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Measuring the quality of information delivered to patients with severe mental illness (SMI), i.e., schizophrenia, bipolar disorders, and major depressive disorders, is essential to improve their quality of care. In this work, we described the different steps of the validation of the PREMIUM computerized adaptive testing (CAT) for measuring the quality of information delivered to patients with SMI. The PREMIUM item bank regarding information included 25 items. A total of 499 patients with schizophrenia (53%), bipolar disorders (26%), and major depressive disorders (22%) were recruited from numerous in- and outpatient settings in France. Unidimensionality, local independence, and monotonicity were verified for 19 items of the item bank. The psychometric properties were satisfactory for both internal (RMSEA = 0.069, CFI = 0.969, TLI = 0.963) and external validity (in particular, significant associations were found with age, educational level, and social functioning). The CAT exhibited satisfactory accuracy and precision (standard error of measurement

Regionalization of care has been proposed to optimize outcomes in Congenital Cardiac Surgery (CCS). We hypothesized that hospital infrastructure/systems of care factors could also be considered in regionalization efforts.Observed-to-expected mortality (O/E ratio) and hospital volumes were obtained between 2015 and 2018 from public reporting data. Using a resource dependence framework we examined factors obtained from American Hospital Association, Children's Hospital Association and hospital websites. Linear regression models were estimated with volume only, then with hospital factors, stratified by procedural complexity. Robust regression models were re-estimated to assess the impact of outliers.We found wide variation in the volume of congenital cardiac surgeries performed (89-3,920) and in the surgical outcomes (O/E ratio range 0.3-3.1). Six outlier hospitals performed few high complexity cases with high mortality. Univariate analysis including all cases indicated that higher volume predicted lower O/E ratio (β=-0.020, SE=0.008, p=0.011). However, this effect was driven by the most complex cases. Models stratified by Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category show that volume is only a significantly predictor in category 5 cases (β=-1.707, SE=0.663, p=0.012). Robust univariate regression accounting for outliers found no effect of volume on O/E ratio (β =.005, SE =.002, p=.975). Elimination of outliers through robust multivariate regression decreased the volumes/outcomes relationship and found a modest relationship between health plan ownership and outcomes.Systems of care factors should be considered in addition to volume when designing regionalization in CCS. Patient level datasets will better define these factors.

O trabalho aqui apresentado demonstra os resultados do estudo realizado sobre como o podcast pode contribuir para o ensino e aprendizagem de Literatura na educação Básica, sob os conceitos da Educação Tecnológica. Assim, neste recorte, objetivou-se demonstrar as respostas para as seguintes questões da pesquisa focadas nos alunos protagonistas participantes: Como o uso do podcast pode atuar como recurso educacional que contribua positivamente para o gosto e hábito da leitura de textos literários? O uso deste recurso tecnológico é viável à Educação Básica? Os fundamentos teóricos e metodológicos pautaram-se em Eco (1979), Lèvy (1996, 2010), Castells (2012), Nóvoa (2010) e Kenski (2004, 2015) quanto às transformações comunicacionais e tecnológicas do Século XX e as mudanças na educação e, em Freire (2012, 2013, 2015) no que se refere ao conceito educacional de podcast. A pesquisa-ação evidenciou a construção do conhecimento de forma colaborativa por meio da tecnologia educacional a partir da mediação da professora-pesquisadora, com uso do ciberespaço e influência da cibercultura. Para a produção dos dados foram utilizados como instrumentos o podcast, os produtos gerados pelos alunos protagonistas (reconto da obra literária, pod-novela, meta-podcasts e podcast de registro), questionário estruturado aplicado aos alunos beneficiados e observações da professora-pesquisadora. Constatou-se que o uso de tal ferramenta tecnológica no contexto da Educação Básica, gerou benefícios quanto ao ensino e aprendizagem de Literatura junto aos alunos protagonistas que, de modo cooperativo, confirmam que a criação do podcast contribui para fluência, gosto e hábito da leitura, aprimoramento quanto ao ato de ler e falar em público, aprofundamento dos conhecimentos voltados aos tipos textuais trabalhados (novela de cavalaria, resenha) assim como dos processos de escrita (reescrita/síntese), além do desenvolvimento da criticidade dos mesmos, poisperceberam que a pod-novela não substitui a obra, mas instiga sua leitura. Verificou-se que o podcast teve boa aceitação entre os alunos protagonistas, a ferramenta educacional apresentou certa facilidade quanto ao uso, financeiramente viável e em consonância com a Educação Tecnológica e o Ensino de Literatura na Educação Básica; no entanto, há necessidade de que o professor haja conforme o novo contexto educacional e tecnológico propõe – que gerencie habilidades e estimule a participação colaborativa de seus estudantes.

To identify barriers and facilitators to adoption of a new surgical procedure via an implementation science framework to characterize associated socioemotional, clinical, and decision-making processes.Qualitative study with a semistructured interview approach.Large tertiary care referral center.Academic otolaryngologists with at least 2 years of practice were identified and interviewed. Transcripts were thematically coded and separated into steps in the clinical pathway. Synthesis of major themes characterized facilitators and barriers to uptake of a new surgical technique.Of 22 otolaryngologists, 19 were interviewed (85% male). They had a median 18 years of practice (interquartile range, 7.8-26.3), and 65% were subspecialty trained. In the decision to implement a new procedure, improving patient outcomes and addressing unmet clinical needs facilitated adoption, whereas costs and adopting profit-driven technologies without improved outcomes were barriers. In patient consults, establishing trust facilitated implementation of new techniques; barriers included participants' hesitation to communicate about the unknowns of a new procedure. Intraoperatively, little change to existing workflow or improved efficiency facilitated adoption, while a substantial learning curve for the new procedure was a barrier. Achieving favorable outcomes and patient satisfaction sustained implementation of new procedures. Too few referrals or indications for the new procedure hindered implementation.Our study demonstrates that innovation in otolaryngology is often an individual iterative process that providers pursue to improve patients' outcomes. Although models for the oversight of surgical innovation emphasize the need for evidence, obtaining sufficient numbers of providers and patients to generate evidence remains a challenge in specialty surgical practice.

