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RESUMO A população LGBTQIA+ tem demandas de saúde específicas, implicando ações diferenciadas. A Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais, Travestis e Transexuais (PNSI-LGBT) reafirma o compromisso do Sistema Único de Saúde com a universalidade, a integralidade e a equidade. Objetivou-se avaliar o acesso ao acolhimento à população LGBTQIA+ por parte dos profissionais de saúde de um Centro Municipal de Saúde na cidade do Rio de Janeiro. Foi realizado um estudo descritivo, de forma participativa, empregando o método qualitativo. Para tanto, 60 profissionais participaram de rodas de conversa presenciais e responderam a um questionário on-line. A maioria (85%) dos participantes considera a população LGBTQIA+ vulnerável. Apesar de a maior parte não relatar dificuldades no acolhimento dessa população, mais da metade considera que não há treinamento e/ou capacitação apropriados. Foi identificado pelos profissionais que as maiores barreiras de acesso não foram as geográficas, e sim as dos próprios profissionais e usuários, indicando a fragilidade do vínculo. Para a melhoria do acesso ao acolhimento, processos de treinamento/capacitação dos trabalhadores são necessários. A discussão sobre o processo de saúde e doença da população LGBTQIA+ também requer a compreensão dos conceitos de orientação sexual e identidade de gênero, de modo que facilite as ações de aceitabilidade e acessibilidade por parte dos profissionais de saúde.

Abstract Medicinal plants are an integrative and complementary health practice widely used by the population. However, its use is not without risks. This study assessed the profile and associated factors with the traditional use of medicinal plants. To this end, a cross-sectional survey study was conducted in a southeastern Brazilian city. Descriptive analysis was performed by frequency distribution and median and interquartile range. Associated factors with the use of medicinal plants were analyzed using Poisson regression with robust variance. A total of 641 people were interviewed, of whom 258 (40.2%) reported using medicinal plants. A total of 79 distinct plants were identified, of whom Melissa officinalis (31.0%), Peumus boldus (24.4%), Mentha spicata (20.9%), Matricaria recutita L. (18.2%), Rosmarinus officinalis (17.0%), and Foeniculum vulgare (14.7%) were the most used. There were no reports of medicinal plants used to treat COVID-19. However, anxiety was the most frequently cited indication for using medicinal plants, a health condition exacerbated by the COVID-19 pandemic. Furthermore, the use of medicinal plants for treating respiratory and gastrointestinal symptoms similar to those in COVID-19 has been identified. There was an association between the use of medicinal plants and females, non-white, lower schooling, higher income, and comorbidities.

Objetivo: avaliar a implementação, a utilização, o custo do tratamento por paciente-ano e o impacto orçamentário de infliximabe, vedolizumabe e tofacitinibe para o tratamento da retocolite ulcerativa moderada a grave no SUS. Métodos: Foi realizado um estudo de coorte retrospectiva por meio da Sala Aberta de Situação de Inteligência em Saúde, que é originada do Sistema de Informações Ambulatoriais do SUS. Foram incluídos to-dos os pacientes com CID-10 primário da retocolite ulcerativa e em uso de infliximabe, vedolizumabe ou tofacitinibe. O período de análise foi de maio de 2020 a dezembro de 2022. Resultados: Após a incorporação no SUS, o tempo para o início da disponibiliza-ção dos medicamentos variou de 7 a 20 meses. Infliximabe foi o mais utilizado (55%), mas vedolizumabe apresentou difusão mais rápida, com aproximadamente 60 novos pacientes por mês, seguido por infliximabe e tofacitinibe com cerca de 35 e 18 pacien-tes, respectivamente. Os preços unitários dos medicamentos foram inferiores aos pro-postos na incorporação, exceto pelo tofacitinibe na última aquisição. Em 2021, o custo por paciente-ano foi similar para infliximabe e vedolizumabe. Em 2022 o vedolizumabe teve o maior custo. O impacto orçamentário do infliximabe e vedolizumabe foi similar no primeiro ano da implementação e ambos tiveram impacto orçamentário menor que o estimado na incorporação. No segundo ano de implementação do infliximabe, o impacto orçamentário quase duplicou devido à maior difusão do medicamento. Conclusão: Essa análise apresenta dados de mundo real, verificando-se a importância do monitoramento das tecnologias incorporadas pelo SUS.

