Interconsulta médico-enfermeiro na Atenção Primária à Saúde: discursos do sujeito coletivo / Doctor-nurse interconsultation in primary health care: collective subject discourses / Interconsulta médico-enfermero en la atención primaria de la salud: discursos del sujeto colectivo

Objetivando compreender a interconsulta entre médicos e enfermeiros na Atenção Primária à Saúde (APS), empreendeu-se um estudo exploratório e descritivo, qualitativo, com a técnica de grupo focal, analisado à luz do Discurso do Sujeito Coletivo. Participaram quatro enfermeiras e três médicos, cujos discursos sobre sua compreensão da interconsulta e seus formatos originaram quatro ideias centrais: 1. a interconsulta é um trabalho integrado e complementar entre categorias, protagonizado por quem iniciou o atendimento, baseado na comunicação e buscando a integralidade; 2. seu formato depende da segurança dos profissionais, do tempo trabalhando juntos, do ambiente e da demanda do paciente; 3. é importante manter o protagonismo da Enfermagem, rompendo com a lógica centrada no médico; e 4. o modelo "ping-pong" de interconsulta não é funcional. Revelou-se a interconsulta como dispositivo de cuidado bem-sucedido, desafiando a lógica centrada no médico pela atuação integrada e complementar de médicos e enfermeiros da APS.(AU)

With the aim of understanding doctor-nurse interconsultation in primary health care, we conducted a descriptive exploratory qualitative study using focus groups. The data were analyzed using collective subject discourse. Four nurses and three doctors participated in the study, whose discourses on their understanding of interconsultation and its different formats gave rise to four central ideas: interconsultation is integrated and complementary across professions, instigated by the person who began the appointment, communication-based and seeks to promote comprehensiveness; format depends on professional confidence, length of time working together, the environment and patient demands; it is important to maintain nurse protagonism, breaking with doctor-centered logic; the "ping-pong" interconsultation model does not work. The findings reveal that interconsultation is a successful care tool that challenges doctor-centered logic by promoting integrated and complementary working between doctors and nurses.(AU)

Con el objetivo de comprender la interconsulta entre médicos y enfermeros en la Atención Primaria de la Salud (APS), se realizó un estudio exploratorio y descriptivo, cualitativo, con la técnica de grupo focal, analizado a la luz del Discurso del Sujeto Colectivo. Participaron cuatro enfermeras y tres médicos, cuyos discursos sobre su comprensión de la interconsulta y sus formatos originaron cuatro Ideas Centrales: la interconsulta es un trabajo integrado y complementario entre categorías, protagonizado por quien comenzó la atención, con base en la comunicación y buscando la integralidad; su formato depende de la seguridad de los profesionales, del tiempo trabajando juntos, del ambiente y de la demanda del paciente; es importante mantener el protagonismo de la enfermería, rompiendo con la lógica médico-centrada; el modelo "ping-pong" de interconsulta no es funcional. La interconsulta se reveló como un dispositivo de cuidado exitoso, desafiando la lógica médico-centrada por la actuación integrada y complementaria de médicos y enfermeros de la APS.(AU)

Functional richness shows spatial scale dependency in Pheidole ant assemblages from Neotropical savannas.

There is a growing recognition that spatial scale is important for understanding ecological processes shaping community membership, but empirical evidence on this topic is still scarce. Ecological processes such as environmental filtering can decrease functional differences among species and promote functional clustering of species assemblages, whereas interspecific competition can do the opposite. These different ecological processes are expected to take place at different spatial scales, with competition being more likely at finer scales and environmental filtering most likely at coarser scales. We used a comprehensive dataset on species assemblages of a dominant ant genus, Pheidole, in the Cerrado (savanna) biodiversity hotspot to ask how functional richness relates to species richness gradients and whether such relationships vary across spatial scales. Functional richness of Pheidole assemblages decreased with increasing species richness, but such relationship did not vary across different spatial scales. Species were more functionally dissimilar at finer spatial scales, and functional richness increased less than expected with increasing species richness. Our results indicate a tighter packing of the functional volume as richness increases and point out to a primary role for environmental filtering in shaping membership of Pheidole assemblages in Neotropical savannas. OPEN RESEARCH BADGES: This article has been awarded Open Materials, Open Data, Preregistered Research Designs Badges. All materials and data are publicly accessible via the Open Science Framework at https://doi.org/10.5061/dryad.31201jg.

