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A pandemia da COVID-19 afetou vários setores da sociedade. Diferentes medidas de intervenção para controle da doença foram adotadas, destacando-se a substituição de atividades presenciais por remotas. Tendo em vista o impacto da pandemia da COVID-19 no desenvolvimento de projetos de extensão, a proposta deste artigo é apresentar o relato de experiência da equipe do projeto “Boletim Informativo” da Faculdade de Medicina, Campus JK (FAMED), Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), durante o período de pandemia. O projeto “Boletim Informativo” foi reestruturado, continuando suas atividades através da utilização de Tecnologias Digitais de Informação e Comunicação (TDICs). Adotamos o Instagram como mais um veículo de comunicação. A equipe realizou uma análise reflexiva através de um encontro virtual com a pergunta norteadora “O que o projeto Boletim Informativo trouxe de contribuição para o seu desenvolvimento profissional e pessoal?”. Os temas mais mencionados foram: (i) atuação do projeto no contexto da pandemia; (ii) importância da visibilidade e da divulgação de informações relacionadas a FAMED por meio das mídias sociais; (iii) aprimoramento da habilidade de comunicação escrita; (iv) estreitamento das conexões pessoais e acadêmicas; (v) importância do planejamento e da organização das atividades do trabalho em equipe. Conforme relatado, o projeto propiciou um ambiente favorável para o aprimoramento de habilidades, estreitamento das relações e redução dos efeitos deletérios ocasionadas pelo isolamento social imposto pela pandemia.

Trata-se de um relato de experiência da equipe de uma universidade no interior de Minas Gerais, em que se discute a necessidade de uma formação continuada dos docentes da Faculdade de Medicina. A partir do projeto “Se Liga na Dica”, discorre-se sobre a importância de o docente estar atento à legislação; à estrutura administrativa da universidade; ao planejamento de aulas e manejo dos recursos tecnológicos como ferramentas educativas; às responsabilidades presentes no ensino remoto e no ensino híbrido e a aplicação e aprimoramento das metodologias ativas, tanto no ensino remoto quanto no retorno ao ensino presencial. Embora se tenha observado certa resistência na adesão dos docentes aos momentos de feedback das ações e do projeto, o objetivo de proporcionar formação continuada foi atingido, uma vez que todos os docentes do curso receberam as dicas e àqueles que participaram das devolutivas demonstraram satisfação com as ações e uma visão positiva e utilitária sobre o projeto.

Disentangling the impact of Late Quaternary climate change from human activities can have crucial implications on the conservation of endangered species. We investigated the population genetics and demography of the Mediterranean monk seal (

Este artigo trata-se de um relato de experiência de atuação de uma Comissão Própria de Avaliação (CPA) na realização do processo de autoavaliação. O objetivo é divulgar como o trabalho desenvolvido pela CPA tem contribuído no processo de tomada de decisões da IES, repercutindo em melhorias dos processos administrativos e pedagógicos nos serviços prestados e na qualidade de ensino. Demonstra-se que, após dez anos de Sinaes, ainda hoje, o grande desafio do processo de avaliação da qualidade do ensino superior é o de transformar as culturas estabelecidas, superar atitudes negativas, historicamente arraigadas quanto à avaliação no cenário educacional e obter mais participação de todos os envolvidos. A CPA é o canal de diálogo entre a comunidade acadêmica e os gestores no processo de avaliação institucional e traz, em sua própria constituição, potencialidades que, se bem aproveitadas, podem gerar maximização de resultados para todos.

The English teaching provides the learner with new opportunities for knowledge, work, communication and more. This must be as conscious as possible, with didactic and pedagogical, cognitive and metacognitive strategies, aimed at seeking better results. The aim is to discuss English language teaching with playfulness, in light of maintheories of Piaget, Vygotsky, Wallon and Ausubel, making it as meaningful as possible. As results and discussion, it emphasizes that the teaching of so-called foreign languages, such as English, is conscious and needs didactic and pedagogical strategies that involve the learner in his in its multiple contexts, making his programmatic content interesting and motivating for those who learn it. For Piaget, this learning must be according to the student’s age group, their interactions and adaptations; Vygotsky argues the need for social interaction; Wallon involves the affective and motivating question and Ausubel defends the valorization of the student’s previous knowledge. Thus, it is stated that English teaching should be stimulated as soon as possible, in the youngest age groups, so it can be assimilated and learned in a playful, social, interactive and meaningful way.

