Spatiotemporal trends of Chagas disease-related mortality in the Northeast of Brazil, 2007-2017.

Chagas disease (CD) is a neglected disease and endemic in Brazil. In the Brazilian Northeast Region, it affects millions of people. Therefore, it is necessary to identify the spatiotemporal trends of CD mortality in the Northeast of Brazil. This ecological study was designed, in which the unit of analysis was the municipality of the Brazilian northeast. The data source was the Information System of Mortality. It was calculated relative risk from socioeconomic characteristics. Mortality rates were smoothed by the Local Empirical Bayes method. Spatial dependency was analysed by the Global and Local Moran Index. Scan spatial statistics were also used. A total of 11 287 deaths by CD were notified in the study. An expressive parcel of this number was observed among 70-year-olds or more (n = 4381; 38.8%), no schooling (n = 4381; 38.8%), mixed-race (n = 4381; 62.3%), male (n = 6875; 60.9%). It was observed positive spatial autocorrelation, mostly in municipalities of the state of Bahia, Piauí (with high-high clusters), and Maranhão (with low-low clusters). The spatial scan statistics has presented a risk of mortality in 24 purely spatial clusters (P < 0.05). The study has identified the spatial pattern of CD mortality mostly in Bahia and Piauí, highlighting priority areas in planning and control strategies of the health services.

Mortality and survival of COVID-19.

This study aims to identify the risk factors associated with mortality and survival of COVID-19 cases in a state of the Brazilian Northeast. It is a historical cohort with a secondary database of 2070 people that presented flu-like symptoms, sought health assistance in the state and tested positive to COVID-19 until 14 April 2020, only moderate and severe cases were hospitalised. The main outcome was death as a binary variable (yes/no). It also investigated the main factors related to mortality and survival of the disease. Time since the beginning of symptoms until death/end of the survey (14 April 2020) was the time variable of this study. Mortality was analysed by robust Poisson regression, and survival by Kaplan-Meier and Cox regression. From the 2070 people that tested positive to COVID-19, 131 (6.3%) died and 1939 (93.7%) survived, the overall survival probability was 87.7% from the 24th day of infection. Mortality was enhanced by the variables: elderly (HR 3.6; 95% CI 2.3-5.8; P < 0.001), neurological diseases (HR 3.9; 95% CI 1.9-7.8; P < 0.001), pneumopathies (HR 2.6; 95% CI 1.4-4.7; P < 0.001) and cardiovascular diseases (HR 8.9; 95% CI 5.4-14.5; P < 0.001). In conclusion, mortality by COVID-19 in Ceará is similar to countries with a large number of cases of the disease, although deaths occur later. Elderly people and comorbidities presented a greater risk of death.

Functionality and opposite roles of two interleukin 4 haplotypes in immune cells.

Cytokines expression can be influenced by polymorphisms in their respective coding genes. We associated the CTI/TTD haplotype (Hap-1) and TCI/CCI haplotype (Hap-2) in the IL4 gene formed by the -590, +33 and variable number of tandem repeat polymorphisms with the severity of chronic periodontitis in humans. The functionality of these IL4 haplotypes in the response of immune cells to phorbol 12-myristate 13-acetate (PMA) with Ionomycin and IL-1ß (as inflammatory stimuli) was evaluated. Gene expression (quantitative real-time PCR), profile of secreted cytokines (multiplex) and phenotypic polarization of T cells (flow cytometry) were the outcomes assessed. Green fluorescent protein reporter plasmid constructs containing specific IL4 haplotype were transiently transfected into JM cells to assess the influence of the individual haplotypes on promoter activity. In response to inflammatory stimuli the immune cells from Hap-1 haplotype had increased expression of anti-inflammatory IL4; conversely, the Hap-2 haplotype showed higher levels of pro-inflammatory cytokines. The haplotype CTI proved to be the most important for the regulation of IL4 promoter, regardless of the nature of the inflammatory stimulation; whereas the polymorphism in the promoter region had the least functional effect. In conclusion, IL4 haplotypes studied are functional and trigger opposite immune responses: anti-inflammatory (Hap-1) and pro-inflammatory (Hap-2). In addition, we identified the CTI haplotype as the main responsible for the regulation of IL4 transcriptional activity.

[King's theory reach to families of persons with systemic arterial hypertension]. / Alcance da Teoria de King junto a famílias de pessoas portadoras de hipertensão arterial sistêmica.

The aim was to verify the reach of the King's theory (1981) to families of persons with systemic arterial hypertension. The study was developed analyzing the reach of this theory; verification of its applicability in the family context as related by Moreira (1999); and construction of a concept of family with chronic sick persons which is compatible with the theory. The data showed that the theory is interaccionist, with vulnerable borders, and with content elements and context not well defined. In the focalized situation, a family definition with chronic sick persons was built, showing that is possible to use it as part of part of the subject of King's theory.

[The process if teaching-learning in blood pressure monitoring]. / O processo ensino-aprendizagem na verificação da pressão arterial.

The nurse is considered the professional that obtains more trustworthy data in the measures insinuations of arterial pressure for inducing less reactions of alert in the customer, generating of values falsely high. Even so, a lot of times, she presents spaces in the knowledge of the subject, so much in the technical aspects, as in the anátomo-physiologic ones. That prioritizes the development of teaching strategies, seeking to minimize flaws and to turn the effective learning process. Objectifying to promote the knowledge of the technique of measurement of the arterial pressure close to a research group, it took place a reciclation and avaliation questionnaire of the knowledge of the group was applied before and after the same. The effectiveness of that method was evidenced, because 100% of the sample (nine) they referred contribution for better of the fundamentation theoretical-practice, decreasing difficulties originating from of the verification of the arterial pressure. It is ended that, being the education actions in extremely valid and necessary health, the male nurse, as educator that is, needs to recycle its knowledge and its better techniques continually.

[Brazilian Nursing Association: 70 years of struggle for life]. / Associação Brasileira de enfermagem: 70 anos de luta pela vida.

This work is about the Brazilian Nursing Association (ABEn), its origin, its expansion and projection based on its philosophy and highlighting its achievements from its origin in 1926 until today when its 70th anniversary is being celebrated. This work aims at reporting this institution history and narrating the support provided so that nursing may contribute decisively to the construction of a body of profession knowledge itself, the legal definition of professional practice, teaching regulamentation through its commissions. Methodology has been composed of bibliographic research and interviews with active professionals. It has been concluded that ABEn is stronger and stronger and aware of the way on how to achieve many other goals which will bear great conquests which will contribute for granting nursing power and space as a profession set to the human, therefore, to a better life, with more love, peace and social justice.