Links between the three-dimensional movements of whale sharks (Rhincodon typus) and the bio-physical environment off a coral reef.

BACKGROUND: Measuring coastal-pelagic prey fields at scales relevant to the movements of marine predators is challenging due to the dynamic and ephemeral nature of these environments. Whale sharks (Rhincodon typus) are thought to aggregate in nearshore tropical waters due to seasonally enhanced foraging opportunities. This implies that the three-dimensional movements of these animals may be associated with bio-physical properties that enhance prey availability. To date, few studies have tested this hypothesis. METHODS: Here, we conducted ship-based acoustic surveys, net tows and water column profiling (salinity, temperature, chlorophyll fluorescence) to determine the volumetric density, distribution and community composition of mesozooplankton (predominantly euphausiids and copepods) and oceanographic properties of the water column in the vicinity of whale sharks that were tracked simultaneously using satellite-linked tags at Ningaloo Reef, Western Australia. Generalised linear mixed effect models were used to explore relationships between the 3-dimensional movement behaviours of tracked sharks and surrounding prey fields at a spatial scale of ~ 1 km. RESULTS: We identified prey density as a significant driver of horizontal space use, with sharks occupying areas along the reef edge where densities were highest. These areas were characterised by complex bathymetry such as reef gutters and pinnacles. Temperature and salinity profiles revealed a well-mixed water column above the height of the bathymetry (top 40 m of the water column). Regions of stronger stratification were associated with reef gutters and pinnacles that concentrated prey near the seabed, and entrained productivity at local scales (~ 1 km). We found no quantitative relationship between the depth use of sharks and vertical distributions of horizontally averaged prey density. Whale sharks repeatedly dove to depths where spatially averaged prey concentration was highest but did not extend the time spent at these depth layers. CONCLUSIONS: Our work reveals previously unrecognized complexity in interactions between whale sharks and their zooplankton prey.

Pooling Saliva Sample as an Effective Strategy for the Systematic CMV Screening of Newborns-A Multicentric Prospective Study.

BACKGROUND: Cytomegalovirus is the most common cause of congenital infections worldwide. Screening all newborns in the first 2 weeks of life is the only way to detect all cases of congenital infection, allowing the monitoring of children with asymptomatic infection at birth and early intervention. AIM: In this multicenter study, we aimed to evaluate the feasibility of using a saliva pool strategy for mass screening in 7 Portuguese hospitals, and to estimate the current prevalence of this congenital infection in these hospitals. METHODS: A total of 7033 newborns were screened between June 2020 and June 2022, and 704 pools of 10 saliva samples were analyzed by polymerase chain reaction (PCR). RESULTS: Of the 704 pools analyzed, 685 were negative and 19 had positive PCR results for cytomegalovirus. After individual PCR testing, 26 newborns had positive saliva results, of which 15 were confirmed by urine testing. Thus, this study's prevalence of congenital infection was 0.21% (95% confidence interval: 0.12%-0.35%). CONCLUSIONS: In this study, the pooling strategy proved to be effective for the systematic screening of newborns, although this low prevalence raises questions regarding the cost-effectiveness of implementing universal screening. However, this prevalence is probably the result of the control measures taken during the pandemic; therefore, the rates are expected to return to prepandemic values, but only a new study after the pandemic will be able to confirm this.

Back to the wild: movements of a juvenile tiger shark released from a public aquarium.

Sharks are an important attraction for aquaria; however, larger species can rarely be kept indefinitely. To date, there has been little work tracking shark movements post-release to the wild. The authors used high-resolution biologgers to monitor a sub-adult tiger shark's pre- and post-release fine-scale movements following 2 years of captivity in an aquarium. They also compared its movement with that of a wild shark tagged nearby. Despite the differences in movement between the two sharks, with vertical oscillations notably absent and greater levels of turning seen from the released shark, the captive shark survived the release. These biologgers improve insight into post-release movements of captive sharks.

Acceptability and applicability of an intervention programme with substance addicts. / Aceitabilidade e aplicabilidade de um programa de intervenção com usuários dependentes de substâncias.

The complexity of the problems related to the harmful use of substances requires regular questioning of practices. This article aims to explore the acceptability and applicability of an intervention programme for patients with problematic substance use. Qualitative study. Data collection, through a focus group with 6 nurses and 6 semi-structured interviews with patients under treatment. We have used lexicographic textual analysis. From the focus group, 151 text segments were analysed, retaining 85.8% of the total for the creation of five classes. An analysis of similarity led to the formation of two central nuclei, represented by the words "Nursing" and "Intervention". From interviews, 252 text segments were analysed, retaining 71.83% for the creation of 5 classes. An analysis of similarity led to the formation of three central nuclei, represented by the words "want", "programme" and "see". Nurses recognise the need for a more structured and flexible approach focused on people's needs. Users also affirm the need for flexible interventions, without a pre-established time frame, that promote labour integration, therapeutic support for abstinence and management of comorbidities.

A complexidade dos problemas relacionados com o uso problemático de substâncias requer questionamento regular das práticas. O objetivo deste artigo é explorar a aceitabilidade e a aplicabilidade de um programa de intervenção com pessoas dependentes de substâncias. Estudo qualitativo. Recolha de dados, realizada através de 1 grupo focal com 6 enfermeiros e 6 entrevistas semiestruturadas a usuários em tratamento. Utilizou-se à análise textual lexicográfica. No grupo focal, foram analisados 151 segmentos de texto, retendo 85,8% do total para a criação de cinco classes. A análise de similitude conduziu à formação de dois núcleos centrais, representados pelas palavras: Enfermeiro e Intervenção. Das entrevistas, foram analisados 252 segmentos de texto, retendo 71,83% para a criação de 5 classes. A análise de similitude conduziu à formação de três núcleos centrais, representados pelas palavras: querer, programa e ver. Os enfermeiros reconhecem a necessidade de uma abordagem mais estruturada, centrada nas necessidades das pessoas e flexível. Os usuários, acrescentam a necessidade de ser flexível, sem tempo definido à partida, promovendo trabalho, suporte terapêutico para abstinência e gestão das comorbilidades.

Aceitabilidade e aplicabilidade de um programa de intervenção com usuários dependentes de substâncias / Acceptability and applicability of an intervention programme with substance addicts

Resumo A complexidade dos problemas relacionados com o uso problemático de substâncias requer questionamento regular das práticas. O objetivo deste artigo é explorar a aceitabilidade e a aplicabilidade de um programa de intervenção com pessoas dependentes de substâncias. Estudo qualitativo. Recolha de dados, realizada através de 1 grupo focal com 6 enfermeiros e 6 entrevistas semiestruturadas a usuários em tratamento. Utilizou-se à análise textual lexicográfica. No grupo focal, foram analisados 151 segmentos de texto, retendo 85,8% do total para a criação de cinco classes. A análise de similitude conduziu à formação de dois núcleos centrais, representados pelas palavras: Enfermeiro e Intervenção. Das entrevistas, foram analisados 252 segmentos de texto, retendo 71,83% para a criação de 5 classes. A análise de similitude conduziu à formação de três núcleos centrais, representados pelas palavras: querer, programa e ver. Os enfermeiros reconhecem a necessidade de uma abordagem mais estruturada, centrada nas necessidades das pessoas e flexível. Os usuários, acrescentam a necessidade de ser flexível, sem tempo definido à partida, promovendo trabalho, suporte terapêutico para abstinência e gestão das comorbilidades.