Interaction of IL1B and IL1RN polymorphisms, smoking habit, gender, and ethnicity with aggressive and chronic periodontitis susceptibility.

BACKGROUND: Although the interleukin-1 (IL-1) plays a critical role in the pathogenesis of periodontitis, associations between IL1 gene cluster polymorphisms and the disease remains unclear. AIMS: To investigate the importance of IL1B-511C>T (rs16944), IL1B +3954C>T (rs1143634), and IL1RN intron 2 variable number tandem repeat (VNTR) (rs2234663) polymorphisms, individually or in combination, as the risk factors of periodontitis in a Southeastern Brazilian population with a high degree of miscegenation. SUBJECTS AND METHODS: A total of 145 individuals, with aggressive (aggressive periodontitis [AgP], n = 43) and chronic (chronic periodontitis [CP], n = 52) periodontitis, and controls (n = 50) were genotyped by polymerase chain reaction (PCR) (IL1RN intron 2 VNTR) or PCR-restriction fragment length polymorphism (PCR-RFLP) (IL1B-511 C>T and IL1B + 3954C>T) techniques. STATISTICAL ANALYSIS: The independent t-test, Chi-square, and Fisher's exact tests were used. The SNPStats program was used for haplotype estimation and multiplicative interaction analyses. RESULTS: The IL1B +3954T allele represented risk for CP (odds ratio [OR] = 2.84), particularly in smokers (OR = 4.43) and females (OR = 6.00). The minor alleles IL1RN*2 and *3 increased the risk of AgP (OR = 2.18), especially the IL1RN*2*2 genotype among  white Brazilians (OR = 7.80). Individuals with the combinations of the IL1B + 3954T and IL1RN*2 or *3-containing genotypes were at increased risk of developing CP (OR = 4.50). Considering the three polymorphisms (rs16944, rs1143634, and rs2234663), the haplotypes TC2 and CT1 represented risk for AgP (OR = 3.41) and CP (OR = 6.39), respectively. CONCLUSIONS: Our data suggest that the IL1B +3954C>T and IL1RN intron 2 VNTR polymorphisms are potential candidates for genetic biomarkers of periodontitis, particularly in specific groups of individuals.

Diversidade e riqueza de formigas (Hymenoptera: Formicidae) em remanescentes de Mata Atlantica na Bacia Hidrografica do Alto Tiete, SP

The objective of this study was to describe the diversity, composition and similarity of the ant fauna in seven remnants of Atlantic Forest of Upper Tietê River Basin. Two of these remnants belong to Conservation Units, four are under the protection and a fragment belongs to a private property. In each area, 50 m2 litter samples were collected, which underwent mini-Winkler extractors, where they remained for 48 h. All collections occurred during the rainy season. In total were recorded 11 subfamilies, 44 genera and 158 morphospecies/species of ants. The most frequent species in all areas were Pheidole sp.7, Solenopsis sp.1, Hypoponera sp.1 and Strumigenys denticulate. The highest α diversity value was recorded in the conservation unit with characteristic Atlantic Forest floristic composition, the lowest value in forests with anthropogenic influence. The variation in species composition between areas indicates the replacement of species among remnants of dense rain forest of the Alto Tietê River Basin, which suggests the importance of preserving these areas for the conservation of the regional ant fauna.

