ABSTRACT Copper is an essential element for beet; however, it needs to be made available in adequate quantities since this nutrient, which is a heavy metal, can cause toxicity to plants and/or humans. This study aimed to evaluate the agronomic performance of beet fertigated with copper in a semi-arid region of Brazil. Two experiments were carried out in complete randomized blocks, with five treatments (0, 1.5, 3.0, 4.0, and 6.0 kg ha-1 of copper) and four replicates. In 2019, the copper content was within the adequate range for beet. In 2021, fertigation with copper above 0.8 kg ha-1 led to contents in the phytotoxicity range, which may explain the reduction in total and tuberous root dry mass accumulation. Fertilization with copper increased marketable yield in 2019 (17.32 t ha-1 at the dose of 3.9 kg ha-1 of copper), while, in 2021, there was no fit of the equations. Copper fertilization altered the tuberous root pH but did not influence the other tuberous root quality components. Plants fertilized with copper accumulated more copper in the leaves than in the tuberous root, with a maximum accumulation of 6.0 kg ha-1 of copper in 2019 and 2021. Fertilization with 3.9 kg ha-1 suits soils with low copper content.

RESUMO O cobre é um elemento essencial à beterraba, no entanto, é necessário disponibilizá-lo em quantidade adequada uma vez que esse nutriente, que é um metal pesado, pode causar toxicidade às plantas e, ou, ao ser humano. Esta pesquisa teve como objetivo avaliar o desempenho agronômico de beterraba fertirrigada com cobre em uma região semiárida do Brasil. Foram conduzidos dois experimentos em delineados em blocos casualizados ao acaso, com cinco tratamentos (0, 1.5, 3.0, 4.5 e 6.0 kg ha-1 de cobre) e quatro repetições. Em 2019, o teor de cobre estava dentro da faixa adequada para a beterraba. Em 2021, a fertirrigação com cobre acima de 0.8 kg ha-1 proporcionou teores na faixa de fitotoxicidade, o que pode explicar a redução no acúmulo de massa seca total e de raízes tuberosas. A adubação com cobre aumentou a produtividade comercial em 2019 (17.32 t ha-1 na dose de 3.9 kg ha-1 de cobre) enquanto que, em 2021, não houve modelo ajustado. A adubação alterou o pH da raiz tuberosa, mas não influenciou nos demais atributos de qualidade pós-colheita da raiz tuberosa. Plantas adubadas com cobre acumularam mais cobre nas folhas do que na raiz tuberosa, com máxima acumulada em 2019 e em 2021, na dose 6.0 kg ha-1 de cobre. A adubação com 3.9 kg ha-1 é adequada para solos com baixo teor de cobre.

Resumo Introdução: A promoção da literacia em saúde é crucial para que os utentes possam tomar decisões adequadas em matéria de saúde, promovendo uma utilização mais eficiente dos recursos e contribuindo para a sua sustentabilidade. Objetivos: Promover a literacia em saúde entre os utentes de seis Unidades de Saúde Familiar (USF) no Norte de Portugal acerca da organização e estrutura dos cuidados de saúde primários (CSP) e a especialidade médica de medicina geral e familiar (MGF). Métodos: Estudo observacional, prospetivo, do tipo coorte. Foram aplicados questionários em formato Google® Docs a utentes com 18 ou mais anos, que preenchiam os critérios de inclusão, antes e após um mês da intervenção. A intervenção consistiu na visualização de um vídeo formativo preparado pelos autores acerca da organização e os recursos dos CSP e a especialidade de MGF. Resultados: O questionário pré-intervenção foi preenchido por 274 utentes, 165 visualizaram o vídeo educativo e 113 preencheram o questionário pós-intervenção. Apenas 88 utilizadores participaram em todas as fases do projeto e foram considerados elegíveis para a interpretação dos resultados. Após a intervenção verificou-se uma melhoria estatisticamente significativa na classificação geral obtida no questionário, com um aumento na percentagem de respostas corretas de 66,7% para 72,7% (p=0,004; IC 95%). Verificou-se também um aumento na taxa de respostas corretas em quase todas as questões aplicadas. Discussão e Conclusão: A literacia em saúde ajuda os cidadãos a tomar melhores decisões em relação à sua saúde, com um consequente impacto económico e social. Este projeto culminou na criação de uma ferramenta multimédia capaz de melhorar os conhecimentos dos utentes portugueses acerca dos CSP, passível de ser replicada noutros locais do País.

Abstract Introduction: Promoting health literacy is essential for patients to make informed healthcare decisions, ensuring more efficient resource utilization and contributing to long-term sustainability. Objectives: Enhance health literacy among patients in six health units in Northern Portugal, focusing on the organization and structure of primary healthcare services (PHC) and the medical specialty of general practice/family medicine (GPFM). Methods: An observational, prospective cohort study was conducted. Questionnaires in Google® Docs format were administered to patients aged 18 and older who met the inclusion criteria, both before and one month after the intervention. The intervention involved watching an educational video created by the authors about PHC's organization, resources, and GPFM specialty. Results: The pre-intervention questionnaire received responses from 274 patients, with 165 of them viewing the educational video and 113 completing the post-intervention questionnaire. Eighty-eight participants engaged in all phases of the project and were considered eligible for result analysis. After the intervention, there was a statistically significant improvement in the overall questionnaire score, with the percentage of correct answers increasing from 66.7% to 72.7% (p=0.004; CI 95%). Correct answer rates also improved across most of the questions. Discussion and Conclusion: Health literacy empowers individuals to make informed health choices, resulting in economic and social benefits. This project led to the creation of a multimedia tool that can enhance the understanding of Portuguese patients regarding PHC, with potential for replication in other regions of the country.

ABSTRACT This study aimed to calibrate and test the SARRA-H (Système d’Analyse Régionale des Risques Agroclimatologiques) crop model for cowpea, as well as conducting a climate risk zoning for this crop in a region located in Eastern Amazon, allowing the identification of locations and sowing dates that favor the production considering both the water deficit and the probability of occurrence of severe rains during the harvest period. The model was calibrated and validated with data from experiments conducted between 2013 and 2016 in the municipality of Castanhal, PA, Brazil. Low climate risk areas were defined as those that had a water requirement satisfaction index (WRSI) greater than or equal to 0.5 in the reproductive phase combined with the occurrence of rainfall below 20 mm at the harvest for, at least, 80% of the years for which planting was simulated. The model was able to simulate the water balance, growth and development of cowpea under the climate and soil conditions of the studied location with high precision and accuracy. The optimal period for sowing cowpea comprises the interval between June 5th and 25th for regions located above 2° S and between March 25th and April 15th for regions below 2º S.

RESUMO Esta pesquisa teve como objetivo calibrar e testar o modelo de cultura SARRA-H (Système d’Analyse Régionale des Risques Agroclimatologiques) para o caupi, bem como realizar o zoneamento de risco climático para esta cultura em uma região localizada na Amazônia Oriental, a fim de permitir a identificação de locais e datas de semeadura que favoreçam a produção considerando tanto o déficit hídrico como a probabilidade de ocorrência de chuvas severas durante o período da colheita. O modelo foi calibrado e validado com dados de experimentos realizados entre 2013 e 2016 no município de Castanhal, PA. As áreas de baixo risco climático foram definidas como aquelas que apresentaram índice de satisfação da necessidade hídrica (WRSI) maior ou igual a 0,5 na fase reprodutiva combinado com a ocorrência de chuvas abaixo de 20 mm na colheita por, pelo menos, 80% dos anos onde foi simulado o plantio. O modelo foi capaz de simular o balanço hídrico, crescimento e desenvolvimento do feijão-caupi nas condições climáticas e de solo da região estudada com boa precisão e exatidão. O período de ótima semeadura para o feijão-caupi compreende o intervalo entre 5 e 25 de junho para regiões localizadas acima de 2° S, e entre 25 de março e 15 de abril para regiões abaixo de 2º S.

