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Background: Lymphedema is a common complication following breast cancer treatment. The aim of this study is to evaluate the effectiveness of a self-adjusting compression garment (ReadyWrap®) in reducing (phase 1) and maintaining (phase 2) upper limb volume in women presenting breast cancer-related lymphedema., Methods: This study will comprise a randomized, controlled, single-blind clinical trial concerning women with breast cancer-related lymphedema undergoing treatment at a public cancer treatment reference hospital in the city of Rio de Janeiro, Brazil. The intervention will be carried out by adapting self-dressing versus the standard treatment of compressive bandaging (phase 1) and compressive mesh (phase 2). Both groups will be assessed at the beginning and end of intensive treatment and followed up for up to 12 months to evaluate immediate and late outcomes. Assessments will be carried out by physical upper limb examination (inspection, palpation, volume, dynamometry, and thermography) and questionnaires application to assess patient's quality of life pertaining to the health, functionality, and symptoms of the affected upper limb, as well adverse effects and adherence to treatment. Data will be analyzed descriptively and analytically through univariate and multiple linear regressions. P values < 0.05 will be considered statistically significant., Discussion: This study will evaluate the effectiveness of a self-adjustable garment (ReadyWrap®) in the treatment of lymphedema secondary to breast cancer in Brazilian women compared to the gold standard treatment for limb volume reduction (phase 1) and maintenance (phase 2) phases comprising, respectively, a compressive bandaging and a compressive mesh. The outcome results will provide data based on both quantitative responses and self-reported participant outcomes. The study will also assess the cost-effectiveness of the ReadyWrap® treatment versus standard care. Finally, we expect to reaffirm one more product/therapy as a treatment for this extremely complex and impactful condition following the data analysis., Trial Registration: NCT04934098 [Clinical trials phase 1]. Registered on June 22, 2021. NCT04881604 [Clinical trials phase 2]. Registered on May 11, 2021., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Although there are several ways to assess pain in dementia, there is still a need for tools with better items to assess the presence of pain intensity in these individuals., Objective: To validate to Brazilian version of the "Pain Intensity Measure for Persons with Dementia - PIMD-p., Methods: Older adults, all demented with impaired verbal communication and exposed to potentially painful situations, were selected from an outpatient clinic and long-term care facility (LTCF). The PIMD-p was applied independently by 2 researchers (E1 and E2) on the same day. Within 14 days, the instrument was reapplied by one of the 2 researchers (E3). The pain intensity reported by participants' caregivers and LTCF nurses were recorded on a verbal numeric pain scale. For the statistical analysis, Cronbach's Alpha, Spearman's Coefficient and intraclass correlation Index were calculated., Results: A total of 50 older individuals were selected (mean age 86 years), majority with musculoskeletal pain. The PIMD-p demonstrated good internal consistency according to Cronbach's α (0.838), excellent intra and interobserver reproducibility (0.927 and 0.970, respectively; p  < 0.001), and convergent validity (strong significant correlations between reported pain intensities and pain indicators on the PIMD-p (except for expressive eyes; corr = 0.106 and p  = 0.462). A ROC curve was plotted to determine the best cut-off for the PIMD-P, and a score of 7.5 predicted moderate-to-severe pain, with 77.8% sensitivity and 95.7% specificity ( p  < 0.001)., Conclusion: The PIMD-p showed satisfactory psychometric properties for measuring intensity of pain in demented older adults with impaired verbal communication., Competing Interests: There is no conflict of interest to declare., (Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/).)

Objective: Takayasu arteritis (TAK) is a rare chronic granulomatous vasculitis that affects large vessels and usually begins in women of childbearing age, so it is not uncommon for pregnancies to occur in these patients. However, there is limited information about these pregnancies, with reports of adverse maternal and obstetric outcomes. The objective of this study is to evaluate adverse maternal, fetal and neonatal events in pregnant patients with TA., Methods: This is a cross-sectional study with retrospective data collection. We reviewed 22 pregnancies in 18 patients with TAK, according to the American College of Rheumatology criteria, that were followed up in a high-risk prenatal clinic specialized in systemic autoimmune diseases and thrombophilia (PrAT) at Hospital Universitário Pedro Ernesto, from 1998 to 2021., Results: In twenty-two pregnancies, the mean age of patients was 28.09 years and the mean duration disease was 10.9 years. Of the 18 patients with TAK studied, only one had the diagnosis during pregnancy and had active disease. All other patients had a previous diagnosis of TAK and only 3 had disease activity during pregnancy. Twelve patients (66.6%) had previous systemic arterial hypertension and eleven (61.1%) had renal involvement. Among maternal complications, eight patients (36.3%) developed preeclampsia and six (27.2%) had uncontrolled blood pressure without proteinuria, while 10 (45%) had puerperal complications. Four (18.1%) births were premature, all due to severe preeclampsia and eight newborns (34.7%) were small for gestational age. When all maternal and fetal/neonatal outcomes included in this study were considered, only 6 (27.2%) pregnancies were uneventful., Conclusion: Although there were no maternal deaths or pregnancy losses in this study, the number of adverse events was considerably high. Hypertensive disorders and small for gestational age newborns were more common than general population, while the number of patients with active disease was low. These findings suggest that pregnancies in patients with TAK still have several complications and a high-risk prenatal care and delivery are necessary for these patients., (© 2023. The Author(s).)

