Abstract Large quantities of residual cooking oil are being increasingly generated in various sectors, as it is often improperly disposed of and causes serious environmental problems. A commonly used alternative is the use of lipases in enzymatic hydrolysis, since it is rather attractive to several sectors, in addition to allowing the use of products generated thereof, such as: free fatty acids, diacylglycerols, monoacylglycerols and free glycerol, moreover, it is capable of operating in mild temperature and pressure conditions. Therefore, the present study aimed to evaluate alternatives for the hydrolysis of residual frying oil by evaluating the efficiency of different types of supports and heating systems using free and immobilized forms of lipase from Burkholderia cepacia (BCL) and Porcine pancreas (PPL) as biocatalyst. Polyhydroxybutyrate (PHB), niobium oxide (Nb2O5) and chitosan (CHIT) were evaluated as support for immobilizing BCL and PPL lipases, and superior results were found regarding the hydrolytic activity of immobilization derivatives using PHB and Nb2O5. Among the heating systems under evaluation, the highest percentage of residual oil hydrolysis was found using the ultrasound system for both free and immobilized lipases, reaching 57.91% hydrolysis for lipases immobilized on Nb2O5 and 61.11% hydrolysis for the derivative immobilized on PHB. The operational stability of both biocatalysts was evaluated using similar half-life time values for both. Thus, it was observed that the ultrasound system was efficient in improving lipase performance in the hydrolysis of free fatty acids, once this unconventional heating system is quite promising for accelerating such enzymatic reactions.

Resumo A vasculite de imunoglobulina A (VIgA) é uma vasculite de pequenos vasos que afeta sobretudo crianças. As principais manifestações clínicas são exantema purpúrico, proteinúria/hematúria, artralgia e dor abdominal. Este artigo apresenta uma revisão dos dados mais recentes de epidemiologia, diagnóstico e abordagem da VIgA em pediatria. A VIgA afeta 10 a 56 por 100.000 crianças/ano, manifestando-se inicialmente na idade média de 6 anos. Tanto fatores genéticos como ambientais contribuem para a sua patogénese, sendo que a deposição de imunocomplexos contendo imunoglobulina A1 anormalmente glicosilada desempenha um papel preponderante. Atendendo ao curso habitualmente benigno da doença, o tratamento conservador é geralmente suficiente. As complicações a curto prazo estão sobretudo relacionadas com envolvimento gastrointestinal, incluindo risco de perfuração e hemorragia. A morbilidade a longo prazo está associada a doença renal crónica e hipertensão. Os corticosteroides não estão recomendados na prevenção do envolvimento renal, mas podem ser úteis no tratamento, assim como outros fármacos imunossupressores.

Abstract Immunoglobulin A vasculitis (IgAV) is a small-vessel vasculitis that primarily affects children. Major manifestations include purpuric rash, proteinuria/hematuria, arthralgia, and abdominal pain. In this article, the authors review data on the epidemiology, diagnosis, and treatment of IgAV in children. IgAV affects 10 to 56 children per 100,000 per year. The mean age at presentation is six years. Both genetic and environmental factors contribute to its pathogenesis, but the deposition of immune complexes containing abnormal glycosylated immunoglobulin (Ig) A1 plays a predominant role. The course of the disease is usually benign and supportive care is sufficient. Short-term complications are mostly related to gastrointestinal involvement, including the risk of perforation and bleeding. Long-term morbidity is due to chronic kidney disease and hypertension. Corticosteroids are not recommended for prevention of renal involvement, but may be useful as a treatment strategy, as well as more aggressive immunosuppressive drugs.

Resumo É descrito o caso grave de uma patologia comum num rapaz saudável de oito anos de idade. O rapaz foi observado em consulta devido a queda de cabelo com sete meses de evolução sem outros sintomas associados, que condicionou grandemente a sua qualidade de vida, fazendo-o utilizar chapéu em todas as situações. Foi estabelecido o diagnóstico de alopecia areata e o rapaz foi submetido a diversos tratamentos ao longo de quatro anos antes de alcançar crescimento capilar completo. Os autores relembram que a alopecia areata pode ser um sinal precoce de uma doença autoimune que poderá manifestar-se apenas anos mais tarde.

