Abstract Background Professional soccer athletes are exposed to repetitive head impacts and are at risk of developing chronic traumatic encephalopathy. Objective To evaluate regional brain glucose metabolism (rBGM) and gray matter (GM) volume in retired soccer players (RSPs). Methods Male RSPs and age and sex-matched controls prospectively enrolled between 2017 and 2019 underwent neurological and neuropsychological evaluations, brain MRI and [18F]FDG-PET in a 3.0-Tesla PET/MRI scanner. Visual analysis was performed by a blinded neuroradiologist and a blinded nuclear physician. Regional brain glucose metabolism and GM volume were assessed using SPM8 software. Groups were compared using appropriate statistical tests available at SPM8 and R. Results Nineteen RSPs (median [IQR]: 62 [50–64.5] years old) and 20 controls (60 [48–73] years old) were included. Retired soccer players performed worse on mini-mental state examination, digit span, clock drawing, phonemic and semantic verbal fluency tests, and had reduced rBGM in the left temporal pole (pFDR = 0.008) and the anterior left middle temporal gyrus (pFDR = 0.043). Semantic verbal fluency correlated with rBGM in the right hippocampus, left temporal pole, and posterior left middle temporal gyrus (p ≤ 0.042). Cray matter volume reduction was observed in similar anatomic regions but was less extensive and did not survive correction for multiple comparisons (pFDR ≥ 0.085). Individual [18F]FDG-PET visual analysis revealed seven RSPs with overt hypometabolism in the medial and lateral temporal lobes, frontal lobes, and temporoparietal regions. Retired soccer players had a higher prevalence of septum pellucidum abnormalities on MRI. Conclusion Retired soccer players had reduced rBCM and CM volume in the temporal lobes and septum pellucidum abnormalities, findings possibly related to repetitive head impacts.

Resumo Antecedentes Jogadores profissionais de futebol estão expostos a impactos cranianos repetitivos e ao risco de desenvolver encefalopatia traumática crônica. Objetivo Avaliar o metabolismo glicolítico cerebral regional (MCCr) e o volume de substância cinzenta (vSC) em jogadores de futebol aposentados (JFAs). Métodos Jogadores de futebol aposentados masculinos e controles pareados por idade e sexo foram incluídos prospectivamente entre 2017 e 2019. Foram realizadas avaliações neurológica e neuropsicológica, ressonância magnética (RM) e [18F]FDG-PET cerebrais (3.0-Tesla PET/RM). As imagens foram analisadas visualmente por um neurorradiologista e um médico nuclear cegos ao grupo de cada participante. O metabolismo glicolítico cerebral regional e o vSC foram avaliados através do programa SPM8. Os grupos foram comparados através de testes estatísticos apropriados disponíveis em SPM8 e R, de acordo com a distribuição e o tipo dos dados. Resultados Dezenove JFAs (mediana [IIQ]: 62 [50–64.5] anos) e 20 controles (60 [48–73] anos) foram incluídos. Os JFAs tiveram pior desempenho no mini-exame do estado mental e nos testes de dígitos, desenho do relógio, fluência verbal e fluência semântica e apresentaram MCCr significativamente reduzido no polo temporal e no giro temporal médio anterior esquerdos. Fluência semântica (animais) apresentou correlação positiva com MCCr no hipocampo direito, no polo temporal esquerdo e no aspecto posterior do giro temporal médio esquerdo. Menor vSC foi observado nas mesmas regiões, porém este achado não sobreviveu à correção para comparações múltiplas. Análise individual do [18F]FDG-PET cerebral revelou sete JFAs com claro hipometabolismo nas faces medial e lateral dos lobos temporais, nos lobos frontais e nas regiões temporoparietais. Os JFAs apresentaram ainda maior prevalência de anormalidades do septo pelúcido. Conclusão Os JFAs apresentam MCCr e vSC reduzidos nos lobos temporais, além de anormalidades do septo pelúcido, achados possivelmente relacionados a impactos cranianos repetitivos.