Introdução: A neoplasia mamária no homem apresenta-se em pequena escala epidemiológica, porém vem crescendo com o passar dos anos; não há cobertura assistencial adequada à sua prevenção pelo corpo multidisciplinar de saúde. Objetivo: Conhecer a assistência multidisciplinar de saúde na prevenção de neoplasias mamárias em homens, a partir da descrição seu perfil epidemiológico, manifestações clínicas e possibilidades de atuação da equipe multidisciplinar. Metodologia: Foi realizada uma pesquisa de revisão integrativa da literatura, de cunho qualitativo e descritivo, num intervalo de 10 anos (2008 a 2018), com busca nas bases de dados: Biblioteca Virtual da saúde (BVS), Scientific Electronic Library Online (SCIELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Banco de Dados em Enfermagem (BDENF), Portal de Periódicos da CAPES, Sistema Regional de Información en Línea para Revistas Científicas de América Latina, el Caribe, España y Portugal (LATINDEX). Resultados: Após aplicação dos critérios de inclusão e exclusão, foram obtidos 26 artigos na amostra final, com diversas metodologias. Discussão: O estudo resultou em evidências como: o aumento da incidência do câncer de mama no homem, quais seus principais fatores de risco, a semelhança clínica do câncer de mama em ambos os sexos e métodos preventivos que podem ser aplicados, obtendo resultados significativos. Conclusão: Concluiu-se que há uma real necessidade de conhecimento profissional acerca do câncer mamário no homem e que há importantes lacunas na educação em saúde da população masculina. Sobretudo, há escassez no controle dos fatores desencadeadores da patologia, sobre as quais devem ser aplicadas as medidas preventivas, educativas e clínica por parte dos profissionais de saúde.

Blood pressure measurement is a marker of antenatal care quality. In well resourced settings, lower blood pressure cutoffs for hypertension are associated with adverse pregnancy outcomes. We aimed to study the associations between blood pressure thresholds and adverse outcomes and the diagnostic test properties of these blood pressure cutoffs in low-resource settings.We did a secondary analysis of data from 22 intervention clusters in the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials (NCT01911494) in India (n=6), Mozambique (n=6), and Pakistan (n=10). We included pregnant women aged 15-49 years (12-49 years in Mozambique), identified in their community by trained community health workers, who had data on blood pressure measurements and outcomes. The trial was unmasked. Maximum blood pressure was categorised as: normal blood pressure (systolic blood pressure [sBP]120 mm Hg and diastolic blood pressure [dBP]80 mm Hg), elevated blood pressure (sBP 120-129 mm Hg and dBP80 mm Hg), stage 1 hypertension (sBP 130-139 mm Hg or dBP 80-89 mm Hg, or both), non-severe stage 2 hypertension (sBP 140-159 mm Hg or dBP 90-109 mm Hg, or both), or severe stage 2 hypertension (sBP ≥160 mm Hg or dBP ≥110 mm Hg, or both). We classified women according to the maximum blood pressure category reached across all visits for the primary analyses. The primary outcome was a maternal, fetal, or neonatal mortality or morbidity composite. We estimated dose-response relationships between blood pressure category and adverse outcomes, as well as diagnostic test properties.Between Nov 1, 2014, and Feb 28, 2017, 21 069 women (6067 in India, 4163 in Mozambique, and 10 839 in Pakistan) contributed 103 679 blood pressure measurements across the three CLIP trials. Only women with non-severe or severe stage 2 hypertension, as discrete diagnostic categories, experienced more adverse outcomes than women with normal blood pressure (risk ratios 1·29-5·88). Using blood pressure categories as diagnostic thresholds (women with blood pressure within the category or any higher category vs those with blood pressure in any lower category), dose-response relationships were observed between increasing thresholds and adverse outcomes, but likelihood ratios were informative only for severe stage 2 hypertension and maternal CNS events (likelihood ratio 6·36 [95% CI 3·65-11·07]) and perinatal death (5·07 [3·64-7·07]), particularly stillbirth (8·53 [5·63-12·92]).In low-resource settings, neither elevated blood pressure nor stage 1 hypertension were associated with maternal, fetal, or neonatal mortality or morbidity adverse composite outcomes. Only the threshold for severe stage 2 hypertension met diagnostic test performance standards. Current diagnostic thresholds for hypertension in pregnancy should be retained.University of British Columbia, the BillMelinda Gates Foundation.