Abstract The authors report a severe case of a common disorder in a healthy eight-year-old male child. The boy was observed for asymptomatic hair loss with seven months of evolution that greatly disrupted his life and caused him to wear a hat at all times. Alopecia areata was diagnosed, and the boy underwent four years of multiple treatments before achieving full hair regrowth. It should be noted that alopecia areata can be an early sign of an autoimmune disease that may manifest later with other symptoms.

Abstract Objective To investigate associations of maternal and cord blood cytokine patterns with newborn size and body composition. Methods This cross-sectional study involved 70 pregnant women and their healthy newborns selected from the “Araraquara Cohort Study”. Newborn anthropometric measurements were recorded at birth. Body composition was evaluated by air displacement plethysmography. Maternal blood samples were collected from pregnant women between 30 and 36 weeks of gestation, and umbilical cord blood samples were collected immediately after placenta discharge. The concentrations of the cytokines were determined in plasma by ELISA. Multiple linear regression models were used to assess associations between maternal and cord blood cytokine concentrations and newborn anthropometry and body composition measurements. Results Maternal plasma TGF-β1 concentration was inversely associated with newborn weight (β= -43.0; p= 0.012), length (β= -0.16, p= 0.028), head circumference (β= -0.13, p= 0.004), ponderal index (β= -0.32, p= 0.011) and fat-free mass (β= -0.05, p= 0.005). However, the association persisted just for head circumference (β= -0.26; p= 0.030) and ponderal index (β= - 0.28; p= 0.028), after adjusting for pre-gestational BMI, gestational weight gain, gestational age, hours after delivery, newborn sex, smoking and alcohol consumption. Conclusions Maternal plasma TGF-β1 concentration may be involved in the regulation of newborn size, mainly head circumference and ponderal index. Further cohort studies are necessary to investigate the role of TGF-β1 in different trimesters of pregnancy and its effect during the early stages of fetal development.

Abstract Introduction: Lower respiratory infections are a major cause of hospital admission in pediatric care. Respiratory syncytial virus (RSV) is the most commonly identified agent, either isolated or with other agents. Coinfection rates vary between 10-44%, with conflicting data regarding the role of coinfection in clinical severity. Aims: This study aimed to assess whether viral respiratory coinfection is associated with a more severe clinical course. Materials and Methods: This was a retrospective cross-sectional study based on the clinical records of patients under the age of five years admitted to the Pediatric Department of a level II hospital over 13 months and who tested positive in the immunofluorescence viral analysis of nasopharyngeal aspirates. Ten viruses were investigated. Results: A total of 224 positive cases were identified among 434 patients in the study cohort (51.6%), with a coinfection rate of 5.8% (n=13). RSV was the most common virus, detected in 76.9% of coinfections. RSV-Coronavirus OC43 was the most common association found in coinfections. Forty-four percent of patients required supplemental oxygen. Five percent were transferred to a tertiary care hospital, although neither presented with coinfection. No statistically significant differences were found between both groups for any of the considered parameters, including hospital length of stay, transferal rate, supplementary oxygen requirement, or use of intravenous corticosteroids. Despite this, differences were found in the percentage of patients with at least one risk factor for respiratory infections (56% in patients with one virus identified vs. 69% in patients with coinfection). Conclusions: The results of this study suggest that viral respiratory coinfection is not associated with a more severe clinical course. The scarcity of national studies and variable results in the literature highlight the need for additional studies with greater statistical power to better clarify the prognosis of patients with respiratory viral coinfection.

