ARE THERE ADVANTAGES IN DOUBLE TRANSIT RECONSTRUCTION AFTER TOTAL GASTRECTOMY IN PATIENTS WITH GASTRIC CANCER? A SYSTEMATIC REVIEW.

BACKGROUND: Curative treatment for gastric cancer involves tumor resection, followed by transit reconstruction, with Roux-en-Y being the main technique employed. To permit food transit to the duodenum, which is absent in Roux-en-Y, double transit reconstruction has been used, whose theoretical advantages seem to surpass the previous technique. AIMS: To compare the clinical evolution of gastric cancer patients who underwent total gastrectomy with Roux-en-Y and double tract reconstruction. METHODS: A systematic review was carried out on Web of Science, Scopus, EmbasE, SciELO, Virtual Health Library, PubMed, Cochrane, and Google Scholar databases. Data were collected until June 11, 2022. Observational studies or clinical trials evaluating patients submitted to double tract (DT) and Roux-en-Y (RY) reconstructions were included. There was no temporal or language restriction. Review articles, case reports, case series, and incomplete texts were excluded. The risk of bias was calculated using the Cochrane tool designed for randomized clinical trials. RESULTS: Four studies of good methodological quality were included, encompassing 209 participants. In the RY group, there was a greater reduction in food intake. In the DT group, the decrease in body mass index was less pronounced compared to preoperative values. CONCLUSIONS: The double tract reconstruction had better outcomes concerning body mass index and the time until starting a light diet; however, it did not present any advantages in relation to nutritional deficits, quality of life, and post-surgical complications.

In vitro Evaluation of Fungal Susceptibility and Inhibition of Virulence by Diosgenin.

Fungal infections are a public health problem that mainly affects immunosuppressed people, Candida spp. have been responsible for most sources of contamination and invasive fungal infections described around the world. The need arises to find new therapeutic approaches to combat growing infections. Plants and natural products have been considered a valuable source for discovering new molecules with active ingredients. Diosgenin is a sapogenin found in the families of Leguminosae and Dioscoreaceae, it is obtained mainly from the dioscin saponin through the hydrolysis method, it is a phytochemical that has been highlighted in the treatment of various diseases, as well as in combating microbial resistance. The present study aimed to evaluate the susceptibility of fungal strains to diosgenin, as well as verify the association with the reference drug and evaluate the inhibition of the virulence factor through morphological changes in the yeast state to the filamentous form of hyphae and pseudohyphae in strains of Candida albicans, Candida tropicalis and Candida krusei using the broth microdilution method and microculture technique. Antifungal assays revealed that diosgenin was not able to inhibit the growth of the tested strains. However, it was able to inhibit the fungal dimorphism of the strains evaluated, however further studies are recommended to verify its effectiveness against other virulence factors.

Partial nitritation/anammox applied to real anaerobically pretreated domestic sewage under subtropical climate: aeration strategies and nitrogen cycle bacteria.

The combination of sewage anaerobic treatment and partial nitritation/anammox process (PN/A) can make wastewater treatment plants energetically self-sufficient. However, PN/A application has been a challenge in low-nitrogen wastewaters and it is little explored in anaerobically pretreated domestic sewage, as well as aeration strategies and the PN/A feasibility at ambient temperature. This study investigated PN/A in a sequential batch reactor (SBR) treating real anaerobically pretreated domestic sewage. After the startup, SBR was fed with real wastewater and operated at 35°C and at ambient temperature (20-31°C) without total nitrogen (TN) removal decrease (71 ± 8 and 75 ± 6%, respectively). The median ammonium and TN removals were 68 ± 21 and 59 ± 9%, respectively with 7 min on/14 min off strategy, which represents 12.3 ± 4.2 mg L-1 N-NH4+ effluent, which is lower than Brazilian discharge limits. The qPCR results showed anammox abundance in the range of 108-109 n° copies gVSS-1. Thus, results were very promising and showed the feasibility of the PN/A process for treating real anaerobically pretreated domestic sewage at ambient temperature.

O cuidar do adolescente com obesidade na atenção primária à saúde: perspectivas de gestores e profissionais / The care of obese adolescents in primary health care: perspectives of managers and professionals / Atención a adolescentes con obesidad en atención primaria de salud: perspectivas de gestores y profesionales

RESUMO Objetivo: Descrever e explorar, sob a perspectiva de gestores e profissionais de saúde, o cuidado ofertado ao adolescente com obesidade no âmbito da Atenção Primária à Saúde. Método: Estudo de caso, realizado em município do estado do Ceará-Brasil. A coleta de dados ocorreu em 2022, por meio de entrevistas semiestruturadas. Os dados foram examinados através da Análise de conteúdo de Bardin. Resultados: O cuidado ao adolescente com obesidade é fragmentado, cada profissional atua conforme decisão própria, pois o município não utiliza protocolos que subsidiem a prática assistencial. Foram elencadas potencialidades para o cuidado, sendo a principal a equipe multiprofissional. Quanto às dificuldades, destacou-se a procura do serviço de saúde pelo adolescente. Conclusão: Faz-se necessária uma (re)organização do modelo de atenção ao adolescente com obesidade no município. Além disso, o estudo ressalta a necessidade de maior atenção a obesidade na adolescência e provoca reflexões acerca do cuidado dispensado a este adolescente.