Abstract Introduction: cystic fibrosis is a disease that causes inflammation, oxidative stress and metabolic changes that lead to nutrient deficiency, such as vitamin D deficiency. On the other hand, it is suggested that vitamin D has anti-inflammatory and antioxidant actions. Objective: to evaluate the prevalence of hypovitaminosis D and the association between serum 25 hydroxyvitamin D levels with markers of oxidative stress and inflammation in patients with cystic fibrosis. Method: a cross-sectional study was carried out with 48 patients with cystic fibrosis including children, adolescents and adults in the northeast region of Brazil. Blood collection was performed for analysis of 25-hydroxyvitamin D, calcium, parathyroid hormone, inflammatory process (C-reactive protein [CRP] and alpha-1-acid glycoprotein-A1 [A1GPA]) and oxidative stress (malondialdehyde (MDA) and total antioxidant capacity [CAOT]). The statistical analysis was performed using the "Statistical Package for the Social Sciences", adopting a significance level of p < 0.05. Results: vitamin D insufficiency/deficiency was found in 64.6 % of patients. After multiple linear regression analysis, MDA showed an inverse association with blood values of 25-hydroxyvitamin D (p < 0.05) conditioned by the presence of inflammatory process markers. When only oxidative stress was evaluated, this association disappeared. Conclusion: in conclusion, there was a high prevalence of hypovitaminosis D, with 25(OH)D levels associated with greater oxidative stress when combined with inflammatory markers. Improved vitamin D levels may be an alternative to reduce the damage caused by excess oxidative stress and inflammation in CF patients.

Resumen Introducción: la fibrosis quística es una enfermedad que cursa con inflamación, estrés oxidativo y cambios metabólicos que conducen a deficiencia de nutrientes como la vitamina D. Por otro lado, se sugiere que la vitamina D tiene acción antiinflamatoria y antioxidante. Objetivo: evaluar la prevalencia de hipovitaminosis D y la asociación entre los niveles séricos de 25 hidroxivitamina D con los marcadores de estrés oxidativo e inflamación en pacientes con fibrosis quística. Método: estudio transversal realizado con 48 pacientes con fibrosis quística, niños, adolescentes y adultos, de la región nordeste de Brasil. Se realizó una extracción de sangre para el análisis de 25-hidroxivitamina D, calcio, hormona paratiroidea, proceso inflamatorio (proteína C-reactiva [PCR] y alfa-1-glucoproteína ácida-A1 [A1GPA]) y estrés oxidativo (malondialdehído [MDA] y capacidad antioxidante total [CAOT]). El análisis estadístico se realizó utilizando el "Paquete Estadístico para las Ciencias Sociales", adoptando un nivel de significancia de p < 0,05. Resultados: se encontró insuficiencia/deficiencia de vitamina D en el 64,6 % de los pacientes. Después de un análisis de regresión lineal múltiple, la MDA mostró una asociación inversa con los valores sanguíneos de 25-hidroxivitamina D (p < 0,05) condicionado a la presencia de marcadores de proceso inflamatorio; cuando solo se evalúa el estrés oxidativo, esta asociación desaparece. Conclusión: en conclusión, hubo una alta prevalencia de hipovitaminosis D, con niveles de 25(OH)D asociados a mayor estrés oxidativo cuando se combina con marcadores inflamatorios. La mejora de los niveles de vitamina D puede ser una alternativa para reducir el daño causado por el exceso de estrés oxidativo y la inflamación en pacientes con FQ.

ABSTRACT Vulnerable populations, such as migrants and refugees, have an increased risk of tuberculosis disease, especially in the first years after arrival in the host country. The presence of migrants and refugees in Brazil exponentially grew over the period between 2011 and 2020, and approximately 1.3 million migrants from the Global South were estimated to be residing in Brazil, most of whom from Venezuela and Haiti. Tuberculosis control programs for migrants can be divided into pre- and post-migration screening strategies. Pre-migration screening aims to identify cases of tuberculosis infection (TBI) and can be carried out in the country of origin (pre-entry) or in the destination country (at entry). Pre-migration screening can also detect migrants at an increased risk of developing tuberculosis in the future. High-risk migrants are then followed up in post-migration screening. In Brazil, migrants are considered a priority group for the active search for tuberculosis cases. However, there is no recommendation or plan regarding screening for TBI in migrants and refugees. Ensuring prevention, diagnosis, and treatment for TBI and tuberculosis disease in migrant populations is an important aspect of tuberculosis control and elimination. In this review article, we address epidemiological aspects and access to health care for migrants in Brazil. In addition, the migration medical screening for tuberculosis was reviewed.

