Changes in splenic tissue and immune response profile of Schistosoma mansoni infected mice submitted to chronic ethanol intake.

In Schistosoma mansoni infection, the spleen is one of the organs affected, causing its enlargement (splenomegaly). Intake of ethanol through alcoholic beverages can cause spleen atrophy and interfere with immune activity. To gain knowledge of this association on the spleen and on the immune response profile, male mice were used as an experimental model. These animals were divided into four groups: C. control; EC. uninfected/ethanol gavage; I. infected; and IE. infected/ethanol gavage. Groups I and IE were infected with about 100 cercariae (BH strain) of S. mansoni and in the fifth week of infection, gavage 200 µL/day/animal of 18 % ethanol was started for 28 consecutive days. At the end of the gavage (9th week of infection) all animals were euthanized. The spleen was removed and longitudinally divided in two parts. After histological processing, the sections were stained with H&E and Gomori's Reticulin for histopathological and stereological analyses, white pulp morphometry and quantification of megakaryocytes. The other fragment was macerated (in laminar flow) and the cell suspension, after adjusting the concentration (2 × 106), was plated to obtain cytokines produced by spleen cells that were measured by flow cytometry (Citometric Bead Array). Histopathological and quantitative analyzes in the spleen of the IE group showed an increase in the number of trabeculae and megakaryocytes, a decrease in reticular fibers, as well as important organizational changes in the white pulp and red pulp. Due to the decrease in the levels of cytokines measured and the result of the calculation of the ratio between the IFN-y and IL-10 cytokines (p = 0.0079) of the infected groups, we suggest that ethanol decreased the inflammatory and anti-inflammatory response generated by the infection (group IE, the production of cytokines was significantly decreased (p < 0.01). These changes demonstrate that ethanol ingestion interferes with some parameters of experimental S. mansoni infection, such as changes in splenic tissue and in the pattern of cytokine production.

Impact of acute schistosomiasis mansoni and long-term ethanol intake on mouse liver pathology.

While the effect of ethanol and schistosomiasis mansoni on liver injury has been well-documented, the influence of comorbidity on liver pathology remains unclear. To address this gap, schistosomiasis-infected mice were given one daily dose of 18% ethanol for 28 consecutive days, from day 35 post-infection. Mice were assigned to four groups: A. control; B. uninfected/ethanol gavage; C. infected; and D. infected/ethanol gavage. At day 64 post-infection, mice were euthanized by CO2 asphyxiation, livers were excised, fixed in 10% buffered formalin, paraffin embedded and cut into 5 µm sections. These were stained with hematoxylin and eosin (HE), Lennert's Giemsa and picrosirius red (for polarization microscopy) to assess histopathological and stereological changes. Group B showed alcoholic liver disease (ALD), including microsteatosis, hepatocyte karyopyknosis, karyorrhexis, karyolysis, increased frequency of Kupffer cells, hydropic degeneration of hepatocyte, thickened plasma membrane and binucleated hepatocytes. Infected mice showed typical exudative and exudative-productive hepatic granulomas, and destruction of the adjacent hepatic parenchyma, resulting in necrotic tissue and periovular leukocyte infiltrate. Group D showed hyperemia (parenchymal panlobular lesions), and liquefactive necrosis in hepatic abscess area. There was also reduced liver collagen deposition (-76%; p = 0.0001) and reduced microsteatosis (-80%, p = 0.0079) compared to group C and group B, respectively. In conclusion, comorbidity exacerbated liver damage.

Co-circulation of Chikungunya Virus during the 2015-2017 Zika Virus Outbreak in Pernambuco, Brazil: An Analysis of the Microcephaly Epidemic Research Group Pregnancy Cohort.

Co-circulation of arthropod-borne viruses, particularly those with shared mosquito vectors like Zika (ZIKV) and Chikungunya (CHIKV), is increasingly reported. An accurate differential diagnosis between ZIKV and CHIKV is of high clinical importance, especially in the context of pregnancy, but remains challenging due to limitations in the availability of specialized laboratory testing facilities. Using data collected from the prospective pregnancy cohort study of the Microcephaly Epidemic Research Group, which followed up pregnant persons with rash during the peak and decline of the 2015-2017 ZIKV epidemic in Recife, Pernambuco, Brazil, this study aims to describe the geographic and temporal distribution of ZIKV and CHIKV infections and to investigate the extent to which ZIKV and CHIKV infections may be clinically differentiable. Between December 2015 and June 2017, we observed evidence of co-circulation with laboratory confirmation of 213 ZIKV mono-infections, 55 CHIKV mono-infections, and 58 sequential ZIKV/CHIKV infections (i.e., cases with evidence of acute ZIKV infection with concomitant serological evidence of recent CHIKV infection). In logistic regressions with adjustment for maternal age, ZIKV mono-infected cases had lower odds than CHIKV mono-infected cases of presenting with arthralgia (aOR, 99% CI: 0.33, 0.15-0.74), arthritis (0.35, 0.14-0.85), fatigue (0.40, 0.17-0.96), and headache (0.44, 0.19-1.90). However, sequential ZIKV/CHIKV infections complicated discrimination, as they did not significantly differ in clinical presentation from CHIKV mono-infections. These findings suggest clinical symptoms alone may be insufficient for differentiating between ZIKV and CHIKV infections during pregnancy and therefore laboratory diagnostics continue to be a valuable tool for tailoring care in the event of arboviral co-circulation.

