Detection of Multiple Human Viruses, including Mpox, Using a Wastewater Surveillance Approach in Brazil.

Sewage surveillance can be used as an effective complementary tool for detecting pathogens in local communities, providing insights into emerging threats and aiding in the monitoring of outbreaks. In this study using qPCR and whole genomic sewage surveillance, we detected the Mpox virus along with other viruses, in municipal and hospital wastewaters in Belo Horizonte, Brazil over a 9-month period (from July 2022 until March 2023). MPXV DNA detection rates varied in our study, with 19.6% (11 out of 56 samples) detected through the hybrid capture method of whole-genome sequencing and 20% (12 out of 60 samples) through qPCR. In hospital wastewaters, the detection rate was higher, at 40% (12 out of 30 samples) compared to 13.3% (4 out of 30 samples) in municipal wastewaters. This variation could be attributed to the relatively low number of MPXV cases reported in the city, which ranged from 106 to 341 cases during the study period, and the dilution effects, given that each of the two wastewater treatment plants (WWTP) investigated serves approximately 1.1 million inhabitants. Additionally, nine other virus families were identified in both hospitals and municipal wastewaters, including Adenoviridade, Astroviridae, Caliciviridae, Picornaviridade, Polyomaviridae, Coronaviridae (which includes SARS-CoV-2), Herspesviridae, Papillomaviridae and Flaviviridae (notably including Dengue). These findings underscore the potential of genomic sewage surveillance as a robust public health tool for monitoring a wide range of viruses circulating in both community and hospitals environments, including MPXV.

Effectiveness of a two-component nutritional strategy for blood pressure control in individuals with hypertension users of a public health system: a randomized controlled clinical trial.

OBJECTIVE: To evaluate the effectiveness of a nutritional strategy based on two components and adapted for the public health system on blood pressure, cardiometabolic features, self-care, qualify of life and diet quality in individuals with hypertension. METHODS: NUPRESS was an open-label, parallel-group, superiority randomized controlled clinical trial in which participants at least 21 years with hypertension and poorly controlled blood pressure were randomly assigned (1 : 1 allocation ratio) to either an individualized dietary prescription according to nutritional guidelines (control group, n  = 205); or a two-component nutrition strategy, including a goal-directed nutritional counseling and mindfulness techniques (NUPRESS [intervention] group, n  = 205). Primary outcomes were SBP (mmHg) after 24 weeks of follow up and blood pressure control, defined as either having SBP more than 140 mmHg at baseline and achieving 140 mmHg or less after follow-up or having SBP 140 mmHg or less at baseline and reducing the frequency of antihypertensive drugs in use after follow-up. RESULTS: In total, 410 participants were randomized and submitted to an intention-to-treat analysis regarding primary outcomes. Both groups decreased blood pressure, but after adjusting for baseline values, there was no significant difference between them on SBP [intervention-control difference: -0.03 (-3.01; 2.94); P  = 0.98] nor blood pressure control [odds ratio 1.27 (0.82; 1.97); P  = 0.28]. No differences between groups were also detected regarding secondary and tertiary outcomes. CONCLUSION: There was no difference between a two-component nutritional strategy and an established dietary intervention on blood pressure in participants with hypertension.

An adapted cardioprotective diet with or without phytosterol and/or krill oil supplement in familial hypercholesterolemia: A pilot study protocol