ABSTRACT Objective: Describe and explore, from the perspective of managers and health professionals, the care offered to adolescents with obesity in the context of Primary Health Care. Method: A case study conducted in a municipality in the state of Ceará-Brazil. Data collection took place in 2022 through semi-structured interviews. The data were examined using Bardin Content Analysis. Results: The care of obese adolescents is fragmented, and each professional acts according to their own decision, as the municipality does not use protocols that subsidize the practice of care. Potentials for care were listed, the main one being the multidisciplinary team. Regarding the difficulties, the adolescent's demand for health services was highlighted. Conclusion: It is necessary to (re) organize the care model for obese adolescents in the municipality. In addition, the study highlights the need for greater attention to adolescent obesity and causes reflections on the care provided to this adolescent.

RESUMEN Objetivo: Describir y explorar, desde la perspectiva de los gestores y profesionales sanitarios, la atención ofrecida a los adolescentes con obesidad en el ámbito de la Atención Primaria de Salud. Método: Estudio de caso, realizado en un municipio del estado de Ceará-Brasil. Los datos se recogieron en 2022 mediante entrevistas semiestructuradas. Los datos se analizaron mediante el análisis de contenido de Bardin. Resultados: La atención a los adolescentes con obesidad está fragmentada, y cada profesional actúa según su propia decisión, ya que el municipio no utiliza protocolos para subvencionar la práctica asistencial. Se enumeraron las potencialidades asistenciales, siendo la principal el equipo multiprofesional. En cuanto a las dificultades, se destaca la búsqueda del servicio sanitario por parte del adolescente. Conclusión: Es necesario (re)organizar el modelo de atención a los adolescentes con obesidad en el municipio. Además, el estudio pone de manifiesto la necesidad de prestar más atención a la obesidad en la adolescencia y suscita reflexiones sobre la atención prestada a este adolescente.

Drosophila nasuta (Diptera, Drosophilidae) in Brazil: a decade of invasion and occupation of more than half of the country.

As a result of human activities and natural dispersal, exotic species can be brought to new areas, where they become established and spread, becoming invaders. These species are responsible for the loss of biodiversity and cause ecosystemic harm throughout the world. In this paper, we report the rapid, broad geographic expansion of the invasive fly Drosophila nasuta in Brazil. An 84% increase was found in its area of occupation in the country compared to previous studies. The present data reveal its arrival to the Pantanal wetlands in a location more than one thousand kilometers from the closest previous record in the Cerrado biome. We present the first record of D. nasuta in the Atlantic Forest in the states of Paraíba and Bahia. We report its introduction in the Amazon Forest in the state of Amazonas approximately 700 kilometers from previous records. The relative abundance of D. nasuta in this biome increased fivefold in comparison to a previous study. In the first decade of invasion in Brazil, D. nasuta has already colonized more than half of the country. The present data reveal its invasive potential and underscore the importance of following up the possible negative effects of this biological invasion.

Translation, cross-cultural adaptation, reliability, and construct validity of the Brazilian Portuguese version of the Basic Psychological Needs in Exercise Scale.

RESULTS: 59 patients were included (61% with COPD and 39% with ILD). BPNES factor scores were not significantly different between raters' assessments (p > 0.05). The internal consistency was 0.70 for autonomy, 0.76 for competence, and 0.80 for relatedness. Inter-rater and test-retest reliability were good to very good for autonomy (ICC = 0.78, 95%CI 0.62-0.87; ICC = 0.75, 95%CI 0.57-0.86, respectively), competence (ICC = 0.81, 95%CI 0.68-0.89; ICC = 0.65, 95%CI 0.43-0.80, respectively), and relatedness (ICC = 0.79, 95%CI 0.65-0.88; ICC = 0.70, 95%CI 0.50-0.83, respectively). Significant correlations were observed between BPNES factors and quality of life, anxiety, depression, and functional status. In conclusion, this study confirmed the reliability and construct validity of the Brazilian Portuguese version of the BPNES in patients with COPD and ILD.

Synthesis and In Vitro Biocompatibility Studies of Novel Alkoxy 4,4-Difluoro-4-bora-3a,4a-diaza-s-indacenes.

BODIPYs are bicyclic aromatic compounds with unique spectroscopic, photophysical, and chemical properties. This study aimed to find BODIPYs with characteristics biocompatible with human cell lines for possible use as imaging agents. Six BODIPY derivatives were synthesised with groups linked to boron, fluorine, phenol, or catechol, resulting in compounds with different physicochemical characteristics. NMR, absorption, and emission spectroscopy and mass spectrometry were subsequently used to characterise them. Afterwards, the biocompatibility of these compounds was evaluated using MTT, SRB, and cellular uptake assays in A549 and H1299 cell lines. Furthermore, a haemolysis assay was performed on human blood cells. To summarise the main results, BODIPYs 1 to 4 showed considerable fluorescence. In contrast, BODIPYs 5 and 6 showed very weak fluorescence, which could be related to the presence of the catechol group and its quenching properties. Regarding biocompatibility, all compounds had metabolic activity and viability above 80% and 70%, respectively. BODIPYs 3 and 6 presented the most consistent data, demonstrating good uptake and, in general, haemolytic activity below 25%. In conclusion, the cytotoxic effects of the compounds were not considerable, and the presence of cyclic alkoxides in BODIPYs 3 and 6 may introduce exciting features that should be highlighted for dual imaging for BODIPY 3 due to its fluorescence or for radioactive labelling in the case of both BODIPYs.

