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Biofilm formation has been shown to be critical to the success of uropathogens. Although Staphylococcus saprophyticus is a common cause of urinary tract infections, its biofilm production capacity, composition, genetic basis, and origin are poorly understood. We investigated biofilm formation in a large and diverse collection of S. saprophyticus (n = 422). Biofilm matrix composition was assessed in representative strains (n = 63) belonging to two main S. saprophyticus lineages (G and S) recovered from human infection, colonization, and food-related environment using biofilm detachment approach. To identify factors that could be associated with biofilm formation and structure variation, we used a pangenome-wide association study approach. Almost all the isolates (91%; n = 384/422) produced biofilm. Among the 63 representative strains, we identified eight biofilm matrix phenotypes, but the most common were composed of protein or protein–extracellular DNA (eDNA)–polysaccharides (38%, 24/63 each). Biofilms containing protein–eDNA–polysaccharides were linked to lineage G and environmental isolates, whereas protein-based biofilms were produced by lineage S and infection isolates (p < 0.05). Putative biofilm-associated genes, namely, aas, atl, ebpS, uafA, sasF, sasD, sdrH, splE, sdrE, sdrC, sraP, and ica genes, were found with different frequencies (3–100%), but there was no correlation between their presence and biofilm production or matrix types. Notably, icaC_1 was ubiquitous in the collection, while icaR was lineage G-associated, and only four strains carried a complete ica gene cluster (icaADBCR) except one that was without icaR. We provided evidence, using a comparative genomic approach, that the complete icaADBCR cluster was acquired multiple times by S. saprophyticus and originated from other coagulase-negative staphylococci. Overall, the composition of S. saprophyticus biofilms was distinct in environmental and clinical isolates, suggesting that modulation of biofilm structure could be a key step in the pathogenicity of these bacteria. Moreover, biofilm production in S. saprophyticus is ica-independent, and the complete icaADBCR was acquired from other staphylococci.

Introdução: O acidente vascular cerebral é a principal causa de morte e incapacidade em Portugal. Os tumores cardíacos primários são raros, a maioria é benigna e o mixoma auricular é o mais comum de todos. Este tipo de tumor é mais frequente em mulheres jovens e tem apresentação clínica variável, dependendo da localização, tamanho e mobilidade da massa, podendo condicionar fenómenos cardioembólicos, como o acidente vascular cerebral. O tratamento é cirúrgico e, se detetado precocemente, o prognóstico pode ser favorável. Descrição do caso: Descreve-se o caso de uma mulher de 37 anos, com antecedentes de acidente vascular cerebral isquémico considerado idiopático aos 22 anos, com quadro de hemi-hipostesia esquerda, alterações da visão, diminuição da força muscular do membro superior esquerdo e alterações na marcha, com evidência de lesão isquémica tálamo-capsular direita na tomografia computorizada e ressonância magnética crânio-encefálica. No ecocardiograma transtorácico identificou-se uma massa auricular esquerda sugestiva de mixoma, que foi confirmada por ecocardiograma transesofágico e submetida à resseção cirúrgica e confirmação histológica. Comentário: Na suspeita de uma causa cardiogénica, o ecocardiograma deve ser prontamente realizado. O tumor cardíaco do tipo mixoma tem uma indicação de tratamento específico que é a resseção cirúrgica, com baixo risco de recorrência de evento cerebrovascular no follow-up. Este caso realça a importância do estudo complementar no acidente vascular cerebral. Por outro lado, o caso também demonstra a importância da articulação que deve existir entre os cuidados de saúde primários e secundários, particularmente com a cardiologia, para a deteção e gestão de patologias como o mixoma auricular e o acidente vascular cerebral isquémico.

The objectives of this study were to characterize the microtensile bond strength to enamel of two experimental adhesive systems, one containing a novel monomer and the other having the same composition as commercial adhesive systems, and comparing them to commercial materials. Two experimental adhesive systems were developed in the lab, one with Bisphenol A diglycidyl methacrylate (Bis-GMA) and the other with G(2)-isocyanatoethyl methacrylate (G-IEMA) as a substitute for Bis-GMA. Twenty healthy human permanent molars were cut into halves and randomly divided into eight groups based on the application mode. The experimental universal adhesive system without Bis-GMA demonstrated comparable adhesive strength to enamel as the other universal adhesive systems containing Bis-GMA.