Desde o início do isolamento social motivado pela pandemia de COVID-19 em 2020, o ensino remoto tornou-se necessário para a continuidade das atividades educativas de vários níveis de ensino no Brasil, tendo as Tecnologias de Informação e Comunicação (TIC) como apoio para a interação e ensino-aprendizagem. Nesse contexto, o presente estudo busca discutir como a criação de uma disciplina remota de jogos para o ensino de ciências permite desenvolver discussões sobre ciência e questões sociais de maneira participativa na pós-graduação. Para isso, são apresentados diferentes fatores necessários ao melhor aproveitamento das disciplinas em ambientes digitais, além de critérios utilizados para a organização prévia das ferramentas. Como resultado, são apresentados os materiais e ferramentas formulados, além de feedbacks dos cursistas da disciplina ministrada entre agosto e outubro de 2020. Dessa forma, o estudo permite apontar estratégias não apenas para o ensino remoto, mas também a importância dos jogos como fenômeno tecnológico e cultural, e que permitem discutir diferentes questões sociais.

Introdução: A retocolite ulcerativa é uma condição inflamatória crônica imunomediada do intestino grosso que está frequentemente associada à inflamação do reto. Atualmente, os medicamentos infliximabe, vedolizumabe e tofacitinibe são disponibilizados pelo Sistema Único de Saúde (SUS) para os casos de dependência de corticoide apesar de dose adequada de azatioprina por um tempo mínimo de 12 semanas. Objetivo: Avaliar a implementação, a utilização, o custo do tratamento por paciente-ano e o impacto orçamentário de infliximabe, vedolizumabe e tofacitinibe para o tratamento da retocolite ulcerativa moderada a grave no SUS. Material e Método: Foi realizado um estudo de coorte retrospectiva por meio da Sala Aberta de Situação de Inteligência em Saúde (Sabeis), que é originada do Sistema de Informações Ambulatoriais do SUS (SIA/SUS). Foram incluídos todos os pacientes com CID-10 primário da retocolite ulcerativa e em uso de infliximabe, vedolizumabe ou tofacitinibe. O período de análise foi da implementação do infliximabe até dezembro de 2022. Resultados: Após a incorporação no SUS, os medicamentos foram disponibilizados em um período que variou de 7 a 20 meses. Foram atendidos 5.484 pacientes, sendo que 5.038 permaneceram em tratamento em 2022. O infliximabe foi o mais utilizado (55%), possivelmente por ser o primeiro implementado. No entanto, o vedolizumabe apresentou maior crescimento, com acréscimo de cerca de 60 pacientes por mês, seguido por infliximabe e tofacitinibe com cerca de 35 e 18 pacientes por mês, respectivamente (p

Background The aim of this study was to provide quantitative evidence of the use of polygenic risk scores for systematically identifying individuals for invitation for full formal cardiovascular disease (CVD) risk assessment. Methods and Results A total of 108 685 participants aged 40 to 69 years, with measured biomarkers, linked primary care records, and genetic data in UK Biobank were used for model derivation and population health modeling. Prioritization tools using age, polygenic risk scores for coronary artery disease and stroke, and conventional risk factors for CVD available within longitudinal primary care records were derived using sex‐specific Cox models. We modeled the implications of initiating guideline‐recommended statin therapy after prioritizing individuals for invitation to a formal CVD risk assessment. If primary care records were used to prioritize individuals for formal risk assessment using age‐ and sex‐specific thresholds corresponding to 5% false‐negative rates, then the numbers of men and women needed to be screened to prevent 1 CVD event are 149 and 280, respectively. In contrast, adding polygenic risk scores to both prioritization and formal assessments, and selecting thresholds to capture the same number of events, resulted in a number needed to screen of 116 for men and 180 for women. Conclusions Using both polygenic risk scores and primary care records to prioritize individuals at highest risk of a CVD event for a formal CVD risk assessment can efficiently prioritize those who need interventions the most than using primary care records alone. This could lead to better allocation of resources by reducing the number of risk assessments in primary care while still preventing the same number of CVD events.

