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Based on the Theory of Subjectivity in a cultural-historical perspective, this paper presents an empirical study of two infant teachers and their subjective dynamics of being "enchanted" with singular aspects of their professional lives. Through the constructive-interpretative principle driven from the Qualitative Epistemology, the study aims to understand the relationship between the subjects and the specific manner in which they express ways of being and feeling as early childhood teachers. The way teachers express themselves indicates the way they experience their working lives in a symbolic and emotional amalgam which cannot otherwise be captured from a formal linguistic perspective and in isolation from the subject's integral expression. A review of Vygotsky's concepts of "perezhivanie" and sense highlights the value of two common characteristics widely considered in the current development of our theoretical approach. Both concepts (1) compose an integrated theoretical model of psychic functioning, and (2) are oriented towards the quality of the subject's participation in his/her everyday life's processes. The study challenges cognitive-linguistic reductionist bias and demonstrates the value of the concept of subjective senses as a theoretical alternative. Consequently, it enhances our understanding of the symbolic-emotional nature in which individuals shape their life stories through their current experiences.

In the period after the 2008 financial crisis, the European Union and Brazil experienced, respectively, periods of regional divergence and convergence. The research developed in these two territories brings new evidence on the importance of non-territorial policies, that worked as indirect regional policy, for these trajectories. In the case of the EU, (direct) regional policy was not strong enough to counteract more non-territorial policies that acted in favour of divergence. In the case of Brazil, the absence of a relevant direct regional policy did not prevent convergence, since the government adopted a set of non-territorial sectoral policies that functioned as indirect regional policy. This is particularly relevant in the current European context, where prolonged social and economic stagnation or decline in many regions has been the source of discontent that is expressed electorally. [ABSTRACT FROM AUTHOR]

Background: Brazil is one of the countries with the highest rates of caesarean sections (CS), reaching almost 90% of births in the private sector. A quality improvement project called "Adequate Childbirth Project (PPA)" was conceived to reduce CS in the private sector. This project consisted of four primary components: "Governance", "Participation of Women", "Reorganization of Care" and "Monitoring". This paper aims to evaluate: (1) which specific activities of the PPA had the largest effect on the probability of a woman having a vaginal delivery; (2) which primary component of the PPA had the largest effect on the probability of vaginal delivery and (3) which scenarios combining the implementation of different activities planned in the PPA had a higher effect on the probability of vaginal delivery. Methods: A sample of 12 private hospitals participating in the PPA was evaluated. We used a Bayesian Network (BN) to capture both non-linearities and complex cause-effect relations. The BN integrated knowledge from experts and data from women to estimate 26 model parameters. The PPA was evaluated in 2473 women belonging to groups 1–4 of the Robson classification, who were divided into two groups: those participating or not participating in the PPA. Results: The probability of a woman having a vaginal delivery was 37.7% higher in women participating in the PPA. The most important component of the project that led to an increase in the probability of vaginal delivery was "Reorganization of Care", leading to a 73% probability of vaginal delivery among women in labor. The activity that had the greatest effect on the type of delivery was access to best practices during labor, with a 72% probability of vaginal delivery. Considering the 12 scenarios combining the different activities of the PPA, the best scenarios included: a non-scheduled delivery, access to information about best practices, access to at least 4 best practices during labor and respect of the birth plan, with an 80% probability of vaginal delivery in the best combinations. Conclusion: PPA has been shown to be an effective quality improvement program, increasing the likelihood of vaginal delivery in private Brazilian hospitals. Plain English Summary: Introduction: Brazil boasts one of the highest rates of caesarean sections (CS) globally, with nearly 90% of births in private facilities being delivered via CS. In response, the 'Adequate Childbirth Project – PPA' was launched as a quality improvement initiative aimed at curbing CS rates in private healthcare. Its goal is to improve the quality of childbirth and reduce the number of CS in private healthcare. The project has four main parts: 'Governance', 'Participation of Women', 'Reorganization of Care', and 'Monitoring'. Method: an evaluative study was conducted across 12 private hospitals involved in the PPA, involving 2473 women who were categorized into PPA participants and non-participants. They used a method called a cause-effect network to see which parts of the PPA helped more women have vaginal deliveries. Results: They found that women in the PPA were 37.7% more likely to have a vaginal delivery. Giving women access to good practices during labor and birth was really important. Also, 'Reorganization of Care' was the most important part of the project. It led to a 73% chance of vaginal delivery for women in labor. Conclusion: The PPA is effective in helping more women in private hospitals have vaginal deliveries. This means it's a good program for improving childbirth in Brazil's private hospitals. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the prevalence and associated risk factors of inappropriate use of emergency services among young adults in Vitória, Brazil. Methods: A cross-sectional study was conducted over 30 consecutive days in November and December 2019, involving systematic random sampling of young adults (aged 18–39) visiting the municipal emergency care unit. Data were collected through structured interviews, utilizing the Hospital Urgency Appropriateness Protocol (HUAP) to identify inappropriate use. Demographic characteristics, healthcare utilization patterns, and medical diagnoses were assessed. Poisson regression models were employed to explore associations between variables. Results: Among the 631 young adults surveyed, 30.6% exhibited inappropriate use of the emergency care unit. Factors associated with higher rates of inappropriate use included not seeking previous care in other healthcare services; having specific medical diagnoses like diseases of the respiratory system (PR: 2.03), diseases of the skin (PR: 4.13), and diseases of the ear and mastoid (PR: 3.74). Conclusion: The study underscores the significance of addressing inappropriate use of emergency services among young adults. Though the prevalence of inappropriate use was not significantly different from other age groups, the demographic characteristics and healthcare utilization patterns of young adults contribute to their unique challenges. To mitigate inappropriate use, efforts should focus on improving access to primary healthcare services, enhancing continuity of care, and raising awareness about appropriate healthcare-seeking behaviors among young adults. Ultimately, these interventions can foster a more effective and sustainable healthcare system that better serves the needs of the community. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study evaluated the current practices of selecting cold storage preservation solutions in Brazil and their impact on delayed graft function (DGF) incidence and 1-year outcomes in kidney transplant recipients. A retrospective cohort study was conducted, including 3,134 brain-dead deceased donor kidney transplants performed between 2014 and 2015 in 18 Brazilian centers. The most commonly used preservation solution was Euro-collins (EC, 55.4%), followed by Histidine-tryptophan-ketoglutarate (HTK, 30%) and Institut Georges Lopez (IGL-1, 14.6%). The incidence of DGF was 54.4%, with 11.7% of patients requiring dialysis for more than 14 days, indicating prolonged DGF. Upon adjusting for confounding variables, HTK demonstrated a significantly lower risk of DGF than EC (OR 0.7350.82500.926), as did IGL-1 (OR 0.6050.7120.837). Similar protective effects were observed for prolonged DGF when comparing HTK (OR 0.4780.5990.749) and IGL-1 (OR 0.4780.6810.749) against EC. No significant association was found between preservation solutions and 1-year death-censored graft survival. In conclusion, EC was the most frequently used cold storage perfusion solution, demonstrating a higher incidence and duration of DGF compared with HTK and IGL-1, but with no impact on 1-year graft survival. [ABSTRACT FROM AUTHOR]