Correlation between musculoskeletal pain and stress levels in teachers during the remote teaching period of the COVID-19 pandemic / Correlação entre dor musculoesquelética e níveis de estresse em professores durante o período de ensino remoto na pandemia de COVID-19

Abstract Introduction Remote teaching during the COVID-19 pandemic caused teachers to work under adverse conditions and sit in front of a computer rather than stand, which can lead to musculoskeletal pain and stress in this population. Objective To observe the prevalence of musculoskeletal pain and its correlation with stress levels in teachers during the remote teaching period of the COVID-19 pandemic. Methods A cross-sectional study carried out in elementary and high schools in the city of São José do Belmonte, Pernambuco state (PE). Sixty teachers of both sexes aged 18 years and older were evaluated. The Nordic Questionnaire of Musculoskeletal Symptoms (NQMS) was used to assess musculoskeletal pain, the Visual Analogue Scale to quantify pain intensity and the Maslach Burnout Inventory to identify symptoms of stress and burnout. Results Seventy five percent (n = 45) of the teachers reported musculoskeletal pain, with a higher prevalence in the lumbar spine 68.3% (n = 41), followed by the cervical spine 45.0% (n = 27),thoracic spine, wrists and hands, both with 41.7% (n = 25). A positive correlation was observed between the presence of musculoskeletal pain and high levels of occupational stress (p = 0.036). Conclusion A high prevalence of musculoskeletal pain was identified in teachers during the remote teaching period. The lumbar, cervical and thoracic spine, wrists and hands exhibited the highest pain prevalence. Teachers who experienced musculoskeletal pain had higher stress levels and there was a positive correlation between musculoskeletal pain intensity and high occupational stress levels.

Resumo Introdução O ensino remoto, ocorrido durante a pan-demia de COVID-19, levou os professores a trabalharem em condições adversas e modificou a postura em que eles ensinavam, passando da posição ortostática para a sentada diante de um computador, o que pode favorecer a presença de dores musculoesqueléticas e estresse. Objetivo Observar a prevalência de dor musculoesquelética e sua correlação com níveis de estresse em professores durante o ensino remoto na pandemia de COVID-19. Métodos Estudo de corte transversal realizado em escolas do ensino fundamental e médio do município de São José do Belmonte, em Pernambuco. Foram avaliados 60 professores, de ambos os sexos e faixa etária acima dos 18 anos. Para avaliar a presença de dores musculoesqueléticas, utilizou-se o N ordic Questionnaire of Musculoskeletal Symptoms ; para quantificar a intensidade das dores, a Escala Visual Analógica; e para identificar sintomas de estresse e esgotamento profissional, o Maslach Burnout Inventory . Resultados Setenta e cinco por cento (n = 45) dos professores avaliados apresentavam dores musculo-esqueléticas, com maior prevalência na coluna lombar (68,3%, n = 41), seguida pela coluna cervical (45,0%,n = 27), coluna torácica, punhos e mãos, ambos com (41,7%, n = 25). Observou-se também uma correlação positiva entre a presença de dor musculoesquelética e níveis elevados de estresse ocupacional nos professores avaliados (p = 0,036). Conclusão Observou-se uma elevada prevalência de dor musculoesquelética nos professores durante o período de ensino remoto. A coluna lombar, cervical, torácica, punhos e mãos foram as regiões com maior prevalência das dores. Os professores que apresentavam dor musculoesquelética relataram maiores níveis de estresse e houve uma correlação positiva entre a intensidade da dor musculoesquelética e níveis elevados de estresse ocupacional.

Neighbourhood-level income and Zika virus infection during pregnancy in Recife, Pernambuco, Brazil: an ecological perspective, 2015-2017.

Zika virus (ZIKV) infections during pregnancy can lead to adverse neurodevelopmental and clinical outcomes in congenitally infected offspring. As the city of Recife in Pernambuco State, Brazil-the epicentre of the Brazilian microcephaly epidemic-has considerable disparities in living conditions, this study used an ecological approach to investigate the association between income at the neighbourhood level and the risk of ZIKV infections in pregnant individuals between December 2015 and April 2017. The spatial distribution of pregnant individuals with ZIKV infection was plotted on a map of Recife stratified into four categories based on mean monthly income of household heads. Additionally, a Poisson regression model with robust variance was fitted to compare proportions of ZIKV infections among pregnant individuals in relation to the mean monthly income of household heads, based on the 2010 census data, across 94 neighbourhoods in Recife. The results provide evidence that the risk of ZIKV infection to pregnant individuals was higher among those residing in lower-income neighbourhoods: relative to neighbourhoods that had a mean monthly income of ≥5 times minimum wage, neighbourhoods with <1 and 1 to <2 times minimum wage had more than four times the risk (incidence rate ratio, 95% CI 4.08, 1.88 to 8.85 and 4.30, 2.00 to 9.20, respectively). This study provides evidence of a strong association between neighbourhood-level income and ZIKV infection risks in the pregnant population of Recife. In settings prone to arboviral outbreaks, locally targeted interventions to improve living conditions, sanitation, and mosquito control should be a key focus of governmental interventions to reduce risks associated with ZIKV infections during pregnancy.

Zika-related adverse outcomes in a cohort of pregnant women with rash in Pernambuco, Brazil.

BACKGROUND: While Zika virus (ZIKV) is now widely recognized as a teratogen, the frequency and full spectrum of adverse outcomes of congenital ZIKV infection remains incompletely understood. METHODS: Participants in the MERG cohort of pregnant women with rash, recruited from the surveillance system from December/2015-June/2017. Exposure definition was based on a combination of longitudinal data from molecular, serologic (IgM and IgG3) and plaque reduction neutralization tests for ZIKV. Children were evaluated by a team of clinical specialists and by transfontanelle ultrasound and were classified as having microcephaly and/or other signs/symptoms consistent with congenital Zika syndrome (CZS). Risks of adverse outcomes were quantified according to the relative evidence of a ZIKV infection in pregnancy. FINDINGS: 376 women had confirmed and suspected exposure to ZIKV. Among evaluable children born to these mothers, 20% presented with an adverse outcome compatible with exposure to ZIKV during pregnancy. The absolute risk of microcephaly was 2.9% (11/376), of calcifications and/or ventriculomegaly was 7.2% (13/180), of additional neurologic alterations was 5.3% (13/245), of ophthalmologic abnormalities was 7% (15/214), and of dysphagia was 1.8% (4/226). Less than 1% of the children experienced abnormalities across all of the domains simultaneously. Interpretation: Although approximately one-fifth of children with confirmed and suspected exposure to ZIKV in pregnancy presented with at least one abnormality compatible with CZS, the manifestations presented more frequently in isolation than in combination. Due to the rare nature of some outcomes and the possibility of later manifestations, large scale individual participant data meta-analysis and the long-term evaluation of children are imperative to identify the full spectrum of this syndrome and to plan actions to reduce damages.

