Impact of Nonpharmaceutical Interventions during the COVID-19 Pandemic on the Prevalence of Respiratory Syncytial Virus in Hospitalized Children with Lower Respiratory Tract Infections: A Systematic Review and Meta-Analysis.

During the COVID-19 pandemic, nonpharmaceutical interventions (NPIs) were implemented in order to control the transmission of SARS-CoV-2, potentially affecting the prevalence of respiratory syncytial virus (RSV). This review evaluated the impact of NPIs on RSV-related hospitalizations in children during the lockdown (2020-2021) compared to the pre-pandemic (2015-2020) and post-lockdown (2021-2022) periods. In this systematic review and meta-analysis, we searched through PubMed, Scopus, and Web of Science for studies published in English between 1 January 2015 and 31 December 2022. Additionally, we conducted hand searches of other records published between 1 January 2023 and 22 January 2024. Our target population was hospitalized children aged 0-18 years with RSV-related lower respiratory tract infections confirmed through immunofluorescence, antigen testing, or molecular assays. We focused on peer-reviewed observational studies, analyzing the primary outcome of pooled RSV prevalence. A generalized linear mixed model with a random-effects model was utilized to pool each RSV prevalence. Heterogeneity was assessed using Cochran's Q and I2 statistics, while publication bias was evaluated through funnel plots and Egger's tests. We identified and analyzed 5815 publications and included 112 studies with 308,985 participants. Notably, RSV prevalence was significantly lower during the lockdown period (5.03% [95% CI: 2.67; 9.28]) than during the pre-pandemic period (25.60% [95% CI: 22.57; 28.88], p < 0.0001). However, RSV prevalence increased notably in the post-lockdown period after the relaxation of COVID-19 prevention measures (42.02% [95% CI: 31.49; 53.33] vs. 5.03% [95% CI: 2.67; 9.28], p < 0.0001). Most pooled effect estimates exhibited significant heterogeneity (I2: 91.2% to 99.3%). Our findings emphasize the effectiveness of NPIs in reducing RSV transmission. NPIs should be considered significant public health measures to address RSV outbreaks.

Global Extension and Predominance of Human Metapneumovirus A2 Genotype with Partial G Gene Duplication.

Human metapneumovirus (HMPV) is an important respiratory pathogen and is divided in two main groups (A and B). HMPV strains with partial duplications (111-nt and 180-nt duplication) of the G gene have been reported in recent years. Since the initial reports, viruses with these characteristics have been reported in several countries. We analyzed all complete HMPV G gene ectodomain sequences available at GenBank to determine if viruses with 111-nt or 180-nt duplication have become the leading HMPV strains worldwide, and to describe their temporal and geographic distribution. We identified 1462 sequences that fulfilled study criteria (764 HMPV A and 698 HMPV B) reported from 37 countries. The most frequent HMPV A genotype was A2b2 (n = 366), and the most frequent B genotype was B2 (n = 374). A total of 84 sequences contained the 111-nt duplication, and 90 sequences contained the 180-nt duplication. Since 2016, viruses with a partial duplication comprise the most frequent HMPV A sequences globally and have displaced other HMPV A viruses in Asia, Europe, and South America; no sequences of viruses with partial duplication have been reported in North America or Africa so far. Continued surveillance of HMPV is required to identify the emergence and spread of epidemiologically relevant variants.

Global distribution of respiratory syncytial virus A and B infections: a systematic review.

Respiratory syncytial virus (RSV) is the main cause of severe respiratory infections in young children. The need for global epidemiologic data regarding RSV has been increasingly recognized. RSV A infections are reported more frequently than RSV B. Nonetheless, the temporal distribution of infections caused by both RSV groups has not been investigated globally. A systematic review was carried out regarding published studies on RSV A and B epidemiology, as well as RSV G gene ectodomain sequence data available at GenBank. A total of 76,668 [45,990 (60%) RSV A and 30,678 (40%) RSV B] positive samples from 83 countries were identified and included in the analysis. Genotype assignment was obtained in 5,340 RSV A and 2,518 RSV B sequences. Two patterns of RSV circulation were observed: continuous seasons with RSV A predominance and alternate predominance of RSV A and B. These patterns were observed in all regions, but the predominant RSV group seldom coincided in all continents during a given year or season. The most frequently identified RSV A genotype was NA1 (including ON1 viruses) (76.30%), and the most frequently identified RSV B genotype was BA (70.65%). Multiple genotypes circulated simultaneously throughout the evolutionary history of RSV, but genotype diversity decreased after the year 2000. The classification of RSV group and genotype is important for the development of vaccines, as well as to understand viral dynamics. This study displays the global and continental RSV circulation patterns from the first report of human RSV infection until the end of 2020.

Ectyoplasin, a novel cytotoxic cyclic peptide from Ectyoplasia ferox sponge.

A new cyclic heptapeptide, ectyoplasin (1), was isolated from a methanol extract of the sponge Ectyoplasia ferox. The planar structure of 1, cyclo(-Leu1-Asn2-Ala3-Val4-Thr5-Pro6-Gly7-), was determined by one and two-dimensional NMR spectroscopy and high-resolution tandem mass spectrometry. Its absolute stereochemistry was solved by Marfey's method. The in vitro assays show that ectyoplasin (1) possess significant cytotoxic activity (2.9 - 23.5 µM) against the cell lines, DU-145 (human prostate cancer), Jurkat (human T-cell acute leukaemia), MM144 (human multiple myeloma), HeLa (human cervical carcinoma) and CADO-ES1 (human Ewing's sarcoma). The DU-145 cell line showed apoptotic cell death in response to ectyoplasin (1) treatment.

