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We analysed the effects of a 25–year–old motorway on the distribution of five vertebrates inhabiting a fragmented forest landscape and differing in their ability to move across linear infrastructures. We found clear evidence of barrier effects on the distribution of the forest lizard Psammodromus algirus. The roe deer (Capreolus capreolus) was also unequally distributed on both sides of the motorway, but this could also be due, at least in part, to fragmentation. The eyed lizard (Timon lepidus), that can move through open fields, showed no evidence of barrier effects. The distribution of two small birds (Erithacus rubecula and Phylloscopus bonelli) was unaffected by the motorway. Our results show that a motorway may severely restrict the distribution of species which can withstand high levels of forest fragmentation but show limited dispersal ability, highlighting the role of linear infrastructures in shaping species’ ranges at regional scales.

No Brasil, os princípios da educação integral têm se tornado um paradigma para as políticas educacionais e práticas escolares. Todos os conteúdos devem colaborar para que esse princípio seja levado a efeito. Existe, porém, um desafio em particular: o ensino religioso. Este conteúdo historicamente foi utilizado com interesses políticos para imposição da religião hegemônica. Porém, a Base Nacional Comum Curricular lhe confere uma nova possibilidade, em que é utilizado para reforçar a diversidade e a liberdade religiosa. Através de pesquisa documental e bibliográfica, este artigo discute possibilidades para a colaboração deste novo modelo de ensino religioso em um contexto de educação integral

Recensão crítica de Petra Eisele, Annette Ludwig e Isabel Naegele. Futura: The Typeface. London: Laurence King Publishing, 2017. 519 pp. ISBN 978-17-8627-093-1.

Recensão crítica de Adam Joseph Shellhorse, Anti-Literature: The Politics and Limits of Representation in Modern Brazil and Argentina, Pittsburg: University of Pittsburg Press, 2017. 258 pp. ISBN 978-0-8229-6447-6.

Até a finalização deste estudo, não existia no Brasil uma legislação no seguimento de produtos saneantes que disponibilizasse um guia cientificamente embasado para realização de estudos de estabilidade. O objetivo deste trabalho consiste na análise das legislações para registro de produtos saneantes de uso em assistência à saúde no Brasil, comparando seus diferentes critérios de estudo com legislações internacionais. Como resultado desta análise, propõem-se um guia para garantir a eficácia e a segurança ao longo do prazo de validade definido para estes produtos. Verifica-se que as legislações internacionais estudadas apresentam critérios mais rígidos, tais como (i) a avaliação das especificações de qualidade e segurança ao longo de todo o prazo de validade proposto; (ii) a avaliação do comportamento da embalagem e informações da rotulagem; (iii) o uso de uma metodologia de análise validada; (iv) e quando aplicável um estudo que simule as variações do produto nas condições de uso (ex.: diluições ou ativação para uso). Após análise crítica destas legislações, chega-se à proposta de um guia adequado às realidades do setor produtivo brasileiro, de forma a se regulamentar este procedimento como parte integrante do processo administrativo de registro sanitário nas rotinas da Agencia Nacional de Vigilância Sanitária - Brasil (ANVISA).

Desde a promulgação da lei que regula direitos e obrigações relativos à Propriedade Industrial, Lei n. 9.279/96, baseada nos preceitos ditados pelo TRIPS - Trade-Related Aspects of Intellectual Property Right, a retomada da proteção dos produtos e processos farmacêuticos, inicialmente, através dos arts. 230-232 que possibilitaram a revalidação, no Brasil, de patentes concedidas no exterior, sem análise de mérito, vem sendo debatida em diversos foros. Embora não seja de opinião unívoca, é constante e acirrada a discução sobre a constitucionalidade do ato de se conceder o privilégio à uma suposta invenção sem análise dos requisitos básicos de patenteabilidade exigidos internacionalmente, insculpidos no art. 8º que se confunde com as acirradas discussões sobre a dualidade que permeia a concessão patentes a tecnologias utilizadas na produção de medicamentos considerados de interesse público e o direito à propriedade imaterial, ambos garantidos constitucionalmente. Em virtude dessas considerações, o presente documento destina-se a relatar a atividade que vem sendo implantada em Farmanguinhos, através da qual as tecnologias afetas à produção dos medicamentos é monitorada, como uma inovação na gestão pública, através da identificação de pontos mais relevantes a serem apreciados na análise de pedidos de patente ou patentes concedidas considerando o arcabouço jurídico nacional e internacional que norteia o sistema de propriedade industrial no Brasil à luz dos ditames constitucionais.

