Methodological Quality of Pulmonary Arterial Hypertension Treatment Evidence-Based Guidelines: A Systematic Review Using the AGREE II and AGREE REX Tools.

PURPOSE: Pulmonary arterial hypertension (PAH) is a progressive disease with a poor prognosis, and its management should be grounded in well-developed clinical practice guidelines (CPG). Thus, we critically assess the methodological quality of the available CPG for pharmacological treatments for PAH. METHODS: A systematic review (CRD42023387168) was performed in PubMed, Cochrane, Embase, and Tripdatabase (Jan-2023). Eligible records were appraised by four reviewers using the Appraisal of Guidelines, Research, and Evaluation Collaboration tool (AGREE II) and the complementary tool for assessing recommendations' quality and certainty, AGREE REX. Descriptive statistics were used to summarize the data. RESULTS: Overall, 31 guidelines, mainly authored by professional societies (90%), targeting only physicians as primary users (84%), were identified. Guidelines presented a moderate overall quality (scores of 63% and 51% in AGREE II and AGREE REX, respectively), with a few domains showing slight improvements over the years. AGREE II "Scope and Purpose" (94%) and "Presentation Clarity" (99%) domains obtained the highest scores. The items related to "Stakeholder involvement," "Editorial independence," and "Clinical applicability" (AGREE REX) were fairly reported. Conversely, CPG lacks rigor in development (32% score, AGREE II), scarcely discusses the role of stakeholders, and provides deficient data on the implementation of recommendations (scores of 35% and 46% in AGREE II and AGREE REX, respectively). No differences in the quality of guidelines published by different developers or countries were observed (p > 0.05). CONCLUSION: Methodological weaknesses are common among guidelines addressing PAH treatment, especially regarding scientific rigor, stakeholders' values and preferences, and facilitators and barriers to implementability. Particular attention should be given to developing future guidelines.

Methodological quality and clinical recommendations of guidelines on the management of dyslipidaemias for cardiovascular disease risk reduction: a systematic review and an appraisal through AGREE II and AGREE REX tools.

BACKGROUND: Clinical practice guidelines (CPGs) are statements to assist practitioners and stakeholders in decisions about healthcare. Low methodological quality guidelines may prejudice decision-making and negatively affect clinical outcomes in non-communicable diseases, such as cardiovascular diseases worsted by poor lipid management. We appraised the quality of CPGs on dyslipidemia management and synthesized the most updated pharmacological recommendations. METHODS: A systematic review following international recommendations was performed. Searches to retrieve CPG on pharmacological treatments in adults with dyslipidaemia were conducted in PubMed, Scopus, and Trip databases. Eligible articles were assessed using AGREE II (methodological quality) and AGREE-REX (recommendation excellence) tools. Descriptive statistics were used to summarize data. The most updated guidelines (published after 2019) had their recommendations qualitatively synthesized in an exploratory analysis. RESULTS: Overall, 66 guidelines authored by professional societies (75%) and targeting clinicians as primary users were selected. The AGREE II domains Scope and Purpose (89%) and Clarity of Presentation (97%), and the AGREE-REX item Clinical Applicability (77.0%) obtained the highest values. Conversely, guidelines were methodologically poorly performed/documented (46%) and scarcely provided data on the implementability of practical recommendations (38%). Recommendations on pharmacological treatments are overall similar, with slight differences concerning the use of supplements and the availability of drugs. CONCLUSION: High-quality dyslipidaemia CPG, especially outside North America and Europe, and strictly addressing evidence synthesis, appraisal, and recommendations are needed, especially to guide primary care decisions. CPG developers should consider stakeholders' values and preferences and adapt existing statements to individual populations and healthcare systems to ensure successful implementation interventions.

Mosquito vector competence for dengue is modulated by insect-specific viruses.

Aedes aegypti and A. albopictus mosquitoes are the main vectors for dengue virus (DENV) and other arboviruses, including Zika virus (ZIKV). Understanding the factors that affect transmission of arboviruses from mosquitoes to humans is a priority because it could inform public health and targeted interventions. Reasoning that interactions among viruses in the vector insect might affect transmission, we analysed the viromes of 815 urban Aedes mosquitoes collected from 12 countries worldwide. Two mosquito-specific viruses, Phasi Charoen-like virus (PCLV) and Humaita Tubiacanga virus (HTV), were the most abundant in A. aegypti worldwide. Spatiotemporal analyses of virus circulation in an endemic urban area revealed a 200% increase in chances of having DENV in wild A. aegypti mosquitoes when both HTV and PCLV were present. Using a mouse model in the laboratory, we showed that the presence of HTV and PCLV increased the ability of mosquitoes to transmit DENV and ZIKV to a vertebrate host. By transcriptomic analysis, we found that in DENV-infected mosquitoes, HTV and PCLV block the downregulation of histone H4, which we identify as an important proviral host factor in vivo.