ABSTRACT BACKGROUND: Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects multiple joints. It is associated with psoriasis and treated with synthetic and biologic drugs. OBJECTIVE: The objective of this study was to assess the outcomes of patients who received biologic therapy with tumor necrosis factor (TNF) inhibitors in terms of effectiveness, safety, functionality, and quality of life. DESIGN AND SETTING: A prospective observational study was performed at a single center in Belo Horizonte, Brazil. METHODS: Patients with PsA who received their first TNF inhibitor treatment were followed up for 12 months. Disease activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Clinical Disease Activity Index (CDAI). Functionality was measured using the Health Questionnaire Assessment (HAQ), and quality of life was evaluated using the European Quality of Life Five Dimensions (EQ-5D). Multiple linear regression was used to identify predictors of the clinical response at 12 months. RESULTS: A total of 143 patients treated with adalimumab or etanercept were evaluated. Most of the clinical measures were significantly improved at 12 months. However, 31%–51% of the patients did not achieve good clinical control. No differences were observed between adalimumab and etanercept, except for poor functionality at 12 months among patients treated with etanercept. The main predictors of a worse clinical response were female sex, etanercept use, poor functionality, or lower quality of life at baseline. The main adverse reactions were alopecia, headache, injection site reaction, sinusitis, flu, dyslipidemia, and infections. CONCLUSION: TNF inhibitor therapy was effective and safe. However, despite improvements in clinical measures, most patients did not achieve satisfactory control of the disease.

Objective: this study evaluated the biological therapy effects on disease activity, functionality, quality of life, drug survival, and safety of patients with psoriatic arthritis naïve and experienced in biological therapy. Methods: a oneyear prospective observational study was performed. The outcomes assessed were drug survival, disease activity, functionality, quality of life, and safety. Multiple linear regression was used to assess predictive factors for clinical response. Results: a total of 205 patients were included, 155 of whom were biologic naïve and 50 biologic experienced. Drug survival rate was greater for naïve patients than experienced patients at 6 months, but not at 12 months. Drug survival rates were 71.5% for naïve patients and 70.0% for experienced patients at 12 months. All clinical parameters improved for both biologic naïve and experienced patients. At 12 months, 63% of naïve patients and 52% of experienced patients had an improvement in their quality of life. Besides, 48% of naïve patients and 42% of experienced patients had an improvement in functionality. The axial disease improved in 67% of naïve individuals and 56% of experienced patients. Good control of peripheral disease was achieved by 49% of naïve patients and 44% of experienced patients. Female sex, use of etanercept or infliximab, and lower functionality or quality of life at baseline were the main predictors of poor clinical response. Conclusion: Patients’ health improved after starting biological therapy. In general, biologic experienced patients had more adverse reactions and lesser effectiveness.

Objetivo: identificar os sinais de maus tratos vividos por esse grupo etário. Métodos: trata-se de um estudo exploratório e descritivo, com abordagem qualitativa, realizado no município de Cajazeiras, Paraíba, Brasil. A coleta de dados compreendeu dois grupos a serem investigados: idosos que participavam de grupos de convivência e pessoas idosas residentes em Instituições de Longa Permanência. Resultados: Por meio da análise das falas dos idosos, emergiu a categoria “Vestígios de violência contra a pessoa idosa” e suas respectivas subcategorias: “Violência intrafamiliar”, “Conflitos de vizinhança” e “Violência Urbana”. Conclusão: percebe-se que os idosos são vulneráveis à violência, em que as características relacionadas a esta variam de acordo com o local no qual esses indivíduos estão inseridos.

