Acupuncture improves certain aspects of sleep in hematopoietic stem cell transplantation patients: a secondary analysis of a randomized controlled trial.

BACKGROUND: High-dose chemotherapy followed by hematopoietic stem cell transplantation (HSCT) is associated with a high symptom burden including sleep disturbance. Here we present the results of a secondary analysis of a randomized, sham-controlled trial assessing the effect of acupuncture on sleep quality during HSCT. METHODS: Adult multiple myeloma patients undergoing inpatient and outpatient autologous HSCT were randomized and blinded to receive either true or sham acupuncture (by licensed acupuncturists) once daily for 5 days starting the day after chemotherapy. Sleep onset, total sleep time, sleep efficiency percentage and sleep-onset latency time were assessed using an actigraphy-based sleep monitor. A multivariate regression analysis was conducted to compare the average area-under-the-curve of five acupuncture intervention days for each sleep outcome between groups, adjusted by baseline score and inpatient or outpatient chemotherapy stratum. RESULTS: Over 32 months, 63 patients were enrolled. Participants undergoing true acupuncture experienced a significant improvement in sleep efficiency when compared to sham (-6.70, 95% CI -13.15, -0.25, p = 0.042). Subgroup analysis showed that the improvement was more prominent in the inpatient setting (-9.62, 95% CI -18.76, -0.47; p = 0.040). True acupuncture tended to improve wake time after sleep onset (WASO; -10.95, p = 0.054). Between-group differences in other sleep related variables were not statistically significant. CONCLUSION: Our data suggest that true acupuncture may improve certain aspects of sleep, including sleep efficiency and possibly WASO, in multiple myeloma patients undergoing HSCT. By studying patient reported outcomes in future larger scale studies, acupuncture's role in improving sleep quality during HSCT treatment could be further elucidated. TRIAL REGISTRATION NUMBER: NCT01811862 (ClinicalTrials.gov).

Chemicals with increasingly complex modes of action result in greater variation in sensitivity between earthworm species.

The scale of variation in species sensitivity to toxicants has been theoretically linked to mode of action. Specifically, it has been proposed there will be greater variations for chemicals with a putative specific biological target than for toxicants with a non-specific narcotic mechanism. Here we test the hypothesis that mode of action is related to variation in sensitivity in a specifically designed experiment for species from a single ecologically important terrestrial taxa, namely earthworms. Earthworm toxicity tests were conducted with five species for four chemicals, providing a series of increasingly complex modes of action: a putative narcotic polycyclic aromatic hydrocarbon (fluoranthene), and three insecticides (chlorpyrifos, cypermethrin, imidacloprid) with known neuronal receptor targets. Across all the chemicals, the standard epigeic test species Eisenia fetida and Lumbricus rubellus, were generally among the two least sensitive, while the endogenic Aporrectodea caliginosa and Megascolecidae Amynthas gracilis were generally more sensitive (never being among the two least sensitive species). This indicates a potential for bias in the earthworm ecotoxicology literature, which is dominated by studies in epigeic Lumbricidae, but contains few endogeic or Megascolecidae data. Results confirmed the lowest range of variation in sensitivities for effects on reproduction was for fluoranthene (2.5 fold). All insecticides showed greater variation for species sensitivity (cypermethrin: 7.5 fold, chlorpyrifos: 10.3 fold, imidacloprid: 31.5 fold) consistent with the specific mechanisms of the pesticides. Difference in toxicodynamics, based on mode of action specificity and receptor complexity was reflected in the magnitude of sensitivity variation. However, measurements of tissue concentrations also indicated the potential importance of toxicokinetics in explaining species sensitivity variations for chlorpyrifos and cypermethrin.

Integração do agente de combate às endemias na Estratégia Saúde da Família, Campo Grande, Mato Grosso do Sul, 2017* / Integración del agente de combate a las endemias en la Estrategia Salud Familiar, Campo Grande, Mato Grosso do Sul, Brasil, 2017 / Integration of endemic disease control workers in the Family Health Strategy, Campo Grande, Mato Grosso do Sul, Brazil, 2017

