Analysis of conditions sensitive to primary care in a successful experience of primary healthcare expansion in Brazil, 1998-2015.

OBJECTIVE: To analyze trends in expansion of coverage of the family health strategy and hospitalization for conditions sensitive to primary care (CSPC) in a successful experience of primary healthcare expansion in Brazil. STUDY DESIGN: Ecological study with data from the Brazilian National Health Information System. METHODS: CSPC were analyzed between 1998 and 2015 in Rio de Janeiro, Brazil, by cause groups. Trends, variation, and correlation between indicators in the period were evaluated. RESULTS: Most of the cause groups showed a reduction in hospitalization rate, particularly cardiovascular diseases and asthma, but an increase was seen for obstetric causes. The main causes of hospitalization were heart failure, cerebrovascular diseases, and bacterial pneumonia. The contribution of vaccine-preventable diseases, cardiovascular diseases, diabetes, nutritional deficiencies, and chronic lung diseases to the total number of hospitalizations was seen to decrease. CONCLUSIONS: Analysis demonstrates that the family health strategy, as access to the healthcare system, decreases the majority of CSPC hospitalization rates.

Transcultural adaptation of the user satisfaction scale to the health service: Brazilian version of the EORTC IN-PATSAT32 questionnaire.

OBJECTIVE: To describe the cross-cultural adaptation and psychometric properties of the Brazilian version of the IN-PATSAT32 questionnaire. METHODS: The questionnaire was applied to 328 patients in a public hospital, and the retest was performed with 86 patients, approximately 1 week after the test. Psychometric analyses were performed to evaluate the structure, reliability, and internal consistency of the questionnaire. RESULTS: The adapted questionnaire presented high sensitivity and the intraclass correlation coefficient (ICC > 8) indicated strong convergent validity and discriminant properties of the instrument, as well as high internal consistency (Cronbach's α > 0.8). Exploratory factor analysis divided the questionnaire into five dimensions: satisfaction with a multidisciplinary team (α = 0.953, kp = 0.61, ICC = 0.953), doctors (α = 0.993, kp = 0.817, ICC = 0.966), therapeutic (α = 0.946, kp = 0.869, ICC = 0.972), hospital structure (α = 0.97, kp = 0.87, ICC = 0.947), and hospital discharge. CONCLUSION: The results indicated that the Brazilian version maintained its psychometric properties when used in a heterogeneous population and with different diagnoses and stages of treatment for cancer. PRACTICE IMPLICATIONS: This questionnaire can be used in the Brazilian hospital routine to gauge the satisfaction of patients with hospitalization.

Heat-resistant protein expression during germination of maize seeds under water stress.

Low water availability is one of the factors that limit agricultural crop development, and hence the development of genotypes with increased water stress tolerance is a challenge in plant breeding programs. Heat-resistant proteins have been widely studied, and are reported to participate in various developmental processes and to accumulate in response to stress. This study aimed to evaluate heat-resistant protein expression under water stress conditions during the germination of maize seed inbreed lines differing in their water stress tolerance. Maize seed lines 91 and 64 were soaked in 0, -0.3, -0.6, and -0.9 MPa water potential for 0, 6, 12, 18, and 24 h. Line 91 is considered more water stress-tolerant than line 64. The analysis of heat-resistant protein expression was made by gel electrophoresis and spectrophotometry. In general, higher expression of heat-resistant proteins was observed in seeds from line 64 subjected to shorter soaking periods and lower water potentials. However, in the water stress-tolerant line 91, a higher expression was observed in seeds that were subjected to -0.3 and -0.6 MPa water potentials. In the absence of water stress, heat-resistant protein expression was reduced with increasing soaking period. Thus, there was a difference in heat-resistant protein expression among the seed lines differing in water stress tolerance. Increased heat-resistant protein expression was observed in seeds from line 91 when subjected to water stress conditions for longer soaking periods.

Physiological quality and gene expression during the development of habanero pepper (Capsicum chinense Jacquin) seeds.