The current national burden of emergency general surgery (EGS) illnesses and the extent of surgeon involvement in the care of these patients remain largely unknown. To inform needs assessments, research, and education, we sought to: (1) translate previously developed International Classification of Diseases (ICD), 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes representing EGS conditions to ICD 10th Revision, CM (ICD-10-CM) codes and (2) determine the national burden of and assess surgeon involvement across EGS conditions.We converted ICD-9-CM codes to candidate ICD-10-CM codes using General Equivalence Mappings then iteratively refined the code list. We used National Inpatient Sample 2016 to 2017 data to develop a national estimate of the burden of EGS disease. To evaluate surgeon involvement, using Wisconsin Hospital Association discharge data (January 1, 2016 to June 30, 2018), we selected adult urgent/emergent encounters with an EGS condition as the principal diagnosis. Surgeon involvement was defined as a surgeon being either the attending provider or procedural physician.Four hundred and eighty-five ICD-9-CM codes mapped to 1,696 ICD-10-CM codes. The final list contained 985 ICD-10-CM codes. Nationally, there were 2,977,843 adult patient encounters with an ICD-10-CM EGS diagnosis. Of 94,903 EGS patients in the Wisconsin Hospital Association data set, most encounters were inpatient as compared with observation (75,878 [80.0%] vs. 19,025 [20.0%]). There were 57,780 patients (60.9%) that underwent any procedure. Among all Wisconsin EGS patients, most had no surgeon involvement (64.9% [n = 61,616]). Of the seven most common EGS diagnoses, surgeon involvement was highest for appendicitis (96.0%) and biliary tract disease (77.1%). For the other five most common conditions (skin/soft tissue infections, gastrointestinal hemorrhage, intestinal obstruction/ileus, pancreatitis, diverticular disease), surgeons were involved in roughly 20% of patient care episodes.Surgeon involvement for EGS conditions ranges from highly likely (appendicitis) to relatively unlikely (skin/soft tissue infections). The wide range in surgeon involvement underscores the importance of multidisciplinary collaboration in the care of EGS patients.Prognostic/epidemiological, Level III.

ANÁLISE ECONÔMICA DA PRODUÇÃO DE LODO DE ESGOTO COMPOSTADO PARA FINS AGRÍCOLAS NA ESTAÇÃO DE TRATAMENTO DE ESGOTO DE BOTUCATU-SP. SARA FERNANDES MARTINS1, MAURA SEIKO TSUTSUI ESPERANCINI2, NURIA ROSA GAGLIARDI QUINTANA3 FRANKLIN DE SOUZA BARBOSA4 1 Departamento de Controladoria e Planejamento Integrado do Médio Tietê, SABESP, Rua Costa Leite, nº 2000, Vila Nogueira, 18606-820, Botucatu, São Paulo, Brasil, e-mail: sfmartins@sabesp.com.br 2 Departamento de Engenharia Rural e Sócio Economia, Faculdade de Ciências Agronômicas, UNESP, Av. Universitária, nº 3780, Altos do Paraíso, Botucatu - SP, 18610-034, Botucatu, São Paulo Brasil, e-mail: maura.seiko@unesp.br 3Faculdade de Botucatu – UNIBR. Avenida Paula Vieira, 624, Vila Jahu. Botucatu-SP, 18611-020, Botucatu, São Paulo Brasil, e-mail: nuria.quintana@unibrbotucatu.com.br 4 Departamento de Engenharia Rural e Sócio Economia, Faculdade de Ciências Agronômicas, UNESP, Av. Universitária, nº 3780, Altos do Paraíso, Botucatu - SP, 18610-034, Botucatu, São Paulo Brasil, e-mail: franklin.barbosa@unesp.br RESUMO: Este estudo teve como objetivo avaliar o custo de compostagem do lodo in natura produzido na Estação de Tratamento de Esgotos (ETE), da SABESP de Botucatu, São Paulo e determinar o valor dos nutrientes presentes no lodo compostado com e sem adição de material estruturante (ME). O estudo baseou-se na produção de 16 toneladas diárias de lodo, o que gera um custo anual aproximado de R$ 1.466.438,40 em transporte e disposição em aterro localizado no município de Paulínia, São Paulo. Foi estimado o custo anual de produção do lodo de esgoto compostado com e sem ME. Foram realizadas análises de amostras dos produtos finais para estimar o valor dos nutrientes presentes nos dois tipos de lodo compostado. As amostras também indicam que o produto final atende aos parâmetros da Resolução CONAMA 375/06 e às exigências do Ministério da Agricultura (MAPA). Estimou-se o valor do produto final com base nos valores médios pagos pela agricultura, verificando-se que o composto com ME geraria uma receita anual de R$ 349.653,9 e o produto sem ME de R$ 51.269,9. O resultado econômico é positivo, pois o custo da compostagem, descontado o valor dos nutrientes, é menor que o custo de disposição em aterros sanitários. Palavras-chave: lodo compostado, compostagem, tratamento de resíduos, reúso agrícola. ECONOMIC ANALYSIS OF THE PRODUCTION OF COMPOSTING SEWAGE SLUDGE FOR AGRICULTURAL PURPOSES IN THE SEWAGE TREATMENT FACILITY OF BOTUCATU-SP ABSTRACT: This study aimed to evaluate the composting cost of in natura sludge produced at the SABESP's Sewage Treatment Plant in Botucatu, São Paulo, and to determine the value of nutrients present in the composting sludge with and without the addition of structuring material (ME). The study was based on the diary production of 16 tons of sludge, which generates an approximate annual cost of R$ 1,466,438.40 in transport and disposal in a landfill located in the municipality of Paulínia, São Paulo. The annual production cost of composting sewage sludge with and without ME was estimated. Analyzes of samples of the final products were carried out to estimate the value of nutrients present in the two types of composting sludge. The samples also indicate that the final product meets the parameters of CONAMA Resolution 375/06 and the requirements of the Ministry of Agriculture (MAPA). The value of the final product was estimated based on the average amounts paid by agriculture, verifying that the compost with ME would generate an annual income of R$ 349,653.9 and the product without ME of R$ 51,269.9. The economic result is positive; that is, the cost of composting, discounted the value of the nutrients, is less than the cost of landfill disposal. Keywords: sludge composting, composting, waste treatment, agricultural reuse.

Recurrence of atrial fibrillation (AF) within the blanking period after catheter ablation (CA) is traditionally classified as a transient and benign event. However, recent findings suggest that early recurrence (ER) is associated with late recurrence (LR), challenging the predefined "blanking period". We aimed to determine the clinical and procedural predictors of ER and LR after CA and establish the risk of LR in patients who experience ER.Retrospective single-centre study including all patients who underwent a first procedure of AF CA between 2017 and 2019. ER was defined as any recurrence of AF, atrial flutter or atrial tachycardia30 s within 90 days after CA and LR as any recurrence after 90 days of CA. A total of 399 patients were included, 37% women, median age of 58 years [49-66] and 77% had paroxysmal AF. Median follow-up was 33 months (from 13 to 61). ER after CA was present in 14% of the patients, and LR was reported in 32%. Among patients who experienced ER, 84% also had LR (p .001). Patients with ER had a higher prevalence of moderate/severe valvular heart disease, persistent AF, previous electrical cardioversion, a larger left atrium, higher coronary artery calcium score, and higher rates of intraprocedural electrical cardioversion and cardiac fibrosis on eletroanatomical mapping compared with patients without ER. After covariate adjustment, ER and female sex were defined as independent predictors of LR (hazard ratio [HR] 4.69; 95% confidence interval [CI], 2.99-7.35; p .001 and HR 2.73; 95% CI, 1.47-5.10; p = .002, respectively).The risk of LR after an index procedure of CA was significantly higher in patients with ER (five-fold increased risk). These results support the imperative need to clarify the clinical role of the blanking period.