Objetivo: Descrever o processo de integração do agente de combate às endemias (ACE) na Estratégia Saúde da Família (ESF). Métodos: Estudo transversal descritivo. Os dados foram coletados por questionário semiestruturado autoaplicável, de fevereiro a maio de 2017, em quatro unidades de Saúde da Família na região urbana de Campo Grande, Mato Grosso do Sul, Brasil. Resultados: Participaram 57 agentes comunitários de saúde (ACS) e 8 ACEs. Todos os participantes informaram realizar orientações ao morador e 58 realizavam controle mecânico durante a vistoria de imóveis, visando evitar e eliminar possíveis criadouros do Aedes aegypti. Quanto à integração dos ACEs na ESF, 18 participantes destacaram o trabalho em equipe como aspecto positivo, enquanto 15 referiram falta de autonomia para intervenções legais como aspecto negativo. Conclusão: A integração do ACE na ESF é viável; contudo, ajustes devem ser realizados para potencializar as atividades, na perspectiva do trabalho compartilhado em uma mesma base territorial.

Objetivo: Describir el proceso de integración del Agente de Combate a las Endemias (ACE) en la Estrategia de Salud Familiar (ESF). Métodos: Estudio descriptivo transversal. Los datos se recopilaron por un cuestionario semiestructurado autoadministrado, de febrero a mayo de 2017, en cuatro Unidades de Salud Familiar en la región urbana de Campo Grande, Mato Grosso do Sul, Brasil. Resultados: Participaran 57 Agentes de Salud Comunitaria (ACS) y 8 ACE. Todos informaron que proporcionaron orientación a los habitantes y 58 realizaron control mecánico durante la inspección de las propiedades, buscando evitar y eliminar posibles sitios de reproducción para Aedes aegypti. En cuanto a la integración de los ACE en la ESF, 18 participantes destacaron el trabajo en equipo como un aspecto positivo, y 15, la falta de autonomía para las intervenciones legales como un aspecto negativo. Conclusión: La integración de los ACE en la ESF es factible, sin embargo, son necesarios ajustes para mejorar las actividades en la perspectiva del trabajo compartido sobre la misma base territorial.

Objective: To describe the process of Endemic Disease Control Worker (EDCW) integration into the Family Health Strategy. Methods: This was a descriptive cross-sectional study. Data were collected through a self-administered semi-structured questionnaire, from February to May 2017, in four Family Health centers in the urban region of Campo Grande, Mato Grosso do Sul, Brazil. Results: 57 Community Health Agents (CHW) and eight EDCWs participated. All participants reported providing guidance to property dwellers and 58 carried out mechanical vector control during the inspection of properties, in order to avoid and eliminate possible Aedes aegypti breeding sites. With regard to EDCW integration in the Family Health Strategy, 18 participants highlighted teamwork as a positive aspect; while 15 highlighted lack of autonomy to undertake legal interventions as a negative aspect. Conclusion: EDCW integration in the Family Health Strategy is feasible, however, adjustments need to be made to optimize activities within the perspective of shared work in the same territorial area.

Integration of endemic disease control workers in the Family Health Strategy, Campo Grande, Mato Grosso do Sul, Brazil, 2017. / Integração do agente de combate às endemias na Estratégia Saúde da Família, Campo Grande, Mato Grosso do Sul, 2017.

OBJECTIVE: To describe the process of Endemic Disease Control Worker (EDCW) integration into the Family Health Strategy. METHODS: This was a descriptive cross-sectional study. Data were collected through a self-administered semi-structured questionnaire, from February to May 2017, in four Family Health centers in the urban region of Campo Grande, Mato Grosso do Sul, Brazil. RESULTS: 57 Community Health Agents (CHW) and eight EDCWs participated. All participants reported providing guidance to property dwellers and 58 carried out mechanical vector control during the inspection of properties, in order to avoid and eliminate possible Aedes aegypti breeding sites. With regard to EDCW integration in the Family Health Strategy, 18 participants highlighted teamwork as a positive aspect; while 15 highlighted lack of autonomy to undertake legal interventions as a negative aspect. CONCLUSION: EDCW integration in the Family Health Strategy is feasible, however, adjustments need to be made to optimize activities within the perspective of shared work in the same territorial area.