Microplastics (5 mm) are a ubiquitous marine pollutant which are highly bioavailable to marine organisms across all trophic levels. Marine predators are especially vulnerable to microplastic pollution through direct and indirect ingestion (e.g., trophic transfer) due to their high trophic position. In particular, oceanic islands are more susceptible to plastic accumulation, increasing the relative number of microplastics in the environment that are available for consumption. The dynamics of microplastic accumulation in marine predators inhabiting remote islands, however, is sparsely documented. Here we describe microplastic exposure in the Critically Endangered Mediterranean monk seal (Monachus monachus) from the Madeira archipelago (Northeast Atlantic) using scat-based analysis. Microplastics were recovered from 18 scat samples collected between 2014-2021 and were characterized to the polymer level using Fourier-Transform Infrared (u-FTIR) spectroscopy. A total of 390 microplastic particles were recovered, ranging between 0.2-8.6 particles g

Objectives To investigate the relationship between the use of social networking sites (SNSs) on patient perceptions, acceptance, and expectations of treatment using temporary anchorage devices (TADs) and to compare differences between patients from the United Kingdom and Brazil. Materials and Methods Cross-sectional questionnaires were administered to 39 participants at orthodontic practices in the United Kingdom and Brazil about patients' use of SNSs, exposure to TADs on SNSs, and thoughts on extractions, jaw surgery, or TADs as treatment options. Results UK patients prefer for clinicians to have SNS profiles (P = .022). Most UK and Brazilian patients want to see their clinician's work online (76.7%) and use SNSs to get information about treatment options (76.6%). There was a statistically significant difference in Brazilian patients' acceptance of TADs as a treatment option compared with UK patients, particularly if it meant avoiding extractions (P = .002), avoiding jaw surgery (P = .004), or reducing treatment time (P = .010). Knowledge of TADs was greater in Brazilian patients (P < .001). Conclusions Patients use SNSs to obtain information about treatments and prefer clinicians to have social media accounts. Patients exposed to TADs on SNSs are more likely to accept them as an orthodontic treatment option. UK patients have less knowledge of TADs and are therefore less sure to consider TADs as an option. Brazilian patients are more confident in considering the use of TADs. Clinicians should consider increasing their social media presence to accommodate patients' expectations and acceptance of TADs.

The mental status examination (MSE) is an important component of clinical assessment. Medical training programs must adjust their teaching methods to facilitate MSE learning. This study aimed to describe a set of playful and purposeful strategies developed in a public university in Brazil to teach about psychopathology and the MSE. The teaching strategies were developed in the form of word search, crosswords, and syllable puzzles to catch students’ attention and enhance their training process. They were designed to help improve visual perception, focused attention, processing speed and agility, vocabulary, and familiarity with specialized terminology. The results showed that the teaching strategies created a relaxed environment, providing instant feedback and allowing for productive failure. All students reported satisfaction with the learning experience. Games and creative activities, such as crosswords, word search, and syllable puzzles, can be effective teaching methods to be applied in medical schools or similar institutions where psychopathology and the MSE are taught.

Introduction: The current pandemic has caused several social and behavioural changes at a national level. These changes had a negative impact on mental health and sleep quality. Sleep is one of the main regulators and repairers of the body and is involved in both cognition and memory as well as immunity and hormonal balance. Objective: This study seeks to identify the main sleep disorders aggravated by the COVID-19 Pandemic and their consequences to the population. Methods: A bibliographic narrative review was made with articles dating from the last 5 years (2016-2021), which were extracted from the National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Latin American and Caribbean Literature in Health Sciences (LILACS) and “Google Academic” databases, using the following keywords and descriptors in Portuguese and English; “Sleep/Sono”, “Sleep Disorders/Disturbios do Sono”, “Insomnia”, “Pandemic/Pandemia”, “COVID-19”, “Immunity/Imunidade”, “Viral Infections/Infeccoes virais”, “Coronavirus”, “Sleep-Wake Cycle Rhythm/Ritmo ciclo-vigilia”, “Biological Clocks/Relogios biologicos” and the Boolean operator “and/e”. Results and Discussion: Insomnia and sleep-wake cycle changes have been quite evident among the population and were mainly aggravated by the increase of anxiety and depressive symptoms taking place during the pandemic. Students have gone through major routine changes disrupting their daily activities, such as physical activities, class schedules, and use of electronic equipment, which in turn accentuate sleep problems affecting their academic performance and learning. Conclusion: The pandemic has changed many habits and routines, with students among those who were affected the most, both in terms of psychological disorders affecting quality of sleep, as well as irregular sleep that itself influences cognition and learning. Insomnia has proved to be frequent in the population, and its effects on the body, especially regarding the immune system and emotional regulation are not favourable for confronting the new coronavirus.