Given the scarcity of studies relating fire to deforestation in the Atlantic Forest and great economic and ecological importances of this biome, this work aimed to investigate this relationship in the Atlantic Forest of the State of São Paulo, trying to answer whether deforestation is related to fire events in up to three years, if there are regions most affected by this relationship and what land use and land cover predominates after fire and deforestation in these areas. The study was carried out in Evergreen Forest and Semideciduous Seasonal, along the time series from 2000 to 2019 using the MapBiomas Project database to survey deforested and burned sites with moderate to high severity fires. Burning positively influenced deforestation in EGF in eight of 19 years studied (2001, 2004, 2005, 2007, 2008 and 2009, 2013 and 2015), while only for three years in the SSF. Burning followed by deforestation corresponded to only 3.2% of the total deforestation, located mainly in the eastern region of the state with the highest density in the EGF. Most of these areas have been converted to agriculture. This study provides the first indication that, generally, fire is not a driver of deforestation in the southeast Atlantic Forest., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 de Praga Baião et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Osteoporosis compromises bone strength and increases the risk of fractures. Zoledronate prevents loss of bone mass and reduces the risk of fractures., Objectives: To determine the efficacy and safety of zoledronate in postmenopausal women with osteopenia and osteoporosis., Design and Settings: A systematic review and meta-analysis was conducted within the evidence-based health program at the Universidade Federal de São Paulo., Methods: An electronic search of the CENTRAL, MEDLINE, Embase, and LILACS databases was performed until February 2022. Randomized controlled trials comparing zoledronate with placebo or other bisphosphonates were included. Standard methodological procedures were performed according to the Cochrane Handbook and the certainty of evidence for the Grading of Recommendations Assessment, Development, and Evaluation Working Group. Two authors assessed the risk of bias and extracted data on fractures, adverse events, bone turnover markers (BTM), and bone mineral density (BMD)., Results: Twelve trials from 6,652 records were included: nine compared zoledronate with placebo, two trials compared zoledronate with alendronate, and one trial compared zoledronate with ibandronate. Zoledronate reduced the incidence of fractures in osteoporotic [three years: morphometric vertebral fractures (relative risk, RR = 0.30 (95% confidence interval, CI: 0.24-0.38))] and osteopenic women [six years: morphometric vertebral fractures (RR = 0.39 (95%CI: 0.25-0.61))], increased incidence of post-dose symptoms [RR = 2.56 (95%CI: 1.80-3.65)], but not serious adverse events [RR = 0.97 (95%CI: 0.91-1.04)]. Zoledronate reduced BTM and increased BMD in osteoporotic and osteopenic women., Conclusion: This review supports the efficacy and safety of zoledronate in postmenopausal women with osteopenia for six years and osteoporosis for three years., Prospero Registration Number: CRD42022309708, https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=309708.

Introduction: With the COVID-19 pandemic, hospitals in low-income countries were faced with a triple challenge. First, a large number of patients required hospitalisation because of the infection's more severe symptoms. Second, there was a lack of systematic and broad testing policies for early identification of cases. Third, there were weaknesses in the integration of information systems, which led to the need to search for available information from the hospital information systems. Accordingly, it is also important to state that relevant aspects of COVID-19's natural history had not yet been fully clarified. The aim of this research protocol is to present the strategies of a Brazilian network of hospitals to perform systematised data collection on COVID-19 through the WHO platform., Methods and Analysis: This is a multicentre project among Brazilian hospitals to provide data on COVID-19 through the WHO global platform, which integrates patient care information from different countries. From October 2020 to March 2021, a committee worked on defining a flowchart for this platform, specifying the variables of interest, data extraction standardisation and analysis., Ethics and Dissemination: This protocol was approved by the Research Ethics Committee (CEP) of the Research Coordinating Center of Brazil (CEP of the Hospital Nossa Senhora da Conceicao), on 29 January 2021, under approval No. 4.515.519 and by the National Research Ethics Commission (CONEP), on 5 February 2021, under approval No. 4.526.456. The project results will be explained in WHO reports and published in international peer-reviewed journals, and summaries will be provided to the funders of the study., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