Effect of melatonin on otoprotection in rodents: a systematic review with meta-analysis

Abstract Objectives: To determinate the otoprotective efficacy of melatonin.in experimental models of rodents through a systematic review of the literature. Methods: Altogether, 154 articles were found in four databases. The PICOS strategy (Population, Intervention, Comparison, and Outcome) was used to define the eligibility criteria. Studies that met the inclusion criteria for the second step were included in a qualitative synthesis. Each study type was analyzed with the CAMARADES quality of assessment's checklist and the SYRCLE RoBS risk of bias. Results: Seven articles were selected, and four were included in the meta-analysis. It was possible to obtain seven outcomes according to the standard auditory frequencies presented among the studies, considering a minimum of three standard frequencies. The outcomes analyzed were for the frequencies of 1500, 2000, 3000, 4000, 5000, 6000, and 8000 Hz. Conclusion: Melatonin can provide protection against the ototoxic effects of cisplatin and aminoglycosides at 5000 Hz, 6000 Hz, and 8000 Hz, thereby minimizing the reduction in Otoacustic Emissions (OAE) amplitude. The same effect was not observed in the lower frequencies. Despite the limited number of studies that were evaluated, the results appeared consistent in higher frequencies. However, the methodology of the available studies did not meet the necessary methodological rigor that promotes the safe replicability of these studies.

Health condition, income loss, food insecurity and other social inequities among migrants and refugees during the COVID-19 pandemic in Brazil.

BACKGROUND: Brazil is the destination of many international migrants and refugees and, given the circumstances of their entry into the country, many face difficulties due to the absence of targeted policies. Thus, the objective of this study was to survey the social impact of COVID-19 on international migrants and refugees regarding income loss, food insecurity and other social inequities, and to identify explanatory factors on these aspects. METHODS: This is a cross-sectional, analytical study. We used a validated instrument applied by trained interviewers. Descriptive analysis and binary logistic regression were performed to identify factors associated with income loss and food insecurity. RESULTS: A total of 360 individuals from sub-Saharan African and South American countries participated in the study. Individuals who were white, black/brown, yellow, had an occupation/employment, and earned less than one minimum wage were more likely to lose income. Those who reported no income, received less than one minimum wage, and were diagnosed with COVID-19 were more likely to be food insecure. CONCLUSIONS: The study advances knowledge by identifying factors associated with income loss, food insecurity, and individuals' difficulty in accessing health services and social support measures in Brazil.

Digital health for treatment adherence in people with tuberculosis: a systematic review / Saúde digital para a adesão ao tratamento da pessoa com tuberculose: uma revisão sistemática / Salud digital para la adherencia al tratamiento en personas con tuberculosis: una revisión sistemática

Justifications and Objectives: the use of digital health, among people diagnosed with tuberculosis, can be an effective strategy, combined with health services, to increase adherence to treatment and impact the disease's epidemiological data in the country. As this topic has been widely discussed and improved in recent years, it is necessary to further investigate the research available on scientific bases. The objective of this study was to describe the use of digital health technologies to assist with adherence to tuberculosis treatment. Methods: this is a systematic literature review with a rapid review approach, following the PRISMA guidelines and the Cochrane guide. Evidence quality was assessed using the Mixed Methods Appraisal Tool. The studies were identified in PubMed, VHL, CINAHL, Cochrane Trial, SciELO, Scopus and Embase. Experimental, quasi-experimental studies and clinical trials were included, without language restrictions, published between 2020 and 2022. Content: nine studies were selected, which demonstrated that the implementation of digital technologies improved adherence rates to medication treatment and cure rates. Applications use strategies such as synchronous and asynchronous video, voice calls and text messages. Among the studies, only two technology/application names were mentioned. Conclusion: digital technologies have had a positive impact on the treatment of people diagnosed with tuberculosis.(AU)

Justificativas e Objetivos: a utilização da saúde digital, junto às pessoas diagnosticadas com a tuberculose, pode ser uma estratégia eficaz, aliada dos serviços de saúde, para aumentar a adesão ao tratamento e impactar os dados epidemiológicos da doença no país. Como esse tema tem sido amplamente discutido e aprimorado nos últimos anos, é necessário investigar mais a fundo as pesquisas disponíveis nas bases científicas. O objetivo deste estudo foi descrever o uso de tecnologias em saúde digital para auxiliar na adesão ao tratamento da tuberculose. Método: trata-se de revisão sistemática da literatura com abordagem de revisão rápida, seguindo as diretrizes do PRISMA e o guia da Cochrane. A qualidade das evidências foi realizada utilizando a ferramenta Mixed Methods Appraisal Tool. Os estudos foram identificados nas bases de dados PubMed, BVS, CINAHL, Cochrane Trial, SciELO, Scopus e Embase. Foram incluídos estudos experimentais, quase-experimentais e ensaios clínicos, sem restrição de idioma, publicados entre 2020 e 2022. Conteúdo: foram selecionados nove estudos, que demonstraram que a implementação de tecnologias digitais melhorou as taxas de adesão ao tratamento medicamentoso e as taxas de cura. Os aplicativos utilizam estratégias como vídeo síncrono e assíncrono, chamadas de voz e mensagens de texto. Entre os estudos, apenas dois nomes de tecnologia/aplicativo foram mencionados. Conclusão: as tecnologias digitais têm impactado de forma positiva no tratamento das pessoas com diagnóstico de tuberculose.(AU)