Genetic diversity and antimicrobial resistance of invasive, noninvasive and colonizing group B Streptococcus isolates in southern Brazil.

Introduction: Group B Streptococcus (GBS) is a human commensal bacterium that is also associated with infection in pregnant and non-pregnant adults, neonates and elderly people. Gap Statement: The authors hypothesize that knowledge of regional GBS genetic patterns may allow the use of prevention and treatment measures to reduce the burden of streptococcal disease. Aim: The aim was to report the genotypic diversity and antimicrobial sensitivity profiles of invasive, noninvasive urinary and colonizing GBS strains, and evaluate the relationships between these findings. Methodology: The study included consecutive and non-duplicated GBS isolates recovered in southern Brazil from 2015 to 2017. We performed multiple-locus variable-number tandem repeat analysis (MLVA) and PCR analyses to determine capsular serotypes and identify the presence of the resistance genes mefA/E, ermB and ermA/TR, and also antibiotic susceptibility testing. Results: The sample consisted of 348 GBS strains, 42 MLVA types were identified, and 4 of them represented 64 % of isolates. Serotype Ia was the most prevalent (42.2 %) and was found in a higher percentage associated with colonization, followed by serotypes V (24.4 %), II (17.8 %) and III (7.8 %). Serotype V was associated with invasive isolates and serotypes II and III with noninvasive isolates, without significant differences. All isolates were susceptible to penicillin. GBS 2018/ hvgA was observed in 17 isolates, with 11 belonging to serogroup III. The Hunter-Gaston diversity index was calculated as 0.879. The genes mefA/E, erm/B and erm/A/TR were found in 45, 19 and 46 isolates. Conclusion: This report suggests that the circulating GBS belong to a limited number of genetic lineages. The most common genotypes were Ia/MT12 and V/MT18, which are associated with high resistance to macrolides and the presence of the genes mefA/E and ermA/TR. Penicillin remains the antibiotic of choice. Implementation of continuous surveillance of GBS infections will be essential to assess GBS epidemiology and develop accurate GBS prevention, especially strategies associated with vaccination.

Virological Surveillance of Aedes aegypti Vectors Identifies All Four Dengue Serotypes in a Hyperendemic Region.

Dengue virus (DENV) 1-4 is the etiological agent of dengue, the most important viral infection transmitted by Aedes spp mosquitoes to humans. Our goal was to identify the circulating DENV in Aedes aegypti collected in an area of Brazil where all four DENV serotypes had already been detected in humans, understand the epidemiology better, and to test the vector as a virological surveillance tool. Twenty-eight larvae pools and 174 females of Aedes aegypti were screened by reverse transcriptase quantitative polymerase chain reaction and semi-nested PCR assays. PCR products were sequenced, and phylogenetic analyses were performed. Nine larvae pools (32.1%) were positive for DENV, four (44.4%) with DENV-3, and five (55.6%) with more than one serotype. Fifteen females (8.6%) were positive for any DENV serotype. DENV-1 isolates belong to genotype V, DENV-2 to American-Asian genotype, DENV-3 to genotypes I and III, and DENV-4 to genotypes I and II. We demonstrate for the first time the co-circulation of all four DENV serotypes in larvae pools and adult Aedes aegypti in a hyperendemic area. This scenario represents a challenge for disease control and reinforces the importance of virological surveillance in the vector as a tool for predicting circulating DENV serotypes in humans.

An international, interlaboratory ring trial confirms the feasibility of an extraction-less "direct" RT-qPCR method for reliable detection of SARS-CoV-2 RNA in clinical samples.

Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) is used worldwide to test and trace the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). "Extraction-less" or "direct" real time-reverse transcription polymerase chain reaction (RT-PCR) is a transparent and accessible qualitative method for SARS-CoV-2 detection from nasopharyngeal or oral pharyngeal samples with the potential to generate actionable data more quickly, at a lower cost, and with fewer experimental resources than full RT-qPCR. This study engaged 10 global testing sites, including laboratories currently experiencing testing limitations due to reagent or equipment shortages, in an international interlaboratory ring trial. Participating laboratories were provided a common protocol, common reagents, aliquots of identical pooled clinical samples, and purified nucleic acids and used their existing in-house equipment. We observed 100% concordance across laboratories in the correct identification of all positive and negative samples, with highly similar cycle threshold values. The test also performed well when applied to locally collected patient nasopharyngeal samples, provided the viral transport media did not contain charcoal or guanidine, both of which appeared to potently inhibit the RT-PCR reaction. Our results suggest that direct RT-PCR assay methods can be clearly translated across sites utilizing readily available equipment and expertise and are thus a feasible option for more efficient COVID-19 coronavirus disease testing as demanded by the continuing pandemic.

