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Background and Objectives: Down syndrome (DS) is the most common chromosomal disorder in the world. It is caused by the imbalance of the chromosomal constitution of 21 by free trisomy, translocation or mosaicism. Children and adolescents with Down syndrome have immune dysregulation and are more susceptible to infections. This study aims to evaluate hospitalizations of children and adolescents with DS in the pediatric ward of Botucatu Clinics Hospital (HCFMB) and to classify the population of children included in the study according to age, diagnosis, outpatient follow-up, length of stay and need for the intensive care unit (ICU). Thus, it will be possible to improve care for these children, aiming to reduce these hospitalizations. Materials and Methods: This study was an observational, cross-sectional study, with retrospective data collected from the last nine years of hospitalization, from January 2013 to December 2021, from children and adolescents with DS in the pediatric ward, emergency room, and the ICU of HCFMB. Children hospitalized in this period in the pediatric ward and ICU, in the age range of 30 days to 15 years, were included in this study. The evaluation of comorbidities that culminated in the need for hospitalization in this population can be the focus of actions to improve the diagnoses and conducts for this population, which can prevent worsening illness and hospitalizations in future populations. Results: In this analysis, 80 children with DS were evaluated, with a total of 283 hospitalizations. The most prevalent age group was 1 to 3 years, and the main cause was due to problems in the respiratory system (99 cases). Among the respiratory causes, the main cause of hospitalization was due to pneumonia in 50% of cases, followed by acute respiratory failure in 14%. The average hospitalization time was 8 days, and in 49 hospitalizations, the children required the ICU. The main cause of hospitalization in the ICU was due to respiratory causes (36%), followed by cardiac malformations (14%). During the ICU hospitalizations, there were 13 deaths, and we observed a higher prevalence of heart conditions and, in some cases, positive urine cultures in these children. Conclusions: The Hospital serves as a reference for pediatric hospitalizations within its region and beyond, owing to its specialized capabilities. The main causes of hospitalization were those related to the respiratory system and cardiac malformations. Roughly one-third of the children required admission to the intensive care unit. [ABSTRACT FROM AUTHOR]

Abstract Background The comprehensive core set for knee dysfunction was developed to classify the functioning of people with any knee dysfunction. To be used as a clinical instrument to measure the functioning of people with knee dysfunction, the construct validity of the core set still needs to be assessed. The purpose of this study was to analyze the construct validity of the comprehensive core set for knee dysfunction as an instrument to measure functioning. Methods A cross-sectional study with 200 participants with knee dysfunction with or without clinical diagnosis of knee pathology, with or without complaint of pain, with or without instability, and/or with or without knee movement restriction of any type. Participants were assessed using the comprehensive core set for knee dysfunction with 25 categories, the subjective form from the International Knee Documentation Committee scale, and measures of self-perceived general health and functioning. The construct validity of the core set was assessed by Rasch analysis, and the external construct validity was assessed by correlation between the score of the brief core set for knee dysfunction with the subjective form from the International Knee Documentation Committee scale, and scores of self-perception of health and functioning. Results Twelve categories were consistent with a unidimensional construct, with no difference in the response pattern for age, sex, educational level, and time of complaint. These categories were included in the brief core set for knee dysfunction. The mean score of the brief core set was 37 ± 21 points, a value classified as moderate impairment regarding functioning. Correlations with the subjective form from the International Knee Documentation Committee scale and scores of self-perception were adequate (p 0.5). Conclusion The brief core set for knee dysfunction, a set with 12 categories, can be used as a clinical instrument to measure and score the functioning of people with knee dysfunction, aged between 18 and 89 years, with adequate construct validity.

Background: The comprehensive core set for knee dysfunction was developed to classify the functioning of people with any knee dysfunction. To be used as a clinical instrument to measure the functioning of people with knee dysfunction, the construct validity of the core set still needs to be assessed. The purpose of this study was to analyze the construct validity of the comprehensive core set for knee dysfunction as an instrument to measure functioning. Methods: A cross-sectional study with 200 participants with knee dysfunction with or without clinical diagnosis of knee pathology, with or without complaint of pain, with or without instability, and/or with or without knee movement restriction of any type. Participants were assessed using the comprehensive core set for knee dysfunction with 25 categories, the subjective form from the International Knee Documentation Committee scale, and measures of self-perceived general health and functioning. The construct validity of the core set was assessed by Rasch analysis, and the external construct validity was assessed by correlation between the score of the brief core set for knee dysfunction with the subjective form from the International Knee Documentation Committee scale, and scores of self-perception of health and functioning. Results: Twelve categories were consistent with a unidimensional construct, with no difference in the response pattern for age, sex, educational level, and time of complaint. These categories were included in the brief core set for knee dysfunction. The mean score of the brief core set was 37 ± 21 points, a value classified as moderate impairment regarding functioning. Correlations with the subjective form from the International Knee Documentation Committee scale and scores of self-perception were adequate (p < 0.01; r > 0.5). Conclusion: The brief core set for knee dysfunction, a set with 12 categories, can be used as a clinical instrument to measure and score the functioning of people with knee dysfunction, aged between 18 and 89 years, with adequate construct validity. [ABSTRACT FROM AUTHOR]

This study aims to identify the challenges encountered by nurses in Family Health Strategy (ESF) teams concerning the praxis of the integrality attribute. This descriptive qualitative study was conducted with ESF nurses from a municipality in the central region of Rio Grande do Sul, Brazil. Fourteen nurses were individually interviewed from August to October 2022. Data analysis followed Minayo's Thematic Analysis steps. After an exhaustive reading of the interviews, the following categories were developed: Vulnerability of users; Failures in management and service integration; and High demand and work overload. Identifying weaknesses in health services allows for strengthening and improving the quality of care and assistance, thus ensuring effective integrality. [ABSTRACT FROM AUTHOR]

IntroductionThe implementation of technologies in Primary Health Care with monitoring and evaluation of the quality of health care is fundamental to direct the access and quality of health care in the context of the Sustainable Development Goals. Our objective was to develop a model for evaluating digital health interventions in primary care, considering its impact on first contact, longitudinality, integrality and coordination in health.MethodologyThis is an exploratory methodological study of a qualitative nature. This study seeks to explore strategic actors’ perceptions of an evaluation model, and was developed in a process between June 2021 and March 2024. The following stages were followed: Identification of previous models available in the literature, model development, model validation, model update. We performed a nominal group consensus technique online with seven experts. Stages taken to define the design of the model: sending the elaborated model, together with an electronic form with 18 subjective questions, such as brainstorming strategy, for recording impressions, judgment of agreement and suggestions; workshop for discussion by videoconference, at the time the objectives and the model diagram were presented, followed by debate with clarification of doubts and suggestions for clarification of the step-by-step design. After incorporating the suggestions, the model agreed upon in the workshop was subjected to another analysis by the same experts, sent in an online Google document, in which possible inconsistencies between the proposed model and the agreed one were verified, as well as the final agreement on the recommended proposal. At the end of this stage, with synchronous and asynchronous remote procedures, consensus was reached.ResultsThe proposed evaluation model presents as primary categories, structure, process and result. The structure encompasses four indicators, namely, employees; financial resources; infrastructure resources; and regulatory and strategic resources. The process is organized into three dimensions, namely: technical dimension, organizational dimension and relational dimension. The results will be evaluated in products; intermediate results; and impacts (short, medium and long term). The results will be measured by the seven pillars of quality: efficacy, effectiveness, efficiency, optimization, acceptability, legitimacy, equity.ConclusionThis study achieved the goal of developing a model to evaluate digital health interventions in Primary Health Care, helping to identify adequate and useful evaluation methods filling the gap of the lack of quality evaluation standards in the brazilian Digital Health Strategy. It presents an important difference in relation to models from different countries, as it considers the impacts on Primary Health Care quality attributes such as first contact care, longitudinality, integrality and coordination of care. The model will be used by managers and health professionals of Primary Health Care in a case study in Brazil to evaluate the quality of health care. It is expected that the proposed model may be used in other evaluation studies and countries through contextual adaptations.