Clinical case A 39-year-old smoker woman underwent a percutaneous coronary intervention with two Zotarolimus-eluting stents implantation due to right coronary artery occlusion in the context of ST-elevation myocardial infarction (MI). She was medicated with dual antiplatelet therapy and high-intensity statin and stopped smoking. Nine months later, due to angina symptoms, cardiac catheterization with intravascular ultrasound showed severe restenosis, treated with a drug-coated balloon (DCB). Two months later, she was admitted due to non-ST elevation MI and the cardiac catheterization presented thrombotic occlusion of previously implanted stents, treated with balloon dilatation. After two months, she remained with angina and a dobutamine stress echocardiogram showed inferior wall ischemia. The angiographic revision revealed proximal in-stent restenosis, treated with DCB. About a year later, a fifth coronary angiography was performed due to recurrence of angina. Diffuse in-stent restenosis by neo-atherosclerosis was identified by optical coherence tomography. The lesion was treated with a cutting balloon and Everolimus-eluting stent implantation. The cholesterol-lowering treatment was optimized and the patient remained stable for some months. However, she is currently reporting recurrence of angina. Clinical management and guidance await Heart Team discussion. Learning points

Presentation We report a case of a 44-year-old woman with past medical history of dyslipidemia under atorvastatin, overweight and depression, that presented to the emergency department with a 1-month history of dyspnea. On physical examination, blood pressure was within normal range, however she was hypoxemic, needing oxygen via nasal cannula, and tachycardic. Pulmonary auscultation revealed basal crackles. Blood workup showed discrete leukocytosis, increased C-reactive protein, mild hypertransaminasemia and increased troponin and NT-proBNP levels. An EKG revealed sinus tachycardia with 123 beats per minute. A D-shaped left ventricle, an enlarged right ventricle and right heart mobile thrombus were observed in a transthoracic echocardiogram. Diagnosis Scoring 2 points on simplified Wells’ Score and with a visible mobile right ventricular thrombus, pulmonary embolism was suspected and further confirmed by computed tomographic pulmonary angiography. Management: In the absence of hemodynamic instability this case fulfils criteria for intermediate-high risk pulmonary embolism. Therefore, anticoagulation with enoxaparin was started under strict electrocardiographic monitoring. Unfortunately, a day later the patient had a sudden cardiac arrest in asystole, with no recuperation after prolonged advanced life support and administration of rescue thrombolysis (alteplase 50mg). Learning points

Atherosclerosis represents a systemic disease that can involve multiple vascular beds, including coronary artery disease and peripheral artery disease (PAD). Acute coronary syndrome (ACS) with concomitant PAD represents a high-risk subgroup that deserves special attention. In particular, sex-based differences in PAD treatment and outcomes have been discussed. This study aimed to clarify the main differences in clinical outcomes between women and men with PAD admitted for ACS. The authors performed a retrospective analysis of adult patients with PAD, included in the Portuguese Registry on Acute Coronary Syndromes (ProACS) between October 2010 and July 2022. A P-value < 0.05 is statistically significant. Of the total of 32 251 hospitalized patients admitted for ACS, 1588 (4.9%) had known PAD, of which 320 were women and 1268 men. Table 1 shows the most important baseline characteristics and differences between groups. After propensity score matching, with 640 patients, female gender appeared to be an independent factor for acute heart failure (OR 0.68, 95% CI [0.48, 0.96], P-value = 0.03) and in-hospital mortality (OR 0.36, 95% CI [0.17, 0.73], P-value < 0.01). However, there are no differences between sex for 1-year mortality (P-value = 0.70). In conclusion, in this group of patients, PAD is less prevalent among women, and probably underdiagnosed. In addition, there is a significant difference in medication with fewer women taking acetylsalicylic acid, probably undertreated. Finally, women have more in-hospital complications, including mortality. Hence, additional efforts are needed in order to better understand sex-based differences in PAD and increase awareness of this condition in women.

Background Cardiovascular events in the young appear to be increasing. Conversely, this is not the tendency reported in older adults. Identifying risk factors is of the uttermost importance to improve cardiovascular prevention. Material and methods Retrospective, single-centre analysis of patients with less than 45 years and suspected coronary heart disease who were subjected to cardiac catheterization in our centre during a 5-year period. Results and conclusions A total of 171 patients were included with a median age of 42 ± 6 years of which 82% were male. Overweight (73%), smoking (61%) and dyslipidemia (42%) were the most prevalent cardiovascular risk factors. Coronary heart disease was diagnosed in 67% of patients. After univariate analysis, gender (P = 0.049), age (P = 0.005), smoking (P = 0.032), low-density lipoprotein cholesterol (P = 0.005) and total cholesterol (P = 0.003) were significantly associated with disease in coronary angiography. After multivariate logistic regression, only age (OR = 1.123; CI 95% [1.036–1.217]; P < 0.005) and low-density lipoprotein cholesterol (OR = 1.016; CI 95% [1.004–1.028]; P = 0.009) remained as independent factors of coronary heart disease. It is known that awareness regarding a healthy lifestyle should be raised in the general population. As several modifiable risk factors have an impact on cardiovascular disease, there is an urgent need to improve primary prevention. Conversely, a more thorough investigation is needed in the cases where no significant coronary disease is found. According to our analysis, age and low-density lipoprotein cholesterol appear to have a stronger relevance in this young population.

Background Undercovering the etiology responsible for pathologic states is of the uttermost importance, especially regarding young people. Arterial and venous thromboembolism may have an impact on morbidity and mortality, enhancing the need to prevent recurrences. Material and methods Retrospective, single-centre analysis of 24-h Holter monitoring in patients with thrombotic events and less than 40 years during a 5-year period, using IBM® SPSS® software to perform descriptive analysis. Results and conclusions Thrombosis was the reason for requesting 24-h Holter monitoring in 7% (n = 41) from a total of 581 exams screened – 68.3% had a stroke, 6% a transient ischemic stroke, 4.9% a pulmonary embolism, 4.9% an intestinal ischemia and 2.4% had both pulmonary embolism and deep vein thrombosis. Patients had a median age of 35 ± 6 years, 63.7% were male and past medical history consisted of cardiovascular risk factors, particularly smoking (36.6%), high blood pressure (19.5%) and dyslipidemia (12.2%). Merely 4.9% had a diagnostic finding – atrial flutter and second-degree atrioventricular block Mobitz II. On the other hand, autoimmune tests were altered in 12.2% and echocardiogram revealed patent foramen ovale, atrial septum aneurysm and interatrial septum bulging with shunt in 9.8%, 2.4% and 2.4%, respectively. Regarding management, 78% were medicated with aspirin or anticoagulant and 4.9% were submitted to percutaneous closure of patent foramen ovale. Despite low prevalence of diagnostic findings, Holter monitoring is an important complementary exam that can have therapeutic implications in these cases and, consequently, in preventing new events.

