Notes

Biotechnological Approaches for Hereditary Enhancement involving Orange (Acid limon (T.) Burm. f.) towards Douleur Secco Disease.
Understanding imbalances between the supply and demand of the human resour- ces for health (HRH) is essential for enhancing health outcomes. Addressing the HRH demand is particularly challenging, especially given the deficit of accurate data and surplus of unresolved methodological flaws. This study presents a systematic review of the literature surrounding HRH demand and answers the following key questions How has HRH demand been addressed? What are the harms and barriers that accompany HRH demand modeling? This systematic review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Relevant keywords were used in a thorough search of the PubMed/MEDLINE, SCOPUS, and Web of Science databases. A total of 2,599 papers were retrieved and evaluated according to their title and abstract. Of these, the full-text of 400 papers was analyzed, 53 of which successfully met the inclusion criteria in our study. While the topic's relevance is widespread, it still lacks a validated approach to model HRH demand adequately. The main characteristics of the applied methods are presented, such as their application complexity by health policymakers. Opportunities and orientations for further research are also highlighted.This study aimed to assess the Baixo Vouga sub-region (Portugal) governance system through 15 interviews with leaders of institutions with decision-making power and provide healthcare. The interviews were subjected to a content analysis, organized in matrices by cases, categories, subcategories, and indicators. Recording units were extracted from the interviews to produce data for each indicator. A Collaborative Place-based Governance Framework systematizing operational definitions of collaborative governance was implemented to serve as a benchmark for assessing the collaborative and place-based dimensions. The Baixo Vouga sub-Region governance system is collaborative because it is based on a shared structure of principles that translates into the services provided. It has a multilevel and multisector collaboration, and can undertake shared decisions. These dimensions could be reinforced through increased participation, autonomy, subsidiarity if more place-based information and practical knowledge were sought. The system would also benefit from an extensive adoption of bottom-up methods to formulate and implement policies.
This systematic review aimed to assess antibiotic use in Brazilian hospitals in the 21st century, as well as to understand the different drug utilization metrics adopted to assess the consumption of these drugs.

We systematically reviewed five databases (MEDLINE [Medical Literature Analysis and Retrieval System Online], CENTRAL [The Cochrane Central Register of Controlled Trials], EMBASE® [Excerpta Medica Database], Scopus [Elsevier's abstract and citation database], and LILACS [Literatura Latino-Americana e do Caribe em Ciências da Saúde]) for observational or experimental studies that assessed antibiotic utilization in Brazilian hospitals. The main outcomes were the drug utilization metrics and the consumption of antibiotics.

We included 23 studies, of which 43.5% were carried out in adult and pediatric care units, 39.1% in adult units, and 17.4% in pediatric units. Regarding the complexity of healthcare, 26.1% of the studies were performed in intensive care units. Two drug utilization metrics were used in these studies the defined daily dose (DDD) and the percentage of antibiotic prescriptions. The most commonly used antibiotic classes were third-generation cephalosporins, carbapenems, fluoroquinolones, and combinations of penicillins when the DDD was the adopted drug utilization metric.

Although few studies have been conducted, existing data indicate a high use of broad-spectrum antibiotics. We found that the lack of standardized antibiotic utilization metrics impaired the mapping of drug consumption at the national level.
Although few studies have been conducted, existing data indicate a high use of broad-spectrum antibiotics. We found that the lack of standardized antibiotic utilization metrics impaired the mapping of drug consumption at the national level.
Healthcare workers (HCWs) have a high risk of acquiring tuberculosis infection (TBI). However, annual testing is resource-consuming. We aimed to develop a predictive model to identify HCWs best targeted for TBI screening.

We conducted a secondary analysis of previously published results of 708 HCWs working in primary care services in five Brazilian State capitals who underwent two TBI tests tuberculin skin test and Quantiferon®-TB Gold in-tube. We used a classification and regression tree (CART) model to predict HCWs with negative results for both tests. The performance of the model was evaluated using the receiver operating characteristics (ROC) curve and the area under the curve (AUC), cross-validated using the same dataset.

Among the 708 HCWs, 247 (34.9%) had negative results for both tests. CART identified that physician or a community health agent were twice more likely to be uninfected (probability = 0.60) than registered or aid nurse (probability = 0.28) when working less than 5.5 years in the primary care setting. In cross validation, the predictive accuracy was 68% [95% confidence interval (95%CI) 65 - 71], AUC was 62% (95%CI 58 - 66), specificity was 78% (95%CI 74 - 81), and sensitivity was 44% (95%CI 38 - 50).

Despite the low predictive power of this model, CART allowed to identify subgroups with higher probability of having both tests negative. The inclusion of new information related to TBI risk may contribute to the construction of a model with greater predictive power using the same CART technique.
Despite the low predictive power of this model, CART allowed to identify subgroups with higher probability of having both tests negative. The inclusion of new information related to TBI risk may contribute to the construction of a model with greater predictive power using the same CART technique.
To analyze the effect of a multifaceted intervention in the care of pregnant women with syphilis in primary health care.