Atypical Prolonged Viral Shedding With Intra-Host SARS-CoV-2 Evolution in a Mildly Affected Symptomatic Patient.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is caused by a respiratory virus with a wide range of manifestations, varying from asymptomatic to fatal cases, with a generally short outcome. However, some individuals present long-term viral shedding. We monitored 38 individuals who were mildly affected by the SARS-CoV-2 infection. Out of the total studied population, three (7.9%) showed atypical events regarding the duration of positivity for viral RNA detection. In one of these atypical cases, a previously HIV-positive male patient presented a SARS-CoV-2 RNA shedding and subgenomic RNA (sgRNA) detected from the upper respiratory tract, respectively, for 232 and 224 days after the onset of the symptoms. The SARS-CoV-2 B.1.1.28 lineage, one of the most prevalent in Brazil in 2020, was identified in this patient in three serial samples. Interestingly, the genomic analyses performed throughout the infectious process showed an increase in the genetic diversity of the B.1.1.28 lineage within the host itself, with viral clearance occurring naturally, without any intervention measures to control the infection. Contrasting widely spread current knowledge, our results indicate that potentially infectious SARS-CoV-2 virus might be shed by much longer periods by some infected patients. This data call attention to better adapted non-pharmacological measures and clinical discharge of patients aiming at preventing the spread of SARS-CoV-2 to the population.

Coadministration of ibuprofen/caffeine on bleaching-induced tooth sensitivity: A randomized clinical trial.

This clinical trial evaluated the effect of the coadministration of ibuprofen/caffeine on bleaching-induced tooth sensitivity (TS). A triple-blind, parallel-design, randomized clinical trial was conducted on 84 patients who received ibuprofen/caffeine or placebo capsules. The drugs were administered for 48 hours, starting 1 hour before the in-office bleaching. Two bleaching sessions were performed with 35% hydrogen peroxide gel with 1-week interval. TS was recorded up to 48 hours after dental bleaching with a 0-10 visual analogic scale (VAS) and a 5-point numeric rating scale (NRS). The color was evaluated with VITA Classical and VITA Bleachedguide scales (ΔSGU) and VITA Easyshade spectrophotometer (ΔE*ab and ΔE00). The absolute risk of TS in both groups was evaluated using Fischer's exact test. Comparisons of the TS intensity (NRS and VAS data) were performed by using the Mann-Whitney test and a two-way repeated measures ANOVA, respectively. The color alteration between the groups was compared with the Student's t test. The significance level was 5%. There was no statistically significant difference between the groups for the absolute risk of TS (p = 1.00) or for the intensity of TS (p > 0.05). A bleaching of approximately 7 shade guide units was observed on the Vita Classical and Vita Bleachedguide scales, with no statistical difference between the groups. It was concluded that coadministration of ibuprofen and caffeine did not reduce the absolute risk or intensity of TS and did not interfere with the efficacy of dental bleaching.

Coadministration of ibuprofen/caffeine on bleaching-induced tooth sensitivity: A randomized clinical trial

Abstract This clinical trial evaluated the effect of the coadministration of ibuprofen/caffeine on bleaching-induced tooth sensitivity (TS). A triple-blind, parallel-design, randomized clinical trial was conducted on 84 patients who received ibuprofen/caffeine or placebo capsules. The drugs were administered for 48 hours, starting 1 hour before the in-office bleaching. Two bleaching sessions were performed with 35% hydrogen peroxide gel with 1-week interval. TS was recorded up to 48 hours after dental bleaching with a 0-10 visual analogic scale (VAS) and a 5-point numeric rating scale (NRS). The color was evaluated with VITA Classical and VITA Bleachedguide scales (ΔSGU) and VITA Easyshade spectrophotometer (ΔE*ab and ΔE00). The absolute risk of TS in both groups was evaluated using Fischer's exact test. Comparisons of the TS intensity (NRS and VAS data) were performed by using the Mann-Whitney test and a two-way repeated measures ANOVA, respectively. The color alteration between the groups was compared with the Student's t test. The significance level was 5%. There was no statistically significant difference between the groups for the absolute risk of TS (p = 1.00) or for the intensity of TS (p > 0.05). A bleaching of approximately 7 shade guide units was observed on the Vita Classical and Vita Bleachedguide scales, with no statistical difference between the groups. It was concluded that coadministration of ibuprofen and caffeine did not reduce the absolute risk or intensity of TS and did not interfere with the efficacy of dental bleaching.