Abstract Objectives: to evaluate the second stage of the Kangaroo Mother Care (KMC) and its integration with the third stage in maternity hospitals in Recife in the context of the coronavirus pandemic. Methods: normative assessment carried out at the Kangaroo Neonatal Intermediate Care Unit (KNICU) in two public reference maternity hospitals for KMC between November/2021 and May/2022. The logical model and matrix of KMC indicators were developed and validated using the Delphi Method: semi-structured interviews were carried out with professionals from the KNICU team and the municipal child health coordination. It was considered implemented when the criteria were met (from 100.0 to 80.0%); partially implemented (79.9 to 60.0%); incipient (59.9 to 40.0%) and not implemented (

BackgroundThe physical health of adolescents is crucial for the prosperity and sustainable development of a nation. Developing specific growth standards is essential for prioritizing the wellbeing of the youth of Pakistan. This study aimed to establish normative standards for height, weight, and body mass index (BMI) among 12- to 16-year-olds in South Punjab, facilitating accurate health assessments and tailored interventions.MethodThis study utilized a cross-sectional design and stratified random sampling to select 2,970 adolescents (49.73% boys and 50.26% girls) aged 12–16 years from South Punjab, Pakistan. Anthropometric measurements, including height, weight, and BMI, were collected. The data were stratified by age and sex, and smoothed percentile curves were computed using the LMS method, which incorporates the L (γ-lambda), M (μ-mu), and S (δ-sigma) parameters. The results were compared to international references to provide a comprehensive analysis.ResultsThe results highlight sex-specific trends in anthropometric indicators among adolescents. Boys exhibited higher mean values in height (160.50 ± 11.50 cm), weight (45.02 ± 9.78 kg), and BMI (17.30 ± 2.41) than girls (158.57 ± 9.34 cm, 41.00 ± 7.89 kg, and 16.29 ± 2.82, respectively). Growth patterns indicate boys grow faster in height and weight between ages 12 and 14, whereas girls show slower annual increases. Comparative analysis with international standards reveals that boys’ height and weight were generally lower than international medians (P50th), whereas girls’ height was comparable or higher. BMI values for both sexes were lower than international norms, reflecting unique regional growth patterns.ConclusionThis research establishes updated age- and sex-specific normative reference standards for adolescents in South Punjab, Pakistan. The study revealed that Pakistani adolescent boys exhibit higher mean values in height, weight, and BMI than girls, with faster growth rates between ages 12 and 14. Compared to international standards, Pakistani adolescents show lower BMI values, highlighting unique regional growth patterns. These standards have practical applications in screening, monitoring, and health strategy planning, contributing to efforts to promote a healthier future for the population. Future studies are recommended to utilize these local growth references for health surveillance and treatment in the local population.

Abstract Background The “Adequate Childbirth Program” (PPA) is a quality improvement project that aims to reduce the high rates of unnecessary cesarean section in Brazilian private hospitals. This study aimed to analyze labor and childbirth care practices after the first phase of PPA implementation. Method This study uses a qualitative approach. Eight hospitals were selected. At each hospital, during the period of 5 (five) days, from July to October 2017, the research team conducted face to face interviews with doctors (n = 21) and nurses (n = 28), using semi-structured scripts. For the selection of professionals, the Snowball technique was used. The interviews were transcribed, and the data submitted to Thematic Content Analysis, using the MaxQda software. Results The three analytical dimensions of the process of change in the care model: (1) Incorporation of care practices: understood as the practices that have been included since PPA implementation; (2) Adaptation of care practices: understood as practices carried out prior to PPA implementation, but which underwent modifications with the implementation of the project; (3) Rejection of care practices: understood as those practices that were abandoned or questioned whether or not they should be carried out by hospital professionals. Conclusions After the PPA, changes were made in hospitals and in the way, women were treated. Birth planning, prenatal hospital visits led by experts (for expecting mothers and their families), diet during labor, pharmacological analgesia for vaginal delivery, skin-to-skin contact, and breastfeeding in the first hour of life are all included. To better monitor labor and vaginal birth and to reduce CS without a clinical justification, hospitals adjusted their present practices. Finally, the professionals rejected the Kristeller maneuver since research has demonstrated that using it’s harmful.

Accurately assessing the state of health (SOH) of lithium batteries is of great significance for improving battery safety performance. However, the current assessment for SOH suffers from the difficulty of selecting health features and the lack of uncertainty using data-driven methods. To this end, this paper proposes a health state assessment method for lithium-ion batteries based on health feature extraction and an improved Informer model. First, multiple features that can reflect the SOH of lithium-ion batteries were extracted from the charging and discharging time, the peak value of incremental capacity curve (ICC), and the inflection point value of differential voltage curve, etc., and the correlation between multiple health features and the health state was evaluated by gray correlation analysis. Then, an improved Informer model is proposed to establish a health state estimation method for lithium-ion batteries. Finally, the proposed algorithm is tested and validated using publicly available battery charge/discharge datasets and compared with other algorithms. The results show that the method in this paper can realize high-precision SOH prediction with a root-mean-square error (RMSE) of 0.011, and the model fit reaches more than 98%. [ABSTRACT FROM AUTHOR]

Background: Brachial plexus reconstruction (BPR) is a rapidly advancing field within hand surgery. BPR procedures are complex, time-intensive, and require microsurgical expertise. As physician reimbursement rates for BPR are poorly defined, relative to more common hand procedures, we sought to analyze compensation for BPR across different payor groups and understand the factors contributing to their reimbursement. Methods: A retrospective review was performed of surgeries by a single senior staff member in a 4-year period to evaluate Current Procedural Terminology (CPT) codes from BPR cases. For comparison, all finger fracture fixations and skin graft reconstructions performed by the same surgeon over the same time period were analyzed as well. Results: A total of 57 BPR cases, 94 finger fracture fixation cases, and 69 skin grafting cases met inclusion criteria. Among the top 5 insurance providers, average work relative value unit (wRVU)/hour was 6.55, 3.49, and 12.67 for BPR, fracture fixation, and skin grafts, respectively. Reimbursements were an average $685.76/hour for BPR, compared to $590.10/hour for fracture fixation and $1,197.94/hour for skin grafts. Conclusions: BPR demonstrates a relative undervaluation, in terms of reimbursement per hour, given the time and surgical skill required for such cases, particularly compared to shorter, less complex cases such as skin grafting and fracture fixation. We find that this discrepancy is amplified across multiple levels of coding, billing, and reimbursement. We suggest specific strategies for physician leadership to more directly participate in the financial decisions that affect themselves, their patients, and their specialty. [ABSTRACT FROM AUTHOR]

Background: The "Adequate Childbirth Program" (PPA) is a quality improvement project that aims to reduce the high rates of unnecessary cesarean section in Brazilian private hospitals. This study aimed to analyze labor and childbirth care practices after the first phase of PPA implementation. Method: This study uses a qualitative approach. Eight hospitals were selected. At each hospital, during the period of 5 (five) days, from July to October 2017, the research team conducted face to face interviews with doctors (n = 21) and nurses (n = 28), using semi-structured scripts. For the selection of professionals, the Snowball technique was used. The interviews were transcribed, and the data submitted to Thematic Content Analysis, using the MaxQda software. Results: The three analytical dimensions of the process of change in the care model: (1) Incorporation of care practices: understood as the practices that have been included since PPA implementation; (2) Adaptation of care practices: understood as practices carried out prior to PPA implementation, but which underwent modifications with the implementation of the project; (3) Rejection of care practices: understood as those practices that were abandoned or questioned whether or not they should be carried out by hospital professionals. Conclusions: After the PPA, changes were made in hospitals and in the way, women were treated. Birth planning, prenatal hospital visits led by experts (for expecting mothers and their families), diet during labor, pharmacological analgesia for vaginal delivery, skin-to-skin contact, and breastfeeding in the first hour of life are all included. To better monitor labor and vaginal birth and to reduce CS without a clinical justification, hospitals adjusted their present practices. Finally, the professionals rejected the Kristeller maneuver since research has demonstrated that using it's harmful. Plain English summary: Brazil has high Cesarean Section (CS) rates, with rates far from the ideal recommended by the World Health Organization and a model of care that does not favor women's autonomy and empowerment. In 2015, a quality improvement project, called "Projeto Parto Adequado" (PPA), was implemented in Brazilian private hospitals to reduce unnecessary cesarean section, in addition to encouraging the process of natural and safe childbirth. One of the components of this project was to reorganize the model of care in hospitals to prepare professionals for humanized and safe care. The data were collected in 8 hospitals with interviews with 49 professionals, approximately two years after the beginning of the project in the hospitals. There were changes in the hospital routine and in the care of women after the project. The professionals incorporated practices such as skin-to-skin contact and breastfeeding; diet during labor; non-invasive care technologies, especially to relieve pain during labor; birth plan; pregnancy courses with guided tours in hospitals (for pregnant women and family); and analgesia for vaginal labor. There was adaptation of existing practices in hospitals to reduce CS that had no clinical indication; better monitoring of labor, favoring vaginal delivery. And finally, the professionals rejected the practice that presses the uterine fundus, for not having shown efficacy in recent studies. We can conclude that the hospitals that participated in this study have made an effort to change their obstetric model. However, specific aspects of each hospital, the organization of the health system in Brazil, and the incentive of the local administration influenced the implementation of these changes by professionals in practice. [ABSTRACT FROM AUTHOR]

Health assessment is one of the important theoretical bases for deciding whether the diversion tunnel can operate safely and stably. A project of the TBM diversion tunnel is taken as the research object to ensure the normal operation of the diversion tunnel. Based on measured data and considering multiple safety aspects such as structural response, durability, and external factors of the diversion tunnel, a TBM diversion tunnel structural health evaluation index system is established. A new method for the TBM diversion tunnel structural health comprehensive evaluation based on Analytic Hierarchy Process-Matter Element Extension-Variable Weight Theory (AMV) is proposed to explore the impact of AMV fluctuation with the measured results of the indicators on the weight, closeness, and health grade of each evaluation index. The high sensitivity and high-risk evaluation indicators for the structural health of the diversion tunnels are identified. It is found that the variable weight varies with the changes in various indicator values, which can accurately evaluate the health status of tunnels in real-time. The characteristic values of the tunnel grade calculated by the AHP and the AMV are 1.589 and 1.695, respectively. The results of the corresponding interval diversion tunnel are the basic safety state of grade B. Except for the two evaluation indicators of concrete strength and slurry properties, the variable weight values and grade characteristic values of other evaluation indicators increase with the increase of indicator values. The four indicators of segment settlement, segment opening, segment misalignment, and segment cracks are more sensitive to the health of the TBM diversion tunnel. This AMV can accurately evaluate the health status of the diversion tunnel structure. The research results can provide references for later maintenance work and similar projects. [ABSTRACT FROM AUTHOR]

Lithium-ion batteries are widely used in modern society as important energy storage devices due to their high energy density, rechargeable performance, and light weight. However, the capacity and performance of lithium-ion batteries gradually degrade with the number of charge or discharge cycles and environmental conditions, which can affect the reliability and lifetime of the batteries, so it is necessary to accurately evaluate their health. The belief rule base (BRB) model is an evaluation model constructed based on rules that can handle uncertainties in the operation of lithium-ion batteries. However, lithium-ion batteries may be affected by disturbances from internal or external sources during operation, which may affect the evaluation results. To prevent this problem, this paper proposes a disturbance-considering BRB modeling approach that considers the possible effects of disturbances on the battery in the operating environment and quantifies the disturbance-considering capability of the assessment model in combination with expert knowledge. Second, robustness and interpretability constraints are added in this paper, and an improved optimization algorithm is constructed that maintains or possibly improves the resistance of the model to disturbance. Finally, using the lithium-ion batteries provided by the National Aeronautics and Space Administration (NASA) Prediction Centre of Excellence and the University of Maryland as a case study, this paper verifies that the proposed modeling approach is capable of constructing robust models and demonstrates the effectiveness of the improved optimization algorithm. [ABSTRACT FROM AUTHOR]

The association between physical activity in daily life (PADL) and simple functional tests is not yet clearly understood in subjects with chronic obstructive pulmonary disease (COPD). Therefore, the aim of this study was to investigate the association of two functional tests (Sit-to-Stand test [STS] and the 4-Metre Gait Speed test [4MGS]) with PADL, as well as to identify whether these tests can discriminate those subjects who are physically inactive. In this cross-sectional study, 28 subjects with COPD performed the five repetitions Sit-to-Stand (STS5r), the 4MGS and used the DynaPort activity monitor for 7 days in order to assess PADL. Walking time, movement intensity while walking (MI) and Physical Activity Level index (PAL) were considered as PADL outcomes. STS5r and 4MGS, respectively, were significantly associated with walking time (R2 = 0.16; p = 0.024 and R2 = 0.25; p = 0.006) and PAL index (R2 = 0.17; p = 0.002 and R2 = 0.30; p = 0.003), whereas movement intensity was associated only with the 4MGS (R2 = 0.23; p = 0.009). Additionally, both tests were able to discriminate physically inactive subjects (cutoffs: STS5r = 11.48s [AUC = 0.73]; 4MGS = 1.09m/s [AUC = 0.88]). In conclusion, STS5r and 4MGS can predict up to 30% of PADL in subjects with COPD. Both tests are related to PADL duration (e.g. time spent walking), while only the 4MGS reflects movement intensity. Both tests presented discriminative capacity to identify subjects with worse PADL pattern.

Background and Objectives: Down syndrome (DS) is the most common chromosomal disorder in the world. It is caused by the imbalance of the chromosomal constitution of 21 by free trisomy, translocation or mosaicism. Children and adolescents with Down syndrome have immune dysregulation and are more susceptible to infections. This study aims to evaluate hospitalizations of children and adolescents with DS in the pediatric ward of Botucatu Clinics Hospital (HCFMB) and to classify the population of children included in the study according to age, diagnosis, outpatient follow-up, length of stay and need for the intensive care unit (ICU). Thus, it will be possible to improve care for these children, aiming to reduce these hospitalizations. Materials and Methods: This study was an observational, cross-sectional study, with retrospective data collected from the last nine years of hospitalization, from January 2013 to December 2021, from children and adolescents with DS in the pediatric ward, emergency room, and the ICU of HCFMB. Children hospitalized in this period in the pediatric ward and ICU, in the age range of 30 days to 15 years, were included in this study. The evaluation of comorbidities that culminated in the need for hospitalization in this population can be the focus of actions to improve the diagnoses and conducts for this population, which can prevent worsening illness and hospitalizations in future populations. Results: In this analysis, 80 children with DS were evaluated, with a total of 283 hospitalizations. The most prevalent age group was 1 to 3 years, and the main cause was due to problems in the respiratory system (99 cases). Among the respiratory causes, the main cause of hospitalization was due to pneumonia in 50% of cases, followed by acute respiratory failure in 14%. The average hospitalization time was 8 days, and in 49 hospitalizations, the children required the ICU. The main cause of hospitalization in the ICU was due to respiratory causes (36%), followed by cardiac malformations (14%). During the ICU hospitalizations, there were 13 deaths, and we observed a higher prevalence of heart conditions and, in some cases, positive urine cultures in these children. Conclusions: The Hospital serves as a reference for pediatric hospitalizations within its region and beyond, owing to its specialized capabilities. The main causes of hospitalization were those related to the respiratory system and cardiac malformations. Roughly one-third of the children required admission to the intensive care unit.

This study evaluated factors associated with hospitalization related to the mental health of people undergoing follow-up in Psychosocial Care Centers (CAPS, in Portuguese) in the city of São Paulo, Brazil, referred from Primary Health Care (PHC). This was an evaluative study conducted with 297 individuals in 24 adult CAPS. This study analyzed the prevalence ratios (PR) and their respective 95% confidence intervals (95% CI), obtained through Poisson Regression with robust variance. A statistically significant association was found with hospitalization during follow-ups in CAPS: having health insurance and/or medical plan; waiting time between the diagnosis and the first consultation with a nonmedical professional of more than seven days; not having received medical advice regarding how long to use medication; not having received a psychopharmaceutical prescription at PHC; and having a medical history of the hospitalization due to mental health. The results warn of the need to expand access to the more socially vulnerable population, in addition to a restructuring of the services in order to provide more interactive and inclusive practices geared toward the singularities of the users. [ABSTRACT FROM AUTHOR]

To evaluate professional records of prenatal care in electronic medical records in a city in Ceará. Retrospective, cross-sectional, and descriptive study, carried out through the analysis of medical records of pregnant women followed up at a Family Health Unit during the period from January 2021 to December 2022. The data collec-tion instrument contains sociodemographic information, obstetric history and care. The data were analyzed based on absolute and relative frequencies. The percentage of suitability of consultations decreased as more cri-teria were used to assess quality, at level 1 it presented 73.1% suitability, at level 2 57.7%, at level 3 53.8% and at level 4 50.0%. Prenatal care was in compliance with Ministry of Health guidelines. However, weaknesses were identified in the patients' electronic medical records, especially related to sociodemographic information. [ABSTRACT FROM AUTHOR]

To assess the content validity of the preliminary core set for knee dysfunction based on the opinion of experts. A panel of 180 experts in knee disorders or on the use of the International Classification of Functioning, Disability, and Health for musculoskeletal conditions was invited for this Delphi study. The experts gave their opinion on whether to include the categories of the preliminary core set for knee dysfunction in a more comprehensive core set, using a six-item Likert scale. Kappa coefficient was used to analyze the agreement between the experts, and a consensus of 75% among responses was considered acceptable. Nineteen experts participated in all rounds. Of the 24 categories from the preliminary core set for knee dysfunction, 15 remained in the comprehensive core set and one category was further detailed into three new categories. Seven new categories were included. Thus, the comprehensive core set for knee dysfunction was composed of 25 categories with an agreement of 81.5% among responses and a Kappa value of 0.63. After validation by experts, the comprehensive core set for knee dysfunction was composed of 25 categories that can be used to assess the functioning of patients with knee dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Since the beginning of the COVID-19 pandemic, medical specialties have adapted their routine, postponing non-essential procedures, which resulted in a reduction in the number of surgical visits, directly impacting teaching hospitals. This work aims to evaluate the impact of the COVID-19 pandemic on the activities of the surgical specialties at the University Hospital Professor Edgard Santos (C-HUPES), located in Salvador-BA. Method: Observational, cross-sectional, retrospective study, which compares the year 2020 to the year 2019, in which the impacts of the pandemic on the surgical activities (especially plastic surgery) of the hospital are analyzed through the total number of procedures, hospitalizations, and outpatient consultations of surgical specialties. Results: A reduction of 45,45% of the total number of surgical procedures was observed, with 220 surgeries in 2019 and 120 surgeries in 2020. Reduction of 37.29% in hospitalizations, totaling 236 in 2019 and 148 in 2020. There was a decrease of 40.90% in outpatient consultations, with 2941 consultations performed in 2019 and 1738 consultations in 2020. It is noticed that the worst periods of reduction in 2020 were from March to June, in addition to a new drop in November and December. Conclusion: The pandemic impacted the activities of the surgical specialties at C-HUPES due to the total reduction in the number of surgeries, consultations, and hospitalizations in 2020, impairing the care of plastic surgery patients in absolute numbers. It is inferred that the COVID-19 pandemic hampered the training of plastic surgery residents.

Abstract Background In Brazil, despite advances in public health policies aimed at eliminating and controlling infectious and parasitic diseases, the incidence of neglected diseases is still high. The epidemiological scenario in Brazil of diseases such as tuberculosis and leprosy evidences a public policy agenda that has not been resolute in terms of control, nor in terms of elimination. Objective To analyze the actions of diagnosis and treatment of leprosy and tuberculosis in the context of primary health care. Methods In this ecological study, data from the third cycle of the Program for the Improvement of Access and Quality of Primary Care were extracted from electronic address of the Primary Health Care Secretariat of Brazil in the area of Actions, Programs and Strategies. A total of 37,350 primary health care teams were that answered the questionnaire were eligible, with variables extracted from leprosy and tuberculosis control actions. The municipalities were grouped according to the characteristic of the Brazilian municipality. The partition chi-square and the Residuals Test were used to assess whether there was a difference in the proportion of tuberculosis and leprosy actions between types of municipalities. Statistics were carried out using Minitab 20 and Bioestat 5.3. Results Regarding the leprosy treatment location, there is a higher proportion of people referred to be treated at the reference in adjacent rural (p = 0.0097) and urban (p

The waters of the northern Shandong Peninsula are spawning and nursery grounds for many fishery organisms from the Bohai Sea and Yellow Sea and play an important supporting role in the supplementation and reproduction of fishery resources in these seas. In recent years, with global warming and intensification of human activities, the fishery resources in Shandong offshore have generally declined, with obvious species miniaturization, low quality, and reduction of species diversity. Important fishery resources have been unable to achieve the minimum amount for the fishing seasons, and its support function in the Bohai and Yellow seas is increasingly diminishing. The fishery organisms research in the northern part of the Shandong Peninsula is less focused on their composition, community structure, and fishery biological health evaluation. Therefore, based on the northern Shandong Peninsula fishery resource survey data of May–June 2021, this study analyzed the fishery's biological diversity and identified the dominant species in these waters. Key species were evaluated through food web topology and social network analysis, and the fishery's biological health status was provided based on the survey data of 2011 and 2013. The study showed that the fishery resources of the Shandong Peninsula would be conserved and managed in 2021. The proportion of pelagic fish in spring decreased in 2021, and the turnover of dominant species showed a gradual decrease in pelagic fish, mainly small and less economically valuable. In the past 40 years, the spring fish diversity and evenness indices in the northern Shandong Peninsula sea area have been continuously reduced, reaching values lower than the reasonable range of the proposed diversity index, which indicates that the species in this area are poorly homogeneous concerning their horizontal structure. The higher number and extremely uneven distribution of species can lead to a lower diversity index. Compared with the late 20th century to the early 21st century, Engraulis japonicus was a dominant resource based on the results of this study, and the lower number of other fishes may be a factor for the lower diversity index. The significant increase in the richness index may be related to the occurrence of succession in the community structure, resulting from the mutual replacement of small, low-quality species with short life cycles, rapid resources renewal, and small individuals. The dominant species E. japonicus is often found among the catch. Shandong offshore fisheries development history corresponds to a significant number of large, high-value class invertebrates fishing, including cephalopods such as Loligo chinensis, in an unhealthy state. Crangon affinis is the absolute dominant species of invertebrates. In the spring of 2021, the fish food web in the northern Shandong Peninsula showed correlation values ranging from 0.03 to 0.30, excluding a possible specific relationship between the population feeding and the community. Moreover, external factors may disturb the community, which is consistent with the community interspecific feeding relationship under natural conditions. The key community species were Liparis tanakae, Lophius litulon, E. japonicus, Larimichthys polyactis, and Chaeturichthys stigmatias. E. japonicus was both the dominant and key species in the fish community in the northern Shandong Peninsula waters in 2021. The regulating effect of E. japonicus on the food web was related to its upward control effect through changes in resource abundance that affects the changes of other fish that use this area as bait. L. tanakae, L. litulon, and L. polyactis were important predators in the sea through the downward control effect, affecting the stability of the whole food web. Fishery biological density, fish density, and crustacean density health index were found within healthy parameters, while the cephalopod density health index was in a sub-healthy state. Compared with 2011–2013, the densities of various economic species have increased significantly, and the overall health of fishery organisms in the northern part of the Shandong Peninsula is good. Overall, the results of this study can provide a reference for conserving and managing fishery resources in the Shandong offshore region.

ABSTRACT Objective: To analyze characteristics of the home visit (HV) in Brazil, 2012 and 2017. Methods: Ecological study, with panel data whose units of analysis were the Primary Health Care teams in Brazil, participants of the 1st and 3rd cycles of the Program to Improve Access and Quality of Primary Care of the Unified Health System. Descriptive, inferential and spatial analyzes (alpha=5%) were performed. Results: There was an increase in the proportion of teams that carried out home visits at a frequency defined based on risk and vulnerability analysis and actively searched for people with respiratory symptoms and women with delayed and altered cytopathological examination. In the heat maps, the Northeast, Southeast and South regions had a higher concentration of teams that carried out the HV and carried out an active search. Conclusion: The maintenance and qualification of HVs must be a priority in Brazil, since there are few countries in the world with such capillarity of health services, reaching the homes of millions of people.

ABSTRACT Objective: To build and validate an instrument to evaluate Lean Healthcare in healthcare institutions. Method: Methodological study conducted in three stages: 1) Instrument construction; 2) Content validity using the Delphi technique with 14 experts; and 3) Construct validation using Structural Equation Modeling with sample consisted of 113 professionals with experience in Lean Healthcare. Data collection carried out from October/2020 to January/2021 using a digital form. Data analysis performed with the SmartPLS2.0/M3 software. Results: Items were developed after an integrative review and divided into the dimensions Structure, Process and Outcome, according to Donabedian’s theoretical framework. Content validation in two rounds of the Delphi technique. Final instrument, after model adjustment, containing 16 items with Cronbach’s alpha of 0.77 in Structure, 0.71 in Process and 0.83 in Outcome. Conclusion: The instrument presented evidence of validity and reliability, enabling its use in healthcare institutions to evaluate Lean Healthcare.

Objective: to evaluate the patient safety climate in Primary Health Care from the perspective of nurses working in the services. Method: a quantitative and cross-sectional study conducted with 148 nurses from a municipality in the state of São Paulo. The Brazilian version of the Primary Care Safety Questionnaire Survey and personal, professional, and organizational performance variables (intention to stay at work, job satisfaction, care quality, and frequency of incidents) were used. Parametric and non-parametric comparison tests and Spearman’s correlation coefficient were performed, considering a 5% significance level. Results: the safety climate was positive, varying from 4.52 to 5.33 and differing across districts for workload (p=0.0214) and leadership (p=0.0129). The safety climate professional variables and dimensions differed in relation to the frequency of incidents. Teamwork and safety and learning system were strongly correlated with job satisfaction and moderately with perceived care quality. Conclusion: teamwork and safety and learning system stood out for their positive correlations with job satisfaction and care quality. A positive safety climate favors the involvement of Primary Care nurses to develop improvement plans aligned with the National Patient Safety Program.

ABSTRACT Objective: To map the current status of parameters and tools to assess quality of care related to peripheral venous catheter use in adults. Methods: Scoping review, conducted in 2022 in the MEDLINE, LILACS, CINAHL and SCOPUS databases and with a publication time limit from 2013 to 2022. Results: The sample consisted of 15 articles, summarized in the following categories: Indication, documentation and registration, coverage assessment, connection, stabilization and signs and symptoms inherent to the catheter. The use of a complete instrument, with the domains observed in this review, may have a positive impact on a more effective and safe clinical practice. Conclusions: The present review mapped the evidence about the insertion and maintenance of peripheral venous catheters that can be improved with training of good practices and the quality of the team, regarding the use of tools, materials and instruments for the evaluation of care.

Introduction: the National Policy for Permanent Health Education is a strategy for training workers in the Brazilian Unified Health System. Objective: we sought to evaluate the implementation of the Permanent Health Education Policy from the perspective of professionals from the Expanded Center for Family Health and Primary Care in the city of Vitória, Espírito Santo. Methods: this is a case study, quantitative and qualitative research, with triangulation of methods. A Logic Model and an Analysis and Judgment Matrix were prepared based on document analysis and scientific literature. Results: 49 questionnaires were applied and 28 interviews were conducted with health professionals with at least one year of experience in the position. A descriptive analysis of the quantitative data (absolute and relative frequencies) was performed using SPSS version 21.0, and thematic content analysis of the interviews was conducted using MAXQDA (22.0.1), with the results being applied to the matrix, following the score for each classification level of the criteria provided for in the Governance, Technical Quality, and Sustainability dimensions. Conclusion: the full degree of implementation of the policy was obtained in the view of the teams, with facilitating factors such as the good performance of the Technical School of Health. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the cost-effectiveness of anti–epidermal growth factor receptor (cetuximab and panitumumab) or anti–vascular endothelial growth factor (bevacizumab) monoclonal antibodies associated with conventional chemotherapy (CT) (fluorouracil and leucovorin with irinotecan) as a first-line treatment for unresectable metastatic colorectal cancer. A partitioned survival analysis model was adopted to simulate direct health costs and benefits comparing therapeutic options in a 10 years' time horizon. Model data were extracted from the literature and costs were obtained from Brazilian official government databases. The analysis considered the perspective of the Brazilian Public Health System; costs were measured in local currency (BRL) and benefits in quality-adjusted life-years (QALY). A 5% discount rate was applied to costs and benefits. Alternative willingness-to-pay scenarios, varying from 3 to 5 times the cost-effectiveness threshold established in Brazil, were estimated. The results were presented incremental cost-effectiveness ratio (ICER), and both deterministic and probabilistic sensitivity analyses were performed. The most cost-effective choice would be the association of CT with panitumumab, with an ICER of $58 330.15/QALY compared with isolated CT. The second-best option was CT with bevacizumab and panitumumab, with an ICER of $71 195.40/QALY compared with panitumumab alone. Although having higher costs, the second-best option was the most effective. Both strategies were cost-effective in part of the Monte Carlo iterations, considering the 3× threshold. The therapeutic option CT + panitumumab + bevacizumab represents the most significant effectiveness gain in our study. It is the second-lowest cost-effectiveness, and this option includes monoclonal antibodies association for patients with and without KRAS mutation. • To the best of our knowledge, this is the first study to estimate the cost-effectiveness of first-line treatment for unresectable metastatic colorectal cancer. The treatments options assessed were anti–epidermal growth factor receptor (cetuximab and panitumumab) or anti–vascular endothelial growth factor (bevacizumab) monoclonal antibodies associated with conventional chemotherapy with fluorouracil and leucovorin with irinotecan in the perspective of the Brazilian Unified Health System. • The presented model compared different drug incorporation alternatives for the 2 KRAS status types and seeks to represent actual decision making for resource allocation when comparing strategies and nonisolated treatments. The decision interpretation is also improved with cost-effectiveness frontiers and threshold analyses. • Regarding effectiveness, the present model adopts survival curves using robust data extrapolation methods, which are widely applicable to oncological models. The deterministic and probabilistic sensitivity analyses adequately dealt with parameter uncertainty. [ABSTRACT FROM AUTHOR]

The aim of the present study was to propose a quality prenatal (PN) care assessment model combining use and visit content (both adjusted for the weeks of gestation) to estimate inadequate PN care and associated factors in Rio Branco, Acre. A cross-sectional study was conducted using a population-based cohort of 1030 women in the city of Rio Branco in 2015. The use of PN care was classified according to the adapted Kotelchuck index by combining the performance of clinical-obstetric procedures adjusted for weeks of gestation. Levels of adequacy were built according to PN care use and content. Gross and adjusted odds ratios were estimated by using a logistic regression. The prevalence rates of inadequate prenatal care quality were 25.9% (Level-1), 54.8% (Level-2), 68.8% (Level-3), and 78.6% (Level-4). The factors associated with Level-1 were age ≤ 34 years (ORaj:3.74), not having a partner (ORaj:1.62), unplanned pregnancy (ORaj:1.73), and multiparity (ORaj:2.25); those for Level-2 comprised not having a partner (ORaj:1.82) and multiparity (ORaj:1.33); those for Level-3 were age ≤ 34 years (ORaj:3.31), not having a partner (Oraj:1.71), unplanned pregnancy (Oraj:1.45), PN in the private sector (Oraj:3.08), and multiparity (ORaj:2.17); those for Level 4 comprised not having a partner (ORaj:2.33), family income < 1 MW (ORaj:2.05), unplanned pregnancy (ORaj:1.41), PN in the private sector (ORaj:6.80), and multiparity (ORaj:1.49). The Kotelchuck index was proven efficient in assessing the combined effect of use and content in assessing PN care quality.

Introduction: Although extracorporeal photopheresis (ECP) is a promising second-line therapy in the treatment of chronic graft-versus-host disease (cGVHD), its use is limited by its high cost. This study aims to describe the clinical evolution of patients who underwent ECP therapy for cGVHD and to perform an economic analysis of the therapy Methods: This was a case series between 2016 and 2020 describing the clinical response to ECP and a micro-cost analysis of the therapy using time-driven activity-based costing. Results: Six patients underwent ECP for corticosteroid-dependent cGVHD The cost per ECP session is 14,960.90 Brazilian reais (BRL), which primarily consists of the ECP kit with an activator (82.78%), followed by the hospital's physical structure (14.66%), human resources (2.48%) and exams/inputs (0.08%). The number of sessions performed ranged from 2 to 42. The total cost of the therapy per patient ranged from BRL 30,000 to 500,000. Conclusion: The response of the patient with cGVHD to treatment with ECP was variable. These micro-costing results can be used to develop remuneration and cost control strategies in hematopoietic stem cell transplantation programs, as well as in further economic studies.

Accurately assessing the state of health (SOH) of lithium batteries is of great significance for improving battery safety performance. However, the current assessment for SOH suffers from the difficulty of selecting health features and the lack of uncertainty using data-driven methods. To this end, this paper proposes a health state assessment method for lithium-ion batteries based on health feature extraction and an improved Informer model. First, multiple features that can reflect the SOH of lithium-ion batteries were extracted from the charging and discharging time, the peak value of incremental capacity curve (ICC), and the inflection point value of differential voltage curve, etc., and the correlation between multiple health features and the health state was evaluated by gray correlation analysis. Then, an improved Informer model is proposed to establish a health state estimation method for lithium-ion batteries. Finally, the proposed algorithm is tested and validated using publicly available battery charge/discharge datasets and compared with other algorithms. The results show that the method in this paper can realize high-precision SOH prediction with a root-mean-square error (RMSE) of 0.011, and the model fit reaches more than 98%.

Lithium-ion batteries are widely used in modern society as important energy storage devices due to their high energy density, rechargeable performance, and light weight. However, the capacity and performance of lithium-ion batteries gradually degrade with the number of charge or discharge cycles and environmental conditions, which can affect the reliability and lifetime of the batteries, so it is necessary to accurately evaluate their health. The belief rule base (BRB) model is an evaluation model constructed based on rules that can handle uncertainties in the operation of lithium-ion batteries. However, lithium-ion batteries may be affected by disturbances from internal or external sources during operation, which may affect the evaluation results. To prevent this problem, this paper proposes a disturbance-considering BRB modeling approach that considers the possible effects of disturbances on the battery in the operating environment and quantifies the disturbance-considering capability of the assessment model in combination with expert knowledge. Second, robustness and interpretability constraints are added in this paper, and an improved optimization algorithm is constructed that maintains or possibly improves the resistance of the model to disturbance. Finally, using the lithium-ion batteries provided by the National Aeronautics and Space Administration (NASA) Prediction Centre of Excellence and the University of Maryland as a case study, this paper verifies that the proposed modeling approach is capable of constructing robust models and demonstrates the effectiveness of the improved optimization algorithm.

Abstract Objective: To evaluate the measles epidemiological surveillance system, before and during the COVID-19 pandemic in Pernambuco, Brazil. Methods: This was a descriptive evaluation of the quality (duplicity; completeness; consistency), timeliness and usefulness attributed, classified as excellent ≥ 90.0%, regular ≥ 70.0% and < 90.0%, and poor (< 70.0%). Data from the Notifiable Health Conditions Information System and Laboratory Environment Management System were used, before (03/11/2018-03/10/2020) and during (03/11/2020-03/10/2022) the pandemic. Results: 1,548 suspected measles cases were registered (1,469 before and 79 during the pandemic). In the two periods studied, there were 11 and 1 duplicate records, average completeness in filling out the variables was 99.2% and 95.7%, while average consistency was 96.7% and 97.5%, respectively. Timeliness (receipt of samples, 16.2% and 33.0%. Release of results, 1.3% and 1.3%) and usefulness (43.5% and 24.4%) were poor. Conclusion: Quality was classified as excellent in the periods studied, timeliness and usefulness were classified as poor, signaling non-compliance with the purpose of the system.

The aim of this study is to analyze the level of implantation of the Tuberculosis Control Program in Primary Health Care in a medium-sized city. Normative evaluation study, with a quantitative approach, emphasizing the level of implantation of programs. The sample included 80 nurses and data collection took place from November 2017 to March 2018, using a questionnaire with 62 questions. To identify the level of implantation, the percentage of responses identified was distributed in four classifications: not implanted (from 0% to 25%); incipient (from 26% to 50%); partially implanted (from 51% to 75%) and implanted (from 76% to 100%). The Tuberculosis Control Program in the city was classified as partially implanted (62.85%). The dimensions Structure and Process were also evaluated as being in the same level (61.80% and 63.17%, respectively). The level of implantation of the program was classified as partially implanted, showing shortcomings with regard to the activities developed in the city. Health professionals are expected to make decisions to improve the program.

IntroductionThe COVID-19 pandemic presented health systems across the globe with unparalleled socio-political, ethical, scientific, and economic challenges. Despite the necessity for a unified, innovative, and effective response, many jurisdictions were unprepared to such a profound health crisis. This study aims to outline the creation of an evaluative tool designed to measure and evaluate the Vitalité Health Network’s (New Brunswick, Canada) ability to manage health crises.MethodsThe methodology of this work was carried out in four stages: (1) construction of an evaluative framework; (2) validation of the framework; (3) construction of the evaluative tool for the Health Authority; and (4) evaluation of the capacity to manage a health crisis.ResultsThe resulting evaluative tool incorporated 8 dimensions, 74 strategies, and 109 observable elements. The dimensions included: (1) clinical care management; (2) infection prevention and control; (3) governance and leadership; (4) human and logistic resources; (5) communication and technologies; (6) health research; (7) ethics and values; and (8) training. A Canadian Health Authority implemented the tool to support its future preparedness.ConclusionThis study introduces a methodological strategy adopted by a Canadian health authority to evaluate its capacity in managing health crises. Notably, this study marks the first instance where a Canadian health authority has created a tool for emergency healthcare management, informed by literature in the field and their direct experience from handling the SARS-CoV-2 pandemic.

Background: In Brazil, despite advances in public health policies aimed at eliminating and controlling infectious and parasitic diseases, the incidence of neglected diseases is still high. The epidemiological scenario in Brazil of diseases such as tuberculosis and leprosy evidences a public policy agenda that has not been resolute in terms of control, nor in terms of elimination. Objective: To analyze the actions of diagnosis and treatment of leprosy and tuberculosis in the context of primary health care. Methods: In this ecological study, data from the third cycle of the Program for the Improvement of Access and Quality of Primary Care were extracted from electronic address of the Primary Health Care Secretariat of Brazil in the area of Actions, Programs and Strategies. A total of 37,350 primary health care teams were that answered the questionnaire were eligible, with variables extracted from leprosy and tuberculosis control actions. The municipalities were grouped according to the characteristic of the Brazilian municipality. The partition chi-square and the Residuals Test were used to assess whether there was a difference in the proportion of tuberculosis and leprosy actions between types of municipalities. Statistics were carried out using Minitab 20 and Bioestat 5.3. Results: Regarding the leprosy treatment location, there is a higher proportion of people referred to be treated at the reference in adjacent rural (p = 0.0097) and urban (p < 0.0001) municipalities; monitoring of people with leprosy referred to the service network (p. = 0.0057) in remote rural areas. Lower proportion of teams requesting bacilloscopy in remote rural areas (p = 0.0019). Rural areas have a higher proportion of teams that diagnose new cases (p = 0.0004). Regarding the actions of diagnosis and treatment of tuberculosis. There is a higher proportion of teams that carry out consultations at the unit itself in rural areas when compared to adjacent intermediaries (p = 0.0099) and urban (p < 0.0001); who requested sputum smear microscopy in adjacent intermediaries (p = 0.0021); X-ray in adjacent intermediaries (p < 0.0001) and urban (p < 0.0001); collection of the first sputum sample in urban (p < 0.0001) and adjacent rural areas (p < 0.0001); directly observed treatment (p < 0.0001) in adjacent rural municipalities. Conclusion: There are inequalities in the diagnosis and treatment of leprosy and tuberculosis among the types of municipalities. [ABSTRACT FROM AUTHOR]

Keywords: Medical overuse; Intervention bias; Randomized controlled trials; Health evaluation; Appropriate use; Public Health; Climate change EN Medical overuse Intervention bias Randomized controlled trials Health evaluation Appropriate use Public Health Climate change 913 916 4 08/16/23 20230801 NES 230801 Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10654-023-01025-0. Medical overuse, Intervention bias, Randomized controlled trials, Health evaluation, Appropriate use, Climate change, Public Health Only 1% of trials constituted a "stop trial", meaning that it was designed to evaluate whether current everyday care is indeed beneficial to patients, or whether it should be abandoned. [Extracted from the article]

The aim of the present study was to propose a quality prenatal (PN) care assessment model combining use and visit content (both adjusted for the weeks of gestation) to estimate inadequate PN care and associated factors in Rio Branco, Acre. A cross-sectional study was conducted using a population-based cohort of 1030 women in the city of Rio Branco in 2015. The use of PN care was classified according to the adapted Kotelchuck index by combining the performance of clinical-obstetric procedures adjusted for weeks of gestation. Levels of adequacy were built according to PN care use and content. Gross and adjusted odds ratios were estimated by using a logistic regression. The prevalence rates of inadequate prenatal care quality were 25.9% (Level-1), 54.8% (Level-2), 68.8% (Level-3), and 78.6% (Level-4). The factors associated with Level-1 were age ≤ 34 years (ORaj:3.74), not having a partner (ORaj:1.62), unplanned pregnancy (ORaj:1.73), and multiparity (ORaj:2.25); those for Level-2 comprised not having a partner (ORaj:1.82) and multiparity (ORaj:1.33); those for Level-3 were age ≤ 34 years (ORaj:3.31), not having a partner (Oraj:1.71), unplanned pregnancy (Oraj:1.45), PN in the private sector (Oraj:3.08), and multiparity (ORaj:2.17); those for Level 4 comprised not having a partner (ORaj:2.33), family income < 1 MW (ORaj:2.05), unplanned pregnancy (ORaj:1.41), PN in the private sector (ORaj:6.80), and multiparity (ORaj:1.49). The Kotelchuck index was proven efficient in assessing the combined effect of use and content in assessing PN care quality. [ABSTRACT FROM AUTHOR]

Plain Language Summary Brazil has a high rate of cesarean sections with low participation of nurse-midwives in childbirth care. Nurse-midwife care is associated with less use of interventions, lower proportions of cesarean sections and greater women’s satisfaction. In 2015, a quality improvement project, called the “Adequate Childbirth Project” (Projeto Parto Adequado, PPA), was implemented in Brazilian private hospitals to reduce unnecessary cesarean sections. One of its components is the expansion of nurse-midwives in labor and childbirth care. In this study, we evaluated the results of PPA on childbirth care by nurse-midwives. Data were collected in 12 hospitals with interviews with 4798 women. Women assisted in the PPA model of care had a higher proportion of labor and vaginal birth, but there was no increase in the proportion of women assisted by nurse-midwives, neither during labor nor vaginal birth. The use of recommended practices was adequate, except for the use of epidural analgesia, with greater use of some recommended practices in women assisted by nurse-midwives compared to those seen only by doctors. However, we observed excessive use of non-recommended practices during labor, both by doctors and nurses. We can conclude that there was an increase in the proportion of women with labor and vaginal birth in the PPA model of care and a greater use of recommended practices in women assisted by nurse-midwives, but without an increase in the proportion of women assisted by nurses. The expansion of nurse-midwives’ participation in childbirth care and the reduction of non-recommended practices therefore continue to be challenges.

Plain language summary This study aims to analyze the care model of the first postpartum hour offered by two hospitals participating in the Adequate Childbirth Project (PPA), a quality improvement project to enhance normal delivery and reduce unnecessary cesarean sections in Brazilian private hospital. It is a qualitative analysis, based on the narrative of 102 women attended at two hospitals participating in the PPA. Categories that emerged from the analysis: “First hour; dimension of time and care expressed in the lived experience” and “Interferences in care in the first hour of life”. Most women expressed a chronological time of skin-to-skin contact far from the ideal recommended in the first postpartum hour; however, they valued the experience and its meaning. Two barriers were observed in this care process: the interruption of skin-to-skin contact for neonatal care and the transfer to the recovery room, without observing the duration of the "golden hour". We can conclude that women evaluated the service positively, with indications that point to the sustainability of the PPA. Information during antenatal care to increase women´s autonomy are needed to improve the implementation of these practices and access to their health benefits.

One of the features of COVID-19 infection is a long recovery process and development of the long-term health effects of COVID-19. Therefore, the interest of scholars in ensuring patients' quality of life after treatment of COVID-19 is increasing and puts a long-term health assessment on the agenda. However, there have been limited studies examining subjective evaluation of physical and mental health of patients who have undergone COVID-19 in Kazakhstan. The study aims to examine the subjective health assessment of patients who suffered from COVID-19 in 2020 and 2021 in Nur-Sultan city using the SF-36 tool. These patients were included and observed in the research with confirmed and probable COVID-19 cases as well as their close contacts. Material and methods: The study employed questionnaires of respondents through direct interviews, including common questions SF-36. The scoring was done in Microsoft Excel. Statistical analysis of data was performed using the SPSS program, version 23. Results: Questionnaires were administered among 64 out of 172 patients, 52 (81%) were women and 12 (19%) were men. The majority of respondents were over 40 (41%) and 31 (31%) years old. Nearly half of participants (46%) responded that their health condition was about the same as a year ago, 27% rated their health somewhat worse than a year ago, and 2%, that is, 1 participant, rated their condition as much worse than before COVID-19. Men considered themselves significantly healthier than women (p>0.05). Conclusion: There is a need for additional research on "Long COVID-19" using more specific HRQoL instruments.

The COVID-19 pandemic has affected city dwellers' physical and mental health and has raised concerns about the health of urban public spaces. This field investigation research in Dalian, China, examined the perceived audiovisual environment characteristics of urban pedestrian streets with traffic noise and their influences on the environmental health of the pedestrian streets. Five indicators reflecting psychological responses to environmental characteristics (willingness to walk, relaxation, safety, beauty, and comprehensive comfort) were used to measure environmental health of pedestrian streets with traffic noise. The results showed that safety was rated the highest, and willingness to walk was evaluated as the lowest among health evaluation indicators. The imageability and openness of the streetscape were associated with each health evaluation indicator. In contrast, the rhythm and continuity of the street buildings had a greater effect on willingness to walk than the other health indicators. There were negative correlations between LAeq for traffic noise and health evaluations. Positive health evaluations were observed when LAeq was less than 55 dBA. In contrast, soundscape indicators showed positive correlations with health evaluations, and acoustic comfort and noise annoyance, rather than sound preference and subjective loudness were associated with each health evaluation indicator. In terms of the combined audio-visual factors, acoustic comfort, the quantity of greening, annoyance, sky visibility, spatial scale, and building distance were examined as the determining factors affecting health evaluations, and 55.40% of the variance in health evaluations was explained by the soundscape and streetscape indicators. The findings provide references for better understanding the relationships between healthy experience and audio-visual perceptions. Moreover, they enable environmental health quality optimisation of pedestrian spaces considering audio-visual indicators and approaches in the post-epidemic era. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To discuss the use of the Fourth Generation Evaluation methodology as a powerful theoretical-methodological path for the implementation of Knowledge Translation in child and adolescent mental health. Method: It comprises the description of the stages and fieldwork of a research that evaluated mental health practices aimed at adolescents in a Child and Adolescent Psychosocial Care Center, between August and December 2018, with the health care team. Results: Using strategies to involve workers in all stages, a dialectical construction of knowledge, the adaptation of the path to the field - with the implementation of interventions suggested by the participants - and the research path itself, in its condition of product/result, enable the interface with Knowledge Translation. Final considerations: The characteristics discussed allow to suggest using the Evaluation as an alternative to the implementation of Translation, especially in the field of mental health.

