Perceptions of the usefulness of external support to immunization coverage in Guinea-Bissau: a Delphi analysis of the GAVI-Alliance cash-based support

INTRODUCTION: Although many countries have improved vaccination coverage in recent years, some, including Guinea-Bissau, failed to meet expected targets. This paper tries to understand the main barriers to better vaccination coverage in the context of the GAVI-Alliance (The Global Alliance for Vaccines and Immunisation) cash-based support provided to Guinea-Bissau. METHODS: The analysis is based on a document analysis and a three round Delphi study with a final consensus meeting. RESULTS: Consensus attributed about 25% of the failure to perform better to implementation problems; and about 10% to governance and also 10% to scarce resources. The qualitative analysis validates the importance of implementation issues and upgraded the relevance of the human resources crisis as an important drawback. The recommendations were balanced in their upstream-downstream focus but were blind to health information issues and logistical difficulties. CONCLUSIONS: It is commendable that such a fragile state, with all sorts of barriers, manages to sustain a slow steady growth of its vaccination coverage. Not reaching the targets set reflects the inappropriateness of those targets rather than a lack of commitment of the health workforce. In the unstable context of countries such as Guinea-Bissau, the predictability of the funds from global health initiatives like the GAVI-Alliance seem to make all the difference in achieving small consistent health gains even in the presence of other major bottlenecks.

Microspines in the pylorus of Pseudonannolene tricolor and Rhinocricus padbergi (Arthropoda, Diplopoda)

The aim of this paper is to report the morphology and distribution of microspines in diplopods pylorus, as these are important structures present along the alimentary tract of arthropods. The morphology of the internal surface of the pylorus of Pseudonannolene tricolor Brolemann, 1901 and Rhinocricus padbergi Verhoeff, 1938 was analyzed by SEM. Pseudonannolene tricolor presents two morphologically distinct pyloric regions: anterior and posterior. The first region is characterized by the presence of thin microspines that increase in number and size towards the posterior portion; the second region presents smaller and triangular-shaped microspines distributed throughout small plates. The pylorus of R. padbergi does not present differentiated regions; the anterior portion is characterized by microspines grouped in plates that decrease in number and increase in size towards the ileum.

Stridulatory file and calling song of two populations of the tropical bush cricket Eneoptera surinamensis (Orthoptera, Gryllidae, Eneopterinae)

This study characterizes the calling song and ultramorphology of the stridulatory file of two geographically isolated populations of the tropical bush cricket Eneoptera surinamensis (De Geer, 1773) from city of Foz do Iguaçu, state of Paraná, and town of Rio Claro, state of São Paulo, Brazil, distant 1,000 Km from each other. The teeth are shell-shaped, the larger ones are distributed in the medium region of the file, decreasing gradually in size towards the edges. Specimens from Foz do Iguaçu have a file with 82 ± 9.8 teeth, length=1.89 mm ± 0.15 with 43.76 ± 5.94 teeth per mm (n=15). Specimens from Rio Claro present a file with 87 ± 9.81, length=1.96 ± 0.19 mm with 44.52 ± 4.61 teeth per mm (n=15). Statistical differences found between the two populations are not significant. The calling song is an uninterrupted trill that alternates two sets of notes distinct for its temporal features.

Conservation status assessment of the amphibians and reptiles of Uruguay

The native species of amphibians and reptiles of Uruguay were categorized according to the IUCN Red List criteria. Out of 47 amphibian species, seven are listed as Critically Endangered (CR), five as Endangered (EN), one as Vulnerable (VU), three as Near Threatened (NT), and two as Data Deficient (DD); the remaining species are considered to be Least Concern (LC). Among the 64 species of reptiles evaluated, one is listed as Critically Endangered (CR), seven as Endangered (EN), two as Vulnerable (VU), one as Near Threatened (NT) and seven as Data Deficient (DD); the rest are considered to be Least Concern (LC). The use of these results as an additional criterion in the definition of protected areas in Uruguay will contribute towards the conservation of the aforementioned threatened species and their associated ecosystems.

The intermediate snail-host: an agenda for future study

The strategy for the control of schistosomiasis has shifted from one directed towards the interruption of transmission to one of reducing morbidity. As a consequence of this change, it appears prudent to reassess the role of the malacologist and malacology and identify the future direction to be taken by the discipline. The present paper addresses these concerns; first, by reviewing the role of the snail-hosts in the epidemiology and control of schistosomiasis, and, secondly, by suggesting areas for future study. The possible application of newer methods in biotechnology for the resolution of malacological problems are discussed.

