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Objetivo: Identificar a prevalência de somatótipos e analisar a associação com o perfil lipídico e glicêmico em idosas. Métodos: O estudo contou com 102 idosas de três centros de convivência do município de Cuiabá/MT, com idade entre 60 e 84 anos. Foram realizados avaliações antropométricas e cálculo dos somatótipos endomorfo (ENDO), mesomorfo (MESO) e ectomorfo (ECTO). As análises da glicemia em jejum (GJ) e glicemia pós-prandial (GPP) foram feitas com o método enzimático colorimétrico da glicose oxidase; a hemoglobina glicada (HbA1C) foi determinada segundo o método Trivelli modificado; triglicérides (Tg), colesterol total (CT) e HDL-colesterol foram analisados com o método colorimétrico enzimático e o LDL-colesterol foi calculado segundo o método de Friedewald. Resultados: Houve associação entre ECTO x GPP (rs = -0,25; p = 0,05) e ECTO x Tg (rs = -0,27; p = 0,03) na faixa etária de 60-69 anos e entre ENDO x GPP (rs = 0,33; p = 0,03), ENDO x Tg (rs = 0,41; p = 0,006) e ENDO x CT (r = 0,41; p = 0,007) no grupo acima de 70 anos. Os resultados da análise de regressão múltipla foram significantes entre ECTO x GPP (p = 0,04) no grupo de 60-69 anos e entre ENDO x Tg (p = 0,02) e ENDO x CT (p = 0,006) para as idosas com mais de 70 anos. Conclusão: Os lípides plasmáticos apresentaram associações positivas apenas com o componente ENDO no grupo de idosas acima de 70 anos, podendo ter papel diferenciado em relação à idade, talvez pelo fato de a gordura corporal exercer fator de proteção em idosos.

Considera-se uma postura correta o alinhamento do corpo com eficiência fisiológica e biomecânica máxima, o que minimiza os estresses e as sobrecargas sofridas ao sistema de apoio pelos efeitos da gravidade. A postura está relacionada à coordenação, ao equilíbrio e ao controle postural. Um dos principais problemas associados ao envelhecimento humano é a redução da habilidade para controlar a postura e a marcha. Estudos têm demonstrado associações entre controle postural e alteração do equilíbrio relacionadas à idade acima de 75 anos. Estima-se que a prevalência de queixas de equilíbrio nessa população chega a 85%, gerando disfunções biomecânicas e dependência funcional, podendo resultar em quedas frequentes responsáveis por aproximadamente 70% das mortes acidentais nos idosos. Chegar a uma idade avançada da vida em pleno uso de sua independência funcional é certamente um desejo comum do indivíduo para gozo de desempenho de suas funções. Dessa forma, este artigo se propõe a analisar as alterações posturais decorrentes do envelhecimento e suas implicações clínicas como fator relevante na qualidade de vida do indivíduo idoso, chamando a atenção para o planejamento de ações preventivas e cuidados da saúde funcional.

O presente artigo pretende examinar o envelhecimento humano à luz da teoria do desenvolvimento psicossocial de Erik Erikson. Postula-se que a consolidação da identidade é um processo que envolve tanto o indivíduo quanto a cultura. Enfrentar as perdas decorrentes da velhice com possibilidade de encarar a morte com serenidade exigirá do idoso, de acordo com essa teoria, revisão de sua vida e aceitação de falhas do passado. Assim, durante esse processo, conflitos anteriores poderão ressurgir e o desespero diante da finitude da vida possivelmente aparecerá. Entretanto, se o idoso conquistar a sabedoria e o envolvimento vital por meio do amadurecimento de forças psicossociais, a integridade do ego poderá ser consolidada. Para tanto, o ambiente psicossocial é de suma importância. O artigo faz uma releitura dos textos de Erik Erikson acerca do envelhecimento, destacando seus principais conceitos. Além disso, as autoras trazem contrapontos com teorias sobre o envelhecimento, além de propostas para atuação com idosos.

O crescente aumento da expectativa de vida tem originado diversas preocupações com a qualidade de vida dos indivíduos, principalmente no âmbito da saúde. Nesse contexto, destaca-se o aumento na incidência de doenças crônico-degenerativas, dentre as quais está a osteoporose. Dessa maneira, o presente trabalho objetivou realizar um estudo teórico acerca das terapias farmacológicas e não farmacológicas disponíveis para serem utilizadas no tratamento e na prevenção da osteoporose. A realização desta pesquisa é importante, uma vez que busca mostrar as principais opções farmacológicas e medidas não farmacológicas utilizadas no tratamento e, principalmente, na prevenção dessa doença tão prevalente nos dias atuais. A metodologia utilizada para a realização deste estudo consistiu de pesquisa bibliográfica, buscando compilar as principais informações disponíveis sobre o tema em estudo. A osteoporose é uma doença osteometabólica, caracterizada pela diminuição da massa óssea e deterioração da microarquitetura do tecido ósseo, o que resulta no aumento da suscetibilidade às fraturas. A doença está relacionada principalmente ao envelhecimento e afeta ambos os sexos. Os agentes terapêuticos utilizados para o tratamento da osteoporose podem ser divididos em duas classes: compostos com ação antirreabsortiva (bifosfonatos, calcitonina, estrogênios e moduladores seletivos do receptor de estrogênio) e os agentes formadores de osso (fluoreto, paratormônio, teriparatida). Alguns fármacos mais recentes também estão disponíveis para utilização na terapêutica dessa doença, como o ranelato de estrôncio.

Objetivos: Avaliar a relação do desempenho físico de MMII com a força muscular respiratória e a capacidade funcional de idosas saudáveis da comunidade. Métodos: Foram avaliadas 24 idosas, com média de idade de 66,17 ± 4,22 anos. Para análise da avaliação da força muscular de MMSS, utilizou-se o teste de preensão manual e para avaliar o desempenho de membros inferiores o instrumento short physical performance battery (SPPB). A pressão respiratória máxima foi realizada por meio da manovacuometria, e a capacidade funcional por meio do teste de caminhada de seis minutos (TC6). Resultados: O IMC foi de 26, 51 ± 5,2 kg/m², a força de preensão manual 23,15 ± 5,57 kgf, a pontuação total média da SPPB encontrada foi de 10,58 ± 1,67 pontos, e a PImáx 57,29 ± 18,47 cmH2O e da PEmáx 74,59 ± 19,11 cmH2O. A distância percorrida no TC6 foi de 487,88 ± 88m. Encontramos correlações entre a distância percorrida no TC6, o SPPB (r = 0,43; p ≤ 0,05) e a PImáx (r = 0,43; p ≤ 0,05) e também entre o SPPB e a PEmáx (r = 0,51; p ≤ 0,05). Conclusão: Houve associação entre a capacidade funcional e desempenho físico de MMII e força respiratória de idosas da comunidade, sugerindo que esses músculos devem ser incluídos nos programas de reabilitação de idosos para melhora da capacidade funcional.

Objetivo:Comparar a prevalência da síndrome metabólica (SM) com diferentes critérios de classificação e perfil lipídico em idosos remanescentes dos quilombos. Métodos: Foram avaliados 110 idosos, 54 remanescentes dos quilombos (IRQ), média de idade 71,1 ± 9,6 anos. A classificação para SM ocorreu pela International Diabetes Federation (IDF) e National Cholesterol Education Program’s Adult Treatment Panel III (NCEP/ATPIII). Os IRQ foram pareados e comparados a um grupo controle de 56 idosos não remanescentes dos quilombos (INRQ) com idade média 68,8 ± 5,7 anos. Foram submetidos a uma entrevista, avaliação clínica, antropométrica e bioquímica. Resultados: A prevalência de SM entre os IRQ foi de 18,5% e 38,9%, e nos INRQ foi de 34% e 64,3%, pelos critérios do NCEP/ATPIII e da IDF. Pelo NCEP/ATPIII, o critério de SM mais prevalente foi baixo HDL-c. No perfil lipídico dos grupos, houve diferença de colesterol total (p ≤ 0,037), (VLDL p ≤ 0,001) e triglicerídeos (p ≤ 0,001). Os IRQ apresentaram redução na glicemia de jejum e triglicerídeos. Conclusão: Os IRQ apresentaram menor prevalência de SM em ambas as definições e valores significativamente menores de triglicerídeos, colesterol total e VLDL-c.