Resumo Introdução: As infeções respiratórias inferiores (IRI) são uma causa frequente de internamento hospitalar em Pediatria. O agente etiológico mais prevalente é o vírus sincicial respiratório (VSR); quer isoladamente; quer em contexto de coinfeção. As taxas de coinfeção na literatura variam entre 10-44%; não existindo consenso quanto ao impacto da coinfeção no prognóstico das IRI. Objetivo: O objetivo deste estudo foi investigar uma possível associação entre coinfeção vírica e gravidade clínica. Materiais e Métodos: Foi conduzido um estudo observacional retrospetivo com base na informação contida nos processos clínicos de doentes com idade inferior a cinco anos admitidos ao longo de 13 meses no Serviço de Pediatria de um hospital de nível II e com resultados positivos no exame virológico do lavado nasofaríngeo (pesquisa de 10 vírus por análise de imunoensaio fluorenzimático). Resultados: Foram identificados 224 resultados positivos em 434 doentes na coorte de estudo (51.6%); com uma taxa de coinfeção de 5.8%. O vírus mais prevalente foi o VSR; presente em 76.9% das coinfeções. A associação mais frequentemente identificada foi entre o VSR e o Coronavírus OC43. Cinco por cento dos doentes foram transferidos para unidades hospitalares de nível III; nenhum dos quais com coinfeção. Não foram observadas diferenças estatisticamente significativas entre os doentes com um ou mais vírus detetados para qualquer dos parâmetros analisados; nomeadamente duração do internamento; taxa de transferência; e necessidade de oxigenoterapia ou corticoterapia endovenosa. Apesar disso; a presença de fatores de risco para IRI foi mais frequente nos doentes com coinfeção. Conclusões: No presente estudo; a coinfeção vírica não se associou a uma maior gravidade clínica. A escassez de estudos nacionais e os resultados variáveis na literatura revelam a necessidade de estudos com maior poder estatístico para melhor esclarecer o prognóstico da coinfeção virica respiratória.

O objetivo foi analisar as percepções de trabalhadores da atenção primária à saúde (APS) sobre a colaboração interprofissional na perspectiva da ciência de implementação. Trata-se de estudo qualitativo que utilizou a entrevista em profundidade como técnica de produção de dados. Foram entrevistados 15 trabalhadores (três agentes comunitários de saúde, um auxiliar de enfermagem, três enfermeiros, três gerentes, três médicos e dois técnicos de enfermagem) de unidades básicas de saúde no Município de São Bernardo do Campo, São Paulo, Brasil. O roteiro da entrevista baseou-se em três dimensões do Quadro Conceitual Consolidado para Pesquisa de Implementação (CFIR; Consolidated Framework for Implementation Research). Foi realizada análise de conteúdo temática. Na dimensão características da colaboração interprofissional, os entrevistados destacaram a complexidade, e sua possível influência, na implementação e sustentabilidade dessa prática. Na dimensão cenário interno, foram identificados fatores que influenciam a colaboração interprofissional: como se utiliza o tempo destinado a comunicação formal/reuniões de equipe; interações sociais entre os profissionais; e características da liderança, como feedback, autonomia e participação nas decisões. Na dimensão características dos indivíduos, os participantes destacaram a colaboração interprofissional direcionada para a qualidade do cuidado e a necessidade de integração entre os núcleos de saberes. Assim, ações para aperfeiçoar a qualidade da comunicação, a construção coletiva em equipe e o aprimoramento da liderança podem contribuir para melhorar a colaboração interprofissional na APS e potencializar seus impactos na atenção à saúde.

The objective was to analyze the perceptions of primary health care (PHC) workers about interprofessional collaboration from the perspective of implementation science. This is a qualitative study that used in-depth interview as a data production technique. Interviews were conducted with 15 workers (three community health agents, one nursing assistant, three nurses, three managers, three physicians, and two nursing technicians) from basic health units in the Municipality of São Bernardo do Campo, São Paulo State, Brazil. The interview plan was based on three domains of the Consolidated Framework for Implementation Research (CFIR). Thematic content analysis was used. In the interprofessional collaboration characteristics domain, respondents highlighted the complexity, and its possible influence, as to the implementation and sustainability of this practice. In the inner setting domain, factors that influence interprofessional collaboration were identified, namely: how the time allocated to formal communication/team meetings is used; social interactions between professionals; and leadership characteristics, such as feedback, autonomy and participation in decisions. In the individuals characteristics domain, participants noted interprofessional collaboration geared to quality of care and the need for integration between knowledge centers. Thus, measures to enhance the quality of communication, collective team building and leadership can contribute to improve interprofessional collaboration in PHC and leverage its impacts on health care.