Resumo Este ensaio clínico avaliou o efeito da coadministração de ibuprofeno/cafeína na sensibilidade dental decorrente de clareamento (SD). Um estudo clínico randomizado, paralelo, triplo-cego, foi realizado em 84 pacientes que receberam cápsulas de ibuprofeno/cafeína ou placebo. Os fármacos foram administrados por 48 horas, começando 1 hora antes do clareamento em consultório. Duas sessões de clareamento foram realizadas com gel de peróxido de hidrogênio 35% com intervalo de 1 semana. A SD foi registrada até 48 horas após o clareamento dental com uma escala visual analógica (VAS) de 0-10 e uma escala de classificação numérica (NRS) de 5 pontos. A cor foi avaliada com as escalas Vita Classical e Vita Bleachedguide (ΔSGU) e com o espectrômetro Vita Easyshade (ΔE*ab e ΔE00). O risco absoluto de SD em ambos os grupos foi avaliado por meio do teste exato de Fischer. As comparações da intensidade da SD (NRS e VAS) foram realizadas utilizando-se o teste Mann-Whitney e uma ANOVA de dois fatores com medidas repetidas, respectivamente. A alteração de cor entre os grupos foi comparada com a o teste t de Student. O nível de significância foi de 5%. Não houve diferença estatisticamente significante entre os grupos para o risco absoluto de SD (p = 1,00) ou para a intensidade de SD (p > 0,05). Observou-se clareamento de aproximadamente 7 unidades nas escalas Vita Classical e Vita Bleachedguide, sem diferença estatística entre os grupos. Concluiu-se que a coadministração de ibuprofeno e cafeína não reduziu o risco absoluto ou intensidade da SD e não interferiu na eficácia do clareamento dental.

An international, interlaboratory ring trial confirms the feasibility of an open-source, extraction-less "direct" RT-qPCR method for reliable detection of SARS-CoV-2 RNA in clinical samples.

Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) is used worldwide to test and trace the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). "Extraction-less" or "direct" real time-reverse transcription polymerase chain reaction (RT-PCR) is an open-access qualitative method for SARS-CoV-2 detection from nasopharyngeal or oral pharyngeal samples with the potential to generate actionable data more quickly, at a lower cost, and with fewer experimental resources than full RT-qPCR. This study engaged 10 global testing sites, including laboratories currently experiencing testing limitations due to reagent or equipment shortages, in an international interlaboratory ring trial. Participating laboratories were provided a common protocol, common reagents, aliquots of identical pooled clinical samples, and purified nucleic acids and used their existing in-house equipment. We observed 100% concordance across laboratories in the correct identification of all positive and negative samples, with highly similar cycle threshold values. The test also performed well when applied to locally collected patient nasopharyngeal samples, provided the viral transport media did not contain charcoal or guanidine, both of which appeared to potently inhibit the RT-PCR reaction. Our results suggest that open-access, direct RT-PCR assays are a feasible option for more efficient COVID-19 coronavirus disease testing as demanded by the continuing pandemic.

Effect of topical application of nanoencapsulated eugenol on dental sensitivity reduction after in-office dental bleaching: a randomized, triple-blind clinical trial.

PURPOSE: This randomized, split-mouth, triple-blind clinical study evaluated the effect of application of nanoencapsulated eugenol (NE) on the absolute risk and intensity of tooth sensitivity (TS) resulting from in-office bleaching. METHODS: Fifty-six patients received a NE in one hemiarch and a placebo gel in the other hemiarch, determined by random sequence, before in-office bleaching. A visual analogue scale (VAS) (0-10) and a numeric rating scale (NRS) (0-4) were used to record TS during bleaching and 1 and 48 h after bleaching. The tooth color was performed from baseline to 2 weeks after bleaching with shade guides (ΔSGU) and a spectrophotometer (∆Eab , ∆E00, and WID ). The TS was assessed through the McNemar test (α = 0.05) and by the Wilcoxon signed-rank test (NRS) and paired t-test (VAS). The paired test-t was employed to compare the color changes (ΔSGU and ΔEab , ∆E00, and WID ). The significance level was 5%. RESULTS: No statistically significant difference was found in the absolute risk or intensity of TS between both groups (p > 0.05). A significant color change was observed in both groups (p > 0.05). CONCLUSION: Administration of the gel containing NE before the in-office dental bleaching did not reduce the TS and did not interfere in the bleaching effect. CLINICAL RELEVANCE STATEMENT: The use of desensitizing gel containing NE did not reduce in-office bleaching-induced tooth sensitivity.