Analysis of the prevalence of musculoskeletal disorders and occupational stress in professors of a higher education institution in the state of Pernambuco.

INTRODUCTION: The consequences of technological innovations and current ways of work organization have prompted the appearance of various health conditions, namely repetitive strain disorders, work-related musculoskeletal disorders, and burn-out; these can emotionally and physically overload workers. OBJECTIVES: To evaluate the prevalence of musculoskeletal disorders and occupational stress in professors of the Serra Talhada campus of Instituto Federal do Sertão Pernambucano. METHODS: Participants signed a free and informed consent form and answered to the Nordic Musculoskeletal Questionnaire. Subsequently, we applied the Maslach Burnout Inventory-Human Services Survey and evaluated the participants' postures during teaching by using the Rapid Upper Limb Assessment tool (Ergolândia software). RESULTS: We observed that 82% of the participants presented musculoskeletal symptoms, mainly in the lower back and lower limbs. Professors presented high scores for the burn-out syndrome, and posture evaluation indicated action levels of 3-4 (suggesting immediate intervention). CONCLUSIONS: The implementation of an occupational physical therapist in this higher education institution is recommended in order to promote ergonomic adaptations and to elaborate a protocol for workplace physical activity, ultimately aiming to prevent musculoskeletal disorders and occupational stress.

Effects of multiple doses of simvastatin and artesunate monotherapy on SCHISTOSOMA MANSONI adult worms during infection in hyperlidemic mice / Efectos de múltiples dosis de simvastatina y artesunato en monoterapia en gusanos adultos de SCHISTOSOMA MANSONI durante la infección en ratones hiperlidémicos / Efeitos de doses múltiplas de monoterapia com sinvastatina e artesunato em vermes adultos SCHISTOSOMA MANSONI durante a infecção em camundongos hiperlidêmicos

A single dose of simvastatin and of artesunate monotherapy cause damage to the reproductive system of schistosomes as well as severe tegumental damage in male worms recovered from mice fed high-fat chow. This study aims to investigate whether treatment with multipledose regimes may offer more antischistosomal activity advantages than single daily dosing in mice fed high-fat chow. For this purpose, nine weeks post-infection, Swiss Webster mice were gavaged with simvastatin (200 mg/kg) or artesunate (300 mg/kg) for five consecutive days and euthanized two weeks post-treatment. Adult worms were analyzed using brightfield microscopy, confocal microscopy and scanning electron microscopy, presenting damages caused by simvastatin and artesunate to the reproductive system of males and females as well as tegument alterations, including peeling, sloughing areas, loss of tubercles, tegumental bubbles and tegument rupture exposing subtegumental tissue. The overall findings in this study revealed the potential antischistosomal activity of simvastatin and artesunate against Schistosoma mansoni adult worms, in addition to showing that multiple doses of either monotherapy caused severe damage to the tegument.

Una sola dosis de simvastatina y de artesunato en monoterapia causa daño al sistema reproductivo de los esquistosomas, así como daño tegumental severo en gusanos machos recuperados de ratones alimentados con comida rica en grasas. Este estudio tiene como objetivo investigar si el tratamiento con regímenes de dosis múltiples puede ofrecer más ventajas de actividad antiesquistosomal que la dosis única diaria en ratones alimentados con comida rica en grasas. Para este propósito, nueve semanas después de la infección, los ratones Swiss Webster se alimentaron por sonda con simvastatina (200 mg / kg) o artesunato (300 mg / kg) durante cinco días consecutivos y se sacrificaron dos semanas después del tratamiento. Los gusanos adultos se analizaron utilizando campo claro microscopía, microscopía confocal y microscopía electrónica de barrido, presentando daños causados ​​por simvastatina y artesunato en el sistema reproductivo de machos y hembras, así como alteraciones del tegumento, incluyendo descamación, desprendimiento, pérdida de tubérculos, burbujas tegumentales y rotura del tegumento exponiendo tejido subtegumental. Los hallazgos generales de este estudio revelaron la posible actividad antiesquistosomal de la simvastatina y el artesunato contra los gusanos adultos de Schistosoma mansoni, además de mostrar que dosis múltiples de cualquiera de las dos monoterapia causaron daños graves al tegumento.

Uma única dose de sinvastatina e de monoterapia com artesunato causa danos ao sistema reprodutivo dos esquistossomos, bem como danos graves ao tegumento em vermes machos recuperados de camundongos alimentados com ração rica em gordura. Este estudo tem como objetivo investigar se o tratamento com regimes de múltiplas doses pode oferecer mais vantagens da atividade anti-esquistossomótica do que uma única dose diária em ratos alimentados com ração rica em gordura. Para tanto, nove semanas após a infecção, camundongos Swiss Webster foram inoculados com sinvastatina (200 mg / kg) ou artesunato (300 mg / kg) por cinco dias consecutivos e sacrificados duas semanas após o tratamento. Vermes adultos foram analisados ​​usando campo claro microscopia, microscopia confocal e microscopia eletrônica de varredura, apresentando danos causados ​​pela sinvastatina e artesunato ao sistema reprodutivo de homens e mulheres, bem como alterações do tegumento, incluindo descamação, áreas de descamação, perda de tubérculos, bolhas tegumentais e ruptura do tegumento com exposição de tecido subtegumentar. Os achados gerais deste estudo revelaram a potencial atividade anti-esquistossomótica da sinvastatina e do artesunato contra vermes adultos do Schistosoma mansoni, além de mostrar que doses múltiplas de ambas as monoterapias causaram danos graves ao tegumento.

