Clostridioides difficile laboratory diagnostic techniques: a comparative approach of rapid and molecular methods.

Clostridioides difficile infection is a public health problem because of it is easily spread; with harmful consequences, it is essential to reduce hospital costs and prevent its dissemination by having a precise diagnosis. The gold standard for its diagnosis is polymerase chain reaction (PCR); however, the technique is not available for all laboratories due to the high cost. New approaches using non-molecular tests to detect C. difficile and toxin A/B production has been proposed to improve cost benefits. The objective of this study is to compare molecular methods (PCR) and rapid methods (immunochromatographic test and enzymatic immunoassay). A series of tests comprising these diagnostic techniques was performed with 50 patients with a clinical diagnosis for Clostridioides difficile on GeneXpert® devices test; a calculation of the sensitivity was executed, followed by a comparison of the efficiency of all techniques. Greater sensitivity was observed in the PCR-based methods (BD MAX™ and BioFire FilmArray®) and the GDH-based assays (RIDASCREEN® and Alere Techlab®). The proposed algorithm represents minor monetary disadvantages but a significant temporal optimization of 10%. Future studies concerning both positive and negative results could be advantageous because of the possibility of calculating more method concordance indexes, such as the specificity and Kappa index, in addition to being able to indicate a monetary profit if the proposed algorithm was applied due to the nonproceeding PCR cases.

Physiological profile regulation during weight gain and loss by ovariectomized females: importance of SIRT1 and SIRT4.

Obesity in menopausal women occurs because of the systemic effects of loss of ovarian function, resulting in increased body weight and oxidative stress. Caloric restriction (CR) is essential for weight loss, since it provides benefits associated with metabolic normalization resulting from the action of sirtuins. The aim of this work was to evaluate the physiological effects of weight cycling in ovariectomized females. Females aged 2 mo (n = 8/group) were submitted to simulated surgery, ovariectomy (OVX group), and ovariectomy with weight fluctuation (WF group). In the WF group, weight cycling was performed two times, using 21 days of ad libitum commercial feed and 21 days of caloric restriction with 40% of the feed consumed by the OVX group. After 17 wk, the animals were evaluated experimentally. Weight fluctuations reduced triacylglycerol and the adipose tissue index of the WF animals, while increasing the expression of antioxidant proteins. In addition to causing fluctuations in the physiological parameters, the weight cycling led to increases of adipocyte number and serum fatty acids. These effects were reflected in increased expression of the sirtuin (SIRT) 1 and SIRT4 proteins, as well as protein complexes of the mitochondrial electron transport chain, especially in the liver and adipose tissues. The weight-cycling results suggested that mitochondrial and nuclear sirtuins were active in cellular signaling for the control of lipid metabolism, oxidative phosphorylation, and redox status. Weight cycling was able to restore the health characteristics of lean animals.

Pro-abortion rights narratives in Brazil, 1976 to 2016. / Narrativas pró-direito ao aborto no Brasil, 1976 a 2016.

The article explores pro-abortion rights narratives in Brazil based on the narrative policy framework (NPF). I analyzed pro-abortion rights documents written by feminist activists from 1976 to 1988 and documents from feminist organizations, law proposals and policy documents regarding abortions produced between 1989 and 2016. I carried out a content analysis of both sets of documents using the OpenLogos software. Findings show that feminists made a strategic choice in favor of a public health narrative so as to expand the pro-abortion rights coalition through inclusion of actors from the health sector. The alliance with the health sector led to achievements, such as the creation of the first legal abortion services and the inclusion of anencephaly among the cases in which abortion is permitted. The public health narrative was, therefore, institutionalized, becoming both the main narrative employed by the coalition and the main narrative found in policy documents. This institutionalization is a goal for advocacy coalitions, but also imposes limits to their future work, since abandoning an institutionalized narrative may risk the coalition, while future demands must be formulated within the already-existing public policy structure.