Silent Circulation of the Saint Louis Encephalitis Virus among Humans and Equids, Southeast Brazil.

Saint Louis encephalitis virus (SLEV) is a mosquito-borne flavivirus that occurs throughout the Americas, and is considered a public health threat. In Brazil, SLEV has been detected from human cases associated with dengue-like disease, but no neurological symptoms were reported. Furthermore, the epidemiology of SLEV in human populations is still poorly explored in the country. We reported serological and molecular detection of SLEV in a healthy population of equids and humans from rural areas in Southeast Brazil. A plaque reduction neutralization test was applied, and neutralizing antibodies were detected in 11 individuals (4.6%) and 60 horses (21.5%). A qPCR targeting the 5'UTR region and reverse transcription-PCR (RT-PCR) targeting the non-structural protein (NS5) gene were performed and three individuals tested positive in both assays. Subsequent phylogenetic analysis confirmed SLEV circulation and its findings suggest the occurrence of an asymptomatic or subclinical presence in human and animal cases, correlating with the risks for outbreaks and consequently burden of SLEV infections to public health. Preventive strategies should include improved surveillance in regions with a high probability of SLEV occurrence, improvement in diagnostic methods, and evaluation of exposure/risk factors that can favor SLEV emergence.

Equine infectious anemia virus in naturally infected horses from the Brazilian Pantanal.

Equine infectious anemia (EIA) has a worldwide distribution, and is widespread in Brazil. The Brazilian Pantanal presents with high prevalence comprising equine performance and indirectly the livestock industry, since the horses are used for cattle management. Although EIA is routinely diagnosed by the agar gel immunodiffusion test (AGID), this serological assay has some limitations, so PCR-based detection methods have the potential to overcome these limitations and act as complementary tests to those currently used. Considering the limited number of equine infectious anemia virus (EIAV) sequences which are available in public databases and the great genome variability, studies of EIAV detection and characterization molecular remain important. In this study we detected EIAV proviral DNA from 23 peripheral blood mononuclear cell (PBMCs) samples of naturally infected horses from Brazilian Pantanal using a semi-nested-PCR (sn-PCR). The serological profile of the animals was also evaluated by AGID and ELISA for gp90 and p26. Furthermore, the EIAV PCR amplified DNA was sequenced and phylogenetically analyzed. Here we describe the first EIAV sequences of the 5' LTR of the tat gene in naturally infected horses from Brazil, which presented with 91% similarity to EIAV reference sequences. The Brazilian EIAV sequences also presented variable nucleotide similarities among themselves, ranging from 93,5% to 100%. Phylogenetic analysis showed that Brazilian EIAV sequences grouped in a separate clade relative to other reference sequences. Thus this molecular detection and characterization may provide information about EIAV circulation in Brazilian territories and improve phylogenetic inferences.

The spatial and temporal scales of local dengue virus transmission in natural settings: a retrospective analysis.

BACKGROUND: Dengue is a vector-borne disease caused by the dengue virus (DENV). Despite the crucial role of Aedes mosquitoes in DENV transmission, pure vector indices poorly correlate with human infections. Therefore there is great need for a better understanding of the spatial and temporal scales of DENV transmission between mosquitoes and humans. Here, we have systematically monitored the circulation of DENV in individual Aedes spp. mosquitoes and human patients from Caratinga, a dengue endemic city in the state of Minas Gerais, in Southeast Brazil. From these data, we have developed a novel stochastic point process pattern algorithm to identify the spatial and temporal association between DENV infected mosquitoes and human patients. METHODS: The algorithm comprises of: (i) parameterization of the variogram for the incidence of each DENV serotype in mosquitoes; (ii) identification of the spatial and temporal ranges and variances of DENV incidence in mosquitoes in the proximity of humans infected with dengue; and (iii) analysis of the association between a set of environmental variables and DENV incidence in mosquitoes in the proximity of humans infected with dengue using a spatio-temporal additive, geostatistical linear model. RESULTS: DENV serotypes 1 and 3 were the most common virus serotypes detected in both mosquitoes and humans. Using the data on each virus serotype separately, our spatio-temporal analyses indicated that infected humans were located in areas with the highest DENV incidence in mosquitoes, when incidence is calculated within 2.5-3 km and 50 days (credible interval 30-70 days) before onset of symptoms in humans. These measurements are in agreement with expected distances covered by mosquitoes and humans and the time for virus incubation. Finally, DENV incidence in mosquitoes found in the vicinity of infected humans correlated well with the low wind speed, higher air temperature and northerly winds that were more likely to favor vector survival and dispersal in Caratinga. CONCLUSIONS: We have proposed a new way of modeling bivariate point pattern on the transmission of arthropod-borne pathogens between vector and host when the location of infection in the latter is known. This strategy avoids some of the strong and unrealistic assumptions made by other point-process models. Regarding virus transmission in Caratinga, our model showed a strong and significant association between high DENV incidence in mosquitoes and the onset of symptoms in humans at specific spatial and temporal windows. Together, our results indicate that vector surveillance must be a priority for dengue control. Nevertheless, localized vector control at distances lower than 2.5 km around premises with infected vectors in densely populated areas are not likely to be effective.