Abstract The complexity of the problems related to the harmful use of substances requires regular questioning of practices. This article aims to explore the acceptability and applicability of an intervention programme for patients with problematic substance use. Qualitative study. Data collection, through a focus group with 6 nurses and 6 semi-structured interviews with patients under treatment. We have used lexicographic textual analysis. From the focus group, 151 text segments were analysed, retaining 85.8% of the total for the creation of five classes. An analysis of similarity led to the formation of two central nuclei, represented by the words "Nursing" and "Intervention". From interviews, 252 text segments were analysed, retaining 71.83% for the creation of 5 classes. An analysis of similarity led to the formation of three central nuclei, represented by the words "want", "programme" and "see". Nurses recognise the need for a more structured and flexible approach focused on people's needs. Users also affirm the need for flexible interventions, without a pre-established time frame, that promote labour integration, therapeutic support for abstinence and management of comorbidities.

Designing a Nurse-Led Program for Self-Management of Substance Addiction Consequences: A Modified e-Delphi Study.

Therapeutic interventions for people with problematic use of psychoactive substances can help tackle specific needs related to substance addiction consequences. This modified e-Delphi study aimed to establish consensus on a training program for self-management of substance addiction consequences. The study was conducted between February and April 2022, with an experts' sample of 28 participants in the first round and 24 in the second. A priori consensus criteria were defined for each round. The results revealed a very strong consensus was achieved on the structure of the program and on clinical areas, such as the problematic use of substances, general health knowledge, health-seeking behavior and adherence, self-knowledge and well-being, social role and personal dignity, and family process. Additionally, over 80% participant consensus was achieved on an extensive number of interventions categorized as psychoeducational, psychotherapeutic, socio therapeutic, brief interventions, social skills training, problem solving techniques, relaxation techniques, and counseling. These findings may be able to fulfill a gap concerning structured treatment approaches for people with problematic use of psychoactive substances. Supporting self-management of the consequences of substance addiction and its application can change nurses' interventions.

Análise de custo de um centro de reprodução humana assistida no Sistema Único de Saúde / Cost analysis of an assisted human reproduction center in the Unified Health System (SUS)

Resumo O objetivo do estudo foi estimar o custo da implantação de um centro de reprodução humana em um hospital público de referência nacional localizado no Rio de Janeiro. A população elegível foi a de homens e mulheres que possuem diagnóstico das causas mais frequentes de infertilidade. Os itens de custos incluídos foram consultas, exames, equipamentos, recursos humanos e insumos. Os custos foram identificados e quantificados a partir de consulta a clínicas de reprodução assistida, especialistas e literatura. Foram valorados através de bases públicas. A análise dos dados foi realizada através de um modelo de decisão analítico. A perspectiva do estudo foi do SUS provedor. O custo por procedimento na alta complexidade foi de R$ 18.829 para a fertilização in vitro com injeção intracitoplasmática de espermatozoide e de R$ 5.649 para a inseminação artificial. O investimento inicial necessário para funcionamento do centro de alta complexidade para a realização de 480 ciclos foi de R$ 15.903.361 no primeiro ano, o qual incluiu a estruturação do ambiente físico. A estimativa do investimento necessário para a incorporação e manutenção dos serviços no SUS é indispensável para a gestão financeira.

Abstract This study aimed to estimate the cost of implementing a center for assisted human reproduction in a public reference hospital in Rio de Janeiro. The cost analysis was carried out from the perspective of the SUS provider of assistance. The eligible population was men and women diagnosed with the most frequent causes of infertility. The cost items included in primary care and medium complexity were consultations and examinations and in high complexity were equipment, human resources and supplies. Costs were identified and quantified through consultation with assisted reproduction clinics, specialists and literature. They have been valued through public databases. Data analysis was performed using an analytical decision model that included costs of assisted reproduction and effectiveness procedures. The cost per procedure in high complexity was R$ 18,829 for in vitro fertilization with intracytoplasmic sperm injection and R$ 5,649 for artificial insemination. The initial investment required to operate the high complexity center for 480 cycles was R$ 15,903,361 in the first year, which included structuring the physical environment. Estimating the investment required for the incorporation and maintenance of services in SUS is essential for the management of available financial resources.