Objetivo: A avaliação das intervenções em saúde na população idosa frágil sempre constituiu um desafio devido ao caráter múltiplo e complexo dos seus problemas. Uma vez que ela tem se mostrado adequada com o uso de questionários de avaliação de qualidade de vida, uma revisão da literatura sobre esse tema se faz necessária. Foi realizada revisão utilizando como palavras-chave “frail elderly”, “questionnaire” e “quality of life, acrescentando “Brazil” numa segunda busca, tendo como resultado final a inclusão de 63 artigos. A combinação de um questionário genérico de avaliação de qualidade de vida com um específico para a patologia ou condição a ser avaliada é a estratégia mais utilizada pelos autores para acessar essa dimensão do conhecimento. Embora não existam questionários específicos para idosos frágeis, a aplicação de questionários já testados tem se mostrado válida, e o desenvolvimento de uma ferramenta específica para essa população é fortemente recomendada pelos autores estudados.

Objetivo: Avaliar o nível de conhecimento de diabéticos idosos (DMI) em alimentação e saúde, atendidos no Núcleo de Apoio ao Idoso (NAI)/PROIDOSO da Universidade Federal de Pernambuco (UFPE). Métodos: Estudo transversal do tipo pré-teste/pós-teste em 60 DMI tipo 2. Foi desenvolvido projeto de educação alimentar e nutricional em 3 cursos, com oficinas específicas de fisiopatologia DMI, tratamento alimentar, medicamentoso e importância da atividade física. A avaliação foi realizada através de notas (0 a 10), de comparação dos grupos e, das oficinas de alimentação e nutrição, realizada por Teste t de Student e Teste Quiquadrado, com significância de 0,005. Resultado: Na comparação através de perguntas no pós-teste de cada curso, não foi revelado aprendizado significativo; por outro lado, quando se comparam as médias obtidas por cada paciente em cada curso, observou-se aprendizado significativo no 1° curso (maioria nível superior), no mesmo tempo em que foi observada uma melhora nos níveis de conhecimento quando se avaliou o nível de aprendizado por nota nos 3 cursos, embora não tenha sido significativa (p = 0,096). Na comparação de aprendizado nas oficinas de tratamento alimentar dos 3 cursos, denota-se aprendizado significativo em 50% nos temas abordados. Conclusão: O estudo demonstrou que o nível de conhecimento nutricional aumentou, e que a educação nutricional poderá ser utilizada no atendimento a idosos diabéticos, como forma de adesão ao tratamento global que inclui a nutrição como foco principal.

Objetivo: Avaliar a prevalência do uso de medicamentos potencialmente inapropriados (MPIs) em pacientes idosos admitidos nas enfermarias de Clínica Médica, Infectologia, Neurologia e Cardiologia do Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR). Métodos: Estudo observacional, transversal, analítico e retrospectivo para identificação de medicamentos inapropriados utilizados entre idosos hospitalizados entre janeiro e dezembro de 2012. A amostra foi composta pelo total de internações de idosos nas enfermarias avaliadas. Os critérios de Beers (versão 2012) foram utilizados para identificação de MPI. Resultados: Foram avaliadas 605 internações de 512 pacientes. A média de idade dos pacientes da Clínica Médica foi de 71±7,4 anos, da Infectologia, 67±5,4 anos, da Neurologia, 70±6,5 anos, e da Cardiologia, 71±7,9 anos. Dos 8.715 medicamentos utilizados, 1.933 (~22%) eram inapropriados para idosos. Considerando a classificação ATC, os grupos com mais prescrições foram: A – aparelho digestivo e metabolismo (48,5%), B – sangue e órgão hematopoiéticos (17,4%), N – sistema nervoso (17%) e C – aparelho cardiovascular (12,5). Entre os MPIs, os princípios ativos mais prescritos foram metoclopramida (28,45%), glibenclamida (17,17%), diazepam (6,67%) e óleo mineral (6,31%). Conclusão: O presente estudo mostrou que a prescrição de MPI entre os idosos hospitalizados é prática comum e sua prevalência é semelhante à encontrada em outros estudos, mesmo quando são utilizados critérios anteriores ao de 2012. O grupo de medicamentos que atuam no aparelho digestivo e metabolismo foi o mais utilizado. Este estudo servirá como instrumento de educação terapêutica para o uso seguro e racional do medicamento e sensibilização dos prescritores, podendo ainda auxiliar na escolha de alternativas mais seguras para o paciente idoso e como ferramenta para possíveis intervenções multiprofissionais no manejo de MPI.

Introdução e objetivo: Este estudo avalia problemas de saúde em idosos, aplica um índice de envelhecimento bem-sucedido e analisa sua relação com fatores sociodemográficos e capacidade funcional em amostra aleatória representativa de Ouro Preto. Métodos: Associação entre capacidade funcional e variáveis sociodemográficas e clínicas foi avaliada usando regressão logística múltipla. Resultados: A mediana de idade foi 67; 59% eram de classe econômica baixa e 50% de baixa escolaridade. Foi elevada a prevalência de incontinência urinária, quedas, depressão, dependência, problemas de visão, audição, imunização e rastreamento de neoplasias. Houve associação entre dependência funcional e sexo feminino, idade, déficit cognitivo e problemas de visão. A chance de apresentar envelhecimento bem-sucedido foi menor entre mulheres, idosos de 75-79 anos e escolaridade baixa. Conclusão: Os idosos apresentam elevada prevalência de problemas de saúde. Maior expectativa de vida em mulheres não se associou a ganho de expectativa de vida livre de incapacidade. O envelhecimento bem-sucedido pode ser privilégio de classes mais favorecidas.

OBJETIVO: Avaliar se a melhor mobilidade funcional pode estar associada a um menor número de quedas e melhor desempenho funcional em idosas hígidas da comunidade. MÉTODOS: Quarenta e uma idosas foram divididas em dois grupos segundo o desempenho no teste Timed Up & Go (TUG) e foram avaliadas quanto ao histórico de quedas; ao medo de cair (Falls Efficacy Scale International - FES-I); à Força de Preensão Manual (FPM); à potência muscular (Teste de Sentar e Levantar Cinco Vezes - Five Times Sit-to-Stand Test - 5TSTS); à Velocidade da Marcha em 10 m; e ao Teste da Caminhada de Seis Minutos (TC6). Para comparação entre os grupos, foram realizados o Teste t de Student para amostras independentes e o teste de Mann-Whitney U (p ≤ 0,05). RESULTADOS: Dezoito idosas atingiram o ponto de corte no Timed Up And Go para sua faixa etária e foram alocadas no Grupo 1 (G1, n = 18; idade= 66,1 ± 6,7 anos; TUG = 7,3 ± 0,4 s) e 23 idosas não atingiram o ponto de corte proposto para sua faixa etária e foram alocadas no Grupo 2 (G2, n = 23; idade = 68,7 ± 6,4 anos; TUG = 10,2 ± 2,6 s). O G1, quando comparado ao G2, apresentou melhor potência muscular (5TSTS = 11,7 ± 2,0 s vs. 12,8 ± 2,2 s; p = 0,032); velocidade da marcha (VM = 1,6 ± 0,2 vs. 1,4 ± 0,3 m/s; p = 0,001); e distância percorrida em seis minutos (TC6 = 506,9 ± 60,1 m vs. 421,2 ± 70,9 m; p = 0,001). CONCLUSÃO: Boa mobilidade funcional (indicada pelo teste TUG) pode indicar melhor desempenho musculoesquelético e capacidade funcional de exercício em idosas hígidas da comunidade.