Introduction: Studies evaluating smoking and periodontal status show controversial results regarding the impact on oral health‐related quality of life (OHRQol). The aim was to evaluate the association between OHRQol and periodontal status in patients according to their smoking habit. Methods: Cross‐sectional study with a total of 100 patients (31.44 ± 8.50 years, 55% females) answered the short version of Oral Health Impact Profile (OHIP‐14) and underwent a periodontal examination. Associations between periodontal status and total mean OHIP‐14 scores related with smoking habit were analysed with Kruskal–Wallis test. Results: Mean percentage of sites with Bleeding on Probing (BOP), Clinical Attachment Loss (CAL) and Number of Teeth were significantly different between current smokers (n = 53) and never (n = 40) or former smokers (n = 7; p < 0.05). There was no significant difference for Periodontal Probing Depth (PPD) in relation to smoking status. A total mean OHIP‐14 score of 13.07 was observed for the entire sample. The corresponding total mean OHIP‐14 scores, for current smokers, never smokers and former smokers, were 15, 10 and 13 (p = 0.280), respectively. The domains social disability and handicap of the OHIP‐14 were worse in current smokers (p = 0.028 and p = 0.026, respectively). Conclusion: Current smoking was associated with a negative influence on OHRQoL in the domain of social disability and handicap. In addition, smokers have worse periodontal status, related to less BOP, greater CAL and fewer teeth than never and former smokers. [ABSTRACT FROM AUTHOR]

Background: Brazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project ("Projeto Parto Adequado"- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication. This research aims to evaluate the implementation of PPA in private hospitals in Brazil. Method: Evaluative hospital-based survey, carried out in 2017, in 12 private hospitals, including 4,322 women. We used a Bayesian network strategy to develop a theoretical model for implementation analysis. We estimated and compared the degree of implementation of two major driving components of PPA—"Participation of women" and "Reorganization of care" – among the 12 hospitals and according to type of hospital (belonging to a health insurance company or not). To assess whether the degree of implementation was correlated with the rate of vaginal birth data we used the Bayesian Network and compared the difference between the group "Exposed to the PPA model of care" and the group "Standard of care model". Results: PPA had a low degree of implementation in both components "Reorganization of Care" (0.17 – 0.32) and "Participation of Women" (0.21 – 0.34). The combined implementation score was 0.39–0.64 and was higher in hospitals that belonged to a health insurance company. The vaginal birth rate was higher in hospitals with a higher degree of implementation of PPA. Conclusion: The degree of implementation of PPA was low, which reflects the difficulties in changing childbirth care practices. Nevertheless, PPA increased vaginal birth rates in private hospitals with higher implementation scores. PPA is an ongoing quality improvement project and these results demonstrate the need for changes in the involvement of women and the care offered by the provider. [ABSTRACT FROM AUTHOR]

Introduction: Congenital Generalized Lipodystrophy (CGL) is a rare autosomal recessive disease caused by mutations in genes responsible for the formation and development of adipocytes. Bone abnormalities are described. However, there is a scarcity of data. Objective: To describe bone characteristics in a large CGL1 and 2 case series. Methods: Cross-sectional study that assessed bone radiological features of CGL patients of a reference hospital in Fortaleza (CE), Brazil. Patients underwent clinical and bone mineral metabolism evaluation, radiographs of the axial and appendicular skeleton and bone mineral density (BMD) assessment by DEXA (dual energy X-ray absorptiometry). Results: Nineteen patients were included, fourteen were CGL1 and 5, CGL2. Median age was 20 years (8-42) and 58% were women. Median BMI and percentage of body fat were, respectively, 21 Kg/m² (16-24), and 10.5% (7.6- 15). The median leptin concentration was 1 ng/mL (0.1-3.3). Diabetes mellitus and dyslipidemia were present in 79% and 63% of patients, respectively. Median calcium and phosphate were normal in almost all patients (95%). Median parathyroid hormone and 25-OH-vitamin D were 23 pg/mL (7-75) and 28 ng/mL (18-43). Osteolytic lesions, osteosclerosis and pseudo-osteopoikylosis, were present in 74%, 42% and 32% of patients, respectively. Lytic lesions were found predominantly in the extremities of long bones, bilaterally and symmetrically, spine was spared. Osteosclerosis was present in axial and appendicular skeleton. Pseudo-osteopoikilosis was found symmetrically in epiphyses of femur and humerus, in addition to the pelvis. BMD Z-score greater than +2.5 SD was observed in 13 patients (68.4%). BMD was higher in CGL1 compared to CGL2 in lumbar spine and total body in adults. No associations were found between high BMD and HOMA-IR (p=0.686), DM (p=0.750), osteosclerosis (p=0.127) or pseudo-osteopoikilosis (p=0.342), and, between pain and bone lesions. Fractures were found in 3 patients. Conclusion: Bone manifestations are prevalent, heterogeneous, and silent in CGL1 and CGL2. Osteolytic lesions are the most common, followed by osteosclerosis and pseudo-osteopoikilosis. Bone mass is high in most cases. There was no pain complaint related to bone lesions. Thus, systematic assessment of bone manifestations in CGL is essential. Studies are needed to better understand its pathogenesis and clinical consequences. [ABSTRACT FROM AUTHOR]

Background: In 2015, a quality improvement project called "Adequate Childbirth Project" (PPA) was implemented in Brazilian private hospitals in order to reduce cesarean sections without clinical indication. The PPA is structured in four components, one of which is directed at women and families. The objective of this study is to evaluate the effects of PPA on women's preference for vaginal birth (VB) at the end of pregnancy. Methods: Evaluative research conducted in 12 private hospitals participating in the PPA. Interviews were carried out in the immediate postpartum period and medical record data were collected at hospital discharge. The implementation of PPA activities and women's preference for type of birth at the beginning and end of pregnancy were compared in women assisted in the PPA model of care and in the standard of care model, using a chi-square statistical test. To estimate the effect of PPA on women's preference for VB at the end of pregnancy, multiple logistic regression was performed with selection of variables using a causal diagram. Results: Four thousand seven hundred ninety-eight women were interviewed. The implementation of the planned activities of PPA was less than 50%, but were significantly more frequent among women assisted in the PPA model of care. Women in this group also showed a greater preference for VB at the beginning and end of pregnancy. The PPA showed an association with greater preference for VB at the end of pregnancy in primiparous (OR 2.54 95% CI 1.99–3.24) and multiparous women (OR 1.44 95% CI 0.97–2.12), although in multiparous this association was not significant. The main factor associated with the preference for VB at the end of pregnancy was the preference for this type of birth at the beginning of pregnancy, both in primiparous (OR 18.67 95% CI 14.22–24.50) and in multiparous women (OR 53.11 95% CI 37.31–75.60). Conclusions: The PPA had a positive effect on women's preference for VB at the end of pregnancy. It is plausible that more intense effects are observed with the expansion of the implementation of the planned activities. Special attention should be given to information on the benefits of VB in early pregnancy. Plain English summary: Cesarean rates have been increasing worldwide and constitute the most frequent type of childbirth in Brazil since 2009. In 2015, a quality improvement project was implemented in Brazilian private hospitals, with the objective of reducing medically unnecessary cesarean sections and increasing the number of vaginal births. This project, called "Adequate Childbirth Project" (PPA), has four components, one of which is directed at women and families, aiming to increase their participation in decision-making processes related to childbirth. In this study, we assessed whether this program contributed to increased preference for vaginal birth at the end of pregnancy. In previous studies in Brazil, we saw that women who maintained preference for vaginal birth throughout pregnancy were those who had the lowest proportion of cesarean sections. We found that the PPA increased preference for vaginal birth by almost three times in primiparous women. Among women with previous births, this increase was smaller. In this group of women, having a previous cesarean section was an important factor for not wanting a vaginal birth, and this is a very common condition in Brazil. For all women, having preference for vaginal birth at the beginning of pregnancy was the main factor in wanting this type of birth at the end of pregnancy. The results demonstrate the importance of educational activities that disseminate information about the benefits of vaginal birth, increasing the preference of women for this type of childbirth, in addition to supporting them throughout pregnancy, so that they feel empowered in their choice. [ABSTRACT FROM AUTHOR]