O artigo explora as narrativas pró-direito ao aborto no Brasil com base no narrative policy framework (NPF). Foram analisados documentos pró-direito ao aborto elaborados por ativistas feministas entre 1976 e 1988 e documentos de organizações feministas, projetos de leis e documentos de políticas públicas sobre aborto referentes ao período de 1989 a 2016. Foi feita uma análise de conteúdo dos dois conjuntos de documentos usando-se o software OpenLogos. Os resultados da pesquisa revelam que as feministas fizeram uma escolha estratégica por uma narrativa de saúde pública, de modo a expandir a coalizão pró-direito ao aborto por meio da inclusão de atores da área da saúde. A aliança com a saúde levou a conquistas para a coalizão, com a criação de serviços de aborto legal e a inclusão da anencefalia entre os casos em que o aborto é permitido. A narrativa de saúde pública foi, assim, institucionalizada, tornando-se tanto a principal narrativa da coalizão quanto a principal narrativa contida nos documentos de políticas públicas. Essa institucionalização é um objetivo da atuação das coalizões de militância, mas também impõe limites à sua atuação futura, já que seu abandono pode colocar em risco a coalizão, ao mesmo tempo em que demandas futuras têm de ser elaboradas com base na estrutura de políticas públicas já existentes.

El artículo investiga los relatos pro-derecho al aborto en Brasil, basándose en la narrative policy framework (NPF). Se analizaron documentos pro-derecho al aborto elaborados por activistas feministas entre 1976 y 1988 y documentos de organizaciones feministas, proyectos de leyes y documentos de políticas públicas sobre el aborto, referentes al período de 1989 a 2016. Se realizó un análisis de contenido de los dos conjuntos de documentos usando el software OpenLogos. Los resultados de la investigación revelan que las feministas escogieron estratégicamente un relato de salud pública para que se expandiera la coalición pro-derecho al aborto, mediante la inclusión de actores del área de la salud. La alianza con la salud condujo a conquistas para la coalición, con la creación de servicios de aborto legal y la inclusión de la anencefalia entre los casos en los que se permite el aborto. El relato de salud pública fue, de esta forma, institucionalizado, convirtiéndose tanto en el principal relato de la coalición, como en el relato principal contenido en los documentos de políticas públicas. Esta institucionalización es un objetivo de la actuación de las coaliciones de militantes, así como también impone límites a su actuación futura, ya que su abandono puede poner en riesgo la coalición, al mismo tiempo en que las demandas futuras se han de elaborar a partir de la estructura de políticas públicas ya existentes.

Narrativas pró-direito ao aborto no Brasil, 1976 a 2016 / Relatos pro-derecho al aborto en Brasil, de 1976 a 2016 / Pro-abortion rights narratives in Brazil, 1976 to 2016

O artigo explora as narrativas pró-direito ao aborto no Brasil com base no narrative policy framework (NPF). Foram analisados documentos pró-direito ao aborto elaborados por ativistas feministas entre 1976 e 1988 e documentos de organizações feministas, projetos de leis e documentos de políticas públicas sobre aborto referentes ao período de 1989 a 2016. Foi feita uma análise de conteúdo dos dois conjuntos de documentos usando-se o software OpenLogos. Os resultados da pesquisa revelam que as feministas fizeram uma escolha estratégica por uma narrativa de saúde pública, de modo a expandir a coalizão pró-direito ao aborto por meio da inclusão de atores da área da saúde. A aliança com a saúde levou a conquistas para a coalizão, com a criação de serviços de aborto legal e a inclusão da anencefalia entre os casos em que o aborto é permitido. A narrativa de saúde pública foi, assim, institucionalizada, tornando-se tanto a principal narrativa da coalizão quanto a principal narrativa contida nos documentos de políticas públicas. Essa institucionalização é um objetivo da atuação das coalizões de militância, mas também impõe limites à sua atuação futura, já que seu abandono pode colocar em risco a coalizão, ao mesmo tempo em que demandas futuras têm de ser elaboradas com base na estrutura de políticas públicas já existentes.