RESUMO O objetivo foi realizar um estudo de avaliabilidade da atenção à saúde dos reclusos no Estabelecimento Penitenciário Provincial de Maputo (EPPM) – Moçambique com base na descrição da estrutura e dos processos de atenção à saúde no EPPM e na descrição dos contextos externos e organizacionais que interferem na atenção à saúde. Estudo de caso único com abordagem qualitativa usando as técnicas de análise documental, observação direta e questionário. Verificou-se que o EPPM possui estrutura precária, falta de insumos e profissionais em número insuficiente para a assistência à saúde. Reclusos formados como educadores de pares e ou como chefes de saúde dão apoio às atividades do posto médico, gerando seu empoderamento no Estabelecimento Penitenciário (EP). A atenção à saúde do recluso em Moçambique não é objeto de debate e não está incluída nas políticas do Serviço Nacional de Saúde, o que resulta em atenção inadequada e insuficiente. O estudo sugere a importância e viabilidade de futuras pesquisas de avaliação da atenção à saúde prisional em Moçambique para que a implantação das ações seja baseada em evidências.

Abstract: Introduction: Flipped Classroom (FC) is an Active Learning Methodology characterized by the sending of teaching materials to students in advance, so that the classroom moment is entirely dedicated to non-expository activities. The FC was implemented in 2019 for the teaching of Clinical Examination (CE) aimed at undergraduate medical students at a Higher Education Institution in the Northeast region of Brazil. Objective: To analyze the implementation of FC for CE learning compared to the mini-exposure methodology followed by practice. Method: Analysis of educational intervention with historical control over the implementation of the FC methodology carried out in three phases. In the first, the two tutors involved in the implementation or who acted as teachers were evaluated through a semi-structured interview about the FC implementation process and its initial operation. The second consisted in the assessment of 44 medical students, through a Likert questionnaire, on learning with the new methodology. The third consisted in evaluating the grades obtained by 66 students who experienced learning with FC in relation to 142 students who experienced the previous methodology. Result: The evaluated tutors knew little about the methodology before it was implemented and believe that its implementation promoted gains, such as students’ greater dedication to individual study. The initial difficulty arose from the creation of an extensive database of questions for the pre-test, which was carried out at the beginning of the in-person moments. The evaluated students reported being well adapted and agree with the benefits of FC, including: feeling stimulated to study, developing the practice more easily and the presence of pre-tests that help to improve individual study. The results of the comparison of grades showed a significant increase in performance when comparing students who experienced the FC (9,11 - SD 0,45) with those who experienced the previous methodology (8,49 - SD 0,91). Conclusion: The methodology was satisfactorily implemented, promoted gains in learning and optimized the in-person time to be entirely dedicated to practical learning.

Few studies have explored the impacts of COVID-19 and lockdown on the mental health of undergraduate nursing students. This study aimed: a) to explore perceived stress among undergraduate nursing students in Portugal and Spain during the COVID-19 pandemic outbreak; and b) to analyze several COVID-19 related factors and psychological issues that may be associated with perceived stress. A cross-sectional study was conducted with a convenience sample of Portuguese and Spanish undergraduate nursing students (n=1075). The data gathered included demographic information, questions about COVID-19 related factors, and psychological issues. Data were analyzed using multiple logistic regression with a degree of significance at p