Integration of local health agent in the Family Health Strategy, Campo Grande, Mato Grosso do Sul, Brazil, in 2017 / Integración del agente de endemiación en la Estrategia Salud Familiar, Campo Grande, Mato Grosso do Sul, Brasil, en 2017 / Integração do agente de combate às endemias na Estratégia Saúde da Família, Campo Grande, Mato Grosso do Sul, em 2017

Objective. To describe the process of integrating the Agent to Combat Endemic Diseases (ACE) in the Family Health Strategy (ESF). Methods. Cross-sectional descriptive study. Data were collected through a self-administered semi-structured questionnaire, from February to May 2017, in four Family Health Units in the urban region of Campo Grande, Mato Grosso do Sul, Brazil. Results. 57 Community Health Agents (ACS) and eight ACE participated. All participants reported providing guidance to the resident and 58 carried out mechanical control during the inspection of properties, to avoid and eliminate possible Aedes aegypti breeding sites. As for the integration of ACEs in the ESF, 18 participants highlighted teamwork as a positive aspect; and 15, the lack of autonomy for legal interventions as a negative aspect. Conclusion. The integration of ACE in the ESF is feasible, however, adjustments must be made to enhance the activities in the perspective of shared work on the same territorial basis.

Objetivo. Descrever o processo de integração do agente de combate às endemias (ACE) na Estratégia Saúde da Família (ESF). Métodos. Estudo transversal descritivo. Os dados foram coletados por questionário semiestruturado autoaplicável, de fevereiro a maio de 2017, em quatro unidades de Saúde da Família na região urbana de Campo Grande, Mato Grosso do Sul, Brasil. Resultados. Participaram 57 agentes comunitários de saúde (ACS) e 8 ACE. Todos os participantes informaram realizar orientações ao morador e 58 realizavam controle mecânico durante a vistoria de imóveis, visando evitar e eliminar possíveis criadouros do Aedes aegypti. Quanto à integração dos ACEs na ESF, 18 participantes destacaram o trabalho em equipe como aspecto positivo, enquanto 15 referiram falta de autonomia para intervenções legais como aspecto negativo. Conclusão. A integração do ACE na ESF é viável; contudo, ajustes devem ser realizados para potencializar as atividades, na perspectiva do trabalho compartilhado em uma mesma base territorial.

Subjetividades em trânsito: identidade, diáspora africana e cultura imaterial / Subjetividades en tránsito: la identidad, la diáspora y cultura inmaterial / Subjectivities in transit: identity, african diaspora and intangible culture

RESUMO A proposta do artigo pretende trazer contribuições para a valorização da memória oral da diáspora africana no contexto latino-brasileiro contemporâneo, com ênfase na relação entre identidade e diáspora africana do início do século XXI. Para o desenvolvimento do artigo foram utilizados os dados etnográficos coletados, entre os anos de 2013 e 2015, no Estado do Rio de Janeiro, com angolanos que vivem na capital carioca e têm interesse pela manutenção de uma memória oral da diáspora africana contemporânea no Brasil. Assim sendo, a potência das ideias e crenças foram analisadas para que se identifiquem as redes de movimento e reprodução social e subjetiva, que mobilizam os sujeitos envolvidos na pesquisa, enfatizando a importância da salvaguarda da memória atlântica contemporânea, para que não seja esquecida e nem silenciada.

RESUMEN El artículo propuesto tiene como objetivo reunir las contribuciones para la valorización de la memoria oral de la diáspora africana en el contexto contemporáneo latinobrasileño, con énfasis en la relación entre la identidad y la diáspora africana de principios del siglo XXI. Para el desarrollo del artículo se utilizaron datos etnográficos recogidos entre 2013 y 2015 en el Estado de Río de Janeiro con los angoleños que viven en la capital carioca y tienen un interés en mantener una memoria oral de la diáspora africana contemporánea en Brasil. Por lo tanto, se analizó el poder de las ideas y creencias con el fin de identificar las redes de circulación y reproducción social y subjetiva que movilizan los sujetos involucrados en la investigación, haciendo hincapié en la importancia de salvaguardar la memoria contemporánea del Atlántico, para que no se la olvide ni silencie.

ABSTRACT The article proposes to contribute to the valorization of the oral memory of the African diaspora in the contemporary Latin-Brazilian context, with emphasis on the relationship between identity and African diaspora of the beginning of the 21st century. Ethnographic data collected between the years of 2013 and 2015 in the State of Rio de Janeiro were used for the development of the article. Interviews with Angolans living in the capital of Rio de Janeiro and interested in maintaining an oral memory of the contemporary African diaspora in Brazil were conducted. Therefore, the power of ideas and beliefs were analyzed to identify the networks of social and subjective movement and reproduction that mobilize the subjects involved in the research, emphasizing the importance of safeguarding the contemporary Atlantic memory, so that it is neither forgotten nor silenced.

