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Importance Data are lacking on the outcomes of patients with severely reduced left ventricular ejection fraction (LVEF) who undergo revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Objective To compare the long-term outcomes in patients undergoing revascularization by PCI or CABG. Design, Setting, and Participants This retrospective cohort study performed in Ontario, Canada, from October 1, 2008, and December 31, 2016, included data from Ontario residents between 40 and 84 years of age with LVEFs less than 35% and left anterior descending (LAD), left main, or multivessel coronary artery disease (with or without LAD involvement) who underwent PCI or CABG. Exclusion criteria were concomitant procedures, previous CABG, metastatic cancer, dialysis, CABG and PCI on the same day, and emergency revascularization within 24 hours of a myocardial infarction (MI). Data analysis was performed from June 2, 2018, to December 28, 2018. Exposures Revascularization by PC.8) and heart failure (HR, 1.5; 95% CI, 1.3-1.6) compared with matched patients who underwent CABG. Conclusions and Relevance In this study, higher rates of mortality and MACE were seen in patients who received PCI compared with those who underwent CABG. The findings may provide insight to physicians who are involved in decision-making for these patients.INTRODUCTION The recent emergence and rapid spread of Zika and Chikungunya fevers in Brazil, occurring simultaneously to a Dengue fever epidemic, together represent major challenges to public health authorities. This study aimed to identify and compare the 2015-2016 spatial diffusion pattern of Zika, Chikungunya, and Dengue epidemics in Salvador-Bahia. METHODS We used two study designs comprising a cross-sectional-to-point pattern and an ecological analysis of lattice data. Residential addresses involving notified cases were geocoded. We used four spatial diffusion analysis techniques (i) visual inspection of the sequential kernel and choropleth map, (ii) spatial correlogram analysis, (iii) spatial local autocorrelation (LISA) changes analysis and, (iv) nearest neighbor index (NNI) modeling. RESULTS Kernel and choropleth maps indicated that arboviruses spread to neighboring areas near the first reported cases and occupied these new areas, suggesting a diffusion expansion pattern. A greater case density occurred in central and western areas. In 2015 and 2016, the NNI best-fit model had an S-curve compatible with an expansion pattern for Zika (R2 = 0.94; 0.95), Chikungunya (R2 = 0.99; 0.98) and Dengue (R2 = 0.93; 0.99) epidemics, respectively. Spatial correlograms indicated a decline in spatial lag autocorrelations for the three diseases (expansion pattern). Significant LISA changes suggested different diffusion patterns, although a small number of changes were detected. CONCLUSIONS These findings indicate diffusion expansion, a unique spatial diffusion pattern of Zika, Chikungunya, and Dengue epidemics in Salvador-Bahia, namely. Knowing how and where arboviruses spread in Salvador-Bahia can help improve subsequent specific epidemic control interventions.INTRODUCTION Leishmaniasis constitutes a serious but neglected tropical disease. Recently, socio-environmental, biological and physical changes have altered the range of leishmaniasis, causing it to spread into urban areas. In Minas Gerais, the disease is endemic, exhibiting regional differences and reaching urban centers. The purpose of this study was to evaluate entomological aspects related to the ecoepidemiology of leishmaniasis in Itaúna. METHODS Monthly catches with HP traps were carried out from June 2017 to May 2018, in three ecological areas (urban, rural, and forest). The adaptability of the species to anthropic environments was assessed using the synanthropy index (SI). RESULTS We collected 1306 specimens of phlebotomine sand flies. Of the species of medical importance, Lutzomyia longipalpis, the vector of Leishmania infantum, represented 90.4% of the specimens identified at species level (n=1260). Nyssomyia whitmani, the vector of Leishmania braziliensis, represented 1.6% of the total. Lu. longipalpis displayed an SI of +95.8, a value that denotes a marked preference for human environments. For Ny. whitmani, the SI was -25, expressing the tendency of this species to occupy uninhabited areas. The population of the three most numerous species captured increased with rain, high temperatures, and high relative humidity. Although captured at low numbers, Ny. whitmani showed a different profile concerning the climate variables analyzed. CONCLUSIONS Understanding the epidemiology of the disease may assist the health services in formulating effective control measures for improving community health and contributing to the establishment of a dynamic relationship and a global awareness of the health/disease process.INTRODUCTION The study of the landscape ecology, biological microhabitat, and epidemiological implications for the distribution of the main vectors Aedes aegypti and Aedes albopictus contribute to the prevention and control actions regarding the diseases they transmit. METHODS This study sought to assess data on positive properties of the vector control program activities from 1998 to 2010. An entomological survey was also carried out on a sample of buildings collecting larvae and pupae from containers between October and April (spring / summer) from 2002 to 2005. We assessed the physico-chemical data of the water in 20% of positive containers. The vegetation and urbanization were assessed with the aid of satellite images and microenvironments were classified as urbanized, woods, and shrubs. The data were analyzed using statistical and geoprocessing software. RESULTS Ae. aegypti and Ae. albopictus colonized all