Resumo Introdução Adesão ao tratamento e aumento das taxas de cura resultam da interação de fatores relacionados aos serviços de saúde, pacientes, sociedade e gestão pública. Objetivo Conhecer os fatores relativos à adesão ao tratamento da tuberculose multidroga resistente (TBMDR), na perspectiva dos usuários, profissionais e gestores. Método Estudo de caso de abordagem qualiquantitativa, diferentes fontes de evidência, estatística descritiva e análise de conteúdo das categorias: adesão, acesso, acolhimento, vínculo e responsabilização. Resultados Oferta gratuita da medicação, realização de exames no ambulatório, flexibilidade na agenda, busca de faltosos e vínculo com a equipe de saúde foram descritos como favoráveis à adesão; sendo a dificuldade de acesso aos benefícios sociais e equipe de saúde incompleta como desfavoráveis. Conhecimento sobre a doença atual, o tratamento e o desejo de cura foram relatados como importantes fatores para superar barreiras encontradas para adesão. Conclusão Apesar da existência de fatores desfavoráveis à adesão, as ações de acolhimento, vínculo e responsabilização desenvolvidas pelo serviço foram suficientes para promover a adesão neste grupo. Recomenda-se a melhoria do acesso aos benefícios assistenciais, implementação de novas formas de comunicação e articulação com outros segmentos públicos e da sociedade para o enfrentamento da TBMDR.

AbstractIntroduction Elements such as Ca and P are involved in important physiological processes and their concentrations may differ significantly between healthy and diseased individuals [1]. Investigation of the role of single elements has been questioned because it ignores important interactions amongst various elements [2]. Often, when concentrations of various elements are obtained in the same study, comparisons between healthy and diseased tissues, or correlations between those elements, both intrinsically multivariate, are implemented with univariate methods, which may result in inflated or unobserved existing effects [3,4]. The methodologies in here complement multielement determinations by X-ray fluorescence spectroscopy (XRF) with multivariate data analysis methodologies, and offer an important contribute to fill existing gaps in current knowledge of the role elements in such metabolic pathways.Materials and methods Here, the XRF technique is applied to assess the concentration profile of Ca and P, in samples of 4 groups of Wistar rat tibiae, aiming at assessing the musculoskeletal impact of the synergy effects of an environmental factor and a disease with recognised systemic effects. Each group contained 12 animals: exposed to low-frequency noise (yes/no) and diabetic/hyperglycaemic rats (yes/no). Animals from each group were randomly divided into three timepoints and sacrificed after 1, 6 and 12 weeks of exposure. In view of this experimental design, Two-Way ANOVA has been used to assess the effect of main factors and interaction of those factors on the dependent variables, after validation of model assumptions.Results For bone Ca concentration, there was no interaction between the two main factors, with no effect due to noise exposure (p = .501) but with a significant effect due to diabetes (p = .038), with observed power of 68%. A similar outcome was observed for bone P concentration (p = .456), with no interaction between factors, no effect due to noise, but with significant impact due to diabetes (p = .003), with observed power of 69.2%. In both cases, the concentrations of Ca and P were decreased in the group of diabetic animals. For the ratio Ca/P no significant effects or interactions were detected (p = .140).Discussion and conclusions XRF spectrometry is clearly a highly promising technique to be used in the discrimination of elemental concentrations in healthy and diseased rat tissues. As this is a pioneer investigative work and the number of animals included is limited in this first approach, it is early to anticipate definite results. However, we can, in the meantime, observe the presence of diabetic-induced osteopenia, with no effects resulting from exposure to noise.

AbstractIntroduction It has been shown that the concentrations of some elements, for example K, Ca, Cu, Fe, and Zn, may differ significantly between the healthy area and the tumour area in the same human tissue [1]. Most studies conducted so far are focussed on specific elements which are a priori known to be involved in physiological or pathological processes, and thus risk neglecting the potential role of the excluded elements in those processes [2]. The role of elements considered in isolation has been questioned because it ignores the important interactions amongst the various elements [3]. However, even when concentrations of various elements are obtained in the same study, comparisons between healthy and diseased tissues, or correlations between the various elements, both intrinsically multivariate, are often implemented with univariate methods, which may result in observed effects or the inability to detect such effects [4]. The methodologies in this study, which complement multielement determinations by X-ray fluorescence spectroscopy (XRF) and X-ray diffraction (XRD) in several types of biological samples, with multivariate data analysis methodologies, provide an important contribute to fill existing gaps in current knowledge of the role elements in such metabolic pathways.Materials and methods Samples consisted of five matched pairs (10 samples) of normal and tumour human tongue tissue. In the developing work, the XRF and XRD techniques are applied in the determination of the concentration profile of several elements of interest, in samples of healthy tissue and tongue carcinoma, with the objective of developing a classification system based on the profile of elemental concentrations which allows to discriminate between healthy tissue and carcinoma, and thus clarify the role of these elements in the aetiology of the disease.Results Potential differences in Ca, Fe and S were observed. Intrasampling tests determined that samples were inhomogeneous which may affect the ability to discriminate between normal and tumour tissues.Discussion and conclusions It is highlighted that the limited number of samples prevents any conclusive findings for now nevertheless results provide areas of focus for upcoming study.