BACKGROUND AND AIMS: A healthy diet is one of the pillars of familial hypercholesterolemia (FH) treatment. However, the best dietary pattern and indication for specific supplementation have not been established. Our aim is to conduct a pilot study to assess the effect of an adapted cardioprotective diet with or without phytosterol and/or krill oil supplement in participants with a probable or definitive diagnosis of FH, treated with moderate/high potency statins. METHODS: A national, multicenter, factorial, and parallel placebocontrolled randomized clinical trial with a superiority design and 1:1:1:1 allocation rate will be conducted. The participants will undergo whole exome sequencing and be allocated into four treatment groups: 1) a cardioprotective diet adapted for FH (DICAFH) þ phytosterol placebo þ krill oil placebo; 2) DICA-FH þ phytosterol 2 g/day þ krill oil placebo; 3) DICA-FH þ phytosterol placebo þ krill oil 2 g/day; or 4) DICA-FH þ phytosterol 2 g/day þ krill oil 2 g/day. The primary outcomes will be low-density lipoprotein (LDL)-cholesterol and lipoprotein (a) levels and adherence to treatment after a 120-day follow-up. LDL- and high-density lipoprotein (HDL)-cholesterol subclasses, untargeted lipidomics analysis, adverse events, and protocol implementation components will also be assessed. RESULTS: A total of 58 participants were enrolled between May e August 2023. After the end of the follow-up period, the efficacy and feasibility results of this pilot study will form the basis of the design of a large-scale randomized clinical trial. CONCLUSIONS: This study's overall goal is to recommend dietary treatment strategies in the context of FH.

Comprehensive phylogeny of Pieridae butterflies reveals strong correlation between diversification and temperature.

Temperature is thought to be a key factor influencing global species richness patterns. We investigate the link between temperature and diversification in the butterfly family Pieridae by combining next generation DNA sequences and published molecular data with fine-grained distribution data. We sampled nearly 600 pierid butterfly species to infer the most comprehensive molecular phylogeny of the family and curated a distribution dataset of more than 800,000 occurrences. We found strong evidence that species in environments with more stable daily temperatures or cooler maximum temperatures in the warm seasons have higher speciation rates. Furthermore, speciation and extinction rates decreased in tandem with global temperatures through geological time, resulting in a constant net diversification.

To and fro in the archipelago: Repeated inter-island dispersal and New Guinea's orogeny affect diversification of Delias, the world's largest butterfly genus.

The world's largest butterfly genus Delias, commonly known as Jezebels, comprises ca. 251 species found throughout Asia, Australia, and Melanesia. Most species are endemic to islands in the Indo-Australian Archipelago or to New Guinea and nearby islands in Melanesia, and many species are restricted to montane habitats over 1200 m. We inferred an extensively sampled and well-supported molecular phylogeny of the group to better understand the spatial and temporal dimensions of its diversification. The remarkable diversity of Delias evolved in just ca. 15-16 Myr (crown age). The most recent common ancestor of a clade with most of the species dispersed out of New Guinea ca. 14 Mya, but at least six subsequently diverging lineages dispersed back to the island. Diversification was associated with frequent dispersal of lineages among the islands of the Indo-Australian Archipelago, and the divergence of sister taxa on a single landmass was rare and occurred only on the largest islands, most notably on New Guinea. We conclude that frequent inter-island dispersal during the Neogene-likely facilitated by frequent sea level change-sparked much diversification during that period. Many extant New Guinea lineages started diversifying 5 Mya, suggesting that orogeny facilitated their diversification. Our results largely agree with the most recently proposed species group classification system, and we use our large taxon sample to extend this system to all described species. Finally, we summarize recent insights to speculate how wing pattern evolution, mimicry, and sexual selection might also contribute to these butterflies' rapid speciation and diversification.

The genome sequence of the Large Skipper, Ochlodes sylvanus, (Esper, 1777).

We present a genome assembly from an individual female Ochlodes sylvanus, the Large Skipper (Arthropoda; Insecta; Lepidoptera; Hesperiidae). The genome sequence is 380 megabases in span. Most of the assembly (99.97%) is scaffolded into 30 chromosomal pseudomolecules, including the assembled W and Z sex chromosomes. The mitochondrial genome has also been assembled and is 17.1 kilobases in length. Gene annotation of this assembly on Ensembl identified 13,451 protein coding genes.

Antioxidant effects of phenolic extract from sugarcane straw and mannan extract from brewer's spent yeast on fresh-cut apples.