O objetivo deste estudo foi descrever a diversidade, composição e a similaridade da fauna de formigas entre sete remanescentes de Floresta Ombrófila Densa da Bacia Hidrográfica do Alto Tietê. Dois desses remanescentes pertencem à Unidades de Conservação, quatro estão sob proteção e um fragmento pertence à propriedade particular. Em cada área foram coletadas 50 m2 de serapilheira, que foram submetidas à extratores do tipo mini-Winkler, onde permaneceram por 48 h. Todas as coletas ocorreram no período chuvoso. No total foram registradas 11 subfamílias, 44 gêneros e 158 morfoespécies/espécies de formigas. As espécies mais frequentes em todas as áreas foram Pheidole sp.7, Solenopsis sp.1, Hypoponera sp.1 e Strumigenys denticulate. O maior valor de diversidade α foi registrado na unidade de conservação com composição florística de Mata Atlântica; o menor valor em florestas com influência antrópica. A variação na composição de espécies entre as áreas indica a substituição de espécies entre os remanescentes de Floresta Ombrófila Densa da Bacia Hidrográfica do Alto Tietê, o que sugere a importância da preservação dessas áreas para a conservação da diversidade regional da fauna de formigas.

Methicillin-resistant Staphylococcus aureus (MRSA) carriage in a dermatology unit.

OBJECTIVE: The aim of this study was to characterize Staphylococcus aureus (MRSA) carriage in a dermatology unit. METHODS: This was a prospective and descriptive study. Over the course of 26 weeks, surveillance cultures were collected weekly from the anterior nares and skin of all patients hospitalized in a 20-bed dermatology unit of a tertiary-care hospital. Samples from healthcare workers (HCWS) were cultured at the beginning and end of the study. Colonized patients were put under contact precautions, and basic infection control measures were enforced. Staphylococcus aureus colonization pressure was determined monthly. Colonized and non-colonized patients were compared, and isolates were evaluated for antimicrobial susceptibility, SCCmec type, virulence factors, and type. RESULTS: Of the 142 patients evaluated, 64 (45%) were colonized by MRSA (39% hospital acquired; 25% community acquired; 36% indeterminate). Despite isolation precautions, hospital-acquired Staphylococcus aureus occurred in addition to the continuous entry of Staphylococcus aureus from the community. Colonization pressure increased from 13% to 59%, and pemphigus and other bullous diseases were associated with MRSA colonization. Eleven out of 71 HCWs (15%) were Staphylococcus aureus carriers, although only one worker carried a persistent clone. Of the hospital-acquired MRSA cases, 14/28 (50%) were SCCmec type IV (3 PFGE types), 13 were SCCmec type III (46%), and one had an indeterminate type. These types were also present among the community-acquired Staphylococcus aureus isolates. SSCmec type IV isolates were shown to be more susceptible than type III isolates. There were two cases of bloodstream infection, and the pvl and tst virulence genes were absent from all isolates. CONCLUSIONS: Dermatology patients were colonized by community- and hospital-acquired Staphylococcus aureus. Half of the nosocomial Staphylococcus aureus isolates were SCCmec type IV. Despite the identification of colonized patients and the subsequent contact precautions and room placement, Staphylococcus aureus colonization continued to occur, and colonization pressure increased. Pemphigus and other bullous diseases were associated with Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) carriage in a dermatology unit