ABSTRACT Objective To evaluate the therapeutic response (functionality) and its associated factors in patients on biological drugs on the Public Health System for treatment of rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Methods An open prospective cohort was carried out from 2011 to 2019, in Belo Horizonte (MG). Functionality was assessed using the Health Assessment Questionnaire Disability-Index at baseline, and after 6 and 12 months of follow-up. Factors associated with poor functionality were identified through logistic regression. Results The median Health Assessment Questionnaire Disability-Index at baseline was 1.5 (interquartile range of 0.8-1.9), with poor functionality observed in patients with rheumatoid arthritis. Improved functionality was seen at 6 months of treatment for the three diseases. The predictors of poor functionality at 6 months for psoriatic arthritis and ankylosing spondylitis were female sex, low education levels, and high disease activity; and for rheumatoid arthritis and psoriatic arthritis were female sex, advanced age, and high disease activity. In 12 months, the three diseases had predictors of worse functionality: female sex, low education, and high disease activity. Conclusion There was a significant improvement in functionality during the follow-up, with better response at 6 months of treatment. Poor functionality was observed in older, female patients, with low education and high disease activity.

Background: Conventional synthetic disease-modifying antirheumatic drugs are the first-line treatment to inhibit the progression of psoriatic arthritis. Despite their widespread clinical use, few studies have been conducted to compare these drugs for psoriatic arthritis.Methods: a longitudinal study was carried out based on a centered patient national database in Brazil. Market share of drugs, medication persistence, drug costs, and cost per response were evaluated.Results: a total of 1,999 individuals with psoriatic arthritis were included. Methotrexate was the most used drug (44.4%), followed by leflunomide (40.6%), ciclosporin (8.2%), and sulfasalazine (6.8%). Methotrexate and leflunomide had a greater market share than ciclosporin and sulfasalazine over years. Medication persistence was higher for leflunomide (58.9 and 28.2%), followed by methotrexate (51.6 and 25.4%) at six and 12 months, respectively. Leflunomide was deemed the most expensive drug, with an average annual cost of $317.25, followed by sulfasalazine ($106.47), ciclosporin ($97.64), and methotrexate ($40.23). Methotrexate was the drug being the lowest cost per response.Conclusion: Methotrexate had the best cost per response ratio, owing to its lower cost and a slightly lower proportion of persistent patients when compared to leflunomide. Leflunomide had a slightly higher medication persistence than methotrexate, but it was the most expensive drug.

Objectives: This retrospective observational cohort study aimed to characterise and compare the demographics, initial laboratory tests and outcomes between patients with large-joint bacterial septic arthritis (BSA) and tuberculous septic arthritis (TBSA). Methods: All patients with a culture from a large, native joint growing either non-mycobacterial bacteria or Mycobacterium tuberculosis between 1 January 2012 and 1 October 2018 in our institution were included. Clinical details and admission laboratory values were obtained from patient records. Comparisons were made by Mann-Whitney U, chi-squared tests, and logistic regression analysis. Results: We identified 64 BSA and 29 TBSA. On average, the BSA cases were older, had higher CRP levels and neutrophil counts and lower albumin levels. The odds ratio for having a BSA was 46 in cases with a CRP greater than 100 mg/L (95% confidence interval (CI) 8.5–850, p

Abstract Background Pharmaceutical Assistance (PA) is a dynamic and multidisciplinary process that aims to supply health systems, programs or services with quality medicines, enabling access and health care, in an efficient and timely manner. The objective of the study was to evaluate the profile of administrative processes for the treatment of PsA, identify the time elapsed in the flow of processes and its associated factors. Methods A cross-sectional study of medication requests for the treatment of PsA was carried out between November 2014 and December 2016. Linear regression was used to verify the factors associated with time to delivery. Results A total of 218 cases containing 250 drugs were analyzed. The median time between the medical appointment and the first dispensation was 66 days (interquartile range, 44–90). The State proceedings, which includes requesting the drug until the authorization of treatment, was the stage that most contributed to the total time spent. The factors associated with the longer time to delivery of medications were prescriptions coming from clinics and specialty centers, from dermatologists, non-authorized processes and non-persistent patients in the treatment in 12 months. Conclusion The median time to receive medicines for the PsA treatment in Belo Horizonte health region after a medical prescription was higher than 2 months. The time between the solicitation of the medicines and the authorization of the treatment in the SUS (State administrative procedure) was the main component of the total time spent.