The COVID-19 pandemic caused unprecedented pressure over health care systems worldwide. Hospital-level data that may influence the prognosis in COVID-19 patients still needs to be better investigated. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with in-hospital mortality in COVID-19 patients admitted to Brazilian institutions. This multicenter retrospective cohort study is part of the Brazilian COVID-19 Registry. We enrolled patients ≥ 18 years old with laboratory-confirmed COVID-19 admitted to the participating hospitals from March to September 2020. Patients' data were obtained through hospital records. Hospitals' data were collected through forms filled in loco and through open national databases. Generalized linear mixed models with logit link function were used for pooling mortality and to assess the association between hospital characteristics and mortality estimates. We built two models, one tested general hospital characteristics while the other tested ICU characteristics. All analyses were adjusted for the proportion of high-risk patients at admission. Thirty-one hospitals were included. The mean number of beds was 320.4 ± 186.6. These hospitals had eligible 6556 COVID-19 admissions during the study period. Estimated in-hospital mortality ranged from 9.0 to 48.0%. The first model included all 31 hospitals and showed that a private source of funding (β = - 0.37; 95% CI - 0.71 to - 0.04; p = 0.029) and location in areas with a high gross domestic product (GDP) per capita (β = - 0.40; 95% CI - 0.72 to - 0.08; p = 0.014) were independently associated with a lower mortality. The second model included 23 hospitals and showed that hospitals with an ICU work shift composed of more than 50% of intensivists (β = - 0.59; 95% CI - 0.98 to - 0.20; p = 0.003) had lower mortality while hospitals with a higher proportion of less experienced medical professionals had higher mortality (β = 0.40; 95% CI 0.11-0.68; p = 0.006). The impact of those association increased according to the proportion of high-risk patients at admission. In-hospital mortality varied significantly among Brazilian hospitals. Private-funded hospitals and those located in municipalities with a high GDP had a lower mortality. When analyzing ICU-specific characteristics, hospitals with more experienced ICU teams had a reduced mortality., (© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

This study aims to map the changes in land use and land cover between 1970 and 2018, analyzing the influence of the protected area s (PAs) in the Cerrado biome, specifically in the area of the Jalapão Mosaic. Images from the Landsat 1-MSS, 5-TM, and 8-OLI satellites were used and processed in SPRING and ArcGIS software. The analyses were based on three approaches: (1) the boundary of the Jalapão Mosaic, (2) the PAs, and (3) a comparison between the PAs and their surroundings. The Jalapão Mosaic results demonstrated that 26% (≅ 8410 km 2 ) of the area was burned, and 15.5% (4971 km 2 ) was anthropized in at least one of the analyzed periods. Among the PAs, the Serra Geral do Tocantins Ecological Station (Integral Protection) presented the largest burned area (43.7% ≅ 3095 km 2 ); however, there was no significant increase in the anthropized areas due to fire. Meanwhile, the anthropized areas in the Rio Preto and Serra da Tabatinga Environmental Protection Areas (Sustainable Use) increased by 27.5% and by 75%, respectively, due to agricultural expansion. By analyzing the two groups of PAs and their surroundings, it was observed that the loss of natural vegetation was restrained and fires were less intense in the Integral Protection Units; in the Sustainable Use Units, there was a significant increase in the anthropized areas. Furthermore, over 70% of the anthropized areas occurred in the surrounding areas, thus showing the importance of creating PAs., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Patients with mucopolysaccharidosis type VI (MPS VI) present with a wide range of disease severity and clinical manifestations, with significant functional impairment and shortened lifespan. Enzyme replacement therapy (ERT) with galsulfase has been shown to improve clinical and biochemical parameters including patient survival, quality of life and growth. The present study is a resurvey of 34 Brazilian MPS VI patients with rapidly progressive disease (classical phenotype) who initiated ERT with galsulfase under five years of age and had been on ERT until data collection in 2019, with few exceptions (n = 4 patients who died before 2019). Anthropometric measures, urinary glycosaminoglycans, and data regarding cardiac, orthopedic, neurologic, sleep apnea, hearing and ophthalmologic outcomes were filled in by specialists. Pubertal development, clinical complications, hospitalizations, and surgeries were also assessed. In this resurvey study, treatment with galsulfase has shown to be safe and well tolerated in MPS VI patients who initiated ERT under the age of 5 years and who have been undergoing ERT for approximately 10 years. Mortality rate suggests that early initiation of ERT may have a positive impact on patients' survival, improving but not preventing disease progression and death. MPS VI patients on ERT also showed improved growth velocity and the pubertal development was normal in all surviving patients. Follow-up data on pneumonia and hospitalization suggest that early ERT may have a protective effect against major respiratory complications. Cardiac valve disease progressed since their prior evaluation and spinal cord compression was observed in a large number of patients, suggesting that these disease complications were not modified by ERT., Competing Interests: Declaration of Competing Interest AG, AMM, ASSP, AXA, BFFR, CML, FCS, JFSF, LCLL, LRG, TBT, JICFN: declared no conflict of interest. ACMS, ALB, CAK, DDGH, EKEAL, EMR, MCSR, MK, RCFB: received funds or reimbursement from BioMarin Brasil Farmaceutica LTDA for attending related symposia, or speaker honoraria. DDGH: received consulting fees from BioMarin Brasil Farmaceutica LTDA., (Copyright © 2021. Published by Elsevier Inc.)

Introduction: Vertebral fractures (VF) are associated with poorer quality of life, morbidity, and mortality in aging, and are the main risk factors for new VF or fractures in other sites. Thus, to explore them in the elderly is important, especially considering the very elderly individuals (age ≥ 80), who belong to the fastest growing population in the world, a portion that is still very little studied., Objective: To evaluate the prevalence, specific characteristics and associations of VFs in a very elderly population., Method: Observational, descriptive, and analytical cross-sectional study of the "Longevous Project" - São Paulo, Brazil, an ongoing prospective cohort that includes elderly of both gender, aged 80 yr or more. For the diagnosis of VF 2 methods were used VFA ("VF Assessment) by bone densitometry and X-ray, by 2 independent physicians, and using the Genant semiquantitative technique. The VFs by VFA were correlated with demographic, anthropometric, clinical, laboratory, and densitometric data. Statistical tests applied were qui-square and ANOVA., Results: We analyzed data of 125 individuals with a mean age of 86.7 ± 4.1 yr and majority of female (71.2%). The prevalence of osteoporosis and osteopenia was 35.5% and 47.6%, respectively. A higher prevalence of VF was verified by VFA (30.4%) than by X-ray (20.8%), besides the majority was considered severe, 52.6% and 57.7%, by VFA and X-ray, respectively. A concordance index between the 2 methods was considered regular for the diagnosis of VF (Kappa = 0.419), and good for the VF severity (Kappa = 0.743). The VF were significantly associated to bone densitometry analysis VF (p = 0.05), and its severity was significantly correlated with total hip BMD (p = 0.049) and glomerular filtration rate (p = 0.017)., Conclusion: This study observed a high prevalence of VF in a very elderly population, being the great majority severe fractures and suggests that VFA might be more effective to detect VF in oldest-old individuals., (Copyright © 2019 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)

Objective: To assess the frequency of the leadership practices performed by the manager nurses of hospital institutions and their association with the variables of the socioprofessional profile., Method: Cross-sectional, descriptive, correlational study conducted in four hospitals in a city of the state of São Paulo. A sociodemographic questionnaire and the instrument Leadership Practices Inventory were used. Data collection and analysis were based on an exemplary Leadership Practices Model., Results: Eighty-four manager nurses participated in the study. The mean values of the leadership practices used by the nurses were: enable others to act (50.6); encourage the heart (48.2); model the way (46.7); challenge the process (43.3); and inspire a shared vision (43.1). Data analysis also evidenced a correlation between the practice encourage the heart and the variables time of care and employment relationship., Conclusion: The study evidenced the presence of manager nurses exercising moderate leadership, and promoting teamwork, an environment of trust, and a horizontal vision. However, moderate values also reveal managerial aspects to be improved by the leaders by means of organizational strategies and/or tools aimed at best leadership practices., Objetivo: Avaliar a frequência das práticas de liderança executadas pelos enfermeiros gerentes de instituições hospitalares e sua associação às variáveis do perfil socioprofissional., Método: Estudo transversal, descritivo e correlacional, realizado em quatro hospitaisde um município do interior paulista. Utilizou-se de questionário sociodemográfico e do instrumento Leadership Practices Inventory. A coleta e a análise de dados foram fundamentadas em um Modelo de Práticas para Liderança exemplar., Resultados: Participaram 84 enfermeiros gerentes. As médias das práticas de liderança utilizadas pelos enfermeiros foram: capacitar os outros a agir (50,6), encorajar o coração (48,2), traçar o caminho (46,7), desafiar o processo (43,3) e inspirar uma visão compartilhada (43,1). Na análise dos dados também se constatou correlação entre a prática encoraje o coração e as variáveis tempo de assistência e vínculo empregatício., Conclusão: O estudo constatou a presença de enfermeiros gerentes exercendo liderança moderada, promovendo o trabalho em equipe, propiciando um clima de confiança e visão horizontalizada. No entanto, os valores moderados também revelam aspectos gerenciais a serem aprimorados pelos líderes, por meio de ferramentas e/ou estratégias organizacionais em busca de melhores práticas de liderança.