Dissertação de Mestrado Integrado em Medicina Veterinária, na área científica de Clínica O suicídio é a maior causa de morte entre os jovens adultos (20 a 30 anos), sendo que estudos realizados na população de Médicos Veterinários (MV) apontam um maior risco destes quer para esta problemática, quer para doenças mentais. A ideação suicida é um precedente do ato suicida, assim a determinação desta, embora não seja um método exato de determinação do risco de suicídio, é um fator predisponente para que este ocorra, indicando que o individuo que apresenta ideação suicida se entra em risco de o cometer. Vários são os estudos realizados noutros países concluíram que o risco de suicido em MV varia, consoante o estudo e país em que é realizado de 2.1 a 12 vezes superior ao da população em geral. Estudos semelhantes não podem ser realizados em Portugal dada a escassez de dados estatísticos e às falhas na categorização da profissão, uma vez que os MV tanto podem ser classificados como trabalhadores de saúde, tratadores de animais; profissionais qualificados da produção animal. Dada esta impossibilidade, a avaliação da presença de ideação suicida pode ser um bom indicador para avaliar se à semelhança de outros países os MV em Portugal também se encontram em maior risco de incidência de ideação suicida, uma vez que já foi relatada que esta pode ser 5.5 vezes superior à da população em geral. A incidência de outras patologias mentais tais como, depressão maior, burnout, ansiedade, fadiga de compaixão, que são também fatores de risco para o suicídio foram também apontadas como sendo particularmente altas nesta área. A presença de ideação suicida seria identificada através da aplicação do Questionário de ideação suicida (QIS), assim como um questionário sociodemográfico. A avaliação dos fatores de riscos ou protetores da presença de ideação suicida podem ser avaliados através de entrevista guiadas ou através de questionários aplicados à posteriori. Assim o objetivo é a criação de uma ferramenta que permita detetar se em Portugal os MV são afetados pela presença de ideação suicida, quais os fatores de risco próprios desta população e quais as medidas preventivas que podem ser tomadas para diminuir a incidência da ideação suicida, se se determinar que à semelhança dos colegas de outros países esta é uma realidade que também afeta os MV em Portugal ABSTRACT - Suicidal Ideation in Veterinarians in Portugal, a study Project - Suicide is the leading cause of death among young adults (20 to 30 year old) , and the studies conducted in Veterinarians indicate ever a greater risk for suicide and for mental illness. The suicide ideation is a precedent of suicidal act, so the determination of this, although not exact, can determinate a bigger risk of suicide. Several studies carried out in other countries have concluded that the risk of suicide in Veterinarians varies, depending on the study and country in which it is carried out, from 2.1 to 12 times higher than that of the general population. Similar studies cannot be carried out in Portugal due to the lack of statistical data and the flaws in the categorization of the profession, since this can be classified as health workers, animal handlers, qualified professionals in animal production. The presence of suicidal ideation would be identified through the application of the Suicidal Ideation Questionnaire (SQ), as well as a sociodemographic questionnaire. The assessment of risk or protective factors for the presence of suicidal ideation can be assessed through guided interviews or through questionnaires applied to posteriority. The objective of this project is to create a tool that allows detecting the presence of suicidal ideation, which are the risk factors typical of this population and what preventive measures can be taken to reduce the incidence of suicidal ideation, if it is determined that, like colleagues from other countries, this is a reality that also affects Veterinarians in Portugal N/A

Commonly geodiversity is associated with geological knowledge, leaving aside others abioticcomponents such as geomorphological, pedological and hydrological. Geodiversity, compared tobiodiversity, does not yet have the same prestige and political position. In the Brazilian semiaridregion, there are still many gaps related to the knowledge of geodiversity. In 2022, the SeridóGlobal Geopark was recognized by UNESCO as a territory that provides an intriguing insight intothe Earth’s history through its unique natural landscape, cultural and culinary history. Among themunicipalities inserted in the territory of the Seridó Geopark is Acari-RN, which has richgeodiversity. The objective of this work was to present an integrated analysis of the geodiversityof the municipality of Acarí-RN, encompassing information related to variety of geological,geomorphological, pedological and hydrological features and processes. Fieldwork was carriedout, we identified and mapped landforms and their physiognomic aspects and georeferenced usingportable GPS. We collected soils to represent the different landforms. A ten geosites werecharacterized in the municipality, four of them belonging to the Seridó Geopark, in which we alsosought to consider the information about the relief and soils. In the present work, the term"integrated analysis of geodiversity" was used in order to encourage debate and to make it clearthat geodiversity is not limited to geological aspects. The integrated analysis of geodiversity canbe a subsidy for geotourism, regional valorization of the semiarid and also preservation of theCaatinga biome. The identification and characterization of potential geosites in Acarí-RN canhelp for developing efficient municipal policy to combining the conservation of their uniquegeological heritage with public outreach and sustainable development

The aim of this study was to (1) calibrate an item bank to measure patients’ experience of drug therapy for adult patients with SMIs and (2) develop computerized adaptive testing (CAT) to improve its use in routine practice. This is a cross-sectional, multicentric study involving 541 patients with schizophrenia, bipolar disorder, and major depressive disorder. Analyses based on classical test and item response theories were performed. After 7 highly inter-correlated items and 4 items with low factor loadings were removed, the remaining 26 items were sufficiently unidimensional (RMSEA = 0.069, CFI = 0.969, TLI = 0.963) and showed adequate fit to the generalized partial credit model. There was no differential item functioning by gender, age, care setting, or diagnosis from moderate- to large-magnitude. The mean score was 46.0 ± 16.9 and was significantly higher for patients reporting good medication adherence. The resulting PREMIUM-DT item bank has strong psychometric properties, and CAT facilitates widespread use in clinical settings (an average of 8 items administered, corresponding to a reliability of >0.90). Our results suggest that practical information and information about the side effects of psychotropic treatments and how to cope with them should be targeted as a priority to improve patients’ experience of drug therapy.

A pesquisa e o debate a respeito da Formação do Professor de Geografia e do Estágio Supervisionado têm crescido consideravelmente, sobretudo a partir da década de 1990. O estágio supervisionado na contemporaneidade representa um momento ímpar na formação do docente de Geografia, sendo entendido como um momento de preparação profissional, possibilitando a vivência, a reflexão e a intervenção do licenciando no ambiente escolar. O planejamento e a execução de intervenções educacionais são experiências que incorporam o conjunto de conhecimentos proporcionados pelos estágios, pois os discentes da licenciatura, a partir de uma perspectiva docente, idealizam as intervenções que os mesmos compreendem como significativas para o contexto escolar e educacional. O presente artigo busca contribuir com esta discussão, apresentando casos exemplares de intervenção de estagiários no ambiente escolar, destacando como o trabalho de campo pode ser uma alternativa profícua de intervenção, tanto para contribuir com uma aprendizagem significativa dos conteúdos da Geografia escolar, como para o processo de formação inicial e continuada dos licenciandos e dos professores supervisores. Palavras-chave: Estágio Curricular Supervisionado; Intervenções práticas; Metodologia de ensino; Trabalho de Campo.

