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Resumen: Introducción: Las fracturas de tercio distal femoral son una causa importante de morbimortalidad, siendo su tratamiento actualmente controvertido. Objetivos: Comparar los resultados entre técnicas mínimamente invasivas frente a exposición del foco de fractura. Secundariamente, evaluar la relación entre factores demográficos, mecanismo lesional y demora quirúrgica con el pronóstico de los pacientes. Método: Estudio tipo cohortes retrospectivas realizado entre 2015 y 2021 en un hospital de tercer nivel. La recogida de datos se realizó mediante la revisión de historias clínicas, midiendo parámetros demográficos, hospitalarios y estrategia de tratamiento definitivo. Se completó un año de seguimiento en todos los pacientes, evaluando la aparición de complicaciones quirúrgicas y mortalidad. Se realizó un análisis estratificado de las variables de interés entre pacientes mayores de 65 años. Resultados: Se registraron 128 fracturas, realizándose osteosíntesis definitiva en 117. Los pacientes intervenidos mediante técnicas mínimamente invasivas requirieron una menor estancia hospitalaria (9 [7-12] vs. 12 [8,75-16] días) (p = 0,007), sin diferencias en mortalidad o complicaciones durante el seguimiento. En mayores de 65 años, la apertura del foco de fractura asoció un aumento del riesgo de infección frente a las técnicas mínimamente invasivas (33,3% vs. 2%) (p = 0,507). Todos los fallecidos fueron pacientes mayores de 65 años (33,7% al año). La demora quirúrgica superior a 48 horas aumentó la mortalidad un 10% entre los mayores de 65 años (p = 0,3). Los traumatismos de alta energía presentaron mayor proporción de pseudoartrosis (27,6% vs. 6,1%) (p = 0,011). Conclusiones: Las técnicas mínimamente invasivas disminuyeron la estancia hospitalaria pero no las complicaciones ni la mortalidad a largo plazo.Nivel de evidencia: IIb. Abstract: Introduction: Fractures of the distal femoral third are an important cause of morbidity and mortality, and their treatment is currently controversial. Objectives: To compare the results between minimally invasive techniques versus exposure of the fracture site. Secondly, to evaluate the relationship between demographic factors, mechanism of injury and surgical delay with patient prognosis. Method: Retrospective cohort study carried out between 2015 and 2021 in a tertiary hospital. Data collection was performed by reviewing medical histories, measuring demographic and hospital parameters and definitive treatment strategy. One year of follow-up was completed in all patients, assessing the occurrence of surgical complications and mortality. A stratified analysis of the variables of interest was performed among patients over 65 years of age. Results: 128 fractures were recorded, with definitive osteosynthesis being performed in 117. Patients who underwent minimally invasive techniques required a shorter hospital stay (9 [7-12] vs. 12 [8.75-16] days) (p = 0.007), with no differences in mortality or complications during follow-up. In those over 65 years of age, opening the fracture site was associated with an increased risk of infection compared to minimally invasive techniques (33.3% vs. 2%) (p = 0.507). All the deceased were patients over 65 years of age (33.7% at one year). Surgical delay longer than 48 hours increased mortality by 10% among those older than 65 years (p = 0.3). High-energy trauma had a higher proportion of pseudarthrosis (27.6% vs. 6.1%) (p = 0.011). Conclusions: Minimally invasive techniques decreased hospital stay but not complications or long-term mortality.Level of evidence: IIb.

Resumen: Introducción La osteoartritis es una patología incapacitante caracterizada por dolor y rigidez articular. En nuestro país se reporta una prevalencia de coxartrosis del 7,4%. El reemplazo articular total de cadera está indicado en etapas avanzadas, procedimiento que no está exento de complicaciones, la más frecuente es la luxación protésica, que puede ser prevenida con sistemas de doble movilidad (DM). El siguiente estudio tiene como objetivo determinar la tasa de complicaciones y los resultados clínicos en los sistemas de DM en coxartrosis primaria. Materiales y métodos: Estudio retrospectivo donde se incluyeron 120 casos en 114 pacientes con diagnóstico de coxartrosis grado III, la media de edad fue de 62,43 años, con seguimiento medio de 4,5 años. El reemplazo articular se realizó mediante abordaje de Hardinge. Todos los casos fueron valorados clínicamente mediante la escala de Harris Hip Score (HHS) y radiológicamente para demostrar los resultados a mediano plazo. Resultados: El valor preoperatorio en la escala HHS tuvo una media de 56,45, posquirúrgica al mes 74,23; seis meses de 85,40; un año de 94,01 y a los cinco años de 94,84 puntos, representando una mejoría funcional de 17,78 mes posquirúrgico; 28,95 a los seis meses posquirúrgicos; 37,56 al año posquirúrgico y 38,39 puntos a los cinco años posquirúrgicos. Una tasa de complicaciones de 3,44%; 0,86% de las complicaciones se asociaron a los componentes protésicos. Conclusión: El sistema de DM debe ser considerado como una opción terapéutica en reemplazo articular primario de cadera debido a los resultados funcionales excelentes y bajas tasas de complicaciones. Nivel de evidencia: IV. Estudio observacional retrospectivo tipo serie de casos. Abstract: Introduction: Osteoarthritis is a disabling pathology characterized by joint pain and stiffness. A prevalence of coxarthrosis of 7.4% is reported in our country. Total hip joint replacement is indicated in advanced stages, a procedure that is not free of complications, the most frequent being prosthetic dislocation, which can be prevented with dual mobility systems. The following study aims to determine the rate of complications and clinical outcomes in dual mobility systems in primary coxarthrosis. Materials and methods: A retrospective study included 120 cases in 114 patients diagnosed with grade III coxarthrosis, mean age was 62.43 years, with a mean follow-up of 4.5 years. Joint replacement was performed by Hardinge approach. All cases were assessed clinically using the Harris Hip Score (HHS) and radiologically to demonstrate mid-term results. Results: The preoperative value on the HHS scale had a mean of 56.45, postoperative at one month 74.23; 6 months 85.40; 1 year 94.01 and at 5 years 94.84 points, representing a functional improvement of 17.78 postoperative month; 28.95 at 6 months postoperative; 37.56 at one year postoperative and 38.39 points at 5 years postoperative. A complication rate of 3.44%; 0.86% of complications were associated with the prosthetic components. Conclusion: The dual mobility system should be considered as a therapeutic option in primary hip joint replacement due to excellent functional results and low complication rates. Evidence level: IV. Retrospective observational case series study.