El artículo investiga los relatos pro-derecho al aborto en Brasil, basándose en la narrative policy framework (NPF). Se analizaron documentos pro-derecho al aborto elaborados por activistas feministas entre 1976 y 1988 y documentos de organizaciones feministas, proyectos de leyes y documentos de políticas públicas sobre el aborto, referentes al período de 1989 a 2016. Se realizó un análisis de contenido de los dos conjuntos de documentos usando el software OpenLogos. Los resultados de la investigación revelan que las feministas escogieron estratégicamente un relato de salud pública para que se expandiera la coalición pro-derecho al aborto, mediante la inclusión de actores del área de la salud. La alianza con la salud condujo a conquistas para la coalición, con la creación de servicios de aborto legal y la inclusión de la anencefalia entre los casos en los que se permite el aborto. El relato de salud pública fue, de esta forma, institucionalizado, convirtiéndose tanto en el principal relato de la coalición, como en el relato principal contenido en los documentos de políticas públicas. Esta institucionalización es un objetivo de la actuación de las coaliciones de militantes, así como también impone límites a su actuación futura, ya que su abandono puede poner en riesgo la coalición, al mismo tiempo en que las demandas futuras se han de elaborar a partir de la estructura de políticas públicas ya existentes.

The article explores pro-abortion rights narratives in Brazil based on the narrative policy framework (NPF). I analyzed pro-abortion rights documents written by feminist activists from 1976 to 1988 and documents from feminist organizations, law proposals and policy documents regarding abortions produced between 1989 and 2016. I carried out a content analysis of both sets of documents using the OpenLogos software. Findings show that feminists made a strategic choice in favor of a public health narrative so as to expand the pro-abortion rights coalition through inclusion of actors from the health sector. The alliance with the health sector led to achievements, such as the creation of the first legal abortion services and the inclusion of anencephaly among the cases in which abortion is permitted. The public health narrative was, therefore, institutionalized, becoming both the main narrative employed by the coalition and the main narrative found in policy documents. This institutionalization is a goal for advocacy coalitions, but also imposes limits to their future work, since abandoning an institutionalized narrative may risk the coalition, while future demands must be formulated within the already-existing public policy structure.

Do electrical current and laser therapies improve bone remodeling during an orthodontic treatment with corticotomy?

OBJECTIVES: Evaluate the bone remodeling during orthodontic movement with corticotomy when submitted to low-intensity electrical stimulation application (microcurrent-MC) and low-level laser therapy (LLLT). MATERIAL AND METHODS: One hundred and fifty Wistar rats were divided into the following 5 groups: (C) submitted to tooth movement; (Cort) tooth movement/corticotomy; (Cort-L) tooth movement/corticotomy/laser AsGaAl 808 nm (4.96J/50s); (Cort-Mc) tooth movement/corticotomy/microcurrent (10 µA/5 min); (Cort-L-Mc) tooth movement/corticotomy and laser/microcurrent alternated. Inflammation, angiogenesis, and osteogenesis were evaluated in the periodontal ligament (PDL) and alveolar bone on the 7th, 14th, and 21st days of orthodontic movement. RESULTS: The quantification of inflammatory infiltrate, angiogenesis and expression of TGF-ß1, VEGF, and collagen type I were favorably modulated by the application of therapies such as low-level laser therapy (LLLT), MC, or both combined. However, electrical stimulation increased fibroblasts, osteoclasts and RANK numbers, birefringent collagen fiber organization, and BMP-7 and IL-6 expression. CONCLUSIONS: Low-level laser therapy (LLLT) and MC application both improved the process of bone remodeling during orthodontic treatment with corticotomy. Still, electrical current therapy promoted a more effective tooth displacement but presented expected root resorption similar to all experimental treatments. CLINICAL RELEVANCE: It is important to know the effects of minimally invasive therapies on cellular and molecular elements involved in the bone remodeling of orthodontic treatment associated with corticotomy surgery, in order to reduce the adverse effects in the use of this technique and to establish a safer clinical routine.

Involvement of M1 and M3 receptors in isolated pancreatic islets function during weight cycling in ovariectomized rats.