The treatment of patients with headache represents an important part of a neurologist's activity. It requires sufficient training for neurology residents. In France, residents in neurology can complete this training by attending specialized consultations or by participating in a postgraduate training program called "Diplôme Inter-Universitaire Migraine et Céphalées" (DIUMC).The objective of this cross-sectional study was to investigate the French residents' knowledge in headache medicine and the impact of different types of training in headache medicine that are available in France.An anonymous survey was carried out among 548 French residents in neurology.The questionnaires of 121 residents (22.1%) were analyzed. Among them, 54.5% (66/121) had no complementary training apart from the internship (Group 1), 21.5% (26/121) had attended only specialized consultations (Group 2), and 24% (29/121) had participated in the DIUMC (Group 3). There was no difference between all groups regarding the knowledge of the prevalence of primary or chronic headaches. There was almost no difference between the groups in the management of episodic migraine. In contrast, the management of tension-type headache and chronic headache was better known by residents of Group 3 than residents of Group 1. In these two diseases, residents of Group 3 offered prophylactic treatment more often. Almost 29% of the residents (35/121) had read the French guidelines for the diagnosis and management of migraine. In Group 3, residents had read them significantly more often (1.6% in Group 1, 38.5% in Group 2 and 62.1% in Group 3, p 0.001).This study shows the lack of knowledge among French neurology residents regarding headache medicine. It highlights the interest of specific training programs that could improve the practical and theoretical knowledge of future neurologists.

BACKGROUND AND AIMS Anemia is a highly prevalent and modifiable comorbidity in patients with chronic kidney disease (CKD), which tends to aggravate as the disease progresses. The economic burden of anemia in CKD is high, and quality of life issues (e.g. fatigue, reduced productivity) is common in these patients. Data on the prevalence and treatment of anemia in CKD stages 3 and 4 (based on the estimated glomerular filtration rate according to KDIGO classification) in Portugal are lacking. The NEFROPOR study aimed to estimate the prevalence of anemia in patients with CKD stage 3 or 4 admitted to a Nephrology consultation between 1 January and 31 March 2017 and characterize anemia treatment in this patient population. METHODS NEFROPOR was a retrospective, multicentric study carried out in 10 Portuguese centers. All patients aged ≥18 years with stage 3 or 4 CKD admitted to a Nephrology consultation in one of those centers between 1 January and 31 March 2017 were invited to participate, and data for up to 24 months after admission were collected from patients’ clinical files. Retrieved data included age, body mass index (BMI), anemia status according to the World Health Organization (WHO) diagnostic criteria, and anemia treatment type and duration. Three assessments of the prevalence anemia were performed: at the time of the first Nephrology visit (presentation), at the first analytical results and the overall prevalence in the study cohort. Statistical analysis was performed in SPSS Statistics (v26) and a 0.05 significance level was adopted. RESULTS A total of 176 patients were included in this study, mostly (61.9%) male, with a median age of 76 years (range, 26–97) and a mean BMI indicative of pre-obesity (28.2; standard deviation, 4.2). CKD stage 3b was predominant (43.2%), followed by stage 4 (32.4%) and stage 3a (24.4%). The most frequent CKD etiologies in this cohort were diabetes (39.8%), followed by arterial hypertension (27.8%) and unknown cause (25.6%). Arterial hypertension was largely the most frequent comorbidity, present in 90.3% of patients, followed by diabetes (54.0%). Although less prevalent, coronary artery disease (18.2%) and congestive heart failure (14.8%) were also identified in this patient population. A total of 44.9% of patients [95% confidence interval (CI), 37.7%–52.3%] had anemia at presentation, which was significantly associated with CKD stage, diabetes, peripheral vascular disease and myocardial infarction comorbidities, and diabetes and unknown CKD etiology. The overall prevalence of anemia in the study cohort was 61.9% (95% CI 54.6%–68.9%), and it was significantly associated with diabetes and peripheral vascular disease comorbidities and with diabetes and primary glomerulonephritis as CKD etiologies. The prevalence of anemia at the first analytical results was 49.4% (95% CI 42.1%–56.8%), and it was significantly associated with CKD stage, diabetes, non-skin cancer, peripheral vascular disease and myocardial infarction comorbidities, and diabetes as CKD etiology. Figure 1 shows the evolution of anemia treatment in this cohort over 24 + months. CONCLUSION The three estimates of the prevalence of anemia in this study were consistent with each other, particularly those for the first visit and first analytical results. The latter were also consistent with evidence in the literature reporting a prevalence of anemia in the population of patients with CKD stages 3 and 4 between 40% and 60%. The overall prevalence of anemia in this study was 12%–15% higher than first visit and first analytical results estimates, in agreement with the fact that this refers to a cumulative prevalence. These data support the need for optimized and individualized treatment strategies for patients with CKD stages 3 and 4, maximizing the efficiency of health-care resource use.

Background Emergency general surgery (EGS) conditions account for over 3 million or 7.1% of hospitalizations per year in the US. Patients are increasingly transferred from community emergency departments (EDs) to larger centers for care, and a growing demand for treating EGS conditions mandates a better understanding of how ED clinicians transfer patients. We identify patient, clinical, and organizational characteristics associated with interhospital transfers of EGS patients originating from EDs in the United States. Method We analyze data from the Agency for Healthcare Research and Quality Nationwide Emergency Department Sample (NEDS) for the years 2010–2014. Patient-level sociodemographic characteristics, clinical factors, and hospital-level factors were examined as predictors of transfer from the ED to another acute care hospital. Multivariable logistic regression analysis includes patient and hospital characteristics as predictors of transfer from an ED to another acute care hospital. Results Of 47,442,892 ED encounters (weighted) between 2008 and 2014, 1.9% resulted in a transfer. Multivariable analysis indicates that men (Odds ratio (OR) 1.18 95% Confidence Interval (95% CI) 1.16–1.21) and older patients (OR 1.02 (95% CI 1.02–1.02)) were more likely to be transferred. Relative to patients with private health insurance, patients covered by Medicare (OR 1.09 (95% CI 1.03–1.15) or other insurance (OR 1.34 (95% CI 1.07–1.66)) had a higher odds of transfer. Odds of transfer increased with a greater number of comorbid conditions compared to patients with an EGS diagnosis alone. EGS diagnoses predicting transfer included resuscitation (OR 36.72 (95% CI 30.48–44.22)), cardiothoracic conditions (OR 8.47 (95% CI 7.44–9.63)), intestinal obstruction (OR 4.49 (95% CI 4.00–5.04)), and conditions of the upper gastrointestinal tract (OR 2.82 (95% CI 2.53–3.15)). Relative to Level I or II trauma centers, hospitals with a trauma designation III or IV had a 1.81 greater odds of transfer. Transfers were most likely to originate at rural hospitals (OR 1.69 (95% CI 1.43–2.00)) relative to urban non-teaching hospitals. Conclusion Medically complex and older patients who present at small, rural hospitals are more likely to be transferred. Future research on the unique needs of rural hospitals and timely transfer of EGS patients who require specialty surgical care have the potential to significantly improve outcomes and reduce costs.