Resumen: Introducción: En los últimos años se han producido importantes cambios en la prevención y tratamiento del ictus isquémico agudo en el adulto. Sin embargo, la baja incidencia en edades pediátricas hace más difícil desarrollar protocolos y guías de asistencia específicas. Este trabajo busca conocer la situación de estos niños en nuestra región, con el objetivo de establecer un protocolo autonómico que mejore la atención a estos pacientes. Métodos: Estudio de incidencia de base hospitalaria del ictus infantil (≤15 años de edad) en Aragón (1.308.728 habitantes, 15% ≤15 años), desde 2008 a 2019. Los datos se extrajeron de los episodios de alta hospitalaria, incluidas las defunciones, del Servicio Aragonés de Salud, de acuerdo a los códigos de la Codificación Internacional de Enfermedades (CIE) definidos para enfermedad cerebrovascular. Se analizaron aspectos demográficos, clínicos, diagnóstico-terapéuticos y de pronóstico. Resultados: Se recogieron un total de 21 eventos, ocho isquémicos (38,1%) y 13 hemorrágicos (61,9%). La media de edad fue 9,3 años (desviación típica 1,0). Hubo 12 hombres y nueve mujeres. No se encontraron diferencias estadísticamente significativitas entre ictus isquémicos y hemorrágicos, salvo por el síntoma guía (déficit motor o del lenguaje en isquémicos, y cefalea en hemorrágicos). Ninguno de los eventos isquémicos recibió terapias de reperfusión. Incluyendo los tres pacientes que fallecieron durante el ingreso, ocho (42,1%) tenían una puntuación en la escala modificada de Rankin (mRS) > 2 a los 12 meses. El déficit motor fue la secuela más común (n = 9). Conclusiones: El ictus infantil, aunque infrecuente, supone una importante limitación funcional. En España, Madrid fue pionera en adaptar las redes de asistencia existentes del Código Ictus en el adulto. En el caso de Aragón, esta revisión nos ha permitido trabajar de cerca con los diferentes actores implicados, para poder ofrecer un plan autonómico de atención al ictus isquémico infantil. Sin embargo, registros nacionales prospectivos ayudarían a avanzar en la atención a estos niños. Abstract: Background: Recent years have seen considerable changes in the prevention and treatment of acute ischaemic stroke in adult patients. However, the low incidence of paediatric stroke makes the development of specific guidelines more challenging. This study aims to clarify the situation of these children in our region in order to establish a regional protocol to improve the care provided to these patients. Methods: We performed a regional incidence study of pediatric stroke (≤ 15 years of age) in Aragon, Spain (1 308 728 population, 15% aged ≤ 15 years) between 2008 and 2019. Data were obtained from hospital discharge records, including deaths, from the regional health service of Aragón, according to ICD codes for cerebrovascular disease. We analysed demographic, clinical, diagnostic/therapeutic, and prognostic variables. Results: A total of 21 events were recorded: 8 ischaemic (38.1%) and 13 haemorrhagic strokes (61.9%). The mean age (SD) was 9.3 years (1.0). The sample included 12 boys and nine girls. No statistically significant differences were found between ischaemic and haemorrhagic strokes, except in the chief complaint (language and motor impairment in ischaemic stroke and headache in haemorrhagic stroke). None of the patients with ischaemic stroke received reperfusion therapies. Including the 3 patients who died during hospitalisation, eight patients (42.1%) had modified Rankin Scale scores > 2 at 12 months. Motor deficits were the most common sequela (n = 9). Conclusion: Though infrequent, paediatric stroke has an important functional impact. In Spain, Madrid was the first region to adapt the existing code stroke care networks for adult patients. In Aragon, this review has enabled us to work closely with the different stakeholders to offer a care plan for acute paediatric ischaemic stroke. Nevertheless, prospective national registries would be valuable to continue improving the care provided to these patients.

ABSTRACT: Objective: to identify the prevalence of mental and behavioral disorders among nursing workers in the context of COVID-19 and its associated factors. Method: cross-sectional web survey carried out between October 2021 and January 2022, with 1.073 nursing professionals. An instrument with sociodemographic and occupational variables, and a self-assessment of mental and behavioral disorders was applied to collect data. A descriptive analysis with absolute and relative frequencies and univariate and multivariate inferential analyses using Poisson Regression were conducted. Results: mental and behavioral disorders were reported by 50.8% of participants, showing a significant association with the female sex, more than 10 years in the profession, more than two employment contracts, and poor self-rated health. Conclusion: There was a high prevalence of self-reported mental and behavioral disorders in the sample. The length of time working in the profession and the number of employment relationships were variables strongly associated with the outcome. Studies like these are essential to assist in the development of effective strategies for reducing risk factors to workers' health, especially those of occupational origin that can be modified.

