve blood pressure control and hypertension registry coverage at six demonstration sites in St Lucia. Methods. From January 2020 to December 2021, St Lucia's Ministry of Health, with support of the Pan American Health Organization, implemented the HEARTS Technical Package in six primary health care facilities with six-monthly monitoring of blood pressure control and hypertension registry coverage. The modules included healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based cardiovascular management, team-based care and systems for monitoring. Results. Levels of blood pressure control at 6, 12, 18 and 24-months after the intervention were 37.1%, 28.9%, 33.9% and 36.5% respectively. Hypertension registry coverage increased by 17.8% (1 434 to 1 689) for patients accessing service. Implementing the monitoring for action initiative 12 to 15 months after the start of the intervention resulted in policy and operational changes, improved documentation, and provided accurate and reliable data. Conclusions. The HEARTS initiative unearthed basic infrastructural challenges in blood pressure control. The essential elements for success were (1) buy in at all levels of the health sector; (2) addressing policy and operational changes; (3) accurate documentation and required analysis; (4) standardization of equipment and procedures and (5) regular monitoring and evaluation. Capacity building underpinned all changes.

RESUMEN Objetivo. Mejorar el control de la presión arterial y aumentar la cobertura del registro de la hipertensión en seis centros de referencia en Santa Lucía. Métodos. Entre enero del 2020 y diciembre del 2021, el Ministerio de Salud de Santa Lucía, con el apoyo de la Organización Panamericana de la Salud, implementó el paquete técnico HEARTS en seis centros de atención primaria de salud acompañado de un seguimiento semestral del control de la presión arterial y la cobertura del registro de la hipertensión. Se incluyeron los siguientes módulos: asesoramiento sobre hábitos y estilos de vida saludables, protocolos clínicos basados en la evidencia, acceso a medicamentos y tecnologías esenciales, manejo de las enfermedades cardiovasculares basado en la estratificación del riesgo, trabajo basado en equipos multidisciplinarios y sistemas de monitoreo. Resultados. Los niveles de control de la presión arterial a los 6, 12, 18 y 24 meses después de la intervención fueron de 37,1%, 28,9%, 33,9% y 36,5% respectivamente. La cobertura del registro de la hipertensión aumentó en 17,8% (de 1 434 a 1 689) para los pacientes que acceden al servicio. Con la implementación de la iniciativa de seguimiento entre los 12 y 15 meses después del inicio de la intervención se lograron cambios operativos y en las políticas, se mejoró la documentación y se obtuvieron datos rigurosos y fiables. Conclusiones. La iniciativa HEARTS reveló los desafíos básicos relativos a la infraestructura que afronta el control de la presión arterial. Los factores principales que contribuyeron al éxito fueron: 1) la aceptación en todos los niveles del sector de la salud; 2) el abordaje de cambios políticos y operativos; 3) una documentación rigurosa y la ejecución de los análisis necesarios; 4) la estandarización de los equipos y procedimientos; y 5) la ejecución de labores de seguimiento y evaluación con regularidad. El fortalecimiento de la capacidad fue la base de todos los cambios.

RESUMO Objetivo. Melhorar o controle da pressão arterial e a cobertura do registro de hipertensão em seis locais-piloto em Santa Lúcia. Métodos. De janeiro de 2020 a dezembro de 2021, o Ministério da Saúde de Santa Lúcia, com apoio da Organização Pan-Americana da Saúde, implementou o pacote técnico HEARTS em seis unidades básicas de saúde com monitoramento semestral do controle da pressão arterial e cobertura do registro de hipertensão. Os módulos incluíram aconselhamento sobre estilo de vida saudável, protocolos de tratamento baseados em evidências, acesso a medicamentos e tecnologias essenciais, manejo cardiovascular baseado em risco, cuidados em equipe e sistemas de monitoramento. Resultados. Os níveis de controle da pressão arterial aos 6, 12, 18 e 24 meses após a intervenção foram de 37,1%, 28,9%, 33,9% e 36,5%, respectivamente. A cobertura do registro de hipertensão aumentou 17,8% (de 1 434 para 1 689) para pacientes que acessam o serviço. A implementação da iniciativa de monitoramento para ação, 12 a 15 meses após o início da intervenção, resultou em mudanças de política e operacionais, melhoria da documentação e fornecimento de dados exatos e confiáveis. Conclusões. A iniciativa HEARTS revelou desafios básicos de infraestrutura para o controle da pressão arterial. Os elementos essenciais para o sucesso foram: (1) adesão em todos os níveis do setor de saúde; (2) abordagem das mudanças de política e operacionais; (3) documentação exata e análise necessária; (4) padronização de equipamentos e procedimentos; e (5) monitoramento e avaliação regulares. A capacitação foi a base de todas as mudanças.

Apport du test expert MTBRIF dans le diagnostic de la tuberculose toute forme à Saint-Louis / contribution of the Xpert MTB / Rif test in the diagnosis of tuberculosis of any form in Saint-Louis

Introduction: le test Xpert MTB/RIF présente un double avantage d'une part le diagnostic rapide des cas mêmes difficiles par la technique standard de l'examen direct à la microscopie et d'autre part par la détection de la résistance à la rifampicine. Notre objectif était de déterminer l'apport du test Xpert dans le diagnostic de la tuberculose toutes formes confondues. Matériels et méthode : étude transversale, descriptive à collecte rétrospective menée dans le service de Pneumophtisiologie de CHRU de Saint-Louis. Tous les cas suspects de tuberculose qui avaient bénéficié d'un test Xpert de 2018 à 2020avec un dossier médical accessible et exploitable ont été inclus. Les paramètres étudiés étaient les données sociodémographiques, cliniques et biologiques. Résultats : Nous avions colligés 524dossiers de malades avec un sex-ratio de 1,3. L'âge moyen des patients était de 37 ans+/-15 ans. Il y'avait 285 prélèvements positifs au GeneXpert dont 224 d'origine pulmonaire et 61d'origine extra pulmonaire. Le nombre d'échantillons résistants à la rifampicine était de cinq, tous d'origine respiratoire. Conclusion: le test Xpert est une nouvelle technique moléculaire recommandée par l'OMS dans le diagnostic de la tuberculose pulmonaire. Toutefois il doit être évaluer dans le diagnostic de la tuberculose extra pulmonaire