RESUMO Populações vulneráveis, como imigrantes e refugiados, apresentam maior risco de tuberculose doença, especialmente nos primeiros anos após a chegada ao país de acolhimento. A presença de imigrantes e refugiados no Brasil cresceu exponencialmente no período entre 2011 e 2020, sendo estimado que aproximadamente 1,3 milhão de imigrantes do Sul Global residiam no Brasil, a maioria proveniente da Venezuela e do Haiti. Os programas de controle da tuberculose para imigrantes podem ser divididos em estratégias de triagem pré- e pós-migração. A triagem pré-migração visa identificar casos de tuberculose infecção (TBI) e pode ser realizada no país de origem (pré-entrada) ou no país de destino (no momento da entrada). A triagem pré-migração também pode detectar imigrantes com maior risco de desenvolver tuberculose no futuro. Os imigrantes de alto risco são então acompanhados na triagem pós-migração. No Brasil, os imigrantes são considerados um grupo prioritário para a busca ativa de casos de tuberculose. No entanto, não há recomendação ou plano sobre triagem para TBI em imigrantes e refugiados. Garantir a prevenção, o diagnóstico e o tratamento da TBI e da tuberculose doença em populações imigrantes é um aspecto importante do controle e eliminação da tuberculose. Neste artigo de revisão, abordamos aspectos epidemiológicos e acesso à saúde para imigrantes no Brasil. Além disso, revisou-se a triagem médica de imigrantes para tuberculose.

Abstract Background The accuracy of the New York Heart Association (NYHA) classification to assess prognosis may be limited compared with objective cardiopulmonary exercise test (CPET) parameters in heart failure (HF). Objective To investigate the prognostic value of the NYHA classification in addition to Weber class. Methods Adult outpatients with HF undergoing CPET in a Brazilian tertiary care center were included. The physician-assigned NYHA class and the CPET-derived Weber class were stratified into “favorable” (NYHA I or II; Weber A or B) or “adverse” (NYHA III or IV; Weber C or D). Patients with one favorable class and one adverse class were defined as “discordant.” The primary endpoint was time to all-cause mortality. A 2-sided p value < 0.05 was considered statistically significant. Results A total of 834 patients were included. Median age was 57 years; 42% (351) were female, and median left ventricular ejection fraction was 32%. Among patients with concordant NYHA and Weber classes, those with adverse NYHA and Weber classes had significantly higher all-cause mortality compared to those with favorable classes (hazard ratio [HR]: 5.65; 95% confidence interval [CI]: 3.38 to 9.42). Among patients with discordant classes, there was no significant difference in all-cause mortality (HR: 1.38; 95% CI: 0.82 to 2.34). In the multivariable model, increments in NYHA class (HR: 1.55 per class increase; 95% CI: 1.26 to 1.92) and reductions in peak VO 2 (HR: 1.47 per 3 ml/kg/min decrease; 95% CI: 1.28 to 1.70) significantly predicted mortality. Conclusions Physician-assigned NYHA class and objective CPET measures provide complementary prognostic information for patients with HF.

Resumo Fundamento A precisão da classificação da New York Heart Association (NYHA) para avaliar o prognóstico pode ser limitada em comparação com os parâmetros objetivos do teste de exercício cardiopulmonar (TECP) na insuficiência cardíaca (IC). Objetivo Investigar o valor prognóstico da classificação da NYHA e da classe Weber. Métodos Foram incluídos pacientes ambulatoriais adultos com IC submetidos a TECP em um centro terciário brasileiro. A classe NYHA atribuída pelo médico e a classe Weber derivada do TECP foram estratificadas como “favorável” (NYHA I ou II com Weber A ou B) ou “adversa” (NYHA III ou IV com Weber C ou D). Pacientes com uma classe favorável e uma classe adversa foram definidos como “discordantes”. O desfecho primário foi o tempo para mortalidade por todas as causas. Um valor de p bilateral < 0,05 foi considerado estatisticamente significativo. Resultados Foram incluídos 834 pacientes. A mediana de idade foi de 57 anos; 42% (351) eram do sexo feminino e a mediana da fração de ejeção do ventrículo esquerdo foi de 32%. Entre os pacientes com classes NYHA e Weber concordantes, aqueles com classes NYHA e Weber adversas tiveram mortalidade por todas as causas significativamente maior em comparação com aqueles com classes favoráveis ( hazard ratio [HR]: 5,65; intervalo de confiança de 95%: 3,38 a 9,42). Entre os pacientes com classes discordantes, não houve diferença significativa na mortalidade por todas as causas (HR: 1,38; intervalo de confiança de 95%: 0,82 a 2,34). No modelo multivariado, incrementos na classe NYHA (HR: 1,55 por aumento na classe; intervalo de confiança de 95%: 1,26 a 1,92) e reduções no VO 2 pico (HR: 1,47 por diminuição de 3 ml/kg/min; intervalo de confiança de 95%: 1,28 a 1,70) previu significativamente a mortalidade. Conclusões A classe NYHA atribuída pelo médico e as medidas objetivas do TECP fornecem informações prognósticas complementares para pacientes com IC.