Manejo de factores de riesgo cardiovascular en Venezuela mediante educación de los médicos que trabajan en atención primaria de salud / Management of cardiovascular risk factors in Venezuela by educating physicians working in primary healthcare services

Estudios recientes en América Latina corroboraron la prevalencia de la hipertensión arterial, el colesterol elevado en plasma, los trastornos metabólicos y otros factores de riesgo cardiovascular (FRCV), todo esto sumado a la falta de control de la enfermedad, la escasa adhesión al tratamiento y el uso de pocas medidas preventivas, lo que derivó en la necesidad de educar tanto al médico como al paciente. Se han realizado estudios limitados para demostrar la eficacia del desarrollo profesional continuo y su capacidad de influir positivamente en los indicadores de salud del paciente. En Venezuela se llevó a cabo un estudio para tratar de medir la efectividad de un curso combinado basado en actividades online y presenciales sobre el manejo de los FRCV, dirigido a médicos que trabajan en atención primaria. Un grupo piloto de 37 médicos de atención primaria del área metropolitana de Caracas completó una intervención educativa de 12 semanas, la cual consistió en sesiones semanales en línea, utilizando la estrategia educativa basada en problemas sobre el manejo de los FRCV, así como talleres presenciales relacionados con los cambios de comportamiento del médico y del paciente, utilizando los principios de la educación terapéutica. Se trabajó con una cohorte de 303 pacientes con hipertensión arterial de grado I-II no controlada y/o colesterol plasmático elevado, y se llevó a cabo un seguimiento durante seis meses. Los resultados evidenciaron cambios significativos en los médicos respecto a los aspectos cognitivos y al estilo de su práctica profesional en el manejo de los FRCV. Los participantes se mostraron muy satisfechos con el contenido y el formato de la intervención educativa. De igual manera, encontramos un resultado positivo en la inducción de cambios en toda la cohorte de pacientes, sobre todo en el perfil lipídico, la presión arterial y la modificación del estilo de vida. Sería interesante su aplicación a mayor escala para medir su efectividad a largo plazo

Recent studies in Latin-America corroborated the prevalence of hypertension, elevated plasma cholesterol, metabolic disorders and other cardiovascular risk factors (CVRF) along with lack of disease awareness. Treatment and preventive measures indicated the urgent need for patient and physician education. Limited studies have been conducted to demonstrate the effectiveness of continual professional development (CPD) and its ability to positively improve health care outcomes. A study was done in Venezuela to measure the effectiveness of a blended web-based education in the management of CVRF by primary health care physicians (PCP), working in primary care services. A pilot group of 37 PCP, from the Caracas metropolitan area, completed a 12-week educational intervention consisting of weekly online problem based sessions on CVRF management and face-to-face workshops on physician and patient behavioural changes, using principles of therapeutic education. A cohort of 303 of their patients with uncontrolled grade I-II arterial hypertension and/or elevated plasma cholesterol were included and followed up for a 6-month period. Significant changes in the cognitive aspects and attitudes about the management of CVRF occurred among the PCP, who were highly satisfied with the content and format of the educational intervention. We also found a positive role in inducing changes in the entire patient cohort, particularly on the plasma lipid profile, blood pressure, and lifestyle changes. Results of this pilot study reflect the effective use of CPD on patient care and PCP interactions in creating synergy and understanding with participating institutions. There is a need of large scale implementation and more extensive comparison with other educational approaches

Changes, trends and challenges of medical education in Latin America.

This paper briefly reviews the current situation of Latin American medical schools and the search to improve the quality and professionalism of medical education through the region. Institutional evaluation and accreditation programs based on nationally ongoing developing standards have been accepted, now optimized and complemented by the framework of the Global & International Standards of Medical Education working jointly with the WFME. More recently, the process has evolved to look into the quality of the outcomes of the medicals as seen by examinations implemented at the end of medical studies and the initiation of medical practice. In addition, there is vision for the application of new programs such as the global minimum essential requirements advanced by the Institute for International Medical Education (IIME). The PanAmerican Federation of Associations of Medical Schools (PAFAMS), an academic, non-governmental organization, is fostering the exchange of ideas and experiences among members, associations and affiliated medical schools geared to focus on the quality and professionalism of the graduates of medical schools in Latin America. These actions also aim to consolidate databases of information on medical education and innovative endeavors in continuing professional education and development through e-learning projects in the region.