El objetivo fue analizar las percepciones de los trabajadores de atención primaria de salud (APS) sobre la colaboración interprofesional desde la perspectiva de la ciencia de implementación. Se trata de un estudio cualitativo que utilizó la entrevista en profundidad como técnica de producción de datos. Fueron entrevistados 15 trabajadores (tres agentes comunitarios de salud, un auxiliar de enfermería, tres enfermeros, tres gerentes, tres médicos y dos técnicos de enfermería) de unidades básicas de salud en el Municipio de São Bernardo do Campo, São Paulo, Brasil. La guía de la entrevista se basó en tres dimensiones del Marco Consolidado para la Investigación sobre la Implementación (CFIR; Consolidated Framework for Implementation Research). Se realizó un análisis de contenido temático. En la dimensión característica de la colaboración interprofesional, los entrevistados destacaron la complejidad y la posible influencia en su implantación y sostenibilidad. En la dimensión escenario interno, fueron identificados factores que influencian en la colaboración interprofesional: cómo se utiliza el tiempo destinado a la comunicación formal/reuniones de equipo; las interacciones sociales entre los profesionales, y las características del liderazgo, como feedback, la autonomía y la participación en las decisiones. En la dimensión de las características de los individuos, los participantes destacaron la colaboración interprofesional orientada a la calidad de la atención y la necesidad de integración entre los núcleos de saberes. Así, las acciones para mejorar la calidad de la comunicación, la construcción colectiva en equipo y la mejora del liderazgo pueden contribuir para mejorar la colaboración interprofesional en la APS y mejorar sus impactos en la atención a la salud.

Abstract This work aimed to investigate the physicochemical and functional composition of bee pollen produced in different municipalities in the state of Rio Grande do Norte/Brazil (RN) and commercial samples produced in other places. To perform these experiments, samples of dehydrated bee pollen were crushed and subjected to physicochemical evaluation, instrumental color, fatty acid profile, evaluation of the presence of bioactive compounds [Total Phenolic Compounds (TPC), carotenoids] and antioxidant activity (reduction of DPPH radical). The pH of the pollen samples varied from 4.55 to 5.08, the protein from 19.01% to 29.71%, and the ash from 2.44% to 4.27%. All pollen samples showed a yellowish-red hue (a* and b* positive), and the pollen produced in Touros/RN/BR stood out with a lighter color (L* = 32.91). The pollen produced in Touros/RN/BR showed a higher (p < 0.05) percentage of saturated fatty acids (41.60%), whereas the pollen collected in Taipu/RN/BR had a higher percentage of monounsaturated fatty acids (7.44%). Pollen samples showed a low concentration of Total Carotenoid Content (TCC) (0.81 to 22.82 µg/g), as well as a high content of TPC (1.79 to 2.28 mg GAE/g) and antioxidant activity (1.40 to 5.70 µmol TE/g) when compared with the consulted literature. According to the obtained results, we could infer that pollen samples from different locations showed variations in physicochemical composition, coloration, fatty acid profile, TPC and antioxidant activity which reflects the geographic diversity inherent to the production sites.

ABSTRACT BACKGROUND: Social distancing has led to lifestyle changes among older adults during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES: This study aimed to estimate the prevalence risk of sarcopenia (RS) and investigate its associated factors during the COVID-19 pandemic in older Brazilian adults. DESIGN AND SETTING: Cross-sectional observational analysis of baseline data as part of the Remobilize Study. METHODS: Participants in the study were older adults (≥ 60 years), excluding those who were bedridden or institutionalized. The data collected consisted of answers about the RS (SARC-F), functional status, walking, sedentary behavior (SB), pain, comorbidity, and life space mobility. RESULTS: A total of 1,482 older adults (70 ± 8.14 years, 74% women) participated in the study, and an RS prevalence of 17.1% was found. (95% confidence interval [CI] 15.25–19.15%). The adjusted multivariate model showed a significant association between RS and functional limitation (odds ratio [OR]: 19.05; CI 13.00–28.32), comorbidity (OR: 5.11; CI 3.44–7.81), pain (OR: 4.56; CI 3.33–6.28), total walking (OR: 0.99; CI 0.99–1.00), SB of 8–10 hours (OR: 1.85; CI 1.15–2.93), and SB of > 10 hours (OR: 3.93; CI 2.48–6.22). RS was associated with mobility during the pandemic (OR: 0.97; CI 0.96–0.98). P < 0.05. CONCLUSIONS: During the pandemic, the prevalence of RS in older Brazilians was estimated at 17.1%. Moderate to severe functional limitation, comorbidities, presence of pain, walking, longer SB period, and reduced life space mobility significantly contributed to RS in older adults during the pandemic.