Objective: The term Locomotive Syndrome refers to conditions in which the elderly are at high risk of inability to ambulate due to problems in locomotor system. For Locomotive Syndrome screening, the 25-Question Geriatric Locomotive Function Scale was created. The objective here was to translate, adapt culturally to Brazil, and study the psychometric properties of 25-Question Geriatric Locomotive Function Scale., Method: The translation and cultural adaptation of 25-Question Geriatric Locomotive Function Scale were carried out, thus resulting in GLFS 25-P, whose psychometric properties were analyzed in a sample of 100 elderly subjects. Sociodemographic data on pain, falls, self-perceived health and basic and instrumental functionalities were determined. GLFS 25-P was applied three times: in one same day by two interviewers, and after 15 days, again by the first interviewer., Result: GLFS 25-P showed a high internal consistency value according to Cronbach's alpha coefficient (0.942), and excellent reproducibility, according to intraclass correlation, with interobserver and intraobserver values of 97.6% and 98.4%, respectively (p<0.01). Agreements for each item of the instrument were considerable (between 0.248 and 0.673), according to Kappa statistic. In its validation, according to the Pearson's coefficient, regular and good correlations were obtained for the basic (BADL) and instrumental (IADL) activities of daily living, respectively (p<0.01). Statistically significant associations with chronic pain (p<0.001), falls (p=0.02) and self-perceived health (p<0.001) were found. A multivariate analysis showed a significantly higher risk of Locomotive Syndrome in the presence of chronic pain (OR 15.92, 95% CI 3.08-82.27) and with a worse self-perceived health (OR 0.23, 95% CI 0.07-0.79)., Conclusion: GLFS 25-P proved to be a reliable and valid tool in Locomotive Syndrome screening for the elderly population., (Copyright © 2016. Published by Elsevier Editora Ltda.)

Background: The nontuberculous mycobacteria (NTM) are widely spread. In Brazil, 2,520 cases of rapidly growing mycobacteria (RGM) infections after medical procedures were reported, with 5.4% of cases related to nonsurgical invasive procedures and with an occurrence of 1 clone (BRA100) of Mycobacterium abscessus subsp bolletii., Objective: To describe a pseudooutbreak of M abscessus subsp bolletii in an endoscopy and bronchoscopy unit., Methods: The alert for a pseudooutbreak was given when 3 patients, in the same week, had a positive bronchoalveolar lavage culture for M abscessus subsp bolletii. The patients had no symptoms/signs of mycobacterial infection; thus, contamination of bronchoscopes was suspected. Samples for culturing were collected from bronchoscopes, digestive endoscopes, automated disinfection machines, and the water supply. Clinical samples were identified by polymerase chain reaction restriction-enzyme analysis (PRA) of the hsp65 gene and their pulsed-field gel electrophoresis pattern was compared with environmental samples., Results: The investigation demonstrated a contamination of bronchoscopes, digestive endoscopes, and disinfection machines. Molecular typing demonstrated that all strains belonged to the same clone (MAB01), identical to clone BRA100., Discussion: Cross-transmission due to poor disinfection as well as resistance to glutaraldehyde may play roles in the spread of MAB01 M abscessus subsp bolletii, which may have a unique resistance to the environment and adaption to human hosts. However the water supply may have played a role. Attention is needed to ensure the quality of water used to rinse disinfected equipment., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To validate the Pain Assessment Checklist for Seniors with Limited Ability to Communicate - Portuguese in demented elderly and to analyze its measurement properties., Methods: We evaluated 50 elderly with dementia, residing in a nursing home and with limited communication ability, when exposed to potentially painful situations. The tool was applied at two different moments. First, two interviewers applied it simultaneously, and the intensity of pain was asked based on the caregiver's opinion. After 14 days, with no analgesic intervention, one of the interviewers applied it again., Results: The sample comprised more females, aged over 80 years, with dementia due to Alzheimer, presenting musculoskeletal pain of moderate to severe intensity. The psychometric properties of the tool demonstrated appropriate internal consistency (Cronbach's alpha coefficient of 0.827). The scale had excellent reproducibility, according to the intraclass correlation coefficient, and the tool has been duly validated., Conclusion: The Pain Assessment Checklist for Seniors with Limited Ability to Communicate - Portuguese had adequate measuring properties for use with elderly presenting limited communication., Objetivo: Validar o Pain Assessment Checklist for Seniors with Limited Ability to Communicate - Portuguese em idosos dementados e analisar as propriedades de suas medições., Métodos: Foram avaliados 50 idosos dementados, residentes de uma casa de repouso e com capacidade de comunicação verbal limitada, quando expostos a situações potencialmente dolorosas. A ferramenta foi utilizada em dois momentos diferentes. Primeiro, foi aplicada por dois entrevistadores simultaneamente, e a intensidade da dor foi questionada com base na opinião do cuidador. Depois de 14 dias, sem intervenção de analgésico, a ferramenta foi aplicada novamente por um dos entrevistadores., Resultados: A amostra teve predominância de mulheres, acima de 80 anos de idade, com demência de Alzheimer, apresentando dores musculoesqueléticas com intensidade moderada a grave. As propriedades psicométricas do instrumento demonstraram consistência interna adequada (coeficiente alfa de Cronbach de 0,827). A escala teve excelente reprodutibilidade, de acordo com o coeficiente de correlação intraclasse, e o instrumento demonstrou validade adequada., Conclusão: O Pain Assessment Checklist for Seniors with Limited Ability to Communicate - Portuguese teve propriedades de medição adequadas para idosos com limitações de comunicação.