BACKGROUND: Fresh-cut fruit are convenient ready-to-eat products increasingly demanded by consumers, but highly susceptible to oxidation. To increase the shelf life of these products, this industry is currently facing the challenge of finding sustainable natural preservatives capable of maintaining fresh-cut fruit quality while meeting consumers' expectations regarding health and environmental concerns. RESULTS: In this work, fresh-cut apple slices were treated with two antioxidant extracts derived from industrial by-products: a phenolic-rich extract produced from sugarcane straw (PE-SCS) and applied at 15 g L-1 , and a mannan-rich extract obtained from brewer's spent yeast (MN-BSY) applied at two concentrations: 1 and 5 g L-1 . PE-SCS, having a brown color, imparted a brownish hue to the fruit and increased the browning rate during storage, and not even the initial robust antioxidant response (high superoxide dismutase, catalase, ascorbate peroxidase and guaiacol peroxidase activities), prevented oxidation. Fruit treated with MN-BSY extract at 5 g L-1 showed lower color loss rate and higher polyphenol oxidase inhibition, while at 1 g L-1 it showed lower firmness loss rate and lower lipid peroxidation after 6 days of storage. CONCLUSION: The results showed that PE-SCS triggers a potent antioxidant response in fresh-cut fruit and, despite it imparting a brown color to the fruit at 15 g L-1 , it may have potential for application at lower concentrations. Regarding MN-BSY, it generally decreased oxidative stress, but its effect on quality maintenance was dependent on the concentration and, thus, to confirm its potential as a fruit preservative more concentrations must be tested. © 2023 Society of Chemical Industry.

Factors associated with diet quality among Brazilian individuals with cardiovascular diseases.

BACKGROUND: An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors. METHODS: This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant. RESULTS: In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence. CONCLUSIONS: A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country.

Factors associated with diet quality among Brazilian individuals with cardiovascular diseases

BACKGROUND: An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors. METHODS: This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant. RESULTS: In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence. CONCLUSIONS: A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country.

A global phylogeny of butterflies reveals their evolutionary history, ancestral hosts and biogeographic origins.

Butterflies are a diverse and charismatic insect group that are thought to have evolved with plants and dispersed throughout the world in response to key geological events. However, these hypotheses have not been extensively tested because a comprehensive phylogenetic framework and datasets for butterfly larval hosts and global distributions are lacking. We sequenced 391 genes from nearly 2,300 butterfly species, sampled from 90 countries and 28 specimen collections, to reconstruct a new phylogenomic tree of butterflies representing 92% of all genera. Our phylogeny has strong support for nearly all nodes and demonstrates that at least 36 butterfly tribes require reclassification. Divergence time analyses imply an origin ~100 million years ago for butterflies and indicate that all but one family were present before the K/Pg extinction event. We aggregated larval host datasets and global distribution records and found that butterflies are likely to have first fed on Fabaceae and originated in what is now the Americas. Soon after the Cretaceous Thermal Maximum, butterflies crossed Beringia and diversified in the Palaeotropics. Our results also reveal that most butterfly species are specialists that feed on only one larval host plant family. However, generalist butterflies that consume two or more plant families usually feed on closely related plants.

Correlations between different plaque indexes and bleeding on probing: A concurrent validity study.