Abstract The aim of this study was to evaluate the time elapsed from first symptoms to the treatment of oral and oropharyngeal cancer (OOC) and to identify variables associated with treatment delay. This is an observational study with retrospective and prospective data collection. Patients with a diagnosis of OOC seen at the Head and Neck Surgery outpatient clinic of a Brazilian public hospital were included and followed up to treatment initiation. Participants answered a questionnaire for the collection of socioeconomic, demographic, cultural, and clinical information, as well as information about the time elapsed from first symptoms to the first appointment with a head and neck surgeon. Time to treatment was classified into four intervals: 1- first symptoms to first medical appointment; 2- first medical appointment to specialized medical care; 3- specialized medical care to preparation for treatment; and 4- preparation for treatment to treatment initiation. Bivariate statistics were computed. Out of 100 participants, nine died before treatment. Mean time to treatment was 217 days. Highest mean time was observed for interval 2 (94 days), followed by interval 1 (63 days), interval 4 (39 days), and interval 3 (21 days). At interval 1, a longer time was associated with severe alcohol consumption, severe smoking, and family history of cancer. At interval 2, the delay was associated with appointment with a general practitioner, clinical diagnosis of disease other than cancer, and antibiotic prescription. At interval 4, delay in treatment was associated with surgical treatment. Patients with OOC experience delays from symptom onset to treatment initiation. The longest interval was associated with professional delay, followed by patient delay in help-seeking.

ABSTRACT Objective: To assess the efficacy and safety of the use of midazolam as monotherapy, compared to the associated use of midazolam and hydroxyzine for minimum and moderate sedation of children in dental offices, using data obtained from clinical trials. Material and Methods: A systematic review protocol was developed and registered on PROSPERO (CR42020208633). An electronic search was carried out in Pubmed, Lilacs, Science Direct, Open Gray, Web of Science, and central Cochrane Library. No language restrictions were included. Clinical trials were carried out with children aged 0-12 years, using midazolam as monotherapy compared to the use of midazolam associated with hydroxyzine to verify the effectiveness and safety of oral sedation. The quality of the studies was individually assessed and grouped using the RoB 2 (Revised Cochrane risk-of-bias tool for randomized trials) and GRADE (Grading of Recommendations Assessment, Development and Evaluation) systems, respectively. Results: A total of 749 studies were found. After analyzing the inclusion and removal of duplicates, two studies were analyzed for the quality of evidence. Through this analysis, it was possible to verify the very low level of scientific evidence on the superiority of the efficacy and safety of the combined use of midazolam and hydroxyzine for oral sedation in children in dental offices. Conclusion: The conflicting results and limitations of the studies enabled to establish that there is insufficient evidence to support the use of these drugs combined. There is only evidence for the use of midazolam as monotherapy.

Abstract Objectives: to evaluate the contribution of the Maternal Mortality and Death Surveillance Committee for women of childbearing age (WCA) and maternal mortality in the magnitude of maternal mortality and in the qualification of the causes of death in Recife, Brazil. Methods: ex ante/ex post evaluation, ecological, of the annual indicators of mortality of WCA, maternal and case study of declared maternal deaths according to causes of death before and after surveillance. Deaths of WCA (2010 and 2017) were analyzed. The percentage of investigation of deaths of WCA was calculated; their rates and maternal mortality ratio (MMR) were estimated; the groups of causes of death, classification of death, the moment of death, the proportional variation before and after surveillance, and the relocation of the causes after this process were described. Results: 4.327 (97.0%) of deaths of WCA were investigated (increase of 40.7% of maternal deaths) and MMR of 62.9/100 thousand live births. Improved notifications of immediate/late (75.0%) and remote (300.0%) postpartum; there was a difference in direct obstetric causes, total maternal deaths and late maternal death (p<0.001). Conclusion: the surveillance and the Maternal Mortality Committee showed potential in identifying the magnitude and qualification of causes of maternal death in order to propose the interventions directed to obstetric care.

