Rastreamento da retinopatia diabética pelo médico generalista na Atenção Primária de Saúde do Brasil / Screening of diabetic retinopathy by the physician of Primary Health Care in Brazil

RESUMO Objetivo: Avaliar a acurácia de médicos generalistas em reconhecer a retinopatia diabética por meio da retinografia colorida, com um curso de capacitação com duração de 2 horas, comparando a capacidade de rastrear e classificar a retinopatia diabética em relação ao exame presencial com oftalmologista. Métodos: No primeiro braço do estudo, de 142 pacientes diabéticos incluídos, avaliaram-se 274 olhos, em que esses pacientes foram examinados com oftalmoscópio binocular indireto e classificados quanto ao grau da retinopatia diabética. No segundo braço do estudo, 14 médicos não especialistas em oftalmologia receberam um treinamento de 2 horas para o diagnóstico de retinopatia diabética com a retinografia colorida e se aferiu a acurácia desses profissionais em rastrear a retinopatia diabética antes e depois do curso de capacitação, utilizando as retinografias obtidas na primeira frente do estudo. Resultados: Verificou-se aumento significativo da sensibilidade (82% para 99%) e da especificidade (44% para 83%) na detecção da retinopatia diabética pelos médicos generalistas, com o curso de capacitação. Conclusão: O médico generalista capacitado pode avaliar a retinopatia diabética por meio da retinografia colorida, sendo o programa de rastreamento dessa complicação do diabetes uma proposta viável e benéfica ao país.

ABSTRACT Objective: To assess the accuracy of general practitioners in recognizing diabetic retinopathy through color retinal retinography, with a two-hour training course, by comparing the capacity of screening and classifying diabetic retinopathy. Methods: In the first arm of the study, of 142 diabetic patients included, 274 eyes were evaluated, and these patients were examined with an indirect binocular ophthalmoscope and classified according to the degree of diabetic retinopathy. In the second arm of the study, 14 physicians who are not specialists in ophthalmology received two-hour training to diagnose diabetic retinopathy with color retinography, and the accuracy of these professionals in screening for diabetic retinopathy before and after the training course was measured using the photographic images obtained on the first front of the study. Results: There was a significant increase in sensitivity (82% to 99%) and specificity (44% to 83%) in detecting diabetic retinopathy by general practitioners, after attending the training. Conclusion: Qualified general practitioners can assess diabetic retinopathy through color retinography, and the screening program for this diabetes complication is a viable and beneficial proposal for the country.

Mortalidade proporcional nos povos indígenas no Brasil nos anos 2000, 2010 e 2018 / Proportional mortality in Brazil's indigenous population in the years 2000, 2010, and 2018

RESUMO O objetivo do estudo foi analisar a mortalidade indígena no Brasil em 2000, 2010 e 2018. Estudo descritivo com dados do Sistema de Informação sobre Mortalidade. Calculou-se a mortalidade proporcional entre indígenas e restante da população brasileira, segundo idade, sexo, causa e regiões do Brasil. A proporção de óbitos em indígenas menores de 1 ano em 2000, 2010 e 2018 foi de 15,3%, 17,7% e 16,2%; e no restante do Brasil, foi de 7,2%, 3,5% e 2,7% respectivamente. A proporção de óbitos a partir de 50 anos nos indígenas nos mesmos anos foi de 47,0%, 48,1% e 52,0%; e no restante do Brasil, foi de 66,8%, 74,4% e 79,4%. Em 2018, indígenas menores de 1 ano morreram mais de afecções perinatais (39,4%), doenças infecciosas e parasitárias (10,1%) e causas externas (9,8%). Em menores de 1 ano do restante da população brasileira, essas causas corresponderam a 57,8%, 3,8% e 2,8%. Indígenas acima de 50 anos morreram mais por doenças circulatórias (28,6%), respiratórias (15,4%) e neoplasias (14,6%); e no restante da população brasileira, essas causas representaram 31,5%, 13,6% e 19,0%. Evidenciaram-se desigualdades em saúde e piores indicadores nos povos indígenas no Brasil.