Enhancing the hydrophilicity of polymeric materials is an important step for achieving anti-adhesiveness. Thus, in this study, atmospheric plasma as a pre-treatment was combined with a UV grafting process to obtain a durable surface modification on polyethylene terephthalate (PET). The most promising conditions for the atmospheric plasma process were found to be 15 kW power and 4 m/min speed, leading to a contact angle reduction from 70 ± 6° to approximately 30°. However, it was observed that these values increased over time due to the ageing and washing of the PET surface, ultimately causing it to recover its initial contact angle. Therefore, the plasma-pre-treated PET samples were further modified through a UV grafting process using sodium acrylate (NaAc) and 3-sulfopropyl acrylate potassium salts (KAc). The grafted acrylate PET samples exhibited contact angles of 8 ± 3° and 28 ± 13° for NaAc and KAc, respectively, while showing durability in ageing and washing tests. The dry film thicknesses for both samples were found to be 28 ± 2 μm. Finally, the anti-adhesive properties of the NaAc- and KAc-treated surfaces were evaluated using an Escherichia coli expressing YadA, an adhesive protein from Yersinia. The modified PET surfaces were highly effective in reducing bacterial adhesion by more than 90%., This work was supported by the ViBrANT project, which received funding from the EU Horizon 2020 Research and Innovation Programme under Marie Sklowdowska-Curie (grant agreement no. 765042), and the Portuguese Foundation for Science and Technology (FCT) (grant number UIDB/04469/2020)., info:eu-repo/semantics/publishedVersion

Objetivo: Avaliar o conhecimento dos acadêmicos de medicina do ciclo básico (1° ao 4° período) e clínico (5º ao 8º período) de uma instituição particular em Anápolis, Goiás, sobre o câncer colorretal, fatores de risco e rastreamento. Métodos: Estudo descritivo realizado com acadêmicos de medicina matriculados do 1° ao 8º período, do curso de medicina da Universidade Evangélica de Goiás, por meio da aplicação de questionário validado, que avalia o nível de conhecimento sobre o câncer de colorretal. Resultados: O ciclo básico foi composto por 148 participantes e o ciclo clínico com 178 acadêmicos, totalizando 326 acadêmicos. A população do estudo foi composta na maioria pelo sexo feminino (71,2%), na faixa etária de 18 a 21 anos (57,0%) e solteiro(a) (95,1%). A maioria dos acertos a respeito fatores de risco e rastreamento sobre o câncer colorretal foram realizados pelos acadêmicos de ciclo clínico, sendo que o conhecimento aumentou com o avanço do curso. Apesar do ciclo clínico acertaram a maioria dos itens, os resultados demonstraram a necessidade de uma melhor abordagem sobre a neoplasia no decorrer do curso de medicina. Conclusão: Portanto o conhecimento foi satisfatório no ciclo clíncio em relação ao ciclo básico e apresentou progressivo ao longo do curso.

Introdução: A disponibilidade de ecrãs tem sido associada a efeitos negativos. Pretendemos caracterizar e comparar o “tempo de ecrã” em crianças e adolescentes da área de Vila Nova de Gaia, com e sem psicopatologia. Material e Métodos: Estudo observacional, com amostra de conveniência e aplicação de questionários entre 1 de outubro de 2018 e 31 de junho de 2019 a crianças e adolescentes seguidos em Cuidados Saúdes Primários e em consulta de Psiquiatria da Infância e Adolescência. Resultados: Amostra de 223 participantes, 184 com psicopatologia (82,5%) e 39 sem (17,5%). A maioria apresentava “tempo de ecrã” superior ao recomendado (71,4%), com superioridade naqueles com psicopatologia (p=0,006). Verificámos o mesmo relativamente à utilização de dispositivos ao adormecer ou background TV (p=0,024 e 0,008, respetivamente). A covisualização foi mais frequente nos participantes sem psicopatologia (p=0,045). O “tempo de ecrã” superior ao recomendado, background TV e covisualização mantiveram‑se significativos após regressão logística (p=0,029, p=0,024 e p=0,013, e OR = 3,741 [IC 1,148‑12,194]; OR=3,494 [IC 1,175‑10,392] e OR = 0,249 [IC 0,083‑0,750] respetivamente). Discussão: Os resultados coadunam com o que éapontado na literatura sobre uma possível associação entre “tempo de ecrã” e psicopatologia. Será importante avaliar o efeito de causalidade desta associação. Conclusão: O “tempo de ecrã” éexcessivo e mais frequente nos participantes com psicopatologia. A uniformização de recomendações e adaptação à realidade portuguesa são de relevância crescente na atualidade.

Este trabalho pretende mostrar como foi idealizado e como funciona na atualidade o Centro Regional de Estudos, Prevenção e Recuperação de Dependentes Químicos (CENPRE), um programa de extensão permanente da Universidade Federal do Rio Grande (FURG). O CENPRE surgiu a partir das atividades extensionistas desenvolvidas pelo antigo Departamento de Ciências Fisiológicas (DCF), hoje Instituto de Ciências Biológicas (ICB), e foi idealizado para cumprir os objetivos das diretrizes de prevenção ao uso de substâncias psicoativas. Inserido no contexto do Hospital universitário da FURG, o CENPRE conduz suas atividades utilizando uma abordagem interdisciplinar, composta pelo trabalho de um psiquiatra, três psicólogos, duas enfermeiras, um terapeuta familiar, uma assistente social e uma farmacêutica. Adicionalmente, este centro de pesquisas se mantém integrado à comunidade acadêmica e à população em geral, com vistas à promoção da saúde, à prevenção e ao tratamento de transtornos relacionados ao uso de substâncias psicoativas. O CENPRE se consolidou como um centro de referência e apoio à formação de recursos humanos por meio de ações educativas e atividades de ensino; além de fomentar a pesquisa por intermédio de estudos epidemiológicos em comunidades locais e regionais.