ABSTRACT This study presents a new orchid species of the genus Catasetum belonging to the group of species with symmetrical and parallel antennae. It was found in terra-firme and floodplain forests in the Brazilian states of Amazonas and Pará. We provide a formal description of the new species, images, and notes on distribution, habitat, phenology, flower visitors and preliminary conservation status. We compare it with C. cristatum and C. barbatum, both sympatric and morphologically most similar to the new species. It was preliminarily classified in the Endangered (EN) category according to IUCN criteria based on the extent of occurrence, area of occupation, number of occurrence locations and the risks that the known populations are exposed to (deforestation and predatory collection).

RESUMO Este estudo apresenta uma nova espécie de orquídea do gênero Catasetum, do grupo de espécies cujas antenas são simétricas e paralelas. Foi encontrada em florestas de terra-firme e igapó nos estados do Amazonas e Pará, Brasil. Fornecemos uma descrição formal da nova espécie, imagens e comentários referentes à distribuição, habitat, fenologia, visitantes florais e estatus de conservação. A comparamos com C. cristatum e C. barbatum, que ocorrem em simpatria e são morfologicamente mais semelhantes à nova espécie. Ela foi preliminarmente classificada na categoria Em Perigo (EN) segundo os critérios da UICN, com base na extensão de ocorrência, área de ocupação, número de localidades de ocorrência e os riscos a que as populações conhecidas estão expostas (desmatamento e coleta predatória).

Abstract Acerola (Malpighia emarginata DC.) is a super-fruit with high ascorbic acid content and its quality can be highly affected by the genetic and environmental conditions. This systematic review aims to provide an overview of the influence of genetic variability on acerola quality traits. It was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) recommendations. PubMed, Scopus and SciELO electronic databases were searched using terms acerola, selection, and genotypes. 29 studies were selected after assessing articles for eligibility criteria, which reported data on 22 quality parameters. A high genetic diversity was observed for all quality traits. Soluble solids and ascorbic acid contents are the main parameters determined in studies with acerola. Titratable acidity, SS/TA ratio and pH are also evaluated in most studies. Different studies have already identified possible genotypes for use in acerola breeding programs based on fruit quality, both for launching new cultivars and for use as parents in crosses. Our review is a useful basis for acerola breeding programs and germplasm conservation. Future studies are required to further identify and quantify bioactive compounds in acerolas of different genotypes.

ABSTRACT Understanding the green dwarf coconut palm development is essential to improve its management. This study aimed to characterize and understand the seasonality of the green dwarf coconut palm development and yield under rainfed and irrigated conditions in the northeastern region of the Pará state, Brazil. The longitudinal and transverse diameters, fruit mass and yield, in addition to the number of live leaves, live bunches, fruits of the bunches nº 11 and 14 and female fowers were monitored. The coconuts between the bunches nº 20 and 22 showed larger dimensions and biomass (fresh and dry). The partition of the production components varies according to the time of the year, with the liquid albumen mass, which is a component of greater commercial focus, being higher in the rainy season, with lower percentage losses in the irrigated cultivation. The meteorological seasonality plays a key role in fower dropping and fruit abortion, directly contributing to the amount of produced fruits.

RESUMO Compreender o desenvolvimento do coqueiro-anão-verde é essencial para melhorar seu manejo. Objetivou-se caracterizar e entender a sazonalidade do desenvolvimento e a produção de frutos do coqueiro-anão-verde sob condições de sequeiro e irrigação na região nordeste do Pará, Brasil. Foram monitorados os diâmetros longitudinal e transversal, massa e produtividade dos frutos, além do número de folhas vivas, cachos vivos, frutos dos cachos nº 11 e 14 e fores femininas. Os cocos entre os cachos nº 20 e 22 apresentam maiores dimensões e biomassa (fresca e seca). A repartição dos componentes da produção varia conforme a época do ano, sendo a massa de albúmen líquido, componente de maior enfoque comercial, maior no período chuvoso, com menores perdas percentuais no cultivo irrigado. A sazonalidade meteorológica desempenha papel fundamental na queda das fores e no aborto dos frutos, contribuindo diretamente para a quantidade de frutos produzidos.