Justificaciones y objetivos: el uso de la salud digital entre las personas diagnosticadas con tuberculosis puede ser una estrategia eficaz y aliada de los servicios de salud para aumentar la adherencia al tratamiento e impactar los datos epidemiológicos de la enfermedad en el país. 3. Método: se realizó una revisión sistemática de la literatura con un enfoque de revisión rápida, siguiendo las pautas de PRISMA y la guía de Cochrane. La calidad de la evidencia se evaluó utilizando la herramienta Mixed Methods Appraisal Tool. Los estudios se identificaron en las siguientes bases de datos: PubMed, BVS, CINAHL, Cochrane Trial, SciELO, Scopus y Embase. Se incluyeron estudios experimentales, cuasiexperimentales y ensayos clínicos, sin restricciones de idioma, publicados entre 2020 y 2022. Contenido: se seleccionaron nueve estudios que demostraron que la implementación de tecnologías digitales mejoró las tasas de adherencia al tratamiento con medicamentos y las tasas de curación. Las aplicaciones utilizan estrategias como video sincrónico y asincrónico, llamadas de voz y mensajes de texto. Entre los estudios, sólo se mencionaron dos nombres de tecnologías/aplicaciones. Conclusión: las tecnologías digitales han tenido un impacto positivo en el tratamiento de personas diagnosticadas con tuberculosis.(AU)

Factors associated with status and self-perceived mental health changes in the face of the COVID-19 pandemic in Brazil.

The SARS-CoV-2-triggered Public Health Emergency of International Importance has significantly contributed to emotional and mental health issues. The aim of this study was to identify factors associated with self-perceived mental health changes while facing the COVID-19 pandemic in Brazil. This was a cross-sectional, descriptive, and analytical study that collected data via a web survey using a validated instrument. The study included individuals over 18 years old residing in the 26 federal units and the Federal District from August 2020 to November 2022. The sample was recruited using the snowball technique. Two logistic regression analyses were conducted to identify factors associated with the outcomes of interest. The first analysis considered individuals who rated their mental health condition as poor as the dependent variable, while the second analysis considered individuals who reported changes in their mental health during the pandemic as the dependent variable. The study found that individuals with complete college education and those using tranquilizers or antidepressants were more likely to perceive their mental health as poor (1.97 and 2.04 times higher likelihood, respectively). Increased consumption of ultra-processed foods during the pandemic was associated with a 2.49 higher likelihood of reporting mental health changes. Participants also reported more difficulty sleeping. The negative self-perception of mental health varied across Brazil's regions and changed over time, with different patterns observed before and after the vaccination period. In 2022, most regions of Brazil classified their mental health as "poor." The study highlights the impact of the COVID-19 pandemic on mental health, with increased prevalence of mental disorders and emotional problems among the population. The results highlight the presence of mental disorders and increased reporting of emotional problems among the population due to the impact of the COVID-19 pandemic.

Carbon Storage in Different Compartments in Eucalyptus Stands and Native Cerrado Vegetation.

This study evaluated Carbon (C) storage in different compartments in eucalyptus stands and native Cerrado vegetation. To determine C above ground, an inventory was carried out in the areas where diameter at breast height (DBH), diameter at base height (Db), and total tree height (H) were measured. In the stands, the rigorous cubage was made by the direct method, and in the native vegetation, it was determined by the indirect method through an allometric equation. Roots were collected by direct method using circular monoliths to a depth of 60 cm and determined by the volume of the cylinder. Samples were collected up to 100 cm deep to estimate C stock in the soil. All samples collected directly had C determined using the CHNS elemental analyzer. Gas samples were collected using a manually closed chamber, and the gas concentration was determined by gas chromatography. The results indicate high C storage in the studied areas > 183.99 Mg ha-1, could contribute to CO2 mitigation > 674.17 Mg ha-1. In addition to low emissions (<1 kg ha-1 yr-1) for the three evaluated areas, with no statistical difference in relation to the Global Warming Potential. Concerning the native cerrado vegetation conversion, the "4-year-old eucalyptus stand" seemed to restore the original soil carbon stocks in the first-meter depth, regardless of some losses that might have occurred right after establishment. Conversely, a significant loss of carbon in the soil was observed due to the alternative setting, where similar natural land was converted into agriculture, mostly soybean, and then, years later, turned into the "6-year-old eucalyptus stand" (28.43 Mg ha-1). Under this study, these mixed series of C baselines in landscape transitions have reflected on unlike C dynamics outcomes, whereas at the bottom line, total C stocks were higher in the younger forest (4-year-old stand). Therefore, our finding indicates that we should be thoughtful regarding upscaling carbon emissions and sequestration from small-scale measurements to regional scales.

Effect of melatonin on otoprotection in rodents: a systematic review with meta-analysis.