ABSTRACT This study aims to analyze indigenous mortality in Brazil in 2000, 2010, and 2018. This is a descriptive study with data from the Mortality Information System (SIM, in Portuguese). Proportional mortality among indigenous people and the remaining Brazilian population was calculated according to age, sex, cause, and regions of Brazil. The proportion of deaths among indigenous people, for individuals younger than one year of age, in 2000, 2010, and 2018 was 15.3%, 17.7%, and 16.2%, respectively. The proportions for the general Brazilian population were 7.2%, 3.5%, and 2.7%, respectively. For indigenous people aged 50 years and over, the proportions in the same years were 47.0%, 48.1%, and 52.0% and in the rest of Brazil, 66.8%, 74.4%, and 79.4%, respectively. In 2018, indigenous children under 1 year of age died more from perinatal disorders (39.4%), infectious and parasitic diseases (10.1%), and external causes (9.8%). In children under 1 year of age, from the non-indigenous Brazilian population, these causes corresponded to 57.8%, 3.8%, and 2.8%, respectively. Indigenous people over 50 years of age died more from circulatory diseases (28.6%), respiratory diseases (15.4%), and neoplasms (14.6%), and in the remaining Brazilian population, these causes represented 31.5%, 13.6%, and 19.0%, respectively. Health inequalities and worse indicators among indigenous peoples in Brazil are evident.

Tracking SARS-CoV-2 lineage B.1.1.7 dissemination: insights from nationwide spike gene target failure (SGTF) and spike gene late detection (SGTL) data, Portugal, week 49 2020 to week 3 2021.

We show that the SARS-CoV-2 B.1.1.7 lineage is highly disseminated in Portugal, with the odds of B.1.1.7 proportion increasing at an estimated 89% (95% confidence interval: 83-95%) per week until week 3 2021. RT-PCR spike gene target late detection (SGTL) can constitute a useful surrogate to track B.1.1.7 spread, besides the spike gene target failure (SGTF) proxy. SGTL/SGTF samples were associated with statistically significant higher viral loads, but not with substantial shift in age distribution compared to non-SGTF/SGTL cases.

Depressão e fobia social: um caso clínico de avaliação e intervenção cognitivo-comportamental / Depression and social phobia: a clinical case study of cognitive-behavioral therapy evaluation and intervention / Depresión y fobia social: un caso clínico de evaluación y intervención cognitivo-conductual

Este artigo pretende dar a conhecer os resultados duma intervenção cognitivo-comportamental num caso clínico de um jovem com problemas de violência doméstica. Apresenta sintomas depressivos que o prejudicam a nível pessoal, acadêmico e social. Para além disso, manifesta medo e ansiedade acerca de diversas situações de âmbito social em que é exposto à possível avaliação por parte dos outros e receio de que possa vir a comportarse de modo embaraçador. A avaliação psicológica permitiu diagnosticar uma perturbação depressiva e fobia social, tendo sido acionada a intervenção cognitivo-comportamental com base no modelo cognitivo para a depressão, de Beck, e no modelo cognitivo para a ansiedade social, de Clark e Wells. Os resultados da intervenção foram positivos, indicando a importância da terapia cognitivo-comportamental nesses tipos de perturbação.

The aim of this paper is to present the results of a cognitive-behavioral therapy clinical case report of a young man with domestic violence issues. The subject shows depressive symptoms that affect him on a personal, academic and social level. Furthermore, he shows fear and anxiety about several social situations in which he may fall under the scrutiny from other people, and worries about the likelihood of behaving in an embarrassing manner. With the psychological assessment, the subject was diagnosed with depression and social phobia, and cognitive-behavioral therapy based on Beck´s Cognitive Model of Depression and Clark & Wells’s Cognitive Model for Social Anxiety were started off. The results of the intervention were positive, indicating the importance of cognitive-behavioral therapy in this kind of disorders.

Este artículo pretende dar a conocer los resultados de una intervención cognitivo-conductual en un caso clínico de un joven con problemas de violencia doméstica. Él presenta síntomas depresivos que lo perjudican a nivel personal, académico y social. Más allá de eso, presenta miedo y ansiedad sobre muchas situaciones sociales en las que es expuesto a la posible evaluación por parte de los demás y miedo de comportarse de manera embarazosa. La evaluación psicológica ha permitido diagnosticar un disturbio depresivo y fobia social, y fue accionada la intervención cognitivoconductual basada en el Modelo Cognitivo de la depresión de Beck y en el Modelo Cognitivo para la ansiedad social de Clark y Wells. Los resultados de la intervención fueron positivos, indicando la importancia de la terapia cognitivo-conductual en este tipo de disturbios.