Abstract Babesiosis and Anaplasmosis are diseases associated with economic losses; ticks and blood-sucking flies are important zoonotic vectors and reservoirs. This study aimed to investigate the presence of anti-Babesia spp. and anti-Anaplasma marginale antibodies using enzyme-linked immunosorbent assay (ELISA), in ruminants at the Catimbau National Park. Blood samples were collected from 119 sheep, 119 goats, and 47 cattle. Rhipicephalus microplus ticks were collected from cattle. ELISA showed seropositivity of 34% (16/47), 20.3% (24/119), and 16% (19/119) for anti-Babesia bovis; 34% (16/47), 15.2% (18/119), and 9% (7/119) for anti-Babesia bigemina; and 34% (16/47), 35.6% (42/119), and 17% (20/119) for anti-A. marginale antibodies in cattle, goats, and sheep, respectively. The information collected using an epidemiological questionnaire showed that mostly are breed in a semi-intensive system, with access to Caatinga vegetation. The circulation of B. bovis, B. bigemina, and A. marginale was confirmed. Thus, based on the prevalence, this suggests this is an enzootic instability area and is prone to outbreaks.

Objective: To describe the cases of women with breast cancer (BC) and identify the epidemiological profile of the cases reported in the Hospital-based Cancer Registries (HCR) of the Oncological Care Network of Espírito Santo (OCN/ES). Methods: This is a hospital-based descriptive observational study, based on secondary data retrieved via the HCR Tumor Registration Form of the eight hospitals that comprising the OCN/ES, between 2000-2020. Results: There were 16,844 case records of women with breast cancer in this historical series. The median age of the women was 52 years. The age group with the highest number of cases (54.0%) was 41-60 years, 57.42% were brown, 51.70% married, and 30.80% had incomplete elementary school, residents of the Metropolitan region of the state (81.70%). Most cases were analytical (75.42%), referred from SUS (59.70%), had no occurrence of more than one primary tumor (94.21%), the most common histological type was infiltrating duct carcinoma (76.03%), and stage II (6.75%), with multimodal treatments (60.09%). Conclusion: The findings point to an increasing trend in the occurrence of breast cancer over the years in OCN/ES, occurring mainly in older, brown women and women with low education, in stage II of the disease.

Objective: To analyze work absences due to mood disorders between 2018 and 2020 in Piauí. Method: Census study, descriptive-analytical, carried out in Piauí, Brazil, between May and July 2021. Data was collected from the National Social Security Institute's database. Analyzed with descriptive and inferential statistics. Results: 1,717 leaves were identified, 65.3% were female workers with an average age of 39.78 years, 91% had an income of one to two minimum wages, 42.7% came from other municipalities, and 82.2% worked in the urban area. Among the absences, 52% were due to depressive episodes, and 84.2% of the workers were granted social security sickness benefits. There was a statistical association between the municipality of origin, the zone of labor activities, and the average duration of work leave. Conclusion: The study contributed to the identification of absences and the provision of data that collaborate in the formulation of intervention strategies and the worker's best working conditions and mental health.

Abstract Objective This study aimed to evaluate the psychometric properties of the Brazilian version of the Maternal-Fetal Attachment Scale applied to pregnant women in Primary Health Care. Method This is a methodological study conducted with 937 pregnant women assisted in the Family Health Strategy in Montes Claros, Minas Gerais, Brazil. Psychometric sensitivity, construct and criterion validity, and reliability were evaluated. Results The instrument achieved adequate psychometric sensitivity (skewness < 3 and kurtosis < 7). Quality fit indicators of the model were obtained: x2/gl = 4.72, CFI = 0.89, GFI = 0.90, TLI = 0.87, RMSEA = 0.063 (90% CI = 0.059-0.067, p = 0.000). Hypothesis testing indicated associations with marital status (p = 0.036), income (p= 0.030), trimester (p < 0.001), planned pregnancy (p = 0.003), social support (p < 0.001), and family APGAR score (p < 0.001). Significant correlations (p < 0.001) with stress (r = -0.12) and depressive symptoms (r = -0.17) demonstrated divergent criterion validity. Cronbach’s α of 0.874 was recorded. Conclusion The scale showed adequate psychometric evidence for application to pregnant women in the Primary Health Care setting.

Introduction: COVID-19 has caused a health, social, and health system emergency, with a dismal infection behavior in patients with special conditions, such as the immunocompromised pediatric population. Objective: To describe the clinical-epidemiological characteristics of infected SARS-CoV-2 pediatric patients with immunocompromised and neoplastic disorders. Methods: Between March 2020 and February 2022, a retrospective descriptive study was carried out in a cancer center in the Colombian Caribbean. Forty-one im-munocompromised children with oncological pathologies and a diagnosis of SARS-CoV-2 infection were included. Inflammatory markers associated with severity, such as ferritin, leukocytosis, and lymphocytosis, were analyzed. Results: 24.39% of the children evaluated had sickle cell anemia and acute lymphoid leukemia (in the consolidation or maintenance phase). The most frequent symptoms were fever (31.71%), cough (29.27%), and runny nose (19.51%). The severity of the COVID-19 infection was mild in 39.02% of the cases, and 24.39% were asymptomatic. Inflammatory markers and clinical manifestations were not associated with severity. Severity was also not associated with oxygen requirements, thoracic radiological changes, or admission to the ICU (P-value >0.05). Conclusions: The results suggest that despite immunosuppression, the pediatric population did not present severe cases of COVID-19 infection.