ABSTRACT The objective of this work was to produce and characterize biochar from sugarcane straw, as well as to investigate possible phytotoxic effects on the germination of cotton, maize, and soybean. To this end, the biochar was produced in a double-drum oven and characterized by different techniques. The germination trials were conducted in vitro, with biochar doses varying between 0 and 100 t/ha. The biochar was obtained with a yield of 40%, pH equal to 9.10, electrical conductivity of 2.22 dS/m and specific surface area of 20.3 m2/g. The elemental analysis showed H/C and O/C atomic ratios of 0.41 and 0.21, respectively. The FTIR showed the presence of C=C groups, while SEM/EDS showed a honeycomb porous structure and nutrients such as Mg, K and Ca. The germination test classified the biochar as a phytonutrient for corn and showed no phytotoxicity for soybeans. On the other hand, for cotton, the highest doses (50 and 100 t/ha) caused phytotoxicity. The results of this work meet the global demands for green techniques. Biochar made from sugarcane straw is a promising technology to improve the infertility of poor soils and manage carbon sequestration.

RESUMO O objetivo deste trabalho foi produzir e caracterizar o biocarvão a partir da palha de cana-de-açúcar, bem como investigar possíveis efeitos fitotóxicos às germinações de algodão, milho e soja. Para tanto, o biocarvão foi produzido em forno de duplo tambor e caracterizado por diferentes técnicas. Os ensaios de germinação foram conduzidos in vitro, com doses de biocarvão variando entre 0 e 100 t/ha. O biocarvão foi obtido com rendimento de 40%, pH igual a 9,10, condutividade elétrica de 2,22 dS/m e área superficial específica de 20,3 m2/g. A análise elementar mostrou razões atômicas H/C e O/C de 0,41 e 0,21, respectivamente. A FTIR mostrou a presença de grupos C=C, enquanto a MEV/EDS mostrou estrutura porosa tipo favo de mel e nutrientes, como o Mg, K e Ca. O ensaio de germinação classificou o biocarvão como fitoestimulante para o milho e mostrou ausência de fitotoxicidade para soja. Por outro lado, para o algodão, as doses mais elevadas (50 e 100 t/ha) causaram fitotoxicidade. Os resultados deste trabalho vêm ao encontro das demandas globais por técnicas verdes. O biocarvão feito da palha de cana-de-açúcar é uma tecnologia promissora para melhorar a infertilidade de solos pobres e gerir o sequestro de carbono.

ABSTRACT. The intergovernmental panel on climate change predicts a progressive increase in atmospheric CO2 concentration and temperature; however, their effects on cereals have been shown for a limited number of species. This study evaluates the effects of increased CO2 concentration and temperature separately and combined on millet growth and grain production in open-top chambers where the microclimate was adjusted to the following conditions: ambient CO2 and temperature; CO2 enriched (~ 800 ppm) and ambient temperature; ambient CO2 and higher temperature (+3ºC); and CO2-enriched and higher temperature. For each treatment, two chambers were used, each containing 15 7 L pots. Each pot received five seeds at the beginning of the experiment and thinning to one plant per pot at 15 days after sowing. Ten plants were harvested from each chamber 65 days after sowing and the plant height, the number of leaves and the longest root length as well as shoot and root biomass were measured. The remaining plants were harvested 130 days after sowing to evaluate grain production. The results indicate that high CO2 levels did not affect plant growth and biomass. On the other hand, plants subjected to high temperature grew 7% taller than those grown under ambient temperature. Contrastingly, plants submitted to both elevated CO2 and temperature were 19% taller and had 22% more shoot biomass than plants under ambient CO2 and temperature. However, grain production did not change in any of the environmental conditions. We provide evidence that millets are tolerant of the predicted climate changes and that grain production potential may not be affected.

ABSTRACT. Signal grass (Urochloa decumbens) and guinea grass (Megathyrsus maximus) are African grasses that are well established in the Brazilian Savannah and we tested their adaptation to different light intensity. Plants were grown for 45 days under 0% shade (full sun) and 25, 40, and 80% induced shade to evaluate their photosynthetic performance. Light curves showed higher values of electron transport rate, photochemical quenching, and effective quantum yield in plants subjected to 0 and 25% shade for signal grass and in 25 and 40% shade for guinea grass. The potential quantum yield evaluations revealed that signal grass felt the effects of excessive light around 11:30 am on plants subjected to 0 and 25% shade. Conversely, guinea grass showed these photoinhibition effects at the same shade level but in a longer time range (9:30 am to 1:30 pm). As shade increased, there was a reduction tendency of the pigment content in signal grass and the opposite was observed for guinea grass. Stomatal conductance showed different values during the day and among different shade levels and there were no differences in relative water content between treatments and species. Results indicated better photosynthetic performance for signal grass under high intensity and better photosynthetic performance for guinea grass subjected to intermediate and higher levels of shade. Altogether, the results indicate that guinea grass seems to be a more appropriate choice for silvopasture systems.

ABSTRACT Background: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant was detected in the psychiatric ward of a general hospital in Brasília, Brazil. Methods: We report the investigation, clinical outcomes, viral sequencing, and control measures applied to outbreak containment. Results: The overall attack rate was 95% (23/24) in a period of 13 days. Among the cases, 78% (18/23) were vaccinated and 17% (4/23) required intensive care. The Omicron variant was isolated from the 19 sequenced samples. Conclusions: The findings highlight the potential harm that highly transmissible variants may generate among hospitalized populations, particularly those with comorbidities.

Resumo Este artigo busca analisar diferenças nas condições de vida e saúde das professoras principais provedoras do domicílio em comparação às coprovedoras, durante a pandemia de Covid-19. Trata-se de estudo transversal realizado em 2020, por meio de formulário on-line enviado aos professores da rede estadual de Minas Gerais. A variável dependente foi ser ou não a principal provedora da família (principal provedora vs. coprovedora) e as independentes foram agrupadas em sociodemográficas, ocupacionais, situação de saúde e comportamentos. Analisaram-se dados somente das mulheres e estimou-se a regressão logística. Entre as 12.817 professoras participantes, 47,2% declararam-se principais provedoras. Dentre elas, observou-se predomínio de mulheres mais velhas, que viviam sem companheiro(a), com filhos(as) e, no geral, apresentavam características que retrataram pior condição socioeconômica, maior acúmulo de trabalho e comportamentos menos saudáveis. Os resultados permitiram identificar desvantagens nas condições de vida e saúde das professoras principais provedoras financeiras de suas famílias em comparação às coprovedoras.

Abstract The objective was to analyze differences in living and health conditions of teachers who are the main providers for their household compared to co-providers during the COVID-19 pandemic. The cross-sectional study was carried out in 2020, through an online form sent to teachers of public schools in the state of Minas Gerais, Brazil. The dependent variable was whether or not they were their family’s main provider (main provider vs. co-provider) and independent variables were grouped into sociodemographic, occupational, health status and behaviors. Only women’s data were analyzed and logistic regression was estimated. Among the 12,817 participating female schoolteachers, 47.2% declared to be the main providers. In this subgroup, there was a predominance of older women, who lived without a partner, with children and, in general, these teachers presented worse socioeconomic conditions, greater accumulation of work and less healthy behaviors. The results of the present study allow to identify disadvantages in living and health conditions of female schoolteachers who are the main financial providers of their families compared to co-providers.