Fatores pessoais, desportivos e psicológicos no comportamento de exercício físico / Personal, athletic and psychological factors in exercise behavior / Factores personales, deportivos y psicológicos en el ejercicio físico

INTRODUÇÃO: os benefícios do exercício físico EF são bem conhecidos. Contudo, mais de 60% da população mundial é fisicamente inativa ou ativa de forma insuficiente para atingir tais vantagens. Nesse sentido, torna-se importante compreender os fatores envolvidos na prática de EF, de modo a promover a participação desportiva e a prevenir o abandono do exercício. OBJETIVO: analisar as diferenças num conjunto de variáveis psicológicas em função da tendência para efetuar EF e as variáveis preditoras do comportamento efetivo de EF. MÉTODOS: participaram no estudo 454 praticantes de musculação, cardiofitness e atividades de ritmo de uma academia desportiva no norte de Portugal, tendo sido avaliados três conjuntos de variáveis: a pessoais sexo, idade e índice de massa corporal; b desportivas tempo anterior de prática e frequência semanal de prática anterior ; e c psicológicas atitudes diante do EF, normas subjetivas diante do EF, percepção de controle comportamental, intenção de prática, benefícios e custos do EF e planejamento da prática. RESULTADOS: os que praticam exercício com maior regularidade apresentaram níveis mais elevados de percepção de controle comportamental, intenção de prática e planejamento do EF, em comparação com os praticantes com atividade pouco ou nada regular. A idade, o tempo anterior de prática, a frequência semanal de prática anterior, as normas subjetivas e a percepção de controle comportamental foram preditores significativos do comportamento efetivo de EF. CONCLUSÃO: este estudo confirmou que os praticantes mais regulares evidenciaram um padrão psicológico mais favorável com relação à possibilidade de assumirem comportamentos estáveis de exercício. Por outro lado, os resultados demonstraram a natureza multifacetada dos fatores envolvidos no comportamento de EF. .

INTRODUCTION: the benefits of exercise are well known; however more than 60% of the world population is physically inactive or insufficiently active to achieve such benefits. Therefore, it is important to understand the factors involved in exercise in order to promote participation and avoid discontinuation. OBJECTIVE: to analyze the differences in a set of psychological variables according the tendency to do exercise and the predictors of actual exercise behavior. METHODS: this study involved 454 practitioners of bodybuilding, cardio-fitness and rhythm activities of a sport center in the north of Portugal. Three sets of variables were evaluated: a personal sex, age, and body mass index; b athletic previous practice time and weekly frequency of previous practice; and c psychological attitudes toward exercise, subjective norms toward exercise, perceived behavioral control, exercise purpose, pros and cons of exercise, and exercise planning. RESULTS: those who practice exercise more regularly had higher levels of perceived behavioral control, intention to practice, and exercise planning compared with practitioners with little or no exercise regular activity. Age, previous practice time, weekly frequency of previous practice, subjective norms and perceived behavioral control were significant predictors of the actual exercise behavior. CONCLUSION: this study confirmed that more regular practitioners showed a more favorable psychological pattern regarding the possibility of assuming stable exercise behavior. Moreover, the results demonstrated the multifaceted nature of the factors involved in exercise behavior. .