types of microhabitats and microenvironments, predominantly in the urbanized area, in isolation and in coexistence. The microhabitat of Ae. aegypti showed a temperature gradient greater than that of Ae. albopictus, and there was an association with urbanized areas for the first species and wooded areas for the last species. CONCLUSIONS Landscape ecology and intra-urban differences favor different microclimates, which contribute to the coexistence of species in the urban environment in an area close to the forest, raising the risk of other arbovirus infections in urban areas. The ecological niche should be considered for Ae. albopictus. Entomological and virologic monitoring are suggested as arbovirus surveillance actions in urban infested centers near preserved forests.INTRODUCTION The genus Rhodnius in the subfamily Triatominae comprises 20 species, which can transmit Trypanosoma cruzi and Trypanosoma rangeli. Due to the development of molecular techniques, Triatominae species can now be characterized by mitochondrial and nuclear markers, making it possible to verify and/or correct the existing data on these species. The results achieved in this study provide a more detailed and accurate differentiation of the Rhodnius species, helping the establishment of a more appropriate classification. METHODS Data collection was performed by DNA analysis, morphological and morphometric studies to distinguish four populations of R. neglectus and four of R. prolixus. Phylogenetic data were compared to morphological and morphometric data. RESULTS The analysis of Cytb fragments suggests that the four colonies designated to Rhodnius neglectus as well as those of R. prolixus were correctly identified. CONCLUSIONS The morphological characters observed in the specimens of the colonies originally identified as R. prolixus and R. neglectus, such as the presence or absence of collar in the eggs, the patterns of the median process of the pygophore, and anterolateral angle, are consistent with the species. Geometric morphometrics also show an intraspecific variability in R. prolixus.in English, Portuguese Este artigo analisou a Síndrome de Burnout (SB) entre os gerentes da Estratégia de Saúde da Família (ESF) no Município do Rio de Janeiro e suas associações entre os fatores que influenciam a presença/ausência da SB nesses profissionais. Com natureza descritiva, ele utilizou um questionário, composto de duas partes 1) perfil do gerente e fatores que possam influenciar a presença de Burnout; 2) Inventário Maslach Burnout Inventory. A taxa percentual de retorno foi de 63,5% (143) dos 225 enviados. Os gerentes da ESF são em geral, enfermeiros (68,6%), jovens (74,5% até 39 anos), do sexo feminino (76,9%) e que atuam na gerência há menos de 5 anos (85,2%). A presença da SB foi identificada em 11,2% dos gerentes. Os fatores de natureza organizacional foram os que obtiveram maior número de variáveis com associação. Esses dados apontam para necessidade de realização de mudanças nas práticas organizativas de serviços e de mudanças nos processos de trabalho. A realização de outros estudos, que aprofundem estas questões, pode contribuir neste sentido.This article aims to identify meat preparation techniques according to sociodemographic variables and health-related behaviors. Cross-sectional population-based survey that used one 24-hour recall to identify the meat preparation techniques. We analyzed 3,376 24-hour recalls. The meat preparation techniques were classified as moist-heat (sauté, stew, boil; MH) or dry-heat (sauté, stew, boil; MH) and dry-heat (baking, grilling/barbecuing and frying; DH). read more The prevalence of use was 39.0% for moist cooking, 32.7% for frying and 28.3% for baking/grilling. Women, the elderly and those from other municipalities/states were more likely to use MH cooking. MH techniques were least prevalent among those of higher socioeconomic status. Among the techniques of DH cooking, women, the elderly and people with higher education and income were less likely to fry meats. Those born in Campinas and those with higher income, education, and those who ate fruits and vegetables on a higher weekly frequency were more likely to roast/grill meats. The results show the epidemiological profile associated with meat preparation techniques. Women, the elderly and those with lower education are more likely to use MH cooking techniques and less likely to fry meats. Those economically more favored are less likely to use MH techniques and frying, and more roasting/grilling.in English, Spanish Se presenta una investigación teórica sobre la educación para la salud, la cual se propone desde una perspectiva emancipadora y constituye una oportunidad para promover la salud en las comunidades porque permite explicitar una concepción de justicia social. La visión de justicia social que se plantea en este artículo está centrada el enfoque de las capacidades que se entienden como un conjunto de oportunidades reales para que las personas tengan la vida que valoran. Este enfoque es pertinente para el trabajo en salud pública porque está centrado en el desarrollo humano, permite incorporar al sujeto en relación dialéctica con la sociedad y se enfoca en las oportunidades reales. Se consideran las diferencias entre las corrientes de salud pública para entender la justicia social y la relevancia de una concepción de salud que permita trascender el abordaje biomédico centrado en la enfermedad. Se reconoce la importancia de avanzar hacia un desarrollo pedagógico de la educación para la salud que supere la perspectiva de educación centrada en los cambios de comportamiento, para entenderla como un proceso social y político con base humanista emancipadora como oportunidad para la construcción de la salud pública.
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