Myrocarpus frondosus is widely used in Brazilian folk medicine for bronchitis, gastritis, ulcers and wound asepsis. However, there is a scarcity of scientific data proving the safe use of tea of this species or if there is any toxic effect on the human organism. This study aimed to evaluate the antiproliferative effect of aqueous extracts of cabreúva on the Allium cepa cell cycle. The aqueous extracts were prepared from leaves, bark and roots (dried material) of the species in two concentrations: 2.5 and 5.0 grams in 250 mL of distilled water. The aqueous extract of the leaves was obtained by infusion and the aqueous extract of the bark and roots by decoction. Distilled water was used as negative control and glyphosate 2% as positive control. Eight groups of four onion bulbs were evaluated and each group corresponded to one treatment and, in each group, 4000 cells were analyzed and the mitotic index was calculated. The results demonstrated reduction of mitotic indices in all treatments when compared to the negative control in water. The aqueous extracts of cabreúva in the studied concentrations have antiproliferative action on the Allium cepa cell cycle, ensuring the safe use of tea of this medicinal species.

A vast number of adhesive formulations exist currently. However, available adhesives still have several drawbacks such as increased hydrophilicity, polymerization deficiency, potential cytotoxicity and limited monomer interdiffusion within dentin. To improve material properties, a Bisphenol A-free adhesive containing a novel dendrimer G(2)-isocyanatoethyl methacrylate (G-IEMA) in replacement of Bis-GMA was made and tested. Sound human molars were sectioned to expose mid-coronal dentin, which was bonded using four adhesives—Futurabond, Scotchbond Universal and experimentals EM1 and EM2. The experimental adhesive EM2 contained G-IEMA, while EM1 had Bis-GMA. Groups were further allocated to two different adhesive strategies: etch-and-rinse (20 s etching) or self-etch. Immediate (24 h) microtensile bond strength to dentin (n = 5) was tested using a universal testing machine (1 mm/min, 5 kN; Shimadzu AGS-X Autograph, Tokyo, Japan), while the ultrastructure of the interface (n = 2) was assessed using scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS). Nanoleakage expression was evaluated using silver nitrate penetration and posterior SEM-EDS analysis (n = 3). Linear mixed models/Generalized models were used for inferential statistics (5% significance level). Bond strength results did not depend on the adhesive choice, although differences were found between strategies (p < 0.001). Regarding nanoleakage, when applied in an etch-and-rinse mode, experimental adhesives scored lower nanoleakage means than Futurabond and Scotchbond Universal. The novel adhesive shows interesting interfacial properties, with favorable nanoleakage results and a bond strength to dentin that matches current commercial adhesives.

The emergence of multidrug resistant Gram-negative pathogens, particularly carbapenemase producers, has forced clinicians to use last line antibiotics, such as colistin. Since colistin susceptibility testing presents several challenges, this study aimed at evaluating the performance of two alternative susceptibility methods for Klebsiella pneumoniae, namely, agar dilution (AD) and MIC test strips (MTS). These approaches were compared with the reference method, broth microdilution (BMD), and provide a quantitative description for the “skipped well” (SW) phenomenon. Colistin susceptibility was evaluated by BMD and AD in parallel and triplicate, using 141 K. pneumoniae clinical isolates while MTS performance was evaluated only for a subset (n = 121). Minimum inhibitory concentration analysis revealed that a substantial part (n = 26/141; 18.4%) of the initial isolates was deemed undetermined by BMD due to the following: discordance between replicates (1.4%); presence of multiple SWs (7.8%); and the combination of both events (9.2%). Both AD and MTS revealed a high number of false-susceptible strains (“very major errors”), 37.5% and 68.8%, respectively. However, AD agreement indices were reasonably high (EA = 71.3% and CA = 94.8%). For MTS these indices were lower, in particular EA (EA = 41.7% and CA = 89.6), but the approach enabled the detection of distinct sub-populations for four isolates. In conclusion, this study provides the most comprehensive study on the performance of AD and MTS for colistin susceptibility testing in K. pneumoniae, highlighting its limitations, and stressing the importance of sample size and composition. Further, this study highlights the impact of the SW phenomenon associated with the BMD method for K. pneumoniae.

