DELAY IN THE DIAGNOSIS OF TUBERCULOSIS IN PRISONS: THE EXPERIENCE OF INCARCERATED PATIENTS

This study analyzed the causes of delay in the diagnosis of tuberculosis in the prison system, according to the experience of incarcerated patients. The theoretical and methodological framework of the French school of discourse analysis was used, which seeks to comprehend the processes of meaning production, in the relationship of language with ideology and the development of subjects in their positions. Semi-directed interviews were conducted with seven incarcerated tuberculosis patients in a hospital of Joao Pessoa, Paraiba, Brazil, between August and October 2009. The delay in the diagnosis of tuberculosis was related to the naturalization of the lack of care for the prisoner, to the interpretation of the prison as a place of death and suffering and to the deprivation of the right to health for the detainees as a result of their position in the asymmetric power relationships and ideological effects.

Lack of COI variation for Clavelina oblonga (Tunicata, Ascidiacea) in Brazil: Evidence for its human-mediated transportation?

Recent studies indicate that ascidians are efficiently dispersed by human transport. We have chosen the mitochondrial gene cytochrome c oxidase subunit I (COI) to address whether Clavelina oblonga is an introduced species in the Brazilian coast. Colonies of C. oblonga were sampled in different localities along Atlantic coasts of USA, Panama, and Brazil. The sequencing of 92 colonies resulted in three haplotypes for the species, two unique to Florida and the other shared by exemplars collected in Brazil and Panama; the latter haplotype is identical to the published sequence of Azores. Our evidence, including the absence of C. oblonga in the country's northern tropical waters, its association with artificial habitats and lack of COI variation suggest that the species has been introduced in the southeastern and southern Brazilian coasts. Previous records (85 years old) suggest that it could be a relatively long-term introduction.

The coordination of care for tuberculosis control

This descriptive epidemiological study analyzed the coordination of tuberculosis (TB) patient care in primary healthcare services according to 23 patients, 16 professionals, and 17 administrators from Ribeirao Preto, Sao Paulo, using an instrument adapted to evaluate TB. According to the informants, the coordination of healthcare provided to patients under the treatment of the Tuberculosis Control Program team was considered satisfactory; however, when there is a need to refer the patient to other care units there are weak points in the coordination of healthcare, which include: interruption of communication flow; and patients' incipient participation in the care process, with a need to increase the sense of responsibility for patient care and encourage patients to become active agents in the process.

Delay in the search for health services for the diagnosis of tuberculosis in Ribeirao Preto, Sao Paulo

The scope of this paper is to analyze delays in locating health services for the diagnosis of tuberculosis in Ribeirao Preto in 2009. An epidemiological and cross-sectional study was conducted with 94 TB patients undergoing treatment. A structured questionnaire, based on the Primary Care Assessment Tool adapted for TB care was used. A median (15 days or more) was established to characterize delay in health attendance. Using the Prevalence Ratio, the variables associated with longer delay were identified. The first healthcare services sought were the Emergency Services (ES) (57.5%). The longest period between seeking assistance occurred among males, aged between 50 and 59, who earned less than five minimum wages, had pulmonary TB, were new cases, were not co-infected with TB/HIV, did not consume alcohol, had satisfactory knowledge about TB before diagnosis (with a statistically significant association with delay) and who did not seek healthcare close to home before developing TB. There is a perceived need for training healthcare professionals about the signs and symptoms of the disease, reducing barriers of access to timely diagnosis of TB and widely disseminating it to the community in general.

Three in one: fixing marine nematodes for ecological, molecular, and morphological studies