OBJECTIVES: To determinate the otoprotective efficacy of melatonin.in experimental models of rodents through a systematic review of the literature. METHODS: Altogether, 154 articles were found in four databases. The PICOS strategy (Population, Intervention, Comparison, and Outcome) was used to define the eligibility criteria. Studies that met the inclusion criteria for the second step were included in a qualitative synthesis. Each study type was analyzed with the CAMARADES quality of assessment's checklist and the SYRCLE RoBS risk of bias. RESULTS: Seven articles were selected, and four were included in the meta-analysis. It was possible to obtain seven outcomes according to the standard auditory frequencies presented among the studies, considering a minimum of three standard frequencies. The outcomes analyzed were for the frequencies of 1500, 2000, 3000, 4000, 5000, 6000, and 8000 Hz. CONCLUSION: Melatonin can provide protection against the ototoxic effects of cisplatin and aminoglycosides at 5000 Hz, 6000 Hz, and 8000 Hz, thereby minimizing the reduction in Otoacustic Emissions (OAE) amplitude. The same effect was not observed in the lower frequencies. Despite the limited number of studies that were evaluated, the results appeared consistent in higher frequencies. However, the methodology of the available studies did not meet the necessary methodological rigor that promotes the safe replicability of these studies.

Antibiotic resistance profile of wastewater treatment plants in Brazil reveals different patterns of resistance and multi resistant bacteria in final effluents.

Wastewater treatment plants (WWTPs) are recognized as important sources of Antibiotic Resistant Bacteria (ARBs) and Antibiotic Resistant Genes (ARGs), and might play a role in the removal and dissemination of antimicrobial resistance (AMR) in the environment. Detailed information about AMR removal by the different treatment technologies commonly applied in urban WWTPs is needed. This study investigated the occurrence, removal and characterization of ARBs in WWTPs employing different technologies: WWTP-A (conventional activated sludge-CAS), WWTP-B (UASB reactor followed by biological trickling filter) and WWTP-C (modified activated sludge followed by UV disinfection-MAS/UV). Samples of raw sewage (RI) and treated effluent (TE) were collected and, through the cultivation-based method using 11 antibiotics, the antibiotic resistance profiles were characterized in a one-year period. MAS was effective in reducing ARB counts (2 to 3 log units), compared to CAS (1 log unit) and UASB/BTF (0.5 log unit). The composition of cultivable ARB differed between RI and TE samples. Escherichia was predominant in RI (56/118); whilst in TE Escherichia (31/118) was followed by Bacillus (22/118), Shigella (14/118) and Enterococcus (14/118). Most of the isolates identified (370/394) harboured at least two ARGs and in over 80 % of the isolates, 4 or more ARG (int1, blaTEM, TetA, sul1 and qnrB) were detected. A reduction in the resistance prevalence was observed in effluents after CAS and MAS processes; whilst a slight increase was observed in treated effluents from UASB/BTF and after UV disinfection stage. The multi-drug resistance (MDR) phenotype was attributed to 84.3 % of the isolates from RI (27/32) and 63.6 % from TE (21/33) samples and 52.3 % of the isolates (34/65) were resistant to carbapenems (imipenem, meropenem, ertapenem). The results indicate that treated effluents are still a source for MDR bacteria and ARGs dissemination to aquatic environments. The importance of biological sewage treatment was reinforced by the significant reductions in ARB counts observed. However, implementation of additional treatments is needed to mitigate MDR bacteria release into the environment.

Quantification of SARS-CoV-2 in wastewater samples from hospitals treating COVID-19 patients during the first wave of the pandemic in Brazil.

The COVID-19 pandemic has caused a global health crisis, and wastewater-based epidemiology (WBE) has emerged as an important tool to assist public health decision-making. Recent studies have shown that the SARS-CoV-2 RNA concentration in wastewater samples is a reliable indicator of the severity of the pandemic for large populations. However, few studies have established a strong correlation between the number of infected people and the viral concentration in wastewater due to variations in viral shedding over time, viral decay, infiltration, and inflow. Herein we present the relationship between the number of COVID-19-positive patients and the viral concentration in wastewater samples from three different hospitals (A, B, and C) in the city of Belo Horizonte, Minas Gerais, Brazil. A positive and strong correlation between wastewater SARS-CoV-2 concentration and the number of confirmed cases was observed for Hospital B for both regions of the N gene (R = 0.89 and 0.77 for N1 and N2, respectively), while samples from Hospitals A and C showed low and moderate correlations, respectively. Even though the effects of viral decay and infiltration were minimized in our study, the variability of viral shedding throughout the infection period and feces dilution due to water usage for different activities in the hospitals could have affected the viral concentrations. These effects were prominent in Hospital A, which had the smallest sewershed population size, and where no correlation between the number of defecations from COVID-19 patients and viral concentration in wastewater was observed. Although we could not determine trends in the number of infected patients through SARS-CoV-2 concentrations in hospitals' wastewater samples, our results suggest that wastewater monitoring can be efficient for the detection of infected individuals at a local level, complementing clinical data.

Concordância às medidas de flexibilização durante a pandemia de covid-19 no brasil / Conformidad con las medidas de flexibilización durante la pandemia de covid-19 en brasil / Agreement to the flexibility measures during the covid-19 pandemic in brazil

RESUMO Objetivo: analisar os fatores associados à concordância com a flexibilização das medidas de proteção no Brasil durante a pandemia pela COVID-19. Método: estudo transversal, com dados de uma web survey realizada com adultos residentes no Brasil, entre agosto de 2020 e fevereiro de 2021. Resultados: dos 1.516 respondentes, a maioria possuía idade entre 40 a 59 anos (38,8%), sexo feminino (69,4%), nível de pós-graduação (48%), raça/cor branca (64,2%), separados/solteiros (48,3%). A maioria dos participantes concordou com as medidas de flexibilização (41,1%), todavia consideraram os ambientes nada ou pouco adequados para a retomada das atividades cotidianas (com exceção dos locais abertos para atividades físicas). As medidas implementadas pelo Estado durante a pandemia por COVID-19 também foram tidas como pouco e nada adequadas. Houve mais chance de concordância com as medidas de flexibilização entre as pessoas que moravam/conviviam com trabalhadores expostos ao risco de contrair a COVID-19. Conclusão: de modo geral, houve concordância às medidas de flexibilização no país. Morar/conviver com trabalhadores expostos ao risco de contrair a COVID-19 foi o principal fator associado à maior chance de concordar com as medidas de flexibilização, o que sinaliza a carga biopsicossocial trazida pela doença.