This study identified the overlap between artisanal fishing areas and the Franciscana dolphin (Pontoporia blainvillei) in the Southwest Atlantic Ocean (SWAO), Brazil, to identify areas where the species was incidentally captured from the perception of artisanal fishers. Using a semistructured questionnaire, ethnographic interviews (n = 330) were carried out from 2012 to 2018 with fishers from ten communities in southeastern (ES and RJ) and southern (PR) Brazil. After the interviews, the fishers presented their fishing routes, locations and areas of incidental capture and occurrence of the Franciscana dolphin. Ninety-five fishers (29%) identified the species: 23 in northern ES, 1 in southern ES, 20 in northern RJ, and 51 in the PR. Among the 235 fishers who could not identify the species, approximately half worked in the distribution gaps. The areas of occurrence noted by the fishers coincided with those described in the “National Action Plan for the Conservation of the Toninha,” an official document from the Brazilian Government and scientific literature. The results indicate that the information provided by fishers is useful for understanding the distribution of the Franciscana dolphin and can be used in the development of management strategies to mitigate the incidental capture of the species. [ABSTRACT FROM AUTHOR]

Forest fire detection towers are crucial in supporting rapid firefighting actions in conservation units and thus reducing environmental, social, and economic damages. Thus, the aim was to evaluate scenarios for optimal allocation of forest fire detection towers, according to the risk of occurrence, in the Caparaó National Park, Brazil. Thus, by geotechnological analysis, the areas most susceptible to forest fires and the optimal locations for installation of detection and monitoring for these events were delimited. To run the proposed models, biological, physical, socioeconomic, and meteorological variables were used. From the application of the methodologies, it was observed that 76.70% of the study area was covered by low, moderate, and shallow fire risk classes, while high and very high-risk classes were concentrated in the buffer zone. The scenario with 45 towers was considered the most advantageous, given that they presented viewing levels above 70% and a lower cost per hectare viewed than the scenario with 48 towers. Results showed no critical risks of fire occurrence within the conservation unit, but preventive measures are still needed to avoid fire spread, particularly near the buffer zone. The study's methodologies can be applied in other areas to improve forest fire prevention and control efforts. [ABSTRACT FROM AUTHOR]

The bioaccumulation of nonessential elements (Al, As, Cd, & Pb) in shrimps and mussels from southeastern Brazil (21°S-23°S) were compared. The objective was to verify and confirm the differential responses of elemental assimilation at both the taxonomic and spatial level. Two hypotheses were predicted: i) shrimps have lower element concentrations than mussels, and ii) both shrimps and mussels from the highly polluted site have higher element concentrations. The results confirmed the first hypothesis. The intense filter feeding activity of mussels explains the taxonomic difference. The second hypothesis was not validated. Both shrimps and mussels from the highly polluted site (Guanabara Bay) have lower elemental concentrations than individuals from the less polluted site. This finding is explained by the large inputs of sewage that result in partially reducing conditions of the water and high sedimentation rates, maintaining elements buried in anoxic sediment and making them unavailable for biological uptake. To understand what drives the bioaccumulation of chemical elements in marine animals it is necessary to know the species feeding habits and physiology, and the habitat characteristics in each region. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction:Use of telehealth (TH) resources increased dramatically during the COVID-19 pandemic. This study set out to examine associations between the level of integration of TH resources and the level of Primary Health Care (PHC) structuring to deal with the COVID-19 pandemic in the State of Minas Gerais, Brazil. Methods:This work was a cross-sectional study conducted through the application of a semistructured questionnaire to a sample of 260 PHC Teams working in the state of Minas Gerais, Brazil, from September to December 2020. This study was approved by the Research Ethics Committee and logged under report number 44.294.637. Results:Two variables were created - Level of the PHC structuring to deal with the COVID-19 pandemic and Level of TH structuring. Variables were grouped into five categories (poor to excellent). Associations between variables were examined using the Tukey's test for multiple comparisons and the Spearman correlation coefficient. Variables associated with socioeconomic dimensions (human development index and Gini index) and health care were also analyzed. Levels of TH structuring in PHC ranged from poor (43%) to regular (40%) in most cases. Most PHC teams had regular (56%) or good (37%) levels of PHC structuring to deal with the pandemic. The greater the availability and use of TH resources at a given unit, the better the structure to face COVID-19 (0.45 – p < 0.001). Conclusion:PHC was structured to tackle the pandemic. However, there is a lot to be done before TH resources are effectively incorporated into PHC. Whenever incorporated, TH resources contributed to a more robust response to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

This study measured concentrations of trace elements (Al, As, Cd, Cu, Fe, Mn, Ni, and Pb) in the muscle of pink shrimps (genus Penaeus) from two anthropized estuarine systems in Brazil: Guanabara Bay (GB) and Sepetiba Bay (SB). Concentrations were highest in the less anthropized SB site, where shrimps showed higher assimilation rates that can be explained by their higher trophic position compared to shrimps from GB. These results reinforce the role of food sources as the main route of trace elements for the aquatic animals. [ABSTRACT FROM AUTHOR]

The helminth fauna of juvenile green sea turtles (Chelonia mydas Linnaeus, 1758) is still poorly known. Herein, we study the gastrointestinal helminths of 28 juvenile green sea turtles found stranded on the north coast of Rio de Janeiro state, Brazil. All turtles were infected showing a rich helminth fauna. In total, 14802 trematodes belonging to 30 species and 5 families including Micros-caphidiidae, Plagiorchiidae, Pronocephalidae, Hapalotrematidae, and Telorchiidae were recovered. An unidentified nematode specimens was also found. The mean intensity was 536 (95% CI = 362 – 853) (range: 1 – 2831), and the species richness was 7.86 (95% CI = 6.46 – 9.21) (range: 1 – 17). The coast of Rio de Janeiro state represents new locality records for Angiodictyum posterovitellatum, Microscaphidium aberrans, M. warui, Octangium hyphalum, O. sagitta, Enodiotrema reductum and Pleurogonius laterouterus. This study confirms that the green sea turtle harbors the richest helminth fauna among sea turtle species and provides useful information on the gastrointestinal helminths of a poorly known stage in the life cycle of this endangered chelonian. [ABSTRACT FROM AUTHOR]

Background: Some oral conditions can have psychosocial consequences that affect children's daily life and well‐being. Aim: To create a structural model for the determination of dental caries, molar–incisor hypomineralization (MIH), and the impact of these conditions and socioeconomic status on schoolchildren's oral health‐related quality of life (OHRQoL). Design: A representative cross‐sectional study was conducted in Lavras, Brazil, with 1181 female and male schoolchildren 8–9 years of age. OHRQoL was measured using the Brazilian version of the CPQ8‐10. Clinical examinations were performed by a calibrated dentist for the diagnosis of dental caries (WHO) and MIH (EAPD). Parents/caregivers answered questionnaires addressing the child's medical history and socioeconomic status. Data were analyzed using structural equation modeling. Results: The model revealed that greater MIH severity (β =.874; p <.001) and worse socioeconomic status (β = −.060; p =.001) were associated with a greater number of teeth with caries experience. The higher the number of teeth with caries experience (β =.160; p =.007) and worse socioeconomic status (β = −.164; p <.001), the greater the negative impact on OHRQoL. Conclusion: The model created showed that dental caries and socioeconomic status had a direct negative impact on the OHRQoL of schoolchildren and MIH had an indirect impact mediated by the occurrence of caries experience. [ABSTRACT FROM AUTHOR]