Resumen: El presente artículo resume los datos correspondientes a la actividad de cirugía cardiovascular realizada en España en el año 2022. Se elabora a partir de un registro anónimo y voluntario de datos agregados de hospitales de todo el país, quienes transfieren sus datos a la Sociedad Española de Cirugía Cardiovascular y Endovascular. Este es el 34.° año consecutivo en el que se reportan los datos de la actividad nacional. El análisis de la información del año 2022 servirá para evaluar la actividad en España después del fin de la pandemia por COVID-19 y sus estragos en el Sistema Nacional de Salud.En el año 2022 comunicaron su actividad 58 centros. Se realizaron 28.998 intervenciones, con 20.127 procedimientos de cirugía cardiaca mayor. De estos, 17.923 procedimientos fueron realizados con circulación extracorpórea, 18.210 fueron de enfermedad adquirida y 1.917 de enfermedad congénita. Además, se registraron 2.828 intervenciones de cirugía vascular periférica. En cuanto a los diferentes tipos de cirugía cardiaca mayor se realizaron: 7.596 procedimientos de cirugía valvular aislada, 1.621 de cirugía valvular combinada, 4.701 procedimientos de revascularización, 2.432 de cirugía de aorta y 579 procedimientos de válvulas transcatéter.En comparación con el año 2021, observamos un aumento de la cirugía cardiaca mayor adquirida, pero sin llegar a recuperar el nivel de actividad previo a la pandemia. Así mismo, se observó una reducción significativa de la mortalidad con respecto del año 2021, con índices de mortalidad ajustada al riesgo por debajo de 1 en todos los tipos de intervenciones salvo en cirugía polivalvular, combinada valvular y coronaria y en las complicaciones mecánicas del infarto. Abstract: This manuscript summarizes the data corresponding to the cardiovascular surgery activity carried out in Spain in 2022. It has been written based on an anonymous and voluntary registry of aggregated data from hospitals throughout the country, who transfer their data to the Spanish Society of Cardiovascular and Endovascular Surgery. This is the 34th consecutive year in which national activity data has been reported. The analysis of the information collected in 2022 will serve to evaluate the activity in Spain after the end of the COVID-19 pandemic and its impact to the National Health System.In 2022, 58 centers reported their activity. 28,998 interventions were performed, with 20,127 major cardiac surgery procedures. Of these, 17,923 procedures were performed with cardiopulmonary bypass, 18,210 were for acquired disease and 1,917 were for congenital disease. In addition, 2,828 peripheral vascular surgery interventions were recorded. Regarding the different types of major cardiac surgery, the following were performed: 7,596 isolated valve surgery procedures, 1,621 combined valve surgery, 4,701 revascularization procedures, 2,432 aortic surgery, and 579 transcatheter valve procedures.Compared to 2021, we observed an increase in acquired major cardiac surgery, but without recovering the level of activity prior to the pandemic. Likewise, a significant reduction in mortality was observed compared to 2021, with risk-adjusted mortality rates below 1 in all types of interventions except for multiple valve, combined valve and coronary procedures, and repair of mechanical complications of infarction.

Objective. To investigate the burden of tracheal, bronchus, and lung (TBL) cancer due to tobacco exposure in the last 30 years in 12 South American countries. Methods. We used the Global Burden of Disease (GBD) 2019 exposure-response function to analyze the total tobacco, smoking, and secondhand smoke exposure-related TBL cancer deaths and disability-adjusted life years (DALYs), for 12 South American countries, between 1990 and 2019. Metrics were described as absolute numbers or rates per 100 000 individuals. The relative change in burden was assessed by comparing the 1990-1994 to 2015-2019 periods. Results. In 2019, the all-ages number of TBL cancer deaths and DALYs associated with tobacco exposure in South America was 29 348 and 658 204 in males and 14 106 and 318 277 in females, respectively. Age-adjusted death and DALYs rates for the region in 2019 were 182.8 and 4035 in males and 50.8 and 1162 in females, respectively. In males, 10/12 countries observed relative declines in TBL death rates attributed to tobacco exposure while only 4 countries reduced their mortality in females. Conclusion. While significant efforts on tobacco control are under place in South America, substantial burden of TBL cancer persists in the region with significant sex-specific disparities. Increased country-specific primary data on TBL cancer and tobacco exposure is needed to optimize healthcare strategies and improve comprehension of regional trends.

Objectives To identify the prevalence and determinants of continued breastfeeding in Haitian children aged 12–23 months. Methods Three cross-sectional surveys were conducted yearly during the summers of 2017 to 2019 as part of a 4-year (2016–2020) multisectoral maternal and infant health initiative in the regions of Les Cayes, Jérémie, and Anse d’Hainault in Haiti. A total of 455 children 12–23 months of age and their mothers participated in the study. A child was considered to be continuing breastfeeding if the mother reported giving breast milk in the 24-hour dietary recall. Unadjusted and adjusted prevalence ratios were estimated, and associations were assessed between continued breastfeeding and explanatory factors related to sociodemographic characteristics, household food security, maternal nutrition, and breastfeeding knowledge and practices. Results The prevalence of continued breastfeeding was 45.8%. Continued breastfeeding was significantly more prevalent among younger children, children who did not have a younger sibling, children whose mother was not pregnant, those living in the Jérémie region, children who had been exclusively breastfed for less than 1 month, and children whose mother knew the World Health Organization’s recommendation for continued breastfeeding up to 2 years or beyond. Conclusions The study results highlight the need for geographically equitable access to tailored and adequate health services and education that support breastfeeding in a way that is compatible with the local context.