OBJECTIVE: To conduct an integrative literature review on epidemiology of falls in older adults in Brazil, seeking to identify occurrence rate, recurrence, and potentially modifiable factors associated with these events. METHOD: This literature review consisted of searching the Medical Literature Analysis and Retrieval System Online (MEDLINE), Scientific Electronic Library Online (SciELO), and Latin American and Caribbean Center on Health Sciences Information (LILACS) databases for scientific articles on November 14, 2017. The following keywords were used for finding articles: “accidental falls,” AND/OR “elderly,” AND/OR “Brazil.” Epidemiological data were collected from primary studies and then compared. RESULTS: Thirty-five studies were selected. Most of them were performed in the Brazilian Southeast (15) and South (11) regions. The occurrence rate of falls ranged from 10.7 to 59.3%. The most common setting for falls was the home during daytime. The most commonly described circumstances were tripping, slipping, dizziness, and uneven flooring, resulting in falling from one’s own height. The factors most frequently associated with falls were female sex, age greater than 80 years, cognitive impairment, and depressive symptoms. The reported consequences were fractures and fear of falling again. CONCLUSION: As some factors associated with falls in older adults in Brazil are modifiable, fall prevention may reduce morbidity and mortality in this population.

OBJECTIVES: To identify the prevalence of accidental falls among elderly persons in their homes, and to evaluate determining factors to that, including intrinsic and extrinsic risk factors, as well as the awareness about falls, assessed by the Falls Risk Awareness Questionnaire (FRAQ-Brazil). METHOD: It consisted of a quantitative, transversal, and descriptive study, performed with 472 elderly persons through interview. Data were analyzed by the chi-squared test with a confidence interval of 95%. RESULTS: The average age of the sample was 70.6 years and most of them were female. Among the sample, 55.2% referred previous episodes of fall. The majority of them self-reported having diseases associated with gait disturbance and used medicines that could cause falls. It was observed less falls among elderly with higher level of awareness about risk factors. CONCLUSION: A high prevalence of accidental falls and exposure of the elderly persons to several independent and concomitant risk factors were observed. Greater awareness level about falls seems to be a preventive factor, presenting a higher association with falls than level of education and income.

OBJECTIVE: To measure the prevalence of and identify factors associated with the occurrence of urinary incontinence (UI) in older adults (aged 60 years or older) living in the rural area of the municipality of Rio Grande, southern Brazil. METHOD: In a single-visit approach, interviewers systematically visited 80% of the households in the rural area of this municipality between April and October 2017. A standardized questionnaire was administered to older adults for information on demographic characteristics, socioeconomic characteristics, lifestyle habits, and morbidity pattern. Prevalence ratio (PR) was used as the effect measure. The c2 test was used to compare proportions. Poisson regression models with robust variance were used in the multivariate analysis. RESULTS: Of 1028 respondents (90.9% of the total), 15.9% (95%CI 13.6–18.1) reported having UI. Adjusted analysis showed that the risk of UI increases with age and is 3 times hig her in women (PR = 3.72; 95%CI 2.66–5.21). Perception of health status as fair, poor, or very poor had a PR = 1.68 (95%CI 1.25–2.26) and having 2 or more comorbidities had a PR = 1.73 (95%CI 1.17–2.55). CONCLUSION: In this study, the prevalence of UI was 15.9%, being significantly more prevalent in women, in older adults aged 65 years or older, in those with 2 or more morbidities, and in those perceiving their health status as fair, poor, or very poor.

Abstract Emerging infectious diseases are a major threat to biodiversity and an important public health issue. Flaviviruses are the cause of several emerging vector-borne zoonotic arboviruses whose distribution is currently increasing in Europe. The evidence that West Nile virus (WNV) circulates in resident and migratory species has implications for both animal and public health and should therefore be studied in depth. USUTU (USUV), Bagaza (BAGV) and tick-borne encephalitis virus (TBEV) are other viruses that are beginning to spread more widely. An integrated surveillance program, namely in birds, is essential for reducing the risk of infection in human populations within the One Health principles. In the present study, wild birds admitted to wildlife rehabilitation centers in Portugal were sampled. Two hundred eight blood samples were assayed serologically for antibodies to flaviviruses by using a commercial ELISA kit. An overall seroprevalence of 19.6% (95% confidence interval [CI]: 13.7–26.7%) was observed. Antibodies against flaviviruses were detected in 13 (35.1%) different species of wild birds. Accipitriformes (26.7%; 95% CI: 18.5–36.2%) and Strigiformes (26.7%; 95% CI: 14.6–42.0%) were the orders with the highest seroprevalence rates recorded. There were no statistically significant differences (p = 0.725) between the geographical regions (NUTS II) studied, but a statistically significant difference (p = 0.017) was found between sex (male: 34.4%; female: 4.8%). A higher seroprevalence was detected in adults (32.1%) than in juvenile birds (9.3%) (p = 0.014), and age was considered a risk factor for flavivirus infection in wild birds (odds ratio 1.4; 95% CI: 0.5–4.0). More epidemiological studies are needed in Portugal since the actual spread of the genus Flavivirus throughout the country is unknown.

Abstract Background There remain key knowledge gaps regarding HIV testing needs and priorities among refugee youth in low and middle-income country (LMIC) humanitarian settings. The HIV prevention cascade framework focuses on three domains (motivation, access, effective use) central to prevention uptake, yet is understudied in relationship to HIV testing, particularly among refugee youth. Uganda is an exemplar context to explore refugee youth HIV testing needs and priorities as it hosts 1.5 million refugees and is Africa’s largest refugee hosting nation. In this study, we explored perceptions and experiences regarding HIV testing among refugee youth living in Bidi Bidi refugee settlement, Uganda. Methods We conducted a community-based research study in Bidi Bidi Refugee Settlement, one of the world’s largest refugee settlements with over 195,000 residents. This qualitative study involved four focus groups (2 with young women, 2 with young men) with refugee youth aged 16–24 living in Bidi Bidi refugee settlement. We applied thematic analysis informed by the HIV prevention cascade to understand domains of motivation, access, and effective use that emerged as salient for HIV testing engagement. Results Participants (n = 40; mean age: 20 years, standard deviation: 2.2) included refugee young women (n = 20) and young men (n = 20), of whom 88% had a lifetime HIV test and 58% had ever heard of HIV self-testing. Participant discussions described HIV testing motivation was influenced by dimensions of: HIV treatment and testing knowledge; risk perception; positive and negative consequences of use; and social norms regarding gender and age. Access to HIV testing was shaped by: limited availability; distance and language barriers; confidentiality concerns; and affordability. Effective use of and engagement with HIV testing was related to HIV serostatus knowledge self-efficacy and in/equitable partner dynamics. Conclusions Complex, multi-level factors shape motivation for, access to, and effective use of HIV testing among refugee youth in Bidi Bidi. Findings align with the HIV prevention cascade framework that helps to identify gaps to inform intervention development with youth in humanitarian settings. HIV testing approaches tailored for refugee youth in contexts such as Bidi Bidi can foster HIV prevention and treatment literacy, gender equity, gender-based violence prevention, and intersectional stigma reduction.