Nas últimas décadas, ocorreram transformações significativas na área da saúde pública, dentre elas a implantação da estratégia saúde da família (ESF) o que tem demandado novas tecnologias do chr(38)quot;fazerchr(38)quot; em saúde. Neste sentido, objetivou-se avaliar a experiência de usuários da ESF em um grupo de promoção de saúde na comunidade. Trata-se de um estudo descritivo e exploratório, que utilizou o método de análise de conteúdo temática para a análise qualitativa do material. Foram realizadas seis entrevistas abertas com os participantes do grupo. A análise das entrevistas permitiu que fossem construídas duas categorias temáticas: Concepções do Grupo e Percepções de Mudanças. Conclui-se que o Grupo é percebido com um espaço de divertimento, facilitador de vínculos e de lazer, além de auxiliar na formação de uma rede de apoio mútuo e ainda, numa maior interação entre equipe de saúde - usuários e de proporcionar mudanças em aspectos psicossociais e na qualidade de vida

Objectives: To assess the frequency of symptoms in patients with Oropouche fever and compare them with those observed in patients with dengue and other arboviral diseases., Methods: A systematic review was conducted following the MOOSE and PRISMA reporting guidelines. The review included studies on acute clinical manifestations in patients with Oropouche fever. Searches were conducted in PubMed, Virtual Health Library, Cochrane Library, and Google Scholar up to September 2024. The symptoms of Oropouche fever were compared to those of dengue and other arboviral diseases. Certainty of evidence was assessed using the GRADE approach., Results: A total of 23 studies covering 3648 patients with Oropouche fever were included. The most frequent symptoms in patients with Oropouche virus infection were fever (97%) and headache (86%). There was no difference in frequency of fever or headache between patients with Oropouche and dengue. However, odynophagia (28%) and abdominal pain (15%) were more frequent in Oropouche than in dengue, with odds ratios (ORs) of 3.20 and 2.50, respectively. Myalgia (69%) and arthralgia (57%) were less frequent in Oropouche fever than in dengue., Conclusions: Fever and headache are common in Oropouche virus infection, but do not help discriminate it from dengue. However, odynophagia and abdominal pain are more frequent in patients with Oropouche fever, while myalgia, arthralgia, and rash are more prevalent in dengue. These findings may aid in differential diagnosis in areas of arboviral co-circulation. Further studies on the recurrence and duration of symptoms are needed to improve diagnostic strategies., Competing Interests: Conflictos de intereses. Ninguno declarado.

Objective: To analyse the lines of action identified in the health promotion projects participating in the EvaluA GPS research, and their relationship with the scores assigned in EvalGuia, a tool for evaluating evidence-based community participation., Design: Qualitative-quantitative multicentre study., Setting: Primary care or intersectoral network of primary care and municipalities in five autonomous communities in Spain., Participants: Participants of 10 health promotion projects, selected with convenience sampling, following inclusion criteria (projects with a minimum of community engagement and centred on community health)., Method: Data were collected through questionnaires (EvalGuía tool) and participatory workshops. Quantitative data were analysed with descriptive statistics, qualitative data were analysed using matrix analysis., Results: After implementing the EvalGuide tool, the lowest scores were assigned in outcome evaluation, knowledge of policies related to community participation, diversity in the core working group, inclusivity policies, financial resources and diffusion of results. The lines of action proposed were heterogeneous and did not always match with those prioritised as lower score. The prioritised lines revolved around project organisation and communication., Conclusions: The EvalGuide tool can be helpful to design action plans in Health Promotion projects. The implementation of measures in 12 months to increase the diversity of the core working group, to incorporate work-life balance measures or to improve evaluation is difficult. More time is needed to implement such measures., (Copyright © 2023 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Introduction: The concrete burden of neonatal seizures in neurodevelopmental outcome of term newborns is still unknown in literature. The aim of this study was to describe prognostic predictors in neonatal seizures., Subjects and Methods: Observational prospective study of term neonates with clinical seizures from a tertiary center (2009-2018). Adverse outcome was determined as death, global developmental delay, cerebral palsy or epilepsy. Perinatal characteristics, etiology, electrographic features, neuroimaging and antiepileptic treatment were analyzed in a logistic regression model., Results: A total of 102 newborns were included (52 infants with normal outcome). Twelve fatalities were registered. In the survival group, 38 children had an adverse outcome (28 global developmental delay, 27 cerebral palsy, 21 epilepsy). From the prognostic variables identified in univariate analysis, perinatal complications, seizure onset in the first day of life, moderate to severe abnormal background activity, abnormal amplitude-integrated EEG pattern, and treatment response remained independently associated with adverse outcome after a logistic regression model., Conclusions: There is conflicting data about surrogate markers in neonatal seizures. Aside from confirming the predictive value of previously described variables, we observed that amplitude-integrated EEG monitoring is a forthcoming prognostic tool. Future approaches may include a wider use of amplitude-integrated EEG monitoring, being crucial for timely seizure identification and prompt treatment.