Klebsiella pneumoniae is an increasing threat to public health and represents one of the most concerning pathogens involved in life-threatening infections. The resistant and virulence determinants are coded by mobile genetic elements which can easily spread between bacteria populations and co-evolve with its genomic host. In this study, we present the full genomic sequences, insertion sites and phylogenetic analysis of 150 prophages found in 40 K. pneumoniae clinical isolates obtained from an outbreak in a Portuguese hospital. All strains harbored at least one prophage and we identified 104 intact prophages (69.3%). The prophage size ranges from 29.7 to 50.6 kbp, coding between 32 and 78 putative genes. The prophage GC content is 51.2%, lower than the average GC content of 57.1% in K. pneumoniae. Complete prophages were classified into three families in the order Caudolovirales: Myoviridae (59.6%), Siphoviridae (38.5%) and Podoviridae (1.9%). In addition, an alignment and phylogenetic analysis revealed nine distinct clusters. Evidence of recombination was detected within the genome of some prophages but, in most cases, proteins involved in viral structure, transcription, replication and regulation (lysogenic/lysis) were maintained. These results support the knowledge that prophages are diverse and widely disseminated in K. pneumoniae genomes, contributing to the evolution of this species and conferring additional phenotypes. Moreover, we identified K. pneumoniae prophages in a set of endolysin genes, which were found to code for proteins with lysozyme activity, cleaving the β-1,4 linkages between N-acetylmuramic acid and N-acetyl-D-glucosamine residues in the peptidoglycan network and thus representing genes with the potential for lysin phage therapy.

Objetivo: Identificar e analisar estudos de avaliação de intervenções (programas e ações) de atenção em saúde aos estomizados. Método: Revisão integrativa da literatura com busca de evidências no período de setembro a outubro de 2017 nas bases de dados LILACS, PUBMED, IBECS e Scopus. Resultados: Identificaram-se 09 publicações relacionadas à atenção aos estomizados, em diferentes níveis e objetos de análise. Apenas um estudo avaliou o serviço de atenção, incluindo o modelo teórico da intervençao na metodologia, revelando a escassez de pesquisas avaliativas nesta área. Os demais estudos, apesar de terem sido considerados pelo autores como pesquisas avaliativas, não utilizaram conceitos e métodos avaliativos. Conclusões: A avaliação da atenção às pessoas estomizadas no Brasil, é uma temática que, apesar de estar prevista na legislação nacional, necessita de mais pesquisas para ajudar na tomada de decisão dos gestores e profissionais de saúde, frente aos diversos problemas enfrentados para oferta de serviço de saúde de qualidade aos usuários de estomias. Palavras-chave: Avaliação; Avaliação de programas; Ostomia; Serviços de saúde. Objective: To identify studies evaluating health care programs for ostomates. Method: Integrative review of literature with search of evidence from September to October 2017 in LILACS, PUBMED, IBECS and Scopus databases. Results: 9 publications related to attention to ostomates were identified at different levels and objects of analysis. Only one study evaluated the care service using the theoretical model of intervention in the methodology, revealing the scarcity of evaluative research in this area. The other studies, although they were considered by the authors as evaluative surveys, did not use evaluative concepts and methods. Conclusions: The evaluation of care for ostomized people in Brazil is a subject that, although it is foreseen in national legislation, requires more research, to assist in the decision-making of health managers and professionals in face of the various problems faced for the provision of quality health care for ostomies users. Keywords: Evaluation; Evaluation of programs; Ostomy; Health services.

Unmanned aerial systems (UASs) have recently been proven to be valuable remote sensing tools for detecting marine macro litter (MML), with the potential of supporting pollution monitoring programs on coasts. Very low altitude images, acquired with a low-cost RGB camera onboard a UAS on a sandy beach, were used to characterize the abundance of stranded macro litter. We developed an object-oriented classification strategy for automatically identifying the marine macro litter items on a UAS-based orthomosaic. A comparison is presented among three automated object-oriented machine learning (OOML) techniques, namely random forest (RF), support vector machine (SVM), and k-nearest neighbor (KNN). Overall, the detection was satisfactory for the three techniques, with mean F-scores of 65% for KNN, 68% for SVM, and 72% for RF. A comparison with manual detection showed that the RF technique was the most accurate OOML macro litter detector, as it returned the best overall detection quality (F-score) with the lowest number of false positives. Because the number of tuning parameters varied among the three automated machine learning techniques and considering that the three generated abundance maps correlated similarly with the abundance map produced manually, the simplest KNN classifier was preferred to the more complex RF. This work contributes to advances in remote sensing marine litter surveys on coasts, optimizing the automated detection on UAS-derived orthomosaics. MML abundance maps, produced by UAS surveys, assist coastal managers and authorities through environmental pollution monitoring programs. In addition, they contribute to search and evaluation of the mitigation measures and improve clean-up operations on coastal environments.

No Brasil, as ações de controle da tuberculose destinadas à população carcerária estão há dez anos regulamentadas pelo Plano Nacional de Saúde no Sistema Penitenciário. Os estados da federação têm modelos distintos de organização do Programa de Controle da Tuberculose (PCT) no sistema prisional. Este estudo avaliou o grau de implantação do PCT em unidades prisionais de dois estados brasileiros. Procedeu-se a um estudo de casos múltiplos com abordagem qualitativa e desenvolvimento de uma matriz de análise e julgamento. Segundo critérios pré-definidos foram selecionados dois casos estaduais, com duas unidades de análise para cada caso e um hospital penal no Caso 2. A implantação parcial do programa foi identificada nas unidades prisionais do Caso 1 e no hospital penal; um baixo nível de implantação foi constatado nas unidades prisionais não hospitalares do Caso 2. A falta de investimento financeiro e de recursos, a falta de integração entre as coordenações da justiça e da saúde e a dificuldade de acesso ao serviço de saúde foram alguns dos fatores desfavoráveis à implantação do programa.

Background and aims: Dysphagic patients who underwent endoscopic gastrostomy (PEG) usually present protein-energy malnutrition, but little is known about micronutrient malnutrition. The aim of the present study was the evaluation of serum zinc in patients who underwent endoscopic gastrostomy and its relationship with serum proteins, whole blood zinc, and the nature of underlying disorder. Methods: From patients that underwent gastrostomy a blood sample was obtained minutes before the procedure. Serum and whole blood zinc was evaluated using Wavelength Dispersive X-ray Fluorescence Spectroscopy. Serum albumin and transferrin were evaluated. Patients were studied as a whole and divided into two groups: head and neck cancer (HNC) and neurological dysphagia (ND). Results: The study involved 32 patients (22 males), aged 43-88 years: HNC = 15, ND = 17. Most (30/32) had low serum zinc, 17/32 presented normal values of whole blood zinc. Only two, with traumatic brain injury, presented normal serum zinc. Serum zinc levels showed no differences between HNC and ND patients. There was no association between serum zinc and serum albumin or transferrin. There was no association between serum and whole blood zinc. Conclusions: Patients had low serum zinc when gastrostomy was performed, similar in HNC and ND, being related with prolonged fasting and unrelated with the underlying disease. Decrease serum zinc was unrelated with low serum proteins. Serum zinc was more sensitive than whole blood zinc for identifying reduced zinc intake. Teams taking care of PEG-patients should include zinc evaluation as part of the nutritional assessment, or include systematic dietary zinc supply.

Early diagnosis of uterine cervical cancer is extremely important to reduce morbidity and mortality caused by this type of cancer. This justifies a study to examine the coverage and results of the Pap smear test in SUS users, taking into account the alterations pattern and proposed treatment, and the women proportion who do not return to receive the results of such tests. With these aims, it was developed a quantitative, descriptive and exploratory research, using the records of a Basic Health Unit (UBS) in the metropolitan region of Rio de Janeiro and databases (SISCOLO and IBGE) of 2011. The results pointed total coverage of 11.25%, abnormal results in 78.66% of cases, proportion of 29.9% of exams undeliverable, average time between collection and arrival of the exam result into UBS of one month and 26 days and average time between collection and delivery of the results to the user of four months and six days.

‘Kaxuyana’ é a denominação dos índios que se reconhecem como a ‘gente’ (yana) do ‘Cachorro’ (Kaxuru), tributário direito do médio Trombetas (Kahu), localizado na porção brasileira da Amazônia Setentrional. No final da década de 1960, assolados por doenças trazidas pelas frentes de colonização, estes índios dividiram-se entre duas frentes de dispersão, rumando, por um lado, para o rio Paru de Oeste e, por outro, para o rio Nhamundá. Ao promoverem casamentos interétnicos com os índios Tiriyó no Paru de Oeste, e com os índios Hixkaryana no Nhamundá, a população kaxuyana voltou a crescer. Depois de quatro décadas separadas, estas duas frentes voltaram a se reunir no seu lugar de habitação tradicional. O presente artigo procura descrever esses movimentos, refletindo sobre a dinâmica espaço-temporal viven­ciada por este povo indígena a partir da última metade do século passado. Palavras-chave: Guiana. Kaxuyana. Tiriyó. Organização Social. Amazônia Resumen ‘Kaxuyana’ es la denominación de los indígenas que se recono­cen como la ‘gente’ (-yana) del ‘Cachorro’ (Kaxuru), afluente derecho del medio Trombetas (Kahu), situado en la porción bra silena Amazonia Septentrional. En finales de la década de 1960, devastados por las enfermedades traídas por los frentes de colo­nización, estos indígenas se han dividido entre dos frentes de dis­persión, siguiendo en dirección, por un lado, al río Paru d´Oeste y, por otro, al río Nhamundá. Al promovieren matrimonios inte­rétnicos con los Tiriyó en Paru de Oeste y con los Hixkaryana en Nhamundá, la población kaxuyana retomó su crecimiento. Después de cuatro décadas separadas, las dos frentes han vuelto a reunirse en su lugar de habitación tradicional, en la cuenca del medio rio Trombetas. El presente artículo tiene como objetivo describir estos movimientos, reflexionando sobre la dinámica espacio-temporal vivenciada por estos indígenas desde la última mitad del siglo pasado. Palavras claves: Guiana. Kaxuyana. Tiriyó. Organización So­cial. Amazonia Abstract ‘Kaxuyana’ is the denomination of the amerindians who recog­nize themselves as the ‘people’ (-yana) of ‘Cachorro’ (Kaxuru), a right tributarie of the middle Trombetas (Kahu) river, located at the brazilian portion of the Northern Amazonia. In the late 1960’s, ravaged by diseases brought by fronts of colonization, these indians were dispersed into two migratory fronts, directed, on the one hand, to the river Paru de Oeste and, on the other, to the river Nhamundá. By promoting interethnic marriages with the Tiriyó at the Paru de Oeste and the Hixkaryana at the Nha­mundá, the kaxuyana population began to grow again. After four decades separated, these two fronts met again at their traditional dwelling-place. This paper aims to describe these movements, reflectiong on the spatiotemporal dynamics experienced by this indigenous people from the last half century on. Keywords: Guiana. Kaxuyana. Trio. Social Organization. Ama­zonia