Resumen El objetivo fue analizar las diferencias en las condiciones de vida y salud entre las profesoras que son las principales proveedoras del hogar y las coproveedoras, durante la pandemia de COVID-19. Estudio transversal realizado en 2020, a través de un formulario en línea enviado a profesoras de escuelas públicas del estado de Minas Gerais, Brasil. La variable dependiente fue ser o no la proveedora principal de la familia (proveedora principal versus coproveedora) y las variables independientes se agruparon en sociodemográficas, ocupacionales, sanitarias y conductuales. Solo se analizaron los datos de las mujeres y se estimó una regresión logística. Entre las 12.817 maestras participantes, el 47,2 % se declaró proveedora principal. En este subgrupo predominaron las mujeres mayores, que vivían sin pareja, con hijos y, en general, estas profesoras tenían características que retrataban una peor condición socioeconómica, mayor acumulación de trabajo y conductas menos saludables. Los resultados del presente estudio permiten identificar desventajas en las condiciones de vida y salud de las profesoras de escuela que son las principales proveedoras económicas de sus familias en comparación con las coproveedoras.

The aim of this paper was to determine the influence of machining parameters on the surface layer, and consequently on the electrochemical properties, of ASTM F138 austenitic stainless steels. Eight different surface conditions were generated in cylindrical samples by turning and polishing. The surface was characterized by surface roughness Ra and Rt, Vickers microhardness and microstructural characteristics. Cyclic voltammetric tests were performed to evaluate the potential of repassivation and pitting. The surfaces were analyzed by Scanning Electron Microscopy after the electrochemical tests were performed. The cutting parameters were identified to have a significant influence, and the feed rate was as influential as the depth of cut. The use of polishing alone is not sufficient to ensure that a surface has good surface integrity. Even with the polishing application, usually used to produce prostheses, a significant reduction in corrosion resistance occurs if care is not taken to minimize surface machining damage. Corrosion resistance is lower and pitting nucleation is higher in the samples with no polishing and with more severe machining parameters. The tests indicated that softer machining parameters can contribute to an increase in the life of implantable components, reducing the probability of localized corrosion, as well as improving the mechanical properties of prostheses.

Resumo O objetivo do estudo foi avaliar as cantinas localizadas em diferentes tipos de escolas, de diferentes redes de ensino, tipos de administração e com a presença de profissional técnico em relação às boas práticas de higiene. O estudo observacional foi realizado em 111 cantinas, 35 de escolas particulares e 76 públicas de Curitiba/PR, Brasil. Uma lista de verificação, baseada na legislação nacional e internacional de boas práticas de higiene, foi elaborada e aplicada durante a rotina de trabalho. Juntamente com a lista, foram levantadas informações sobre o tipo de administração e a presença de um profissional técnico (nutricionista) nas cantinas. A maioria das cantinas escolares foi classificada como Regular, com 50% e 69% de adequação em relação às boas práticas de higiene. Os critérios mais insatisfatórios foram: controle da temperatura dos alimentos, treinamento de manipuladores de alimentos e Manual de Boas Práticas de Higiene e Procedimentos Operacionais Padrão. As cantinas de escolas particulares foram melhores que as de escolas públicas na maioria das categorias avaliadas (p <0,05). Além disso, as cantinas terceirizadas e com responsável técnico (nutricionista) (p <0,01) obtiveram os melhores resultados. Isso mostra a necessidade de as cantinas de escolas públicas com sistemas de autogestão e sem profissional técnico reavaliarem os critérios sanitários e implementar novas estratégias, para melhorar os procedimentos de controle da temperatura dos alimentos, treinamento para manipuladores de alimentos e elaboração do Manual de Boas Práticas de Higiene e dos Procedimentos Operacionais Padrão. A melhoria desses procedimentos ajudará no melhor controle da segurança dos alimentos e na prevenção de doenças na população estudantil, contribuindo para a promoção da saúde no ambiente escolar.

Abstract The aim of the study was to evaluate the school canteens located within different types of schools, together with their types of administration and the presence of a technical professional regarding Good Hygiene Practices (GHPs). The observational study was conducted in 111 school canteens, 35 from private and 76 public schools in Curitiba, Brazil. A checklist based on national and international legislation on good hygiene practices -GHP was elaborated and applied during the work routine. With the list, the information was gathered about the type of administration and the presence of a technical professional (nutritionist) in these canteens. Most school canteens were classified as Regular, comprising between 50% and 69% of adequate assessment in relation to GHPs. The most unsatisfactory criteria were related to food temperature control, training of food handlers and Manual of GHPs and Standard Operating Procedures (SOP). Private school canteens were better classified than public school canteens in most of the categories evaluated (p < 0.05). In addition, the school canteens that have been outsourced and have also had a person technically responsible (nutritionist) (p < 0.01) presented the best results. This shows the need for the public school canteens with self-management systems and no technical professional to re-evaluate the sanitary criteria and to implement new strategies, as well as improving procedures for food temperature control, training of food handlers and elaboration of Manual of GHPs and SOP. Improvement with respect to these procedures will assist in better control of food safety and prevent diseases in the student population, contributing to health promotion in the school environment.