[Challenges to Performance Management: logical analysis of an Evaluation Policy in Health Surveillance]. / Desafios à Gestão do Desempenho: análise lógica de uma Política de Avaliação na Vigilância em Saúde.

Acknowledging the contributions of the assessment area in supporting the performance of health policies, is to admit it in an ongoing and permanent way in the management context. This requires a set of procedures that go beyond monitoring and evaluation practices, known as performance management. The goal of this study was to analyze the logic of the Health Surveillance (HS) Evaluation Policy of Pernambuco, comparing it with the corresponding Canadian policy. For this purpose, a qualitative study of logical analysis of the program theory was carried out, using as a tool the design of the logical model of performance management and its respective matrix of analysis and judgment with the criteria to be evaluated. In HS, 9 key-informants were interviewed, and documents were analyzed; the Canadian model was analyzed based on a paper written by Lahey (2010). Both policies analyzed by this study are convergent and have the necessary elements for performance management. While the evaluation featured largely in the Canadian model, monitoring was the driving force behind the institutionalization of assessment practices in HS. Some lessons learned in the Canadian model can be recommended, such as the development of an assessment plan, based on the strategic and decision-making level of HS.

Reconhecer as contribuições da área de avaliação no suporte ao desempenho das políticas de saúde, é admiti-la de forma contínua e permanente no contexto da gestão. Isso requer um conjunto de procedimentos, para além das práticas de monitoramento e avaliação, denominado gestão do desempenho. O objetivo desse estudo foi analisar a lógica da Política de Avaliação da Vigilância em Saúde (VS) de Pernambuco, comparando-a com a Política canadense correspondente. Para tal, foi realizado um estudo qualitativo, análise lógica da teoria do programa, utilizando-se como ferramenta o desenho do modelo lógico da gestão do desempenho, e sua respectiva matriz de análise e julgamento com os critérios a serem avaliados. Na VS, foram entrevistados 9 informantes-chave e analisados documentos; o modelo canadense foi analisado com base em um documento produzido por Lahey (2010). As duas políticas estudadas são convergentes, possuindo os elementos necessários à gestão do desempenho. Porém, enquanto a avaliação teve destaque no modelo canadense, o monitoramento constituiu-se o eixo condutor da institucionalização das práticas avaliativas na VS. Algumas lições aprendidas no modelo canadense podem ser recomendadas, como o desenvolvimento de um plano de avaliação, pautado no nível estratégico e decisor da VS.

The first hundred days of COVID-19 in Pernambuco State, Brazil: epidemiology in historical context. / Cem dias de COVID-19 em Pernambuco, Brasil: a epidemiologia em contexto histórico.

The timeline of the COVID-19 pandemic began on December 31, 2019, in China, with SARS-CoV-2 identified as the etiological agent. This article aims to describe the COVID-19 epidemic's spatial and temporal dynamics in the first hundred days in the State of Pernambuco, Brazil. We present the evolution in cases and deaths according to epidemiological weeks. We analyzed the series of accumulated daily confirmed COVID-19 cases, with projections for the subsequent 15 days, using the JoinPoint app. This software allows identifying turning points, testing their statistical significance. We also analyze the trend in the spread of COVID-19 to the interior of the state, considering the percent distribution of cases in the state capital, Recife, municipalities in Greater Metropolitan Recife, and the state's interior, by sets of three weeks, constructing thematic maps. The first hundred days of the COVID-19 epidemic resulted in 52,213 cases and 4,235 deaths from March 12, or epidemiological week 11, until June 20, 2020 (epidemiological week 25). The peak in the epidemic curve occurred in epidemiological week 21 (May 23), followed by deceleration in the number of cases. We initially detected the spread of cases from the city center to the periphery of the state capital and Metropolitan Area, followed by rapid spread to the state's interior. There was a decrease in the mean daily growth starting in April, but with an average threshold of more than 6,000 weekly cases of COVID-19. At the end of the period, the state's case series indicates the persistence of SARS-CoV-2 circulation and community transmission. Finally, paraphrasing Gabriel Garcia Marques in One Hundred Years of Solitude, we ask whether we are facing "a pause in the storm or a sign of redoubled rain".

A pandemia de COVID-19 iniciou sua linha do tempo em 31 de dezembro de 2019 na China e o SARS-CoV-2 identificado como agente etiológico. O objetivo deste manuscrito é descrever a dinâmica espacial e temporal da epidemia de COVID-19 nos primeiros cem dias, no Estado de Pernambuco, Brasil. Apresentamos a evolução de casos e óbitos segundo semana epidemiológica. Realizamos a análise da série do acumulado diário de casos da COVID-19 confirmados, com projeções para os 15 dias subsequentes, utilizando o aplicativo JoinPoint. Esse programa possibilita identificar pontos de inflexão testando sua significância estatística. Analisamos também a tendência de interiorização da COVID-19 no estado, considerando a distribuição percentual de casos ocorridos no Recife, municípios da Região Metropolitana de Recife e do interior, por conjuntos de três semanas, com construção de mapas temáticos. Os 100 dias da epidemia de COVID-19 resultaram em 52.213 casos e 4.235 óbitos entre 12 de março, correspondendo se 11, até 20 de junho de 2020 (semana epidemiológica 25). O pico da curva epidêmica ocorreu na semana epidemiológica 21 (23 de maio), seguido por desaceleração do número de casos. Detectou-se, inicialmente, a periferização dos casos na capital e região metropolitana, seguida por rápida disseminação para o interior do estado. Houve redução das taxas de crescimento médio diário a partir de abril, mas com patamar de mais de 6.000 casos semanais de COVID-19, em média. Ao final do período, a série de casos do estado indica persistência da circulação e transmissão comunitária do SARS-CoV-2. Finalmente, questiona-se parafraseando Garcia Marques em Cem Anos de Solidão, se estaríamos diante de "uma estiagem ou prenúncio de recrudescimento".