Programa de suporte medicamentoso com pessoas dependentes de substâncias: Satisfação com os cuidados de enfermagem / Medication based program with substance dependent people: Satisfaction with nursing care

Resumo Contexto: Na saúde, a satisfação com os cuidados recebidos é um indicador relevante para a qualidade e é fundamental para a adesão terapêutica dos utentes. Objetivos: Caraterizar a satisfação com os cuidados de enfermagem numa população atendida por enfermeiros num programa de suporte medicamentoso para pessoas dependentes de substâncias. Métodos: Estudo quantitativo, observacional de corte transversal. Amostra de conveniência acedida em janeiro 2019. Elaborou-se um questionário para caraterização sociodemográfica e psicossocial, e utilizada a "Escala da satisfação dos utentes com os cuidados de enfermagem no centro de saúde", com 22 itens [resposta entre 0-66], que avaliam a satisfação em 6 dimensões (Qualidade na assistência; Envolvimento do utente; Formalização da informação; Promoção de elo de ligação; Informação de recursos; Individualização da informação). Obteve-se o parecer positivo de uma comissão de ética. Resultados: Participaram 181 (n) pessoas. Obteve-se um Alpha de Cronbach da escala, de 0,892. A média apurada foi 59,36 dp=8,19 [23-66]. A subescala que revelou maior índice de satisfação foi "Individualização da informação" (itens relacionados com explicação da informação, de forma compreensível, por parte dos enfermeiros, assim como garantir que o utente percebeu a informação). Com menor índice de satisfação "Informação de recursos" (preocupação em envolver os familiares, informação sobre utilização de outros recursos disponíveis ou serviços de saúde). Conclusões: A satisfação é elevada, sendo a maior dificuldade apontada à inclusão de outros agentes no processo de acompanhamento e a informação de outros recursos disponíveis. Os resultados mantêm aberta a discussão sobre a melhor forma de fazer investigação sobre satisfação.

Abstract Background: In health, satisfaction with received care is a relevant indicator for quality and is fundamental for the users' therapeutic adherence. Aim: To characterize satisfaction with nursing care in a population attended by nurses in a medication-based support program for people dependent on substances. Methods: Quantitative, observational cross-sectional study. Convenience sample accessed in January 2019. A questionnaire was designed for sociodemographic and psychosocial characterization and the "User satisfaction scale with nursing care at the health center" was used, with 22 items [answer between 0-66], that assess satisfaction in 6 dimensions (Quality of care; User involvement; Formalization of Information; Promotion of a link; Information of resources; Individualization of information). Positive opinion of an ethics committee was obtained. Results: 181 (n) people participated. A Cronbach's Alpha of 0.892 was obtained. The mean found was 59.36 SD = 8.19 [23-66]. The subscale that showed the highest level of satisfaction was "Individualization of information" (items related to explanation of information in an understandable way by nurses, as well as ensuring that the user perceived the information). With lower satisfaction index "Resource information" (concern with involving family members, information on the use of other available resources or health services). Conclusions: Satisfaction is high, with the greatest difficulty being the inclusion of other agents in the monitoring process and information about other available resources. The results keep open the discussion about the best way to do research on satisfaction.

Beneficial Effects of Broccoli (Brassica oleracea var italica) By-products in Diet-induced Obese Mice.

BACKGROUND/AIM: Obesity currently affects the whole world, with greater incidence in high-income countries, with vast economic and social costs. Broccoli harvest generates many by-products equally rich in bioactive compounds with potential anti-obesity effects. This study aimed to evaluate the anti-obesity effects of broccoli by-products flour (BF) in obese mice. MATERIALS AND METHODS: A commercial high-fat diet formulation (representing a Western diet) was used to induce obesity in mice. BF (0.67% or 1.34% weight/weight) was incorporated as a chemoprevention compound into a control and a hypercholesterolemic diet, at two different concentrations, and fed for 14 weeks to C57BL/6J mice. For a therapeutic approach, two groups were fed with the hypercholesterolemic diet for 10 weeks, and then fed with BF-supplemented diets in the last 4 weeks of the study. RESULTS: BF supplementation helped to maintain a lower body weight, reduced adipose tissue accumulation, and enhanced the basal activity of superoxide dismutase and glutathione S-transferase. Although BF supplementation tended to reduce the relative liver weight increased by the Western diet, the differences were not significant. CONCLUSION: BF appears to have a beneficial effect in preventing weight gain and fat accumulation induced by hypercholesterolemic diets.

