Potencialidade do conceito de vulnerabilidade para a compreensão das doenças transmissíveis

O artigo traz a evolução e a contribuição da produção científica relacionada ao conceito de vulnerabilidade e sua potencialidade em estudos das doenças transmissíveis. Apresenta-se o conceito de Vulnerabilidade e a produção do conhecimento em Enfermagem, particularmente desenvolvida no Grupo Pesquisa Vulnerabilidade, Adesão e Necessidades em Saúde, do CNPq. Tem como finalidade ampliar a compreensão de agravos de saúde, com base neste conceito, além de possibilitar a proposição de intervenções para o seu enfrentamento, que extrapolem o âmbito do indivíduo, mas contemple a organização do trabalho nos serviços de saúde e a determinação social do processo saúde-doença.

Classificação Internacional das Práticas de Enfermagem em Saúde Coletiva - CIPESC®: instrumento pedagógico de investigação epidemiológica

A CIPESC® é um instrumento de trabalho do enfermeiro em Saúde Coletiva, que visa apoiar a sistematização de sua prática assistencial, gerencial e de investigação. É também, instrumental pedagógico potente para a formação e qualificação de enfermeiros comprometidos com o SUS. No ensino das doenças transmissíveis, o uso da CIPESC® auxilia a análise sobre as intervenções, ao estimular o raciocínio clínico e epidemiológico do processo saúde-doença e das necessidades de saúde dos indivíduos, famílias e grupos sociais. Com o propósito de desenvolver recursos didáticos para graduação de enfermagem e estimular a reflexão sobre o processo de trabalho de enfermagem, este artigo apresenta o relato de uma experiência de aplicação da CIPESC®, tomando como exemplo a meningite meningocócica.

Diferenças entre adolescentes do sexo feminino e masculino na vulnerabilidade individual ao HIV

O objetivo deste estudo foi analisar comparativamente a vulnerabilidade ao HIV/AIDS de homens e mulheres adolescentes, baseada em seus conhecimentos, valores e práticas. Trata-se de um estudo exploratório-descritivo com abordagem quantitativa. Os estudantes responderam a um questionário do qual foram selecionadas questões relevantes para análise. Totalizaram 207 adolescentes, sendo 43,5% do sexo masculino e 56,5% do feminino. A maior parte dos adolescentes declara já ter tido sua primeira relação sexual até o momento do estudo. Observaram-se déficits de conhecimento sobre transmissão do HIV e práticas sexuais seguras. Embora haja conhecimento declarado das técnicas de uso do preservativo, isso não reflete em seu uso constante. Observaram-se valores ligados às representações de gênero, mas percebe-se uma evolução quanto à autonomia e poder de negociação das meninas sobre o uso do preservativo.

Estudantes do ensino médio e o conhecimento em HIV/AIDS: que mudou em dez anos?

Estudo exploratório, descritivo, comparativo, com abordagem quantitativa, cujo objetivo foi comparar o conhecimento de estudantes do ensino médio de duas escolas estaduais públicas de Peruíbe, SP, Brasil, sobre o Vírus da Imunodeficiência Humana (HIV) e da Síndrome da Imunodeficiência Adquirida (aids), nos anos de 1999 e 2010. Nos dois anos, na população estudada predominaram estudantes do sexo feminino, menores de 18 anos, solteiros e de cor branca. Foi encontrada diferença estatisticamente significativa quanto ao conhecimento sobre HIV/aids entre os grupos estudados. Verificou-se que mesmo havendo intervalo de dez anos entre os estudos, os dois grupos de estudantes não se consideraram vulneráveis ao HIV e apresentaram dúvidas quanto ao conhecimento correto sobre o tema, o que indica a necessidade de sua abordagem contínua com adolescentes jovens.

Comprehensiveness and programmatic vulnerability to stds/hiv/aids in primary care




This study aimed to identify programmatic vulnerability to STDs/HIV/AIDS in primary health centers (PHCs). This is a descrip - tive and quantitative study carried out in the city of São Paulo. An online survey was applied (FormSUS platform), involving administrators from 442 PHCs in the city, with responses received from 328 of them (74.2%), of which 53.6% were nurses. At - tention was raised in relation to program - matic vulnerability in the PHCs regarding certain items of infrastructure, prevention, treatment, prenatal care and integration among services on STDs/HIV/AIDS care. It was concluded that in order to reach comprehensiveness of actions for HIV/ AIDS in primary health care, it is necessary to consider programmatic vulnerability, in addition to more investment and reor - ganization of services in a dialogue with the stakeholders (users, multidisciplinary teams, and managers, among others).