Epidemiology of cutaneous and mucocutaneous leishmaniasis in Nicaragua.

Leishmaniasis is a major neglected tropical disease which contributes a huge economic burden on already meager economic resources. The World Health Organization (WHO) has estimated an annual incidence of 700,000--1,000,000 patients and about 20,000-30,000 deaths per year. Approximately 66,941 patients of cutaneous leishmaniasis are reported annually in the Americas. In recent years, Nicaragua has presented alarmingly high numbers of patients and elevated incidence rates. Unfortunately, there are no detailed spatial descriptions on the epidemiological situation of leishmaniasis in this country. The objective of this study is to present descriptive data about the epidemiology of leishmaniasis in Nicaragua in the context of the distribution of this neglected tropical disease (NTD) in the Americas. This paper also provides an epidemiological update on different forms of leishmaniasis found in the three administrative regions of Nicaragua and its municipalities. Health authorities from the Ministry of Health of Nicaragua (MINSA) provided the entomological and epidemiological information for the different forms of the disease from 2001 to 2018. Prevalence, incidence rates, clinical classification of disease, age groups, sex, and geographic distribution by municipality and department are described in this study. Approximately 90%-95% of the national patients corresponded to CL and 5-10% correspond to MCL. The disease is distributed in the three regions of the country, with a higher burden in the Departments of Jinotega, Matagalpa and Atlántico Norte. The municipalities with the highest proportion of patients were El Cuá (23.92%), Waslala (14.16), Santa Maria de Pantasma (9.62%), Rancho Grande (9.03%) and Siuna (7.67%). There is an expansion of spatial distribution of CL and MCL in the North Central and South Atlantic regions of the country. These results could inform interventional strategies to address the burden of leishmaniasis in Nicaragua, which would improve the likelihood of meeting the goals for the Leishmaniasis Plan of Action for the Americas.

Ciencia y evolución del dióxido de zirconio, de la prioridad mecánica a la necesidad estética / Science and evolution of zirconium dioxide, from mechanical priority to aesthetic need

RESUMEN En la actualidad, los procedimientos de alta tecnología enfocados a las restauraciones en base a cerámicas dentales han permitido la evolución y perfeccionamiento de distintas formas de manufactura de restauraciones, iniciándose así, la utilización de cerámicas como el dióxido de zirconio. Objetivo : Identificar las publicaciones recientes de los materiales de restauración a base de dióxido de zirconio que incluyan estudios clínicos, propiedades mecánicas, físicas y estéticas, así como su evolución, manufactura y diversas aplicaciones en la práctica clínica diaria. Material y métodos : La búsqueda sistemática de la literatura se realizará en las bases de datos de PubMed y Ebsco, se considerarán publicaciones del 2010- 2019 y que fueran investigaciones clínicas, laboratoriales y todas aquellas que mostraban la evolución en el tiempo del dióxido de zirconio, así como su aplicabilidad y diversificación. Resultados: Se revisaron 48 artículos que cumplieron con los criterios de selección para la revisión bibliográfica. Se encontró que todas las restauraciones protésicas a base de dióxido de zirconio, indistintamente a su forma de utilización, mostraron un desempeño clínico muy similar a los tres años, después de ese tiempo, dependerá del tipo de utilización, composición y elección del caso. Conclusiones: El éxito clínico de las restauraciones en base a dióxido de zirconio, es debido a las múltiples ventajas mecánicas y, con las recientes modificaciones estructurales, sumadas al agregado de aditivos para su estabilización, se perfila como un material idóneo para el trabajo tanto en zonas estéticas como en áreas de necesidad de soporte mecánico con carga funcional elevada.

SUMMARY At present, high-tech procedures focused on restorations based on dental ceramics have allowed the evolution and improvement of different forms of manufacturing restorations, thus initiating the use of ceramics such as zirconium dioxide. Objective: To identify recent publications of zirconium dioxide based restoration materials that include clinical studies, mechanical, physical and aesthetic properties, as well as their evolution, manufacturing and various applications in daily clinical practice. Materials and methods: The systematic search of the literature will be carried out in the databases of PubMed and Ebsco, publications from 2010-2019 will be considered and that they were clinical, laboratory research and all those that showed the evolution in time of zirconium dioxide , as well as its applicability and diversification. Results: 48 articles were reviewed that met the selection criteria for the literature review. It was found that all prosthetic restorations based on zirconium dioxide, regardless of their use, showed a clinical performance very similar to three years, after that time, will depend on the type of use, composition and choice of case. Conclusions: The clinical success of restorations based on zirconium dioxide is due to the multiple mechanical advantages and, with the recent structural modifications, added to the addition of additives for stabilization, is emerging as an ideal material for work both aesthetic areas as in areas of need for mechanical support with high functional load.

Contribuições do Programa Mais Médicos ao desempenho de equipes de Saúde da Família na atenção à hipertensão e ao diabetes no Brasil, 2012 a 2015

[RESUMO]. Objetivo. Comparar as tendências temporais de acesso e utilização de serviços para controle de hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) em equipes com e sem a participação de profissionais do Programa Mais Médicos (PMM). Métodos. Utilizou-se um delineamento analítico-descritivo, com comparação entre equipes participantes do PMM (intervenção) e não participantes, em uma abordagem quase-experimental em série temporal. Comparouse o desempenho de uma amostra de 30 000 equipes da Estratégia Saúde da Família em 2012 e 20 000 equipes em 2015. Os padrões nos dois grupos foram analisados pela técnica de diferença-em-diferença com estratificação por região geopolítica, porte populacional e perfil municipal. A média semestral de atendimentos foi estimada pela divisão do número total de consultas de DM e HAS realizadas por médicos e enfermeiros em determinada equipe de saúde pelo total de usuários com DM/HAS cadastrados no mesmo local e período. Uma média de consultas/usuário maior do que 14,2 para DM e 10,8 para HAS foi considerada como outlier, sendo as equipes com essas médias excluídas das análises. Resultados. A análise de diferença-em-diferença indicou melhor desempenho na oferta de consulta para DM (P < 0,001) e HAS (P < 0,001) entre as equipes com PMM em comparação àquelas sem o programa. O efeito foi mais pronunciado nas regiões Norte e Nordeste, em municípios com mais de 20% da população em extrema pobreza e em municípios de todos os portes populacionais. Conclusões. Os resultados mostram que o PMM amplia o acesso e a utilização dos serviços de saúde.