Introduction: The Xpert MTB / RIF assay has a dual advantage on the one hand, the rapid diagnosis of even difficult cases by the standard technique of direct microscopic examination and on the other hand by the detection of resistance to rifampicin. Our objective was to determine the contribution of the Xpert test in the diagnosis of tuberculosis of all forms. Materials and method: retrospective, descriptive and analytical study carried out in the Pneumophtisiology department of the CHRU of Saint-Louis. All suspected tuberculosis cases who had received an Xpert test from 2018 to 2020 were included. The parameters studied were socio-demographic, clinical and biological data. Results: 524 patient records included in the study with a sex ratio of 1.3. The mean age of the patients was 37 +/-15 years. There were 285 positive GeneXpert samples, of which 224 were of pulmonary origin and 61 of extra-pulmonary origin. The number of rifampicin resistant samples was five, all of respiratory origin. Conclusion: the Xpert test is a new molecular technique recommended by the WHO in the diagnosis of pulmonary tuberculosis

Caracterización biológica de cepas del virus Encefalitis San Luis en células de la inmunidad innata / Biological characterization of St. Louis Encephalitis virus strains in cells of innate immunity

Los flavivirus transmitidos por mosquitos son una amenaza actual y emergente en todo el mundo. Dentro de este género, el virus Encefalitis San Luis (VESL) causa una forma severa de enfermedad neuroinvasiva donde la respuesta inmune es un componente crucial de la defensa del huésped. En este trabajo se investigó la interacción entre VESL y células de la inmunidad innata, en un modelo de infección in vitro de monocitos humanos (células U937) con cepas de distinta virulencia y condiciones epidemiológicas de aislamiento (CbaAr-4005 y 78V-6507). Se evaluó la capacidad de infectar y replicar del virus, como también el efecto citopático y la cinética de viabilidad de monocitos durante la infección. Los resultados demostraron la susceptibilidad de los monocitos a la infección, replicación y muerte por ambas cepas virales. Sin embargo, se hallaron diferencias significativas entre ellas. La cepa epidémica y de mayor virulencia CbaAr-4005 registró una tasa de infección y replicación superior a la de la cepa endémica y de menor virulencia 78V-6507. Se comprobó también que el VESL indujo la muerte de monocitos humanos, dependiendo del tiempo post-infección (pi) y de la cepa. Así, CbaAr-4005 provocó a partir del día 3 pi el doble de mortalidad celular que 78V-6507. Además, en los monocitos infectados se observaron alteraciones de parámetros morfológicos que podrían relacionarse con el tipo de mecanismo de muerte celular asociado a la infección por VESL.

Mosquitoes borne Flavivirus infections are an actual and emergent worldwide threat to human health. Within this genus, Saint Louis Encephalitis Virus (SLEV) causes a severe neuroinvasive disease where immune response is crucial for host survival. In this study the interaction between SLEV and innate immune cells was evaluated. An in vitro infection model with human monocytes (U937 cells) and strains with variations in virulence and isolation conditions (CbaAr-4005 and 78V-6507) were used. Infection capacity, replication capacity, cytopathic effect and monocyte viability kinetics were measured. The results showed susceptibility to infection and replication to both strains. However, significant differences were found among them. CbaAr-4005, the epidemic and more virulent strain, showed higher infection and replication ratios compared to 78V-6507. SLEV infection that induces cell death of human monocytes was also found in a post-infection time and in a strain dependent manner. Since day 3 post-infection, twice the mortality in CbaAr-4005 infected cells was observed. Furthermore, infected monocytes showed alterations in morphologic parameters that could be related with apoptosis mechanisms associated to SLEV infections.

Os Flavivírus transmitidos por mosquitos são uma ameaça atual e emergente no mundo todo. Nesse gênero, o vírus Encefalite Saint Louis (VESL) causa uma forma grave de doença neuroinvasiva onde a resposta imune é um componente crucial da defesa do hospedeiro. Neste trabalho nos investigamos a interação entre VESL e células de imunidade inata em um modelo de infecção in vitro de monócitos humanos (células U937) com estirpe de diferentes virulências e condições epidemiológicas de isolamento (CbaAr-4005 e 78V-6507). Foi avaliada a capacidade do vírus de infectar e replicar , assim como o efeito citopático e a viabilidade cinética dos monócitos durante a infecção. Os resultados demonstraram a suscetibilidade dos monócitos à infecção, replicação e morte por ambas as estirpes virais. No entanto, foram detectadas diferenças significativas entre eles. A estirpe epidémica e de maior virulenta CbaAr-4005 teve uma maior taxa de infecção e replicação do que a estirpe endémica e menos virulenta 78V-6507. Foi comprovado também que o VESL induziu a morte de monócitos humanos, dependendo do tempo pós-infecção (pi) e da estirpe. Assim, a CbaAr-4005 causou a partir do dia 3 pi o dobro da mortalidade celular o que a 78V- 6507. Além disso, alterações nos parâmetros morfológicos foram observadas nos monócitos infectados que poderiam estar relacionadas ao tipo de mecanismo de morte celular associado à infecção pelo VESL.

Demographic Factors Associated with Dengue in Saint Lucia

Aims: To identify demographic variables associated with dengue in Saint Lucia.Study Design:Retrospective quasi experimental study of secondary data.Place and Duration of Study:Data was accessed from the Ministry of Health Saint Lucia, the Saint Lucia Tourism Authority and the Central Statistics Office Saint Lucia, 2011-2017.Methodology:This study included 1869 cases tested for dengue between 2011 and 2017 identified through regular surveillance in Saint Lucia. There were 1310 confirmed cases, of which 667 were male and 643 were female. Data on education, employment, and unemployment levels, population density, hospital access and tourist arrivals were accessed from local SaintLucian agencies to determine their relationships with the occurrence of dengue.Results:The largest prevalence of dengue from the sample was found in the district of Castries (29.6%) and 25% of the cases occurring in the adult group (19-44). It was foundthat over 40 % of the dengue cases occurred in the population when between 12500 to 14000 persons (medium level) had tertiary education. Logistic regression of the data allowed the demonstration of strong significant relationships between age, the 13-18-year age group (P<.001, OR 4.091 [CI 2.628-6.369]) and tertiary education (P<.001, OR 4.785 [CI 2.896-7.905]) and occurrence of dengue.Conclusion: Age and education, along with other variables such as location, tourist visitor arrival, employment status, and population density were found to be associated with dengue in Saint Lucia. Further research is warranted to better characterize these relationships and understand how they could be used to develop predictive models for use in public health prevention programmes.