Chemical probes that differentially modulate peroxisome proliferator-activated receptor alpha and BLTR, nuclear and cell surface receptors for leukotriene B(4).

Peroxisome proliferator-activated receptor alpha (PPARalpha)is a nuclear receptor for various fatty acids, eicosanoids, and hypolipidemic drugs. In the presence of ligand, this transcription factor increases expression of target genes that are primarily associated with lipid homeostasis. We have previously reported PPARalpha as a nuclear receptor of the inflammatory mediator leukotriene B(4) (LTB(4)) and demonstrated an anti-inflammatory function for PPARalpha in vivo (Devchand, P. R., Keller, H., Peters, J. M., Vazquez, M., Gonzalez, F. J., and Wahli, W. (1996) Nature 384, 39-43). LTB(4) also has a cell surface receptor (BLTR) that mediates proinflammatory events, such as chemotaxis and chemokinesis (Yokomizo, T., Izumi, T., Chang, K., Takuwa, Y., and Shimizu, T. (1997) Nature 387, 620-624). In this study, we report on chemical probes that differentially modulate activity of these two LTB(4) receptors. The compounds selected were originally characterized as synthetic BLTR effectors, both agonists and antagonists. Here, we evaluate the compounds as effectors of the three PPAR isotypes (alpha, beta, and gamma) by transient transfection assays and also determine whether the compounds are ligands for these nuclear receptors by coactivator-dependent receptor ligand interaction assay, a semifunctional in vitro assay. Because the compounds are PPARalpha selective, we further analyze their potency in a biological assay for the PPARalpha-mediated activity of lipid accumulation. These chemical probes will prove invaluable in dissecting processes that involve nuclear and cell surface LTB(4) receptors and also aid in drug discovery programs.

Development of effervescent products, in powder and tablet form, supplemented with probiotics Lactobacillus acidophilus and Saccharomyces boulardii

Probiotics are living microorganisms, which when administered in adequate amounts confer health benefits on the host through a beneficial influence on the intestinal microbiota related to competition and to antagonistic and immunological effects. Thus, the objective of this study was the development of effervescent products (tablets and powder) supplemented with the probiotics Lactobacillus acidophilus and Saccharomyces boulardii, and the identification of the best formulation in terms of viability of these microorganisms. The physical properties of the tablets (compressive force applied, mean weight, hardness, and friability) were assessed, and the viability of the microorganisms in the gastrointestinal tract and their stability during storage were also determined. The results show that the microorganisms remained stable and viable during the 60-day storage period in the effervescent powder. However, the results indicated that the effect of compression force affected the viability of the microorganisms during the production of the effervescent tablets.

Efectos del consumo de cigarrillo en la presentación y severidad de la dismenorrea

Introducción: La dismenorrea se presenta como una patología cada vez más frecuente en mujeres de 16-30 años. Dentro de los factores asociados a su presentación, el consumo de tabaco ha revelado resultados contradictorios. El objetivo del presente estudio es explorar la asociación entre el consumo de cigarrillo y la presentación de dismenorrea, y determinar si los trastornos del ánimo y la depresión, alteran dicha asociación. Materiales y métodos: Se realizó un estudio de prevalencia analítica en mujeres de la Universidad del Rosario matriculadas en pregrado durante el primer semestre de 2013, para determinar la asociación entre el consumo de tabaco y la presentación de dismenorrea. En el estudio se tuvieron en cuenta variables tradicionalmente relacionadas con dismenorrea, incluyendo las variables ansiedad y depresión como potenciales variables de confusión. Los registros fueron analizados en el programa Estadístico IBM SPSS Statistics Versión 20.0. Resultados: Se realizaron 538 cuestionarios en total. La edad promedio fue 19.92±2.0 años. La prevalencia de dismenorrea se estimó en 89.3%, la prevalencia de tabaquismo 11.7%. No se encontró una asociación entre dismenorrea y tabaquismo (OR 3.197; IC95% 0.694-14.724). Dentro de las variables analizadas, la depresión y la ansiedad constituyen factores de riesgo independientes para la presentación de dismenorrea con una asociación estadísticamente significativa p=0.026 y p=0.024 respectivamente. El análisis multivariado encuentra como factor determinante en la presentación de dismenorrea, la interacción de depresión y ansiedad controlando por las variables tradicionales p<0.0001. Sin embargo, esta asociación se pierde cuando se analiza en la categoría de dismenorrea severa y gana relevancia el uso de métodos de anticoncepción diferentes a los hormonales, mientras que el hecho de haber iniciado la vida sexual presenta una tendencia limítrofe de riesgo. Conclusiones: No se puede demostrar que el tabaco es un factor asociado a la presentación de dismenorrea. Los trastornos del ánimo y la ansiedad constituyen factores determinantes a la presentación de dismenorrea independientemente de la presencia de otros concomitantes. Las variables de asociación se modifican cuando la variable dependiente se categoriza en su estado más severo. Se necesitan estudios más amplios y detallados para establecer dicha asociación.