RESUMEN Objetivo: analizar los factores asociados a la conformidad con la flexibilización de las medidas de protección en Brasil durante la pandemia por COVID-19. Método: estudio transversal, con datos de una websurvey realizada con adultos residentes en Brasil, entre agosto de 2020 y febrero de 2021. Resultados: de los 1.516 encuestados, la mayoría poseía edad entre 40 y 59 años (38,8%), sexo femenino (69,4%), nivel de posgrado (48%), raza/color blanco (64,2%), separados/solteros (48,3%). La mayoría de los participantes estuvo de acuerdo con las medidas de flexibilización (41,1%), sin embargo, consideraron los ambientes nada o poco adecuados para la reanudación de las actividades cotidianas (con excepción de los locales abiertos para actividades físicas). Las medidas aplicadas por el Estado durante la pandemia de COVID-19 también fueron consideradas poco y nada adecuadas. La conformidad con las medidas de flexibilización se dio más entre las personas que vivían/convivían con trabajadores expuestos al riesgo de contraer la COVID-19. Conclusión: en general, hubo concordancia con las medidas de flexibilización en el país. Vivir/convivir con trabajadores expuestos al riesgo de contraer la COVID-19 fue el principal factor asociado a la mayor probabilidad de concordar con las medidas de flexibilización, lo que señala la carga biopsicosocial ocasionada por la enfermedad.

ABSTRACT Objective: to analyze the factors associated with agreement with the flexibility of protection measures in Brazil during the COVID-19 pandemic. Method: cross-sectional study with data from a websurvey conducted with adults living in Brazil, between August 2020 and February 2021. Results: of the 1,516 respondents, the majority were aged between 40 and 59 years (38.8%), female (69.4%), graduate level (48%), white race/color (64.2%), separated/single (48.3%). Most participants agreed with the flexibility measures (41.1%), but considered the environments not suitable or inadequate for the resumption of daily activities (except for places open for physical activities). The measures implemented by the State during the COVID-19 pandemic were also seen as nothing and inadequate. There was a greater chance of agreement with the flexibility measures among people who lived with workers exposed to the risk of contracting COVID-19. Conclusion: in general, there was agreement to the flexibility measures in the country. Living/living with workers exposed to the risk of contracting COVID-19 was the main factor associated with the greater chance of agreeing with the flexibility measures, which signals the biopsychosocial burden brought by the disease.

Qualidade da Atenção Primária à Saúde na pandemia de COVID-19: avaliação por usuários acometidos pela doença / Quality of Primary Health Care During the COVID-19 Pandemic: Evaluation by Users Affected by the Disease

A pandemia da doença pelo coronavírus impacta sobremaneira a sociedade, gerando desafios sem precedentes para a ciência, para os sistemas de saúde e para a Atenção Primária à Saúde, que foram rapidamente cobrados por respostas diversificadas para o enfrentamento desta emergência de saúde pública. O objetivo deste estudo foi avaliar a qualidade da APS segundo a perspectiva de pessoas acometidas pela COVID-19. Tratou-se de um estudo transversal com casos de COVID-19 em um município brasileiro. Utilizou-se um questionário eletrônico com características sociodemográficas e clínicas (de elaboração própria) e o Instrumento PCATool-Brasil ­ para pacientes adultos (versão reduzida), por meio do recurso KoBoToolbox. Após pré-teste e estudo piloto, a coleta de dados ocorreu entre 11 de janeiro e 05 de outubro de 2021. Utilizou-se estatística descritiva, sendo calculado o Escore Geral da APS ­ 0 a 10 (média e desvios padrão). Os 91 participantes avaliaram os atributos/componentes da APS. O Escore Geral da APS (média) foi 4,4 (DP=1,9). Este baixo escore geral da APS obtido sinaliza para fragilidades na qualidade deste nível de atenção à saúde, nos primeiros seis meses da pandemia em 2020. É inédito escore tão baixo de qualidade da APS. Depreende-se que o resultado negativo no município estudado reflete o impacto da COVID-19 e as estratégias adotadas para o enfrentamento da pandemia disparada pelo SARS-CoV-2 no Brasil e no mundo.

The coronavirus disease pandemic greatly impacted society, creating unprecedented challenges for science, healthcare systems, and Primary Health Care, which were quickly charged with diversified responses to face this public health emergency. The objective of this study was to evaluate the quality of PHC from the perspective of people affected by COVID-19. This was a cross-sectional study with cases of COVID-19 in a Brazilian municipality. We used an electronic questionnaire with sociodemographic and clinical characteristics (of our own elaboration) and the PCATool-Brazil Instrument ­ for adult patients (reduced version), through the KoBoToolbox resource. After a pre-test and pilot study, data collection took place between January 11 and October 5, 2021. Descriptive statistics were used, calculating the General PHC Score ­ 0 to 10 (mean and standard deviations). 91 participants evaluated the PHC characteristics/ components. The overall PHC score (mean) was 4.4 (SD=1.9). This low overall PHC score obtained indicates weaknesses in the quality of this level of healthcare, in the first six months of the pandemic in 2020. Such a low PHC quality score is unprecedented. It appears that the negative result in the studied municipality reflects the impact of COVID-19 and the strategies adopted to face the pandemic triggered by SARS-CoV-2 in Brazil and in the world.