Anti-tumoral Effects of Recombinant Lactococcus lactis Strain Secreting IL-17A Cytokine.

Interleukin-17A (IL-17A) is a pro-inflammatory cytokine produced by TH17 cells that participates and contributes in host defense and autoimmune disease. We have recently reported antitumor properties of the probiotic strain of Lactobacillus casei BL23 in mice and TH17 cells was shown to play an important role in this beneficial effect. In order to better understand the role of IL-17A in cancer, we constructed a recombinant strain of Lactococcus lactis producing this cytokine and we determined its biological activity in: (i) a bioassay test for the induction of IL-6 production by murine fibroblasts 3T3 L1 cells line and (ii) in a mouse allograft model of human papilloma virus (HPV)-induced cancer. Our data show that recombinant L. lactis produces and efficiently secretes biologically active IL-17A cytokine. Interestingly, ∼26% of mice intranasally treated with L. lactis-IL-17A and challenged with TC-1 cells remained tumor free over the experiment, in contrast to control mice treated with the wild type strain of L. lactis which developed 100% of aggressive tumors. In addition, the median size of the ∼74% tumor-bearing mice treated with recombinant L. lactis-IL-17A, was significantly lower than mice treated with L. lactis-wt. Altogether, our results demonstrate that intranasal administration with L. lactis secreting IL-17A results in a partial protection against TC-1-induced tumors in mice, confirming antitumor effects of this cytokine in our cancer model.

AIDS tendencies in São Mateus microregion, state of Espírito Santo, and Brazil from 1999 to 2008.

INTRODUCTION: In Brazil, AIDS has been described as a multi-faceted pandemic. This study aimed to describe the trends of AIDS in São Mateus microregion, in Espírito Santo, and in Brazil, from 1999 to 2008. METHODS: Data were collected from the Notification Offences System, and a trend analysis was made. RESULTS: Microregion-based results are close to the state and national levels but with particular features that indicate the presence of regional sub-epidemics. CONCLUSIONS: Despite progress in nearly thirty years of the epidemic, AIDS remains an incurable disease, and prevention is still the best defense against it together with the implementation of specific public policies.

Mortalidade por causas externas na microrregião de São Mateus, estado do Espírito Santo, Brasil: tendências de 1999 a 2008 / Mortality due to external causes in the micro-Region of São Mateus, state of Espírito Santo, Brazil: trends from 1999 to 2008

Objetivo: analisar as tendências da mortalidade por causas externas segundo variáveis sociodemográficas, na microrregião de São Mateus, estado do Espírito Santo, no período 1999-2008. Métodos: os dados foram obtidos do Sistema de Informações sobre Mortalidade (SIM). Foram calculados coeficientes de mortalidade segundo sexo, faixa etária e cor da pele ou raça. Realizou-se análise de tendência usando o modelo de regressão polinomial melhor ajustado. Resultados: No período 1999-2008, o coeficiente de mortalidade por causas externas elevou-se 76,45 para 118,21 óbitos por 100 mil habitantes (p<0,001). Também houve aumento significativo (p<0,001) entre homens, (117,00; 204,22), adolescentes (10 a 19 anos) (51,93; 96,80), adultos (20 a 59 anos), (109,19; 158,79); indivíduos de cor da pele parda (40,59; 144,04) e negra (50,15; 145,66). Conclusão: a mortalidade por causas externas foi maior na população masculina, jovem e negra. No período estudado, a microrregião apresentou forte tendência de aumento da mortalidade por causas externas.