Background: It is stated that plaque indexes emphasizing interproximal areas or gingival margins are important when periodontal inflammation is the main focus. This cross-sectional study aimed to evaluate the concurrent validity between the following indexes: Greene & Vermillion (GV), Quigley & Hein modified by Turesky (QHT), Silness & Löe (SL), Ainamo & Bay (AB), O'Leary (OL), Deinzer (DZ), and bleeding on probing (BOP). Material and Methods: A sample comprising 183 individuals underwent complete periodontal examination and were divided according their periodontal status. BOP was expressed in percentages of affected sites for the entire mouth and for lingual, buccal and interproximal surfaces. Spearman correlations were calculated for each index and BOP at each area. Results: Overall, correlations were moderate between all indexes and BOP at all areas, except for the OL index that showed weak correlations. The concurrent validity increased for the gingival health group, reaching strong correlations between the AB, GV, DZ indexes and BOP at the entire mouth. In the gingivitis and periodontitis groups, the concurrent validity decreased, with most correlations reaching weak or non-significant values. Conclusions: In cross-sectional evaluations, the GV, QHT, SL, AB and DZ indexes showed good validity concurrent with BOP, regardless of their specific characteristics. Key words:Bleeding on probing, concurrent validity, correlation study, periodontal diseases, dental plaque index.

Spent Yeast Waste Streams as a Sustainable Source of Bioactive Peptides for Skin Applications.

Spent yeast waste streams are a byproduct obtained from fermentation process and have been shown to be a rich secondary source of bioactive compounds such as phenolic compounds and peptides. The latter are of particular interest for skin care and cosmetics as they have been shown to be safe and hypoallergenic while simultaneously being able to exert various effects upon the epidermis modulating immune response and targeting skin metabolites, such as collagen production. As the potential of spent yeast's peptides has been mainly explored for food-related applications, this work sought to understand if peptide fractions previously extracted from fermentation engineered spent yeast (Saccharomyces cerevisiae) waste streams possess biological potential for skin-related applications. To that end, cytotoxic effects on HaCat and HDFa cells and whether they were capable of exerting a positive effect upon the production of skin metabolites relevant for skin health, such as collagen, hyaluronic acid, fibronectin and elastin, were evaluated. The results showed that the peptide fractions assayed were not cytotoxic up to the highest concentration tested (500 µg/mL) for both cell lines tested. Furthermore, all peptide fractions showed a capacity to modulate the various target metabolites production with an overall positive effect being observed for the four fractions over the six selected targets (pro-collagen IαI, hyaluronic acid, fibronectin, cytokeratin-14, elastin, and aquaporin-9). Concerning the evaluated fractions, the overall best performance (Gpep > 1 kDa) was of an average promotion of 41.25% over the six metabolites and two cell lines assessed at a concentration of 100 µg/mL. These results showed that the peptide fractions assayed in this work have potential for future applications in skin-related products at relatively low concentrations, thus providing an alternative solution for one of the fermentation industry's waste streams and creating a novel and highly valuable bioactive ingredient with encompassing activity to be applied in future skin care formulations.

Molecular identification of Austrodiplostomum sp., an eye parasite among farmed tambaqui in Amazonia.

Austrodiplostomum Szidat & Nani, 1951 is a genus of parasitic digenetic trematodes widely distributed in the Neotropical region. Infects a wide variety of species, families and requests for freshwater fish. We identify samples of Austrodiplostomum sp, based on metacercariae isolates from eyes of tambaqui (Colossoma macropomum), a fish of high commercial importance in Brazil, and widely consumed by the population of the northern region. The sequences obtained clustered with A. compactum. This is the first report of the occurrence of diplostomids in farmed tambaqui in Amazonia.

Regionalização da saúde no Rio Grande do Sul: olhar dos gestores estaduais / Health regionalization in Rio Grande do Sul, Brazil: view of state managers

Resumo Este artigo teve como objetivo analisar, através da perspectiva dos gestores estaduais, como ocorreu a implementação do processo da regionalização da saúde no Rio Grande do Sul, a partir dos anos 2000. Trata-se de um estudo qualitativo descritivo, desenvolvido na Secretaria da Saúde do Estado do Rio Grande do Sul. As informações foram obtidas através de dez entrevistas semiestruturadas. Para a interpretação dos dados levantados, utilizou-se análise de conteúdo, modalidade temática. Como resultados, destacaram-se a melhoria na qualidade da atenção à saúde, o progresso na organização do sistema de saúde do estado, a mudança na função da gestão estadual, o desenvolvimento da tecnologia e o reconhecimento das instâncias de pactuação para a tomada de decisão. Identificou-se que a governança regional foi dificultada pela fragmentação do sistema e a histórica insuficiência de planejamento. Concluiu-se que se faz necessário implementar uma cultura de gestão estratégica, amparada pela alocação adequada de recursos e qualificação da governança nas regiões de saúde.