Lung Function and Health Status in Patients of Chronic Obstructive Pulmonary Disease on Treatment with Tiotropium

Introduction: Chronic obstructive pulmonary disease (COPD) is a group of chronic and slowly progressive respiratory disordercharacterized by reduced maximum expiratory flow during forced exhalation. Tiotropium, a long-acting antimuscarinic agent,has well-known documented effect on improving lung function and quality of life (QOL). There are many studies globally ontiotropium and its effect on lung function, but limited studies available in our Indian set up. Hence, we planned this study.Materials and Methods: Patients were recruited from chest clinic and outpatient department from the Department of Medicineof University College of Medical Sciences and GTB Hospital. It was a prospective observational cohort study conducted fromNovember 2017 to April 2019. Tiotropium was given as meter dose inhaler in dose of 18 µg per dose, in schedule as prescribedby the Global Initiative for Chronic Obstructive Lung Disease-2017 guidelines. Patients were followed up for 3 months withperiodic assessment of lung functions, Saint George’s Respiratory Questionnaire (SGRQ) score, and symptoms assessment.Results: A total of 65 patients were recruited for study which included 57 (87.7%) males and 8 (12.3%) females. Among thepulmonary function tests measured, there is a significant change in mean forced expiratory volume (FEV1) at the end of followup period compared to FEV1 at baseline. There is a significant change in mean forced vital capacity at the end of follow-upstudy compared to start of the study. There was no significant change in mean SGRQ score after 1 month of start of drug,but significant statistical change observed at end of the 3rd month of the study compared to the 1st month that implies SGRQscore decreased and patients health status and QOL improved. There is a significant change in mean SGRQ score at the endof follow-up study compared to baseline. In our study, 16 patients (24.6%) complained of dry mouth, 7 (10.7%) complained ofpharyngitis or throat irritation, and 3 (4.6%) patients complained of constipation.Conclusion: There was a statistically significant change in lung functions and improvement in QOL scores as assessed bySGRQ at the end of the study compared to baseline by use of inhaled tiotropium in COPD patients

Oogun Àse: estratégias de cuidado com a saúde no Candomblé em Nova Iorque (EUA) / Oogun Àse: estrategias de cuidado de la salud en la Santería en Nueva York (EEUU) / Oogun Àse: Candomblé practices and health care in New York City, USA

Este artigo apresenta resultados de uma etnografia realizada entre 2013 e 2017, por meio de observação participante, entrevistas e acompanhamento da vida cotidiana de mães de santo que buscam reinventar o Candomblé em Nova Iorque (EUA). O artigo acompanha três mães de santo, em suas buscas por traduzirem a religião para esse novo contexto, descrevendo como se dá o encontro com os adeptos e clientes em busca de cuidados com a saúde e bem-viver, por meio do uso das plantas e rezas empregadas nos rituais e nas cerimônias religiosas.

Este artículo presenta resultados de una etnografía realizada entre 2013 y 2017, por medio de observación participante, entrevistas y acompañamiento de la vida cotidiana de madrinas que buscan reinventar la Santería en Nueva York (EE.UU.). El artículo acompaña a tres madrinas en sus búsquedas por traducir la religión para ese nuevo contexto, describiendo cómo se realiza el encuentro con los adeptos y clientes que buscan cuidados con la salud y el bien vivir por medio del uso de plantas y rezos utilizados en los rituales y ceremonias religiosas.

This article presents the results of an ethnography carried out between 2013 and 2017, which relied on participating observation, interviews and monitoring of the everyday life of three Brazilian mães de santo (mothers of saint) who sought to reinvent Candomblé in New York City, USA. The article follows them as they attempt to transpose their religious beliefs and practices to this new, foreign context. It describes their relationship with practitioners who seek health care through the use of plants and prayers during religious rituals and ceremonies.

Voluntad e intelecto: encuentros y desencuentros entre Tomás de Aquino y Duns Escoto / Will and Intellect: agreements and disagreements between Thomas Aquinas and Duns Scotus / Vontade e do intelecto: acordos e desacordos entre Tomás de Aquino e Duns Scotus

Resumen Introducción: la voluntad y el intelecto, dos potencias fundamentales que obran en el espíritu de los hombres determinando de una manera u otra sus elecciones, han sido desarrolladas y comprendidas de formas distintas por diferentes filósofos a la lo largo de la historia, entre ellos, los filósofos medievales Santo Tomás de Aquino y Juan Duns Escoto, cuyo pensamiento sobre estos asuntos se analiza en el presente artículo a partir de referencias como la Suma Teológica de Aquino, Giovanni Duns Scoto: una introduzione bibliografica de Todescan y La vida del espíritu de Hannah Arendt, entre otras. Objetivo: el objetivo del presente artículo es analizar los conceptos de voluntad e intelecto al interior del pensamiento de Tomás de Aquino y Duns Escoto, con el fin de identificar los puntos de encuentro y desencuentro entre ambos autores. Materiales y métodos: este análisis hace parte de una investigación cualitativa con enfoque hermenéutico, que empleó como instrumento de interpretación la revisión documental. Resultados: se logró establecer que la diferencia principal entre el pensamiento de ambos autores se refiere a la primacía que una potencia tiene sobre la otra: en Tomás de Aquino prima el intelecto sobre el deseo, mientras que en Duns Escoto prima la voluntad sobre el intelecto. Conclusión: para efectos de la prevalencia de una potencia sobre la otra, juegan un papel fundamental asuntos como el libre albedrío y, sobre todo, la forma en que ambas potencias actúan en la psique del hombre al momento de la toma de decisiones.