INTRODUCCIÓN: los beneficios del ejercicio físico EF son bien conocidos. Sin embargo, más del 60% de la población mundial es físicamente inactiva o insuficientemente activa para conseguir tales ventajas. En ese sentido, es importante entender los factores implicados en la práctica del EF, de manera a promover la participación en el deporte y prevenir el abandono del ejercicio. OBJETIVO: analizar las diferencias en un conjunto de variables psicológicas en función de la predisposición a realizar EF y los predictores del comportamiento efectivo de EF. MÉTODOS: este estudio analizó 454 practicantes de musculación, cardiofitness y actividades de ritmo de una academia deportiva en el norte de Portugal. Se evaluaron tres conjuntos de variables: a personales sexo, edad e índice de masa corporal; b deportivas tiempo de la práctica anterior y frecuencia semanal de la práctica anterior y c psicológicas actitudes hacia el EF, normas subjetivas hacia el EF, percepción del control de conducta, intención de práctica, costos y beneficios del EF y la planificación de la práctica. RESULTADOS: los participantes con mayor regularidad de práctica de EF presentaron niveles más altos de percepción de control de conducta, intención de práctica y planificación de EF, en comparación con los participantes poco o nada regulares en la práctica. La edad, el tiempo de práctica anterior, la frecuencia semanal de la práctica anterior, las normas subjetivas y la percepción de control de conducta fueron predictores significativos del comportamiento efectivo de EF. CONCLUSIÓN: este estudio confirmó que más participantes regulares mostraron un patrón psicológico más favorable en cuanto a la a la posibilidad de asumir un comportamiento estable de ejercicio. Además, los resultados demostraron la naturaleza polifacética de los factores implicados en el comportamiento del EF. .

Genetic divergence among accessions of Axonopus jesuiticus x A. scoparius based on morphological and agronomical traits.

This study had the objective of assessing the genetic divergence in giant missionary grass (Axonopus jesuiticus x A. scoparius) germplasm based on morphological and agronomic traits. Five accessions were evaluated in the field: V14337, V14403, V14404, V14405 and V14406. Three contrasting groups were formed using the UPGMA clustering method: V14337 and V14404 formed one group, V14403 and V14405 formed another, and V14406 was isolated from the other accessions. The most striking traits for the identification of the accessions were the height of the plant and the change color of the leaf. Only V14406 accession had purplish green leaves. The other four accessions differed with regards to plant height and dry matter production, with superiority of V14337 and V14404 accessions. The high similarity, as assessed by the mean Euclidean distance, suggests that V14337 and V14404 share the same genotype. The genotypic variability among accessions indicates their potential use in breeding programs.

Retinose pigmentar unilateral ou pseudorretinose pigmentar?: relato de caso / Unilateral retinitis pigmentosa or pseudoretinitis pigmentosa?: case report

A retinose pigmentar unilateral é uma doença rara caracterizada pela perda de fotorreceptores e deposição de pigmento na retina sem acometimento do olho contralateral. Apesar de descrita há mais de cem anos sua existência ainda é questionada. Este artigo relata o caso de um paciente com alterações sugestivas de retinose pigmentar unilateral. Os aspectos clínicos e os exames complementares são discutidos.

Unilateral retinitis pigmentosa is a rare disease characterized by loss of photoreceptors and retinal pigment deposition without affecting the contralateral eye. Although described more than one hundred years its existence is still questioned. This article reports a case of a patient with abnormalities suggestive of unilateral retinitis pigmentosa. The clinical and complementary examinations are discussed.

[Unilateral retinitis pigmentosa or pseudoretinitis pigmentosa? Case report]. / Retinose pigmentar unilateral ou pseudorretinose pigmentar? Relato de caso.

Unilateral retinitis pigmentosa is a rare disease characterized by loss of photoreceptors and retinal pigment deposition without affecting the contralateral eye. Although described more than one hundred years its existence is still questioned. This article reports a case of a patient with abnormalities suggestive of unilateral retinitis pigmentosa. The clinical and complementary examinations are discussed.

Sex differences in the dorsolateral telencephalon correlate with home range size in blenniid fish.

Blenniid fish exhibit a polygynandric mating system with parental care restricted to males. Nest-holder males defend a breeding territory centered on their nest, usually a crevice or hole in a rocky substrate, to which they attract females to spawn. Females, on the other hand, must search for nests in order to spawn and usually are the choosy sex, producing several sequential egg batches and broods during the breeding season. Therefore, male blennies are more site-attached than females. This situation offers an opportunity to investigate potential neural correlates of intraspecific differences in selective pressures for different spatial abilities in these species. Since the dorsolateral telencephalon has been considered a teleost homologue of the mammalian hippocampus, we predicted that the spatial abilities required for females to locate and return accurately to nests of males may have produced a sex difference in the size of the telencephalic nuclei involved in spatial abilities, biased towards females. To test this hypothesis, we assessed the home ranges and measured the size of the dorsolateral telencephalon of both sexes during the breeding season in two blenniid species, the shanny (Lipophrys pholis) and the Azorean rock-pool blenny (Parablennius parvicornis). We chose these two species because they differ in the degree of chemical communication they use, and this could also lead to differences in telencephalic areas. As predicted, in both species females present considerably larger home ranges paralleled by larger dorsolateral ventral telencephalic nuclei (DLv) than males. Other telencephalic nuclei that were measured did not show any sex difference in size. These results suggest that the DLv is involved in spatial abilities in blenniid fish and that sexual selection may be promoting this divergence as already described for mammals and birds.