Saúde mental na universidade: atendimento psicológico online na pandemia da covid-19 / Mental health at the university: online psychological care during the covid-19 pandemic / Salud mental en la universidad: atención psicológica en línea en la pandemia de covid-19

Com a pandemia da covid-19, o contexto universitário, que já vinha sendo palco de discussões em relação à saúde mental, tem vivenciado crises mais severas pelos estudantes. Diante deste cenário, foi desenvolvido o projeto Escuta Solidária, voltado à saúde mental dos discentes de graduação e de pós-graduação. Neste artigo, temos como objetivo discutir o atendimento psicológico online com estudantes do curso de psicologia durante o período de isolamento social rígido (maio a junho de 2020). Fizemos, com os psicólogos voluntários, um grupo focal direcionado para a experiência de atendimento psicológico online de curta duração no contexto pandêmico. Trata-se de um estudo qualitativo, realizado com os 11 psicólogos clínicos participantes do referido projeto. A partir de uma análise fenomenológica crítica, os resultados foram divididos em cinco categorias: a) limitações e contribuições do projeto; b) a importância da capacitação e supervisão clínica para a qualidade do projeto; c) atendimento psicológico online; d) ser psicólogo clínico durante a crise da covid-19; e e) demandas emergentes nos atendimentos psicológicos na quarentena. Por fim, discutimos a importância da desmistificação do atendimento psicológico em situações de crise, especialmente na modalidade online, fomentando questionamentos à formação e atuação dos profissionais, no sentido de estarmos atentos às demandas psicológicas que o contexto de crise acarreta na sociedade.(AU)

With the COVID-19 pandemic, the university context, which had already been the stage for discussions regarding mental health, has experienced more severe crises by students. In view of this scenario, the Solidarity Listening project was developed, aimed at the mental health of undergraduate and graduate students. In this article, we aim to discuss online psychological care with psychology students during the period of strict social isolation (May to June 2020). We carried out, with volunteer psychologists, a focus group aimed at the experience of short-termonline psychological care in the pandemic context. This is a qualitative study, carried out with 11 clinical psychologists participating in the aforementioned project. From a critical phenomenological analysis, the results were divided into five categories: a) limitations and contributions of the project; b) the importance of training and clinical supervision for the quality of the project; c) online psychological care; d) being a clinical psychologist during the COVID-19 crisis; and e) emerging demands in psychological care in quarantine. Finally, we discuss the importance of demystifying psychological care in crisis situations, especially in the online modality, promoting questions regarding the training and performance of professionals, to be aware of the psychological demands that the context of crisis entails in society.(AU)

La pandemia del covid-19 provocó que las universidades, que ya habían sido escenario de discusiones sobre la salud mental, experimentaran crisis más severas entre los estudiantes. Ante este escenario, se desarrolló el proyecto Escucha Solidaria, dirigido a la salud mental de estudiantes de grado y posgrado. Este artículo pretende discutir la atención psicológica en línea con estudiantes de Psicología durante el período de aislamiento social más estricto (mayo/junio de 2020). Se conformó un grupo focal con los psicólogos voluntarios orientado a la práctica de la atención psicológica en línea, a corto plazo, en el contexto de una pandemia. Se trata de un estudio cualitativo, realizado con 11 psicólogos clínicos que participaron en el mencionado proyecto. A partir del análisis fenomenológico crítico, los resultados se dividieron en cinco categorías: a) limitaciones y aportes del proyecto; b) importancia de la capacitación y la supervisión clínica para la calidad del proyecto; c) atención psicológica en línea; d) ser psicólogo clínico durante la crisis del covid-19; y e) demandas emergentes en atención psicológica en la cuarentena. Se concluye que es importante desmitificar la atención psicológica en situaciones de crisis, especialmente en la modalidad en línea, al promover principalmente preguntas sobre la formación y el desempeño de los profesionales con el fin de ser conscientes de las demandas psicológicas que el contexto de crisis conlleva la sociedad.(AU)

A hesitação vacinal contra a Covid-19 no Brasil a partir do discurso de quem hesita / Vaccine hesitancy against Covid-19 in Brazil based on the speech of those who hesitate