Abstract This article aims to analyze, from the perspective of state administrators, the implementation of the health regionalization process in Rio Grande do Sul, beginning in the 2000s. This is a qualitative-descriptive study, conducted in the State Health Department. We obtained information from ten semi-structured interviews with state administrators from the central level. We interpreted the data using content analysis, thematic method. As results, we highlight the improvement in healthcare quality, the progress in the organization of the state's health system, the change in the role of the state administration, the development of the technology and the acknowledgment of pact-making spaces for decision-making. We note that the system's fragmentation and the historical planning insufficiency hamper regional governance. In conclusion, implementing a culture of strategic management is necessary, with the backing of adequate resource allocation and enhancement of governance in the health regions.

Association between components of metabolic syndrome and periodontitis: a systematic review and meta-analysis.

OBJECTIVES: To evaluate the role of metabolic syndrome (MetS) components in the association with periodontitis (PE) (#CRD42020218310). MATERIALS AND METHODS: A systematic electronic search was performed in PUBMED, Scielo and Lilacs databases up to April 2022. Cross-sectional, case-control, and cohort studies presenting data on the association between MetS and PE in the adult and elderly populations were included. A random effect meta-analysis was performed to determine association effect estimates. Results interpretation followed the assessment of methodological quality (Joana Briggs Institute tool) together with the certainty of evidence (GRADE approach). RESULTS: This review included 52 studies, totalling 140,434 participants, and 38 studies were meta-analyzed. Association between PE and MetS was observed (ORadj from 1.27 to 1.90; PRajd = 1.19; RRadj from 1.10 to 1.37) (low and very low certainty of evidence). Hyperglycaemia (OR = 1.18), HDL (OR = 1.16), obesity (OR = 1.08), and hypertension (OR = 1.11) were associated with PE, except triglycerides (low and very low certainty of evidence). There was a dose-response gradient between the number of MetS components and PE, with a gradual increase in the effect magnitude for 1 (OR = 1.14), 2 (OR = 1.52), 3 or more (OR = 1.79), and 4 or 5 components (OR = 2.02) (low to high certainty of evidence). CONCLUSIONS: MetS was associated with PE, with a dose-response gradient between the number of MetS components and the occurrence of PE, with an increasing effect magnitude according to an increasing number of components. CLINICAL RELEVANCE: Periodontal examination should be part of a comprehensive propaedeutic approach of MetS patients, particularly those presenting a great number of components.

Diálogos sobre a descentralização do programa de controle da hanseníase em município endêmico: uma avaliação participativa / Diálogos sobre la descentralización del programa de control de la lepra en un municipio endémico: una evaluación participativa / Dialogues on the decentralization of the leprosy control program in an endemic municipality: a participatory evaluation

Resumo Objetivo avaliar a descentralização do Programa de Controle da Hanseníase (PCH) em Governador Valadares. Método o referencial teórico-metodológico foi a Avaliação de Quarta Geração, de abordagem qualitativo-participativa. O estudo envolveu 30 sujeitos divididos em quatro grupos: gestores do PCH; profissionais do Centro de Referência (CR); profissionais da atenção básica e usuários. Os dados foram coletados por entrevistas, utilizando-se a técnica do Círculo Hermenêutico-Dialético. Posteriormente, realizaram-se três oficinas de validação e negociação dos dados. Utilizou-se o Método Comparativo Constante para a análise. Resultados evidenciou-se a manutenção do modelo vertical de atenção à hanseníase, sustentado por determinantes sócio-histórico-culturais que se expressam: na permanência da porta de entrada à demanda espontânea no CR; no encaminhamento rotineiro do usuário para a atenção secundária; na ineficiência da contrarreferência; na centralização da poliquimioterapia; na crença na necessidade do atendimento especializado e no estigma. Evidenciaram-se fragilidades no vínculo com a atenção primária. Conclusão a descentralização do PCH envolve a tensão entre os atores de cada ponto de atenção à saúde, gerando disputas de saberes e práticas de saúde. Implicações para a prática a sustentabilidade da descentralização requer envolvimento político e institucional focado no fortalecimento da atenção primária, na reorientação do papel dos serviços na rede de atenção à hanseníase e na educação em saúde.