OBJECTIVE: The aim of this study was to characterize Staphylococcus aureus (MRSA) carriage in a dermatology unit. METHODS: This was a prospective and descriptive study. Over the course of 26 weeks, surveillance cultures were collected weekly from the anterior nares and skin of all patients hospitalized in a 20-bed dermatology unit of a tertiary-care hospital. Samples from healthcare workers (HCWS) were cultured at the beginning and end of the study. Colonized patients were put under contact precautions, and basic infection control measures were enforced. Staphylococcus aureus colonization pressure was determined monthly. Colonized and non-colonized patients were compared, and isolates were evaluated for antimicrobial susceptibility, SCCmec type, virulence factors, and type. RESULTS: Of the 142 patients evaluated, 64 (45 percent) were colonized by MRSA (39 percent hospital acquired; 25 percent community acquired; 36 percent indeterminate). Despite isolation precautions, hospital-acquired Staphylococcus aureus occurred in addition to the continuous entry of Staphylococcus aureus from the community. Colonization pressure increased from 13 percent to 59 percent, and pemphigus and other bullous diseases were associated with MRSA colonization. Eleven out of 71 HCWs (15 percent) were Staphylococcus aureus carriers, although only one worker carried a persistent clone. Of the hospital-acquired MRSA cases, 14/28 (50 percent) were SCCmec type IV (3 PFGE types), 13 were SCCmec type III (46 percent), and one had an indeterminate type. These types were also present among the community-acquired Staphylococcus aureus isolates. SSCmec type IV isolates were shown to be more susceptible than type III isolates. There were two cases of bloodstream infection, and the pvl and tst virulence genes were absent from all isolates. CONCLUSIONS: Dermatology patients were colonized by community- and hospital-acquired Staphylococcus aureus. Half of the nosocomial Staphylococcus aureus isolates were SCCmec type IV. Despite the identification of colonized patients and the subsequent contact precautions and room placement, Staphylococcus aureus colonization continued to occur, and colonization pressure increased. Pemphigus and other bullous diseases were associated with Staphylococcus aureus.

Dynamics of the leaf-litter arthropod fauna following fire in a neotropical woodland savanna.

Fire is an important agent of disturbance in tropical savannas, but relatively few studies have analyzed how soil-and-litter dwelling arthropods respond to fire disturbance despite the critical role these organisms play in nutrient cycling and other biogeochemical processes. Following the incursion of a fire into a woodland savanna ecological reserve in Central Brazil, we monitored the dynamics of litter-arthropod populations for nearly two years in one burned and one unburned area of the reserve. We also performed a reciprocal transplant experiment to determine the effects of fire and litter type on the dynamics of litter colonization by arthropods. Overall arthropod abundance, the abundance of individual taxa, the richness of taxonomic groups, and the species richness of individual taxa (Formiciade) were lower in the burned site. However, both the ordinal-level composition of the litter arthropod fauna and the species-level composition of the litter ant fauna were not dramatically different in the burned and unburned sites. There is evidence that seasonality of rainfall interacts with fire, as differences in arthropod abundance and diversity were more pronounced in the dry than in the wet season. For many taxa the differences in abundance between burned and unburned sites were maintained even when controlling for litter availability and quality. In contrast, differences in abundance for Collembola, Formicidae, and Thysanoptera were only detected in the unmanipulated samples, which had a lower amount of litter in the burned than in the unburned site throughout most of our study period. Together these results suggest that arthropod density declines in fire-disturbed areas as a result of direct mortality, diminished resources (i.e., reduced litter cover) and less favorable microclimate (i.e., increased litter desiccation due to reduction in tree cover). Although these effects were transitory, there is evidence that the increasingly prevalent fire return interval of only 1-2 years may jeopardize the long-term conservation of litter arthropod communities.

A comparison of the leaf-litter ant fauna in a secondary atlantic forest with an adjacent pine plantation in southeastern Brazil.

We investigated the influence of Pinus afforestation on the structure of leaf-litter ant communities in the southeastern Brazilian Atlantic Forest, studying an old secondary forest and a nearly 30 year-old never managed Pinus elliottii reforested area. A total of 12,826 individual ants distributed among 95 species and 32 genera were obtained from 50 1 m(2) samples/ habitat. Of these, 60 species were recorded in the pine plantation and 82 in the area of Atlantic forest; almost 50% of the species found in the secondary forest area were also present in the pine plantation. The number of species per sample was significantly higher in the secondary forest than in the pine plantation. Forest-adapted taxa are the most responsible for ant species richness differences between areas, and the pine plantation is richer in species classified as soil or litter omnivorous-dominants. The specialized ant predators registered in the pine plantation, as seven Dacetini, two Basiceros, two Attini and two Discothyrea, belong to widely distributed species. The NMDS (non-metric multidimensional scaling) ordination also suggested strong differences in similarity among samples of the two areas. Furthermore, this analysis indicated higher sample heterogeneity in the secondary forest, with two clusters of species, while in the pine plantation the species belong to a single cluster. We applied the ant mosaic hypothesis to explain the distribution of the leaf-litter fauna and spatial autocorrelation tests among samples. We argue that the results are likely related to differences in quality and distribution of the leaf-litter between the pine plantation and the secondary area.