A emergência na produção de vacinas justifica-se devido ao número de óbitos provocados pela síndrome respiratória e a necessidade para que seja realizado o controle desses casos e suas formas graves. Em concomitância com o avanço da imunização da população, observou-se que o movimento social de Hesitação Vacinal (HV), caracterizado pela recusa ou atraso em aceitar a vacinação, tem tomado proporção mundial nos últimos anos, apoiando-se em questionamentos referentes principalmente sobre a eficácia e segurança dos imunizantes. Diante disso, ressalta-se a importância da discussão sobre individualidade versus coletividade e compreender as justificativas que estão associadas ao processo de HV da COVID-19. Este estudo tem por objetivo analisar o processo de HV contra a COVID-19 no Brasil, na perspectiva da visão de quem hesita. Trata-se de um estudo exploratório descritivo, de característica qualitativa, e abordagem por amostra não probabilística do tipo snowball (Bola de neve). A metodologia utiliza cadeias de referências para construir a sua população amostral, os sujeitos da pesquisa são indivíduos que tenham porventura hesitado em tomar qualquer um dos imunobiológicos contra a COVID-19 que atualmente são oferecidos pelo Programa Nacional de Imunização, serem maior de 18 anos, residirem no território geográfico do Rio Grande do Norte, e terem aceitado participar da pesquisa assinando o Termo de Consentimento Livre e Esclarecido ­ TCLE. Para a análise de conteúdo, utilizou-se a técnica do Discurso do Sujeito Coletivo, descrita por LEFEVRE & LEFEVRE, elaborada a partir da Teoria das Representações Sociais. Os resultados preliminares foram organizados de forma sistematizada, onde caracterizou-se socioeconomicamente os sujeitos participantes da pesquisa, foram elencadas categorias de acordo com o sentido das ideias centrais para compreender o indivíduo enquanto ser social a respeito do processo de hesitação vacinal da COVID-19, sendo elas: Vivências e experiências sobre a pandemia e a doença COVID-19; As percepções sobre da vacina a COVID-19 e vacinação; Justificativas associadas a hesitação vacinal contra a COVID-19 e outros fatores relacionados. Evidenciando achados a respeito dessas perspectivas, os principais apontamentos encontrados associados ao processo de hesitação vacinal se relacionam a motivos variados: imposição da imunização, desconfiança dos efeitos do imunobiológico, desinformação, medo das reações, teorias da conspiração, influência política e a infodemia. Portanto, sabendo que a escolha em se vacinar vai além de um critério individual, torna-se necessário que os formadores de políticas de saúde dialoguem sobre estratégias que reforcem a segurança, necessidade, eficácia e importância da vacina para todos (AU).

The emergence of vaccine production is justified by the number of deaths caused by the respiratory syndrome, and the need to control these cases and their severe forms. Concomitantly with the advancement of immunization of the population, it was observed that the social movement of vaccine hesitation characterized by refusal or delay in accepting vaccination has taken on worldwide proportions in recent years, based on questions referring mainly to the efficacy and safety of immunizers. In view of this, it is important to discuss individuality versus collectivity, and to understand the justifications that are associated with the COVID-19 vaccine hesitancy process. This study aims to analyze the vaccine hesitation process against COVID-19 in Brazil, from the perspective of those who hesitate. This is a descriptive exploratory study, with a qualitative characteristic, and a snowball-type non-probabilistic sample approach. The methodology uses chains of references to build its sample population research subjects will be individuals who may have hesitated to take any of the immunobiologicals against COVID-19 that are currently offered by the National Immunization Program, be over 18 years old, reside in the geographic territory of Rio Grande do Norte, and have accepted participate in the research by signing the Term of Free and Informed Consent ­ TCLE, the content analysis used the Collective Subject Discourse technique, described by LEFEVRE & LEFEVRE, based on the Theory of Social Representations. The preliminary results were organized in a systematic way, where the subjects participating in the research were socioeconomically characterized, we listed categories according to the meaning of the central ideas to understand the individual as a social being regarding the process of vaccine hesitation of COVID-19, being them: Experiences and experiences about the pandemic and the COVID-19 disease; Perceptions about the COVID-19 vaccine and vaccination; Justifications associated with vaccine hesitancy against COVID-19 and other related factors. Evidencing findings regarding these perspectives, the main notes found associated with the vaccine hesitation process are related to various reasons, namely: immunization imposition, distrust of the effects of immunobiologicals, misinformation, fear of reactions, conspiracy theories, political influence and the infodemic. Therefore, knowing that the choice to be vaccinated goes beyond an individual criterion, it becomes necessary for health policy makers to dialogue about strategies that reinforce the safety, need, efficacy and importance of the vaccine for everyone (AU).

Diversity and dynamics of bacterial communities in the drinking water distribution network of a mid-sized city in Brazil.

This study assessed the bacterial community composition of a drinking water system (DWS) serving a mid-sized city (120,000 inhabitants) in Brazil. Water samples, including raw and treated water, were collected at seven points throughout the DWS. DNA was extracted and analysed using high-throughput sequencing (Ion Torrent). Free chlorine and turbidity were measured in situ. Results showed that the highest relative abundance of 16S rRNA genes was from phyla Proteobacteria, followed by Bacteroidetes and Actinobacteria. The next most abundant phylum was Cyanobacteria, represented by Arthronema, Calothrix, and Synechococcus. An interesting observation was that the DNA-based analysis suggested a bacterial community change in the distribution network, with treated reservoir water being very different from the network samples. This suggests active microbiology within the distribution network and a tendency for bacterial diversity to decrease after chlorine disinfection but increase after pipeline distribution. In raw water, a predominance of Proteobacteria was observed with reduced Cyanobacteria, showing a negative correlation. In treated water, Proteobacteria were negatively correlated with Bacteroidetes. Finally, 16S rRNA genes from Firmicutes (especially Staphylococcus) had a high abundance in the chlorinated water, which may indicate the phylum's resistance to chlorine residuals. Opportunistic pathogens, e.g., Mycobacteria, Legionella, and Staphylococcus, were also observed.