Resumen Objetivo evaluar la descentralización del Programa de Control de la Lepra (PCL) en Governador Valadares. Método el marco teórico-metodológico fue la Evaluación de Cuarta Generación, con un enfoque cualitativo-participativo. El estudio involucró a 30 sujetos, divididos en cuatro grupos: gerentes del PCL; profesionales del Centro de Referencia (CR); profesionales de atención primaria y usuarios. Los datos fueron recolectados a través de entrevistas, utilizando la técnica del Círculo Hermenéutico-Dialéctico. Posteriormente se realizaron tres talleres de validación y negociación de los datos. Para el análisis se utilizó el Método Comparativo Constante. Resultados se evidenció el mantenimiento del modelo vertical de atención a la lepra, sustentado en determinantes socio-histórico-culturales que se expresan en la permanencia del ingreso a la demanda espontánea en el CR; en la derivación rutinaria del usuario a atención secundaria; en la ineficiencia de la contrarreferencia; en la centralización de la poliquimioterapia; en la creencia en la necesidad de atención especializada y en el estigma. Se evidenciaron debilidades en el vínculo con la atención primaria. Conclusión la descentralización del PCH involucra la tensión entre los actores en cada punto de la atención en salud, generando disputas sobre conocimientos y prácticas de salud. Implicaciones para la práctica la sostenibilidad de la descentralización requiere de una participación política e institucional, enfocada en el fortalecimiento de la atención primaria, reorientando el rol de los servicios en la red de atención a la lepra y en la educación para la salud.

Abstract Objective to evaluate the decentralization of the Leprosy Control Program (LCP) in Governador Valadares. Method the theoretical and methodological framework was the Fourth Generation Evaluation, with a qualitative-participatory approach. The study involved 30 subjects divided into four groups: managers of the LCP; professionals of the Reference Center (RC); primary care professionals and users. Data were collected through interviews, using the Hermeneutic-Dialectic Circle technique. Subsequently, three workshops were held for data validation and negotiation. The Constant Comparative Method was used for the analysis. Results the maintenance of the vertical model of leprosy care was evidenced, sustained by social-historical-cultural determinants that are expressed in: the permanence of the gateway to spontaneous demand in the RC; the routine referral of the user to secondary care; the inefficiency of counter-reference; the centralization of multidrug therapy; the belief in the need for specialized care, and stigma. Weaknesses in the link with primary care were evidenced. Conclusion and implications for practice The sustainability of decentralization requires political and institutional involvement focused on strengthening primary care, reorienting the role of the services in the leprosy care network, and health education. The decentralization of the LCP involves tension between the actors of each health care point, generating disputes of knowledge and health practices.

The Bombycoidea and Mimallonoidea (Lepidoptera) of a research station in the grasslands of Southern Brazil.

We report the Bombycoidea and Mimallonoidea (Lepidoptera) observed at the the Universidade Federal do Rio Grande do Suls (UFRGS) Agronomic Research Station in Eldorado do Sul, Rio Grande do Sul, Brazil from September 7th to November 6th, 2018. This research station is situated in the Campos Sulinos (southern Brazilian grasslands) environment. As part of our inventory, we report the following Bombycoidea: 29 species of Sphingidae, 26 species of Saturniidae, at least seven species of Apatelodidae, and at least four species of Bombycidae. Within Mimallonidae we recorded eight species. New state records include the following Sphingidae: Xylophanes alineae, X. crenulata, and Perigonia stulta; and Mimallonidae: Mimallo grisea and the genus Menevia. Our study represents the first inventory of moths from this location and one of the few from the Campos Sulinos more broadly.