Polimorfismos del gen Butirilcolinesterasa responsables de reacciones adversas en pacientes consumidores de “cocaína”

La butirilcolinesterasa humana (BChE; EC 3.1.1.8) es una enzima polimórfica sintetizada en el hígado y en el tejido adiposo, ampliamente distribuida en el organismo y encargada de hidrolizar algunos ésteres de colina como la procaína, ésteres alifáticos como el ácido acetilsalicílico, fármacos como la metilprednisolona, el mivacurium y la succinilcolina y drogas de uso y/o abuso como la heroína y la cocaína. Es codificada por el gen BCHE (OMIM 177400), habiéndose identificado más de 100 variantes, algunas no estudiadas plenamente, además de la forma más frecuente, llamada usual o silvestre. Diferentes polimorfismos del gen BCHE se han relacionado con la síntesis de enzimas con niveles variados de actividad catalítica. Las bases moleculares de algunas de esas variantes genéticas han sido reportadas, entre las que se encuentra las variantes Atípica (A), fluoruro-resistente del tipo 1 y 2 (F-1 y F-2), silente (S), Kalow (K), James (J) y Hammersmith (H). En este estudio, en un grupo de pacientes se aplicó el instrumento validado Lifetime Severity Index for Cocaine Use Disorder (LSI-C) para evaluar la gravedad del consumo de “cocaína” a lo largo de la vida. Además, se determinaron Polimorfismos de Nucleótido Simple (SNPs) en el gen BCHE conocidos como responsables de reacciones adversas en pacientes consumidores de “cocaína” mediante secuenciación del gen y se predijo el efecto delos SNPs sobre la función y la estructura de la proteína, mediante el uso de herramientas bio-informáticas. El instrumento LSI-C ofreció resultados en cuatro dimensiones: consumo a lo largo de la vida, consumo reciente, dependencia psicológica e intento de abandono del consumo. Los estudios de análisis molecular permitieron observar dos SNPs codificantes (cSNPs) no sinónimos en el 27.3% de la muestra, c.293A>G (p.Asp98Gly) y c.1699G>A (p.Ala567Thr), localizados en los exones 2 y 4, que corresponden, desde el punto de vista funcional, a la variante Atípica (A) [dbSNP: rs1799807] y a la variante Kalow (K) [dbSNP: rs1803274] de la enzima BChE, respectivamente. Los estudios de predicción In silico establecieron para el SNP p.Asp98Gly un carácter patogénico, mientras que para el SNP p.Ala567Thr, mostraron un comportamiento neutro. El análisis de los resultados permite proponer la existencia de una relación entre polimorfismos o variantes genéticas responsables de una baja actividad catalítica y/o baja concentración plasmática de la enzima BChE y algunas de las reacciones adversas ocurridas en pacientes consumidores de cocaína.

Predictability of biomass burning in response to climate changes

Climate is an important control on biomass burning, but the sensitivity of fire to changes in temperature and moisture balance has not been quantified. We analyze sedimentary charcoal records to show that the changes in fire regime over the past 21,000 yrs are predictable from changes in regional climates. Analyses of paleo- fire data show that fire increases monotonically with changes in temperature and peaks at intermediate moisture levels, and that temperature is quantitatively the most important driver of changes in biomass burning over the past 21,000 yrs. Given that a similar relationship between climate drivers and fire emerges from analyses of the interannual variability in biomass burning shown by remote-sensing observations of month-by-month burnt area between 1996 and 2008, our results signal a serious cause for concern in the face of continuing global warming.