Abstract Objective To analyze the trend of hospitalizations for alcohol use disorder (AUD) in Brazil, by region, and establish its relationship with mental health care facilities. Methods Data were collected through the Brazilian Unified Health System’s (SIH/SUS) Hospital Information System (Sistema de Informação Hospitalar) and the National Register of Health Establishments of Brazil (Cadastro Nacional de Estabelecimentos de Saúde [CNES]). We used linear regression models to estimate the effect of SUS psychiatric beds and Center for Psychosocial Care (Centro de Atenção Psicossocial [CAPS]) numbers on AUD hospitalizations. Results From 2015 to 2020, 298,735 hospitalizations for AUD were recorded. Most of the patients admitted for AUD were male (88.8%). Individuals aged 60 years and older accounted for 11.7% of our cohort. The highest concentration of hospitalizations occurred in the South region (40.1%). The rate of hospitalizations per hospital bed remained relatively constant. The number of CAPS has a negative effect on SUS psychiatric beds in Brazil (average effect -22.31 [95% confidence interval {95%CI} -26.92, -17.70]). Psychiatric beds have a positive effect on AUD hospitalizations in the country (average effect 1.82 [95%CI 0.91, 2.74]). Conclusion Prioritization guidelines for other forms of care are associated with a decrease in hospitalizations for AUD, so we highlight the importance of adequate training of health care professionals for proper referral of these patients to hospital admission when necessary.

Abstract Sand flies, vectors capable of transmitting Leishmania spp. and causing leishmaniasis, have been a concern in the central region of Rio Grande do Sul, where canine leishmaniasis (CanL) has been documented since 1985. Notably, there has been a surge in CanL cases since 2017, with two autochthonous cases of human visceral leishmaniasis reported in the area in 2021. This study aimed to identify the sand fly fauna potentially involved in disease transmission. Modified Centers for Disease Control light traps were deployed in three neighborhoods of the city where CanL cases had been previously reported, spanning January 2021 to December 2022. Of the 89 collections conducted, 119 sand flies belonging to five species were captured: Pintomyia fischeri (76/119, 63.86%), Migonemyia migonei (23/119, 19.33%), Lutzomyia longipalpis (16/119, 13.45%), Brumptomyia sp. (2/119, 1.68%), and Psathyromyia lanei (2/119, 1.68%), predominantly between February and April in 2021 and 2022. Polymerase chain reaction testing on all female specimens yielded negative results for Leishmania spp. DNA. Although Leishmania spp. was not detected in these vectors, these findings underscore the imperative to implement measures aimed at curtailing the proliferation of these insects.

Introducción. La incidencia de cáncer colorrectal (CCR) de aparición temprana (CCR-ATem), definido como CCR en individuos menores de 50 años, está aumentando en todo el mundo. A pesar del incremento en la producción científica internacional sobre CCR-ATem, la investigación es limitada en Colombia. El objetivo de este estudio fue caracterizar clínicamente los adultos con CCR-ATem y CCR de aparición tardía (CCR-ATar, CCR en individuos ≥ 50 años). Métodos. Estudio observacional, retrospectivo, transversal, en el que se incluyeron los adultos con CCR atendidos en un centro médico de Medellín, Colombia. Los datos se obtuvieron del Registro Institucional de Cáncer. Se establecieron dos grupos de análisis: CCR-ATem y CCR-ATar. Se aplicó la prueba de Chi cuadrado para comparar las variables de interés entre ambos grupos. Resultados. La muestra incluyó 1,202 pacientes, 53.5 % fueron mujeres (N=643), y la mediana de edad fue de 65 años (rango intercuartil: 55-73). CCR-ATem representó el 15.9 % (N=192). CCR-ATar tuvo más casos de enfermedades cardiometabólicas y tabaquismo (p

Objective: To characterize the epidemiological profile of leprosy cases and deaths in Mato Grosso - Brazil, from 2011 to 2020. Method: A population-based observational study of all leprosy cases and deaths reported between 2011 and 2020. Subsequently, the reported individuals were matched, and the trend was estimated using the Prais-Winsten regression. Results: 37,623 new cases were registered in the study years, with an average rate of 114.7/100,000 inhabitants, with higher incidence rates in multibacillary cases and males, and in the proportion of deaths (58%; 88.2%), respectively. As for the trend, it has increased over the years and among women. Conclusion: The results suggest a profile of more incident cases, possible areas with the spread of the disease, and delayed diagnosis, highlighting the need to use indicators to monitor the endemic and strengthen comprehensive care and surveillance of leprosy.

ABSTRACT The aim of this study was to analyze the validity of self-reported anthropometric measurements (weight and height) for classifying the nutritional status of Brazilian adults and elderly people using data from the 2019 National Health Survey (PNS). The PNS sample is made up of permanent private households from all of Brazil’s federative units and this is a cross-sectional study in which 6,571 records were identified with measured and reported data, with no missing data for one variable being identified when in the presence of another. Validation was carried out with 6,381 data after removing atypical data. The variables used for stratification were: gender, age, race/color, schooling, and income, and the weighted Kappa Coefficient and the Intraclass Correlation Coefficient (ICC) were used to analyze agreement between the nutritional status categories. Accuracy was analyzed based on sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). For construct validity, a Poisson regression was performed for each outcome (measured and self-reported), with the independent variables “gender”, “color/race”, “schooling”, and “family income”. All the analyses showed positive results for validation. There was greater reproducibility among adults (18 to 59 years old) compared to the elderly and among men compared to women. This validation indicates a concrete possibility of carrying out an association of observational studies using reported nutritional status as the outcome variable, as an efficient strategy which could minimize the operational difficulties often encountered.

ABSTRACT Objective To gather the available evidence in the literature on the prevalence and associated factors of diabetic retinopathy (DR) in Latin America. Methods This scoping review was developed according to the PRISMA-ScR. Prevalence data were summarized by weighted mean, considering the type of DM and country. For the analysis of associated factors, meta-analyses were performed with the most homogeneous studies, and the ORs and their 95%CIs were calculated. Results Forty-two articles published between 2004 and 2020 were included in this study. The mean prevalence of DR ranged from 15.0% in Costa Rica to 32.7% in Brazil. Conclusion This variation may be related to the diagnostic method, age of the studied population, duration of disease, glycemic control, or other associated factors such as the presence of diabetic nephropathy or hypertension. This review discloses an important burden of DR in Latin America and highlights the need for further in-country studies.