This study sought to analyze the influence of occupational stress on the body composition of hospital workers after one year of follow-up. This prospective cohort study included 218 workers from one of the leading private hospitals in the municipality of Santo Antônio de Jesus, Recôncavo da Bahia region, Northeast Brazil. Body composition was analyzed by proxy (Body Mass Index and Waist Circumference) and Bioelectrical Impedance Analysis. The primary exposure adopted in the present study was the perception of occupational stress, assessed with the adapted and reduced version of the Job Content Questionnaire evaluating demand and control dimensions. The covariates were work characteristics; biological characteristics; sociodemographic characteristics and lifestyle. Statistical analyses were performed using descriptive, bivariate and multivariate analysis. At the first stage of the study, we identified that 55.96% (n = 122) of workers had high work demand and 25.22% (n = 55) had low control. Among those who had high demand and low control at the beginning of the study, the majority were women, non-white, with low educational and income levels, sleeping less than 7 h/day. After 12 months of follow-up, the median value for demand continued as 13 (IQR: 5–25) and for control, it increased to 16 (IQR: 9–23). In this second moment of the study, 62.38% (n = 136) of workers showed high demand and 45.87% (n = 100) low control. The characteristics of workers with high demand and low control were similar to those of the first moment. The results indicate that high demand and low control at work are risk factors for changes in body mass index, fat mass and fat-free mass in hospital workers. This study shows the importance and need for clinical and epidemiological assessments regarding the body composition of professionals working in hospitals, since high rates of overweight and obesity are triggers of chronic health problems such as dyslipidemia, diabetes mellitus and cardiovascular diseases, among others. Therefore, managers must promote adequate working conditions and understand the need for periodic body composition assessments.

Abstract Background This study aims to investigate the prevalence and associated risk factors of inappropriate use of emergency services among young adults in Vitória, Brazil. Methods A cross-sectional study was conducted over 30 consecutive days in November and December 2019, involving systematic random sampling of young adults (aged 18–39) visiting the municipal emergency care unit. Data were collected through structured interviews, utilizing the Hospital Urgency Appropriateness Protocol (HUAP) to identify inappropriate use. Demographic characteristics, healthcare utilization patterns, and medical diagnoses were assessed. Poisson regression models were employed to explore associations between variables. Results Among the 631 young adults surveyed, 30.6% exhibited inappropriate use of the emergency care unit. Factors associated with higher rates of inappropriate use included not seeking previous care in other healthcare services; having specific medical diagnoses like diseases of the respiratory system (PR: 2.03), diseases of the skin (PR: 4.13), and diseases of the ear and mastoid (PR: 3.74). Conclusion The study underscores the significance of addressing inappropriate use of emergency services among young adults. Though the prevalence of inappropriate use was not significantly different from other age groups, the demographic characteristics and healthcare utilization patterns of young adults contribute to their unique challenges. To mitigate inappropriate use, efforts should focus on improving access to primary healthcare services, enhancing continuity of care, and raising awareness about appropriate healthcare-seeking behaviors among young adults. Ultimately, these interventions can foster a more effective and sustainable healthcare system that better serves the needs of the community.

Abstract Background Race and ethnicity are important drivers of health inequalities worldwide. However, the recording of race/ethnicity in data systems is frequently insufficient, particularly in low- and middle-income countries. The aim of this study is to descriptively analyse trends in data completeness in race/color records in hospital admissions and the rates of hospitalizations by various causes for Blacks and Whites individuals. Methods We conducted a longitudinal analysis, examining hospital admission data from Brazil’s Hospital Information System (SIH) between 2010 and 2022, and analysed trends in reporting completeness and racial inequalities. These hospitalization records were examined based on year, quarter, cause of admission (using International Classification of Diseases (ICD-10) codes), and race/color (categorized as Black, White, or missing). We examined the patterns in hospitalization rates and the prevalence of missing data over a period of time. Results Over the study period, there was a notable improvement in data completeness regarding race/color in hospital admissions in Brazil. The proportion of missing values on race decreased from 34.7% in 2010 to 21.2% in 2020. As data completeness improved, racial inequalities in hospitalization rates became more evident – across several causes, including assaults, tuberculosis, hypertensive diseases, at-risk hospitalizations during pregnancy and motorcycle accidents. Conclusions The study highlights the critical role of data quality in identifying and addressing racial health inequalities. Improved data completeness has revealed previously hidden inequalities in health records, emphasizing the need for comprehensive data collection to inform equitable health policies and interventions. Policymakers working in areas where socioeconomic data reporting (including on race and ethnicity) is suboptimal, should address data completeness to fully understand the scale of health inequalities.

Introdução: Os adolescentes com Diabetes Tipo 1 enfrentam desafios de elevada complexidade associados à gestão da doença crónica. A implementação de programas de autogestão para adolescentes com DM1 tem apontado vantagens no desenvolvimento de competências de autogestão da doença. Objetivo: Mapear intervenções promotoras de autogestão para adolescentes com Diabetes Tipo 1. Métodos: Revisão scoping segue a metodologia proposta pelo Joanna Briggs Institute. Critérios de elegibilidade definidos de acordo com a População - adolescentes dos 10 aos 19 anos; Conceito - autogestão da diabetes; Contexto - considerados todos os contextos de intervenção. Foram incluídos estudos publicados entre 2009 e 2021 em português, inglês e espanhol: MEDLINE, CINAHL, Cochrane Library, Joanna Briggs Institute Databases, e Repositório Científico de Acesso Aberto de Portugal. O protocolo desta revisão está registado no Open Science Framework https://osf.io/z6wbj. Resultados: Foram incluídos nove artigos. As intervenções implementadas envolveram na sua maioria programas educacionais em sessões de grupo. Os indicadores de resultado foram: competências de autogestão (resolução de problemas, tomada de decisão, procurar e utilizar os recursos, parceria com a equipa de saúde e plano de ação); hemoglobina glicada; conhecimentos; qualidade de vida; autoeficácia e autocuidado. Conclusão: Das intervenções analisadas foram extraídos seis indicadores cujos resultados foram significativos nomeadamente no nível de hemoglobina glicada, autogestão, conhecimentos, autoeficácia e qualidade de vida.

Objetivo: identificar los cambios cognitivos y funcionales más frecuentes en personas mayores después de la fase aguda de COVID-19. Método: revisión integrativa de la literatura con búsqueda de artículos en las bases de datos LILACS, MEDLINE, PubMed y Scopus, entre junio y julio de 2024. La selección fue realizada independientemente por dos revisores y validada por un tercer revisor. Se incluyeron los estudios originales primarios que involucraron participantes con mayoría o mediana de edad superior a 60 años, con alteraciones cognitivas y funcionales post-COVID-19. Resultados: se observó la heterogeneidad en las muestras, con un amplio espectro de características clínicas, siendo las más prevalentes: disnea, fatiga, alteraciones en el patrón de sueño y déficit cognitivo. Conclusión: los resultados contribuyen a una mejor evaluación y conducta. Señalan la necesidad de crear protocolos específicos de atención para las personas mayores con síndrome post-COVID-19 y desarrollar intervenciones más adecuadas y dirigidas a la prevención, reducción o minimización de los síntomas persistentes.

Objetivo: identificar as alterações cognitivas e funcionais mais frequentes em pessoas idosas após a fase aguda da COVID-19. Método: revisão integrativa da literatura com busca de artigos nas bases de dados LILACS, MEDLINE, PubMed e Scopus, entre junho e julho de 2024. A seleção foi realizada independentemente por dois revisores e validada por um terceiro revisor. Foram incluídos os estudos originais primários que envolveram participantes com maioria ou mediana de idade superior a 60 anos, com alterações cognitivas e funcionais pós-COVID-19. Resultados: observou-se a heterogeneidade nas amostras, com vasto espectro de características clínicas, sendo as mais prevalentes: dispneia, fadiga, alterações no padrão de sono e déficit cognitivo. Conclusão: os resultados contribuem para uma melhor avaliação e conduta. Apontam a necessidade de criação de protocolos específicos de atendimento às pessoas idosas com síndrome pós-COVID-19 e desenvolvimento de intervenções mais adequadas e direcionadas à prevenção, redução ou minimização dos sintomas persistentes.