Copyright of Interações is the property of Revista Interacoes and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Changes in the regulatory and legal framework for Brazil’s water and sanitation sector (Law 14,026, July 15, 2020) require competitive bidding for service contracts, even in cases where the provision of services was previously delegated to state-owned utilities under program contracts. The aim of this study was to identify the actors who benefited from these changes to the legislation and assess the social effectiveness of the privatization of water supply and sewerage services in the state of Rio de Janeiro by investigating the auction of services provided by the public utility CEDAE in four blocks comprising 35 municipalities in April 2021. We conducted an exploratory analysis of secondary data and used the systemic integration method to identify the main actors involved in the concession process and the role they played. It is concluded that federal, state, and municipal governments, the Brazilian Development Bank, and the concessionaires have gained from the concessions, while the percentage of low-income populations connected to the sewage collection or drainage network is lower and tariffs are higher in municipalities served by the private sector when compared to the municipalities encompassed by the auction. [ABSTRACT FROM AUTHOR]

Background: In 2015, a quality improvement project—the "Adequate Childbirth Project" (Projeto Parto Adequado, or PPA)—was implemented in Brazilian private hospitals with the goal of reducing unnecessary cesarean sections. One of the strategies adopted by the PPA was the implementation of labor and childbirth care by nurse-midwives. The objective of this study is to evaluate the results of the PPA in the implementation and adequacy of labor and childbirth care by nurse-midwives in Brazilian private hospitals. Methods: Cross-sectional, hospital-based study, carried out in 2017, in 12 hospitals participating in the PPA. We assessed the proportion of women assisted by nurse-midwives during labor and childbirth care and the adequacy of 13 care practices following parameters of the World Health Organization. Women assisted in the PPA model of care and in the standard of care model were compared using the chi-square statistical test. Results: 4798 women were interviewed. Women in the PPA model of care had a higher proportion of labor (53% × 24.2%, p value < 0.001) and vaginal birth (32.7% × 11.3%, p value < 0.001), but no significant differences were observed in the proportion of women assisted by nurse-midwives during labor (54.8% × 50.1%, p value = 0.191) and vaginal birth (2.2% × 0.7%, p value = 0.142). The implementation of recommended practices was adequate, except the use of epidural analgesia for pain relief, which was intermediate. There was a greater use of recommended practices including "oral fluid and food", "maternal mobility and position", "monitoring of labor", "use of non-pharmacological methods for pain relief" and "epidural analgesia for pain relief" in women assisted by nurse-midwives in relation to those assisted only by doctors. Many non-recommended practices were frequently used during labor by nurse-midwives and doctors. Conclusions: There was an increase in the proportion of women with labor and vaginal birth in the PPA model of care and an appropriate use of recommended practices in women assisted by nurse-midwives. However, there was no difference in the proportion of women assisted by nurse-midwives in the two models of care. The expansion of nursing participation and the reduction of overused practices remain challenges. Plain Language Summary: Brazil has a high rate of cesarean sections with low participation of nurse-midwives in childbirth care. Nurse-midwife care is associated with less use of interventions, lower proportions of cesarean sections and greater women's satisfaction. In 2015, a quality improvement project, called the "Adequate Childbirth Project" (Projeto Parto Adequado, PPA), was implemented in Brazilian private hospitals to reduce unnecessary cesarean sections. One of its components is the expansion of nurse-midwives in labor and childbirth care. In this study, we evaluated the results of PPA on childbirth care by nurse-midwives. Data were collected in 12 hospitals with interviews with 4798 women. Women assisted in the PPA model of care had a higher proportion of labor and vaginal birth, but there was no increase in the proportion of women assisted by nurse-midwives, neither during labor nor vaginal birth. The use of recommended practices was adequate, except for the use of epidural analgesia, with greater use of some recommended practices in women assisted by nurse-midwives compared to those seen only by doctors. However, we observed excessive use of non-recommended practices during labor, both by doctors and nurses. We can conclude that there was an increase in the proportion of women with labor and vaginal birth in the PPA model of care and a greater use of recommended practices in women assisted by nurse-midwives, but without an increase in the proportion of women assisted by nurses. The expansion of nurse-midwives' participation in childbirth care and the reduction of non-recommended practices therefore continue to be challenges. [ABSTRACT FROM AUTHOR]

Background: The Baby-Friendly Hospital Initiative's Step 4 recommends: "support mothers to start breastfeeding as soon as possible after birth", thus contributing to the reduction of neonatal mortality. The objective of this study is to estimate the prevalence of breastfeeding in the first hour of life in private maternity hospitals participating in the "Adequate Childbirth Project", a quality-of-care improvement project, and to analyze determinants of this outcome. Methods: Secondary analysis of data collected by the cross-sectional evaluative "Healthy Birth Study", conducted in 2017 in 12 maternity hospitals participating in the Adequate Childbirth Project, where 4800 mothers were interviewed, and hospital records were observed. Conditions that prevented breastfeeding at birth, such as maternal HIV-infection and newborns' severe malformations, were excluded. Multiple logistic regression was performed according to a hierarchical theoretical model. Results: The prevalence of breastfeeding in the first hour of life was 58% (CI 95% 56.6–59.5%). Lower maternal education (aOR 0.643; CI 95% 0.528–0.782), lower economic status (aOR 0.687; CI 95% 0.504–0.935), cesarean section delivery (ORa 0.649; CI 95% 0.529–0.797), preterm birth (aOR 0.660; CI 95% 0.460–0.948) and non-rooming-in at birth (aOR 0.669; CI 95% 0.559–0.800) were negatively associated with the outcome. Receiving information during prenatal care about the importance of breastfeeding at birth (aOR 2.585; CI 95% 2.102–3.179), being target of the quality-of-care improvement project (aOR 1.273; CI 95% 1.065–1.522), skin-to-skin contact at birth (aOR 2.127; CI 95% 1.791–2.525) and female newborn (aOR 1.194; CI 95% 1.008–1.415) were factors positively associated with the outcome. Conclusions: The private maternities participating in the Healthy Birth Study showed a good prevalence of breastfeeding in the first hour of life, according to WHO parameters. Prenatal guidance on breastfeeding at birth, being target of the quality-of-care improvement project and skin-to-skin contact at birth contributed to breastfeeding in the first hour of life. [ABSTRACT FROM AUTHOR]

Copyright of Caderno de Educação Física e Esporte is the property of Caderno de Educacao Fisica e Esporte and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Schizotetranychus hindustanicus Hirst (Acari: Tetranychidae) known as the Hindustan citrus mite, is a quarantine pest present in Roraima, Brazil. In 1924 this pest was described in India. It was reported in 2002 in Venezuela and in Roraima in 2008. In 2010, the Hindustan citrus mite was reported in Colombia. It is possible that it will be introduced in other areas of Brazil, resulting in a threat to Brazilian citrus industry. Our objective was to determine the most suitable regions of Brazil for S. hindustanicus using a maximum entropy (Maxent) algorithm, based on native and invasive updated occurrence records from published research, field surveys and online databases. To avoid overfitting and improving transferability, we chose parameter settings of Maxent to construct and validate models by searching for the best combination of feature classes and regularization multipliers. The model obtained showed excellent performance according to all evaluation metrics used. A high potential for the establishment of S. hindustanicus was identified in large areas of Roraima, the extreme west of Amazonas, the entire north of the State of Pará, also in northeast, south, east, and north of the State of Amapá, and in a small portion northwest of the State of Maranhão (all states belonging to the northern region of Brazil). Our results provide information for policy making and quarantine measures, especially where S. hindustanicus is still absent in Brazil. [ABSTRACT FROM AUTHOR]