Objective: To identify, in national and international journals, the studies conducted in Brazil related to breast feeding and reducing cases of diarrhea in children under 2 years of age, featuring health interventions more used., Methods: Descriptive study, based on an integrative review of literature from PubMed and LILACS data published between January 1992 and August 2011. The keywords "breastfeeding AND diarrhea" was searched in Portuguese, English and Spanish in PubMed and LILACS. The guiding question was: "What was knowledge produced about breast feeding and prevention of diarrhea in children under 2 years between 1992 and 2011 in studies conducted in Brazil?", Results: We selected 11 studies that showed the importance of breast feeding in the prevention and protection against diarrhea in children under 6 months, especially among children in exclusive breastfeeding., Conclusion: Public health policies should be directed to the context of each locality, in order to reduce the problems that involve the early weaning.

Fifteen bacterial isolates from spotted fever group rickettsiosis in Brazil were genetically identified as Rickettsia rickettsii. In a phylogenetic analysis with other R. rickettsii isolates from GenBank, the Central/South American isolates showed low polymorphism and formed a clade distinct from two North American clades, with the North American clades having greater in-branch polymorphism., (Copyright © 2014, American Society for Microbiology. All Rights Reserved.)

The Girolando breed is used in pasture-based dairy production systems in Brazil to associate the high production of Bos taurus to the rusticity and thermal adaptation of Bos indicus. This study was designed to evaluate the physiological response to a gonadotropin-releasing hormone (GnRH)-prostaglandin F2α (PGF2α)-GnRH protocol to synchronize the ovulation in 40 Girolando heifers of a pasture-based dairy production system and its relationships with the temperature and humidity index (THI) during the dry (DS) and rainy season (RS) in the tropical savannah-Brazil's cerrado biome. Responses were characterized by follicular and corpus luteum number and diameter, ovulation (D9), and pregnancy rates after first AI. Total follicle number (8.1 ± 0.3 × 8.8 ± 0.3), D9 ovulatory follicle diameter (11.9 ± 0.4 × 10.1 ± 0.4 mm), corpus luteum diameter (8.6 ± 1.3 × 3.9 ± 1.5 mm), corpus luteum score (3.7 ± 0.8 × 1.8 ± 1.0), corpus luteum diameter after AI (9.6 ± 1.6 × 3.9 ± 1.5 mm), and corpus luteum score after AI (3.2 ± 0.4 × 0.9 ± 0.6) in DS and RS differed (P < 0.01). D9 ovulation rate was 40 % (DS) and 20 % (RS), without differences (P > 0.05). Pregnancy rate was 45 % (DS) and 11 % (RS), with differences (P < 0.01). THI differed between DS and RS (P < 0.01). THI may interfere in the follicular and luteal dynamics and in the response of Girolando heifers to the GnRH-PGF2α protocol in the tropical savannah, thus reducing the chances of pregnancy at the first artificial insemination.