Resumo Objetivos: avaliar a contribuição do Comitê de Mortalidade Materna e da Vigilância do Óbito de mulheres em idade fértil (MIF) e materno na magnitude da mortalidade materna e na qualificação das causas dos óbitos no Recife, Brasil. Métodos: avaliação ex ante/ex post, ecológico, dos indicadores anuais de mortalidade de MIF, materna e estudo de caso de óbitos maternos declarados segundo causas de morte antes e após a vigilância. Analisaram-se óbitos de MIF (2010-2017) e calculou-se o percentual de investigação; estimaram-se suas taxas e a razão de mortalidade materna (RMM); descreveram-se: grupos de causa, classificação e momento do óbito, variação proporcional antes e após a vigilância/análise do comitê e a realocação das causas após esse processo. Resultados: investigou-se 4.327 (97,0%) dos óbitos de MIF (incremento de 40,7% das mortes maternas), e RMM de 62,9/100 mil nascidos vivos; melhoraram as notificações do puerpério imediato/ tardio (75,0%) e remoto (300,0%); houve diferença nas causas obstétricas diretas, total de óbitos maternos e morte materna tardia (p<0,001). Conclusão: mostrou-se o potencial da vigilância e do Comitê de Mortalidade Materna na identificação da magnitude e qualificação das causas de morte materna para proposição de medidas direcionadas aos cuidados obstétricos.

Abstract Polishing is an important procedure which takes part in the periodontal disease treatment, being commonly performed with the help of prophylactic paste and provides smoothing of the tooth surface, hindering the adhesion of new plaque. With this study we aimed to evaluate by means of scanning electron microscopy (SEM), the effects of dental polishing observing, qualitatively, the effectiveness and the damage, in three distinct treatments after calculus removal. Twenty (20) teeth were used (four of each dog), from which were obtained three samples each. The sixty samples were distributed into three groups (G0= tooth segmentation submitted to prophylaxis without polishing; G1= vestibular surface prophylaxis followed by polishing with the use of Defengy OC® and G2= vestibular surface prophylaxis followed by polishing with the use of pumice and fluorine gel). The samples were prepared and sent to images execution via SEM. These images, with enlargement of 100x and 500x, were evaluated and the classification averages were obtained. The statistical analysis of these averages was made through the Friedman nonparametric test using the software R. Statistical differences were observed (P<0,05) between groups 0 and 1 in the 100x magnification, whereas in the 500x magnification there was no difference (P>0,05) between the groups. The evaluation based on SEM images at two magnifications was essential, as it allowed the visualization of grooves and remaining calculi in a comprehensive way at 100x magnification and in more detail at 500x.

Resumo O polimento é um procedimento importante que faz parte do tratamento da doença periodontal, sendo comumente realizado com auxílio de pasta profilática e, propicia o alisamento da superfície dental, dificultando a adesão de nova placa bacteriana. Com esse estudo, objetivou-se avaliar por meio da microscopia eletrônica de varredura (MEV) os efeitos do polimento dental, avaliando qualitativamente, a eficácia e o dano, em três tratamentos distintos, após a remoção dos cálculos dentários. Foram utilizados 20 dentes (quatro de cada cão), de onde se obtiveram três amostras de cada. As 60 amostras foram distribuídas em três grupos (G0= segmentos dentários submetidos à profilaxia sem polimento; G1= profilaxia da face vestibular seguida de polimento com utilização de Defengy OC® e G2= profilaxia da face vestibular seguida de polimento com utilização de pedra pomes e flúor gel). As amostras foram preparadas e enviadas para realização das imagens por MEV. Estas imagens, com ampliação de 100x e de 500x, foram avaliadas e as médias de classificação obtidas. A análise estatística dessas médias foi feita por meio do teste não paramétrico de Friedman, utilizando o software R. Observou-se diferença estatística (P<0,05) entre os grupos 1 e 0 na magnificação de 100x, já na magnificação de 500x não houve diferença estatística (P>0,05) entre os grupos. O polimento foi eficaz ao tornar a superfície do esmalte dental lisa e regular reduzindo as ranhuras provocadas pela limpeza e retirou as granulações de cálculo remanescentes. A avaliação a partir das imagens de MEV em duas ampliações foi fundamental, por ter propiciado a visualização de ranhuras e cálculos remanescentes de forma abrangente na magnificação de 100x e mais detalhadamente na de 500x.