Caracterização do cuidado de enfermagem numa equipa de tratamento para os comportamentos aditivos e dependências / Characterization of nursing care in a treatment team for addictive behaviors and dependencies

Resumo Contexto: Uma das respostas à dependência de substâncias psicoativas são os programas farmacológicos. O conhecimento sobre o impacto destes programas é escasso e é necessário avaliar o contributo e o impacto da consulta de enfermagem integrada nestes programas. Objetivo: Caracterizar o cuidado de enfermagem prestado com uma população com dependência de substâncias psicoactivas numa Equipa Técnica Especializada de Tratamento. Metodologia: Estudo transversal, observacional, analítico, de abordagem quantitativa, com uma população com dependência a substâncias psicoactivas, integrada em programa farmacológico e em consulta de enfermagem. Amostragem por conveniência. Utilizou-se formulário para caracterização sociodemográfica, psicossocial e estado de saúde; Escala Consequências da Dependência de Substâncias (CDS) e o Alcohol Use Disorders Identification Test (AUDIT). Registados dois diagnósticos e duas intervenções prioritárias. Resultados: Participaram 162 pessoas. Média de Idade 46,96, maioritariamente homens (76,5%), solteiros (51,9%), desempregados (58,6%), em programa farmacológico com metadona (68,6%), policonsumidores, com consumos nocivos e dependência face ao álcool (34,9%) e com várias comorbilidades. Sobre as CDS, e por ordem decrescente de severidade "ansiedade", "dificuldade em manter um emprego", "tristeza", "dificuldade em manter-se financeiramente", "problemas no relacionamento familiar". Diagnosticou-se "adesão ao regime terapêutico comprometido", "ansiedade presente", "uso de álcool abusivo/dependente". As principais intervenções de enfermagem "reforçar a relação terapêutica", "ensinar e incentivar o autocuidado", "ensinar/reforçar/assistir sobre adesão ao regime terapêutico". Conclusões: Os dados evidenciam que os diagnósticos mais trabalhados pelos enfermeiros são a adesão terapêutica, a minimização dos consumos e o autocuidado. Outros domínios serão eventualmente sub diagnosticados na prática clínica, de acordo com a avaliação das consequências do consumo de substâncias.

Abstract Context: One of the responses to addiction to psychoactive substances is medication-based programs. Knowledge about the impact of these programs is scarce and it is necessary to assess the contribution and impact of the nursing consultation integrated in these programs. Objective: To characterize the nursing care provided to a population with dependence on psychoactive substances in a Specialized Technical Treatment Team. Methodology: Cross-sectional, observational, analytical study, with a quantitative approach, with a population dependent on psychoactive substances, integrated in a pharmacological program and in a nursing consultation. Convenience sampling. A form was used for sociodemographic, psychosocial and health status characterization; Substance Addiction Consequences Scale (SAC) and the Alcohol Use Disorders Identification Test (AUDIT). Two diagnoses and two priority interventions were recorded. Results: 162 people participated. Average Age 46.96, mostly men (76.5%), single (51.9%), unemployed (58.6%), in a medication-based program with methadone (68.6%), polydrug users, with harmful consumption and dependence on alcohol (34.9%) and with several comorbidities. About SAC, and in decreasing order of severity "anxiety", "difficulty in maintaining a job", "sadness", "difficulty in maintaining financially", "problems in family relationships". "Adherence to the compromised therapeutic regime", "present anxiety", "abusive / dependent alcohol use" was diagnosed. The main nursing interventions "reinforce the therapeutic relationship", "teach and encourage self-care", "teach / reinforce / assist about adherence to the therapeutic regime". Conclusions: The data show that the diagnoses most worked by nurses are therapeutic adherence, minimizing consumption and self-care. Other domains will eventually be under diagnosed in clinical practice, according to the assessment of the consequences of substance use.