Observation on the host parasitoid interaction between Periplaneta americana, the American cockroach and Tetrastichus hagenowii, an oothecal parasitoid

Investigations were carried out on the host parasitoid interaction between Periplaneta americana, the American cockroach and Tetrastichus hagenowii, an oothecal parasitoid. This gregarious female parasitoid infected and or oviposited in only one host and caused 100 por cento mortality of the infected host. However, increase in parasitoid density decreased the progeny production and influenced the sex ratio. The progenies produced were male biased. When host preference was tested by offering oothecae of different species of cockroaches, T. hagenowii showed a predilection towards the oothecae of P. americana, suggestings its host specificity.

Tetrameres (Tetrameres) spirospiculum n. sp. (Nematoda, Tetrameridae) from the Buff-necked Ibis, Theristicus caudatus caudatus (Boddaert) (Aves, Threskiornithidae)

Tetrameres (T.) spirospiculum n. sp. is proposed, taking into account the very unusual aspect of the longer spicule, which is slender and progressively spiralled from its middle, towards the distal end, that promptly distinguishes it from all the species of the genus.

Role of the cyclosporin-sensitive transcription factor NFAT1 in the allergic response

Proteins belonging to the NFAT (nuclear factor of activated T cells) family of transcription factors are expressed in most immune cell types, and play a central role in the transcription of cytokine genes, such as IL-2, IL-4, IL-5, IL-13, IFN-gamma, TNF-alpha, and GM-CSF. The activity of NFAT proteins is regulated by the calcium/calmodulin-dependent phosphatase calcineurin, a target for inhibition by CsA and FK506. Recently, two different groups have described that mice lacking the NFAT1 transcription factor show an enhanced immune response, with tendency towards the development of a late Th2-like response. This review evaluates the possible role of NFAT proteins in the Th2 immune response and in the eosinophil-mediated allergic response.

Ecological Aspects of Phebotomine (Diptera, Psychodidae) in an Endemic Area of Tegumentary Leishmaniasis in the Northeastern Argentina, 1993-1998

The first epidemic tegumentary leishmaniasis´ outbreak in the province of Misiones was recorded in 1998, in the locality of Puerto Esperanza. Phlebotominae collected in the region, previously or simultaneously to the outbreak (September 1993-December 1998) showed that the species Lutzomyia intermedia s. l. was prevalent (94%, n 6,150) at all the sites sampled with miniature light trap (10) and Shannon trap (3). L. pessoai, L. whitmani, L. migonei, L. shannoni, L. fischeri, L. misionensis, Brumptomyia avellari and B. guimaraesi were also captured. Sand fly distribution in time and space suggests that in the province of Misiones (1) the species already present before 1990 could give rise to the epidemic by the density/dispersion fluctuation of their local populations; (2) the abundance of L. intermedia s. l. was associated with environments with ecotones of primary-secondary vegetation, close to water bodies and with moderate human disturbance; (3) this species showed, towards the end of 1997, peaks of exceptional abundance, subsequent to rainfall peaks in 1996. This increase in abundance of potential vector sand fly populations close to houses with colonizable surroundings could have generated the 1998 epidemic outbreak.

Cellular and genetic mechanisms involved in the generation of protective and pathogenic immune responses in human Chagas disease

Perhaps one of the most intriguing aspects of human Chagas disease is the complex network of events that underlie the generation of protective versus pathogenic immune responses during the chronic phase of the disease. While most individuals do not develop patent disease, a large percentage may develop severe forms that eventually lead to death. Although many efforts have been devoted to deciphering these mechanisms, there is still much to be learned before we can fully understand the pathogenesis of Chagas disease. It is clear that the host's immune response is decisive in this process. While characteristics of the parasite influence the immune response, it is becoming evident that the host genetic background plays a fundamental role in the establishment of pathogenic versus protective responses. The involvement of three complex organisms, host, parasite and vector, is certainly one of the key aspects that calls for multidisciplinary approaches towards the understanding of Chagas disease. We believe that now, one hundred years after the discovery of Chagas disease, it is imperative to continue with highly interactive research in order to elucidate the immune response associated with disease evolution, which will be essential in designing prophylactic or therapeutic interventions.