Background There is growing concern about measuring patient experience with mental health care. There are currently numerous patient-reported experience measures (PREMs) available for mental health care, but there is little guidance for selecting the most suitable instruments. The objective of this systematic review was to provide an overview of the psychometric properties and the content of available PREMs. Methods A comprehensive review following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines was conducted using the MEDLINE database with no date restrictions. The content of PREMs was analyzed using an inductive qualitative approach, and the methodological quality was assessed according to Pesudovs quality criteria. Results A total of 86 articles examining 75 PREMs and totaling 1932 items were included. Only four PREMs used statistical methods from item response theory (IRT). The 1932 items covered seven key mental health care domains: interpersonal relationships (22.6%), followed by respect and dignity (19.3%), access and care coordination (14.9%), drug therapy (14.1%), information (9.6%), psychological care (6.8%) and care environment (6.1%). Additionally, a few items focused on patient satisfaction (6.7%) rather than patient experience. No instrument covered the latent trait continuum of patient experience, as defined by the inductive qualitative approach, and the psychometric properties of the instruments were heterogeneous. Conclusion This work is a critical step in the creation of an item library to measure mental health care patient-reported experience that will be used in France to develop, validate, and standardize item banks and computerized adaptive testing (CAT) based on IRT. It will also provide internationally replicable measures that will allow direct comparisons of mental health care systems. Trial registration NCT02491866.

To characterize regional variation in the age of patients undergoing umbilical hernia repair to determine costs and subsequent care.We performed a cross-sectional descriptive study using a large convenience sample of US employer-based insurance claims from July 2012 to December 2015. We identified children younger than 18 years of age undergoing uncomplicated (not strangulated, incarcerated, or gangrenous) umbilical hernia repair as an isolated procedure (International Classification of Diseases, Ninth Revision procedure codes 53.41, 53.42, 53.43, or 53.49, International Classification of Diseases, Tenth Revision procedure code 0WQF0ZZ, or Current Procedural Terminology procedure codes 49580 or 49585).In all, 5212 children met criteria for inclusion. Children younger than age 2 years accounted for 9.7% of repairs, with significant variation by census region (6% to 14%, P .001). Total payments for surgery varied by age; children younger than 2 years averaged $8219 and payments for older children were $6137. Postoperative admissions occurred at a rate of 73.1 per 1000 for children younger than age 2 years and 7.43 for older children; emergency department visits were 41.5 per 1000 for children younger than age 2 years vs 15.9 for older children (P .001).Umbilical hernias continue to be repaired at early ages with large regional variation. Umbilical hernia repair younger than age 2 years is associated with greater costs and greater frequency of postoperative hospitalization and emergency department visits.

Introdução – A auto-hemoterapia consiste na retirada de sangue de uma pessoa e sua aplicação no próprio doador com o objetivo, aparente, de instigar o sistema imunológico a se fortificar. Esta terapia vem ganhando espaço nos estudos científicos, demonstrando respostas clínicas às mais diversas patologias para os seres humanos. Contudo, ao se tratar de um método sem comprovação científica, é acompanhado de inúmeras divergências acerca da sua validação como um mecanismo eficaz. Objetivo – Compreender as diversas perspectivas a respeito da validação da auto-hemoterapia como ciência, assim como as discussões da comunidade médica a respeito do tema. Métodos - Trata-se de uma revisão narrativa de literatura, realizada com base em 5 artigos científicos selecionados para composição do estudo. Uma busca foi feita utilizando as seguintes bases de dados: Scielo, PubMEd e LILACS. Utilizou-se o Descritor em Ciências da Saúde “auto-hemoterapia”. Os estudos incluídos na pesquisa foram artigos publicados entre 2008 e 2020, na língua portuguesa. Resultados - Como resultado da pesquisa foi possível concluir que a bioética não condena a auto-hemoterapia e, pelo contrário, incentiva o desenvolvimento de pesquisas comprobatórias apuradas voltadas ao conhecimento do real mecanismo de ação, bem como da correta posologia da auto-hemoterapia. Com a finalidade de que esta alternativa terapêutica possa ser incluída no tratamento das diversas enfermidades humanas. Conclusão - Conclui-se, então, que a escolha dessa abordagem temática justifica-se pela falta de pesquisas sobre essa prática milenar e crescente atualmente, a qual faz com que os métodos de validação e aceitação na comunidade médica, como técnica hemoterápica, sejam questionados. Portanto, é necessário a busca por aparatos médicos, éticos, morais, sociais, econômicos e políticos que ajudem a comprovar ou erradicar de vez essa prática com a finalidade de proteger as pessoas de riscos e vulnerabilidades, visando à segurança do uso dessa prática.

This research aims to provide updated information on caries experience and associated risk factors in children 6-12 years old. A cross-sectional and descriptive study design was carried out with a non-probabilistic, convenient sample of 209 children male and female. Clinical examinations were performed by calibrated dental students following WHO detection criteria. Caries indices dmft and DMFT were calculated. Caries Risk Assessment data was collected using an adapted CAMBRA instrument; following the International Caries Care guidelines. Descriptive statistics were performed to analyze the results and Chi-square test, Contingency Coefficient (C) and Corrected Typified Residues were calculated to determine the association between variables. 58% of the total population had dental caries lesions in its more severe stages (cavitation) and 42% were apparently healthy (AHS) without any cavitated lesions. The mean dmft index was 1.34 ± 1.93, and the mean DMFT index was 0.63 ± 1.22. Lesion severity remained between 1-2 teeth affected on both dentitions. A statistically significant association (p = 0.035) between the health condition and toothbrushing was stablished with a degree of dependence of C = 0.144. A positive standardized residual of 2.1 was evident for schoolchildren that experience caries lesion that never brush their teeth and AHS that brushed their teeth more than once. No association (p = 0.081) was found between health condition and intake of sugary snacks and beverages. A severe dental caries experience with a statistically significant association between the health condition and toothbrushing with fluoridated toothpaste 1450 ppm > 1 a day and a positive correlation in schoolchildren that experience caries lesion that never brush their teeth.

Frances Burney’s novels may be taken as the models par excellence for the feminine bildungsroman. They articulate the eponymous heroines’ (which is to say, Evelina, Cecilia, and Camilla’s) maturati...

Introduction: The use of single-port surgery is widely accepted in pediatric surgery, but the majority of reports are on its use for appendectomy or inguinal hernia repair using multiple instruments. The aim of this report is to demonstrate that both thoracic and abdominal single-instrument procedures are feasible and safe in children. Materials and Methods: The following cases were managed in our department for the past 12 months. Two types of telescopes (10- and 5-mm) with inbuilt working channels were used in all cases. Results: The 10-mm endoscope with a 6-mm inbuilt channel was used to partially reduce and then exteriorize an intussusception secondary to Meckel's diverticulum in a 9-year-old boy, to reduce a left ovarian torsion in a 8 year-old girl, and to perform a thoracoscopic exploration and lung decortication in a 16 year-old girl with empyema. A 5-mm endoscope with a 3-mm working channel was used to perform bilateral 2-level thoracic sympathotomy in a 13-year-old girl with palmar primary hyperhidrosis. There were no perioperative complications and follow-up was uneventful in all patients. Conclusion: Minimally invasive surgery is well established at present. Thoracic and abdominal single-port single-instrument procedures are safe and effective in children. This is a unique report on single-port single-instrument use in four completely different procedures and the first to describe its usage for thoracoscopic sympathotomy in children. Increasing technology development, allied to surgeons' skills, is crucial to worldwide adoption of this surgical modality.