La pandemia de COVID-19 inicia su línea del tiempo el 31 de dicembre de 2019 en China y el SARS-CoV-2 identificado como agente etiológico. El objetivo de este trabajo original es describir la dinámica espacial y temporal de la epidemia de COVID-19 en los primeros cien días de epidemia, en el estado de Pernambuco, Brasil. Presentamos la evolución de casos y óbitos según las semanas epidemiológicas. Realizamos el análisis de la serie del acumulado diario de casos de COVID-19 confirmados, con proyecciones para los 15 días subsiguientes, utilizándose la aplicación JoinPoint. Este programa posibilita identificar puntos de inflexión, probando su significancia estadística. Analizamos también la tendencia de interiorización de la COVID-19 en el estado, considerándose la distribución porcentual de casos ocurridos en Recife, municipios de la Región Metropolitana de Recife y del interior, por conjuntos de tres semanas, con unas construcciones de mapas temáticos. Los cien días de la epidemia de COVID-19 resultaron en 52.213 casos y 4.235 óbitos entre el 12 de marzo, correspondiendo a la semana epidemiológica 11, hasta el 20 de juno de 2020 (semana epidemiológica 25). El pico de la curva epidémica ocurrió en la semana epidemiológica 21 (23 de mayo), seguido de una desaceleración en el número de casos. Se detectó, inicialmente, la periferización de los casos en la capital y región metropolitana, seguido por la rápida diseminación hacia el interior del estado. Hubo una reducción de las tasas de crecimiento medio diario a partir de abril, pero con un nivel de más de 6.000 casos semanales de COVID-19 de media. Al final del período la serie de casos del estado indica la persistencia de la circulación y transmisión comunitaria del SARS-CoV-2. Finalmente, se cuestiona, parafraseando a García Márquez en Cien Años de Soledad, si estamos ante "un periodo de remisión o la antesala de un recrudecimiento".

Desafios à Gestão do Desempenho: análise lógica de uma Política de Avaliação na Vigilância em Saúde / Challenges to Performance Management: logical analysis of an Evaluation Policy in Health Surveillance

Resumo Reconhecer as contribuições da área de avaliação no suporte ao desempenho das políticas de saúde, é admiti-la de forma contínua e permanente no contexto da gestão. Isso requer um conjunto de procedimentos, para além das práticas de monitoramento e avaliação, denominado gestão do desempenho. O objetivo desse estudo foi analisar a lógica da Política de Avaliação da Vigilância em Saúde (VS) de Pernambuco, comparando-a com a Política canadense correspondente. Para tal, foi realizado um estudo qualitativo, análise lógica da teoria do programa, utilizando-se como ferramenta o desenho do modelo lógico da gestão do desempenho, e sua respectiva matriz de análise e julgamento com os critérios a serem avaliados. Na VS, foram entrevistados 9 informantes-chave e analisados documentos; o modelo canadense foi analisado com base em um documento produzido por Lahey (2010). As duas políticas estudadas são convergentes, possuindo os elementos necessários à gestão do desempenho. Porém, enquanto a avaliação teve destaque no modelo canadense, o monitoramento constituiu-se o eixo condutor da institucionalização das práticas avaliativas na VS. Algumas lições aprendidas no modelo canadense podem ser recomendadas, como o desenvolvimento de um plano de avaliação, pautado no nível estratégico e decisor da VS.

Abstract Acknowledging the contributions of the assessment area in supporting the performance of health policies, is to admit it in an ongoing and permanent way in the management context. This requires a set of procedures that go beyond monitoring and evaluation practices, known as performance management. The goal of this study was to analyze the logic of the Health Surveillance (HS) Evaluation Policy of Pernambuco, comparing it with the corresponding Canadian policy. For this purpose, a qualitative study of logical analysis of the program theory was carried out, using as a tool the design of the logical model of performance management and its respective matrix of analysis and judgment with the criteria to be evaluated. In HS, 9 key-informants were interviewed, and documents were analyzed; the Canadian model was analyzed based on a paper written by Lahey (2010). Both policies analyzed by this study are convergent and have the necessary elements for performance management. While the evaluation featured largely in the Canadian model, monitoring was the driving force behind the institutionalization of assessment practices in HS. Some lessons learned in the Canadian model can be recommended, such as the development of an assessment plan, based on the strategic and decision-making level of HS.

Monitoramento do Desempenho da Gestão da Vigilância em Saúde: análise dos usos e da influência / Monitoring of Health Surveillance Management Performance: analysis of uses and influence

RESUMO O monitoramento e a avaliação vêm despontando crescente interesse nas organizações de saúde. Para que esses processos possam qualificar o desempenho, faz-se necessário analisar sua utilidade. Recorreu-se à experiência de Monitoramento do Desempenho da Gestão da Vigilância em Saúde (MDGVS), proposto pela Secretaria Estadual de Saúde do Estado de Pernambuco. O objetivo foi o de analisar fatores dificultadores e facilitadores do uso e influência, baseados nas dimensões de credibilidade, pertinência, fundamentação teórica e capacidade institucional. Trata-se de estudo exploratório, cujos dados foram coletados por meio de entrevistas semiestruturadas com 21 informantes-chave, além de revisão de documentos. Calcularam-se a média e o respectivo desvio padrão das categorias de análise, revelando boa incorporação do monitoramento, com sua contribuição na aprendizagem organizacional. O processo não só apresentou legitimidade como está integrado à agenda política da Vigilância em Saúde. Por outro lado, houve ênfase nas fragilidades como: dificuldades de integração e na divulgação externa dos resultados.