[ABSTRACT]. Objective. To compare temporal trends in access and utilization of systemic arterial hypertension (SAH) and diabetes mellitus (DM) services provided by teams with or without physicians from the More Doctors Program (PMM). Method. An analytical-descriptive design was used, with comparison of teams that joined the PMM (intervention) vs. non-participants, using a quasi-experimental time series approach. The study compared the performance of a sample of 30 000 Family Health Strategy teams in 2012 and 20 000 teams in 2015. The patterns in both groups were analyzed using the difference-in-difference technique with stratification according to geopolitical region, population size, and municipal profile. The mean number of consultations per semester was estimated by dividing the total number of DM and HAS consultations provided by physicians and nurses in a given health care team by the total number of users with DM/HAS registered in the same location and period. A mean number of consultations/user > 14.2 for DM and > 10.8 for HAS was considered as an outlier, and thus the teams with these means were excluded from the analyses. Results. The difference-in-difference analysis indicated better performance in the provision of DM (P < 0.001) and SAH (P < 0.001) services among PMM teams vs. non-PMM teams. The effect was more pronounced in the North and Northeast regions, in municipalities with more than 20% of the population living in extreme poverty, and in municipalities of all population sizes. Conclusions. The results show that the PMM increased access and utilization of health care services.

[RESUMEN]. Objetivo. Comparar las tendencias temporales del acceso y de la utilización de los servicios para el control de la hipertensión arterial sistémica (HAS) y la diabetes mellitus (DM) realizado por los equipos de salud de la familia que trabajan solos y por los que cuentan con la participación de profesionales del Programa Mais Médicos (PMM). Métodos. Se utilizó un diseño analítico y descriptivo, con comparación entre los equipos con participantes del PMM (intervención) y sin ellos, con un método cuasiexperimental de series temporales. Se comparó el desempeño de una muestra de 30 000 equipos que trabajaron dentro del marco de la estrategia de salud de la familia en el 2012 y de 20 000 equipos en el 2015. Se analizaron los patrones observados en ambos grupos con la técnica de doble diferencia con estratificación por zona geopolítica, tamaño de la población y perfil municipal. Se estimó la media semestral de casos atendidos con la división del número total de consultas por DM y HAS a cargo de médicos y miembros del personal de enfermería de un determinado equipo de salud por el total de usuarios con DM y HAS registrados en el mismo lugar y período. Se consideró que una media de consultas por DM por usuario mayor de 14,2 y por HAS mayor de 10,8 era un valor atípico y, por lo tanto, los equipos con esas medias se excluyeron de los análisis. Resultados. El análisis de doble diferencia indicó un mejor desempeño en la atención de consultas por DM (P < 0,001) y por HAS (P < 0,001) a cargo de los equipos con participantes del PMM en comparación con los que trabajaron sin ese programa. El efecto fue más pronunciado en las regiones norte y nordeste, en los municipios con más de 20% de la población en condiciones de extrema pobreza y en municipios de todos los tamaños de población. Conclusiones. Los resultados muestran que el PMM amplía el acceso y la utilización de los servicios de salud.

Studies on the bioactive flavonoids isolated from Azadirachta indica.

Two novel natural metabolites, 3-O-butyl-(-)-epicatechin (1) and 3-O-butyl-(-)-epigallocatechin (2), as well as several known substances, (-)-epicatechin (3), (+)-gallocatechin (4), (-)-epigallocatechin (5), azadirachtin A (6), trilinolein (7) and octadecanoic acid-tetrahydrofuran-3,4-diyl ester (8), were isolated from the bark of Azadirachta indica. The structures of all compounds were established by comprehensive and comparative spectroscopic analysis of NMR and ESI-HRMS data. The new metabolites 1 and 2 represent one of the few examples of natural compounds with a butyl ether group moiety. The acaricidal activity of the compounds was tested using a standard Shaw larval immersion assay. All the compounds, except 7, possess a LD50 value less than or equal to 7.2 mM.

Preventive Action of Sterculic Oil on Metabolic Syndrome Development on a Fructose-Induced Rat Model.

The metabolic syndrome (MS) underlies metabolic disorders considered risk factors for the development of diabetes and cardiovascular diseases, which are major causes of morbidity and mortality in most of the world. Sterculic acid has been proposed as a potential tool for the treatment of MS since it inhibits the activity of the stearoyl-CoA desaturase-1 (SCD1), a central enzyme in lipid metabolism. We analyzed the effect of sterculic oil (SO) co-administration with 30% fructose in drinking water on the development of MS in male Wistar rats. After 8 weeks, 0.4% SO exerted a protective effect from MS development since parameters altered by fructose (blood pressure, insulin resistance, serum glucose and triglycerides, steatosis, and adiposity) were similar to those of control rats.

Contribuições do Programa Mais Médicos ao desempenho de equipes de Saúde da Família na atenção à hipertensão e ao diabetes no Brasil, 2012 a 2015 / Contributions of the More Doctors Program to the performance of Family Health teams concerning hypertension and diabetes care in Brazil, 2012 to 2015 / Contribuciones del Programa Mais Médicos al desempeño de los equipos de salud de la familia en el cuidado de la hipertensión y la diabetes en Brasil, 2012-2015

Objetivo. Comparar as tendências temporais de acesso e utilização de serviços para controle de hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) em equipes com e sem a participação de profissionais do Programa Mais Médicos (PMM). Métodos. Utilizou-se um delineamento analítico-descritivo, com comparação entre equipes participantes do PMM (intervenção) e não participantes, em uma abordagem quase-experimental em série temporal. Comparouse o desempenho de uma amostra de 30 000 equipes da Estratégia Saúde da Família em 2012 e 20 000 equipes em 2015. Os padrões nos dois grupos foram analisados pela técnica de diferença-em-diferença com estratificação por região geopolítica, porte populacional e perfil municipal. A média semestral de atendimentos foi estimada pela divisão do número total de consultas de DM e HAS realizadas por médicos e enfermeiros em determinada equipe de saúde pelo total de usuários com DM/HAS cadastrados no mesmo local e período. Uma média de consultas/usuário maior do que 14,2 para DM e 10,8 para HAS foi considerada como outlier, sendo as equipes com essas médias excluídas das análises. Resultados. A análise de diferença-em-diferença indicou melhor desempenho na oferta de consulta para DM (P < 0,001) e HAS (P < 0,001) entre as equipes com PMM em comparação àquelas sem o programa. O efeito foi mais pronunciado nas regiões Norte e Nordeste, em municípios com mais de 20% da população em extrema pobreza e em municípios de todos os portes populacionais. Conclusões. Os resultados mostram que o PMM amplia o acesso e a utilização dos serviços de saúde.(AU)

Objective. To compare temporal trends in access and utilization of systemic arterial hypertension (SAH) and diabetes mellitus (DM) services provided by teams with or without physicians from the More Doctors Program (PMM). Method. An analytical-descriptive design was used, with comparison of teams that joined the PMM (intervention) vs. non-participants, using a quasi-experimental time series approach. The study compared the performance of a sample of 30 000 Family Health Strategy teams in 2012 and 20 000 teams in 2015. The patterns in both groups were analyzed using the difference-in-difference technique with stratification according to geopolitical region, population size, and municipal profile. The mean number of consultations per semester was estimated by dividing the total number of DM and HAS consultations provided by physicians and nurses in a given health care team by the total number of users with DM/HAS registered in the same location and period. A mean number of consultations/user > 14.2 for DM and > 10.8 for HAS was considered as an outlier, and thus the teams with these means were excluded from the analyses. Results. The difference-in-difference analysis indicated better performance in the provision of DM (P < 0.001) and SAH (P < 0.001) services among PMM teams vs. non-PMM teams. The effect was more pronounced in the North and Northeast regions, in municipalities with more than 20% of the population living in extreme poverty, and in municipalities of all population sizes. Conclusions. The results show that the PMM increased access and utilization of health care services.(AU)

Objetivo. Comparar las tendencias temporales del acceso y de la utilización de los servicios para el control de la hipertensión arterial sistémica (HAS) y la diabetes mellitus (DM) realizado por los equipos de salud de la familia que trabajan solos y por los que cuentan con la participación de profesionales del Programa Mais Médicos (PMM). Métodos. Se utilizó un diseño analítico y descriptivo, con comparación entre los equipos con participantes del PMM (intervención) y sin ellos, con un método cuasiexperimental de series temporales. Se comparó el desempeño de una muestra de 30 000 equipos que trabajaron dentro del marco de la estrategia de salud de la familia en el 2012 y de 20 000 equipos en el 2015. Se analizaron los patrones observados en ambos grupos con la técnica de doble diferencia con estratificación por zona geopolítica, tamaño de la población y perfil municipal. Se estimó la media semestral de casos atendidos con la división del número total de consultas por DM y HAS a cargo de médicos y miembros del personal de enfermería de un determinado equipo de salud por el total de usuarios con DM y HAS registrados en el mismo lugar y período. Se consideró que una media de consultas por DM por usuario mayor de 14,2 y por HAS mayor de 10,8 era un valor atípico y, por lo tanto, los equipos con esas medias se excluyeron de los análisis. Resultados. El análisis de doble diferencia indicó un mejor desempeño en la atención de consultas por DM (P < 0,001) y por HAS (P < 0,001) a cargo de los equipos con participantes del PMM en comparación con los que trabajaron sin ese programa. El efecto fue más pronunciado en las regiones norte y nordeste, en los municipios con más de 20% de la población en condiciones de extrema pobreza y en municipios de todos los tamaños de población. Conclusiones. Los resultados muestran que el PMM amplía el acceso y la utilización de los servicios de salud.(AU)

Post-pandemic influenza-associated mortality in Mexico.

Influenza is a leading cause of respiratory tract infections worldwide and there is limited information on the impact of the influenza A(H1N1)pdm virus on mortality after the 2009 pandemic. Using national mortality register data through 1998-2015 in Mexico, influenza-associated mortality was estimated for respiratory, cardiovascular, and all-cause events. The proportion of influenza-associated respiratory and cardiovascular deaths among different age groups were compared. There were 8,853,986 death registries included for the 1998-2015 winter seasons, average influenza-associated respiratory, cardiovascular, and all-cause mortality rates were 5.2, 6.3, and 19.6 deaths/100,000 population, respectively. The largest number of respiratory influenza-associated deaths occurred in adults 60 years of age and older, followed by children <5 years of age; during the 2009 pandemic, 2011-2012, and 2013-2014 winter seasons there was a larger number of deaths in the 20-59 years old group. Influenza-associated mortality rates showed a continuous reduction in children <5 years of age. After the 2009 pandemic, influenza A(H1N1)pdm09 virus-associated mortality in Mexico showed a persistent change in the demographic pattern of the most severely affected population, particularly during the 2013-2014 season. Influenza associated-mortality has decreased in children <5 years of age and continue to be elevated in adults >60 years of age.

Sclerin, a New Cytotoxic Cyclononapeptide from Annona scleroderma.

A new cytotoxic cyclononapeptide, sclerin, cyclo(⁻Dab¹â»Ser²â»Tyr³â»Gly4⁻Thr5⁻Val6⁻Ala7⁻ Ile8⁻Pro8⁻) (1), was isolated from the methanol extract of the seeds of Annona scleroderma, together with the known metabolite, cyclosenegalin A, cyclo(⁻Pro¹â»Gly²â»Leu³â»Ser4⁻Ala5⁻Val6⁻Thr7⁻) (2). The planar structures for the two compounds were established by comprehensive analysis of NMR and ESI-HRMS data, and the absolute stereochemistry was stablished by Marfey's method. Compound 1 showed moderate cytotoxic activity against the human prostate carcinoma cell line DU-145 at µM concentration.

Waste residues from Opuntia ficus indica for peroxidase-mediated preparation of phenolic dimeric compounds.

A methodology to detect peroxidase activity in Opuntia ficus indica cladodes waste extracts was performed and then used towards phenolic compounds. The extracts were able to dimerize three different molecules. Dimeric compounds were produced with yields ranging from 11% to 55%. The influence of H2O2 concentration was also tested, finding better yields when the peroxide-to-substrate ratio was 1:1. Some water-miscible solvents were used trying to increase overall yields, but no-significant positive results were found. In fact, one of them, THF, seemed to inhibit dimerization reaction. Hence, we have tested an alternative natural peroxidase source obtained from the wastes of a local highly-consumed vegetable and studied their enzymatic activity towards the preparation of biologically active, valuable compounds.

Qualidade da atenção primária à saúde no Brasil e associação com o Programa Mais Médicos

[RESUMO]. Objetivo. Avaliar a qualidade da atenção primária à saúde (APS) no Brasil e sua associação com o Programa Mais Médicos (PMM). Métodos. Este estudo transversal de abrangência nacional utilizou a ferramenta PCATool-Brasil para avaliar a qualidade da APS a partir da experiência dos usuários vinculados a três categorias de médicos: médicos brasileiros do PMM, médicos cubanos do PMM e médicos brasileiros não vinculados ao PMM. Os seguintes escores foram calculados: Escore Geral da APS, Escore de Acesso e Escore de Longitudinalidade. A associação entre o Escore Geral obtido, a categoria do médico e outras características dos usuários e dos profissionais foi investigada por análise multinível. Resultados. O Escore Geral da APS para o Brasil foi 6,78, e o Escore de Longitudinalidade, 7,43. Não houve diferença entre esses escores para as três categorias de médicos. O Escore de Acesso para o Brasil foi de 4,24, havendo diferença pequena, mas significativa (P-valor < 0,001), entre as categorias de médicos: médicos cubanos do PMM com 4,43 (IC: 4,32 a 4,54), médicos brasileiros do PMM com 4,08 (IC: 3,98 a 4,18) e médicos brasileiros não vinculados ao PMM com 4,20 (IC: 4,09 a 4,32). Na análise multinível, idade, estrato socioeconômico, presença de doenças crônicas e o fato de o médico realizar visita domiciliar influenciaram positivamente o Escore Geral. Conclusões. O tipo de médico não influenciou o grau de orientação aos atributos da APS (Escore Geral) no Brasil. O PMM associou-se a maiores Escores de Acesso em regiões de maior vulnerabilidade socioeconômica. Com a análise multinível, identificamos que o fortalecimento da APS também pode ser alcançado ao reforçar papéis fundamentais dos médicos que trabalham na APS (como as visitas domiciliares) e aprimorar o acesso das populações de maior vulnerabilidade socioeconômica e de pessoas mais jovens ou sem doenças crônicas.

[ABSTRACT]. Objective. To assess the performance of primary health care (PHC) in Brazil and its association with the More Doctors Program (Programa Mais Médicos, PMM). Method. This nationwide cross-sectional study used the Primary Care Assessment Tool validated for Brazilian Portuguese (PCATool-Brasil) to determine the achievement of PHC according to user experience associated with three physician categories: Brazilian physicians participating in the PMM, Cuban physicians participating in the PMM, and Brazilian physicians not linked to the PMM. The following PHC scores were calculated: overall PCA score, accessibility (first contact), and longitudinality. The association between PHC scores, physician category, and other user and physician characteristics was investigated using multilevel analysis. Results. The overall PCA score for Brazil was 6.78, and the longitudinality score was 7.43. There was no difference in these scores among the three physician categories. The overall accessibility score was 4.24. A small but significant difference (P < 0.001) in accessibility score was detected among physician categories: 4.43 for Cuban physicians participating in the PMM (CI: 4.32-4.54), 4.08 for Brazilian physicians participating in the PMM(CI: 3.98-4.18), and 4.20 for Brazilian physicians not linked to the PMM (CI: 4.09-4.32). Age, socioeconomic level, presence of chronic diseases, and home visits by physicians positively influenced the overall PCA score on multilevel analysis. Conclusions. The type of physician did not influence the primary care orientation (overall score) of the healthcare system in Brazil. PMM was associated with higher accessibility sores in more socioeconomically vulnerable areas. Multilevel analysis showed that PCH may be strengthened by the reinforcement of essential physician roles (such as home visits) and by improving access for socioeconomically vulnerable, younger populations or those without chronic diseases.

[RESUMEN]. Objetivo. Evaluar la calidad de la atención primaria de salud (APS) en Brasil y su relación con el Programa Más Médicos (PMM). Métodos. Estudio transversal de alcance nacional em el que se utilizó la herramienta PCATool-Brasil para evaluar la calidad de la APS a partir de la experiencia de los usuarios vinculados a tres categorías de médicos: médicos brasileños del PMM, médicos cubanos del PMM y médicos brasileños no vinculados al PMM. Se calcularon los siguientes puntajes: Puntaje general de APS, Puntaje de acceso y Puntaje de longitudinalidad. Se investigaron mediante análisis multinivel la asociación entre el Puntaje general obtenido, la categoría del médico y otras características de los usuarios y los profesionales. Resultados. El Puntaje general de APS para Brasil fue 6,78, y el Puntaje de longitudinalidad, 7,43. No hubo diferencia entre estos puntajes para las tres categorías de médicos. El Puntaje de acceso para Brasil fue de 4,24 y mostró una diferencia pequeña, pero significativa (p <0,001) entre las categorías de médicos: médicos cubanos del PMM 4,43 (IC: 4,32-4,54), médicos brasileños del PMM 4,08 (IC: 3,98-4,18) y médicos brasileños no vinculados al PMM 4,20 (IC: 4,09-4,32). En el análisis multinivel, la edad, el estrato socioeconómico, la presencia de enfermedades crónicas y el hecho de que el médico realizara visitas domiciliarias influyeron positivamente em el Puntaje general. Conclusiones. El tipo de médico no influyó en el grado de orientación a los atributos de la APS (Puntaje general) en Brasil. El PMM se asoció com mayores Puntajes de acceso en las regiones de mayor vulnerabilidad socioeconómica. Con el análisis multinivel se identificó que el fortalecimiento de la APS también puede ser alcanzado reforzando los roles fundamentales de los médicos que trabajan en la APS (como las visitas domiciliarias) y mejorando el acceso de las poblaciones de mayor vulnerabilidad socioeconómica y de las personas más jóvenes o sin enfermedades crónicas.

[Primary health care performance in Brazil and association with the More Doctors physician recruitment programCalidad de la atención primaria de salud en Brasil y relación con el Programa Más Médicos]. / Qualidade da atenção primária à saúde no Brasil e associação com o Programa Mais Médicos.

OBJECTIVE: To assess the performance of primary health care (PHC) in Brazil and its association with the More Doctors Program (Programa Mais Médicos, PMM). METHOD: This nationwide cross-sectional study used the Primary Care Assessment Tool validated for Brazilian Portuguese (PCATool-Brasil) to determine the achievement of PHC according to user experience associated with three physician categories: Brazilian physicians participating in the PMM, Cuban physicians participating in the PMM, and Brazilian physicians not linked to the PMM. The following PHC scores were calculated: overall PCA score, accessibility (first contact), and longitudinality. The association between PHC scores, physician category, and other user and physician characteristics was investigated using multilevel analysis. RESULTS: The overall PCA score for Brazil was 6.78, and the longitudinality score was 7.43. There was no difference in these scores among the three physician categories. The overall accessibility score was 4.24. A small but significant difference (P < 0.001) in accessibility score was detected among physician categories: 4.43 for Cuban physicians participating in the PMM (CI: 4.32-4.54), 4.08 for Brazilian physicians participating in the PMM(CI: 3.98-4.18), and 4.20 for Brazilian physicians not linked to the PMM (CI: 4.09-4.32). Age, socioeconomic level, presence of chronic diseases, and home visits by physicians positively influenced the overall PCA score on multilevel analysis. CONCLUSIONS: The type of physician did not influence the primary care orientation (overall score) of the healthcare system in Brazil. PMM was associated with higher accessibility sores in more socioeconomically vulnerable areas. Multilevel analysis showed that PCH may be strengthened by the reinforcement of essential physician roles (such as home visits) and by improving access for socioeconomically vulnerable, younger populations or those without chronic diseases.

OBJETIVO: Evaluar la calidad de la atención primaria de salud (APS) en Brasil y su relación con el Programa Más Médicos (PMM). MÉTODOS: Estudio transversal de alcance nacional em el que se utilizó la herramienta PCATool-Brasil para evaluar la calidad de la APS a partir de la experiencia de los usuarios vinculados a tres categorías de médicos: médicos brasileños del PMM, médicos cubanos del PMM y médicos brasileños no vinculados al PMM. Se calcularon los siguientes puntajes: Puntaje general de APS, Puntaje de acceso y Puntaje de longitudinalidad. Se investigaron mediante análisis multinivel la asociación entre el Puntaje general obtenido, la categoría del médico y otras características de los usuarios y los profesionales. RESULTADOS: El Puntaje general de APS para Brasil fue 6,78, y el Puntaje de longitudinalidad, 7,43. No hubo diferencia entre estos puntajes para las tres categorías de médicos. El Puntaje de acceso para Brasil fue de 4,24 y mostró una diferencia pequeña, pero significativa (p <0,001) entre las categorías de médicos: médicos cubanos del PMM 4,43 (IC: 4,32-4,54), médicos brasileños del PMM 4,08 (IC: 3,98-4,18) y médicos brasileños no vinculados al PMM 4,20 (IC: 4,09-4,32). En el análisis multinivel, la edad, el estrato socioeconómico, la presencia de enfermedades crónicas y el hecho de que el médico realizara visitas domiciliarias influyeron positivamente em el Puntaje general. CONCLUSIONES: El tipo de médico no influyó en el grado de orientación a los atributos de la APS (Puntaje general) en Brasil. El PMM se asoció com mayores Puntajes de acceso en las regiones de mayor vulnerabilidad socioeconómica. Con el análisis multinivel se identificó que el fortalecimiento de la APS también puede ser alcanzado reforzando los roles fundamentales de los médicos que trabajan en la APS (como las visitas domiciliarias) y mejorando el acceso de las poblaciones de mayor vulnerabilidad socioeconómica y de las personas más jóvenes o sin enfermedades crónicas.