Objectives We investigate the prevalence of unmet need arising from wait times, distance/transportation and financial affordability using the European Health Interview Survey. We explore associations between individual characteristics and the probability of reporting unmet need.Design Cross-sectional survey conducted between February and December 2014.Setting and participants 4004 members of the resident population in private households registered with the health insurance fund in Luxembourg aged 15 years and over.Outcome measures Six binary variables that measured unmet need arising from wait time, distance/transportation and affordability of medical, dental and mental healthcare and prescribed medicines among those who reported a need for care.Results The most common barrier to access arose from wait times (32%) and the least common from distance/transportation (4%). Dental care (12%) was most often reported as unaffordable, followed by prescribed medicines (6%), medical (5%) and mental health (5%) care. Respondents who reported bad/very bad health were associated with a higher risk of unmet need compared with those with good/very good health (wait: OR 2.41, 95% CI 1.53 to 3.80, distance/transportation: OR 7.12, 95% CI 2.91 to 17.44, afford medical care: OR 5.35, 95% CI 2.39 to 11.95, afford dental care: OR 3.26, 95% CI 1.86 to 5.71, afford prescribed medicines: OR 2.22, 95% CI 1.04 to 4.71, afford mental healthcare: OR 3.58, 95% CI 1.25 to 10.30). Income between the fourth and fifth quintiles was associated with a lower risk of unmet need for dental care (OR 0.29, 95% CI 0.16 to 0.53), prescribed medicines (OR 0.38, 95% CI 0.17 to 0.82) and mental healthcare (OR 0.17, 95% CI 0.05 to 0.61) compared with income between the first and second quintiles.Conclusions Recent and planned reforms to address waiting times and financial barriers to accessing healthcare may help to address unmet need. In addition, policy-makers should consider additional policies targeted at high-risk groups with poor health and low incomes.

Objetivo: identificar os sinais de maus tratos vividos por esse grupo etário. Métodos: trata-se de um estudo exploratório e descritivo, com abordagem qualitativa, realizado no município de Cajazeiras, Paraíba, Brasil. A coleta de dados compreendeu dois grupos a serem investigados: idosos que participavam de grupos de convivência e pessoas idosas residentes em Instituições de Longa Permanência. Resultados: Por meio da análise das falas dos idosos, emergiu a categoria “Vestígios de violência contra a pessoa idosa” e suas respectivas subcategorias: “Violência intrafamiliar”, “Conflitos de vizinhança” e “Violência Urbana”. Conclusão: percebe-se que os idosos são vulneráveis à violência, em que as características relacionadas a esta variam de acordo com o local no qual esses indivíduos estão inseridos.

Abstract Background The European Health Examination Survey in Luxembourg (EHES-LUX) is a population based survey performed from 2013 to 2015 with the aim to establish baseline information on the general health status of the Luxembourg population aged 25 to 64 years. The paper introduces the study design, recruitment method and representativeness of the sample, and summarizes the sociodemographic characteristics of participants and the prevalence of major health outcomes. Methods EHES-LUX is based on a random sample representative of the population of Luxembourg based on gender, age and district of residence. The sample size of the study was determined to provide accurate prevalence estimates for major chronic conditions. During two visits, data were collected from participants through a questionnaire (personal data, health status and health care), medical examinations (anthropometric measures, electrocardiogram and spirometry) and biological analysis (blood, urine and hair). Means and frequencies were used to describe the general characteristics of the population and a one-way ANOVA to test the representativeness of the sample and the comparability of participants and non-participants. Results A total of 1529 individuals participated in this study (participation rate of 24.1%). Differences between participants and non-participants based on gender, age and district of residence were corrected by sampling weights. The mean age (±SD) of participants was 44.9 (±10.1) years, of which 52.8% were women. Based on clinical measurements, nearly 20% of participants were obese and more than one in three participants were overweight. From measurements (respectively from self-report), 22.0% (respectively 12.2%) were hypertensive, 49.3% (respectively 22.5%) had hypercholesterolemia, 3.5% (respectively 3.7%) had diabetes and 7.6% (respectively 6.0%) had depressive symptoms. Conclusions This nationwide epidemiological study on the general health status of Luxembourg residents provides updated prevalence estimates on a range of major health conditions. This information can be used by health authorities to evaluate policies and public health initiatives. At European level, prevalence data obtained by this study following the EHES-Reference Committee (EHES-RC) recommendations, will be comparable between European countries participating in this program.