ABSTRACT Health Organizations have showed increasing interest in monitoring and evaluation. In order for these processes to comply performance qualification, it is necessary to analyze its value. The experience of Monitoring the Health Surveillance Management Performance (MDGVS) proposed by the State Health Department of Pernambuco was applied. The goal was to analyze factors that hinder and facilitate the use and influence by adopting the dimensions credibility, pertinence, theoretical framework and institutional capacity. It's an exploratory study whose data were collected by means of semi-structured interviews with 21 key informants, as well as by means of the review of documents. The average and the standard deviation for each analysis category were calculated, showing a good monitoring incorporation and its contribution to organizational learning. The process presented legitimacy, being integrated into the HS political agenda. On the other hand, there was an emphasis on weaknesses, difficulties of integration, and external dissemination of results.

Spatiotemporal Analysis of the Population Risk of Congenital Microcephaly in Pernambuco State, Brazil.

Since an outbreak in Brazil, which started in 2015, Zika has been recognized as an important cause of microcephaly. The highest burden of this outbreak was in northeast Brazil, including the state of Pernambuco. The prevalence of congenital microcephaly in Pernambuco state was estimated from the RESP (Registro de Eventos em Saúde Pública) surveillance system, from August 2015 to August 2016 inclusive. The denominators were estimated at the municipality level from official demographic data. Microcephaly was defined as a neonatal head circumference below the 3rd percentile of the Intergrowth standards. Smoothed maps of the prevalence of microcephaly were obtained from a Bayesian model which was conditional autoregressive (CAR) in space, and first order autoregressive in time. A total of 742 cases were identified. Additionally, high and early occurrences were identified in the Recife Metropolitan Region, on the coast, and in a north-south band about 300 km inland. Over a substantial part of the state, the overall prevalence, aggregating over the study period, was above 0.5%. The reasons for the high occurrence in the inland area remain unclear.

Cem dias de COVID-19 em Pernambuco, Brasil: a epidemiologia em contexto histórico / Cien días de COVID-19 en Pernambuco, Brasil: la epidemiología en contexto histórico / The first hundred days of COVID-19 in Pernambuco State, Brazil: epidemiology in historical context

Resumo: A pandemia de COVID-19 iniciou sua linha do tempo em 31 de dezembro de 2019 na China e o SARS-CoV-2 identificado como agente etiológico. O objetivo deste manuscrito é descrever a dinâmica espacial e temporal da epidemia de COVID-19 nos primeiros cem dias, no Estado de Pernambuco, Brasil. Apresentamos a evolução de casos e óbitos segundo semana epidemiológica. Realizamos a análise da série do acumulado diário de casos da COVID-19 confirmados, com projeções para os 15 dias subsequentes, utilizando o aplicativo JoinPoint. Esse programa possibilita identificar pontos de inflexão testando sua significância estatística. Analisamos também a tendência de interiorização da COVID-19 no estado, considerando a distribuição percentual de casos ocorridos no Recife, municípios da Região Metropolitana de Recife e do interior, por conjuntos de três semanas, com construção de mapas temáticos. Os 100 dias da epidemia de COVID-19 resultaram em 52.213 casos e 4.235 óbitos entre 12 de março, correspondendo se 11, até 20 de junho de 2020 (semana epidemiológica 25). O pico da curva epidêmica ocorreu na semana epidemiológica 21 (23 de maio), seguido por desaceleração do número de casos. Detectou-se, inicialmente, a periferização dos casos na capital e região metropolitana, seguida por rápida disseminação para o interior do estado. Houve redução das taxas de crescimento médio diário a partir de abril, mas com patamar de mais de 6.000 casos semanais de COVID-19, em média. Ao final do período, a série de casos do estado indica persistência da circulação e transmissão comunitária do SARS-CoV-2. Finalmente, questiona-se parafraseando Garcia Marques em Cem Anos de Solidão, se estaríamos diante de "uma estiagem ou prenúncio de recrudescimento".

Resumen: La pandemia de COVID-19 inicia su línea del tiempo el 31 de dicembre de 2019 en China y el SARS-CoV-2 identificado como agente etiológico. El objetivo de este trabajo original es describir la dinámica espacial y temporal de la epidemia de COVID-19 en los primeros cien días de epidemia, en el estado de Pernambuco, Brasil. Presentamos la evolución de casos y óbitos según las semanas epidemiológicas. Realizamos el análisis de la serie del acumulado diario de casos de COVID-19 confirmados, con proyecciones para los 15 días subsiguientes, utilizándose la aplicación JoinPoint. Este programa posibilita identificar puntos de inflexión, probando su significancia estadística. Analizamos también la tendencia de interiorización de la COVID-19 en el estado, considerándose la distribución porcentual de casos ocurridos en Recife, municipios de la Región Metropolitana de Recife y del interior, por conjuntos de tres semanas, con unas construcciones de mapas temáticos. Los cien días de la epidemia de COVID-19 resultaron en 52.213 casos y 4.235 óbitos entre el 12 de marzo, correspondiendo a la semana epidemiológica 11, hasta el 20 de juno de 2020 (semana epidemiológica 25). El pico de la curva epidémica ocurrió en la semana epidemiológica 21 (23 de mayo), seguido de una desaceleración en el número de casos. Se detectó, inicialmente, la periferización de los casos en la capital y región metropolitana, seguido por la rápida diseminación hacia el interior del estado. Hubo una reducción de las tasas de crecimiento medio diario a partir de abril, pero con un nivel de más de 6.000 casos semanales de COVID-19 de media. Al final del período la serie de casos del estado indica la persistencia de la circulación y transmisión comunitaria del SARS-CoV-2. Finalmente, se cuestiona, parafraseando a García Márquez en Cien Años de Soledad, si estamos ante "un periodo de remisión o la antesala de un recrudecimiento".