This article aims to evaluate the completeness of the pregnant woman's card filling according to a model standardized by the Ministry of Health. Hospital based, nationwide, cross-sectional study conducted between 2011 and 2012, evaluated data from pregnant women's cards. Variables related to personal, obstetric history and current pregnancy data were used to assess completeness. We used the Kotelchuck index for quantitative evaluation. We analysed 6,577 cards, equivalent to 39% of the cards presented at the time of delivery. The mean completeness was overall "bad" in Brazil and macro-regions, except in the Southern region. Nationwide, the mean completion was "regular" for personal antecedents, "good" for obstetric history, and "bad" for fields related to the current pregnancy. Prenatal care was adequate for 58% of pregnant women. We observed a reduced use of the card recommended by the Ministry of Health and failures in the completeness of filling valuable information of the pregnant woman's card, related to the current pregnancy. [ABSTRACT FROM AUTHOR]

COVID-19, also known as coronavirus disease 2019, is an infectious viral disease caused by SARS-CoV-2, a novel coronavirus. Since its emergence, its epidemiology has been explored; however, for some regions of the world, COVID-19's behavior, incidence, and impact remain unclear. In continental nations like Brazil, this lack of knowledge results in nonuniform control, prevention, and treatment measures, which can be controversial in some locations. This study aimed to describe the epidemiological profile of patients with COVID-19 in the macroregion of Triângulo Sul in the state of Minas Gerais (MG), Brazil. Between March 25 and October 21, 2020, data were collected and statistically analyzed from 395 hospitalized patients in the city of Uberaba, MG, suspected to have moderate or severe forms of the disease. Of the 395 suspected cases, 82% were confirmed to be positive for COVID-19. The mean age of positive patients was 58.4 years, and 60.76% were male. Following these patients throughout their hospitalization, a mortality rate of 31.3% was observed. In the population positive for COVID-19, the risk of death increased by 4% for each year of the patient's age. Likewise, the older the patient, the longer their hospitalization and the higher the risk of developing acute respiratory failure. Among the treatments tested in patients, heparin was associated with protection against mortality, and the absence of anticoagulant use was linked to a more than six times greater risk of death. Finally, comorbidities in patients with COVID-19 were positively correlated with increased hospitalization time. In summary, this study revealed that age, presence of comorbidities, length of hospitalization, and drug treatment considerably altered COVID-19's lethality. To understand infection rates and the factors involved in COVID-19's lethality, knowledge of the local epidemiology is necessary. [ABSTRACT FROM AUTHOR]

Tomato severe rugose virus (ToSRV) is predominant among the more than 20 tomato-infecting begomoviruses reported in Brazil after the invasion of Bemisia tabaci Middle East-Asia Minor 1 (= biotype B) in the early 1990s. ToSRV is currently detected in association and/or displacing other begomoviruses in major tomato-producing areas. The prevalence of ToSRV across many ecogeographical regions is yet elusive. This peculiar ToSRV feature can be partially explained by its large number of alternative hosts, including those not yet characterized. Here, isolates of ToSRV were characterized in four new natural hosts, including Pachyrhizus erosus (Fabaceae), Solanum betaceum (section Pachyphylla, Solanaceae), S. torvum (section Torva, Solanaceae), and Oxalis latifolia (Oxalidaceae family). These results reinforce the notion that the wide host range of ToSRV may play relevant biological and epidemiological roles in explaining the geographical dispersion and large frequency of this virus in tomato crops in the Neotropics. [ABSTRACT FROM AUTHOR]

We investigate the role of social learning among local government officials in fostering the diffusion of an education programme presented with a reasonable degree of technological and political uncertainty about its outcomes, the schooling decentralisation reform in the state of São Paulo, Brazil. We consider different natures of the exchange of information on the newly adopted tasks, and assess which aspects of the returns to programme participation were most valued by officials in their learning process. Specifically, we attempt to determine the extent to which adherence to the reform resulted from electoral motivations rather than from concerns regarding the quality of education. We present evidence that social learning constitutes a key factor to policy implementation, and we find that mayors that could run for re-election became more likely to support the programme upon receiving good news about its electoral returns. By contrast, information on experiences that were successful in improving the quality of education appears to have been valued and effectively put to use only by term-limited officials or when conveyed by copartisan neighbours. [ABSTRACT FROM AUTHOR]

Background: In 2015, a quality improvement project—the "Adequate Childbirth Project" (Projeto Parto Adequado, or PPA)—was implemented in Brazilian private hospitals with the goal of reducing unnecessary cesarean sections. One of the strategies adopted by the PPA was the implementation of labor and childbirth care by nurse-midwives. The objective of this study is to evaluate the results of the PPA in the implementation and adequacy of labor and childbirth care by nurse-midwives in Brazilian private hospitals. Methods: Cross-sectional, hospital-based study, carried out in 2017, in 12 hospitals participating in the PPA. We assessed the proportion of women assisted by nurse-midwives during labor and childbirth care and the adequacy of 13 care practices following parameters of the World Health Organization. Women assisted in the PPA model of care and in the standard of care model were compared using the chi-square statistical test. Results: 4798 women were interviewed. Women in the PPA model of care had a higher proportion of labor (53% × 24.2%, p value < 0.001) and vaginal birth (32.7% × 11.3%, p value < 0.001), but no significant differences were observed in the proportion of women assisted by nurse-midwives during labor (54.8% × 50.1%, p value = 0.191) and vaginal birth (2.2% × 0.7%, p value = 0.142). The implementation of recommended practices was adequate, except the use of epidural analgesia for pain relief, which was intermediate. There was a greater use of recommended practices including "oral fluid and food", "maternal mobility and position", "monitoring of labor", "use of non-pharmacological methods for pain relief" and "epidural analgesia for pain relief" in women assisted by nurse-midwives in relation to those assisted only by doctors. Many non-recommended practices were frequently used during labor by nurse-midwives and doctors. Conclusions: There was an increase in the proportion of women with labor and vaginal birth in the PPA model of care and an appropriate use of recommended practices in women assisted by nurse-midwives. However, there was no difference in the proportion of women assisted by nurse-midwives in the two models of care. The expansion of nursing participation and the reduction of overused practices remain challenges. Plain Language Summary: Brazil has a high rate of cesarean sections with low participation of nurse-midwives in childbirth care. Nurse-midwife care is associated with less use of interventions, lower proportions of cesarean sections and greater women's satisfaction. In 2015, a quality improvement project, called the "Adequate Childbirth Project" (Projeto Parto Adequado, PPA), was implemented in Brazilian private hospitals to reduce unnecessary cesarean sections. One of its components is the expansion of nurse-midwives in labor and childbirth care. In this study, we evaluated the results of PPA on childbirth care by nurse-midwives. Data were collected in 12 hospitals with interviews with 4798 women. Women assisted in the PPA model of care had a higher proportion of labor and vaginal birth, but there was no increase in the proportion of women assisted by nurse-midwives, neither during labor nor vaginal birth. The use of recommended practices was adequate, except for the use of epidural analgesia, with greater use of some recommended practices in women assisted by nurse-midwives compared to those seen only by doctors. However, we observed excessive use of non-recommended practices during labor, both by doctors and nurses. We can conclude that there was an increase in the proportion of women with labor and vaginal birth in the PPA model of care and a greater use of recommended practices in women assisted by nurse-midwives, but without an increase in the proportion of women assisted by nurses. The expansion of nurse-midwives' participation in childbirth care and the reduction of non-recommended practices therefore continue to be challenges. [ABSTRACT FROM AUTHOR]

Brazil has been severely affected by the COVID-19 pandemic. The high numbers of confirmed cases and deaths have continued unabated since the first reported case, with no flattening or downward turn in the curve. In this context, healthcare workers have been exposed uninterruptedly to stress factors throughout a year of the pandemic. The study´s aim was to identify and analyze healthcare workers´ perceptions of their feelings and concerns that have surfaced in responding to the pandemic. Method: This was a cross-sectional online qualitative survey study of 554 healthcare personnel working in the state of Rio de Janeiro during the COVID-19 pandemic. Recruitment occurred from July 20 to September 30, 2020, using an online survey, preceded byfree informed consent term. Data were analyzed with the Iramuteq software. Results: Through a dendrogram, the words with the highest chi-square were highlighted and grouped into four classes: healthcare workers´ fear of falling ill to COVID-19 and infecting their family members; work/labor issues; feelings of powerlessness and need for public policies for government action; and fatigue and burnout in the pandemic. Each word class was also illustrated by a similarity tree. Conclusion: The study revealed healthcare workers´ exacerbated fear of infection and transmission of COVID-19 to their family members, besides financial losses and feelings of powerlessness and abandonment. [ABSTRACT FROM AUTHOR]

Copyright of Educacao e Pesquisa is the property of Faculdade de Educacao da Universidade de Sao Paulo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article analyzes the repercussions of the early childhood education offer in the private sector since the onset of the mandatory preschool in the city of Caxias do Sul, state of Rio Grande do Sul, Brazil, considering the implications of redefining the public and the private sectors. This research uses a qualitative approach on education, where 19 comprehensive interviews were conducted, which are considered at the same time a method and a technique. It also involves a documentary research. The discussion and the data analysis permitted developing a characterization of the early childhood education in the city studied, evidencing the constitution of a business network propelled by the acquisition of vacancies in the private sector and by the judicialization of this educational stage. Thus, the right to education -- understood as the access to quality education for all in State institutions that provide care and education to children without considering them as a business -- may be in danger, indicating a trend to privatization. It is concluded that the public character of education is decreasing as city policies are aligned to privatizing processes in a market rationale that transforms the citizen into a client. We emphasize that the right to education must be based on laicity, gratuity and quality, accessible for all as constitutionally foreseen. Not only the access must be guaranteed, but the equal access for all. [ABSTRACT FROM AUTHOR]

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this study was to investigate socioeconomic stressors predictive of depressive symptoms and possible epigenetic changes in the glucocorticoid receptor – NR3C1-1F – an encoding gene involved in depressive symptoms. A total of 321 adult volunteers from southeastern Brazil were recruited to evaluate depressive symptoms, socio-demographic and economic factors, including food and nutritional security (FNS) or insecurity (FNiS) status, and NR3C1-1F region methylation by pyrosequencing. Depressive symptom determinants were investigated using a Poisson regression model with robust variance. Mann–Whitney tests and structural mediation equation models were used to evaluate the relationship between NR3C1 DNA methylation, FNiS, and depressive symptoms. Multivariate Poisson regression with robust variance adjusted for sex and FNiS and NR3C1-1F region methylation predicted risk factors for depressive symptoms. Mediation analysis revealed that NR3C1-1F region methylation mediated the relationship between FNiS exposure and depressive symptoms as an outcome, and depressive volunteers and FNiS individuals exhibited a significant increase in NR3C1 methylation when compared to healthy individuals and FNS volunteers, respectively. Therefore, we suggest that stress caused by FNiS may lead to depressive symptoms and that NR3C1-1F DNA methylation can act as a mediator of both FNiS and depressive symptoms. [ABSTRACT FROM AUTHOR]

[Display omitted] • Artisanal fishery is a high risk activity due to meteorologic conditions. • Vocabulary of the weather forecasts are inaccessible to the fishermen. • Fishermen use traditional knowledge to ensure safety. • Public policies are urgent for the safety of these professionals. Marine artisanal fishing is a risky activity due to the use of small vessels subjected to meteorological conditions. The aim of the present study is thus to investigate whether the language used by official Brazilian forecasting institutes is understood by artisanal fishermen in the northern area of the state of Rio de Janeiro, southeastern Brazil and to propose a better use of forecasts by the fishing community. From June to August 2018, we performed 80 interviews with artisanal fishermen by showing them a meteogram containing forecasting data of interest as well as visiting 18 vessels. Fishermen (97.5 %; n = 78) could not interpret the meteogram, probably due to the technical language used by the official institutes. On their websites, we identified 1) strengths – the use of ludic drawings (sun, clouds, and waves); 2) weaknesses – the use of graphics, tables and captions only understandable to highly educated participants; a unit of measurement (m/s) not used by fishermen; and captions and figures of reduced size, hindering their legibility among those with vision problems. Fishermen obtain forecasting data mainly from traditional knowledge (85 %; n = 68), and few vessels (n = 11) obtain these data via VHF radio (very high frequency). Public policies aimed at data distribution in accessible language must be implemented to contribute to fishermen's welfare. This approach can in turn prevent boat accidents and strengthen actions to find victims on the Brazilian coast and in other regions of the world. [ABSTRACT FROM AUTHOR]

Background: The novel coronavirus disease‐2019 (COVID‐19) caused a sudden and unexpected increase in the number of hospital admissions and deaths worldwide. The impact of social distancing on blood stocks was significant. Data on the use of blood products by patients with COVID‐19 are scarce. Material and methods: A retrospective observational study was conducted by analysing the medical records of 3014 hospitalized COVID‐19 patients in 16 Brazilian hospitals. Individual data related to clinical, laboratory and transfusion characteristics and outcomes of these patients were collected. Patients characteristics association with mortality and transfusion need were tested independently by logistic regression models. Results: Patients mean age was 57·6 years. In 2298 (76·2%) patients, there was an underlying clinical comorbidity. A total of 1657 (55%) patients required admission to intensive care unit (ICU), and 943 (31%) patients required ventilatory support and orotracheal intubation (OTI). There was a total of 471 (15·6%) deaths among all patients. 325 patients (10·7%) required blood transfusion; 3187 blood products were transfused: 1364 red blood cells in 303 patients, 1092 platelet units in 78 patients, 303 fresh frozen plasma in 49 patients and 423 cryoprecipitates in 21 patients. The mortality among patients who received transfusion was substantially higher than that among the total study population. Conclusion: Need for transfusion was low in COVID‐19 patients, but significantly higher in patients admitted to ICU and in those who needed OTI. Knowledge of the transfusion profile of these patients allows better strategies for maintaining the blood stocks of hospitals during the pandemic. [ABSTRACT FROM AUTHOR]

Copyright of Fisioterapia e Pesquisa is the property of Universidade de Sao Paulo, Faculdade de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Diffuse solar irradiation (H D) data are essential for the design and management of photovoltaic solar systems, biosphere-atmosphere modeling, and other applications. However, H D observations are scarce in several locations, especially in tropical regions. Employing hourly diffuse solar irradiation (H D h) and global solar irradiation (H G h) data collected between 2002─2003 and 2007─2008 in Alagoas State, Northeast Brazil, this study assesses various modeling techniques. Empirical models, including third-degree polynomial, logistic, sigmoidal, and rational functions, were compared with AI methods such as artificial neural networks (ANN), support vector machine (SVM), and adaptive neuro-fuzzy inference system (ANFIS). Additionally, it explores how solarimetric and meteorological variables impact the performance of these models. The empirical models showed similar performance in estimating K D h (= H D h / H G h) (r2 > 0.726, modified Willmott – d m > 0.704, and RMSD < 0.103), with the third-degree polynomial model standing out. The empirical models had difficulty estimating K D h for hourly atmospheric transmittance (K T h) > 0.80, which indicated that they are not able to adequately simulate clear sky conditions, mostly due to surface reflections and clouds at the end of the day. ANN (r2 > 0.718, d m > 0.702, and RMSD < 0.105) showed better precision and accuracy of estimates for a greater number of schemes in relation to SVM and ANFIS (r2 > 0.704, d m > 0.699, RMSD < 0.108) and to empirical models. AI methods were able to represent the complexity of these conditions, with overall performance in estimating K D h superior or equivalent to empirical models. This study underscores the significance of exploring diverse methods for H D estimation, demonstrating promising potential for accurate and reliable estimation of hourly diffuse solar irradiation. • Hourly diffuse solar irradiation fraction (K D h) was estimated using atmospheric transmittance(K t h). • Empirical models and artificial intelligence (AI) methods were assessed. • Solarimetric and, or meteorological variables were considered on AI methods. • The empirical models and AI methods had similar overall performance. • The AI methos estimating better the complexity of K D h for K T h > 0.80 [ABSTRACT FROM AUTHOR]