Comfort of the patient's family in an Intensive Care Unit related to welcoming

This study aimed to identify the level of comfort of families of patients in a critical health condition related to the welcoming practices performed by the hospital staff. Interviews were conducted with 250 relatives in hospitals of the state Bahia, using a Likert scale. Data were analyzed as percentages and quartiles. For nine of the 12 statements of the scale, most relatives scored their comfort level between very and totally comfortable, median of 4,revealing kindness, tranquility and friendly communication with family members. More than half of the sample scored its level as not at all to more or less comfortable, median of 3, for statements about demonstration of interest towards the relative by the staff and flexible visiting of the patient. The necessity of greater interest of the team in the condition and needs of the family was observed. Promoting comfort from the dimension of welcoming demands interdisciplinary actions grounded in humanistic philosophy, in which the nurse has an important role to play.

Gerontology course in the nursing undergraduate curricula

Objective To explores nursing faculty members’ attitudes towards older people, their thoughts about gerontological nursing education. Method Five focus groups and a survey were used with nursing faculty members 132 at the three nursing schools to explore their attitudes towards the care of older people and the perceived status of gerontological nursing education. The survey was given to 132 faculty members, including 76 clinical instructors, 40 associate professors and 16 professors. The nursing faculty in general had a positive attitude toward older people (M=3.36, SD 0.25), and teachers’ attitudes were higher than those of their nursing students (M=3.18, SD0.29). Results This study results suggests that Saudi nursing curricula should include more extensive gerontology content and clinical experience with older people. Conclusion This is the first time in Saudi Arabia that research has listened to their voices and examined their commitments toward gerontology education.


E-publishing development and changes in the scholarly communication system

New and alternative scientific publishing business models is a reality driven mostly by the information and communication technologies, by the movements towards the recovery of control of the scientific communication activities by the academic community, and by the open access approaches. The hybrid business model, mixing open and toll-access is a reality and they will probably co-exist with respective trade-offs. This essay discusses the changes driven by the epublishing and the impacts on the scholarly communication system stakeholders' interrelationships (publishers-researchers, publishers-libraries and publishers-users interrelationships), and the changes on the scientific publishing business models, followed by a discussion of possible evolving business models. Whatever the model which evolves and dominates, a huge cultural change in authors' and institutions publishing practices will be necessary in order to make the open access happen and to consolidate the right business models for the traditional publishers. External changes such as policies, rewarding systems and institutions mandates should also happen in order to sustain the whole changing scenario.

The learning about imaging diagnosis technology

Objective To investigate the learning about management of the technology (efficient use, acquisition and maintenance of imaging diagnosis equipment) in the radiology residency program of Escola Paulista de Medicina - Universidade Federal de São Paulo, with a view to improving the education of radiologists. Materials and Methods Exploratory research where residents, faculty staff and tutors of the program were quantitative and qualitatively approached with Likert scale questionnaires (46), and deepening with recorded interviews (18) and categorization based upon meaning units (thematic analysis). Results Among the participants, 66% agreed that they had the opportunity of learning about the use of radiological equipment; for 61% the program should include knowledge on the importance of acquiring equipment; and 72% emphasized the lack of learning about equipment management and maintenance. Conclusion As the major moment in the education of specialists, the medical residency program provides residents with a favorable environment to the learning of the skills required to the future of their professional practice, but with limited emphasis on the management of the technology: efficient use, acquisition and mainly maintenance of equipment, still poorly explored. Both the investigated program and the medical residency in radiology should incorporate, whenever possible, the commitment with the training in supplementary skills related to equipment management, developing the competence of the future radiologists.

Learning on human resources management in the radiology residency program

Objective To investigate the process of learning on human resource management in the radiology residency program at Escola Paulista de Medicina – Universidade Federal de São Paulo, aiming at improving radiologists' education. Materials and Methods Exploratory study with a quantitative and qualitative approach developed with the faculty staff, preceptors and residents of the program, utilizing a Likert questionnaire (46), taped interviews (18), and categorization based on thematic analysis. Results According to 71% of the participants, residents have clarity about their role in the development of their activities, and 48% said that residents have no opportunity to learn how to manage their work in a multidisciplinary team. Conclusion Isolation at medical records room, little interactivity between sectors with diversified and fixed activities, absence of a previous culture and lack of a training program on human resources management may interfere in the development of skills for the residents' practice. There is a need to review objectives of the medical residency in the field of radiology, incorporating, whenever possible, the commitment to the training of skills related to human resources management thus widening the scope of abilities of the future radiologists.