Qualidade da atenção primária à saúde no Brasil e associação com o Programa Mais Médicos / Primary health care performance in Brazil and association with the More Doctors physician recruitment program / Calidad de la atención primaria de salud en Brasil y relación con el Programa Más Médicos

Objetivo. Avaliar a qualidade da atenção primária à saúde (APS) no Brasil e sua associação com o Programa Mais Médicos (PMM). Métodos. Este estudo transversal de abrangência nacional utilizou a ferramenta PCATool-Brasil para avaliar a qualidade da APS a partir da experiência dos usuários vinculados a três categorias de médicos: médicos brasileiros do PMM, médicos cubanos do PMM e médicos brasileiros não vinculados ao PMM. Os seguintes escores foram calculados: Escore Geral da APS, Escore de Acesso e Escore de Longitudinalidade. A associação entre o Escore Geral obtido, a categoria do médico e outras características dos usuários e dos profissionais foi investigada por análise multinível. Resultados. O Escore Geral da APS para o Brasil foi 6,78, e o Escore de Longitudinalidade, 7,43. Não houve diferença entre esses escores para as três categorias de médicos. O Escore de Acesso para o Brasil foi de 4,24, havendo diferença pequena, mas significativa (P-valor < 0,001), entre as categorias de médicos: médicos cubanos do PMM com 4,43 (IC: 4,32 a 4,54), médicos brasileiros do PMM com 4,08 (IC: 3,98 a 4,18) e médicos brasileiros não vinculados ao PMM com 4,20 (IC: 4,09 a 4,32). Na análise multinível, idade, estrato socioeconômico, presença de doenças crônicas e o fato de o médico realizar visita domiciliar influenciaram positivamente o Escore Geral. Conclusões. O tipo de médico não influenciou o grau de orientação aos atributos da APS (Escore Geral) no Brasil. O PMM associou-se a maiores Escores de Acesso em regiões de maior vulnerabilidade socioeconômica. Com a análise multinível, identificamos que o fortalecimento da APS também pode ser alcançado ao reforçar papéis fundamentais dos médicos que trabalham na APS (como as visitas domiciliares) e aprimorar o acesso das populações de maior vulnerabilidade socioeconômica e de pessoas mais jovens ou sem doenças crônicas.(AU)

Objective. To assess the performance of primary health care (PHC) in Brazil and its association with the More Doctors Program (Programa Mais Médicos, PMM). Method. This nationwide cross-sectional study used the Primary Care Assessment Tool validated for Brazilian Portuguese (PCATool-Brasil) to determine the achievement of PHC according to user experience associated with three physician categories: Brazilian physicians participating in the PMM, Cuban physicians participating in the PMM, and Brazilian physicians not linked to the PMM. The following PHC scores were calculated: overall PCA score, accessibility (first contact), and longitudinality. The association between PHC scores, physician category, and other user and physician characteristics was investigated using multilevel analysis. Results. The overall PCA score for Brazil was 6.78, and the longitudinality score was 7.43. There was no difference in these scores among the three physician categories. The overall accessibility score was 4.24. A small but significant difference (P < 0.001) in accessibility score was detected among physician categories: 4.43 for Cuban physicians participating in the PMM (CI: 4.32-4.54), 4.08 for Brazilian physicians participating in the PMM(CI: 3.98-4.18), and 4.20 for Brazilian physicians not linked to the PMM (CI: 4.09-4.32). Age, socioeconomic level, presence of chronic diseases, and home visits by physicians positively influenced the overall PCA score on multilevel analysis. Conclusions. The type of physician did not influence the primary care orientation (overall score) of the healthcare system in Brazil. PMM was associated with higher accessibility sores in more socioeconomically vulnerable areas. Multilevel analysis showed that PCH may be strengthened by the reinforcement of essential physician roles (such as home visits) and by improving access for socioeconomically vulnerable, younger populations or those without chronic diseases.(AU)

Objetivo. Evaluar la calidad de la atención primaria de salud (APS) en Brasil y su relación con el Programa Más Médicos (PMM). Métodos. Estudio transversal de alcance nacional em el que se utilizó la herramienta PCATool-Brasil para evaluar la calidad de la APS a partir de la experiencia de los usuarios vinculados a tres categorías de médicos: médicos brasileños del PMM, médicos cubanos del PMM y médicos brasileños no vinculados al PMM. Se calcularon los siguientes puntajes: Puntaje general de APS, Puntaje de acceso y Puntaje de longitudinalidad. Se investigaron mediante análisis multinivel la asociación entre el Puntaje general obtenido, la categoría del médico y otras características de los usuarios y los profesionales. Resultados. El Puntaje general de APS para Brasil fue 6,78, y el Puntaje de longitudinalidad, 7,43. No hubo diferencia entre estos puntajes para las tres categorías de médicos. El Puntaje de acceso para Brasil fue de 4,24 y mostró una diferencia pequeña, pero significativa (p <0,001) entre las categorías de médicos: médicos cubanos del PMM 4,43 (IC: 4,32-4,54), médicos brasileños del PMM 4,08 (IC: 3,98-4,18) y médicos brasileños no vinculados al PMM 4,20 (IC: 4,09-4,32). En el análisis multinivel, la edad, el estrato socioeconómico, la presencia de enfermedades crónicas y el hecho de que el médico realizara visitas domiciliarias influyeron positivamente em el Puntaje general. Conclusiones. El tipo de médico no influyó en el grado de orientación a los atributos de la APS (Puntaje general) en Brasil. El PMM se asoció com mayores Puntajes de acceso en las regiones de mayor vulnerabilidad socioeconómica. Con el análisis multinivel se identificó que el fortalecimiento de la APS también puede ser alcanzado reforzando los roles fundamentales de los médicos que trabajan en la APS (como las visitas domiciliarias) y mejorando el acceso de las poblaciones de mayor vulnerabilidad socioeconómica y de las personas más jóvenes o sin enfermedades crónicas.(AU)