The innate immune system represents the first line of host defense against pathogens. Genetics factors regulating the immune responses play a role in the susceptibility to infectious diseases, such as tuberculosis (TB). We analyzed MBL2 promoter and exon 1 functional single nucleotide polymorphisms (SNPs) in a group of 155TB patients and 148 healthy controls in order to evaluate their influence on the onset of infection and TB development. There was no association between MBL2 -550 HL promoter polymorphisms and susceptibility to develop TB, but heterozygous -221 Y/X genotype was significantly more frequent in pulmonary TB patients than controls. Moreover, MBL2 exon 1 O allele, was significantly associated with susceptibility to TB development in general (p=0.023, OR=1.61, 95% CI 1.05-2.49) and pulmonary TB (p=0.0008, OR=2.16, 95% CI 1.35-3.46); C allele at codon 57, as well as A/C genotype, were significantly more frequent in TB patients than in controls. Our results indicate that MBL2 polymorphisms, especially at codon 57, could be considered as risk factors for TB development., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Aim: Evaluate the IS6110-Taqman system performance in sputum samples from patients with pulmonary tuberculosis from health services in north-eastern Brazil as a diagnostic laboratory tool for pulmonary tuberculosis., Methods and Results: 165 sputum samples from respiratory symptomatic patients were evaluated in the IS6110-TaqMan assay: 66 patients with pulmonary tuberculosis and 99 without TB. When the IS6110-TaqMan assay was evaluated using culture and/or clinical response to the specific treatment as the gold standard, IS6110-TaqMan assay obtained a sensitivity of 87.9% and specificity of 98%. The performance of IS6110-TaqMan assay was also evaluated with the sputum smear microscopy, resulting in a sensitivity of 79.7% and specificity 94.8%., Conclusions: The IS6110-TaqMan was rapid, sensitive and specific for the diagnosis of pulmonary TB., Significance and Impact of the Study: IS6110-TaqMan assay is a promising auxiliary tool for the diagnosis of pulmonary TB when used in conjunction with routine laboratory tests, clinical and epidemiological criteria of the patient, thus increasing the sensitivity and specificity of diagnosis., (© Aggeu Magalhães Research Center © 2012 The Society for Applied Microbiology.)

Suspicion of Brazilian spotted fever (BSF) should occur in endemic regions upon surveillance of the acute febrile icteric hemorrhagic syndrome (AFIHS). However, limitations associated with currently available laboratory tests pose a challenge to early diagnosis, especially in fatal cases. Two real-time PCR (qPCR) protocols were evaluated to diagnose BSF in 110 fatal AFIHS cases, collected in BSF-endemic regions in 2009-2010. Of these, 24 were positive and 86 negative by indirect immunofluorescence (IFA) assay (cut-off IgG and/or IgM ≥ 128). DNA from these samples was used in the qPCR protocols: one to detect Rickettsia spp. (citrate synthase gene) and another to determine spotted fever group (SFG) Rickettsia species (OmpA gene). Of the 24 IFA-positive samples, 5 (21%) were positive for OmpA and 9 (38%) for citrate synthase. In the IFA-negative group (n=86), OmpA and citrate synthase were positive in 23 (27%) and 27 (31%), respectively. These results showed that the 2 qPCR protocols were about twice as sensitive as the IFA test alone (93% concordance). In conclusion, qPCR is a sensitive method for the diagnosis of fatal BSF cases and should be considered for routine surveillance of AFIHS in places like Brazil, where spotted fever-related lethality is high and other endemic diseases like dengue and leptospirosis can mislead diagnosis., (Copyright © 2012 Elsevier GmbH. All rights reserved.)

Brazilian spotted fever (BSF) caused by Rickettsia rickettsii is the most important rickettsiosis and the only reportable tick-borne disease in Brazil. In Brazil, the hard tick Amblyomma cajennense is the most important BSF vector; however, in São Paulo State, A. aureolatum was also recognized as a vector species in remaining Atlantic forest areas near the metropolitan area of São Paulo city. We analyzed clinical and epidemiological features of BSF cases from two distinct areas where A. cajennense (Area 1) and A. aureolatum (Area 2) are the incriminated vectors. The clinical features demonstrate the same severity pattern of BSF in both endemic areas. Differences in seasonality, patient characteristics (median age and gender), and epidemiological risk factors (animals host contact and vegetation characteristics) were observed and possibly could be attributed to the characteristics of each vector and their typical biological cycle (hosts and environment)., (Copyright © 2012 Elsevier GmbH. All rights reserved.)

In recent years, public policy evaluation in Brazil has become a strategic tool for improving the performance of public action, capable of contributing effectively to social welfare. Despite this recognition, evaluative practice has still not been incorporated into the programs' "life cycle", especially in the social area. Programs that lack significant evaluative practice include those related to food and nutrition. This article thus aimed to characterize the field of evaluation of public food and nutrition interventions in graduate studies programs in Brazil. The study focused primarily on theses and dissertations from 1980 to 2004, converging on the functioning of interventions with a predominance of documental research and case studies. Analytically, the principal thematic categories in these theses and dissertations have shifted from a more biological focus to the socio-political dimension.