ABSTRACT Objectives: to analyze the completeness of variables from Hospital-Based Cancer Registries of cases of prostate neoplasm in the Oncology Care Network of a Brazilian state between 2000 and 2020. Methods: an ecological time series study, based on secondary data on prostate cancer Hospital-Based Cancer Registries prostate. Data incompleteness was classified as excellent (50%), according to the percentage of lack of information. Results: there were 13,519 cases of prostate cancer in the Hospital-Based Cancer Registries analyzed. The variables “family history of cancer” (p

ABSTRACT Introduction: the obesity is defined as the excessive accumulation of fat in different areas of the body, a condition that causes damage to health and is a critical risk factor for various comorbidities. Bariatric surgery is the therapeutic option with the best results. Methods: this is a retrospective descriptive study using data obtained from medical records from January 2018 to December 2020 on patients undergoing bariatric surgery. Statistical analysis used a significance level of p

ABSTRACT Objective: To evaluate the epidemiological, clinical, and imaging profile of lesions that mimic choroidal melanoma. Methods: Retrospective study of medical records of suspected choroidal melanoma lesions referred to the Ocular Oncology Service from the Universidade Federal de São Paulo, from 2014 to 2020. Demographic data, clinical history, and exams were evaluated. Results: A total of 104 patients (mean age: 65.57 ± 13.18; 49.04% female) were referred to our service with suspected choroidal melanoma. Of these, 32 (30.77%) were classified as pseudomelanoma, while 72 (69.23%) had a confirmed diagnosis of choroidal melanoma. Pseudomelanoma cases manifested in older individuals (p < 0.001), with smaller lesions in height (p < 0.001), anteroposterior diameter (p = 0.008), and lateral diameter (p = 0.003) on ultrasound. Pseudomelanoma cases were associated with higher frequencies of vitreous hemorrhage (p = 0.014) and lower rates of the presence of a mass (p = 0.001) and retinal detachment (p < 0.001). The main diagnoses of pseudomelanoma cases were choroidal nevus (40.63%), subretinal hemorrhage (18.75%) and choroidal neovascular membrane (18.75%). Conclusion: Almost one third of the cases referred with suspected choroidal melanoma were pseudomelanomas, which demonstrates that there is still a considerable path to improve the ability of general ophthalmologists to clinically discriminate melanoma from other conditions that can mimic it.

Streptococcus pneumoniae causes meningitis, pneumonia and bacteremia, mainly in children under 5 years of age and in the elderly. Pneumococcal conjugate vaccines (PCVs) have been administered globally since the year 2000, contributing to substantially reduce the incidence of pneumococcal diseases (PDs). In 2012, Colombia implemented universal vaccination with PCV10 in children under 2 years of age, achieving a decrease and stabilization of the incidence of PDs. However, since 2014, replacement of vaccine serotypes by non-vaccine serotypes, such as 3 and 19A, predominantly, has been observed. Likewise, in 2019, there was an increase in the incidence of meningitis, coinciding with the increase of multi-resistant 19A clones. In July 2022, the vaccine formulation was changed to PCV13, which also has the potential to control serotypes 3, 6A, and 19A. This paper reviews the epidemiology of pneumococcus in Colombia, before and during the uni-versal PCV10 vaccination.

Abstract Background: The epidemiology of chronic hepatitis B (CHB) in Spain has changed due to migratory movements and the implementation of vaccination programs. The objective is to determine if prevalence has also changed amongst in Catalonia and the potential predictive variables of the infection. Material and method: Observational cross-sectional multi-centre study of CHB prevalence. Epidemiological and clinical variables were included, and their predictive capacity is analysed by means of a multivariable logistic regression model. Results: A total of 6508 prisoners were studied. CHB prevalence was 1.7%, much less than in studies carried out in previous years. In inmates from North Africa, Asia, Eastern Europe, and Sub-Saharan Africa the CHB rate was 2.8, 4.2, 4.9 and 16.2 times higher, respectively, than amongst those born in Spain, which was 0.6%, the same as in the general population. CHB was associated with: a) being an immigrant [2.6%; OR: 4.18 (CI: 2.50-6.90; P

ABSTRACT Objective: The study’s main purpose is to identify changes in the epidemiological profile of spine surgeries before and during the pandemic. Furthermore, we seek to understand how these changes affected the training of resident doctors. Methods: To achieve the proposed objectives, a retrospective analysis of spine surgeries was carried out between March 2019 and February 2021. The data were obtained from the patient’s medical records and subjected to a comparative statistical analysis. Results: The results revealed a significant change like the surgeries performed, with a notable increase in traumatic cases during the pandemic compared to the previous period. Conclusion: It is concluded that the pandemic caused changes in orthopedic surgical practice, with an increase in trauma surgeries and a decrease in elective surgeries. In training spine residents, the pandemic brought challenges that highlighted the need for resilience and adaptability in complex environments. Level of Evidence II; Retrospective Observational Study.