Introduction: Neurovascular ultrasound is a non-invasive, portable and fast imaging method that, when performed by an experienced neurosonologist, offers reliable and reproducible information on the morphological and hemodynamic status of cervical and intracranial vessels., Aim: To review the available evidence regarding the use of this tool in the approach to acute stroke., Development: Neurovascular ultrasound can be used in one of two ways: diagnostic and therapeutic. Considering the low recanalization rates of internal carotid artery and proximal medial cerebral artery occlusions with intravenous recombinant tissue plasminogen activator (r-tPA), neurovascular ultrasound used shortly in Emergency Department may help to select patients that could benefit from endovascular therapy. Moreover, ultrasound monitorization during intravenous r-tPA treatment allows the analysis of the pattern of arterial recanalization. Cervical ultrasound allows the assessment of the stenosis degree and the composition/surface of an arterial plaque that could, for instance, reveal earlier a candidate for carotid intervention. Finally, the therapeutic potential of ultrasound is also being investigated. Sonothrombolysis and sonolysis, that combine ultrasound technology with r-tPA and use exclusively the ultrasound to lyse the clot, respectively, showed promising results., Conclusion: Neurovascular ultrasound has greatly expanded to assume an important role in the study of cerebrovascular disorders.

Background and Objective: White coat effect (WCE) is one of the main bias that can affect office blood pressure (BP) measurement. Therefore, it is a factor must be considered in hypertensives to avoid mistakes in diagnosis and/or treatment. Employment of automated office BP (AOBP) devices could diminish that effect., Methods: Two studies were designed with the objective of evaluating differences between routinely office and AOBP measurements. WCE was also assessed. First, the TRUE-ESP study included normotensive and hypertensive patients attending specialized consultations at Cardiology, Nephrology, Internal Medicine, Endocrinology and Family Practice. Second, the TRUE-HTA study included hypertensives attending a protocoled Hypertension Unit, with a trained staff., Results: TRUE-ESP study included 300 patients, 76% being hypertensives. A significant difference between office BP and AOBP measurement (SBP/DBP 9.8±11.6/3.4±7.9 mmHg, P<.001) was observed. Percentage of patients gathering WCE criteria was 27.7%. TRUE-HTA study included 101 hypertensive patients. A significant difference between office BP and AOBP measurement (SBP/DBP 5.7±9.3/2.1±5.3 mmHg, P<.001) and activity period-ABPM (SBP/DBP 8.5±6.7/3.5±2.5 mmHg, P<.001) was observed. Percentage of WCE patients was 32.1%., Conclusions: Use of AOBP devices can contribute to decrease WCE and to improve accuracy of office BP measurement., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Objective: To assess an interdisciplinary programme for the improvement of pharmacotherapy quality and patient safety in patients with chronic renal disease who are treated with erythropoiesis-stimulating agents., Method: Observational, longitudinal study. Retrospective analysis (period A) and prospective analysis (period B) following implementation of the programme for haemoglobin values and monthly erythropoiesis-stimulating agent dosage. The proportion of patients with haemoglobin values within the target range (10-5-12.5 g/dl) and those with values above the safety limit (>or= 12.5g/dl) were compared every four months and the average percentage of time with haemoglobin values within the target range and above the safety limit were compared during periods A and B., Results: 59 patients were included in the study. The proportion of patients with haemoglobin levels within the target range increased from 28.8% to 65.4% (RR = 2.27; 95% CI, 1.56-3.30) and the value in patients with haemoglobin levels above the safe level reduced from 57.6% to 19.2% (RAR = 0.39; 95% CI, 0.19-0.55). The time with haemoglobin levels in the target range increased 15.7% (95% CI, 7.1-24.2) and the time with values above the safe level reduced 26.9% (95% CI, -35.1 to -18.6). The number of patients included to avoid one reaching a haemoglobin value above the safe range was 2.6 (95% CI, 2.5-2.7)., Conclusions: the implementation of an improvement programme for the quality of pharmacotherapy with erythropoiesis-stimulating agents in patients with haemodialysis significantly increases the proportion of patients with haemoglobin values within the recommended ranges of effectiveness and safety.