The Mediterranean monk seal Monachus monachus is one of the most threatened marine mammals, with only 600–700 individuals restricted to three populations off the coast of Western Sahara and Madeira (North Atlantic) and between Greece and Turkey (eastern Mediterranean). Its original range was from the Black Sea (eastern Mediterranean) to Gambia (western African coast), but was drastically reduced by commercial hunting and human persecution since the early stages of marine exploitation. We here analyse 42 mitogenomes of Mediterranean monk seals, from across their present and historical geographic ranges to assess the species population dynamics over time. Our data show a decrease in genetic diversity in the last 200 years. Extant individuals presented an almost four-fold reduction in genetic diversity when compared to historical specimens. We also detect, for the first time, a clear segregation between the two North Atlantic populations, Madeira and Cabo Blanco, regardless of their geographical proximity. Moreover, we show the presence of historical gene-flow between the two water basins, the Atlantic Ocean and the Mediterranean Sea, and the presence of at least one extinct maternal lineage in the Mediterranean. Our work demonstrates the advantages of using full mitogenomes in phylogeographic and conservation genomic studies of threatened species.

Summary Background To overcome the three delays in triage, transport and treatment that underlie adverse pregnancy outcomes, we aimed to reduce all-cause adverse outcomes with community-level interventions targeting women with pregnancy hypertension in three low-income countries. Methods In this individual participant-level meta-analysis, we de-identified and pooled data from the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trials in Mozambique, Pakistan, and India, which were run in 2014–17. Consenting pregnant women, aged 12–49 years, were recruited in their homes. Clusters, defined by local administrative units, were randomly assigned (1:1) to intervention or control groups. The control groups continued local standard of care. The intervention comprised community engagement and existing community health worker-led mobile health-supported early detection, initial treatment, and hospital referral of women with hypertension. For this meta-analysis, as for the original studies, the primary outcome was a composite of maternal or perinatal outcome (either maternal, fetal, or neonatal death, or severe morbidity for the mother or baby), assessed by unmasked trial surveillance personnel. For this analysis, we included all consenting participants who were followed up with completed pregnancies at trial end. We analysed the outcome data with multilevel modelling and present data with the summary statistic of adjusted odds ratios (ORs) with 95% CIs (fixed effects for maternal age, parity, maternal education, and random effects for country and cluster). This meta-analysis is registered with PROSPERO, CRD42018102564. Findings Overall, 44 clusters (69 330 pregnant women) were randomly assigned to intervention (22 clusters [36 008 pregnancies]) or control (22 clusters [33 322 pregnancies]) groups. 32 290 (89·7%) pregnancies in the intervention group and 29 698 (89·1%) in the control group were followed up successfully. Median maternal age of included women was 26 years (IQR 22–30). In the intervention clusters, 6990 group and 16 691 home-based community engagement sessions and 138 347 community health worker-led visits to 20 819 (57·8%) of 36 008 women (of whom 11 095 [53·3%] had a visit every 4 weeks) occurred. Blood pressure and dipstick proteinuria were assessed per protocol. Few women were eligible for methyldopa for severe hypertension (181 [1%] of 20 819) or intramuscular magnesium sulfate for pre-eclampsia (198 [1%]), of whom most accepted treatment (162 [89·5%] of 181 for severe hypertension and 133 [67·2%] of 198 for pre-eclampsia). 1255 (6%) were referred to a comprehensive emergency obstetric care facility, of whom 864 (82%) accepted the referral. The primary outcome was similar in the intervention (7871 [24%] of 32 290 pregnancies) and control clusters (6516 [22%] of 29 698; adjusted OR 1·17, 95% CI 0·90–1·51; p=0·24). No intervention-related serious adverse events occurred, and few adverse effects occurred after in-community treatment with methyldopa (one [2%] of 51; India only) and none occurred after in-community treatment with magnesium sulfate or during transport to facility. Interpretation The CLIP intervention did not reduce adverse pregnancy outcomes. Future community-level interventions should expand the community health worker workforce, assess general (rather than condition-specific) messaging, and include health system strengthening. Funding University of British Columbia, a grantee of the Bill & Melinda Gates Foundation.