The objective was to analyze the perceptions of primary health care (PHC) workers about interprofessional collaboration from the perspective of implementation science. This is a qualitative study that used in-depth interview as a data production technique. Interviews were conducted with 15 workers (three community health agents, one nursing assistant, three nurses, three managers, three physicians, and two nursing technicians) from basic health units in the Municipality of São Bernardo do Campo, São Paulo State, Brazil. The interview plan was based on three domains of the Consolidated Framework for Implementation Research (CFIR). Thematic content analysis was used. In the interprofessional collaboration characteristics domain, respondents highlighted the complexity, and its possible influence, as to the implementation and sustainability of this practice. In the inner setting domain, factors that influence interprofessional collaboration were identified, namely: how the time allocated to formal communication/team meetings is used; social interactions between professionals; and leadership characteristics, such as feedback, autonomy and participation in decisions. In the individuals characteristics domain, participants noted interprofessional collaboration geared to quality of care and the need for integration between knowledge centers. Thus, measures to enhance the quality of communication, collective team building and leadership can contribute to improve interprofessional collaboration in PHC and leverage its impacts on health care.

El objetivo fue analizar las percepciones de los trabajadores de atención primaria de salud (APS) sobre la colaboración interprofesional desde la perspectiva de la ciencia de implementación. Se trata de un estudio cualitativo que utilizó la entrevista en profundidad como técnica de producción de datos. Fueron entrevistados 15 trabajadores (tres agentes comunitarios de salud, un auxiliar de enfermería, tres enfermeros, tres gerentes, tres médicos y dos técnicos de enfermería) de unidades básicas de salud en el Municipio de São Bernardo do Campo, São Paulo, Brasil. La guía de la entrevista se basó en tres dimensiones del Marco Consolidado para la Investigación sobre la Implementación (CFIR; Consolidated Framework for Implementation Research). Se realizó un análisis de contenido temático. En la dimensión característica de la colaboración interprofesional, los entrevistados destacaron la complejidad y la posible influencia en su implantación y sostenibilidad. En la dimensión escenario interno, fueron identificados factores que influencian en la colaboración interprofesional: cómo se utiliza el tiempo destinado a la comunicación formal/reuniones de equipo; las interacciones sociales entre los profesionales, y las características del liderazgo, como feedback, la autonomía y la participación en las decisiones. En la dimensión de las características de los individuos, los participantes destacaron la colaboración interprofesional orientada a la calidad de la atención y la necesidad de integración entre los núcleos de saberes. Así, las acciones para mejorar la calidad de la comunicación, la construcción colectiva en equipo y la mejora del liderazgo pueden contribuir para mejorar la colaboración interprofesional en la APS y mejorar sus impactos en la atención a la salud.

O objetivo foi analisar as percepções de trabalhadores da atenção primária à saúde (APS) sobre a colaboração interprofissional na perspectiva da ciência de implementação. Trata-se de estudo qualitativo que utilizou a entrevista em profundidade como técnica de produção de dados. Foram entrevistados 15 trabalhadores (três agentes comunitários de saúde, um auxiliar de enfermagem, três enfermeiros, três gerentes, três médicos e dois técnicos de enfermagem) de unidades básicas de saúde no Município de São Bernardo do Campo, São Paulo, Brasil. O roteiro da entrevista baseou-se em três dimensões do Quadro Conceitual Consolidado para Pesquisa de Implementação (CFIR; Consolidated Framework for Implementation Research). Foi realizada análise de conteúdo temática. Na dimensão características da colaboração interprofissional, os entrevistados destacaram a complexidade, e sua possível influência, na implementação e sustentabilidade dessa prática. Na dimensão cenário interno, foram identificados fatores que influenciam a colaboração interprofissional: como se utiliza o tempo destinado a comunicação formal/reuniões de equipe; interações sociais entre os profissionais; e características da liderança, como feedback, autonomia e participação nas decisões. Na dimensão características dos indivíduos, os participantes destacaram a colaboração interprofissional direcionada para a qualidade do cuidado e a necessidade de integração entre os núcleos de saberes. Assim, ações para aperfeiçoar a qualidade da comunicação, a construção coletiva em equipe e o aprimoramento da liderança podem contribuir para melhorar a colaboração interprofissional na APS e potencializar seus impactos na atenção à saúde.