This study evaluated the Brazilian National School Nutrition Program from a structure-process-results perspective. The methodology involved document research and a case study in 45 counties and 73 schools in the State of Bahia, including program manager interviews and household questionnaires involving 3,367 children (7-14 years of age). Relating to program structure, the study analyzed the evolution of normative instruments and some infrastructure aspects. Managers reported problems with the installations for preparing and distributing meals in 28% of the counties. Decentralization to the county (municipal) level was present in 93% of cases and to the school level in about 20%; however, nearly 70% of the schools received the food supplies directly. Although Social Control Councils were created, members were not always chosen democratically. Acceptability of the meals was good, as expected considering the widespread poverty in the target population. Overall program coverage was high (95%), but 77% of schoolchildren in the interior and 39% in the capital city did not receive meals every day. So far, irregular school meal distribution has frustrated the program's aspirations to become a universal social policy and ensure a basic right for children.

This study was designed to determine the seroprevalence of herpes simplex virus type 2 (HSV-2) and to evaluate its association with age, sex as well as other demographic and behavioural factors in 150 human immunodeficiency virus (HIV) positive adults patients attending the general medical outpatient ward for routine care of Niterói, state of Rio de Janeiro, Brazil. Serum samples were screened for HSV-2 antibodies using an indirect ELISA. Eighty-three patients were men (mean age: 38.8) and 67 were women (mean age: 35.4). The estimated prevalence of HSV-2 was 52% (95% CI: 44-60%) and it was higher among men (53%) than among women (50.7%). Overall, the age of first sexual intercourse and past history of genital herpes were associated with HSV-2 seropositivity. Analysis by gender disclosed significant association of number of lifetime sex partners only among men. Although HSV-2 antibodies were frequent in the study group, genital herpes was reported by 21.8% of the HSV-2 positive subjects, indicating low awareness of the HSV-2 infection. These results may have public health importance for Brazil as the high rate of HSV-2 infection may act as a cofactor of HIV transmission.

This is a qualitative study about the care provided by "caregivers" enrolled in the Home Care Program in Betim, Minas Gerais. Interviews were held during home visits in order to identify characteristics of home care providers, analyze their perception about health care, verify factors which interfere in home care and relationships which are established between caregiver/person cared for/other family members. Discourse analysis (Fiorin, 1993) was used to build the empirical categories which revealed that most of the caregivers are family members, women, average age of 42 years, limited schooling, mostly housewives. The subjects sampled reported that the act of caring involves technique, duty and dedication. They referred to financial difficulties, physical and emotional stress. The relationships established during care involved feelings of pleasure, satisfaction and helplessness in the face of the needs and sufferings of the person cared for. The authors concluded that home care fosters more humane care, but requires technical guidance and emotional training for the caregivers and support from the health institution.

Introduction: Previous cross-sectional studies have shown a high prevalence of chronic disease and disability among the elderly. Given Brazil's rapid aging process and the obvious consequences of the growing number of old people with chronic diseases and associated disabilities for the provision of health services, a need was felt for a study that would overcome the limitations of cross-sectional data and shed some light on the main factors determining whether a person will live longer and free of disabling diseases, the so-called successful aging. The methodology of the first follow-up study of elderly residents in Brazil is presented., Method: The profile of the initial cohort is compared with previous cross-sectional data and an in-depth analysis of nonresponse is carried out in order to assess the validity of future longitudinal analysis. The EPIDOSO ('Epidemiologia do Idoso') Study conducted a two-year follow-up of 1,667 elderly people (65+), living in S. Paulo. The study consisted of two waves, each consisting of household, clinical, and biochemical surveys., Results and Conclusions: In general, the initial cohort showed a similar profile to previous cross-sectional samples in S. Paulo. There was a majority of women, mostly widows, living in multigenerational households, and a high prevalence of chronic illnesses, psychiatric disturbances, and physical disabilities. Despite all the difficulties inherent in follow-up studies, there was a fairly low rate of nonresponse to the household survey after two years, which did not actually affect the representation of the cohort at the final household assessment, making unbiased longitudinal analysis possible. Concerning the clinical and blood sampling surveys, the respondents tended to be younger and less disabled than the nonrespondents, limiting the use of the clinical and laboratory data to longitudinal analysis aimed at a healthier cohort. It is worth mentioning that gender, education, family support, and socioeconomic status were not important determinants of nonresponse, as is often the case.