Abstract: The timeline of the COVID-19 pandemic began on December 31, 2019, in China, with SARS-CoV-2 identified as the etiological agent. This article aims to describe the COVID-19 epidemic's spatial and temporal dynamics in the first hundred days in the State of Pernambuco, Brazil. We present the evolution in cases and deaths according to epidemiological weeks. We analyzed the series of accumulated daily confirmed COVID-19 cases, with projections for the subsequent 15 days, using the JoinPoint app. This software allows identifying turning points, testing their statistical significance. We also analyze the trend in the spread of COVID-19 to the interior of the state, considering the percent distribution of cases in the state capital, Recife, municipalities in Greater Metropolitan Recife, and the state's interior, by sets of three weeks, constructing thematic maps. The first hundred days of the COVID-19 epidemic resulted in 52,213 cases and 4,235 deaths from March 12, or epidemiological week 11, until June 20, 2020 (epidemiological week 25). The peak in the epidemic curve occurred in epidemiological week 21 (May 23), followed by deceleration in the number of cases. We initially detected the spread of cases from the city center to the periphery of the state capital and Metropolitan Area, followed by rapid spread to the state's interior. There was a decrease in the mean daily growth starting in April, but with an average threshold of more than 6,000 weekly cases of COVID-19. At the end of the period, the state's case series indicates the persistence of SARS-CoV-2 circulation and community transmission. Finally, paraphrasing Gabriel Garcia Marques in One Hundred Years of Solitude, we ask whether we are facing "a pause in the storm or a sign of redoubled rain".

Long-term ethanol intake causes morphological changes in Schistosoma mansoni adult worms in mice.

Schistosoma mansoni adult worms are extensively challenged by reactive oxygen species from intrinsic sources. However, the effects of extrinsic sources such as ethanol have not been looked at in schistosomes. We examined adult worms recovered from ethanol-consuming mice by light (LM), confocal (CM) and scanning electron microscopy (SEM) to address this question. Schistosomiasis-infected mice were orally gavaged with 18% (v/v) ethanol from 35 to 63 days post-infection, when they were euthanized. CM examination revealed reduced germ cells density (-36%, p = 0.0001) and sperm density (-58%, p = 0.0001) in testicular lobes, and immature cells in seminal vesicle compared to unexposed control worms. Female worms showed reduced density of vitellin glands (-71%, p = 0.0001), maturation of oocytes (-7%, p = 0.0071) and reduced spermatozoa density (-23%, p = 0.0002) within the seminal receptacle. SEM revealed remarkable damages in male's tegument, including tubercles flattening, tegumental peeling and erosive lesions. Given that lipids are present in reproductive system and tegument, our results suggest that phenotypic changes are due to ethanol-induced lipid peroxidation. To the best of our knowledge, this is the first report revealing the biological action of ethanol intake on adult schistosomes in vivo.

Avaliação da influência da idade do abate no rendimento e na qualidade da carne de frangos da raça tricolor / Evaluation of the influence of slaughter age on the yield and quality of the meat of tricolor chickens

Este trabalho se propôs verificar a influência do tempo de abate nas características de qualidade da carne e no rendimento de carcaça e cortes em aves caipiras da raça Tricolor. Foi aplicado um delineamento experimental em blocos inteiramente casualizados com 3 tratamentos (60, 75 e 90 dias de abate) e 4 repetições, totalizando 12 unidades experimentais. As variáveis de peso vivo, peso da carcaça, peso dos cortes, rendimento de carcaça e rendimento de peito e coxa não apresentaram diferenças entre os três tratamentos avaliados, com exceção do rendimento de sobrecoxa que foi superior nos animais abatidos aos 90 dias. A capacidade de retenção de água não foi influenciada pela idade de abate, porém foi observada uma maior perda de água por cocção na carne de peito e sobrecoxa aos 90 dias. Embora a idade de abate não tenha influenciado no desenvolvimento corporal dos frangos da linhagem tricolor (TRC), a mesma teve efeito sobre algumas características qualitativas da carne e rendimento da sobrecoxa.

Translação do Conhecimento na qualificação da gestão da Vigilância em Saúde: contribuição dos estudos avaliativos de pós-graduação / Knowledge Translation in qualification of Health Surveillance management: contribution of postgraduate evaluative studies

Resumo São muitos os desafios no sentido de minimizar as lacunas existentes entre evidências científicas e melhores resultados de saúde. A translação do conhecimento (TC) é o movimento que o conhecimento faz em um contexto organizacional em prol da sua efetiva aplicação. O objetivo deste estudo foi analisar a ocorrência da TC na Secretaria Executiva de Vigilância em Saúde de Pernambuco (SEVS/PE), tomando como objeto dez pesquisas avaliativas sobre programas da Vigilância em Saúde, produzidas no Mestrado de Avaliação em Saúde do Instituto de Medicina Integral Prof. Fernando Figueira, de 2011 a 2015. Para tanto, utilizou-se um roteiro de entrevista semiestruturada, abordando sete gestores e dez técnicos da SEVS-PE. Na análise deste estudo de caso, qualitativo, foi utilizado um modelo de TC, e sobrepondo-se a ele, uma estrutura teórica de uso-influência da avaliação. Em oito pesquisas analisadas, foram categorizadas evidências em cinco fases da TC. Apenas a etapa de avaliação do uso do conhecimento não foi evidenciada. Diferentes tipos de uso, dimensões e níveis de influência das avaliações foram relatados. Dentre as mudanças ocorridas, foram relatadas: criação de novas agendas, elaboração de protocolos, mudança do processo de trabalho, instituição de novos fluxos, contratação de novos profissionais.

Abstract There are many challenges in minimizing the gaps between scientific evidence and better health outcomes. The translation of knowledge (TC) is the movement that knowledge makes in an organizational context in favor of its effective application. This study aimed to analyze the occurrence of CT in the Executive Secretariat of Health Surveillance of Pernambuco (SEVS / PE), focusing on 10 evaluative surveys on Health Surveillance programs, produced in the Master's Degree in Health Evaluation of the Institute of Comprehensive Medicine Prof. Fernando Figueira, from 2011 to 2015. For this purpose, a semi-structured interview script was used, addressing 7 managers and 10 SEVS-PE technicians. In the analysis of this qualitative case study, a CT model was used, and overlapping it, a theoretical structure of use-influence of the evaluation. In eight studies analyzed, evidence was categorized into five phases of CT. Only the evaluation stage of the use of knowledge was not evidenced. Different types of use, dimensions and influence levels of the evaluations were reported. Among the changes occurred, the following were reported: creation of new agendas, elaboration of protocols, change of work process, creation of new flows, hiring of new professionals.