Introduction Age-related immunosenescence influences the presentation of tuberculosis (TB) in older patients. Here, we explore the clinical and radiological presentation of TB in the elderly and the factors associated with time to treatment for TB. Methods This is a retrospective cohort study comparing the clinical, radiological and demographic characteristics of TB patients aged ≥65 years with TB patients aged 18–64 years in a large cohort of TB patients in the UK. Factors associated with the time to presentation and time to treatment were identified using a multivariable analysis model. Results 1023 patients were included in the analyses: 679 patients aged 18–64 years and 344 patients aged ≥65 years. “Classical” symptoms of TB (cough, haemoptysis, fever, nights sweats and weight loss) were less common among older patients with pulmonary TB (PTB) (p

The aim of this study was to describe the baseline demographic and clinical characteristics as well as the functional status of a prospective cohort of patients with rheumatic diseases assisted by the Brazilian Public Health System (SUS). Data for 302 patients receiving tumor necrosis factor α inhibitors (anti-TNF agents) was collected through a standard form. Among patients, 229 (75.8%) were female and 155 (51.3%) were Caucasian; the mean age was 50.3 ± 12.8 years, and the mean disease duration was 9.9 ± 8.7 years. Among them 214 patients (70.9%) received adalimumab, 72 (23.8%) etanercept, and 16 (5.3%) infliximab. Mean Health Assessment Questionnaire-Disability Index (HAQ-DI) was 1.37 ± 0.67 for all participants. Poor functional response was associated with female gender, married patients and with a score of < 0.6 on the EuroQoL-5 dimensions (EQ-5D). Significant correlation was found between the HAQ-DI values, disease activity and quality of life (QOL). The results obtained in this study contribute to a better understanding of the clinical and demographic characteristics of patients with rheumatic diseases at the beginning of anti-TNF-agent treatment by SUS. Furthermore, our findings are consistent with another Brazilian and foreign cross-sectional investigations. This knowledge can be of great importance for further studies evaluating the effectiveness of biological agents, as well as, to contribute to improve the well-being of the patients with rheumatic diseases.

Dengue represents a serious threat to human health, with billions of people living at risk of the disease. Wolbachia pipientis is a bacterial endosymbiont common to many insect species. Wolbachia transinfections in mosquito disease vectors have great value for disease control given the bacterium's ability to spread into wild mosquito populations, and to interfere with infections of pathogens, such as dengue virus. Aedes fluviatilis is a mosquito with a widespread distribution in Latin America, but its status as a dengue vector has not been clarified. Ae. fluviatilis is also naturally infected by the wFlu Wolbachia strain, which has been demonstrated to enhance infection with the avian malarial parasite Plasmodium gallinaceum. We performed experimental infections of Ae. fluviatilis with DENV-2 and DENV-3 isolates from Brazil via injection or oral feeding to provide insight into its competence for the virus. We also examined the effect of the native Wolbachia infection on the virus using a mosquito line where the wFlu infection had been cleared by antibiotic treatment. Through RT-qPCR, we observed that Ae. fluviatilis could become infected with both viruses via either method of infection, although at a lower rate than Aedes aegypti, the primary dengue vector. We then detected DENV-2 and DENV-3 in the saliva of injected mosquitoes, and observed that injection of DENV-3-infected saliva produced subsequent infections in naïve Ae. aegypti. However, across our data we observed no difference in prevalence of infection and viral load between Wolbachia-infected and -uninfected mosquitoes, suggesting that there is no effect of wFlu on dengue virus. Our results highlight that Ae. fluviatilis could potentially serve as a dengue vector under the right circumstances, although further testing is required to determine if this occurs in the field.