Abstract Introduction: The Will and the Intellect, two fundamental powers that work in the spirit of men, determining in one way or another their choices, have been developed and understood in different ways by different philosophers throughout history, among them, the medieval philosophers St. Thomas Aquinas and John Duns Scotus, whose thinking on these matters is analyzed in this article, from references such as the "Theological Summa" of Aquinas, "Giovanni" of Duns Scoto, "A bibliographical introduction" by Todescan, and" The life of the spirit" by Arendt, among others. Objective: The objective of this article is to analyze the concepts of Will and Intellect within the thought of Thomas Aquinas and Duns Scotus, in order to identify the points of encounter and disagreement between both authors. Material and methods: This analysis is part of a qualitative research with a hermeneutic approach, which used documentary review as an instrument of interpretation. Results: It was established that the main difference between the thinking of both authors, refers to the primacy that one power has over the other: in Thomas Aquinas the intellect over desire, while in Duns Scotus the will prevails over the intellect. Conclusions. For the effects of the prevalence of one power over the other, issues such as free will play a fundamental role and, above all, the way in which both powers act in the psyche of man at the moment of decision making.

Resumo Introdução: Vontade e Intelecto, dois poderes fundamentais que operam no espírito dos homens, determinando de uma maneira ou de outra suas escolhas, foram desenvolvidos e compreendidos de diferentes maneiras por diferentes filósofos ao longo da história, entre eles, os filósofos medievais Santo Tomás de Aquino e João Duns Scotus, cujo pensamento sobre essas questões é analisado neste artigo, a partir de referências como a "Summa Teologico" de Aquino, "Giovanni" de Duns Scoto, "Uma introdução bibliográfica" de Todescan, e "A Vida do Espírito" de Arendt, entre outros. Objetivo: O objetivo deste artigo é analisar os conceitos de Vontade e Intelecto no pensamento de Tomás de Aquino e Duns Scotus, a fim de identificar os pontos de encontro e discordância entre os dois autores. Materiais e métodos: Esta análise é parte de uma pesquisa qualitativa com abordagem hermenêutica, que utilizou a revisão documental como instrumento de interpretação. Resultados: Foi estabelecido que a principal diferença entre os pensamentos de ambos autores refere-se à primazia que um poder tem sobre o outro: em Tomás de Aquino, o intelecto sobre o desejo, enquanto em Duns Scotus a vontade prevalece sobre o intelecto. Conclusões: Para os efeitos da prevalência de um poder sobre o outro, questões como o livre arbítrio jogan um papel fundamental e, sobretudo, o modo como ambos poderes atuam na psique do homem no momento da tomada de decisão.

MMR2 vaccination coverage and timeliness among children born in 2004 - 2009: a national survey in Saint Lucia, 2015 / Cobertura de vacunación y respeto de los plazos de la segunda dosis de la vacuna triple viral en los niños nacidos en el período 2004-2009: encuesta nacional realizada en Santa Lucía en el 2015 / Cobertura e momento oportuno de vacinação da segunda dose da vacina tríplice viral em crianças nascidas em 2004-2009: pesquisa nacional em Santa Lúcia, 2015

ABSTRACT Objectives To more accurately determine coverage and timeliness of the second dose of measles-mumps-rubella vaccine (MMR2), while identifying factors associated with low MMR2 vaccination uptake among children in Saint Lucia. Methods A survey was conducted in October - November 2015 targeting children born in 2004 - 2009. At 86 preschools and primary schools, two children from each grade were randomly selected, yielding an effective sample of 836 children. Health records were reviewed to assess vaccination coverage and timeliness. Parents and/or guardians and principals of all 86 schools were interviewed regarding knowledge, attitudes, and practices related to vaccination. Results Of 767 children included, 75% were vaccinated with MMR2 (n = 572); 46.7% were vaccinated in a timely manner, i.e., by 5 years of age. Cohorts born in 2004, 2005, and 2008 reported the lowest proportion. 'Mothers as caregivers' was positively associated with timely MMR2 vaccination. Although 97% of principals surveyed considered vaccination important, 48.8% were not aware of national legislation requiring complete vaccination prior to school entry. Survey results concurred with the low MMR2 administrative coverage rates reported by Saint Lucia, much lower than the recommended 95%. Conclusions Based on the results of this survey, Saint Lucia's national immunization program has lowered the age of MMR2 to 18 months in 2016, increased advocacy with schools to enforce the school-entry law, and is working to vaccinate the cohorts of children who have not received timely MMR2.

RESUMEN Objetivos Determinar con mayor precisión la cobertura y el respeto de los plazos de vacunación de la segunda dosis de la vacuna contra el sarampión, la rubéola y la parotiditis (triple viral), al tiempo que se detectan los factores asociados con la baja aceptación de esa vacuna en Santa Lucía. Métodos En octubre y noviembre del 2015 se llevó a cabo una encuesta centrada en niños nacidos entre el 2004 y el 2009. En 86 centros preescolares y primarios se seleccionó al azar a dos niños de cada grado, lo que arrojó un tamaño real de la muestra de 836 niños. Se analizaron los registros de salud para evaluar la cobertura y el respeto de los plazos de vacunación. Se entrevistó a los padres o tutores y los directores de las 86 escuelas sobre conocimientos, actitudes y prácticas en materia de vacunación. Resultados De los 767 niños incluidos, el 75% fueron vacunados con la segunda dosis de la triple viral (n = 572); el 46,7% fueron vacunados a tiempo, es decir, a los 5 años de edad. La proporción más baja se dio en las cohortes nacidas en el 2004, 2005 y 2008. Se observó que las madres cuidadoras influían positivamente en el respeto de los plazos de vacunación de la segunda dosis de la triple viral. Aunque el 97% de los directores encuestados consideraba que la vacunación era importante, el 48,8% desconocía la legislación nacional que exige la vacunación completa antes de ingresar a la escuela. Los resultados de la encuesta estaban en consonancia con las tasas bajas de cobertura administrativa de la segunda dosis de la triple viral informadas por Santa Lucía, muy por debajo del 95% recomendado. Conclusiones Según los resultados de esta encuesta, el programa nacional de vacunación de Santa Lucía redujo la edad de la segunda dosis de la triple viral a los 18 meses en el 2016, aumentó las actividades de promoción en las escuelas para fomentar el cumplimiento de la ley que obliga a recibir la vacunación antes de ingresar a la escuela y está trabajando para vacunar a las cohortes de niños que no recibieron la segunda dosis de la triple viral en su debido momento.

RESUMO Objetivos Determinar com precisão a cobertura vacinal e o momento oportuno para ministrar a segunda dose da vacina tríplice viral (sarampo, caxumba e rubéola - SCR) e identificar os fatores associados à baixa utilização da vacina em crianças. Métodos Uma pesquisa direcionada a crianças nascidas de 2004 a 2009 foi realizada em Santa Lúcia em outubro e novembro de 2015. Em 86 unidades de ensino infantil e fundamental, duas crianças de cada série foram selecionadas aleatoriamente, constituindo uma amostra efetiva de 836 crianças. Dados sobre a cobertura e o momento oportuno de vacinação foram obtidos das fichas de saúde. Foram conduzidas entrevistas com os pais e/ou responsáveis e os diretores das 86 escolas sobre conhecimento, atitudes e práticas relacionadas à vacinação. Resultados Das 767 crianças incluídas na amostra, 75% foram vacinadas com a segunda dose de SCR (n = 572) e 46,7% receberam a vacina no momento oportuno (ou seja, até os 5 anos de idade). Observou-se menor proporção de vacinados nas coortes nascidas em 2004, 2005 e 2008. "Mães como cuidadoras" teve uma associação positiva com ministrar a segunda dose de SCR no momento oportuno. Apesar de 97% dos diretores entrevistados considerarem a vacinação importante, 48,8% desconheciam a legislação nacional que exige vacinação completa para a matrícula escolar. Os resultados reforçaram a baixa cobertura vacinal da segunda dose de SCR registrada em Santa Lúcia, bem inferior ao índice recomendado de 95%. Conclusões A partir dos resultados desta pesquisa, em 2016, o programa nacional de vacinação de Santa Lúcia reduziu para 18 meses a idade de administração da segunda dose de SCR, intensificou a recomendação para que as escolas cumpram com a legislação para matrícula escolar e está empenhado em vacinar as coortes de crianças que não receberam a segunda dose de SCR no momento oportuno.

Del filósofo al santo: consideraciones acerca del goce en el reverso del psicoanálisis / From the philosopher to the saint: Reflection on enjoyment in the other side of psychoanalysis

En este trabajo nos proponemos realizar una caracterización del concepto de goce en El reverso del psicoanálisis. Principalmente, nos centraremos en ubicar las coordenadas del goce en relación con el discurso del amo y al discurso del analista. Para estos fines, en un primer momento, presentaremos a Foucault como antecedente histórico de los desarrollos lacanianos en El reverso del psicoanálisis. En un segundo momento, expondremos la escritura de los cuatros discursos. En un tercer momento, analizaremos las relaciones entre significante y goce para mostrar las consecuencias que acarrean para los conceptos de saber y verdad. Este recorrido nos llevará a detenernos en la figura del filósofo -ilustrada por el Sócrates de Platón- como funcional al discurso del amo. En cuarto momento, intentaremos mostrar que la proximidad del analista respecto al santo lo aleja de la perversión. Finalmente, haremos un balance de los puntos más importantes de nuestro recorrido.

In this work we propose to make a presentation of the concept of enjoyment in The Other Side of Psychoanalysis. Mainly, we will focus on locating the enjoyment in relation to the Master's discourse and the Analyst's discourse. For these purposes, first, we will present Foucault as a historical antecedent of the Lacanian´s developments in The Other Side of Psychoanalysis. Second, we will present the four discourses writing. Third, we will analyze the relations between signifier and enjoyment to show the implications that they have for the concepts of knowledge and truth. This journey will take us to stop in the figure of the philosopher ­paradigmatically in Plato´s Socrates- as functional to the Master´s discourse. Fourth, we will try to show that the figure of the analyst implies placing himself in the position of the saint, that is, as a waste of enjoyment. Finally, we will sum up the most important points of our theoretical considerations.

San Valentín: patrón de los enamorados y epilepsia / Saint Valentine: Patron of lovers and epilepsy

St. Valentine of Terni a third-century Roman saint was known as the patron saint of lovers. He had the reputation of healing the sick and is said to have restored the sight of Julia the daughter of Asterius his jailer. Valentine had been imprisoned for secretly marrying couples disobeying the edict of roman Emperor Claudius II. The edict forbade roman soldiers to marry for it was thought marriage would diminish their efficiency in the battlefield. Asterius converted to Christianity after his daughter was healed. Valentine and Asterius were beheaded by order of Emperor Claudius II. Before his execution on February 14, 271 AD. Valentine wrote a love letter to Julia signed "from your Valentine" giving rise to the celebration of St. Valentine's Day. But St. Valentine's role as the patron saint of epilepsy is less widely known, for epilepsy was defined as an incurable disease thought of as a supernatural event such as a curse or a possession by an evil spirit. Since there was no cure for epilepsy healing was only possible by divine intervention and saints were called upon to intercede for these patients. While Valentine is widely known as the patron of lovers, very few people know he also was helpful and beneficent to people with epilepsy in ancient times.