Cholesterol oxidation and astaxanthin degradation in shrimp during sun drying and storage.

Dried salted shrimps are made from raw shrimps, which are cooked and dried under direct sunlight. The preparation and storage include treatments and conditions that can promote oxidative changes in different components. The aim of this study was to monitor the formation of major cholesterol oxidation products and the changes in the astaxanthin content and fatty acid profile in dried salted shrimp during cooking, sun drying and storage. During sun drying, most of the astaxanthin (75%) was degraded in cooked shrimp, while cholesterol oxidation products (COPs) showed a dramatic increase (8.6-fold), reaching a total concentration of 372.9 ± 16.3 µg/g of lipids. Further storage favoured both astaxanthin degradation (83%) and COPs formation (886.6 ± 97.9 µg/g of lipids after 90 days of storage). The high degradation of astaxanthin and the elevated formation of COPs during sun drying and storage indicate the necessity to re-evaluate the processing and storage conditions of salted dried shrimp.

Enzymatic reactions and synthesis of n-butyl caproate: esterification, transesterification and aminolysis using a recombinant lipase from Geobacillus thermoleovorans CCR11.

The recombinant lipase LipMatCCR11 from the thermophilic strain Geobacillus thermoleovorans CCR11 was applied in the synthesis of n-butyl caproate via transesterification in hexane and xylene. The short chain flavour ester was obtained by alcoholysis from ethyl caproate and n-butyl alcohol and acidolysis from n-butyl butyrate and caproic acid. This enzyme was also used in the condensation reaction from caproic acid and n-butanol. The conversion percentages at equilibrium (Xe) were similar to those obtained with Candida antarctica lipase fraction B (CAL-B) in the same reaction conditions, while lower conversion velocities (k) were attained. LipMatCCR11 reached high conversion percentages in either hexane or xylene as organic media (> 63%); the enzyme was also able to catalyze the aminolysis reaction of ethyl caproate with benzyl amine in hexane obtaining a conversion percentage > 62%.

Gene cloning, expression, and characterization of the Geobacillus Thermoleovorans CCR11 thermoalkaliphilic lipase.

The gene for a Geobacillus thermoleovorans CCR11 thermostable lipase was recovered by PCR and cloned. Four genetic constructions were designed and successfully expressed in E. coli: (i) the lipase structural gene (lipCCR11) in the PinPoint Xa vector; (ii) the lipase structural gene (lipACCR11) in the pET-28a(+) vector; (iii) the lipase structural gene minus the signal peptide (lipMatCCR11) in the pET-3b vector; and (iv) the lipase structural gene plus its own promoter (lipProCCR11) in the pGEM-T cloning vector. The lipase gene sequence analysis showed an open reading frame of 1,212 nucleotides coding for a mature lipase of 382 residues (40 kDa) plus a 22 residues signal peptide. Expression under T7 and T7lac promoter resulted in a 40- and 36-fold increase in lipolytic activity with respect to the original strain lipase. All recombinant lipases showed an optimal activity at pH 9.0, but variations were found in the temperature for maximum activity and the substrate specificity among them and when compared with the parental strain lipase, especially in the recombinant lipases that contained fusion tags. Therefore, it is important to find the appropriate expression system able to attain a high concentration of the recombinant lipase without compromising the proper folding of the protein.

Immobilization in the presence of Triton X-100: modifications in activity and thermostability of Geobacillus thermoleovorans CCR11 lipase.

A partially purified lipase produced by the thermophile Geobacillus thermoleovorans CCR11 was immobilized by adsorption on porous polypropylene (Accurel EP-100) in the presence and absence of 0.1% Triton X-100. Lipase production was induced in a 2.5% high oleic safflower oil medium and the enzyme was partially purified by diafiltration (co. 500,000 Da). Immobilization conditions were established at 25 degrees C, pH 6, and a protein concentration of 0.9 mg/mL in the presence and absence of 0.1% Triton X-100. Immobilization increased enzyme thermostability but there was no change in neither the optimum pH nor in pH resistance irrelevant to the presence of the detergent during immobilization. Immobilization with or without Triton X-100 allowed the reuse of the lipase preparation for 11 and 8 cycles, respectively. There was a significant difference between residual activity of immobilized and soluble enzyme after 36 days of storage at 4 degrees C (P < 0.05). With respect to chain length specificity, the immobilized lipase showed less activity over short chain esters than the soluble lipase. The immobilized lipase showed good resistance to desorption with phosphate buffer and NaCl; minor loses with detergents were observed (less than 50% with Triton X-100 and Tween-80), but activity was completely lost with SDS. Immobilization of G. thermoleovorans CCR11 lipase in porous polypropylene is a simple and easy method to obtain a biocatalyst with increased stability, improved performance, with the possibility for re-use, and therefore an interesting potential use in commercial conditions.