Objective: To identify the most frequent cognitive and functional changes in elderly people after the acute phase of COVID-19. Method: Integrative literature review with a search for articles in the LILACS, MEDLINE, PubMed, and Scopus databases, between June and July 2024. The selection was conducted independently by two reviewers and validated by a third reviewer. Original primary studies were included that involved participants with a majority or median age over 60 years, with post-COVID-19 cognitive and functional changes. Results: Heterogeneity was observed in the samples, with a wide range of clinical characteristics, the most prevalent being: dyspnea, fatigue, changes in sleep patterns, and cognitive deficit. Conclusion: The results contribute to a better assessment and conduct. They point to the need to create specific care protocols for elderly people with post-COVID-19 syndrome and to develop more appropriate and targeted interventions for the prevention, reduction, or minimization of persistent symptoms.

A Atenção Primária à Saúde (APS) é considerada a porta de entrada preferencial para o cuidado no sistema de saúde; já os serviços de emergência são destinados para situações que exigem atendimento imediato. Este artigo buscou identificar motivações para o uso de pronto atendimentos por problemas de saúde não urgentes em usuários deste serviço. Trata-se de um estudo qualitativo baseado em 29 entrevistas semiestruturadas realizadas em 2019 com usuários de um pronto atendimento do município de Vitória, ES. Os entrevistados percebem os serviços de urgência e emergência como aqueles nos quais obterão cuidados imediatos com maior facilidade e resolubilidade, já que acessar a APS de uma maneira imediata, rápida e resolutiva se apresentou difícil. A utilização de prontoatendimentos por motivos não urgentes mostrou-se complexa e envolve não apenas a dificuldade de acesso à APS, mas a própria compreensão individual e coletiva do papel de cada equipamento do sistema.

BackgroundEmotions can be regulated through several regulatory strategies that are involved in the development of psychopathological symptoms. Despite the well-established association between psychopathology and emotion dysregulation, little is known about the relationship between individual symptoms of depression and anxiety and emotion regulation strategies (ERS), as well as between ERS themselves.MethodWe conducted a cross-sectional study and examined the interactions between six ERS (reappraisal, engagement, rumination, suppression, arousal control, and distraction) and assessed their distinctive association with the activation of specific symptoms of depression and anxiety in a community sample of 376 adults (80.4% female; Mage = 32.70; SDage = 11.80). The Regulation Emotion Systems Survey (RESS) was used to measure ERS. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) were used to assess psychological symptoms. An exploratory graph analysis was performed to examine the structural properties of the network of interactions between these behaviors. Additionally, to test the association of ERS with the activation of the depression symptoms network, an expected symptoms activity (ESA) was conducted.ResultsSix communities were found that correspond to the six ERS. Rumination and suppression have a significant association with symptom activation (particularly low self-esteem), whereas reappraisal reduces symptomatic activation. The effect of arousal control, engagement, and distraction appears to depend on the remaining ERS rather than having much influence on their own.ConclusionThis study provides insight into how ERS interact with each other and with individual symptoms of depression and anxiety. Understanding the effects of these interactions on symptom activation and comorbidity can improve our understanding of psychopathology.

Abstract Background The prevalence of intestinal parasites is known to be high among Amerindian populations; further, there are serious problems in the healthcare of these populations in Brazil. The Maxakali, located in the northeastern region of Minas Gerais, Brazil, is an indigenous group that still preserves many of its cultural aspects. This study aimed to compare the positivity rate of schistosomiasis and soil-transmitted helminths in this ethnic group in epidemiological surveys conducted in 1972 and 2014. Methods Stool parasitological examinations were performed by the Kato-Katz technique during both periods in this population. In 2014, the parasitological diagnosis was also realized with the TF-Test® technique. Results In 1972, 270 inhabitants were examined. The positivity rates were 67.4% for Schistosoma mansoni, 72.9% for hookworms, 43.7% for Ascaris lumbricoides, and 23.7% for Trichuris trichiura. In 2014, 545 individuals were examined, and the positivity rates obtained were 45.7% for S. mansoni, 22.8% for hookworms, 0.6% for A. lumbricoides, and 2.8% for T. trichiura. Conclusions The comparison of the parasitological surveys conducted in 1972 and 2014, indicates that the indigenous Maxakali remained neglected by the health and indigenous protection authorities during these four decades. The infection rate observed in 2014 for schistosomiasis and hookworm remains high, considering the current epidemiological view of these diseases in the Brazilian population.

Objective: To compare the frequency of underweight and obesity among previously hospitalized older adults and analyze their association with malnutrition, sarcopenia, frailty, inflammatory markers, and adverse outcomes both during hospitalization and after discharge. Methods: This secondary analysis of a prospective study, conducted at Hospital das Clínicas da Universidade Federal de Pernambuco, Brazil, included hospitalized older patients (age ≥ 60 y). Nutritional status, body composition, sarcopenia, frailty, and outcomeswere assessed. Cox regression was performed to evaluate the impact of the body mass phenotypes on clinical outcomes. Results: This secondary analysis included one hundred patients. The prevalence of obesity was 22.10%, while that of underweight was 34.60%. Individuals with underweight had a higher frequency of weaker immune response, worse inflammatory profile, higher nutritional risk, higher frequency of sarcopenia and malnutrition, longer hospital stay, and a higher incidence of mortality when compared to those with obesity. Being underweight was independently associated with higher mortality rates, even after adjustment for age, sex, muscle mass, malnutrition, and diagnosis of malignancy [adjusted HR = 2.82 (95% confidence interval 1.03 – 7.72), p = 0.044]. Conclusions: The underweight phenotype represented a worst-case scenario in hospitalized older patients.

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Summary: Background: Although tuberculosis (TB) poses a significant global health threat to children and adolescents, there is limited information on the factors associated with TB treatment outcomes in this group. This study investigated the social and health factors associated with unfavourable treatment outcomes in children and adolescents with TB in Brazil, a high TB burden country. Methods: We conducted a population-based national retrospective cohort study of children (0–9 years) and adolescents (10–17 years) with TB in Brazil notified to the national Sistema de Informação de Agravos de Notificação (Sinan) from Jan 1, 2001, to Dec 31, 2022. Unfavourable treatment outcomes were defined as loss to follow-up, treatment failure, and death. Logistic regression and multinomial models examined the association between social and health factors, unfavourable treatment outcomes overall, and loss to follow-up and death, respectively. Findings: A total of 88,270 children and adolescents with TB were included of whom 25,600 (30.6%) had healthcare worker-supervised directly observed therapy (DOT). Of these, 9303 (10.5%) individuals experienced unfavourable TB treatment outcomes. For children, HIV infection (adjusted Odds Ratio 2.4, 95% confidence interval 1.9–3.1) and did not receive DOT (2.3, 1.9–2.7) were associated with unfavourable treatment outcomes. For adolescents, alcohol use (1.6, 1.2–2.0), illicit drug use (4.2, 3.4–5.1), tobacco use (1.6, 1.3–2.1), HIV infection (2.7, 2.2–3.4), and not receiving DOT (2.6, 2.3–2.9) were associated with unfavourable TB treatment outcome. Receiving social protection through government cash transfers protected against death (0.5, 0.3–0.9). Interpretation: In Brazil, TB treatment success rates were comparable to WHO End TB Strategy targets (90%). Substance use, HIV infection, and the absence of supervised treatment were the main factors associated with unfavourable treatment outcomes. Strategies to improve equity of TB treatment outcomes in this vulnerable group, including integrated HIV-TB services, DOT in healthcare facilities or communities, and holistic, person-centred healthcare and social protection, should be evaluated. Funding: Department of Health and Social Care (DHSC), the Foreign, Commonwealth & Development Office (FCDO), the Medical Research Council (MRC) and Wellcome, UK.

Summary: Background: Female homicides are a public health-relevant issue, and its spatial distribution may evidence socioeconomic vulnerabilities. This study aims to analyze the temporal and spatial trends of female homicides in Brazil and investigate socioeconomic-demographic factors associated with it. Methods: This is an ecological, descriptive, and analytical epidemiological study investigating the age-standardized female homicide rate in all Brazilian municipalities between 2000 and 2018, divided into three periods. Spatial and temporal analyses were conducted using the Global Moran's Index and LISA to identify clusters of high and low rates. Rates were also calculated by population size and means of violence across macro-regions. For the last period, a multivariable linear regression model analyzed the association of female homicide rates with social, economic, and geographic factors. Findings: Female homicide rates in Brazil remained high during the studied period, with differences in trends between regions. Among the potentially associated factors, it was observed that male homicide rate, the high percentage of violent deaths among black women and those with low levels of education, in addition to the low Gross Domestic Product (GDP) per capita, were positively associated with female homicide, whereas larger cities were negatively associated. Interpretation: These findings show that Brazil is a country with a high risk of female homicide. Nevertheless, the vulnerability of women is unequally distributed in the country. Female homicides are mostly caused by domestic conflicts but can also be influenced by changes in the urban and social contexts. Funding: This project is funded by the Bill & Melinda Gates Foundation.

ABSTRACT Objective: The objective of the present study is to describe the sociodemographic and behavioral characteristics of a group of transgender women and travestis (TGW) with a history of incarceration and the institutional and social context of this experience in Brazil. Methods: The analyzed data were derived from the TransOdara Study, a cross-sectional study conducted in five Brazilian capitals from December 2019 to July 2021. Participants were recruited using the Respondent-Driven Sampling (RDS) technique, in which, after an initial formative and exploratory stage, the first participants were identified; in turn, these participants recruited up to six other transgender women and travestis for the research. The study’s outcome was the experience of incarceration throughout life, captured through the question: “Have you ever been arrested in your life?” Results: A total of 1,245 TGW were interviewed, of which 20.3% (n=253) experienced incarceration. Incarceration was more frequent among those aged 33 to 42 years (35.6%), with lower level of education (45.5%, p

Abstract BackgroundStudies have reported the adverse effects of cold events on influenza. However, the role of critical factors, such as characteristics of cold spells, and regional variations remain unresolved. ObjectiveWe aimed to systematically evaluate the association between cold spells and influenza incidence in mainland China. MethodsThis time series analysis used surveillance data of daily influenza from 325 sites in China in the 2014‐2019 period. A total of 15 definitions of cold spells were adopted based on combinations of temperature thresholds and days of duration. A distributed lag linear model was used to estimate the short-term effects of cold spells on influenza incidence during the cool seasons (November to March), and we further explored the potential impact of cold spell characteristics (ie, intensity, duration, and timing during the season) on the estimated associations. Meta-regressions were used to evaluate the modification effect of city-level socioeconomic indicators. ResultsThe overall effect of cold spells on influenza incidence increased with the temperature threshold used to define cold spells, whereas the added effects were generally small and not statistically significant. The relative risk of influenza-associated with cold spells was 3.35 (95% CI 2.89‐3.88), and the estimated effects were stronger during the middle period of cool seasons. The health effects of cold spells varied geographically and residents in Jiangnan region were vulnerable groups (relative risk 7.36, 95% CI 5.44‐9.95). The overall effects of cold spells were positively correlated with the urban population density, population size, gross domestic product per capita, and urbanization rate, indicating a sterner response to cold spells in metropolises. ConclusionsCold spells create a substantial health burden on seasonal influenza in China. Findings on regional and socioeconomic differences in the health effects of cold spells on seasonal influenza may be useful in formulating region-specific public health policies to address the hazardous effects of cold spells.

Summary: Background: Household transmission studies seek to understand the transmission dynamics of a pathogen by estimating the risk of infection from household contacts and community exposures. We estimated within/extra-household SARS-CoV-2 infection risk and associated factors in a household cohort study in one of the most vulnerable neighbourhoods in Rio de Janeiro city. Methods: Individuals ≥1 years-old with suspected or confirmed COVID-19 in the past 30 days (index cases) and household members aged ≥1 year were enrolled and followed at 14 and 28 days (study period November/2020–December/2021). RT-PCR testing, COVID-19 symptoms, and SARS-CoV-2 serologies were ascertained in all visits. Chain binomial household transmission models were fitted using data from 2024 individuals (593 households). Findings: Extra-household infection risk was 74.2% (95% credible interval [CrI] 70.3–77.8), while within-household infection risk was 11.4% (95% CrI 5.7–17.2). Participants reporting having received two doses of a COVID-19 vaccine had lower extra-household (68.9%, 95% CrI 57.3–77.6) and within-household (4.1%, 95% CrI 0.4–16.6) infection risk. Within-household infection risk was higher among participants aged 10–19 years, from overcrowded households, and with low family income. Contrastingly, extra-household infection risk was higher among participants aged 20–29 years, unemployed, and public transportation users. Interpretation: Our study provides important insights into COVID-19 household/community transmission in a vulnerable population that resided in overcrowded households and who struggled to adhere to lockdown policies and social distancing measures. The high extra-household infection risk highlights the extreme social vulnerability of this population. Prioritising vaccination of the most socially vulnerable could protect these individuals and reduce widespread community transmission. Funding: Fundação Oswaldo Cruz, CNPq, FAPERJ, Royal Society, Instituto Serrapilheira, FAPESP.

Abstract: The influenza-like illness (ILI) sentinel surveillance operates in Brazil to identify respiratory viruses of public health relevance circulating in the country and was first implemented in 2000. Recently, the COVID-19 pandemic reinforced the importance of early detection of the circulation of new viruses in Brazil. Therefore, an analysis of the design of the ILI sentinel surveillance is timely. To this end, we simulated a sentinel surveillance network, identifying the municipalities that would be part of the network according to the criteria defined in the design of the ILI sentinel surveillance and, based on data from tested cases of severe acute respiratory illness (SARI) from 2014 to 2019, we drew samples for each sentinel municipality per epidemiological week. The draw was performed 1,000 times, obtaining the median and 95% quantile interval (95%QI) of virus positivity by Federative Unit and epidemiological week. According to the ILI sentinel surveillance design criteria, sentinel units would be in 64 municipalities, distributed mainly in capitals and their metropolitan areas, recommending 690 weekly samples. The design showed good sensitivity (91.65% considering the 95%QI) for qualitatively detecting respiratory viruses, even those with low circulation. However, there was important uncertainty in the quantitative estimate of positivity, reaching at least 20% in 11.34% of estimates. The results presented here aim to assist in evaluating and updating the ILI sentinel surveillance design. Strategies to reduce uncertainty in positivity estimates need to be evaluated, as does the need for greater spatial coverage.

Enquadramento: Têm sido vários os estudos que abordam a problemática do sono e a importância deste para a recuperação física e mental, sendo particularmente importante para os atletas de desporto coletivo. Objetivo: comparar a qualidade de sono dos atletas com não atletas. Metodologia: estudo prospetivo e quantitativo, com 62 participantes (31 atletas e 31 não atletas) que tiveram acesso a um questionário para autopreenchimento, que incluía uma caracterização sociodemográfica e o índice de Pittsburgh para avaliação da qualidade de sono. Resultados: observou-se que os atletas dormem em média cerca de oito horas por noite, apresentando, um tempo maior de latência do sono em comparação aos não atletas (este último sem significado estatístico). Apurou-se também que existe um maior número de indivíduos com boa qualidade de sono no grupo dos atletas em relação aos não atletas. Conclusão: neste estudo, ser atleta parece contribuir para um número médio de horas de sono superior em relação aos não atletas. A consciencialização da adoção de práticas saudáveis para otimizar a qualidade de sono nos atletas pode melhorar a sua performance desportiva.