BACKGROUND Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America. Etiological agents are Paracoccidioides species that diverge phylogenetically throughout South America. OBJECTIVES This study aimed to document the epidemiology of PCM in Venezuela. METHODS We have performed a retrospective cross-sectional descriptive study in 31,081 clinical records of patients from two reference centres during 65 years (1954-2019). FINDINGS PCM diagnosis was confirmed in 745 patients. Chronic PCM was the most prevalent form (90.06% cases); 80.67% were male and the most affected age range was 41-60. Farming and construction were the most prevalent occupation and Miranda State had a higher prevalence. Lung and skin were the most affected organs, followed by oral manifestations. Direct examination, culture and serology showed a high sensibility, and no statistical difference was observed among the diagnostic tools. Out of 17 Paracoccidioides isolates genotyped from Venezuela, one was typed as Paracoccidioides americana and 16 as Paracoccidioides venezuelensis. MAIN CONCLUSIONS Clinical manifestations observed, information about the epidemiology and molecular profile is essential not only for diagnosis but also for understanding therapeutic responses to mycotic drugs and prognosis. Therefore, it is necessary to sequence all positive isolated strains in order to confirm the dominance of P. venezuelensis in Venezuela.

Resumo Este estudo de caso buscou traçar o perfil socioeconômico de participantes de ensaios clínicos em centro de pesquisa brasileiro, analisando suas decisões, motivações e experiências, seu conhecimento sobre riscos, benefícios e cuidados dispensados e o processo de consentimento. Dados de 327 participantes foram coletados, realizando-se entrevistas semiestruturadas com 19 deles. Nas pesquisas executadas no centro estudado houve maior participação de homens, de pessoas com poucos anos de estudo formal e de baixa renda. A maioria é aposentada, não tem assistência privada à saúde e tende a não perceber os efeitos da investigação ou superestimar os benefícios médicos diretos. A busca pelo tratamento médico foi o principal fator que influenciou suas decisões/participação, e a assinatura do termo de consentimento livre e esclarecido não garantiu a expressão da autonomia. Conclui-se que o perfil e o conteúdo dos discursos dos participantes são sensíveis indicadores de vulnerabilidade e desigualdade social.

Abstract This case study aimed to trace the socioeconomic profile of participants in clinical research at a Brazilian research center, analyzing their decisions, motivations, experiences, knowledge of risks, benefits and health care provided, and the consent process. The data of 327 participants were collected, and semi-structured interviews conducted with 19 of them. In the research carried out at the center studied there was a greater participation of men and of people with few years of formal education and low income. Most are retired and have no private health plan, tend not to notice the effects of the investigation, or to overestimate its direct medical benefits. The search for medical treatment was the main factor influencing their decisions/participation, and signing the informed consent form did not guarantee the expression of autonomy. We concluded that the participants’ profile and speeches content are sensitive indicators of vulnerability and social inequality.

Resumen Este estudio de caso trató de esbozar el perfil socioeconómico de participantes de ensayos clínicos en un centro de investigación brasileño, analizando sus decisiones, motivaciones y experiencias, su conocimiento sobre los riesgos, beneficios y cuidados prestados y el proceso de consentimiento. Se recopilaron datos de 327 participantes y se realizaron entrevistas semiestructuradas con 19 de ellos. En las investigaciones realizadas en el centro estudiado hubo una mayor participación de hombres, de personas con pocos años de educación formal y con bajos ingresos. La mayoría es jubilada y no tiene asistencia sanitaria privada, tiende a no percibir los efectos de la investigación o a sobrestimar los beneficios médicos directos. La búsqueda de tratamiento médico fue el factor principal que influyó en sus decisiones/participación, y la firma del término de consentimiento libre e informado no garantizó la expresión de la autonomía. Se concluye que el perfil y el contenido de los discursos de los participantes son sensibles indicadores de vulnerabilidad y desigualdad social.