Multidisciplinary benthic studies are still hindered by the lack of a unique fixative that satisfactorily preserves morphology and DNA, and that is simultaneously adequate for ecological surveys. The objective of this study is to test the performance of five fixatives: formalin, ethanol, dimethylsulfoxide with EDTA and NaCl salts (DESS), methanol with acetic acid (METHAC), and ethanol with acetic acid (ETHAC), for the preservation of estuarine and exclusively marine nematode assemblages for morphological, molecular, and ecological studies. The presence of the stain rose bengal in each fixative was also evaluated in the yield of PCR reactions. For molecular analyses, one species of each habitat was considered. Results revealed that fixative performance for morphological studies is habitat-and species-dependent. For studies of estuarine sediment nematodes, we recommend the use of pure ethanol, because it caused little morphological distortion (<10% of the assemblage), preserved all the species for ecological studies, and yielded high quality DNA sequences. For studies of exclusively marine environments, METHAC or DESS are the most adequate. The first performed better for morphological and ecological surveys, whereas the second was more appropriate for molecular research. For ecological studies, DESS should be used in comparison with formalin, in order to cross check the results. Finally, staining of samples with rose bengal is not recommended, because it hindered DNA amplification regardless of the fixative used.

Nine New Species of Bugula Oken (Bryozoa: Cheilostomata) in Brazilian Shallow Waters

Background: Bugula is a speciose genus of marine bryozoans, represented by both endemic and cosmopolitan species distributed in tropical and temperate waters and important to marine biologists because of the occurrence of many species in harbor and fouling communities, therefore as potential invaders. The southeastern Brazilian coast in the southern Atlantic hosts the highest known diversity of the genus, a status intimately associated with the intensity of collecting efforts. Methodology: Morphological data based on the examination of living specimens, scanning electron and light microscopic images, and morphometric analyses were used to assess the diversity of Bugula along the coastal areas of southern, northeastern, and southeastern Brazil. In this study, morphological species boundaries were based mainly on avicularian characters. For two morphologically very similar species, boundaries are partially supported by 16 S rDNA molecular data. Results: Nine species are newly described from Brazil, as follows: Bugula bowiei n. sp. (= Bugula turrita sensu Marcus, 1937) from the southern, northeastern, and southeastern coasts; Bugula foliolata n. sp. (= Bugula flabellata sensu Marcus, 1938), Bugula guara n. sp., Bugula biota n. sp. and Bugula ingens n. sp from the southeastern coast; Bugula gnoma n. sp. and Bugula alba n. sp. from the northeastern coast; Bugula rochae n. sp. (= Bugula uniserialis sensu Marcus, 1937) from the southern coast; and Bugula migottoi n. sp., from the southeastern and southern coasts. Conclusion: The results contribute to the morphological characterization and the knowledge of the species richness of the genus in the southwestern Atlantic (i.e., Brazil), through the description of new species in poorly sampled areas and also on the southeastern coast of that country. Additionally, the taxonomic status of the Brazilian specimens attributed to B. flabellata, B. turrita and B. uniserialis are clarified by detailed studies on zooidal and avicularia morphology.

A coordenação da assistência no controle da tuberculose

Estudo epidemiológico descritivo que analisa a coordenação da assistência ao doente de Tuberculose em Serviços de Atenção Primária segundo 23 doentes, 16 profissionais e 17 gestores em Ribeirão Preto-SP, através de instrumento adaptado para avaliar a tuberculose. De acordo com os informantes, a coordenação da assistência ao doente em tratamento pela equipe do programa de controle da tuberculose foi considerada satisfatória. No entanto, quando há necessidade de encaminhar o doente a outros pontos de atenção, a coordenação da assistência apresenta pontos deficientes como descontinuidade do fluxo de comunicação e participação incipiente do doente no processo de atenção, havendo necessidade de aumentar a responsabilização pelo cuidado do doente e estimulá-lo como agente ativo do processo.

Causas referidas para o desenvolvimento de úlceras em pés de pessoas com diabetes mellitus

OBJETIVO: Analisar as causas referidas na etiologia das úlceras em pés de pessoas com Diabetes mellitus (DM). MÉTODOS: Estudo seccional, quantitativo, realizado no Ambulatório de Diabetes de um Hospital Universitário em Ribeirão Preto - SP. Os dados foram coletados com instrumento estruturado e exame físico dos pés de amostra de 30 pacientes diabéticos. RESULTADOS: Amostra com idade média de 57,5 anos, predominância do sexo masculino e baixa escolaridade; 90% possuíam DM tipo 2, de longa duração e mal controlado; obesidade/sobrepeso em 77% e insensibilidade plantar em 93,3%. A região metatarsiana foi o local de úlcera referido com maior frequência, e a causa foi a calosidade. CONCLUSÃO: as causas referidas envolvidas na etiologia das úlceras correspondem, de forma direta ou indireta, a fatores extrínsecos que podem ser prevenidos com cuidados básicos e de baixo custo. A insensibilidade plantar, fator fundamental desencadeador das úlceras, no entanto não foi reconhecida pelas pessoas.