Introdução: O estado de Goiás possui expressiva produção de alimentos advindos de agroindústrias rurais familiares. Objetivo: Considerando este cenário e a recente publicação de legislações sobre a artesanalidade de alimentos de origem animal, visamos ampliar o debate sobre o tema por meio de uma análise histórico-crítica das normativas federais e estaduais goianas, bem como caracterizar os empreendimentos que tiveram a concessão do Selo Arte no estado. Método: Foram realizadas uma pesquisa documental para identificação das legislações vigentes e uma pesquisa de campo com aplicação questionário com todos os cinco produtores que adquiriram Selo Arte em Goiás. Resultados: Observou-se que existem muitas lacunas e gargalos nas legislações relacionadas aos produtos artesanais, o que dificulta a comercialização formal de produtos artesanais e a regularização de agroindústrias rurais. Quanto aos empreendimentos goianos que possuem Selo Arte, apesar de possuírem algumas similaridades, não foi possível identificar um padrão característico, muito provavelmente pelo fato de a legislação ser recente e poucos estabelecimentos terem obtido a concessão, o que não gera um quantitativo expressivo para comparações. Conclusões: É indispensável aprimorar legislações nas esferas federal, estadual e municipal com vistas a incentivar a legalização do processamento de alimentos de agroindústrias rurais, especialmente as familiares.

Objective: To evaluate, in the scenario of rapid infusion, the effectiveness of the different regimens of supportive therapy employed in the prevention of nephrotoxicity and electrolyte depletion induced by cisplatin (CDDP). Methods: Data from patients who used CDDP weekly (30 to 40mg/m2) with an infusion time of 60-120 minutes were analyzed. The regimens evaluated were: saline solution (A), saline solution and mannitol (B), saline solution and magnesium (C) and saline solution with mannitol and magnesium (D). The following laboratory parameters were evaluated: creatinine (Cr), magnesium (Mg) sodium (Na) and potassium (K), and glomerular filtration rate (GFR). They were subsequently compiled in Microsoft Office Excel® and analyzed in Software R, using with analysis by means of descriptive statistics, developed in accordance with the recommendations of Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. Results: The study population evaluated were 46 patients, who received 218 infusions of CDDP. It was observed that schemes A and B had a progressive decrease in Mg. Scheme B had decreased levels of K, Cr and increased Na. In the individual analysis of each cycle, the different schemes of supportive therapy in rapid infusion were equally effective in preventing nephrotoxicity and electrolyte depletion. The schemes used were evaluated for throughout CDDP administrations, the regimen C and D demonstrated efficacy in maintaining renal function throughout multiple administration of CDDP. Conclusion: In the analysis of cumulative doses, regimen C proved to be effective in preserving renal function throughout CDDP administrations. In the individual analysis of each cycle, regardless of the number of times CDDP was administered, protocols C and D, which contained Mg supplementation associated or not with mannitol, were equally effective in preventing nephrotoxicity.

Introdução: Desde a confirmação pelas autoridades chinesas de um novo tipo de coronavírus em 7 de janeiro de 2020, a Coronaviris Disease - 19 (COVID-19) já havia causado centenas de mortes. A rápida disseminação da doença levou a Organização Mundial da Saúde a declarar Emergência de Saúde Pública de Importância Internacional em 30 de janeiro de 2020 e uma pandemia em 11 de março do mesmo ano. A disponibilização mundial de testes para o diagnóstico e vigilância epidemiológica da COVID-19 tornou-se urgente e necessária. Em resposta à emergência de saúde pública, a Agência Nacional de Vigilância Sanitária (Anvisa) publicou as Resoluções da Diretoria Colegiada (RDC) nº 379, de 30 de abril de 2020 e nº 445, de 10 de dezembro de 2020 que estabelecem a análise laboratorial dos produtos para o diagnóstico in vitro pelo Instituto Nacional de Controle de Qualidade em Saúde. Objetivo: Avaliar os dados de desempenho dos testes rápidos para detecção de anticorpos (AcTR) contra COVID-19 publicados na plataforma Microsoft® Power Bi no portal Anvisa. Método: No período de 06/04/2020 a 28/12/2021, foi realizado o levantamento dos dados referentes à sensibilidade e à especificidade clínica ou diagnóstica dos AcTR. Resultados: Um total de 55,3% AcTR apresentou resultados conformes e 44,7%, não conformes, de acordo com os critérios de análise estabelecidos. A sensibilidade reduzida foi a principal causa de não conformidade dos 293 lotes de produtos avaliados no período. Conclusões: O monitoramento pós-mercado garantiu a disponibilização de produtos de qualidade, seguros e eficazes no mercado nacional, além de subsidiar as tomadas de decisão por parte de autoridades brasileiras.

Objective: To evaluate, in the scenario of rapid infusion, the effectiveness of the different regimens of supportive therapy employed in the prevention of nephrotoxicity and electrolyte depletion induced by cisplatin (CDDP). Methods: Data from patients who used CDDP weekly (30 to 40mg/m2) with an infusion time of 60-120 minutes were analyzed. The regimens evaluated were: saline solution (A), saline solution and mannitol (B), saline solution and magnesium (C) and saline solution with mannitol and magnesium (D). The following laboratory parameters were evaluated: creatinine (Cr), magnesium (Mg) sodium (Na) and potassium (K), and glomerular filtration rate (GFR). They were subsequently compiled in Microsoft Office Excel® and analyzed in Software R, using with analysis by means of descriptive statistics, developed in accordance with the recommendations of Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. Results: The study population evaluated were 46 patients, who received 218 infusions of CDDP. It was observed that schemes A and B had a progressive decrease in Mg. Scheme B had decreased levels of K, Cr and increased Na. In the individual analysis of each cycle, the different schemes of supportive therapy in rapid infusion were equally effective in preventing nephrotoxicity and electrolyte depletion. The schemes used were evaluated for throughout CDDP administrations, the regimen C and D demonstrated efficacy in maintaining renal function throughout multiple administration of CDDP. Conclusion: In the analysis of cumulative doses, regimen C proved to be effective in preserving renal function throughout CDDP administrations. In the individual analysis of each cycle, regardless of the number of times CDDP was administered, protocols C and D, which contained Mg supplementation associated or not with mannitol, were equally effective in preventing nephrotoxicity.

Enquadramento: para qualquer avaliação de pré-participação, um questionário que analise o histórico clínico pessoal de sinais e sintomas e história clínica familiar pode identificar atletas em risco cardiovascular de morte súbita cardíaca. Objetivos: estratificação do risco cardiovascular com recurso a questionário de pré-participação em atletas jovens e veteranos; avaliar a perceção da importância do exame médico-desportivo entre estes dois grupos. Metodologia: estudo observacional transversal quantitativo, com recolha de dados recorrendo a preenchimento de questionário de pré-participação. Amostra constituída por 66 atletas, 36 atletas jovens e 30 atletas veteranos. Análise estatística com recurso ao programa IBM® SPSS Statistics versão 27.0. Resultados: verificou-se diferença significativa no sexo entre atletas jovens e veteranos (ρ=0,047), tempo de prática desportiva federada (ρ=0,022), tipo de desporto praticado (ρ=0,002), razões para realização de eletrocardiograma (ρ=0,002), prescrição de exame cardíaco por médico no passado (ρ=0,025), não se tendo verificado qualquer significância na história familiar e na perceção da importância do exame médico-desportivo entre os dois grupos. Conclusão: quanto maior é a idade, mais alterações poderão estar presentes a nível cardíaco e mais vezes os atletas nessa faixa etária recorrem aos serviços de saúde para realizar exames cardíacos. Os atletas demonstraram ter uma grande perceção em relação à importância do exame médico-desportivo, bem como do eletrocardiograma. Não se deve dispensar a avaliação criteriosa dos atletas tendo em conta a sua idade.