OBJECTIVE To analyze the influence from context characteristics in the control of tuberculosis in prisons, and the influence from the program implementation degrees in observed effects.METHODS A multiple case study, with a qualitative approach, conducted in the prison systems of two Brazilian states in 2011 and 2012. Two prisons were analyzed in each state, and a prison hospital was analyzed in one of them. The data were submitted to a content analysis, which was based on external, political-organizational, implementation, and effect dimensions. Contextual factors and the ones in the program organization were correlated. The independent variable was the program implementation degree and the dependent one, the effects from the Tuberculosis Control Program in prisons.RESULTS The context with the highest sociodemographic vulnerability, the highest incidence rate of tuberculosis, and the smallest amount of available resources were associated with the low implementation degree of the program. The results from tuberculosis treatment in the prison system were better where the program had already been partially implemented than in the case with low implementation degree in both cases.CONCLUSIONS The implementation degree and its contexts – external and political-organizational dimensions – simultaneously contribute to the effects that are observed in the control of tuberculosis in analyzed prisons.

This research investigated academic competence and its relation to social skills and sociodemographic variables in a sample of 257 elementary school students from First through Fourth Grades, using the SSRS scale - Social Skills Rating System. Socioeconomic level was assessed using the “Critério Brasil” scale. Participants were 185 parents and 12 teachers who also rated the children’s social skills. Results showed that 7,9% of the sample had learning difficulties. Girls had higher scores than boys in academic competence. The competence in school was significantly and positively correlated with socioeconomic level. Also, children from private schools had higher scores than those from public schools. There was a significant relationship between social skills and academic competence, the children with higher social skills scores had the better academic competence and were less likely to fail in school. These results confirm previous findings suggesting that social skills interventions in school can affect the students' outcome positively. Keywords: social skills; academic performance; elementary school students; sociodemographic variables.

O artigo analisa o acesso às equipes certificadas pelo Programa Nacional de Melhoria de Acesso e da Qualidade da Atenção Básica, tendo por categoria central o acesso potencial e duas dimensões: acolhimento e disponibilidade. A partir de questões selecionadas dos instrumentos da Avaliação Externa do Programa, geraram-se escores e três estratos. Os resultados confirmam que os fatores favoráveis ao acesso potencial foram: localização na região Sudeste, em capitais e municípios de maior porte e com maior número de equipes por unidade. Apesar dos progressos, os resultados indicam a necessidade de políticas e ações voltadas à qualificação da atenção prestada, especialmente nos municípios de pequeno porte.

ABSTRACT Objectives: to perform an evaluation study of the Ostomy Care Service in Brazil. Methods: a qualitative methodology was used, with a collaborative approach of the participants using the service, based on the seven elements proposed by Thurston and Ramaliu, which include service modeling and evaluation model proposal. Document analysis, direct observation, consensus workshops, and interviews with key informants were used. Results: the description and construction of the theoretical-logical model of the ostomy care service, the development of evaluative questions, the construction of the analysis and judgment matrix, and the evaluation proposal were presented. Final Considerations: it was found that it is feasible to systematically evaluate the service based on its structural elements, such as its theory, material and human resources. The proposed evaluation aims to provide support for improving the quality of care.

Abstract Cell therapy associated with guided bone regeneration (GBR) can be used to treat bone defects under challenging conditions such as osteoporosis. This study aimed to evaluate the effect of mesenchymal stem cells (MSCs) in combination with a poly(vinylidene-trifluoroethylene)/barium titanate (PVDF-TrFE/BT) membrane on bone repair in osteoporotic rats. Osteoporosis was induced in female rats by bilateral removal of the ovaries (OVX) or sham surgery (SHAM), and the osteoporotic condition was characterized after 5 months by microtomographic and morphometric analyses. Calvarial defects were created in osteoporotic rats that immediately received the PVDF-TrFE/BT membrane. After 2 weeks, bone marrow-derived MSCs from healthy rats, characterized by the expression of surface markers using flow cytometry, or phosphate-buffered saline (PBS) (Control) were injected into the defects and bone formation was evaluated 4 weeks post-injection by microtomographic, morphometric, and histological analyses. A reduction in the amount of bone tissue in the femurs of OVX compared with SHAM rats confirmed the osteoporotic condition of the experimental model. More bone formation was observed when the defects were injected with MSCs compared to that with PBS. The modification that we are proposing in this study for the classical GBR approach where cells are locally injected after a membrane implantation may be a promising therapeutic strategy to increase bone formation under osteoporotic condition.