Atraso no diagnóstico da tuberculose em sistema prisional: a experiência do doente apenado

O estudo analisou as causas de atraso no diagnóstico da tuberculose em sistema prisional, segundo a experiência do doente apenado. Utilizou-se o referencial teórico-metodológico da análise de discurso de matriz francesa, que busca a compreensão dos processos de produção de sentidos, na relação da linguagem com a ideologia e de constituição de sujeitos em suas posições. Foram realizadas entrevistas semidirigidas com sete doentes de tuberculose apenados em um hospital de João Pessoa, Paraíba, Brasil, no período de agosto a outubro de 2009. O atraso no diagnóstico da tuberculose relaciona-se à naturalização da desassistência ao sujeito preso, à interpretação do presídio como um lugar de morte e sofrimentos e à privação do direito à saúde para detentos em decorrência de sua posição nas relações assimétricas de poder e efeitos ideológicos.

Atraso na busca por serviço de saúde para o diagnóstico da tuberculose em Ribeirão Preto (SP)

Foi analisado o atraso na busca por serviço de saúde para o diagnóstico da Tuberculose (TB) em Ribeirão Preto, 2009, em um estudo epidemiológico, transversal, realizado com 94 doentes. Utilizou-se questionário baseado no Primary Care Assessment Tool, adaptado para avaliar a atenção à TB. Estabeleceu-se a mediana (15 dias ou mais) para caracterizar atraso na busca pelo primeiro atendimento. Através da Razão de Prevalência, identificaram-se as variáveis relacionadas ao maior atraso. O primeiro serviço de saúde procurado foi o de pronto atendimento (57,4%). Verificou-se um maior tempo na procura pelos serviços de saúde entre os doentes: do sexo masculino; com idade entre 50 a 59 anos; com renda familiar inferior a cinco salários mínimos; forma pulmonar; casos novos; não coinfecção TB/HIV; não consumiam bebida alcoólica, conhecimento satisfatório sobre TB (apresentou significância estatística na associação com o atraso) e que não procuravam o serviço de saúde próximo do domicílio antes de ter TB. Verificou-se a necessidade de capacitação para os profissionais de saúde quanto aos sinais e sintomas da doença, reduzindo as barreiras de acesso ao diagnóstico oportuno da TB e divulgação ampla para a comunidade em geral.

Cryptic species in the cosmopolitan Bugulan eritina complex (Bryozoa,Cheilostomata)

Previous analyses of the mitochondrial gene cytochrome c oxidase subunit 1 (COI) and γ-proteobacterial endosymbiont diversity have suggested that the marine bryozoan Bugula neritina is a complex of three cryptic species, namely Types S, D and N. Types D and N were previously reported to have restricted distributions along California (western USA) and Delaware and Connecticut (eastern USA), respectively, whereas Type S is considered widespread in tropical, subtropical and temperate regions due to anthropogenic transport. Here, Bayesian species delimitation analysis of a data set composed of two mitochondrial (COI and large ribosomal RNA subunit [16S]) and two nuclear genes (dynein light chain roadblock type-2 protein [DYN] and voltage-dependent anion-selective channel protein [VDAC]) demonstrated that Types S, D and N correspond to three biological species. This finding was significantly supported, in spite of the combinations of priors applied for ancestral population size and root age. Furthermore, COI sequences were used to assess the introduction patterns of the cosmopolitan Type S species. Two COI haplotypes of Type S (S1a and S1d) were found occurring at a global scale. Mantel tests showed correlation between these haplotypes and local sea surface temperature tolerance. Accordingly, the distributions of Type S haplotypes may reflect intraspecific temperature tolerance variation, in addition to the role of introduction vectors. Finally, we show that the Type N may also have been introduced widely, as this species was found for the first time in Central California and north-eastern Australia.