Objective The goal of this scoping review was to summarize the literature on facilitators and barriers to surgical practice change. This information can inform research to implement best practices and evaluate new surgical innovations. Background In an era of accelerated innovations, surgeons face the difficult decision to either acknowledge and implement or forgo new advances. Although changing surgical practice to align with evidence is an imperative of health systems, evidence-based guidelines have not translated into consistent change. The literature on practice change is limited and has largely focused on synthesizing information on methods and trials to evaluate innovative surgical interventions. No reviews to date have grounded their analysis within an implementation science framework. Methods A systematic review of the literature on surgical practice change was performed. Abstracts and full-text articles were reviewed for relevance using inclusion and exclusion criteria and data were extracted from each article. Cited facilitators and barriers were then mapped across domains within the implementation science Theoretical Domains Framework and expanded to the Capability, Opportunity, Motivation, and Behavior model. Results Components of the Capability, Opportunity, Motivation, and Behavior model were represented across the Theoretical Domains Framework domains and acted as both facilitators and barriers to practice change depending on the circumstances. Domains that most affected surgical practice change, in order, were: opportunity (environmental context and resources and social influences), capability (knowledge and skills), and motivation (beliefs about consequences and reinforcement). Conclusions Practice change is predicated on a conducive environment with adequate resources, but once that is established, the surgeon's individual characteristics, including skills, motivation, and reinforcement determine the likelihood of successful change. Deficiencies in the literature underscore the need for further study of resource interventions and the role of surgical team dynamics in the adoption of innovation. A better understanding of these areas is needed to optimize our ability to disseminate and implement best practices in surgery.

Estudos acerca das possibilidades de uso de águas residuárias para o convívio com a seca no semiárido brasileiro apontam para possíveis soluções quanto a utilização humana nessa região. Dessa forma, a presente pesquisa teve como objetivo principal analisar quais as práticas mais adequadas e viáveis para uso de águas provenientes de esgoto doméstico no município de Serra Negra do Norte/RN. Para realização dessa pesquisa, foi realizado o levantamento bibliográfico e documental sobre a temática e trabalhos de campo, incluindo visitas técnicas à secretaria de abastecimento de água do município, à Estação de tratamento de Esgoto - ETE e às áreas estratégicas e com potencial para o reuso de água, tanto na zona rural como nas áreas urbanas do município. Após execução das etapas metodológicas, foi possível detectar que alguns usos da água proveniente da ETE já vêm sendo realizados na área rural do município de Serra Negra do Norte. As plantações do capim elefante existentes nas áreas beneficiárias pela irrigação por águas residuárias são destinadas principalmente aos médios e grandes agricultores da zona rural do município e esta pode ser estendida para pequenos agricultores, caso haja possibilidade de ampliação do sistema de distribuição desse efluente. Também foi possível verificar que na área urbana de Serra Negra do Norte, muitas praças e canteiros poderiam ser contemplados com águas de reuso. Contudo, destacamos os cuidados que devem ser tomados quando do uso de águas provenientes de ETE.

Introduction: Yersinia enterocolitica infection is a zoonotic disease that varies from self-limited gastroenteritis to more severe forms. Its propensity to affect the terminal ileum and to spread to regional lymph nodes explains the potential misdiagnosis with appendicitis. Methods: We reviewed the Y. enterocoliticainfection cases in a pediatric population for the last 12 years. Results: There were 11 cases of Y. enterocolitica infection in the selected period. Four patients had a suspected surgical diagnosis: 1 intussusception, 3 acute appendicitis. Patients who presented with appendicitis-like features were older, whereas younger children most commonly presented with diarrhea and fever. Ultrasound and abdominal computed tomography (CT) were performed in appendicitis-like patients and ruled out appendicitis in 2 of the 3 cases. The only patient submitted to surgery had abnormal CT findings and an important risk factor for this infection that was not recognized at presentation. Conclusion: This condition should be considered in patients with known risk factors (such as iron overload) and with the right epidemiological setting when presenting with abdominal symptoms. The suspicion of this diagnosis in these particular cases might obviate unnecessary surgical interventions.

One of the most common causes of rapidly progressive glomerulonephritis (RPGN) is pauci-immune crescentic glomerulonephritis (CrGN). In the majority of cases, this condition has a positive serologic marker, the anti-neutrophil cytoplasmic antibodies (ANCAs), but in approximately 10% there are no circulating ANCAs, and this subgroup has been known as the ANCA-negative pauci-immune CrGN. RPGN can be associated with systemic diseases, but there are only few case reports describing the association with mixed connective tissue disease (MCTD). The authors report a case of ANCA-negative CrGN associated with a MCTD.

The S-QoL 18 is a self-administered questionnaire that assesses quality of life (QoL) among individuals with schizophrenia. This study aims to validate the S-QoL 18 in bipolar and depressive disorders for a more widespread use in psychiatric settings. This study was conducted in a non-selected sample of individuals with bipolar and depressive disorders in the day hospital of a regional psychiatric academic hospital. Two-hundred and seventy-two stable outpatients with bipolar (n = 73) and recurrent and persistent depressive (n = 199) disorders were recruited over a 12 month-period. The S-QoL 18 was tested for construct validity, reliability, and external validity. The eight-factor structure of the S-QoL 18 was confirmed by confirmatory factor analysis (RMSEA = 0.075 (0.064–0.086), CFI = 0.972, TLI = 0.961). Internal consistency and reliability were satisfactory. External validity was confirmed via correlations between S-QoL 18 dimension scores, symptomatology, and functioning. The percentage of missing data for the eight dimensions did not exceed 5%. INFIT statistics were ranged from 0.7 to 1.2, ensuring that all items of the scale measured the same QoL concept. In conclusion, the S-QoL 18 appears to be a valid and reliable instrument for measuring QoL in patients with bipolar and depressive disorders. The S-QoL 18 may be used by healthcare professionals in clinical settings to accurately assess QoL in individuals with bipolar and depressive disorders, as well as in schizophrenia.

Posttransplant lymphoproliferative disorders (PTLDs) are a feared complication after transplant. They are mostly of B cell origin and are frequently Epstein-Barr virus (EBV)-positive, particularly in early onset PTLD. Later on, non-B and EBV-negative PTLD are increasingly reported. EBV seronegative receptors (particularly when paired with an EBV seropositive donor) together with the net degree of immunosuppression-a concept often difficult to quantify-are the most consistently described risk factors for the development of PTLD. Conversely, its association with a particular immunosuppressive agent or other virus, namely cytomegalovirus (CMV) infection or disease, has been inconsistently reported. We present a challenging case where an EBV negative monomorphic peripheric T-cell lymphoma was diagnosed in the first year after kidney transplant in a patient with a recent history of CMV disease from a resistant strain.