Abstract Quilombolas are ethnic-racial groups, of black ancestry, and had their territories consolidated in Brazil in regions with difficult access and far from large centers. The objective of this study is to know the therapeutic itinerary (IT) adopted by quilombola women in traditional communities located in the North of the state of Minas Gerais. This is a qualitative study with the theoretical model using the Arthur Kleinman health care system. The study scenario was 23 quilombola communities in northern Minas Gerais. Forty quilombola women aged between 25 and 89 years were interviewed. Data analysis was performed following the IT. Units of analysis emerged that were grouped into three categories: quilombola women and the meaning of health and care; the professional care system in quilombola communities; and route of care in situations experienced by women. The therapeutic itinerary of the communities is mainly related to the actions of popular medicine. It was also possible to observe that there are weaknesses in relation to health care due to factors such as difficulty of access to institutionalized services.

Resumo Os quilombolas são grupos étnico-raciais de ancestralidade negra e tiveram seus territórios consolidados no Brasil em regiões com acesso difícil e distante dos grandes centros. O objetivo desse estudo é conhecer o itinerário terapêutico (IT) adotado por mulheres quilombolas em comunidades tradicionais localizadas no norte do estado de Minas Gerais. Trata-se de um estudo com abordagem qualitativa com o modelo teórico utilizando o sistema de cuidados à saúde de Arthur Kleinman. O estudo se deu em 23 comunidades quilombolas do norte de Minas Gerais. Foram entrevistadas 40 mulheres quilombolas, com idades entre 25 e 89 anos. A análise dos dados foi realizada seguindo os IT. Emergiram unidades de análise que foram agrupadas em três categorias: as mulheres quilombolas e o significado da saúde e do cuidado; o sistema de cuidado profissional nas comunidades quilombolas; e itinerário de cuidados nas situações vivenciadas pelas mulheres. O itinerário terapêutico das comunidades se mostra relacionado principalmente às ações de medicina popular. Foi possível observar ainda que existem fragilidades em relação à atenção à saúde devido a fatores como dificuldade de acesso aos serviços institucionalizados.

Abstract Objective: To analyze the existing state legislation, including not only the ordinary laws, but also their infralegal regulation and the state legislation on Hospital Dentistry. Material and Methods: A survey was carried out in the databases of the Legislative Assemblies of the Brazilian States and the Federal District, as well as the Regional and Federal Councils of Dentistry in Brazil. Subsequently, a survey was carried out in the databases of the Ministry of Health, State Dental Councils and Federal Dental Council in Brazil. Results: Only 8 Brazilian states have legislation in force regarding hospital dentistry, which represents 29.63% of the federative units. Among the Brazilian regions, the Midwest presented the highest prevalence of the laws found (37.50%), followed by the North (25%) and the other regions with the same coverage (12.50%). Also, an orientation and an ordinance from the Ministry of Health, six resolutions from the Federal Council of Dentistry, and a technical note from the National Health Surveillance Agency were found. Conclusion: Several States do not have rules on the subject, making it imperative to create a federal rule that not only imposes the presence of the dentist, but also regulates the proportion of the team, workload, and availability.

ABSTRACT Introduction: Peritoneal dialysis patients are at increased risk of developing abdominal wall complications, including hernias. This study aimed to determine the incidence of hernias in peritoneal dialysis patients, identify risk factors, and evaluate their impact on technique survival. Methods: A retrospective cohort study was conducted, including prevalent peritoneal dialysis patients in a single center, from January 2010 to October 2020. Data on baseline characteristics, previous abdominal surgeries, and hernia history were collected. Patients with diagnosed hernias during peritoneal dialysis were compared to a control group. Results: Among 155 peritoneal dialysis patients, hernias occurred in 29% (n=45) of the population, with an incidence rate of 0.09 hernias/patient/year. Umbilical hernias were the most common subtype. Autosomal dominant polycystic kidney disease (OR (odds ratio) 3.925; 95% confidence interval (CI), 1.208 - 12.75) history of surgical repaired hernias (OR 5.586; 95% CI 1.540 - 20.255) and a higher number of previous abdominal surgeries (OR 1.680; 95% CI 1.025 - 2.752) were independent predictors of hernia development. Surgical treatment was performed in 59.3% of cases, with a 18.8% recurrence rate. Higher daytime infusion volumes were associated with hernia recurrence (p=0.045). Peritoneal dialysis technique survival did not differ significantly between the hernia and control groups (p=0.700). Conclusion: Hernias are frequent in peritoneal dialysis patients, with autosomal dominant polycystic kidney disease, previous abdominal surgeries, and history of surgically repaired hernias as identified risk factors. Hernias do not significantly interfere with peritoneal dialysis technique survival, but comprehensive management strategies, including early surgical repair and peritoneal dialysis prescription adaptations, can optimize outcomes.