The study analyzes the quantity of scientific publications related to impacts of Programa Nacional de Fortalecimento da Agricultura Familiar (PRONAF) on family farming in Brazil, in order to identify the main approaches within this theme and point eventual lack of research. For this purpose, it was used a systematic literature review from 2000 to 2020. The research cataloged 58 articles and among the main results we highlight the level of coverage of PRONAF, improvements in the productive sector and promotion of regional development. The biggest challenges are found in the high concentration of resource, bureaucratic processes, ineffective participation of marginalized groups, low quantity of technical assistance, commoditization of production and low emphasis on environmental issues. [ABSTRACT FROM AUTHOR]

Total mercury (Hg) concentration and stable isotope ratios (δ13C and δ15N) were used as chemical tracers in two crustaceans and four fish species that are targets of subsistence fishery in the inner estuary of the Paraíba do Sul River. This fluvial environment in southeast Brazil has a large historical utilization of Hg. δ15N was a better predictor of Hg concentration in the muscle (edible part) than δ13C; i.e., the Hg concentration was more closely related to the trophic position of species than species' trophic habitat. Consumers at higher trophic levels had higher Hg concentrations. The Hg concentration was below the maximum permissible limits established by the Brazilian Government in fishery products, and there are no human risks related to its consumption. [ABSTRACT FROM AUTHOR]

Background: Zoonotic visceral leishmaniasis is caused by the protozoan Leishmania infantum and is highly lethal in humans and dogs if left untreated. The frequency of this parasite and associated histological changes in the pancreas of dogs are poorly studied. Therefore, the objectives of this study were to evaluate the frequency of detection and load of amastigotes in the pancreas of L. infantum-seropositive dogs and to identify the clinical signs and histological changes associated with parasitism of this organ. Methods: One hundred forty-three dogs from an endemic area in Brazil that tested seropositive for L. infantum were studied. The dogs were clinically examined, killed, and necropsied between 2013 and 2014. One fragment of the pancreas was randomly collected for histopathology and immunohistochemistry, and spleen and bone marrow were collected for culture. Results: Leishmania amastigotes were detected in the pancreas of 22 dogs (15.4%) by immunohistochemistry, all exhibiting L. infantum parasitism in the spleen and/or bone marrow. Poor body condition and cachexia were only associated with infection of the pancreas with Leishmania spp. (p = 0.021) and were found in 40.9% of dogs with pancreatic infection. Anorexia, vomiting, and/or diarrhea were observed in 9.2% of dogs with pancreatitis. The median parasite load in the pancreas was 1.4 infected macrophages/mm2. Pancreatic histological changes and their frequencies were: granulomatous pancreatitis (28.0%), lymphoplasmacytic pancreatitis (23.8%), acinar cell degeneration (6.3%), fibrosis (5.6%), hemorrhage (2.1%), eosinophilic pancreatitis (0.7%), suppurative pancreatitis (0.7%), and necrosis (0.7%). Conclusions: The present results demonstrate that L. infantum is one of the etiological agents of chronic pancreatitis in dogs; however, the frequency of detection and parasite load are low in this organ. The lack of an association of poor body condition and cachexia with pancreatitis and the low frequency of clinical signs commonly associated with pancreatitis suggest that a significant portion of the organ is not affected by this parasite. On the other hand, the association of poor body condition and cachexia with concomitant infection of the pancreas, spleen, and/or bone marrow with this parasite suggests that these manifestations are the result of a more advanced stage of canine visceral leishmaniasis. [ABSTRACT FROM AUTHOR]

Summary: This retrospective multicenter (n = 18) cohort study evaluated the incidence, risk factors, and the impact of delayed graft function (DGF) on 1‐year kidney transplant (KT) outcomes. Of 3992 deceased donor KT performed in 2014–2015, the incidence of DGF was 54%, ranging from 29.9% to 87.7% among centers. Risk factors (lower‐bound‐95%CI OR upper‐bound‐95%CI) were male gender (1.0661.2491.463), diabetic kidney disease (1.0531.2961.595), time on dialysis (1.0051.0071.009), retransplantation (1.0351.3971.885), preformed anti‐HLA antibodies (1.0111.3831.892), HLA mismatches (1.0061.0661.130), donor age (1.0111.0171.023), donor final serum creatinine (sCr) (1.2391.3171.399), cold ischemia time (CIT) (1.0311.0431.056), machine perfusion (0.4010.5420.733), and induction therapy with rabbit antithymocyte globulin (rATG) (0.6580.8000.973). Duration of DGF > 4 days was associated with inferior renal function and DGF > 14 days with the higher incidences of acute rejection, graft loss, and death. In conclusion, the incidence and duration of DGF were high and associated with inferior graft outcomes. While late referral and poor donor maintenance account for the high overall incidence of DGF, variability in donor and recipient selection, organ preservation method, and type of induction agent may account for the wide variation observed among transplant centers. [ABSTRACT FROM AUTHOR]

This paper reports three recovered species of digeneans from an adult loggerhead sea turtle - Caretta caretta (Testudines, Cheloniidae) in Brazil. These trematodes include Diaschistorchis pandus (Pronocephalidae), Cymatocarpus solearis (Brachycoeliidae) and Rhytidodes gelatinosus (Rhytidodidae) The first two represent new geographic records. A list of helminths reported from the Neotropical region, Gulf of Mexico and USA (Florida) is presented. [ABSTRACT FROM AUTHOR]

Background: In 2015, a quality improvement project of childbirth care called Adequate Childbirth Project ("Projeto Parto Adequado"- PPA) was implemented in Brazilian public and private hospitals, aiming to improve the quality of childbirth care and to reduce caesarean sections without clinical indications. The objective of this study is to conduct an economic analysis of two models of care existing in a private Brazilian hospital—the model following the recommendations of the PPA and the standard of care model—in reducing the proportion of caesarean sections. Methods: We conducted a cost-effectiveness analysis using data from one of the private hospitals included in the PPA project. The main outcome was the proportion of caesarean section. We used total cost of hospitalization for women and newborns, from the health care sector perspective, during the length of the observed hospital stay. We did not apply discount rates and inflation rate adjustments due to the short time horizon. We conducted univariate sensitivity analysis using the minimum and maximum costs observed in hospitalizations and variation in the probabilities of caesarean section and of maternal and neonatal complications. Results: 238 puerperal women were included in this analysis. The PPA model of care resulted in a 56.9 percentage point reduction in the caesarean section probability (88.6% vs 31.7%, p < 0.001) with an incremental cost-effectiveness ratio of US$1,237.40 per avoided caesarean section. Women in the PPA model of care also had a higher proportion of spontaneous and induced labor and a lower proportion of early term births. There were no maternal, fetal or neonatal deaths and no significant differences in cases of maternal and neonatal near miss. The cost of uncomplicated vaginal births and caesarean sections was the parameter with the greatest impact on the cost-effectiveness ratio of the PPA model of care. Conclusion: The PPA model of care was cost-effective in reducing caesarean sections in women assisted in a Brazilian private hospital. Moreover, it reduced the frequency of early term births and did not increase the occurrence of severe negative maternal and neonatal outcomes. Plain English summary: Caesarean section is a safe intervention to save the lives of women and newborns. However, it is associated with negative health consequences for women and children in the short, medium and long term. Therefore, its harmful effects can outweigh its benefits when used excessively. Caesarean rates are increasing globally. In Brazil, caesarean section is the most frequent type of birth since 2009. In 2015, a quality improvement project, called "Adequate Childbirth Project" (PPA), was implemented in Brazilian public and private hospitals with the aim of improving the quality of childbirth care and reducing caesarean sections without clinical indications. In this study, we compared the caesarean rate and the hospitalization costs of women assisted in this new model of care and in the standard of care model. The women attended in the PPA model of care had a lower rate of caesarean section (31.7% vs 88.6% in the standard of care model), with no differences in severe negative maternal and neonatal outcomes. Women in the PPA model of care also had a higher frequency of spontaneous or induced labor and a lower frequency of early term births, that is, less than 39 weeks of gestation. The PPA model of care was considered cost-effective, that is, it produced good results for the amount of money spent. This is a promising result for services that face the problem of increasing numbers of caesarean sections and are looking for strategies to improve the quality of childbirth care. [ABSTRACT FROM AUTHOR]