Objective: to analyze trends in mortality due to external causes according to sociodemographic variables, in the microrregion of São Mateus, Espírito Santo state, in the period 1999-2008. Methods: data were obtained from the Mortality Information System (SIM). Mortality rates by sex, age and skin color, and race were calculated. Trends were analyzed using adjusted polynomial regression models. Results: In the period 1999-2008, the mortality rate from external causes rose from 76.45 to 118.21 deaths per 100,000 inhabitants (p <0.001). There were also significant increases (p <0.001) among men, (117.00,204.22), adolescents (10 to 19 years) (51.93,96.80), adults (20 to 59 years) (109.19,158.79); and individuals with brown (40.59,144.04) and black (50.15,145.66) skin color. Conclusion: the mortality from external causes was higher among the male, young and black individuals. In the studied period, there was a strong trend towards increase in the mortality from external causes.

Tendência da AIDS segundo categoria exposta na microrregião São Mateus, no Espírito Santo e no Brasil, no período de 1999 a 2008 / Aids tendency according to exposure category in São Mateus microregion, Espírito Santo State and Brazil from 1999 to 2008 / Tendencia del sida, según categoría expuesta en la microregión de San Mateus, Espírito Santo, Y en Brasil durante el período de 1999 a 2008

O perfil da pandemia de Aids vem sendo marcado pela feminização,envelhecimento, pauperização, heterossexualização e interiorização. A microrregião São Mateus é limítrofe aos estados da Bahia e Minas Gerais, caracterizada por carência social e grande afluxo de pessoas em busca de atividades econômicas e acesso a serviços de saúde. Objetivou-se descrever a tendência da Aids segundo categoria exposta, na Microrregião São Mateus, no Espírito Santo (ES) e no Brasil, no período de 1999 a 2008. Os dados foram coletados no Sistema de Informação de Agravos e Notificações (SINAM); realizou-se análise de tendência no programa GENES. No geral, a primeira, segunda e quarta maior médiade casos ocorreu na exposição heterossexual, ignorada e usuários de drogas injetáveis, respectivamente. Por área avaliada, a transmissão homossexual foi a terceira maior no ES e Brasil e quinta maior na Microrregião; transmissão vertical (TV) terceira maior na Microrregiãoe sexta maior no Brasil e ES. As tendências foram crescentes em todas as categorias na Microrregião; somente nas ignoradas, usuários de drogas injetáveis e TV no ES; e ignorada e TV no Brasil. A Microrregião apresentou perfil semelhante ao estadual e nacional, mas comparticularidades que apontam para a presença de subepidemias regionais.

The profile of the Aids pandemic has been marked by feminization, aging,pauperization, heterosexualization and interiorization. The microregion of Sao Mateus neighbouring the states of Bahia and Minas Gerais is characterized by social deprivation and high flow of people who seek economic activities and access to health care. The aim of thisstudy is to describe the tendency of Aids according to exposure category, in the Microregion of Sao Mateus, in the state of Espírito Santo and in Brazil, from 1999 to 2008. The data was collected from the National disease notification system, and a trend analysis was made throughthe GENES program. In general, the first, second and fourth highest average cases occurred through ignored heterosexual sexual contact and with injecting drug users, respectively. Taking into consideration the studied areas, homosexual transmission was the third largest in the stateof Espírito Santo and Brazil and fifth largest in Sao Mateus; In regards to vertical transmission (VT) this study shows the third largest rates in the Microregion and the sixth largest in Brazil and Espírito Santo. The tendencies have been increasing in all categories in Sao Mateus; and onlyin categories ignored, injecting drug users and VT in the state of Espírito Santo, and ignored categories and VT in Brazil. The Microregion of Sao Mateus showed a similar profile to the state and national levels, but with characteristics that indicate the presence of regional sub-epidemics.

El perfil de la pandemia del SIDA ha estado marcada por la feminizacíon,envejecimiento, pauperización, heterosexualizacíon e interiorización. La Microregíon de San Mateus hace limite con los estados de Bahía y Minas Gerais, se caracteriza por la privación social y la gran afluencia de personas en busca de las actividades económicas y el acceso a los servicios de salud. El objetivo de este estudio fue describir la tendencia del SIDA de acuerdo con la categoría expuesta en la Microregión de San Mateus, Espírito Santo, y Brasil, de 1999 a 2008. Los datos fueran colectados en el Sistema de Enfermedades y notificaciones, El análisis de tendencia se realizó con el programa GENES. En general, el primero, segundo y cuarto promedio más grande de casos ocurrió en la exposición heterosexual, ignorado, y usuarios de drogas inyectables respectivamente. Para el área evaluada, la transmisión homosexual fue la tercera más grande en Brasil y en Espírito Santo, y la quinta mayor en la Microregión; transmisión vertical (TV) tercera más grande en la Microregión y sexta en Brasil y en Espírito Santo. Las tendencias fueron crecientes en todas las categorías en la Microregíon; Solamente en las ignorados, usuarios de drogas inyectables y TV en Espírito Santo; e ignorado y TV en Brasil. La Microregíon presentó semejante al estadual ynacional, pero con particularidades que indican subepidemias regionales.