A comparison of the leaf-litter ant fauna in a secondary atlantic forest with an adjacent pine plantation in southeastern Brazil / Comparação da fauna de formigas de serapilheira entre área de floresta atlântica secundária e plantação adjacente de pinus no sudeste do Brasil

We investigated the influence of Pinus afforestation on the structure of leaf-litter ant communities in the southeastern Brazilian Atlantic Forest, studying an old secondary forest and a nearly 30 year-old never managed Pinus elliottii reforested area. A total of 12,826 individual ants distributed among 95 species and 32 genera were obtained from 50 1 m² samples/ habitat. Of these, 60 species were recorded in the pine plantation and 82 in the area of Atlantic forest; almost 50 percent of the species found in the secondary forest area were also present in the pine plantation. The number of species per sample was significantly higher in the secondary forest than in the pine plantation. Forest-adapted taxa are the most responsible for ant species richness differences between areas, and the pine plantation is richer in species classified as soil or litter omnivorous-dominants. The specialized ant predators registered in the pine plantation, as seven Dacetini, two Basiceros, two Attini and two Discothyrea, belong to widely distributed species. The NMDS (non-metric multidimensional scaling) ordination also suggested strong differences in similarity among samples of the two areas. Furthermore, this analysis indicated higher sample heterogeneity in the secondary forest, with two clusters of species, while in the pine plantation the species belong to a single cluster. We applied the ant mosaic hypothesis to explain the distribution of the leaf-litter fauna and spatial autocorrelation tests among samples. We argue that the results are likely related to differences in quality and distribution of the leaf-litter between the pine plantation and the secondary area.

A influência do reflorestamento com Pinus na estrutura da fauna de formigas de serapilheira foi investigada, estudando uma floresta Atlântica secundária inalterada há 30 anos e uma área reflorestada com Pinus elliottii no Sudeste do Brasil. Em 50 amostras de 1 m² tomadas em cada área, foram coletados 12.826 indivíduos, distribuídos em 95 espécies e 32 gêneros de formigas. Foram identificadas 60 espécies na área reflorestada com Pinus e 82 espécies na área de floresta secundária; aproximadamente 50 por cento das espécies foram registradas nas duas áreas. A mediana do número de espécies por amostra foi maior na floresta secundária. Táxons com biologia especializada são responsáveis por grande parte das diferenças de composição de fauna, sendo a área de reflorestamento com Pinus mais rica em espécies onívoras e dominantes. Predadoras especializadas registradas na área de Pinus, como sete espécies de Dacetini, duas Basiceros, duas Attini e duas Discothyrea, têm ampla distribuição na Floresta Atlântica. A ordenação das amostras com o escalonamento multidimensional não-métrico (NMDS) indicou grande diferença na similaridade entre as amostras das áreas. Adicionalmente, essa análise sugere maior heterogeneidade na composição das amostras da floresta secundária, identificando dois agrupamentos de espécies, enquanto a área de Pinus apresenta um agrupamento apenas. Para investigar quais fatores podem explicar a heterogeneidade observada, testes de co-ocorrência e de autocorrelação espacial foram aplicados entre amostras de cada área. Nossa conclusão é que as diferenças observadas devem estar relacionadas com diferenças na qualidade e distribuição da serapilheira entre as áreas.