Cinemática da canoagem: revisão / Canoe kinematics: a review

A canoagem é um esporte equipado praticado em ambientes abertos que utiliza caiaques e canoas. O praticante se desloca com a utilização de remos. As competições são disputadas em diferentes distâncias e a classificação ocorre pelo menor tempo. Na modalidade, a remada para frente é o gesto básico. O objetivo deste estudo é a investigação especifica dos parâmetros cinemáticos da remada de canoagem, realizando uma revisão dos aspectos biomecânicos da modalidade e identificar os parâmetros, sua aplicação e desenvolvimento. As palavras-chave utilizadas para procura dos estudos foram: paddle, kayak, flatwater, piragüismo, canotaje e sports kinematics nas bases Scopus, Google Acadêmico e Capes. Uma melhor técnica de remada proporciona melhores desempenhos, a análise cinemática do movimento de remada, com os parâmetros freqüência média de remada (FR) e comprimento médio de remada (CR), fornecem importantes informações para a melhoria da remada e do rendimento na canoagem. O conhecimento dos parâmetros cinemáticos pode contribuir para melhores escolhas de regulagens e modelos de equipamentos, assim como selecionar atletas para compor embarcações. A avaliação das variáveis cinemáticas ao longo da temporada e carreira de atletas demonstra o desenvolvimento da remada do atleta de forma objetiva.

Canoeing is an equipped sport, whose practice is in open areas and utilizes canoes and cayaks. Athlete moves itself by means of paddles. Competitions are developed in different distances and final classification is by the time. In this modality, paddling is the basic task. The purpose of this review is the specific investigation of the kinematics parameters of the canoeing paddling, by means of a systematic review of the modality biomechanics aspects, and to identify parameters and its application and development. Key-words used to search articles in Scopus, Google Schoolar and CAPES data-base were: paddle, kayak, flat-water, piragüismo, canotaje and sports kinematics. Better paddling technique can improve performance and kinematics analysis made about paddling rate and length can supply important information to technique improvements and paddling performance. Knowledge about kinematics parameters can contribute for better choices in equipments and adjusts, as to select athletes to the boats teams. Assessment of the kinematics variables, along the season shows de individual paddling development in an objective way.

Behavioural endocrinology: no hormonal response in tied fights.

Androgens are the principal sex steroids controlling reproduction and aggression in male fish, but their production can also be affected by social interactions. Here we show that androgen concentrations are not significantly increased in cichlid fish (Oreochromis mossambicus) that are fighting their own image in a mirror, despite their aggressive behaviour towards the virtual intruder. Our results indicate that the hormonal response normally triggered in male contests is not induced under these circumstances by the act of fighting itself, and that it may therefore depend on some indicator of relative fighting ability that cannot be delivered by a mirror-image challenger.

Neurochemical correlates of male polymorphism and alternative reproductive tactics in the Azorean rock-pool blenny, Parablennius parvicornis.

In the common Azorean rock-pool blenny, Parablennius parvicornis, males exhibit alternative reproductive morphologies: (1) larger males defend nest sites, provide parental care, have anal glands (involved in pheromone release), testicular glands, and low gonad:body weight ratio (GSI) and (2) smaller, younger, males do not defend nests, have reduced glands and high GSI. These smaller non-nesting males behave as satellites (associated with nests) or sneakers (moving among nests), attempting to achieve parasitic fertilizations via sperm competition. In non-mammals, arginine vasotocin (AVT) is a key hypothalamic peptide involved in the control of reproductive behavior and physiology, and several fish species that exhibit alternative male reproductive morphs show polymorphism in AVT brain chemistry. We conducted an immunocytochemical study to generate comparative data on this intertidal blenny. Our analysis showed no difference in AVT-immunoreactive cell number or size between the male morphs, which is consistent with studies on other fish, including blennies. The number of AVT cells was positively correlated to fish body mass, while cell size showed no such relation. If corrected for body mass, the smaller non-nesting males have significantly more cells than the large nesting males. Our data suggest that the size and number of forebrain AVT cells develops initially to allow for reproduction in the young non-nesting males and this pattern does not appear to change when males take on the nesting morphotype later in life. This result appears to be consistent in many fishes with alternative male morphotypes.