Introdução: As teorias etiológicas para o Transtorno de Personalidade Dissocial (TPD) são multifatoriais e integram questões biológicas, socioculturais e ambientais. Entre elas, destaca-se a relação entre o transtorno e os polimorfismos do gene transportador de serotonina (5-HTT) e a ocorrência de sintomas de ansiedade e depressão. Neste âmbito, considera-se que a influência do ambiente possa ser bidirecional em relação à mutação em questão. Objetivo: Discutir a influência de fatores ambientais e genéticos na manifestação do TPD. Método: O presente artigo se trata de uma revisão narrativa da literatura, e os artigos utilizados na discussão se encontravam nas bases de dados National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Google Acadêmico. Como critério de inclusão, foram inseridos artigos publicados de 2009 a 2021. Resultados: Foi observada uma relação entre fatores ambientais e polimorfismo genético – como aquele relacionado ao gene MAOA, que atua na degradação de neurotransmissores – e o desenvolvimento de TPD, assim como alterações funcionais e anatômicas a nível de sistema nervoso central, tal qual a diminuição da substância cinzenta em regiões límbicas e paralímbicas, dentre outras. Conclusão: Conclui-se, portanto, que existe uma associação entre fatores genéticos, que influenciam no funcionamento de estruturas importantes no sistema nervoso central, como é o caso da região cortical e do sistema límbico, e fatores ambientais na manifestação do Transtorno de Personalidade Dissocial. Palavras chave: Genética, Transtornos da personalidade, Transtorno da personalidade antissocial, Classificação internacional de doenças, DSM-V Abstract Introduction: The etiological theories for Dissocial Personality Disorder (DPD) are multifactorial and integrate biological, social, cultural, and environmental issues. Among them, the relation between the disorder and the polymorphism of the serotonin transporter gene (5-HTT) and the occurrence of anxiety and depression symptoms stands out. In this scope, the influence of the environment in relation to the mutation can be considered bidirectional. Objective: To discuss the influence of environmental and genetic factors on the manifestation of DPD. Methods: The present article is a narrative review, and the articles used on the discussion were found in the databases National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Google Acadêmico. As a criterion, only articles published between 2009 and 2021 were included. Results: It was observed a relation between environmental factors and genetic polymorphism – as the one related to the MAOA gene, that plays a role in the degradation of neurotransmitters – and the development of DPD, as well as functional and anatomical changes in the central nervous system, such as reduction of the gray matter in some limbic and paralimbic regions, and others. Conclusion: It is possible to conclude that there is an association between genetic factors, that can influence in the functioning of important structures of the central nervous system, as the cortical region and the limbic system, and environmental factors in the manifestation of Dissocial Personality Disorder. Keywords: Genetics, Personality disorders, Antisocial personality disorder, International classification of diseases, DSM- There are several etiological theories for Dissocial Personality Disorder (DPD), which integrate organic, social, cultural, emotional, educational, genetic and environmental issues. Among them, the relationship between personality and serotonin transporter polymorphisms (5-HTT) and the occurrence of anxiety and depressive symptoms, as well as the relationship with climacteric and menopause; these and others are bidirectionally integrated with the environment. In order to discuss the influence of environmental and genetic factors in the manifestation of DPD, we made a narrative review using articles from the National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), and Latin Literature databases -American and Caribbean in Health Sciences (LILACS) and “Academic Google”, published from 2009 to 2021, with the descriptors and keywords, with the Boolean operator “and”, “Etiology”; “Genetics”; "Environment"; “Classification of mental and behavioral disorders”; “International Classification of Diseases”; “Diagnostic and Statistical Manual of Mental Disorders”; “ICD-10”; “ICD-11”; “DSM-5”; “Antisocial Personality Disorder”; “Dissocial Personality Disorder”; “Sociopathic personality disorder”; “Shyness”; "Psychopathology". The study was divided into 3 topics: Classification of personality disorders by ICD-10, ICD-11 and DSM-5; Etiologies of personality disorders and Environmental and genetic factors as etiologies of Dissocial Personality Disorder. We concluded that environmental, genetic and other factors integrate and act in different ways, in different people, in the etiology of DPD.