San Valentín de Terni, un santo romano del siglo tercero, fue conocido como el patrono de los enamorados. Se dice que tenía el don de curar y sanó la ceguera de Julia la hija de Asterio, su carcelero. Valentín había sido encarcelado por celebrar matrimonios en secreto desobedeciendo el edicto promulgado por el emperador romano Claudio II. El edicto prohibía que los soldados romanos se casaran porque se pensaba que el vínculo del matrimonio disminuía su eficacia en el campo de batalla. Asterio adoptó la fe cristiana después de la curación de su hija. Valentín y Asterio fueron decapitados por orden de Claudio. Antes de su ejecución el 14 de febrero del an˜ o 271 a. C. le escribió una carta de amor a Julia en la que firmó «de tu Valentín¼ y dio origen a la celebración del Día de San Valentín. Pero el papel como patrono de la epilepsia es menos conocido, pues era definida como una enfermedad incurable asociada con eventos sobrenaturales como una maldición o a la posesión por un espíritu maligno. Puesto que no existía una curación, la única alternativa con que contaban quienes sufrían epilepsia era una intervención divina y se les pedía a los santos que intercedieran por ellos. Mientras que se conoce ampliamente a Valentín como el patrono de los enamorados, muy pocos saben, que también ayudó y benefició a los pacientes epilépticos en la antigüedad

Knowledge of and attitudes toward heel prick screening for sickle cell disease in Saint Lucia / Conocimiento y actitudes hacia la prueba del talón para la detección de la anemia de células falciformes en Santa Lucía / Conhecimento e atitudes em relação ao “teste do pezinho” para triagem de doença falciforme em Santa Lúcia

ABSTRACT Objectives In the Caribbean country of Saint Lucia, umbilical-cord-blood screening for sickle cell disease (SCD) was the testing method that health care workers (HCWs) on the maternity wards of the hospitals preferred until the new heel prick (HP) testing method was introduced in the country in 2014. This SCD study sought to assess HCWs’ knowledge of and attitude toward HP screening and also determine new mothers’ favorability toward HP screening. Methods A total of 70 HCWs and 132 new mothers answered survey questionnaires in three hospitals. In addition, four focus group discussions were held, two with HCWs and two with the mothers. Results Among the HCWs interviewed, 85.7% of them had knowledge of the HP test. However, only 25.7% had attended training sessions on the procedure. Among the HCWs, 64.3% of them felt the HP test should be mandatory, 27.1% said it should not be mandatory, and 8.6% did not know if it should be mandatory. In their focus groups, the HCWs said they believed the mothers would accept the HP method. For their part, 22.0% of the mothers said they had heard about the HP test, and 63.6% reported knowing the reason why the baby would be tested. Further, 83.3% indicated that the test would be beneficial for the baby. In addition, 88.6% of the mothers said that more information on the HP test was needed. In their focus group discussions, the mothers said they were generally not concerned about the pain the heel prick method might cause the baby. Conclusions The HCWs’ knowledge of the HP screening method was high. The mothers trust HCWs, and the mothers would accept the HP procedure irrespective of their knowledge of the test and any discomfort associated with this screening method.

RESUMEN Objetivo En el país caribeño de Santa Lucía, el hemocribado del cordón umbilical para la detección de la anemia de células falciformes o drepanocitosis era el método de tamizaje preferido por el personal de salud en las salas de maternidad de los hospitales hasta que se introdujo la nueva prueba del talón en el 2014. Este estudio sobre la anemia de células falciformes tuvo por objetivo evaluar el conocimiento y las actitudes del personal de salud hacia la prueba del talón, así como determinar si las madres tenían una actitud favorable hacia este método de tamizaje. Método Un total de 70 trabajadores de salud y 132 madres participaron en los cuestionarios realizados en tres hospitales. Además, se celebraron cuatro grupos de debate: dos con el personal de salud y dos con las madres. Resultados Del personal de salud entrevistado, 85,7% tenía conocimientos acerca de la prueba del talón. Sin embargo, únicamente 25,7% había asistido a sesiones de capacitación sobre el procedimiento. Además, 64,3% del personal de salud opinaba que la prueba debía ser obligatoria, 27,1% afirmaba que no debía ser obligatoria y 8,6% manifestó que no lo sabía. En los grupos de debate, el personal de salud manifestó su creencia de que las madres aceptarían este método de tamizaje. Por su parte, 22,0% de las madres afirmaron conocer la prueba del talón y 63,6% manifestó conocer los motivos por los que se sometería al bebé a dicha prueba. Asimismo, 83,3% de las madres señaló que la prueba sería beneficiosa para el bebé. Además, 88,6% de las madres indicó que era necesaria más información sobre la prueba del talón. En sus grupos de debate, las madres expresaron que, por lo general, no les preocupaba el dolor que pudiese suponer para el bebé la prueba del pinchazo en el talón. Conclusiones El personal de salud tiene un nivel alto de conocimiento acerca de la prueba del talón. Las madres confían en el personal de salud, y aceptarían este procedimiento independientemente de sus conocimientos sobre la prueba y cualquier malestar asociado a este método de tamizaje.

RESUMO Objetivos No país caribenho de Santa Lúcia, o exame de sangue de cordão umbilical para detecção da doença falciforme (DF) era o método de triagem preferido pelos profissionais da saúde atuantes em maternidades, até a introdução do “teste do pezinho” (TP) no país em 2014. Este estudo sobre DF buscou avaliar o conhecimento e atitudes de profissionais da saúde em relação à triagem pelo TP e também determinar a favorabilidade das novas mães em direção à triagem de TP. Métodos Setenta profissionais da saúde e 132 novas mães responderam a questionários de pesquisa em três hospitais. Além disso, foram realizadas quatro discussões com grupos focais: dois de profissionais da saúde e dois de mães. Resultados Entre os profissionais da saúde entrevistados, 85,7% tinham conhecimento acerca do TP. Porém, somente 25,7% haviam comparecido às sessões de capacitação sobre o procedimento. Entre os profissionais da saúde, 64,3% opinaram que o TP deveria ser obrigatório, 27,1% disseram que não deveria ser obrigatório e 8,6% não sabiam se deveria ser obrigatório. Em seus grupos focais, os profissionais da saúde disseram acreditar que as mães aceitariam o método do TP. Por sua vez, 22,0% das mães disseram ter ouvido falar sobre o TP, e 63,6% relataram saber o motivo pelo qual o exame seria realizado; ademais, 83,3% indicaram que o exame seria benéfico para o bebê. Além disso, 88,6% das mães disseram que precisavam de maiores informações sobre o TP. Em seus grupos focais, as mães disseram que, em geral, não estavam preocupadas com dor que o teste do pezinho poderia causar ao bebê. Conclusões Os profissionais da saúde apresentaram alto nível de conhecimento acerca do método de triagem pelo TP. As mães confiam nos profissionais da saúde, e aceitariam o procedimento de TP independentemente de seu conhecimento acerca do teste e de qualquer desconforto associado a este método de triagem.