Maize (Zea mays L.) is one of the main cereal crops grown around the world and is widely used as food, feed and raw material in various industries. However, the crop is sensitive to weather conditions, and this causes large variations in yield between crop seasons. Suboptimal irrigation can be used to secure reasonable yields with increased water productivity. For maize grown offseason in the Cerrado biome of Brazil, there is little knowledge about the benefits of suboptimal irrigation. This study was designed to evaluate the effect of different irrigation amounts and two Brachiaria cultivars intercropped with maize on maize grain yield, biomass production for silage and water productivity in the second crop season. The study was conducted at Embrapa Milho e Sorgo Experimental Station, Sete Lagoas, MG, Brazil, in 2018 and 2019. Six irrigation levels were obtained by using a line-source sprinkler irrigation system. The irrigation levels used ranged from 94% to 11% of the cumulative reference evapotranspiration (ET0) in 2018, and from 90% to 34% of ET0 in 2019. Suboptimal irrigation above a certain level did not cause a significant decrease in silage biomass (59% and 71% of the ET0, in 2018 and 2019, respectively) and grain productivity (48% and 60% of the ET0, in 2018 and 2019, respectively). Additionally, there was an increase in crop water productivity and irrigation water productivity, for biomass of both silage and grains. The results demonstrate the potential of suboptimal irrigation as a strategy to reduce water resource usage while maintaining acceptable productivity levels. [ABSTRACT FROM AUTHOR]

Background: Early childhood caries (ECC) is the most common chronic disease in childhood. Measures to reduce the prevalence of ECC cannot be taken without recognizing that oral health is influenced by biopsychosocial factors on individual and community levels. Aim: To evaluate the impact of ECC on OHRQoL and moderation effect of parents' resilience. Design: Population‐based, cross‐sectional study with 497 children (4‐6 years old) at preschools in Ribeirão das Neves, MG, Brazil. Parents self‐completed the Brazilian version of the early childhood oral health impact scale (B‐ECOHIS), the Resilience Scale and questionnaires about socioeconomic and oral health behaviour factors. Calibrated dentists conducted examinations for ECC (ICDASepi) and pulp consequences (pufa). Data analysis used multivariate Poisson regression for complex sample (P <.05). Results: Model#1, adjusted for parents' resilience and socioeconomic factors, revealed that preschoolers with pulp involvement had 2.36 (95% CI: 1.60‐3.49) and fistula/abscess had 3.57 (95% CI: 2.23‐5.72) more prevalence of negative impact on OHRQoL than preschoolers with ECC without pulp consequences. In Model#2, resilience was removed from the analysis and the strength of associations almost did not change (OHRQoL vs pulp involvement RP = 2.33;95% CI: 1.58‐3.43; OHRQoL vs fistula/abscess RP = 3.65;95% CI: 2.22‐5.99). Conclusion: Early childhood caries with pulp consequences had negative impact on OHRQoL of preschoolers and families, and it is not moderated by parents' resilience. [ABSTRACT FROM AUTHOR]

Copyright of Clinical & Biomedical Research is the property of Clinical & Biomedical Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study aims to evaluate the birthplace of preterm infants with less than 34 gestational weeks at birth by type of neonatal care service in maternity hospitals of the "Rede Cegonha" and estimate the maternal factors associated with the inadequate place of birth for gestational age. This national cross-sectional study was performed in 2016/2017 to evaluate health establishments with the Rede Cegonha's action plan. Information was analyzed from 303 puerperae and the respective health establishments of their births. Newborns were classified by gestational age at birth (<30 and 30-33 weeks) and health establishments as hospitals with neonatal intensive care service, hospitals with intermediate neonatal care service, and hospitals without neonatal care service. Ministerial Ordinance N° 930/2012 was used to classify the birthplace as appropriate for the newborn's gestational age. Preterm birth prevalence was 37.3 at less than 30 weeks' gestation and 66.8 at 30-33 weeks. Birth in inappropriate services for the newborn's gestational age occurred in 6.3%, with significant regional and social differences. Inequalities in access to neonatal care for preterm infants persist in the "Rede Cegonha" despite advances. [ABSTRACT FROM AUTHOR]

Using a judgment framework, this article analyzes the degree of implementation of the best practices in labor and childbirth care contained in the guidelines of the Rede Cegonha (RC) across Brazil. The study eligibility criteria were public and mixed hospitals located in a health region with a RC action plan in place in 2015, resulting in a total of 606 facilities distributed across the country. Three different data collection methods were used: face-to-face interviews with managers, health professionals and puerperal women; document analysis; and on-site observation. The framework was built around the five guidelines of the Labor and Childbirth component of the RC. Degree of implantation was rated as follows: adequate; partially adequate and inadequate. The performance of maternity facilities was rated as partially adequate for all guidelines except for hospital environment, which was rated as inadequate. A huge variation in degree of implementation was observed across regions, with the South and Southeast being the best-performing regions in most items. The results reinforce the need for an ongoing evaluation of the actions developed by the RC to inform policy-making and the regulation of labor and childbirth care. [ABSTRACT FROM AUTHOR]

The ongoing coronavirus disease 2019 (COVID-19) pandemic has quickly swept the globe leaving a devastating trail of lost human lives and leading to a public health and economic crisis. With this in mind, prosociality has been heralded as a potential important factor to overcome the negative effects of the pandemic. As such, in this study, we examined the effectiveness of a brief reflexive writing exercise about recent experiences of gratitude on individuals' intentions to engage in prosocial behaviors using a sample of 253 participants living in Portugal and 280 participants living in Brazil. Participants were randomly assigned to either a condition in which they were asked to write about recent experiences of gratitude or a control group in which they were asked to write about daily tasks. We predicted that the gratitude intervention would increase state gratitude and, consequently, increase positive affect and empathic concern, and decrease negative affect, leading to increased intentions to engage in prosocial behaviors during the COVID-19 pandemic. A moderated serial–parallel mediation analysis, in which we controlled for gender, age, and level of religiosity, indicated that our manipulation led to increases in state gratitude, which in turn increased positive emotions and empathic concern, leading to increased prosocial intentions in both countries. A content analysis of participants' responses in the gratitude group revealed that relationships with others and health and well-being were the central themes of their gratitude experiences during the COVID-19 global pandemic. [ABSTRACT FROM AUTHOR]