Microcephaly epidemic related to the Zika virus and living conditions in Recife, Northeast Brazil.

BACKGROUND: Starting in August 2015, there was an increase in the number of cases of neonatal microcephaly in Northeast Brazil. These findings were identified as being an epidemic of microcephaly related to Zika virus (ZIKV) infection. The present study aims to analyse the spatial distribution of microcephaly cases in Recife (2015-2016), which is in Northeast Brazil, and its association with the living conditions in this city. METHODS: This was an ecological study that used data from reported cases of microcephaly from the State Health Department of Pernambuco (August 2015 to July 2016). The basic spatial unit of analysis was the 94 districts of Recife. The case definition of microcephaly was: neonates with a head circumference of less than the cut-off point of -2 standard deviations below the mean value from the established Fenton growth curve. As an indicator of the living conditions of the 94 districts, the percentage of heads of households with an income of less than twice the minimum wage was calculated. The districts were classified into four homogeneous strata using the K-means clustering algorithm. We plotted the locations of each microcephaly case over a layer of living conditions. RESULTS: During the study period, 347 microcephaly cases were reported, of which 142 (40.9%) fulfilled the definition of a microcephaly case. Stratification of the 94 districts resulted in the identification of four strata. The highest stratum in relation to the living conditions presented the lowest prevalence rate of microcephaly, and the overall difference between this rate and the rates of the other strata was statistically significant. The results of the Kruskal-Wallis test demonstrated that there was a strong association between a higher prevalence of microcephaly and poor living conditions. After the first 6 months of the study period, there were no microcephaly cases recorded within the population living in the richest socio-economic strata. CONCLUSION: This study showed that those residing in areas with precarious living conditions had a higher prevalence of microcephaly compared with populations with better living conditions.

Association between microcephaly, Zika virus infection, and other risk factors in Brazil: final report of a case-control study.

BACKGROUND: A Zika virus epidemic emerged in northeast Brazil in 2015 and was followed by a striking increase in congenital microcephaly cases, triggering a declaration of an international public health emergency. This is the final report of the first case-control study evaluating the potential causes of microcephaly: congenital Zika virus infection, vaccines, and larvicides. The published preliminary report suggested a strong association between microcephaly and congenital Zika virus infection. METHODS: We did a case-control study in eight public maternity hospitals in Recife, Brazil. Cases were neonates born with microcephaly, defined as a head circumference of 2 SD below the mean. Two controls without microcephaly were matched to each case by expected date of delivery and area of residence. We tested the serum of cases and controls and the CSF of cases for detection of Zika virus genomes with quantitative RT-PCR and for detection of IgM antibodies with capture-IgM ELISA. We also tested maternal serum with plaque reduction neutralisation assays for Zika and dengue viruses. We estimated matched crude and adjusted odds ratios with exact conditional logistic regression to determine the association between microcephaly and Zika virus infection. FINDINGS: We screened neonates born between Jan 15 and Nov 30, 2016, and prospectively recruited 91 cases and 173 controls. In 32 (35%) cases, congenital Zika virus infection was confirmed by laboratory tests and no controls had confirmed Zika virus infections. 69 (83%) of 83 cases with known birthweight were small for gestational age, compared with eight (5%) of 173 controls. The overall matched odds ratio was 73·1 (95% CI 13·0-∞) for microcephaly and Zika virus infection after adjustments. Neither vaccination during pregnancy or use of the larvicide pyriproxyfen was associated with microcephaly. Results of laboratory tests for Zika virus and brain imaging results were available for 79 (87%) cases; within these cases, ten were positive for Zika virus and had cerebral abnormalities, 13 were positive for Zika infection but had no cerebral abnormalities, and 11 were negative for Zika virus but had cerebral abnormalities. INTERPRETATION: The association between microcephaly and congenital Zika virus infection was confirmed. We provide evidence of the absence of an effect of other potential factors, such as exposure to pyriproxyfen or vaccines (tetanus, diphtheria, and acellular pertussis, measles and rubella, or measles, mumps, and rubella) during pregnancy, confirming the findings of an ecological study of pyriproxyfen in Pernambuco and previous studies on the safety of Tdap vaccine administration during pregnancy. FUNDING: Brazilian Ministry of Health, Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations.

Painel estadual de monitoramento da infecção pelo vírus zika e suas complicações: caracterização e uso pela Vigilância em Saúde / State panel for monitoring of infections by the zika virus and its complications: characterization and usage in Health Surveillance

RESUMO As epidemias causadas por arboviroses, especialmente pelo vírus zika e suas complicações, destacaram-se como importantes problemas de saúde pública no âmbito global. O estado de Pernambuco despontou tanto nas ações de vigilância e atenção à saúde integradas dessas doenças, como no seu monitoramento. Esse é essencial no aprimoramento da gestão em situações de emergência em saúde pública. Objetiva-se aqui relatar o desenvolvimento de painel estadual de monitoramento focado nessas doenças. Espera-se contribuir para o aperfeiçoamento de intervenções que objetivem alcançar resultados semelhantes, uma vez que o monitoramento de casos, considerados inéditos, favorece ao aprendizado institucional.

ABSTRACT Epidemics caused by Arboviruses, especially by the zika virus and its complications, stood out as major public health problems in the global scenario. The State of Pernambuco has emerged also in the integrated surveillance actions and health attention for those diseases as in their monitoring. That tool is effective in improving emergency management in public health. The objective of this paper is to report the development of a monitoring state panel focused on those diseases. It aims at contributing to the improvement of interventions addressed to achieve similar results, since the monitoring of unprecedented cases promotes institutional learning.