Aula magistral: frei jaboatão e a exaltação da cor parda na festa do beato gonçalo garcia no recife setecentista / Master class: friar jaboatão and the exaltation of brown color in the party of beatified gonçalo garcia in the eighteenth-century recife / Master class: friar jaboatão and the exaltation of brown color in the party of beatified gonçalo garcia in the eighteenth-century recife

RESUMO: A grande festa de entronização da imagem do Bem-aventurado Gonçalo Garcia, na Igreja da Irmandade da Senhora do Livramento dos Homens Pardos, no Recife setecentista, é acontecimento notável para nosso intento: interpretar significados e efeitos das ações político-pedagógicas populares dos franciscanos, no Brasil Colonial. Entre os mais diversos eventos acontecidos durante os muitos dias de festa, havemos de destacar o sermão de Frei Antônio de Santa Maria Jaboatão, proferido no citado templo dos pardos da Senhora do Livramento, em 1745. Ante a polêmica que disputava a possibilidade de um santo ter a cor da pele parda, Jaboatão exalta não o Santo, mas a cor parda do Pardo Santo. Toma partido em defesa da gente parda, cada vez mais numerosa, na sociedade colonial escravista. A partir da utopia franciscana, defende posição avançada sobre os benefícios da mestiçagem para um futuro mais promissor do Brasil e da humanidade. Verdadeira aula magistral!

ABSTRACT: The large party of image enthronement of Blessed Gonçalo Garcia, in the Church of Irmandade da Senhora do Livramento dos Homens Pardos, in the eighteenth-century Recife, is a remarkable event for our purpose: the comprehension of the meanings and effects of Franciscans popular political-pedagogical actions in Colonial Brazil. Among the many events that happened during the celebration days, we will highlight the sermon pronounced by Friar Antônio de Santa Maria Jaboatão in the above quoted temple of brown people, in 1745. Beyond the controversy about the possibility if a saint has a brown color skin, Jaboatão does not exalt the Saint, but the brown color instead. He engages in defense of brown people, much ever more numerous in the colonial slave society. From the Franciscan utopia, he defends advanced position on the benefits of crossbreeding for a promising future of Brazil and the humanity. A real master class!

Evidencia serológica de circulación del virus de la encefalitis de San Luis en aves de la Ciudad Autónoma de Buenos Aires, Argentina / Serological evidence of St. Louis encephalitis virus circulation in birds from Buenos Aires City, Argentina

Nuestro objetivo fue conocer la presencia de anticuerpos neutralizantes contra el virus de la encefalitis de San Luis (St. Louis encephalitis virus [SLEV]) y el virus del Nilo Occidental (West Nile virus [WNV]) en sueros de aves silvestres y domésticas de la Ciudad Autónoma de Buenos Aires, Argentina. Desde octubre del 2012 hasta abril del 2013 se colectaron 180 muestras que fueron procesadas por la técnica de microneutralización. El 7,2% de las aves muestreadas resultaron seropositivas para SLEV, mientras que no se detectaron aves seropositivas para WNV

Our goal was to determine the presence of neutralizing antibodies against St. Louis encephalitis virus (SLEV) and West Nile virus (WNV) in sera of wild and domestic birds from Buenos Aires City, Argentina. From October 2012 to April 2013, 180 samples were collected and processed by the microneutralization technique. A 7.2 % of the sampled birds were seropositive for SLEV, while no seropositive birds for WNV were detected

THE ENDANGERED SPECIES Aristelliger georgeensis (SQUAMATA: SPHAERODACTYLIDAE) IN RONCADOR CAY, COLOMBIAN CARIBBEAN / La especie amenazada Aristelliger georgeensis (Squamata: Sphaerodactylidae) en el Cayo Roncador, Caribe colombiano

Aristelliger georgeensis, previously known to occur in the Yucatan peninsula (Mexico), the coasts and islands from Belize and Honduras, and the oceanic islands of Colombia in the Caribbean (San Andres, Providence and Saint Catalina) was registered for the first time in Roncador Cay, a flat and small island of coralline origin, located in the southwest of the Caribbean. Being considered as an endangered species at the national level, the new locality for this gecko constitutes an opportunity for its conservation. Some topics regarding the possible origins of this new population are discussed. This new locality represents the eastern most documented record of this species so far.

Aristelliger georgeensis, previamente conocido de la península de Yucatán (México), las costas e islas de Belice y Honduras y de las islas oceánicas de Colombia en el Caribe (San Andrés, Providencia y Santa Catalina), fue registrado por primera vez en el Cayo Roncador, una isla plana y pequeña de origen coralino, ubicada en el suroccidente del Caribe. Siendo considerada como una especie amenazada a nivel nacional, la nueva localidad para este geco constituye una oportunidad para su conservación. Se discuten algunos tópicos relacionados con el posible origen de esta nueva población. Esta nueva localidad representa el registro documentado más al Este para la especie.

Molecular identification of Saint Louis encephalitis virus genotype IV in Colombia

Saint Louis encephalitis virus (SLEV) is a member of the Japanese-encephalitis virus serocomplex of the genus Flavivirus. SLEV is broadly distributed in the Americas and the Caribbean Islands, where it is usually transmitted by mosquitoes of the genus Culex and primarily to birds and mammalian-hosts. Humans are occasionally infected by the virus and are dead-end hosts. SLEV causes encephalitis in temperate regions, while in tropical regions of the Americas, several human cases and a wide biological diversity of SLEV-strains have been reported. The phylogenetic analysis of the envelope (E) protein genes indicated eight-genotypes of SLEV with geographic overlap. The present paper describes the genotyping of two SLEV viruses detected in mosquito-pools collected in northern Colombia (department of Cordoba). We used reverse transcription-polymerase chain reaction to amplify a fragment of theE-gene to confirm the virus identity and completeE-gene sequencing for phylogenetic analysis and genotyping of the two-SLEV viruses found circulating in Córdoba. This is the first report of SLEV genotype IV in Colombia (Córdoba) in mosquitoes from a region of human inhabitation, implicating the risk of human disease due to SLEV infection. Physicians should consider SLEV as a possible aetiology for undiagnosed febrile and neurologic syndromes among their patients who report exposure to mosquito-bites.