Phytohormones have different characteristics and functions, and they may be subject to changes in their gene expression and synthesis during seed development. In this study, we evaluated the physiological qualities of habanero peppers (Capsicum chinense Jacquin) during seed development and the expression of genes involved in germination. Seeds were obtained from fruits harvested at different stages of development [i.e., 14, 21, 28, 35, 42, 49, 56, 63, and 70 days after anthesis (DAA)]. Immediately after harvesting, the seeds were subjected to various tests to determine moisture content, germination, first count germination, and seedling emergence. Real-time polymerase chain reaction was used to evaluate the expression of various genes, including MAN2, NCED, B73, ICL6, and GA3ox. Electrophoresis was used to assess the expression of various enzymes, including α-amylase, isocitrate-lyase, and endo-ß-mannanase. Habanero peppers harvested at 70 DAA and subjected to 7 days of rest exhibited higher germination rates and vigor compared to those harvested at all other developmental stages. Peppers harvested at 63 DAA without drying exhibited higher α amylase and AmyB73 gene expression levels. Peppers harvested at 70 DAA with 7 days of rest exhibited higher endo-ß-mannanase expression levels. MAN2 gene expression increased during the development of non-dried seeds until 70 DAA. Peppers harvested at 42 DAA exhibited the highest isocitrate-lyase and ICL6 gene activity levels in comparison to those at all other developmental stages.

Expression of genes associated with the biosynthetic pathways of abscisic acid, gibberellin, and ethylene during the germination of lettuce seeds.

Seed germination and dormancy are complex phenomena that are controlled by many genes and environmental factors. Such genes are indicated by phytohormones that interact with each other, and may cause dormancy or promote seed germination. The objective of this study was to investigate gene expression associated with the biosynthetic pathways of abscisic acid (ABA), gibberellic acid (GA), and ethylene (ET) in dormant and germinated lettuce seeds. The expressions of LsNCED, LsGA3ox1, and ACO-B were evaluated in germinating and dormant seeds from the cultivars Everglades, Babá de Verão, Verônica, Salinas, Colorado, and Regina 71. The expressions of LsNCED, LsGA3ox1, and ACO-B were related to the biosynthesis of ABA, GA, and ET, respectively; therefore, the presence of these substances depends on genotype. LsNCED expression only occurred in dormant seeds, and was connected to dormancy. LsGA3ox1expression only occurred in germinated seeds, and was connected to germination. The ACO-B gene was involved in ET biosynthesis, and was expressed differently in germinated and dormant seeds, depending on the genotype, indicating different functions for different characteristics. Furthermore, sensitivity to phytohormones appeared to be more important than the expression levels of LsNCED, LsGA3ox1, or ACO-B.

Expression of genes related to tolerance to low temperature for maize seed germination.

The aim of this study was to characterize maize lines tolerant to cold temperatures during the germination process. Seeds from lines with different levels of tolerance to low temperatures were used; 3 lines were classified as tolerant and 3 as susceptible to low germination temperatures. A field was set up to multiply seeds from selected lines. After the seeds were harvested and classified, we conducted physiological tests and analyzed fatty acid content of palmitic, stearic, oleic, linoleic, linolenic, and eicosenoic acids. In proteomic analysis, the expression of heat-resistant proteins, including catalase, peroxidase, esterase, superoxide dismutase, and α-amylase, were evaluated. Transcript analysis was used to measure the expression of the genes AOX1, AOX2, ZmMPK-17, and ZmAN-13. The material showing the highest susceptibility to low germination temperatures contained high saturated fatty acid content. Expression of α-amylase in seeds soaked for 72 h at a temperature of 10°C was lower than expression of α-amylase when soaked at 25°C for the same amount of time. We observed variation in the expression of heat-resistant proteins in seeds of the lines evaluated. The genes AOX and Zm-AN13 were promising for use in identifying maize materials that are tolerant to low germination temperatures.

Longitudinal brain volumetric changes during one year in non-elderly healthy adults: a voxel-based morphometry study

Previous cross-sectional magnetic resonance imaging (MRI) studies of healthy aging in young adults have indicated the presence of significant inverse correlations between age and gray matter volumes, although not homogeneously across all brain regions. However, such cross-sectional studies have important limitations and there is a scarcity of detailed longitudinal MRI studies with repeated measures obtained in the same individuals in order to investigate regional gray matter changes during short periods of time in non-elderly healthy adults. In the present study, 52 healthy young adults aged 18 to 50 years (27 males and 25 females) were followed with repeated MRI acquisitions over approximately 15 months. Gray matter volumes were compared between the two times using voxel-based morphometry, with the prediction that volume changes would be detectable in the frontal lobe, temporal neocortex and hippocampus. Voxel-wise analyses showed significant (P < 0.05, family-wise error corrected) relative volume reductions of gray matter in two small foci located in the right orbitofrontal cortex and left hippocampus. Separate comparisons for males and females showed bilateral gray matter relative reductions in the orbitofrontal cortex over time only in males. We conclude that, in non-elderly healthy adults, subtle gray matter volume alterations are detectable after short periods of time. This underscores the dynamic nature of gray matter changes in the brain during adult life, with regional volume reductions being detectable in brain regions that are relevant to cognitive and emotional processes.