Neste artigo, pretende-se investigar as práticas do coordenador pedagógico das escolas públicas e particulares de Campos dos Goytacazes, detectando o foco de sua atuação e uma delas é ser o elo integrador da ação que se concretiza no contexto educacional, bem como, refletir sobre os desafios e conflitos enfrentados na sua prática que permeiam o cotidiano deste profissional na comunidade escolar. O seu campo de atuação é muito amplo, envolvendo atividades relacionadas aos componentes curriculares, aprendizagem e construção de conhecimento, disciplina, ética, avaliação, materiais didáticos e a interação com a comunidade. Destaca-se também, a reflexão sobre o papel do Coordenador Pedagógico, pois é um profissional responsável por formar e manter a equipe escolar coesa, empenhada e firme no propósito assumido na proposta de trabalho da unidade escolar. Relata-se, ainda, questões sobre a função deste especialista junto ao corpo docente, acompanhando o professor em suas atividades de planejamento, docência e avaliação, no sentido de melhorar o processo de ensino aprendizagem. O relato das ações desencadeadas na escola está acompanhado dos principais requisitos pedagógicos que a equipe docente precisa para conquistar e obter um trabalho coerente e significativo. A significância deste projeto não pode ser alcançada de imediato, já que demanda sua aplicação, avaliação e permanente redirecionamento por parte da equipe escolar, da qual faz parte. As reflexões, ideias e propostas citadas, bem como a metodologia utilizada na construção deste artigo, baseiam-se em observações do cotidiano escolar desse profissional. É cabível, também, uma revisão de literatura que se alicerçam em pressupostos teóricos, que se dedicaram ao estudo da ação desse especialista, configurando-se esses referenciais em ampla contribuição para o entendimento da atuação própria do coordenador pedagógico.

BACKGROUND:The symbiotic bacterium Wolbachia is currently being trialled as a biocontrol agent in several countries to reduce dengue transmission. Wolbachia can invade and spread to infect all individuals within wild mosquito populations, but requires a high rate of maternal transmission, strong cytoplasmic incompatibility and low fitness costs in the host in order to do so. Additionally, extensive differences in climate, field-release protocols, urbanization level and human density amongst the sites where this bacterium has been deployed have limited comparison and analysis of Wolbachia's invasive potential. METHODOLOGY/PRINCIPAL FINDINGS:We examined key phenotypic effects of the wMel Wolbachia strain in laboratory Aedes aegypti mosquitoes with a Brazilian genetic background to characterize its invasive potential. We show that the wMel strain causes strong cytoplasmic incompatibility, a high rate of maternal transmission and has no evident detrimental effect on host fecundity or fertility. Next, to understand the effects of different urban landscapes on the likelihood of mosquito survival, we performed mark-release-recapture experiments using Wolbachia-uninfected Brazilian mosquitoes in two areas of Rio de Janeiro where Wolbachia will be deployed in the future. We characterized the mosquito populations in relation to the socio-demographic conditions at these sites, and at three other future release areas. We then constructed mathematical models using both the laboratory and field data, and used these to describe the influence of urban environmental conditions on the likelihood that the Wolbachia infection frequency could reach 100% following mosquito release. We predict successful invasion at all five field sites, however the conditions by which this occurs vary greatly between sites, and are strongly influenced by the size of the local mosquito population. CONCLUSIONS/SIGNIFICANCE:Through analysis of laboratory, field and mathematical data, we show that the wMel strain of Wolbachia possesses the characteristics required to spread effectively in different urban socio-demographic environments in Rio de Janeiro, including those where mosquito releases from the Eliminate Dengue Program will take place.