Consistent large-scale temperature responses in warm and cold climates

Climate-model simulations of the large-scale temperature responses to increased radiative forcing include enhanced land-sea contrast, stronger response at higher latitudes than in the tropics, and differential responsesin warm and cool season climates to uniform forcing. Here we show that these patterns are also characteristic of model simulations of past climates. The differences in the responses over land as opposed to over the ocean, between high and low latitudes, and between summer and winter are remarkably consistent (proportional and nearly linear) across simulations of both cold and warm climates. Similar patterns also appear in historical observations and paleoclimatic reconstructions, implying that such responses are characteristic features of the climate system, and not simple model artifacts, thereby increasing our confidence in the ability of climate models to correctly simulate different climatic states.

Precipitation scaling with temperature in warm and cold climates: an analysis of CMIP5 simulations

We investigate the scaling between precipitation and temperature changes in warm and cold climates using six models that have simulated the response to both increased CO2 and Last Glacial Maximum (LGM) boundary conditions. Globally, precipitation increases in warm climates and decreases in cold climates by between 1.5%/°C and 3%/°C. Precipitation sensitivity to temperature changes is lower over the land than over the ocean and lower over the tropical land than over the extratropical land, reflecting the constraint of water availability. The wet tropics get wetter in warm climates and drier in cold climates, but the changes in dry areas differ among models. Seasonal changes of tropical precipitation in a warmer world also reflect this “rich get richer” syndrome. Precipitation seasonality is decreased in the cold-climate state. The simulated changes in precipitation per degree temperature change are comparable to the observed changes in both the historical period and the LGM.

Energy-balance mechanisms underlying consistent large-scale temperature responses in warm and cold climates

Climate simulations show consistent large-scale temperature responses including amplified land–ocean contrast, high-latitude/low-latitude contrast, and changes in seasonality in response to year-round forcing, in both warm and cold climates, and these responses are proportional and nearly linear across multiple climate states. We examine the possibility that a small set of common mechanisms controls these large-scale responses using a simple energy-balance model to decompose the temperature changes shown in multiple lgm and abrupt4 × CO 2 simulations from the CMIP5 archive. Changes in the individual components of the energy balance are broadly consistent across the models. Although several components are involved in the overall temperature responses, surface downward clear-sky longwave radiation is the most important component driving land–ocean contrast and high-latitude amplification in both warm and cold climates. Surface albedo also plays a significant role in promoting high-latitude amplification in both climates and in intensifying the land–ocean contrast in the warm climate case. The change in seasonality is a consequence of the changes in land–ocean and high-latitude/low-latitude contrasts rather than an independent temperature response. This is borne out by the fact that no single component stands out as being the major cause of the change in seasonality, and the relative importance of individual components is different in cold and warm climates.

Evaluation of CMIP5 palaeo-simulations to improve climate projections

Structural differences among models account for much of the uncertainty in projected climate changes, at least until the mid-twenty-first century. Recent observations encompass too limited a range of climate variability to provide a robust test of the ability to simulate climate changes. Past climate changes provide a unique opportunity for out-of-sample evaluation of model performance. Palaeo-evaluation has shown that the large-scale changes seen in twenty-first-century projections, including enhanced land–sea temperature contrast, latitudinal amplification, changes in temperature seasonality and scaling of precipitation with temperature, are likely to be realistic. Although models generally simulate changes in large-scale circulation sufficiently well to shift regional climates in the right direction, they often do not predict the correct magnitude of these changes. Differences in performance are only weakly related to modern-day biases or climate sensitivity, and more sophisticated models are not better at simulating climate changes. Although models correctly capture the broad patterns of climate change, improvements are required to produce reliable regional projections.

Energy-dispersive X-ray fluorescence analysis of a pre-Columbian funerary gold mask from the Museum of Sican, Peru

A funerary gold mask from the Museum of Sican, Ferranafe, Peru was analyzed in 30 different areas using a portable equipment using energy-dispersive X-ray fluorescence. It was deduced from the measurements that the main sheet of the mask and the majority of the pendants have a similar composition and are made of tumbaga, which means a poor gold alloy enriched at the surface by depletion gilding, and have a similar `equivalent` gilding thickness of about 5 mu m. The nose, also on tumbaga, has different composition and a thickness of about 8 mu m. The clamps are on gilded or on silvered copper. The red pigment dispersed on the surface of the mask is cinnabar. Copyright (C) 2009 John Wiley & Sons, Ltd.