La colaboración cubana y el problema de la insuficiencia renal crónica en Santa Lucía: una experiencia internacionalista / Cuban Cooperation and the Problem of Chronic Renal Failure in Saint Lucia: an International Cooperation Experience

El internacionalismo, como valor social, constituye uno de los rasgos esenciales que ha caracterizado a la salud pública cubana desde el triunfo de la Revolución. En noviembre de 2005 se inició la colaboración cubana en materia de salud a la atención de pacientes con insuficiencia renal crónica en Santa Lucía, enfermedad que constituye un importante problema de salud en ese país del Caribe. El objetivo de este artículo está dirigido a destacar el rol de la colaboración cubana en la asistencia al problema de la insuficiencia renal crónica en Santa Lucía, a partir de la realización de diversas intervenciones bien definidas, con énfasis en el impacto de dicha cooperación en la Unidad Renal del Hospital Victoria.

Internationalism, as a social value, is one of the essential characteristics of Cuban public health since the triumph of the Revolution. In November 2005, Cuban medical cooperation in the care of patients with chronic renal failure began in Saint Lucia. This disease constitutes a major health problem in the Caribbean nation. The aim of this article is to highlight the role of Cuban cooperation in assisting chronic renal failure patients in Santa Lucia through various well-defined interventions, emphasizing on the impact of such cooperation in the Renal Unit of the Victoria Hospital.

Detección molecular de virus de encefalitis de Saint Louis en mosquitos de Buenos Aires, Argentina

Durante el mes de marzo de 2013 una población de palomas torcazas (Zenaida auriculata) se instaló en una zona céntrica de la ciudad de Buenos Aires. Conociendo el rol que poseen estas aves como hospedadores competentes del virus de la encefalitis de Saint Louis (SLEV), fue colocada en el lugar una trampa de luz tipo CDC, a fin de realizar una vigilancia entomológica. Durante ese mes,fueron capturados 5 grupos de mosquitos (n = 48), 3 correspondieron a la especie Culex pipiens (n = 10) y 2 a Culex spp.(n = 38), no pudiéndose determinar en estos últimos con precisión la especie por encontrarse dañados. En un grupo de mosquitos Culex spp. se detectó el SLEV por técnicas moleculares. Posteriormente fue secuenciado y clasificado como perteneciente al genotipo III.

During March 2013 a population of eared doves (Zenaida auriculata) was established in the center of City of Buenos Aires. Considering the role of these birds as host competent for Saint Louis encephalitis virus (SLEV), a CDC light trap was put in place to perform entomologic surveillance. During this month 5 pools of mosquitoes (n = 48) were collected and taxonomically determined. Three of them were classified as Culex pipiens (n = 10) and the other two were Culex spp. (n = 38). In this case, the mosquitoes species could not be determined due to that individuals were damaged. One of the Culex spp. pool was found to be positive for Saint Louis encephalitis virus by molecular techniques. This was then sequenced and classified as genotype III.

A Saint Louis encephalitis and Rocio virus serosurvey in Brazilian horses

Introduction Arboviruses are an important public health problem in Brazil, in especially flaviviruses, including the Saint Louis encephalitis virus (SLEV) and the Rocio virus (ROCV), are especially problematic. These viruses are transmitted to humans or other vertebrates through arthropod bites and may cause diseases with clinical manifestations that range from asymptomatic infection, viral hemorrhagic fever to encephalitis. Methods A serological survey of horses from various regions of Brazil using an enzyme-linked immunosorbent assay (ELISA) with recombinant SLEV domain III peptides and ROCV E protein as antigens. Results Overall, 415 (55.1%) of the 753 horses that were screened were seropositive for flavivirus and, among them, monotypic reactions were observed to SLEV in 93 (12.3%) and to ROCV in 46 (6.1%). These results suggested that these viruses, or other closely related viruses, are infecting horses in Brazil. However, none of the studied horses presented central nervous system infection symptoms. Conclusions Our results suggest that SLEV and ROCV previously circulated among horses in northeast, west-central and southeast Brazil. .

Serological evidence for Saint Louis encephalitis virus in free-ranging New World monkeys and horses within the upper Paraná River basin region, Southern Brazil

Introduction Saint Louis encephalitis virus (SLEV) primarily occurs in the Americas and produces disease predominantly in humans. This study investigated the serological presence of SLEV in nonhuman primates and horses from southern Brazil. Methods From June 2004 to December 2005, sera from 133 monkeys (Alouatta caraya, n=43; Sapajus nigritus, n=64; Sapajus cay, n=26) trap-captured at the Paraná River basin region and 23 blood samples from farm horses were obtained and used for the serological detection of a panel of 19 arboviruses. All samples were analyzed in a hemagglutination inhibition (HI) assay; positive monkey samples were confirmed in a mouse neutralization test (MNT). Additionally, all blood samples were inoculated into C6/36 cell culture for viral isolation. Results Positive seroreactivity was only observed for SLEV. A prevalence of SLEV antibodies in sera was detected in Alouatta caraya (11.6%; 5/43), Sapajus nigritus (12.5%; 8/64), and S. cay (30.8%; 8/26) monkeys with the HI assay. Of the monkeys, 2.3% (1/42) of A. caraya, 6.3% 94/64) of S. nigritus, and 15.4% (4/26) of S. cay were positive for SLEV in the MNT. Additionally, SLEV antibodies were detected by HI in 39.1% (9/23) of the horses evaluated in this study. Arboviruses were not isolated from any blood sample. Conclusions These results confirmed the presence of SLEV in nonhuman primates and horses from southern Brazil. These findings most likely represent the first detection of this virus in nonhuman primates beyond the Amazon region. The detection of SLEV in animals within a geographical region distant from the Amazon basin suggests that there may be widespread and undiagnosed dissemination of this disease in Brazil. .