Objective: To determine the clinical and epidemiological characteristics of patients with noninfectious uveitis at a university hospital in Paraguay. Methodology: An observational, descriptive, cross-sectional, retrospective study was performed. Consecutive patients who attended the Ophthalmology Service of the Hospital de Clínicas from January 2020 to October 2021 and who were diagnosed with non-infectious uveitis were included. The variables studied were sex, age, origin, reason for consultation, anatomical classification, clinical course, systemic and ocular associations, and bilaterality. Results: A total of 78 medical records of patients meeting the inclusion and exclusion criteria were analyzed. Of the patients, 66.7% were female and 42 (53.8%) were from the Central Department. The anterior anatomical location of uveitis was the most frequent (53.9%), followed in decreasing order by panuveitis, posterior uveitis, and intermediate uveitis. Regarding anterior uveitis, 24 patients (57.1%) had unilateral uveitis, 40 (95.2%) were non-granulomatous, 19 (45.2%) presented an acute clinical course, the most frequent reason for consultation was "red and painful eye" with 15 patients (35.7%), the most frequent systemic association was HLA- B27+ in 16 patients (38.1%). As for panuveitis, 13 patients (50%) were associated with Vogt-Koyanagi-Harada syndrome, and of the latter, two patients were related to rheumatoid arthritis. Conclusion: The clinical and epidemiological patterns observed in this study were largely consistent with those reported in the literature. Notably, the most frequent associations differed from those reported in the literature: HLA-B27+ for anterior uveitis, rheumatoid arthritis for posterior uveitis, and a significant percentage of Vogt-Koyanagi-Harada syndrome among panuveitis cases.

ABSTRACT OBJECTIVE This study aims to integrate the concepts of planetary health and big data into the Donabedian model to evaluate the Brazilian dengue control program in the state of São Paulo. METHODS Data science methods were used to integrate and analyze dengue-related data, adding context to the structure and outcome components of the Donabedian model. This data, considering the period from 2010 to 2019, was collected from sources such as Department of Informatics of the Unified Health System (DATASUS), the Brazilian Institute of Geography and Statistics (IBGE), WorldClim, and MapBiomas. These data were integrated into a Data Warehouse. K-means algorithm was used to identify groups with similar contexts. Then, statistical analyses and spatial visualizations of the groups were performed, considering socioeconomic and demographic variables, soil, health structure, and dengue cases. OUTCOMES Using climate variables, the K-means algorithm identified four groups of municipalities with similar characteristics. The comparison of their indicators revealed certain patterns in the municipalities with the worst performance in terms of dengue case outcomes. Although presenting better economic conditions, these municipalities held a lower average number of community healthcare agents and basic health units per inhabitant. Thus, economic conditions did not reflect better health structure among the three studied indicators. Another characteristic of these municipalities is urbanization. The worst performing municipalities presented a higher rate of urban population and human activity related to urbanization. CONCLUSIONS This methodology identified important deficiencies in the implementation of the dengue control program in the state of São Paulo. The integration of several databases and the use of Data Science methods allowed the evaluation of the program on a large scale, considering the context in which activities are conducted. These data can be used by the public administration to plan actions and invest according to the deficiencies of each location.

Avian pathogenic Escherichia coli (APEC) is responsible for several anatomopathological conditions in poultry, which cause great damage to the poultry sector. This study aimed to evaluate the pathogenicity of E. coli strains isolated from broiler chickens and to perform in vitro tests on strains classified as APEC to identify their capacity to form biofilms and sensitivity to antimicrobials routinely used in the poultry breeding process. Sixty E. coli poultry isolated were used in this study. The real-time Polymerase Chain Reaction (PCR) test identified that 100% of the isolates had the hlyF and ompT genes, 98.3% the iroN and iss genes, and 83.33% the iutA gene, being all the evaluated strains classified as APEC. In the in vitro evaluations regarding the formation and characterization of biofilms, the APEC samples were characterized as 71.66% weakly biofilm-forming. The antibiotic sensitivity test showed that the highest resistance percentages were found in the molecules of oxytetracycline, with 33%, and doxycycline, with 31.66%, but about 58,33% of the samples had a profile of multi-resistance to antimicrobials. Further studies are needed to better characterize APEC virulence genes and multi-drug resistance, given their impact on poultry health/production and potential risk to human health.

ABSTRACT OBJECTIVE To describe the methodological challenges and strategies of a web survey on the working conditions and health among delivery workers. METHODS The study population consisted of Brazilian delivery workers operating in the national territory. Procedures include building solid and ongoing collaboration with worker representatives and conducting a four-month data collection from February to May 2022, sharing the link to the online questionnaire on social media such as social networks (Facebook, Instagram) and messaging apps (WhatsApp, Telegram). RESULTS The recruitment of 41 leaders or influencers of delivery workers increased the dissemination of the study, some of whom participated in the consensual validation of the questionnaire; the production of content for social media for the dissemination of the questionnaire link on social networks and applications, and the in-person dissemination of the study at the delivery workers’ meeting points during the workday played a fundamental role, totaling around 132 hours in 45 shifts. The strategies adopted for data collection with a hybrid approach to dissemination made it possible to carry out the web survey. After four months of the web survey, 564 delivery workers, 543 men and 18 women, responded to the online questionnaire. CONCLUSION The web survey presented methodological strategies to overcome the challenge of reaching workers, including hybrid work, to increase the participation of workers, on whom epidemiological research is still scarce.

Resumen: La ansiedad es una emoción que ha acompañado a la humanidad durante toda su historia; ha sido motor de cambio y supervivencia, pero cuando aparece de forma desproporcionada o bien ante estímulos erróneos, es cuando estamos ante un trastorno de ansiedad.En la actualidad, los trastornos de ansiedad son un verdadero problema de salud para todos los sistemas sanitarios debido a su alta prevalencia en la población, y desde el inicio de la pandemia de COVID esta situación no ha mejorado para nada.En el presente artículo examinamos los datos de prevalencia a día de hoy, la variabilidad que presentan y su impacto en el contexto de atención primaria. Abstract: Anxiety is an emotion that has accompanied humanity throughout its history; It has been the engine of change and survival, but when it appears disproportionately or in the face of wrong stimuli, it is when we are facing an anxiety disorder.Currently, anxiety disorders are a real health problem for all health systems due to their high prevalence in the population and since the start of the COVID pandemic this situation has not improved at all.In this article we examine the prevalence data to date, the variability that they present and their impact in the context of primary care.