Abstract Introduction: Treatment decision in patients with asymptomatic carotid artery stenosis (ACS) is a matter of current debate with a recent shift towards isolated best medical treatment (BMT) as treatment of choice in most patients. However, poor medical compliance is one of the main constraints to the success of BMT. We hypothesized that more invasive treatment approaches can influence how patients perceive the severity of their illness and hence, treatment compliance. Methods: A cross-sectional study was performed including patients with asymptomatic >50% carotid artery stenosis (NASCET method) followed-up as outpatients in a Vascular Surgery department from January 2017 to December 2021. Optimal BMT was defined according to the European Society of Vascular Surgery Carotid Atherosclerotic Disease 2023 guidelines. Demographic and risk factor patient data was attained and subsequently a Portuguese translation of the Morisky medication-taking adherence scale (MMAS-4) questionnaire was given to all patients. Several additional questions developed by our group were also applied. Results: A total of 320 patients were identified (186 under BMT alone and 134 submitted to BMT and carotid endarterectomy - CEA). Most patients were male in both groups (75%) and the mean age was similar. Furthermore, patients undergoing CEA presented higher rates of current smoking (51.4% vs 15.9%; p<0.001) and lower rates of antiplatelet (80.0% vs. 92.8%; p=0.029) and statin (78.6% vs. 94.2%; p=0.007) prescription. Patients in the CEA group also presented with significantly lower medical compliance (40.3% vs. 24.5%, p<0.001) despite being more aware of their current medication´s name and therapeutic purpose. Conclusion: In conclusion, physicians seem to be more aggressive in controlling risk factors in BMT-only patients when compared to CEA-submitted patients. However, patients subjected to CEA may be more aware of ACS, despite having poorer medical adherence.

Abstract Multiskilled labor is a ubiquitous concept and its adoption is suggested in various production approaches such as sociotechnical systems, cellular arrangements and, most notably, related to Lean Production, as it provides flexibility to the work environment. This research work aimed at identifying the extent of the use of multiskilling in a sample of Brazilian construction sites. A survey was conducted comprising variables such as reasons for simultaneous use of specialized and multiskilled labor. A total of 191 valid questionnaires were returned. Statistical analyses point out that it is common to employ both specialized and multiskilled labor in the majority of sites. Furthermore, multiskilling and subcontracting are concomitant flexible strategies to accommodate labor provision on site. The share of multiskilling is greater than reported in academic works, the number of skills is as restricted as in literature propositions and the size of the building firm is determinant of the share of multiskilled labor in the total workforce. This research work concludes that: work flexibility may be obtained with different strategies (multiskilled; specialized and multiskilled; subcontracting); employing only specialized trades is not a dominant culture on building sites.

Resumo Polivalência é um elemento sugerido em várias abordagens de produção, como a produção enxuta, pois promove flexibilidade. Esta pesquisa objetivou identificar o alcance da polivalência em uma amostra de obras brasileiras. Um questionário foi aplicado buscando levantar variáveis como razões para a simultaneidade entre especialistas e polivalentes, com um total de 191 respostas válidas. Análises estatísticas apontaram que é comum o emprego simultâneo de polivalentes e especialistas na maioria dos canteiros. Além disso, polivalentes e subcontratados compõem uma estratégia concomitante para prover flexibilidade. A propoção de polivalentes é maior do que em outros estudos, o número de habilidades em polivalentes corrobora com a bibliografia e o porte da empresa é determinante para essa proporção em relação a toda a mão de obra. Essa pesquisa concluiu que: a flexibilidade pode ser obtida por diferentes estratégias (polivalência, especialização e polivalência, subcontratação) e empregar apenas especialistas não é uma prática dominante nos canteiros de obras.