Food Plant Shifts Drive the Diversification of Sack-Bearer Moths.

AbstractLepidoptera are a highly diverse group of herbivorous insects; however, some superfamilies have relatively few species. Two alternative hypotheses for drivers of Lepidoptera diversity are shifts in food plant use or shifts from concealed to external feeding as larvae. Many studies address the former hypothesis but with bias toward externally feeding taxa. One of the most striking examples of species disparity between sister lineages in Lepidoptera is between the concealed-feeding sack-bearer moths (Mimallonoidea), which contain about 300 species, and externally feeding Macroheterocera, which have over 74,000 species. We provide the first dated tree of Mimallonidae to understand the diversification dynamics of these moths in order to fill a knowledge gap pertaining to drivers of diversity within an important concealed-feeding clade. We find that Mimallonidae is an ancient Lepidoptera lineage that originated in the Cretaceous ∼105 million years ago and has had a close association with the plant order Myrtales for the past 40 million years. Diversification dynamics are tightly linked with food plant usage in this group. Reliance on Myrtales may have influenced diversification of Mimallonidae because clades that shifted away from the ancestral condition of feeding on Myrtales have the highest speciation rates in the family.

Ações na área da sexualidade adolescente sob a perspectiva do programa Saúde na Escola: visão dos profissionais de saúde / Actions in the area of adolescent sexuality under the perspective of the school health program: the health professionals' perspective

Buscou-se analisar a visão dos profissionais de saúde acerca das ações promovidas pelo Programa Saúde na Escola, no âmbito da sexualidade na adolescência. Estudo de abordagem qualitativa, exploratório e descritivo, realizado com 12 agentes comunitários de saúde, dois enfermeiros e um médico que atuavam na Unidade de Saúde da Família do Bairro Dom José Rodrigues, em Juazeiro, Bahia. Realizado através de entrevista semiestruturada com amostra qualitativa do tipo não-probabilística, intencional, por exaustão. Os depoimentos foram analisados por meio da análise de discurso. A temática sexualidade na adolescência ainda traz estigmas que não foram rompidos pelos profissionais de saúde, dificultando a abordagem com os adolescentes. Atrelado a isso, a escassez de capacitações torna o programa de cunho curativo, baseado no modelo biomédico em saúde. Apesar das dificuldades enfrentadas, os profissionais de saúde apontam possibilidades, embora reconheçam que não possuem preparo e que há deficiência na assistência das gestões. A parceria entre escola e unidade de saúde proposta pelo programa oportuniza o acesso do adolescente ao conhecimento e cuidados com a sua saúde, tornando-o um sujeito capaz de adotar posturas responsáveis.

We sought to analyze the view of health professionals about the actions promoted by the School Health Program within the scope of sexuality in adolescence. Study of qualitative, exploratory, and descriptive approaches, conducted with 12 community health workers, 02 nurses, and 01 doctor who worked in the Family Health Unit of the neighborhood Dom José Rodrigues, in Juazeiro, Bahia. It was conducted through semi-structured interviews with a qualitative, non-probabilistic, intentional, and by exhaustion sample. The interviews were analyzed through discourse analysis. The theme of sexuality in adolescence also brings stigmas that were not broken by health professionals, making it difficult to address with adolescents. Coupled with this, the lack of training makes the program curative, based on the biomedical model of health. Despite the difficulties, health professionals point out opportunities, although they recognize their lack of preparation and that, by management, there is a failure in the assistance. The partnership between the school and the health unit proposed by the program gives adolescents access to knowledge and care of their health, making them subjects capable of adopting responsible attitudes.