Longitudinal brain volumetric changes during one year in non-elderly healthy adults: a voxel-based morphometry study.

Previous cross-sectional magnetic resonance imaging (MRI) studies of healthy aging in young adults have indicated the presence of significant inverse correlations between age and gray matter volumes, although not homogeneously across all brain regions. However, such cross-sectional studies have important limitations and there is a scarcity of detailed longitudinal MRI studies with repeated measures obtained in the same individuals in order to investigate regional gray matter changes during short periods of time in non-elderly healthy adults. In the present study, 52 healthy young adults aged 18 to 50 years (27 males and 25 females) were followed with repeated MRI acquisitions over approximately 15 months. Gray matter volumes were compared between the two times using voxel-based morphometry, with the prediction that volume changes would be detectable in the frontal lobe, temporal neocortex and hippocampus. Voxel-wise analyses showed significant (P < 0.05, family-wise error corrected) relative volume reductions of gray matter in two small foci located in the right orbitofrontal cortex and left hippocampus. Separate comparisons for males and females showed bilateral gray matter relative reductions in the orbitofrontal cortex over time only in males. We conclude that, in non-elderly healthy adults, subtle gray matter volume alterations are detectable after short periods of time. This underscores the dynamic nature of gray matter changes in the brain during adult life, with regional volume reductions being detectable in brain regions that are relevant to cognitive and emotional processes.

[Carpometacarpal dislocations of the long fingers. Apropos of 26 cases with review of 20 cases]. / Les luxations carpo-métacarpiennes des doigts longs. A propos de 26 cas dont 20 cas revus.

PURPOSE OF THE STUDY: A retrospective study reports the evolution of patients treated for dislocation of one or several of the four medial carpometacarpal joints. MATERIALS AND METHODS: In five of twenty-six patients, the dislocations were undiagnosed in emergency. Twenty-five dislocations were dorsal. A patient presented a divergent dislocation of the four medial metacarpals proximal ends. The mean age was 25-30 years. Twenty-six patients were treated: ten by closed reduction and sixteen by open reduction. Stabilization by oblique K-wire pining was used in twenty-four cases. Twenty patients were followed for an average of fourty-one months. Six patients were lost for follow-up. Two patients had an an ulnar nerve injury. In eighteen cases, dislocation was associated with avulsion fracture of the involved bone. Eleven fractures of the distal carpal row was reported. RESULTS: The results were assessed by the range of wrist and fingers motion, grip strength, pain and deformity. Three patients had a limited range of wrist motion, five patients had a limited range of fingers motion. Six patients had a loss of fourth and fifth carpometacarpal joint motion. Eight patients had an excellent grip strength. Four patients were pain free and fourteen had climatic pain, or after strenuous use of the hand. Eleven had no deformity or limited prominence and three a disabling deformity. Results were rated good in thirteen cases, fair in three and poor in four. DISCUSSION: Dislocation or fracture-dislocation of the carpometacarpal joints are uncommon injuries. The diagnosis can be easily missed. The authors recommend closed or open reduction but constant fixation by pins and immobilization in a plaster cast. In this study, the majority of results was good when no serious injuries were associated and when reductions were stabilized with k-wires. One out of four poor results had been treated by closed reduction without k-wires, the three others were due to associated injuries.

Photoparoxysmal responses.

Sixty-five outpatients with photoparoxysmal response (PPR) during routine EEG were studied. The PPR showed prevalence in women (75.4%). Seizures were found in 66.1% of cases. The rest recordings were abnormal in 41.8% with prevalence of generalized paroxysm. Eight patterns of PPR were observed, being polyspike mixed to slow wave the most frequent (53%). The epileptic group showed a bimodal distribution in the several bands of photic stimulation, near 8 and 20-24 Hz. A sustained paroxysmal abnormality persisting after the photic stimulation was present in 6 epileptic patients.

Characteristics of the gait in old people who fall.

Observations were made of the gait of 30 people aged 65 and over who were admitted to hospital shortly after suffering a fall without bone injury. These were compared with 22 patients of similar age admitted to the same hospital who had not suffered a recent fall; with 23 normal active old people of whom 7 had fallen recently; and with 24 normal young subjects. The gait of the hospitalized fallers differed from all other groups, and had the following characteristics: slow speed, short step length, narrow stride width, wide range of stepping frequency, large variability of step length, and increasing variability with increasing frequency. These characteristics may reflect loss of automaticity of gait, and this finding may have implications for pathogenesis and rehabilitation.