ABSTRACT The stem and bulb nematode, Ditylenchus dipsaci, is one of the main problems which affects garlic crop in Brazil; however, information on the host status of the crop to the pathogen is scarce. Thus, the aim of this study was to evaluate the host status of 11 garlic genotypes to Ditylenchus dipsaci and their productivity in experiments conducted under controlled conditions and in the field. In a greenhouse, diverse genetic materials were evaluated for nematode reproduction factor (RF). At the same time, the nematode reproduction, damage caused and productivity of these same genotypes were evaluated in an area naturally infested. In the greenhouse, ‘AM-PC Farias’, ‘Quitéria’, ‘BRS Hozan’, ‘Peruano’, ‘Chonan’ and ‘Moz 114’ were resistant; and, under field conditions, in these same genotypes, the nematode showed the lowest rates of reproduction in the soil (RF= 0.2 to 10.77) and in the tissues (1 to 3,893 specimens/plant), and there were the lowest percentages of symptomatic (0 to 48.66%) and dead (4.17 to 19.57%) plants. Higher productivities (4.32 to 11.05 t/ha) and bulb weight (13.12 to 58.63 g) were obtained with ‘AM-PC Farias’, ‘Quitéria’ and ‘AM-Erenice’; however, only in ‘AM-PC Farias’ and in ‘BRS Hozan’ we observed lower population levels of D. dipsaci in bulb peels (110 and 0.1 specimens/g, respectively).

RESUMO O nematoide-do-amarelão-do-alho é um dos principais problemas que afeta a cultura no Brasil, no entanto, informações sobre a resistência da cultura ao patógeno são escassas. Assim, foi objetivo deste estudo avaliar a reação de 11 genótipos de alho a Ditylenchus dipsaci e sua produtividade em experimentos conduzidos sob condições controladas e de campo. Em casa de vegetação, os diferentes materiais genéticos foram avaliados quanto ao fator de reprodução (FR) do nematoide. Paralelamente, avaliou-se, em área com solo naturalmente infestado, a reprodução do nematoide, os danos causados e a produtividades desses mesmos genótipos. Em casa de vegetação, ‘AM-PC Farias’, ‘Quitéria’, ‘BRS Hozan’, ‘Peruano’, ‘Chonan’ e ‘Moz 114’ foram resistentes e, em condições de campo, nesses mesmos genótipos, o nematoide apresentou as menores taxas de reprodução no solo (FR= 0,2 a 10,77) e nos tecidos (1 a 3.893 espécimes/planta), menores percentagens de plantas sintomáticas (0 a 48,66%) e mortas (4,17 a 19,57%). Maiores produtividades (4,32 a 11,05 t/ha) e peso de bulbos (13,12 a 58,63 g) foram obtidos com ‘AM-PC Farias’, ‘Quitéria’ e ‘AM-Erenice’, porém, apenas no primeiro e em ‘BRS Hozan’, foram observados baixos níveis populacionais de D. dipsaci nas cascas dos bulbos (110 e 0,1 espécimes/g, respectivamente).

ABSTRACT Coronary artery fistula draining into the coronary sinus is a rare vascular malformation, and its diagnosis and clinical manifestations usually occur late. We describe the case of a 72-year-old female patient with dyspnea on exertion (New York Heart Association Class III) associated with palpitations. The transthoracic echocardiogram showed significant tricuspid insufficiency. Cardiac catheterization showed aneurysm of the circumflex coronary artery and fistula of this artery draining into the coronary sinus. The patient underwent fistula ligation and tricuspid valve repair, with excellent surgical results.