Identificaçäo diferencial do Mobiluncus sp nas vaginoses bacteriana atraves do diagnostico morfologico e sua importancia na rede de Saude Publica / The value of Mobiluncus sp in the Public Health

Foram selecionados 1.180 amostras de esfregacos cervicovaginais,provenientes de varias Unidades de Saude do Estado de Sao Paulo,corados pelo metodo de Papaniculau,com achados previos de Flora e Gardnerella vaginalis,para deteccao de Mobiluncus sp,em esfregacos negativos para malignidade.Das amostras diagnosticadas inicialmente como Gardnerella vaginalis ou Flora mista,a revisao foram detectados 10,8 por cento de Mobilluncus sp,distribuidos da seguinte forma:7,1 por cento so Mobiluncus sp e 92,9 por cdento associados a outros agentes infecciosos,tais como:Gardnerella vaginalis,Flora mista,Trichomonas vaginalis,Candida sp e Papilimavirus Humano.Concluiu-se que o metodo de Papaniculau e util na deteccao do Mobilluncus sp e sua introducao na rotina diagnostica em laboratorios de saude publica viabilizara a eventual necessidade de diferenciacao no tratamento das vaginoses bacterianas.

Fatores interferentes na correlaçåo cito-histológica em papilomavírus (HPV) / Sample collection factors related to cyto-histologic discrepancies in papilomavirus detection

Cuidados com a colheita, critérios morfológicos, procedimentos técnicos e fases da infecçåo såo fatores fundamentais na integraçåo cito-histológica em Papilomavirus (HPV). Partindo de 22 biópsias cervicais, com infecçåo por HPV, segundo os critérios histológicos definidos por MEISELS e col., revimos as citologias correspondentes seguindo os critérios citológicos de Meisels e os de Schneider. Hibridaçåo "in situ" com sondas biotiniladas para HPV 6, 11, 16, 18, 31, 33, 35, 42, 43, 44, 45, 51, 52 e 56 e ampliaçåo pelo sistema avidina-biotina-peroxidase foi feita em novos cortes das biópsias. A revisåo da citologia revelou 16 casos com alteraçöes por HPV, dos quais 15 com representaçåo endocervical, que nåo foi detectada nos 6 restantes casos negativos. 18 casos (81,8 por cento) foram positivos para DNA-HPV, tendo 2 dos negativos áreas descoladas durante a reaçåo. Todos os casos foram fixados em excesso (m=18,5 dias nos negativos e 11,6 nos positivos). Este trabalho reafirma a importância da revisåo das amostras citológicas dos casos biopsiados, ressaltando a queståo da amostragem como causa dos falsos negativos. A hibridizaçåo mostrou-se útil mesmo em biópsias de rotina, mas a fixaçåo parece interferir com a reatividade do DNA viral

Alteraçöes coilocitóticas em esfregaços cérvico-vaginais: inter-relaçöes entre os aspectos citológico, imunocitoquímico para papilomavírus e morfométrico / Koilocytosis in cervicovaginal smears: morphological, immunocytochemical and morphometrical findings

Apresenta-se o estudo de 44 esfregaços cérvico-vaginais inflamatórios e neoplasias intra-epiteliais cervicais (NIC) com alteraçöes coilocitóticas (indicativas de infecçäo por papilomavírus). Estes esfregaços foram corados pelo método Papanicolaou e posteriormente pelo método de PAP (peroxidase-antiperoxidase) para antígeno de papilomavírus humano (Ag HPV). Efetuou-se a análise citométrica e estatística das dimençöes do citoplasma e núcleo e da relaçäo núcleo-citoplasmática (N/C) das células coilocitóticas, comparadas às das células de esfregaços normais. A relaçäo N/C nas células coilocitóticas foi significativamente maior que a das células normais em todas as faixas de diâmetro médio citoplasmático, tanto nos esfregaços Ag HPV positivos como nos negativos. Os casos Ag HPV negativos, que tiveram a relaçäo N/C igualmente aumentada, devem representar fases da infecçäo sem expressäo antigênica pelo método utilizado. Os resultados parecem apresentar mais um indício de que há uma estreita relaçäo infecçäo por papilomavírus e neoplasia, já que o aumento na relaçäo N/C constitui um dos principais critérios de malignidade