We investigated the structural and functional adaptations of the pancreas during weight cycling in animals submitted to hypoestrogenism. Female Wistar rats were distributed among the following test groups: ShamAL (AL, ad libitum); OVXAL (ovariectomized); and OVXcycle (dietary restriction with weight cycling). The ShamAL and OVXAL groups received commercial feed ad libitum, whereas the OVXcycle group received 21 days of commercial feed ad libitum, and 21 days of caloric restriction, with caloric intake amounting to 40% of the amount of feed consumed by the rats in the OVXAL group. The tolerance tests for glucose and insulin were applied. After euthanasia, the pancreas and adipose tissue were collected. The disappearance of glucose during the insulin assay occurred at a higher rate in tissues from the OVXcycle group, compared with the OVXAL group. Fasting glycemia and perirenal adipose tissue were lower in the OVXcycle group. By comparison with the ShamAL and OVXAL groups, the OVXcycle group showed higher protein expression of the M1 and M3 receptors and SOD1-2, as well as higher carbachol-induced insulin secretion. Under highly stimulatory conditions with 16.7 mmol/L glucose, the OVXAL and OVXcycle groups presented lower insulin secretion compared with the ShamAL group. Morphological analysis revealed higher iron deposition in the OVXAL islets by comparison with the OVXcycle group. These results show that ovariectomy accelerated the loss of pancreatic islet function, and that weight cycling could restore the function of the islets.

Vitamin E supplementation and caloric restriction promotes regulation of insulin secretion and glycemic homeostasis by different mechanisms in rats.

Vitamin E and caloric restriction have antioxidant effects in mammals. The aim of this study was to evaluate effects of vitamin E supplementation and caloric restriction upon insulin secretion and glucose homeostasis in rats. Male Wistar rats were distributed among the following groups: C, control group fed ad libitum; R, food quantity reduction of 40%; CV, control group supplemented with vitamin E [30 mg·kg-1·day-1]; and RV, food-restricted group supplemented with vitamin E. The experiments ran for 21 days. Glucose tolerance and insulin sensitivity was higher in the CV, R, and RV groups. Insulin secretion stimulated with different glucose concentrations was lower in the R and RV groups, compared with C and CV. In the presence of glucose and secretagogues, insulin secretion was higher in the CV group and was lower in the R and RV groups. An increase in insulin receptor occurred in the fat pad and muscle tissue of groups CV, R, and RV. Levels of hepatic insulin receptor and phospho-Akt protein were higher in groups R and RV, compared with C and CV, while muscle phospho-Akt was increased in the CV group. There was a reduction in hepatic RNA levels of the hepatocyte growth factor gene and insulin degrading enzyme in the R group, and increased levels of insulin degrading enzyme in the CV and RV groups. Thus, vitamin E supplementation and caloric restriction modulate insulin secretion by different mechanisms to maintain glucose homeostasis.

Sex Differences in Diabetes Mellitus Mortality Trends in Brazil, 1980-2012.

AIMS: To investigate the hypothesis that the change from the female predominance of diabetes mellitus to a standard of equality or even male preponderance can already be observed in Brazilian mortality statistics. METHODS: Data on deaths for which diabetes mellitus was listed as the underlying cause were obtained from the Brazilian Mortality Information System for the years 1980 to 2012. The mortality data were also analyzed according to the multiple causes of death approach from 2001 to 2012. The population data came from the Brazilian Institute of Geography and Statistics. The mortality rates were standardized to the world population. We used a log-linear joinpoint regression to evaluate trends in age-standardized mortality rates (ASMR). RESULTS: From 1980 to 2012, we found a marked increment in the diabetes ASMR among Brazilian men and a less sharp increase in the rate among women, with the latter period (2003-2012) showing a slight decrease among women, though it was not statistically significant. CONCLUSIONS: The results of this study suggest that diabetes mellitus in Brazil has changed from a pattern of higher mortality among women compared to men to equality or even male predominance.

Informed consent for record linkage: a systematic review.

BACKGROUND: Record linkage is a useful tool for health research. Potential benefits aside, its use raises discussions on privacy issues, such as whether a written informed consent for access to health records and linkage should be obtained. The authors aim to systematically review studies that assess consent proportions to record linkage. METHODS: 8 databases were searched up to June 2011 to find articles which presented consent proportions to record linkage. The screening, eligibility and inclusion of articles were conducted by two independent reviewers. The authors carried out meta-regression, subgroup and sensitivity analyses to assess heterogeneity. RESULTS: Of the 141 studies identified, only 11 presented empirical consent proportions and were included in the systematic review. The consent proportion varied widely from 39% to 97%. Seven studies presented consent proportions of 88% or higher, one of 72%, and only three presented consented proportion equal to or lower than 53%. None of the studies' characteristics evaluated explained heterogeneity. CONCLUSION: The results of this review show that, in general, individuals tend to consent to the use of their data for record linkage, with exceptions in specific populations or minorities. The authors believe that this, as well as the cited literature, lends support to policies that, while keeping relevant ethical controls in place, do not require individual informed consent for each and every study that relies on secondary data.

