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BackgroundAlthough the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method.MethodsData were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk—RR) of leprosy. Maps considering these risks and their confidence intervals were constructed.ResultsA total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721–4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133–52.984) and 15.24 (95%CI = 10.114–22.919).ConclusionThese findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting.

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A imunização é reconhecida como uma das intervenções mais bem-sucedidas e custo-efetivas, resultando na erradicação e no controle de diversas doenças em todo o mundo. Todavia, uma preocupante redução na cobertura vacinal tem sido observada no Brasil, trazendo o recrudescimento de algumas doenças até então superadas. Dessa forma, no intuito de realizar um diagnóstico situacional que pondere as diferentes regiões do país e a tendência temporal de cobertura vacinal, o presente estudo teve o objetivo de evidenciar áreas com queda da cobertura vacinal de BCG, poliomielite e tríplice viral no Brasil por meio de um estudo ecológico que coletou informações acerca do número crianças de até um ano de idade imunizadas para essas três vacinas, no período entre 2006 e 2016, por município brasileiro. Os dados foram adquiridos por meio do Departamento de Informática do SUS. Foi realizada uma varredura espacial, analisando as variações espaciais nas tendências temporais de cobertura vacinal. Foi observada uma tendência de redução no número de imunizações no Brasil, com quedas de 0,9%, 1,3% e 2,7% ao ano para BCG, poliomielite e tríplice viral, respectivamente. Ademais, aglomerados significativos com tendências temporais de redução da cobertura vacinal foram verificados em todas as cinco regiões brasileiras. O estudo evidencia uma importante redução na cobertura vacinal nos últimos anos, constatando heterogeneidades consideráveis entre os municípios. Dessa forma, uma atenção singular e planejamento estratégico condizente com as características de cada localidade são necessários para o controle tanto da redução de cobertura vacinal como do reaparecimento de doenças no Brasil.

Objective: To describe the evaluation of the Virtual Learning Environment of TelEduc in teaching endocrine physiology for graduates of a nursing degree course at a public university in the state of Sao Paulo. Methods: Cross-sectional, descriptive study with quantitative analysis of data and a sample of 44 students. To collect data, we used an instrument that included educational aspects of the virtual learning environment: content, interaction and activities, and technical aspects: response time and quality of the interface. Results: In the evaluation of students, data indicated that for the majority of responses obtained, the items included the following characteristics: content (84.0%), interaction (83.2%), activities (89.3%), response time (94.0%), and interface quality (95.8%). Conclusion: The virtual learning environment, TelEduc, proved to be an effective tool to support the teaching of Endocrine Physiology. Keywords: Students, nursing; Physiology/education; Educational technology; Nursing education; Informatics in nursing RESUMOObjetivo: Descrever a avaliação do Ambiente Virtual de Aprendizagem do TelEduc no ensino de Fisiologia Endócrina por graduandos de enfermagem de um Curso de Licenciatura em Enfermagem de uma universidade pública do interior do Estado de São Paulo. Métodos: Estudo descritivo, transversal com análise quantitativa de dados e com amostra de 44 alunos. Para a coleta de dados, utilizou-se um instrumento que contemplava aspectos pedagógicos do ambiente virtual de aprendizagem: conteúdo, interação e atividades e aspectos técnicos: tempo de resposta e qualidade da interface. Resultados: Na avaliação dos alunos, os dados apontaram que, na maioria das respostas obtidas, foi explicitado o atendimento dos itens compreendidos nas seguintes características: conteúdo (84,0%), interação (83,2%), atividades (89,3%), tempo de resposta (94,0%) e qualidade da interface (95,8%). Conclusão: O ambiente virtual de aprendizagem do TelEduc mostrou-se uma ferramenta eficaz para apoiar o ensino de Fisiologia Endócrina. Descritores: Estudantes de enfermagem; Fisiologia/educação; Tecnologia educacional; Educação em enfermagem; Informática em enfermagem RESUMEN Objetivo: Describir la evaluación del Ambiente Virtual de Aprendizaje del TelEduc en la enseñanza de la Fisiología Endocrina por graduandos de enfermería de un Curso de Licenciatura en Enfermería de una universidad pública del interior del Estado de Sao Paulo. Métodos: Estudio descriptivo, transversal con análisis cuantitativa de datos, realizado con una muestra de 44 alumnos. Para la recolección de los datos, se utilizó un instrumento que contemplaba aspectos pedagógicos del ambiente virtual de aprendizaje: contenido, interacción y actividades y aspectos técnicos: tiempo de respuesta y calidad de la interfase. Resultados: En la evaluación de los alumnos, los datos apuntaron que, en la mayoría de las respuestas obtenidas, fue explicitada la atención de los items comprendidos en las siguientes características: contenido (84,0%), interacción (83,2%),...

HLA-G is expressed in skin biopsies from patients with SSc, and this is associated with a better disease prognosis. This suggests a modulatory role of HLA-G in SSc, as observed in other skin disorders.

Human leukocyte antigen-G (HLA-G) is a non-classical major histocompatibility complex (MHC) class Ib molecule predominantly expressed in cytotrophoblasts, where it acts as a specific immunosuppressor. Literature data have shown that grafts in some settings, such as cardiac and liver/kidney-associated transplantations, express HLA-G and this expression is associated with less severe rejection and also reduces the incidence of rejection. Fourteen-base pair deletion/insertion polymorphism has been reported in exon 8 of the 3'-untranslated region of HLA-G. This polymorphism within exon 8 of the HLA-G gene might influence transcription activity, which in turn may influence the stability of HLA-G transcripts. This influences the stability of the HLA-G protein and therefore is of potential functional relevance. In order to determine a possible correlation between the 14-bp insertion/deletion polymorphism and kidney allograft outcome, we isolated genomic DNA from 83 patients who had received isolated kidney allografts, and we classified the 83 specimens into two groups, grafts presenting Banff features of rejection group and a non-rejection group, and compared them with a control group of 97 healthy subjects. The 14-bp polymorphism at exon 8 was genotyped in all groups. There was no significant difference in allelic frequencies of 14-bp insertion/deletion polymorphism between normal controls and kidney transplant patients. In the RG, the homozygous genotype +14/+14 bp (P = 0.0238) was significantly increased in the group with acute rejection compared with the healthy control group. Analysis of other HLA-G polymorphisms and functional studies on immune regulation are essential to elucidate the role of HLA-G in kidney allografts.

BackgroundIn Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the “Pact for life” (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income.Methodology/Principal FindingsA cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community.Conclusions/SignificanceThe patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem.