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The issue of withrawing and withholding life-sustaining interventions is an important source of controversy among healthcare professionals caring for patients with serious illnesses. Misguided decisions, both in terms of the introduction/maintenance and the withdrawal/withholding of these measures, represent a source of avoidable suffering for patients, their loved ones, and healthcare professionals. This document represents the position statement of the Bioethics Committee of the Brazilian Palliative Care Academy on this issue and establishes seven principles to guide, from a bioethical perspective, the approach to situations related to this topic in the context of palliative care in Brazil. The position statement establishes the equivalence between the withdrawal and withholding of life-sustaining interventions and the inadequacy related to initiating or maintaining such measures in contexts where they are in disagreement with the values and care goals defined together with patients and their families. Additionally, the position statement distinguishes strictly futile treatments from potentially inappropriate treatments and elucidates their critical implications for the appropriateness of the medical decision-making process in this context. Finally, we address the issue of conscientious objection and its limits, determine that the ethical commitment to the relief of suffering should not be influenced by the decision to employ or not employ life-sustaining interventions and warn against the use of language that causes patients/families to believe that only one of the available options related to the use or nonuse of these interventions will enable the relief of suffering.

Objective: To learn the strategies used regarding underreporting of pesticide use in rural areas., Methods: A qualitative study was carried out in eight primary healthcare units in rural areas and two emergency care units in a municipality in southern Brazil. Data collection took place in 2023 through interviews. Twenty professional nurses participated. The data was submitted to content analysis., Results: The strategies identified were lifelong and continuing education for the professionals who carry out the notification, active search and training of workers who deal directly with this type of substance, computerizing the notification by filling in the forms online, and carrying out research on the subject., Final Considerations: Nurses play an important role in reporting occupational accidents caused by the use of pesticides, improving occupational safety in rural areas.

The study analyzes the development of responses to address the COVID-19 pandemic in Latin America. It is a descriptive study based on an analysis of documents, data, and policy measures adopted or announced between March and December 2020 in 14 Latin American countries. The analysis included assessment of the content, tenor, and scope of policy measures for containment and mitigation, health care, and reorganization of health services identified on government websites. In addition, quantitative demographic indicators were included, as well as those related to the epidemiological situation and the result of the Stringency index. In general, the responses of Latin American countries were heterogeneous, albeit multisectoral, characterizing the complexity and diversity of decision making when confronting a pandemic. The conclusion drawn is that there is still a great deal to reflect upon with respect to the consequences of regulatory weaknesses for the achievement of multidimensional demands during health crises.

Health care for patients with serious illnesses usually implies the need to make a large number of decisions, ranging from how information is shared to which diagnostic or therapeutic procedures will be adopted. The method of such decision-making has important implications from an individual and collective point of view and may contribute to either relieving or aggravating suffering. In this consensus document, the Bioethics Committee of the Brazilian National Academy of Palliative Care (ANCP) and the Permanent Committee on Palliative Care of the Brazilian Geriatrics and Gerontology Society (SBGG) adopt the principles of compassionate listening proposed by Saunders, of the nature of suffering proposed by Cassel, of dignity-preserving care proposed by Chochinov, and of cultural humility as a starting point for the construction of an official position of ANCP and SBGG on shared decision-making in palliative care. The position statement posits that, unlike paternalistic and consumerist models, the decision-making process in the sphere of palliative care must follow the mutualistic model of shared decision, where decisions are built based on dialogue between healthcare professionals and patients/family. The document sets forth the assumptions of this process, the limits of autonomy of patients/family and healthcare professionals and the distinction between futile and potentially inappropriate treatments, besides ratifying its incompatibility with any forms of coercion and conflict of interest foreign to the best interests of patients.

This integrative review examined factors associated with hepatitis C treatment adherence. The articles included were published in English, Spanish and Portuguese in the Lilacs, Medline, PsycINFO, Web of Science, Scopus and CINAHL databases, between 2000 and 2019. Initially, 540 publications were found and, after applying the study inclusion criteria, 22 articles were selected. Percentage non-adherence to treatment ranged from 12% to 32%. The variables identified as facilitating adherence were: receiving treatment for psychiatric disorders identified during treatment; knowing about medications and disease; receiving less complex treatment with greater likelihood of cure; fewer adverse events; social support; doctor-patient communication; and/or being in relationships. Barriers to adherence identified were: presence of depressive symptoms and other mental disorders; abuse of alcohol and psychoactive substances; education; age; ethnicity; unemployment; not having a steady partner; stigma; distance from health services; and the complexity and adverse effects of treatment. This review identified gaps in research on adherence.

Objective: To analyze overweight and associated factors in young adult student girls children in a capital city of Northeast Brazil., Method: An analytical, quantitative study was conducted with 546 young adults from 26 schools in a capital city of the Brazilian Northeast. After obtaining the data by the application of a specific questionnaire, the hierarchical logistic regression was used to identify the confounding variables and predictors of overweight., Results: The frequency of cases of overweight in this group was 36.6%. In the bivariate analysis, Overweight presented a statistically significant association with ethnicity, marital status, weight in childhood and overweight in adolescence, overweight in the family and exposure to alcohol, number of children, and age of menarche. In the final regression model, overweight remained associated with weight in childhood and age of menarche., Conclusion: Characteristics related to nutritional status in earlier life stages and gynecological issues were associated with Overweight during the young adult stage of the woman.

This article discusses an experience using the focus group technique with women from a quilombo, or community of descendants of African slaves in Brazil. This is a descriptive qualitative anthropological study of 13 women from a quilombo in rural Rio Grande do Sul State, Brazil. The focus group technique allowed an approach, interaction, and exchange of knowledge, experiences, perceptions, and feelings, in addition to problematization and in-depth discussion concerning the meaning of women's health care in the quilombo. The focus group was a prime space for learning and understanding the life experiences of quilombola women and the meanings they assigned to the experiences. In order to use the focus group technique, researchers must display creativity, sensitivity, attention, respect, nonjudgmental attitudes, flexibility, prior preparation, and knowledge of the technique and specific study topic.

Even after the publication of Law 8213 in 1991, which established quotas for employing disabled persons, their inclusion in the workplace still presents a challenge for Brazilian society. In order to understand the main barriers that hamper this process a qualitative research study was conducted in the municipality of Belo Horizon-te. This study included interviews with important actors involved in the process of inclusion; and focus groups including disabled persons and members of their families. The main barriers encountered were: preconceived ideas and discrimination; family relationships; the Continuous Cash Benefit (BPC) program; the low level of qualifi-cation among disabled person; lack of access; and the unpreparedness of companies. It was concluded that drafting laws is not sufficient to guarantee inclusion in the labor market and that governments should implement public policies to assist in this process.

Introduction: A dysfunctional autonomic nervous system (ANS) has also been recognized as an important mechanism contributing to the poor outcome in CKD patients, with several studies reporting a reduction in heart rate variability (HRV)., Objective: Evaluate the sympathovagal balance in patients with chronic kidney disease on conservative treatment., Methods: In a cross-sectional study, patients with CKD stages 3, 4 and 5 not yet on dialysis (CKD group) and age-matched healthy subjects (CON group) underwent continuous heart rate recording during two twenty-minute periods in the supine position (pre-inclined), followed by passive postural inclination at 70° (inclined period). Power spectral analysis of the heart rate variability was used to assess the normalized low frequency (LFnu), indicative of sympathetic activity, and the normalized high frequency (HFnu), indicative of parasympathetic activity. The LFnu/HFnu ratio represented sympathovagal balance., Results: After tilting, CKD patients had lower sympathetic activity, higher parasympathetic activity, and lower sympathovagal balance than patients in the CON group. Compared to patients in stage 3, patients in stage 5 had a lower LFnu/HFnu ratio, suggesting a more pronounced impairment of sympathovagal balance as the disease progresses., Conclusion: CKD patients not yet on dialysis have reduced HRV, indicating cardiac autonomic dysfunction early in the course of CKD.

Background: The natural biomembrane of latex extracted from Hevea brasiliensis has been used as a dressing for skin ulcers., Objectives: To evaluate how safe the natural biomembrane is in relation to hypersensitivity to latex when used as a dressing., Methods: We selected patients with skin ulcers, forming the following groups: control - low occupational exposure to latex (n = 17); latex-exposed control - high occupational exposure (n = 14); ulcerated, using the natural biomembrane (n = 13); ulcerated control, not using the natural biomembrane (n = 14); and new cases (n = 9), assessed before and after 3 months of using the natural biomembrane. All patients underwent clinical and epidemiological evaluation for latex hypersensitivity and specific IgE (UniCap(®)), and the control and latex-exposed control groups underwent the patch test., Results: Hypersensitivity was positive in 64.7% of the patients in the control group, 71.4% of the patients in the latex-exposed control group, 61.5% of the ulcerated using the natural biomembrane, 35.7% of the ulcerated control, and only 22 , 2% of the new cases. In the patch test of the control and latex-exposed control groups, only one individual in the control group (low contact) showed erythema in the first reading, which became negative in the second. The mean contact with latex in the latex-exposed control group was 3.42 hours / day. In the fluoroimmunoenzymatic assay, most of the sera was classified as zero (range 0-6). No serum was rated above 2, which is not considered significant for hypersensitivity (classification > 4)., Conclusion: The natural biomembrane proved to be safe as a dressing, for it did not induce hypersensitivity reactions among the volunteers who underwent the patch test or among users of the natural biomembrane, as it was clinically and immunologically demonstrated by IgE levels.

Background: Experimental diabetes promotes contractile dysfunction in cardiomyocytes, but the effects of swimming in this disorder are not known., Objective: To test the effects of a swimming training program (STP) on cardiomyocyte contractile dysfunction in rats with experimental diabetes., Methods: Wistar rats (age: 30 days; mean body weight: 84.19 g) with diabetes induced by streptozotocin (60 mg/kg body weight; glucose > 300 mg/dl) were divided into sedentary diabetic rats (SD, n = 10) and exercised diabetic rats (ED, n = 13). Animals of same age and weight served as sedentary controls (SC, n = 10) and exercised controls (EC, n = 06). Animals and ED and EC underwent a STP (05 days/week, 90 min/day) for 08 weeks. Left ventricular (LV) myocytes were isolated and electrically stimulated at 3.0 Hz at room temperature (∼ 25º C)., Results: Diabetes reduced contractile function in cardiomyocytes of animals compared to controls (i.e., lower amplitude of contraction, longer duration of contraction and relaxation). The STP attenuated the reduced amplitude of contraction (SC, 11 ± 0.2% vs ED, 11.6 ± 0.2%), time to peak contraction (SC, 319 ± 5.8 ms vs ED, 333 ± 4.8 ms) and time to 50.0% of relaxation (SC, 619 ± 22.2 ms vs ED 698 ± 18.6 ms) of cardiomyocytes of diabetic rats. Diabetes reduced the size of cardiomyocytes, however, the STP minimized the reduction of cell volume and width, without changing length., Conclusion: The swimming training program attenuated the contractile dysfunction of the LV myocytes of rats with experimental diabetes.

Patients and health staff frequently need to stay in health care facilities for quite a long time. Therefore, it's necessary to create the conditions that allow the ingestion of food during those periods, namely through the existence of automatic food dispensers. However, the available food and beverages might not always be compatible with a healthy diet. The aim of this work was to evaluate if the food and beverages available in automatic food dispensers in public Ambulatory Care Facilities (ACF) and Hospitals of the Portugal North Health Region were contributing to a healthy diet, during the year of 2007. A questionnaire was elaborated and sent to the Coordinators of the Health Sub-Regions and to the Hospital Administrators. The questionnaire requested information about the existence of automatic food dispensers in the several departments of each health care facility, as well as which food and beverages were available and most sold. Afterwards, the pre-processing of the results involved the classification of the food and beverages in three categories: recommended, sometimes recommended and not recommended. The questionnaire reply ratio was 71% in ACF and 83% in Hospitals. Automatic food dispensers were available in all the Hospitals and 86.5% of ACF. It wasn't possible to acquire food in 37% of the health facility departments. These departments were all located in ACF. The more frequently available beverages in departments with automatic food dispensers were coffee, still water, tea, juices and nectars and soft drinks. Still water, coffee, yogurt, juices and nectars and soft drinks were reported as the most sold. The more frequently avaliable food items were chocolate, recommended cookies, not recommended cakes, recommended sandwiches and sometimes recommended croissants. The food items reported as being the most sold were recommended sandwiches, chocolate, recommended cookies, sometimes recommended croissants and not recommended cookies. The beverages in the recommended and sometimes recommended groups were the most frequently available and sold. The not recommended food items were reported as being the most available, while both the recommended and not recommended food items were equally reported as being the most sold. Results show that unhealthy food and beverages are widely available in public health care facilities of the Portugal North Health Region.

The objective of this study was to evaluate the applicability of Coelho's scale (CS) and to determine its adaptation to the reality observed in the families accompanied in the Maria Rangel Passos health care unit (USFMRP) in the city of Vitória, Espírito Santo State. This is a cross-sectional exploratory, descriptive study developed in the area of health of Greater Maruípe. First, it was made the classification of the families according to CS and the results were presented for a discussion group that proposed changes and possible alterations in CS, being the new tool denominated as "UFES criterium". In order to verify the applicability of that instrument and to accomplish a comparison with the obtained results of the classification for CS, thirty families assisted in USFMRP were randomly selected and visited, including by the HCA. This new scale allowed to identify a larger number of families of minimum risk and to guide the several actions accomplished daily in a health care unit, aiming to define priorities and to reorient the practices exercised by the professionals heading for the consolidation of a more even and integral attendance, centered in the service of the real social needs in health of the families assisted in the extent of the Family Health Strategy (FHS).

Twenty-three isolates of Leishmania sp from patients in the municipalities of Rio Preto da Eva and Manaus were characterized and identified by means of isoenzyme electrophoresis and the degree of similarity between the organisms was analyzed. The results indicated that Leishmania guyanensis and Leishmania naiffi were present in these two environments and that the Leishmania naiffi samples were heterogenous.

Objective: To evaluate quality of life and depression among women who suffer domestic violence and to describe the socioeconomic profile of women who were abused by their partners and aspects of these abuses., Methods: The study sample comprised 100 women who were abused by their partners and filed a complaint at the Police Office for Women of the state of Ceara, Brazil. Three questionnaires were applied: one for collecting demographic and violence data; the second one (GHQ-28) one to evaluate general quality of life; and the third one (Beck) to quantify depression., Results: Abused women are young, married, Catholic, have children, low schooling and low family income. Alcohol use and jealousy were the main reported factors leading to partner's abuse. Of all, 84% of women suffered physical attacks. It was observed that 72% had depression symptoms; 78% had anxiety symptoms and insomnia; 39% had already thought of killing themselves, and 24% started taking anxiety medications after been abused., Conclusions: Data analysis suggests that domestic violence is associated with a negative perception by women of their mental heath.