A estratégia de saúde da família e o rastreamento do câncer de mama / Family health strategy and screening for breast cancer

Identificar as ações de rastreamento do câncer de mama realizadas na Estratégia de Saúde da Família do município de Aracruz/ES e examinar a relação entre as variáveis dependente (realização de mamografia e número de mamografias realizadas) e independente (faixa etária, escolaridade, raça/cor e classe econômica). Estudo descritivo, transversal, quantitativo, realizado nas Unidades de Saúde da Família do município de Aracruz/ES. A coleta de dados foi feita por meio da técnica de entrevista com registro em formulário. A amostra constituiu-se de 459 mulheres com idade igual ou superior a 35 anos. O nível de significância foi de 5%, o Pacote Estatístico, o SPSS 14.0, e o testequi-quadrado foram usados para avaliar a relação entre as variáveis. 55,8% das mulheres já realizaram mamografia, 66,0% fez o primeiro exame até os 49 anos, 70,0% foram submetidas ao exame clínico das mamas durante consulta ginecológica e 65,0% receberam orientações acerca do câncer de mama. A realização de mamografia foi mais prevalente na faixa etária entre 50-59 (76,0%),raça branca (71,4%), classe econômica A/B (84,4%) e não houve significância estatística entre a escolaridade e a realização do exame mamográfico (p=0,775). No que se refere ao número de mamografias realizadas, foi maior no grupo de mulheres de classe econômica A/B e com maior escolaridade (p<0,01). Esses achados apontam a existência de significativas desigualdades socioeconômicas e raciais quanto ao acesso às práticas de rastreamento, reforçando a necessidade de intervenções que levem em consideração essas variáveis como forma de promover a equidade.

To identify actions of breast cancer screening held at the Family Health Strategy in Aracruz/ES and examine the relationship between the dependent variable (mammography and number of mammograms performed) and independent ones (age, education, race/color and social class). Crosssectional study, quantitative, carried out at Family Study Units in Aracruz/ES. Data collection wasdone through the interview technique recorded on proper form. Sample consisted of 459 women aged over 35 years old. The significance level was 5%; the SPSS - Statistical Package 14.0, and the chisquare test was used to assess the relationship between variables. 55.8% of women have mammography performed, 66.0% made their first examination until 49 years old, 70.0% have had clinical breast examination during gynecological examination and 65.0% received guidance on cancer breast. Mammography was more prevalent between the ages 50-59 (76.0%), Caucasian (71.4%); social class A/B (84.4%) and no statistical significance between schooling and completion of mammography (p = 0.775). According to the number of mammograms performed, this number was the largest one at social classes A/B and higher education (p <0.01). These findings indicate the existence of significant socio economic inequalities and racial groups in access to screening practices, reinforcing the need for interventions that consider such variables as a way to promote equity.

Relato de experiência da vivência de acadêmicas de enfermagem no Programa Saúde e Prevenção nas Escolas / Report of the experience of nursing students in the Prevention Health Program at the Schools

Objetivo: relatar a experiência de acadêmicas de enfermagem no Programa Saúde e Prevenção nas Escolas implantado na Escola Municipal de Ensino Fundamental "Roseli Pires Clemente" no bairro SEAC, município de São Mateus, Espírito Santo. Metodologia: o programa foi desenvolvido com alunos da 5ª à 8ª série do ensino fundamental. Resultados: os estudantes foram estimulados a refletirem sobre questões relacionadas à saúde sexual e reprodutiva, uso de substâncias químicas, vulnerabilidade, doenças sexualmente transmissíveis, gravidez não planejada e abuso sexual através de oficinas, exposições temáticas, sensibilização, reflexão, debates e discussões, leitura e análise de textos e de vídeo, uso de modelos/slides e dinâmicas de grupo. e Conclusão: além de fornecer subsídios para a formação profissional das acadêmicas, a vivência com os adolescentes propiciou reflexões sobre a forma de abordagem dos temas, a necessidade da estruturação social em que os adolescentes estão inseridos e a participação da família na vida cotidiana dos mesmos.(AU)