A meta-analytical evaluation of the effects of high-salt water intake on beef cattle.

Adequate drinking water is essential to maintain acceptable production levels in beef cattle operations. In the context of global climate change, the water scarcity forecasted for the future is a growing concern and it would determine an increase in the use of poorer quality water by the agricultural sector in many parts of the world. However, consumption of high-salt water by cattle has consequences often overlooked. A meta-analysis was carried out to assess the impact of utilizing high-salt water on dry matter (DMI) and water intake (WI), and performance in beef cattle. The dataset was collected from 25 studies, which were conducted between 1960 and 2020. Within the dataset, the water quality was divided into three categories according to the ratio of sulfates (SO4) or sodium chloride (NaCl) to total dissolved solids (TDS): 1) TDS = all studies included (average SO4:TDS = 0.4); 2) NaCl = considered studies in which water salinity was dominated by NaCl (average SO4:TDS = 0.1); and 3) SO4 = considered studies in which water salinity was dominated by SO4 (average SO4:TDS = 0.8). Results showed that DMI and WI were negatively affected by high-salt water consumption, although the magnitude of the effect is dependent on the type of salt dissolved in the water. There was a quadratic effect (P < 0.01) for the WI vs. TDS, WI vs. NaCl, DMI vs. TDS, and DMI vs. NaCl, and a linear effect (P < 0.01) for WI vs. SO4 and WI vs. SO4. Average daily gain (ADG) and feed efficiency (FE) were quadratically (P < 0.01) affected by high-salt water, respectively. This study revealed significant negative effects of high-salt water drinking on beef cattle WI, DMI, and performance. However, the negative effects are exacerbated when cattle drink high-sulfate water when compared with high-chloride water. To the best of our knowledge, this is the first approach to evaluate animal response to high-salt water consumption and could be included in the development of future beef cattle models to account for the impact of water quality on intake and performance. In addition, this meta-analysis highlights the need for research on management strategies to mitigate the negative effects of high-salt water in cattle.

Maximum Relevance Minimum Redundancy Dropout with Informative Kernel Determinantal Point Process.

In recent years, deep neural networks have shown significant progress in computer vision due to their large generalization capacity; however, the overfitting problem ubiquitously threatens the learning process of these highly nonlinear architectures. Dropout is a recent solution to mitigate overfitting that has witnessed significant success in various classification applications. Recently, many efforts have been made to improve the Standard dropout using an unsupervised merit-based semantic selection of neurons in the latent space. However, these studies do not consider the task-relevant information quality and quantity and the diversity of the latent kernels. To solve the challenge of dropping less informative neurons in deep learning, we propose an efficient end-to-end dropout algorithm that selects the most informative neurons with the highest correlation with the target output considering the sparsity in its selection procedure. First, to promote activation diversity, we devise an approach to select the most diverse set of neurons by making use of determinantal point process (DPP) sampling. Furthermore, to incorporate task specificity into deep latent features, a mutual information (MI)-based merit function is developed. Leveraging the proposed MI with DPP sampling, we introduce the novel DPPMI dropout that adaptively adjusts the retention rate of neurons based on their contribution to the neural network task. Empirical studies on real-world classification benchmarks including, MNIST, SVHN, CIFAR10, CIFAR100, demonstrate the superiority of our proposed method over recent state-of-the-art dropout algorithms in the literature.

Monogenic diabetes: a new pathogenic variant of HNF1A gene.