Social modulation of androgen levels in male teleost fish.

Androgens are classically thought of as the sex steroids controlling male reproduction. However, in recent years evidence has accumulated showing that androgens can also be affected by the interactions between conspecifics, suggesting reciprocal interactions between androgens and behaviour. These results have been interpreted as an adaptation for individuals to adjust their agonistic motivation and to cope with changes in their social environment. Thus, male-male interactions would stimulate the production of androgens, and the levels of androgens would be a function of the stability of its social environment ['challenge hypothesis', Gen. Comp. Endocrinol. 56 (1984) 417]. Here the available data on social modulation of androgen levels in male teleosts are reviewed and some predictions of the challenge hypothesis are addressed using teleosts as a study model. We investigate the causal link between social status, territoriality and elevated androgen levels and the available evidence suggests that the social environment indeed modulates the endocrine axis of teleosts. The association between higher androgen levels and social rank emerges mainly in periods of social instability. As reported in the avian literature, in teleosts the trade-off between androgens and parental care is indicated by the fact that during the parental phase breeding males decreased their androgen levels. A comparison of androgen responsiveness between teleost species with different mating and parenting systems also reveals that parenting explains the variation observed in androgen responsiveness to a higher degree than the mating strategy. Finally, the adaptive value of social modulation of androgens and some of its evolutionary consequences are discussed.

Forebrain AVT and courtship in a fish with male alternative reproductive tactics.

In this paper, we present the results of cellular and molecular studies on the neuroendocrine correlates of male sexual polymorphism in a population of the blenniid fish Salaria pavo (Risso). Bigger and older males defend nests, whereas smaller and younger males mimic female nuptial coloration and behavior to gain access to nests and sneak fertilizations. In this population, sex-role reversal in courtship also occurs (i.e., females are the courting sex). Immunocytochemistry and in situ hybridization were used to examine the production of arginine vasotocin (AVT) peptide and messenger RNA, respectively. The expression of AVT mRNA on a per-cell basis was correlated with mating behavior, rather than with sex morphotype, which suggests that the greater level of AVT mRNA expression in females and sneakers is correlated with the production of courtship behavior. On the other hand, the number and size of AVT peptide-producing cells in both male types is higher or larger, respectively, than in females, which suggests that it is correlated with sex morphotype, rather than with mating behavior.

Carcinoide de reto com metastase hepatica: apresentaçao de um caso / Rectal carcinoid with hepatic metastasis: a case report

Os autores relatam a conduta terapeutica e o seguimentode uma paciente portadora de tumor carcinoide maligno de reto com metastase hepatica, e fazem uma revisao bibliografica do assunto. Salientam que o tumor retal era assintomatico, embora apresentasse invasao da camada muscular do orgao, tendo sido diagnosticado posteriormente ao achado de sua metastase. Justificam a ressecçao local do tumor devido a presença de disseminaçao para o figado. A paciente tem, no momento, um ano de seguimento pos-operatorio, e nao apresenta sinais clinicos ou radiologicos de recidiva local ou intraperitoneal.

Duplicaçäo do sistema pielo-calicial: diagnóstico intra-útero / Pyelo-calix system duplication: intrauterine diagnosis

Atualmente, a ultra-sonografia se apresenta como excelente método para diagnosticar malformaçöes fetais, ainda na vida intra-uterina. Foi realizado exame ecográfico em gestante com amenorréia de 34 semanas, onde foi identificada duplicaçäo do sistema pielo-calicial do rim esquerdo fetal. A anomalia foi confirmada, poucos dias após o parto, em exame realizado no neo-nato. Este diagnóstico pré-natal é importante como alerta para os possíveis problemas renais que podem ocorrer no futuro