Introduction: COVID-19 continues to drive research aimed at elucidating the disease's behavior and clinical aspects for improved diagnosis. Objective: To describe oral manifestations reported through a survey by dentate and denture-wearing Cuban individuals hospitalized due to confirmed COVID-19 infection. Methods: A cross-sectional descriptive study was conducted through a survey, involving Cuban individuals aged 18 years and above, confirmed COVID-19 positive by PCR. Exclusions encompassed smokers, alcoholics, regular medication users, those with poor oral hygiene, and individuals with pre-existing oral manifestations. A questionnaire was administered to over a thousand individuals, of which 264 met the criteria. Variables related to COVID-19 infection and oral hygiene were assessed. Data were processed using SPSS, adhering to ethical principles. Results: The study comprised 264 participants with an average age of 39.96 years. Xerostomia emerged as the most prevalent oral manifestation (40.2%), followed by mandibular pain, TMJ, or bone pain (18.9%), and non-dental mouth pain (12.5%). Xerostomia was more prevalent in the 35 to 39 age group, while mandibular pain predominated in the 50 to 54 age group. No statistically significant evidence was found for dentate individuals or denture wearers, but significance was observed for those requiring hospitalization, exhibiting painless tongue lesions, single ulcers, and painful tongue lesions. Conclusions: Xerostomia was the most prevalent oral manifestation, followed by mandibular pain, TMJ or bone pain, and non-dental mouth pain. A statistically significant association was noted between the need for hospitalization and certain oral manifestations. The use of dentures was not significantly related to the studied manifestations.

ABSTRACT Infectious diseases transmitted by domestic dogs can have important consequences for wildlife health. This study aimed to investigate the exposure to four selected pathogens in dogs and wild carnivores in six municipalities in the Xingu River Basin (Pará state, Brazil). The prevalence of positive animals, their spatial distribution, and the association with land cover types were analyzed. Blood samples from 298 dogs and 11 free-ranging wild carnivores were tested through serological diagnoses. The seroprevalence to canine distemper virus, canine parvovirus, Leishmania infantum, and Toxoplasma gondii was 68.6, 75.4, 14.8, and 47.1%, respectively. The seroprevalence to canine distemper virus and T. gondii was significantly higher in dogs than in wild carnivores. Spatial analyses revealed a broad distribution of seropositive animals, except for animals seropositive to L. infantum, which were concentrated in the southern region close to the margins of the Xingu River. Spatial clusters of seropositive animals were detected for all tested pathogens, indicating areas with a greater risk of exposure. Positive results for canine distemper virus, T. gondii, and L. infantum were associated with different types of land cover, and thus were considered risk factors for pathogen exposure. The high seroprevalence of dogs to canine distemper virus and to canine parvovirus are concerning, suggesting risks of transmission to wild species inhabiting areas close to the surveyed communities.

Objective. To analyze the temporal trend of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. Methods. This was an ecological time series study of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. Data were extracted from the Notifiable Disease Information System and the Mortality Information System, and population estimates were from the Brazilian Institute of Geography and Statistics. Trends were analyzed by Joinpoint regression, which recognizes inflection points for temporal analysis. Results. The average incidence rate of tuberculosis in Brazil in the period was 35.8 cases per 100 000 population. From 2011 to 2015, this coefficient had an annual percentage change of –1.9% (95% CI [–3.4, –0.5]) followed by an increase of 2.4% (95% CI [0.9, 3.9]) until 2019. The average mortality rate between 2011 and 2019 was 2.2 deaths per 100 000 population, with an average annual percentage change of –0.4% (95% CI [–1.0, 0.2]). Amazonas was the only state with an increase in the annual average percentage variation for the incidence rate (3.2%; 95% CI [1.3, 5.1]) and mortality rate (2.7%; 95% CI [1.0, 4.4]) over the years, while Rio de Janeiro state had an increasing inflection for incidence from 2014 to 2019 (2.4%; 95% CI [1.4, 3.5]) and annual average of decreasing percentage variation (–3.5%; 95% CI [–5.0, –1.9]). Conclusions. During the period analyzed, a decreasing trend in incidence was observed between 2011 and 2015, and an increasing trend for the period from 2015 to 2019. On the other hand, no change in the trend for mortality was found in Brazil.

ABSTRACT Objectives. The study aims to assess the trend of neonatal, post-neonatal, and infant mortality from 1996 to 2020 within the metropolitan region of the state of Rio de Janeiro and other regions. Methods. Ecological study using the region as analysis unity. Data were accessed from the Mortality Information System and Live Birth Information System in the capital Rio de Janeiro, in the neighboring areas of Niterói, São Gonçalo, Baixada Fluminense, and the remaining regions of the state of Rio de Janeiro State. We applied Poisson multilevel modeling, where the models’ response variables were infant mortality and its neonatal and post neonatal components. Fixed effects of the adjusted models were region and death year variables. Results. During the 1996-2020 period, the Baixada Fluminense showed the highest infant mortality rate as to its neonatal and post neonatal components. All adjusted models showed that the more recent the year the lower the mortality risk. Niterói showed the lowest adjusted risk of infant mortality and its neonatal and post neonatal components. Conclusion. Baixada Fluminense showed the highest mortality risk for infant mortality and its neonatal and post-neonatal components in the metropolitan region. The stabilization in mortality rates in recent years was identified by the research.