Maturity onset diabetes of the young defines a diabetes mellitus subtype, with no insulin resistance or autoimmune pancreatic ß-cells dysfunction, that occurs by mutation in a single gene. A 13-year-old girl hospitalised due to hyperglycemia plus glycosuria without ketosis, and with normal glycated haemoglobin of 6.8%. She started a sugar-free fast-absorption diet and no insulin therapy was required. Fasting glucose was normal, but 2 hours after lunch she presented hyperglycemia as after 2 hours of an oral glucose tolerance test, with 217 mg/dL. Family history was positive for type 2 diabetes mellitus with an autosomal dominant pattern. She was discharged with fast-absorption sugar-free diet and low-dose of sulfonylurea. A genetic test was performed detecting a mutation in heterozygosity of HNF1A gene, compatible with the diagnosis of maturity onset diabetes of the young 3 (MODY3), not reported in the literature. Early recognition of signs and symptoms increase awareness of MODY. Genetic test allows confirmation and leads to optimised treatment.

ViralFP: A Web Application of Viral Fusion Proteins.

Viral fusion proteins are attached to the membrane of enveloped viruses (a group that includes Coronaviruses, Dengue, HIV and Influenza) and catalyze fusion between the viral and host membranes, enabling the virus to insert its genetic material into the host cell. Given the importance of these biomolecules, this work presents a centralized database containing the most relevant information on viral fusion proteins, available through a free-to-use web server accessible through the URL https://viralfp.bio.di.uminho.pt/. This web application contains several bioinformatic tools, such as Clustal sequence alignment and Weblogo, including as well a machine learning-based tool capable of predicting the location of fusion peptides (the component of fusion proteins that inserts into the host's cell membrane) within the fusion protein sequence. Given the crucial role of these proteins in viral infection, their importance as natural targets of our immune system and their potential as therapeutic targets, this web application aims to foster our ability to fight pathogenic viruses.

Situación actual de la sífilis congénita en el departamento de Paysandú, años 2015-2019 / Congenital syphilis in Paysandú Department at present (2015-2019) / Situação atual da sífilis congênita no departamento de Paysandú (2015-2019)

Resumen: Introducción: la sífilis es una enfermedad de transmisión sexual, evitable y curable que se transmite al feto. Aunque el tratamiento materno es de fácil realización y bajo costo, Uruguay persiste con dificultades en el control y eliminación de la sífilis congénita (SC). Objetivos: describir la incidencia de casos de SC en el departamento de Paysandú, durante el período comprendido entre el 1/1/2015 y el 31/7/2019. Describir características epidemiológicas y clínicas de las embarazadas y sus recién nacidos (RN) con diagnóstico de SC. Metodología: estudio descriptivo y retrospectivo. Los datos se obtuvieron de auditorías, historias clínicas de internación y policlínicas. Se definió caso de SC según la Organización Panamericana de la Salud y se utilizaron los cuatro escenarios de SC propuestos por el Centers of Disease Control and Prevention (CDC). Resultados: se registraron 30 RN con SC o probabilidad de SC. Veintisiete del subsector público y tres del privado. Casi la mitad fue producto de embarazos mal o no controlados. El 37% de las madres eran consumidoras de drogas, incluso en el embarazo, y en 73% se desconocía o no se había realizado estudio o tratamiento a la pareja sexual. Conclusiones: la mayor incidencia de SC se observa en el subsector público. La mayoría de los casos están relacionados a embarazos de captación tardía, mal controlados o sin controles, y a madres consumidoras de sustancias psicoactivas. El tratamiento de los contactos es un problema sin resolver. Para alcanzar el objetivo sanitario, debemos hacer hincapié en la planificación, control y seguimiento del embarazo, así como en el diagnóstico precoz y en el tratamiento oportuno de esta infección.