Differences between "classical" risk factors for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and risk factors for nosocomial bloodstream infections caused by multiple clones of the staphylococcal cassette chromosome mec type IV MRSA strain.

OBJECTIVE: To identify risk factors associated with nosocomial bloodstream infections caused by multiple clones of the staphylococcal cassette chromosome mec (SCCmec) type IV strain of methicillin-resistant Staphylococcus aureus (MRSA). DESIGN: An unmatched case-control study (at a ratio of 1:2) performed during the period from October 2002 through September 2003. SETTING: A 2,000-bed tertiary care teaching hospital affiliated with the University of São Paulo in São Paulo, Brazil. METHODS: Case patients (n=30) were defined either as patients who had a bloodstream infection due to SCCmec type IV MRSA diagnosed at least 48 hours after hospital admission or as neonates with the infection who were born in the hospital. Control patients (n=60) were defined as patients with SCCmec type III MRSA infection diagnosed at least 48 hours after hospital admission. Genes encoding virulence factors were studied in the isolates recovered from case patients, and molecular typing of the SCCmec type IV MRSA isolates was also done by pulsed-field gel electrophoresis and multilocus sequence typing. RESULTS: In multivariate analysis, the following 3 variables were significantly associated with having a nosocomial bloodstream infection caused by SCCmec type IV strains of MRSA: an age of less than 1 year, less frequent use of a central venous catheter (odds ratio [OR], 0.07 [95% confidence interval {CI}, 0.02-0.28]; p= .025), and female sex. A second analysis was performed that excluded the case and control patients from the neonatal unit, and, in multivariate analysis, the following variables were significantly associated with having a nosocomial bloodstream infection caused by SCCmec type IV strains of MRSA: less frequent use of a central venous catheter (OR, 0.12 [95% CI, 0.03-0.55]; p= .007), lower Acute Physiology and Chronic Health Evaluation II score on admission (OR, 0.14 [95% CI, 0.03-0.61]; p= .009), less frequent surgery (OR, 0.21 [95% CI, 0.06-0.83]; p= .025), and female sex (OR, 5.70 [95% CI, 1.32-24.66]; p= .020). Of the 29 SCCmec type IV MRSA isolates recovered from case patients, none contained the Panton-Valentine leukocidin, gamma-hemolysin, enterotoxin B or C, or toxic shock syndrome toxin-1. All of the isolates contained genes for the LukE-LukD leukocidin and alpha-hemolysin. Genes for enterotoxin A were present in 1 isolate, and genes for beta-hemolysin were present in 3 isolates. CONCLUSIONS: "Classical" risk factors do not apply to patients infected with the SCCmec type IV strain of MRSA, which is an important cause of nosocomial bacteremia. This strain infects a patient population that is less ill and has had less frequent invasive procedures than a patient population infected with the multidrug-resistant strain of SCCmec type III MRSA. We found that virulence factors were rare and that Panton-Valentine leukocidin was absent. There were multiple clones of the SCCmec type IV strain in our hospital. Children under 1 year of age were at a higher risk. There was a predominant clone (sequence type 5) in this patient population.

Prevalence of SCCmec type IV in nosocomial bloodstream isolates of methicillin-resistant Staphylococcus aureus.

Over a period of 7 months, 151 consecutive methicillin-resistant Staphylococcus aureus blood isolates were evaluated. None was community acquired. Twenty (13%) were susceptible to four or more antimicrobials, and 95% of these isolates were identified as SCCmec type IV. Molecular typing demonstrated four patterns, with one predominant pattern. Although usually community acquired, SCCmec type IV in our setting is clearly nosocomial.

Doença de Hailey-Hailey: análise clínica e histopatológica de 4 casos / Hailey-Hailey disease: An clinical and histopathological of 4 cases

Os autores descrevem os casos de doença de Hailey-Hailey registrados no Serviço de Dermatologia do Hospital Universitário Clementino Fraga Filho no período de 1992-1996 e destacam suas semelhanças histológicas com a doença de Darier a doença de Grover