ABSTRACT Objective: To analyze the matrix support for health teams in Specialized Outpatient Care, according to the Chronic Conditions Care Model. Method: Qualitative evaluative research, conducted by the Chronic Conditions Care Model, carried out from February to July 2020. For data collection, interviews were carried out with 21 health professionals, assistance observation and document analysis of the service. Data were analyzed by data triangulation, with the aid of the MAXQDA software, respecting all ethical aspects. Results: The matrix support provided approximation between Primary and Secondary Care; implemented case management and qualified comprehensive care for people with chronic conditions. Weaknesses in communication and understanding of the theoretical bases of matrix support were obstacles to the proper implementation of matrix strategies. Final consideration: Matrix support for specialized health teams qualified the professional care given to people with chronic conditions treated at the service.

Abstract Background To assess the financial impact of incorporating a new (reciprocal) technology into endodontic treatments in the public health system (SUS). Methods This was a economic evaluation study (comparing the 3 different endodontic instrumentation techniques—manual, rotary and reciprocating), allocative efficiency analysis to optimize existing resources in the SUS, and financial contribution impact analysis of incorporation of a new technology. Thirty-one (31) 12 years-old volunteers were evaluated. Results The incremental cost-effectiveness ratio (ICER) was calculated at R$1.34/min, − R$0.60/min and BRL 0.10/min for the single-rooted, bi-rooted and tri-rooted teeth, respectively, when the rotary technique was compared with the manual type. In turn, the ICER was R$ 21.04/min, − R$ 0.73/min and − R$ 2.81/min for the 3 types of teeth, respectively, when the reciprocating technique was compared with the manual type. The incremental financial impact of replacing manual endodontic with rotary endodontic treatments would be − R$ 2060963.66 in the case of single-rooted teeth, but the number of treatments would also be reduced (− 19,379). In the case of two-rooted teeth, the incremental financial impact would be BRL 34921540.62 with the possibility of performing an additional 204,110 treatments. In turn, BRL 11523561.50 represented the incremental financial impact for teeth with 3 or more roots and with an increase of 72,545 procedures. When we analyzed the incremental financial impact of replacing manual endodontic with reciprocating endodontic treatments, it would be − R$ 730227.80 in the case of single-rooted teeth, allowing for an additional 2538 treatments. In turn, R$ 21674853.00 represented the incremental financial impact for bi-radicular teeth, with an increase of 121,700 procedures. In the case of two-rooted teeth, the incremental financial impact would be BRL 13591742.90 with the possibility of performing an additional 40,670 treatments. Conclusions The reciprocating technique could improve access to endodontic treatment in the SUS as it allowed a simultaneous reduction in clinical time and associated costs. However, the higher number of endodontic treatments performed would have a financial impact.

ABSTRACT. Due to the disruption of normal flow of treatment during the restrictions related to the coronavirus disease 2019 (COVID-19) pandemic, the health status of persons with dementia (PwD) and their caregivers’ burden might worsen. Objective: The article aims to find out the health status of PwD and caregivers’ burden during the peak of second wave of COVID-19 and make a comparison with the preceding trough phase. Methods: The study was conducted with 53 PwD and their caregivers in two phases. On their visit to the hospital during the unlock phase (phase 1), data were collected for CDR from PwD, and NPI-Q and ZBI from their caregivers. During the peak of second wave (phase 2), data were collected for NPI-Q, ZBI, and DASS-21 through telephonic communication, and statistical analyses were performed on the collected data. Results: Significantly higher caregiver burden (p=0.001) and neuropsychiatric symptoms (NPSs) [both in severity (p=0.019) and distress (p=0.013)] were observed among the respondents during the peak of second wave of the pandemic as compared to the preceding trough phase. Positive correlations were observed between the caregiver burden and depression, anxiety, and stress of the caregivers (p

ABSTRACT Purpose: to analyze the time trend of audiological procedures in the Brazilian Public Health System (SUS) between 2008 and 2019 in the geographical regions of Brazil. Methods: a time series ecological study with data on audiological procedures from the SUS Outpatient Information System. The study calculated annual indices of audiological procedures with joinpoint regression for the trend analysis. The progress in the provision of procedures between the initial and final years in the series and the distribution of identified records was calculated. Results: altogether, 38,500,404 records were found in the study period. The South (178.84/10,000 inhabitants) and North of Brazil (130.97/10,000 inhabitants), respectively, had the highest and lowest mean procedure indices. Both were the only regions with a trend towards a significant increase in procedures. In Brazil, they increased by 56.91%, with an emphasis on the increase in “otoacoustic evoked emissions in neonatal hearing screening” and a decrease in “visual reinforcement audiometry (air/bone conduction).” In the distribution, procedures concentrated on basic audiological assessments. Conclusion: audiological procedures have increased at SUS, but there are discrepancies between procedures and geographical regions of Brazil.

The association between physical activity in daily life (PADL) and simple functional tests is not yet clearly understood in subjects with chronic obstructive pulmonary disease (COPD). Therefore, the aim of this study was to investigate the association of two functional tests (Sit-to-Stand test [STS] and the 4-Metre Gait Speed test [4MGS]) with PADL, as well as to identify whether these tests can discriminate those subjects who are physically inactive. In this cross-sectional study, 28 subjects with COPD performed the five repetitions Sit-to-Stand (STS5r), the 4MGS and used the DynaPort activity monitor for 7 days in order to assess PADL. Walking time, movement intensity while walking (MI) and Physical Activity Level index (PAL) were considered as PADL outcomes. STS5r and 4MGS, respectively, were significantly associated with walking time (R2 = 0.16; p = 0.024 and R2 = 0.25; p = 0.006) and PAL index (R2 = 0.17; p = 0.002 and R2 = 0.30; p = 0.003), whereas movement intensity was associated only with the 4MGS (R2 = 0.23; p = 0.009). Additionally, both tests were able to discriminate physically inactive subjects (cutoffs: STS5r = 11.48s [AUC = 0.73]; 4MGS = 1.09m/s [AUC = 0.88]). In conclusion, STS5r and 4MGS can predict up to 30% of PADL in subjects with COPD. Both tests are related to PADL duration (e.g. time spent walking), while only the 4MGS reflects movement intensity. Both tests presented discriminative capacity to identify subjects with worse PADL pattern. [ABSTRACT FROM AUTHOR]

Background: Pelvic floor muscle (PFM) activation during efforts activities may predispose to urinary loss. However, there is unclear evidence on the behavior of PFM during situations of coughing and Valsalva maneuver. Objectives: Hence, the present review aimed to evaluate the current evidence on electromyographic (EMG) activity of PFM during coughing and Valsalva maneuver in continent women and women with stress urinary incontinence (SUI). Methods: The databases EMBASE, PubMed, Science Direct, Scopus and were searched up to August, 2021. Two independent reviewers conducted the selection process based on titles, abstracts, and full-text reading. In addition, studies reporting PFM EMG activity during coughing and/or the Valsalva maneuver with surface EMG were included. The methodological quality of the primary studies was assessed through the checklist proposed by the Joanna Briggs Institute for cross-sectional studies. Results: Seven cross-sectional studies were included in this review, four of which were on PFM activation of continent women, while the other three compared continent women versus women with SUI. During both Valsalva maneuver and coughing, an increase of PFM EMG activity compared to rest was observed for continent women and women with SUI. Limitations of the present systematic review are that comparison among studies and a meta-analysis were not possible due to heterogeneity of EMG techniques and devices used. Conclusions: Coughing and Valsalva maneuver lead to an increase in PFM electrical activity compared to rest. This increase was more prominent in women with SUI during Valsalva, with no differences during coughing. [ABSTRACT FROM AUTHOR]