Representações sobre genética em veículos de grande circulação no Brasil / Representations on genetics on major press outlets in Brazil

O objetivo deste artigo é apresentar um conjunto de representações persistente na grande imprensa brasileira, apontando sua relação com um determinado modelo de compreensão da ciência. O tema escolhido é o da genética, em especial nas suas correlações com a saúde. O estudo empírico foi feito por meio do acompanhamento sistemático do noticiário de um jornal e dois periódicos relevantes no contexto nacional, sendo o material selecionado submetido à análise de conteúdo. Encontramos três núcleos de significação no material analisado, que denominamos "determinismo", "simplificação exagerada" e "ganhos futuros". A apresentação do discurso derivado da ciência nos veículos estudados articula-se com narrativas mais amplas com implicações políticas, reforçando a autoridade dos especialistas biológicos.

The purpose of this article is to present a set of persisting representations in the Brazilian press, pointing out its relation to a particular model of understanding science. The theme is that of genetics, especially in their correlations with health. The empirical study was done through the systematic monitoring of a newspaper and two relevant magazines in the national context, with the selected material being subjected to content analysis. We found three clusters of meaning in the material analyzed, which we called "determinism," "oversimplification" and "future gains". The presentation of a discourse derived from science in the studied venues is linked to narratives with broader political implications, reinforcing the authority of biological experts.

All Sexed Up: a resposta de mulheres lésbicas negras jovens ao sexo (mais) seguro em Johannesburg, África do Sul / All Sexed Up: young black lesbian women's responses to safe(r) sex in Johannesburg, South Africa

A saúde sexual de mulheres lésbicas não é um tema frequentemente discutido em nossas sociedades. As questões de saúde da mulher são classificadas sob uma única categoria abrangente e excluem algumas das preocupações específicas de mulheres lésbicas, que, em geral, não têm o mesmo comportamento em relação à saúde que as mulheres heterossexuais. Esta tendência se deve a uma série de razões, entre as quais: falta de conhecimento sobre saúde e risco sexuais lésbicos, medo de estigmatização pelos prestadores de serviço e o processo de "se assumir" (coming out) para esses profissionais, que além de desconhecido, é, algumas vezes, hostil. Além disso, a pouca pesquisa sobre lésbicas e saúde lésbica na África do Sul torna difícil para as mulheres que assim se autoclassificam saberem que questões de saúde sexual as afetam especificamente, bem como onde e de que forma lidar com certos problemas. Existe uma percepção equivocada e generalizada de que questões de sexo seguro não afetam mulheres lésbicas tanto quanto mulheres heterossexuais. O artigo apresenta as visões de um grupo de mulheres de 18 a 35 anos que se autoidentificam como lésbicas na África de Sul. Por meio de questionários autoaplicados e discussões, essas mulheres partilham suas experiências e pensamentos sobre sexo lésbico (seguro) e como elas têm-se relacionado e continuam a se relacionar sexualmente com outras mulheres no momento de HIV e Aids.

Lesbian women's health and sexual health is a theme not generally discussed in our societies. Women's' health issues are generally classified under one umbrella, and exclude some of the concerns specific to lesbian women. Lesbian women in general do not have the same health-seeking behaviours as heterosexual women. This is due to a number of reasons including: lack of knowledge about lesbian sexual health and sexual risk, fear of stigmatization by service providers, and the "coming out" process to unfamiliar and sometimes unsympathetic health-related service providers. Furthermore, limited research on lesbians and lesbian health in South Africa makes it difficult for lesbian women to know what sexual health issues affect them specifically, where and how to address these issues. There is a general misconception that safe sex issues do not affect lesbian women as much as they affect heterosexual women. The paper presents views of a group of young self-identified lesbian women in South Africa between the ages of 18 and 35. Through self-administered questionnaires and discussions these women share their experiences and thoughts of lesbian (safe) sex and how they have related and continue to relate sexually with other women in the time of HIV and Aids.