Resumo Introdução: A internação é um recurso do sistema de saúde utilizado na tentativa de recuperar a saúde do indivíduo. No entanto, o aumento do tempo médio de permanência está relacionado tanto ao aumento dos custos quanto com a qualidade da assistência. Objetivos: Identificar os fatores que contribuem para o aumento do tempo de permanência na Unidade de Clínica Médica de um hospital público do Distrito Federal. Métodos: Trata-se de um estudo descritivo, exploratório de cunho qualitativo, realizado com 15 profissionais da Unidade de Clínica Médica. A coleta de dados ocorreu no período de 10 de outubro a 30 de novembro de 2021. Os dados foram analisados por meio da análise de conteúdo de Bardin: pré-análise, exploração do material e tratamento dos resultados, inferência e interpretação. Resultados: Foi possível encontrar três núcleos de sentido que foram divididos em três categorias: 1 - Fatores que contribuem com o aumento do tempo de internação; 2 - Necessidades de aprendizagens para otimização do processo de desospitalização; e 3 - Aprimoramento do processo de gestão em saúde. Conclusões: A demora na realização dos exames deu-se tanto pela demora no agendamento pelo sistema de regulação quanto pela falta de logística do Núcleo de Apoio e Remoção do Paciente, que deixa de conduzir o paciente por falta de transporte e motorista, os quais podem ser melhorados por intervenção dos gestores locais.

Abstract Introduction: Hospitalization is a resource of the health system used in an attempt to recover the individual's health. However, the increase in the average length of stay is related to both the increase in costs and the quality of care. Goals: To identify the factors that contribute to the increase in the length of stay in the Internal Medicine Unit of a public hospital in the Federal District. Methods: This is a descriptive, exploratory qualitative study, carried out with 15 professionals from the Internal Medicine Unit. Data collection took place from October 10 to November 30, 2021. Data were analyzed using Bardin's content analysis: pre-analysis, material exploration and treatment of results, inference and interpretation. Results: It was possible to find three core meanings that were divided into three categories: 1 - Factors that contribute to the increase in length of stay; 2 - Learning needs to optimize the dehospitalization process; and 3 - Improvement of the health management process. Conclusions: The delay in carrying out the exams was due both to the delay in scheduling by the regulation system, and to the lack of logistics at the Patient Support and Removal Center, which stops taking the patient due to lack of transportation and a driver, which can be improved by the intervention of local managers.

Abstract Background: Endovascular mechanical thrombectomy (MT) changed acute ischaemic stroke management and is considered the standard of care for patients with proximal anterior circulation occlusion. MT improves functional independence, without an increase in mortality. Despite its advantages, up to 20% of patients treated with MT do not have successful recanalization, leading to poor clinical outcome. We present a case of an acute ischaemic stroke of the anterior circulation due to occlusion of the common carotid artery successfully submitted to surgical thrombectomy after failed MT. Case report: A 43-year-old male, with prior history of diabetes, hypertension, dyslipidaemia and heart failure was admitted at the emergency unit with acute bilateral lower limb ischaemia, due to cardioembolic phenomena. He was submitted to bilateral femoral thrombectomy and started endovenous unfractionated heparin. On the fifth postoperative day he developed sudden depression of cognitive status and left side hemiplegia of brachial predominance. Computed tomography angiography revealed an occlusion of brachiocephalic trunk, right subclavian artery and common carotid artery, preserving its branches. MT, performed by interventional neuroradiology, was unsuccessful (no recanalization or clinical improvement). After multidisciplinary discussion, the patient underwent urgent surgical thrombectomy through carotid and transaxillary approaches. Postoperatively, the patient’s mental status and left sided motor function recovered progressively over time. Three months after, patient maintains anticoagulation with warfarin, without neurological sequalae. Conclusion: The low rate of recanalization and poor clinical outcome after MT failure underlines the need for alternative rescue approaches. Surgical thrombectomy could represent a lifeline. More studies are needed to corroborate its efficacy in patients with anterior circulation acute ischaemic stroke.