BackgroundBrazil’s Unified Health System (SUS) ensures universal, equitable, and excellent quality health coverage for all. The broad right to health, supported by the Constitution, has led to excessive litigation in the public sector. This has negatively impacted the financial stability of SUS, created inequality in children and adolescents’ access to healthcare, and affected communication between the healthcare system and the judiciary. The enactment of Law Number 13.655 on 25 April 2018, proposed significant changes in judicial decisions. This study aimed to investigate decision-making changes in health litigation involving children and adolescents following the implementation of the new normative model.MethodsThe study is cross-sectional, analyzing 3753 national judgment documents from all State Courts of Brazil, available on their respective websites from 2014 to 2020. It compares regional legal decisions before and after the promulgation of Law Number 13.655/2018. Data tabulation, statistical analysis, textual analysis, coding, and counting of significant units in the collected documents were performed. The results of data cross-referencing are presented in tables and diagrams.ResultsThe majority (96.86%) of legal claims (3635 cases) received partial or total provision of what was prescribed by the physician. The Judiciary predominantly handled these cases individually. The analysis indicates that the decisions made did not adhere to the norms established in 2018.ConclusionRegional heterogeneity in health litigation was observed, and there was no significant variability in decisions during the studied period, even after the implementation of the new normative paradigm in 2018. Technical-scientific support was undervalued by the magistrates. Prioritizing litigants undermines equity in access to Universal Health Coverage for children and adolescents.

ABSTRACT Objective: To analyze the transmission dynamics of dengue, a public health problem in Brazil and the Metropolitan Region of Belo Horizonte (MRBH). Methods: The spatiotemporal evolution of the occurrence of dengue in the municipality of Contagem, state of Minas Gerais, a region with high arbovirus transmission, was analyzed. Furthermore, epidemic and non-epidemic periods were analyzed, based on probable cases of dengue. This is an ecological study that used the Notifiable Diseases Information System (SINAN) national database. The analyses were carried out considering the period from epidemiological week (EW) 40 of 2011 to 39 of 2017. Spatial analysis tools (crude and smoothed incidence rate, directional distribution ellipse, global Moran index and local Moran index, and spatial scanning time with definition of epidemiological risk) were used. Results: The 2012 to 2013 and 2015 to 2016 epidemic cycles presented high incidence rates. The disease was concentrated in more urbanized areas, with a small increase in cases throughout the municipality. Seven statistically significant local clusters and areas with a high rate of cases and accentuated transmission in epidemic cycles were observed throughout the municipality. Spatial autocorrelation of the incidence rate was observed in all periods. Conclusion: The results of the present study highlight a significant and heterogeneous increase in dengue notifications in Contagem over the years, revealing distinct spatial patterns during epidemic and non-epidemic periods. Geoprocessing analysis identified high-risk areas, a piece of knowledge that can optimize the allocation of resources in the prevention and treatment of the disease for that municipality.

BackgroundMolecular epidemiology techniques allow us to track the HIV-1 transmission dynamics. Herein, we combined genetic, clinical and epidemiological data collected during routine clinical treatment to evaluate the dynamics and characteristics of transmission clusters of the most prevalent HIV-1 subtypes in the state of São Paulo, Brazil.MethodsThis was a cross-sectional study conducted with 2,518 persons living with HIV (PLWH) from 53 cities in São Paulo state between Jan 2004 to Feb 2015. The phylogenetic tree of protease/reverse transcriptase (PR/RT) regions was reconstructed by PhyML and ClusterPicker used to infer the transmission clusters based on Shimodaira–Hasegawa (SH) greater than 90% (phylogenetic support) and genetic distance less than 6%.ResultsOf a total of 2,518 sequences, 2,260 were pure subtypes at the PR/RT region, being B (88%), F1 (8.1%), and C (4%). About 21.2% were naïve with a transmitted drug resistance (TDR) rate of 11.8%. A total of 414 (18.3%) of the sequences clustered. These clusters were less evident in subtype B (17.7%) and F1 (15.1%) than in subtype C (40.2%). Clustered sequences were from PLWH at least 5 years younger than non-clustered among subtypes B (p

Vaccines combatting COVID-19 demonstrate the ability to protect against disease and hospitalization, and reduce the likelihood of death caused by SARS-CoV-2. In addition, monitoring viral loads in sewage emerges as another crucial strategy in the epidemiological context, enabling early and collective detection of outbreaks. The study aimed to monitor the viral concentration of SARS-CoV-2 in untreated sewage in a Brazilian municipality. Also, it attempted to correlate these measurements with the number of clinical cases and deaths resulting from COVID-19 between July 2021 and July 2022. SARS-CoV-2 viral RNA was quantified by RT-qPCR. Pearson's correlation was performed to analyze the variables’ relationship using the number of cases, deaths, vaccinated individuals, and viral concentration of SARS-CoV-2. The results revealed a significant negative correlation (p < 0.05) between the number of vaccinated individuals and the viral concentration of SARS-CoV-2, suggesting that after vaccination, the RNA viral load concentration was reduced in the sample population by the circulating concentration of wastewater. Consequently, wastewater monitoring, in addition to functioning as an early warning system for the circulation of SARS-CoV-2 and other pathogens, can offer a novel perspective that enhances decision-making, strengthens vaccination campaigns, and contributes to authorities establishing systematic networks for monitoring SARS-CoV-2. HIGHLIGHTS The presence of SARS-CoV-2 was detected in 100% of the wastewater samples.; Wastewater SARS-CoV-2 concentration negatively correlated with vaccinated individuals.; Wastewater-based epidemiology is a tool for the monitoring of virus during vaccination campaigns.;

En este texto analizamos el papel Estado cubano en lo concerniente a la política pública de salud reproductiva, teniendo como base reflexiones epistemológicas del pensamiento feminista negro en diálogo con otros abordajes críticos. Al amparo de estos referentes discutimos algunos hallazgos de una investigación doctoral previamente realizada sobre este tema. Constatamos que tanto los enunciados expuestos en documentos normativos, los procesos administrativos y diversos mecanismos institucionales asociados a la salud reproductiva, recrean lógicas coloniales de género, raza y parentesco que inscriben los proyectos de gestación y parentalidad en una matriz de dominación marcada por el racismo reproductivo y la heterosexualidad hegemónica, limitando las posibilidades de que tal política se constituya en un proyecto de justicia reproductiva.

Despite acknowledging the risks of the COVID-19 pandemic for the prison population, Brazil’s Supreme Court declined to issue structural injunctions during the health crisis ordering lower courts to consider these risks when making incarceration-related decisions. These injunctions could have been crucial to mitigate mass incarceration and protect the prison population during the pandemic. Through an examination of the Supreme Court’s rulings in structural cases and in a sample of over 4,000 habeas corpus decisions, this paper argues that granting these injunctions would have overwhelmed the court with an unmanageable influx of individual claims. Consequently, the Supreme Court acted strategically in anticipation of its limited institutional capacity to enforce compliance with structural injunctions among lower courts. This case study illustrates how practical considerations can hinder structural decisions in criminal law and highlights the limits of structural litigation and constitutional jurisdiction to address mass incarceration.