Summary: Introduction: syphilis is a preventable and curable sexually transmitted disease, transmitted to the fetus. Although maternal treatment is easy to perform and has a low cost, Uruguay still has difficulties to control and eliminate congenital syphilis (CS). Objectives: describe the incidence of CS in Paysandú Department between 01/01/2015 and 07/31/2019. Describe epidemiological and clinical characteristics of pregnant women and their NB diagnosed with CS. Metodology: descriptive and retrospective study. The data were obtained from audits, hospitalization and clinical medical records. The CS case was defined according to the Pan American Health Organization (PAHO) and the 4 CS scenarios were described by the Centers of Design Control and Prevention (CDC). Results: there were 30 cases of CS and/or probability of CS in newborns. 27 were assisted in the Public Sector and 3 to the Private one. Almost half of them were the result of lately controlled or uncontrolled pregnancies. 37% of the mothers were illegal drug users, even during pregnancy, and in 73% cases no testing and/or treatment had been performed on their sexual partners. Conclusions: the highest prevalence of CS is observed in the public subsector. Most cases were the result of lately or poorly controlled or uncontrolled pregnancies, and came from mothers who had consumed psychoactive substances. The treatment of contacts is still an unresolved problem in the public subsector. To achieve the health objective, we must emphasize the planning, control and monitoring of pregnancies, as well as the early diagnosis and timely treatment of this infection.

Resumo: Introdução: a sífilis é uma doença sexualmente transmissível, evitável e curável, que é transmitida ao feto. Embora o tratamento materno seja fácil de realizar e de baixo custo, o Uruguai ainda tem dificuldades em controlar e eliminar a sífilis congênita (SC). Objetivos: descrever a incidência de SC no departamento de Paysandú entre 01/01/2015 e 31/07/2019. Descrever características epidemiológicas e clínicas de gestantes e seus recém-nascidos diagnosticados com SC. Metodologia: estudo descritivo e retrospectivo. Os dados foram obtidos em auditorias, internações e prontuários clínicos. O caso de SC foi definido de acordo com a Organização Pan-Americana da Saúde (OPAS) e os quatro cenários de SC descritos pelos Centros de Controle e Prevenção de Projeto (CDC). Resultados: houve 30 casos de SC e/ou probabilidade de SC em recém-nascidos. 27 foram atendidos no setor público e 3 no privado. Quase metade deles foram o resultado de gravidezes tardiamente controladas ou não controladas. 37% das mães eram usuárias de drogas ilegais, mesmo durante a gravidez e em 73% dos casos nenhum teste e/ou tratamento foi realizado nos seus parceiros sexuais. Conclusões: a maior prevalência de SC é observada no subsetor público. A maioria dos casos foi resultado de gravidez mal controlada, controlada tardiamente ou não controlada e veio de mães que consumiram substâncias psicoativas. O tratamento dos contatos ainda é um problema não resolvido no setor público. Para atingir o objetivo de saúde, devemos enfatizar o planejamento, controle e monitoramento das gestações, assim como o diagnóstico precoce e o tratamento oportuno dessa infecção.

Responses to COVID-19 in five Latin American countries.

BACKGROUND: COVID-19 reached Latin-American countries slightly later than European countries, around February/March, allowing some emergency preparedness response in countries characterized by low health system capacities and socioeconomic disparities. OBJECTIVE: This paper focuses on the first months of the pandemic in five Latin American countries: Brazil, Chile, Colombia, Ecuador and Peru. It analyses how the pre-pandemic context, and the government's responses to contain and mitigate the spread together with economic measures have affected the COVID-19 health outcomes. METHODS: Extensive qualitative document analysis was conducted focused on publicly-available epidemiological data and federal and state/regional policy documents since the beginning of the pandemic. RESULTS: The countries were quick to implement stringent COVID-19 measures and incrementally scaled up their health systems capacity, although tracing and tracking have been poor. All five countries have experienced a large number of cases and deaths due to COVID-19. The analysis on the excess deaths also shows that the impact in deaths is far higher than the official numbers reported to date for some countries. CONCLUSION: Despite the introduction of stringent measures of containment and mitigation, and the scale up of health system capacities, pre-pandemic conditions that characterize these countries (high informal employment, and social inequalities) have undermined the effectiveness of the countries' responses to the pandemic. The economic support measures put in place were found to be too timid for some countries and introduced too late in most of them. Additionally, the lack of a comprehensive strategy for testing and tracking has also contributed to the failure to contain the spread of the virus.