We report the case of a 68-year-old male with a diagnosis of unclassifiable myelodysplatic/myeloproliferative disease (WHO classification), under prolonged steroid treatment and unsuccesful chemotherapy response, who developed progressive asthenia, thoracic pain, minimal efforts dyspnea, and abdominal distension, that initially was suspicious of splenic rupture. Exploratory laparotomy showed multiple peritoneal implants, and a diagnosis of peritoneal tuberculosis was obtained from local biopsy. Definitive diagnosis included a positive result to culture and PCR urine test, together with a possible pleural and splenic tuberculous affectation. Response to tuberculostatic treatment was successful. To the best of our knowledge, this is the first reported case with such characteristics.

Failure to establish a contingency plan prior to a public health emergency can have catastrophic consequences. The threat of a new influenza pandemic has prompted countries to draft national strategic preparedness plans to prevent, mitigate, and recover from a potential influenza pandemic. This paper examines these preparations in Latin America and the Caribbean and describes potential scenarios of pandemic impact on the burden of mortality and on health services in the Region. In particular, the paper reports on the progress made by Member States in developing national influenza pandemic preparedness plans and implementation mechanisms at both the national and local levels. These achievements were facilitated through a series of planning workshops and self-assessment exercises conducted by PAHO for intersectoral country teams and guided by the WHO global influenza preparedness plan. Although significant progress has been made in plan completeness, intercountry preparedness planning and local level implementation remain key challenges. Multisectoral partnerships are clearly paramount to securing the commitment and resources needed to reach and sustain effective pandemic preparedness in the Americas.

Objective: To determine epidemiological, biochemical, virological, and histological factors associated with liver steatosis in chronic hepatitis C., Subjects: The medical histories of 53 patients biopsied for chronic hepatitis C diagnosis between June 2000 and December 2002 were retrospectively studied. Epidemiological, biochemical, and virological data were collected. Patients with hepatitis B virus or human immunodeficiency virus coinfection were excluded. Liver biopsy specimens were reviewed and scored by one pathologist. Weight and height were measured at liver biopsy time. The statistic association between qualitative and quantitative variables and the presence of liver steatosis was studied., Results: Steatosis was identified in 52% of biopsies. There was no statistic association with age, sex, method of transmission, duration of infection, alcohol consumption, other diseases, body mass index, glucose, triglycerides, cholesterol, AST, ALT, GGT, alkaline phosphatase, bilirubin, or viral load. Liver steatosis was associated with serum iron, transferrin saturation, and ferritin. Genotype 3 was also associated with steatosis. Piecemeal necrosis, hepatocellular injury, Kupffer cell hyperplasia, liver iron, and portal fibrosis were also associated with steatosis. A multivariate analysis showed that genotype 3, Kupffer cell hyperplasia, and liver iron were associated with the presence of steatosis., Conclusions: Liver steatosis in chronic hepatitis C associates with genotype 3, Kupffer cell hyperplasia, and iron overload. Hepatic steatosis also associates with greater inflammation and fibrosis, and must be considered to contribute to disease progression.

Objective: Analyze the presence of dysplasia in colonoscopy visualized colonic polyps, and the predictive factors for high grade dysplasia., Material and Methods: We studied the polyps observed in the colonoscopies carried out during the year 2001. Colonoscopies carried out in 2,144 patients were analyzed, with demonstration of polyps in 326 patients (average age: 67 12,6 years, 63,5% males). 732 polyps were analyzed, with average of 2.27 2 polyps by patient., Results: 72% polyps were located distally to splenic flexure, and sigmoid colon was the most frequent location (34.7%). Most of the polyps (86%) were sessile. Only 3% were > 2 cm, and the majority (88%) was < 1 cm. The most prevalent histological type was tubular adenoma (36%). Dysplasia was observed in 42.2% (low grade in 40% and high grade in 2.2%) Size > 1 cm and location proximal to splenic flexure were the only variables with indendent significant association to high grade dysplasia., Conclusions: The presence of high grade dysplasia in the colonic polyps was related in our cohort both to the location of the polyps in the colon and to its size, so that greater risk was for proximal polyps and for polyps > 1 cm.