This is a quality improvement project performed in 26 basic care units in the municipality of Rio de Janeiro, between January and December 2017. It has a quasi-experimental mixed design, with previous, later and time series analyses. We evaluated the care provided to all pregnant women with syphilis whose prenatal care that ended during the studied period, using ten quality criteria and one indicator. The intervention was multifaceted, covering permanent education, improvement of records and information systems, audit and feedback, patient education, organizational changes and work processes. We estimated absolute and relative improvements of the criteria and their statistical significance (α = 5%). The facilitators and hinders of the intervention were analyzed according to the Model for Understanding Success in Quality.

After the intervention, there was a total absolute improvement oeful to identify priorities and guide interventions to improve the quality of care for syphilis, although there is still ample room for improvement. The identified problems, as well as the contextual modulators of the effect, should be considered in future interventions.
To predict the risk of absence from work due to morbidities of teachers working in early childhood education in the municipal public schools, using machine learning algorithms.

This is a cross-sectional study using secondary, public and anonymous data from the Relação Anual de Informações Sociais, selecting early childhood education teachers who worked in the municipal public schools of the state of São Paulo between 2014 and 2018 (n = 174,294). Data on the average number of students per class and number of inhabitants in the municipality were also linked. The data were separated into training and testing, using records from 2014 to 2016 (n = 103,357) to train five predictive models, and data from 2017 to 2018 (n = 70,937) to test their performance in new data. The predictive performance of the algorithms was evaluated using the value of the area under the ROC curve (AUROC).

All five algorithms tested showed an area under the curve above 0.76. The algorithm with the best predictive performance (artificiof these workers due to morbidity.Dogs are the main urban reservoir of Leishmania infantum, the causative agent of visceral leishmaniasis (VL), which is transmitted by sand flies. In the state of Paraná, the first detection of a positive dog for VL was in 2014, this year Paraná lost free status for this disease (VL). The objectives of this study were to determine the prevalence of canine visceral leishmaniasis in Palotina, the occurrence of vectors that may transmit Leishmania infantum, and the number of notifications of human visceral leishmaniasis cases from period 2010 to 2020. To determine the occurrence of canine visceral leishmaniasis, blood samples from 204 dogs were analyzed using the rapid test DPP® to detect anti-L. infantum antibodies. To investigate the occurrence of potential vectors, monthly collections were made at 18 points within the urban area of the municipality. The number of human visceral leishmaniasis cases was investigated from Epidemiological Surveillance records. None of the serologically tested dogs showed positive titration. Only two specimens of Lutzomyia neivai, one of Lutzomyia sp. Adlyxin and four of Brumptomyia brumpti specimens were collected. No human visceral leishmaniasis cases were reported. These results suggest that there is no evidence of circulation of L. infantum in Palotina.The aim of this study was to characterize the anthelmintic resistance (AR) of a sheep gastrointestinal nematode population, named Caucaia, from northeastern Brazil. Phenotypic tests performed were egg hatch (EHT), larval development (LDT) and fecal egg count reduction (FECRT). Benzimidazoles (BZs) genotypic evaluation was by frequency of single nucleotide polymorphisms (SNPs) F200Y, F167Y and E198A, and for levamisole (LEV), by frequency of resistance alleles of Hco-acr-8 gene. The primers were designed specifically for Haemonchus contortus. Effective concentrations 50% (EC50) for BZs (EHT), and for macrocyclic lactones (MLs) and LEV (LDT) were 1.02 µg/mL, 1.81 ng/mL and 0.04 µg/mL, respectively. Resistance ratios for MLs and LEV were 0.91 and 3.07, respectively. FECRT efficacies of BZs, MLs, monepantel (MPTL) and LEV were 52.4; 87.0; 94.5 and 99.6%, respectively. qPCR for BZs demonstrated resistance allele frequencies of 0%, 26.24% and 69.08% for SNPs E198A, F200Y and F167Y, respectively. For LEV, 54.37% of resistance alleles were found. There was agreement between EHT, FECRT and qPCR for BZs, and agreement between LDT and qPCR for LEV. Thus, based on higher sensitivity of qPCR, and phenotypic evaluation, the Caucaia population was considered resistant to BZs, MLs, LEV and suspect for MPTL.Toxoplasma gondii is a zoonotic parasite of worldwide distribution that can infect several species of homeothermic animals. Few studies have evaluated the exposure of captive wild animals to T. gondii. This study involved a serological survey of anti-T. gondii antibodies in mammals kept in Cuba's National Zoo (PZN) and in the Rio de Janeiro Zoo (RIOZOO) in Brazil. The study consisted of a total of 231 serum samples from mammals, 108 from PZN and 123 from RIOZOO. All the samples were subjected to IgG anti-T. gondii testing by means of the inhibition ELISA method and the modified agglutination test, respectively. T. gondii antibodies were detected in 85.2% samples from PZN and 32.5% samples from RIOZOO. At the PZN, Perissodactyla (92.3%) was the order with the highest serological prevalence rate, whereas at the RIOZOO, the order Primates (46.7%) stood out (p less then 0.05). In addition to this association, the origin of the PZN animals was also associated with T. gondii infection. This finding demonstrates the need for constant veterinary monitoring of captive wild mammals in order to link the serological diagnosis with clinical alterations indicative of toxoplasmosis.
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