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ABSTRACT Objective To characterize the use of private services in infant vaccination and assess vaccination coverage according to the service used. Methods : This was a national vaccination survey conducted in 2020 that estimated the use of private vaccination services and vaccination coverage among infants residing in state capitals and 12 inland municipalities. Results : Of the 37,801 participants, 25.1% (95%CI 23.2;27.2) used private services at least once, with higher proportions in capitals, larger cities and in the South and Southeast regions. Socioeconomic and demographic differences were identified among families, based on the service used. The coverage for the set of vaccines administered up to 24 months was 60.3% (95%CI 58.6;62.0) in the public service and 59.5% (95%CI 55.9;63.0) in private services, and up-to-date vaccines, 10.3% (95%CI 9.1;11.6) and 9.4% (95%CI 7.4;11.8), respectively. Conclusion The use of private services was frequent, with low coverage for the set of vaccines, regardless of the type of service used, especially for up-to-date vaccines.

ABSTRACT Objective To estimate vaccination coverage, identify barriers and hesitancy to vaccinating children up to 24 months, born between 2017-2018, living in the urban area of Rio Branco, Acre, Brazil. Methods Population survey carried out from 2020 to 2021, which assessed sociodemographic characteristics and vaccination status among children. Results Among 451 included children, vaccination coverage was below 80%. Meningococcal C vaccine had the lowest coverage for administered doses (76.3%; 95%CI 70.5;81.3) and doses on time (27.4%; 95%CI 23.1;32.1). The statements “vaccines cause serious adverse reactions” (26.4%; 95%CI 18.1;36.8) and “you don’t need vaccination for diseases that no longer exist” (22%; 95%CI 15.7;29.8) were the most frequent regarding vaccination hesitancy. Lack of vaccines was the main barrier to care (86.6%; 95%CI 71.8;94.3). Conclusion Vaccination coverage in children born in 2017-2018 was below the target recommended for the full schedule of administered doses, both valid and timely administered.

ABSTRACT Objective To analyze full vaccination coverage in live births in 2017 and 2018 in the capitals of the Midwest region of Brazil, according to social strata. Methods Population-based household survey with cluster sampling. Full coverage in children at 12 and 24 months of age and sociodemographic factors were analyzed. Results 5,715 children were analyzed. Full coverage at 12 months of age was 67.9% (95%CI 65.4;70.4), while at 24 months it was 48.2% (95%CI 45.3;51.1). Pneumococcal vaccine had the highest vaccination coverage (91.3%), while the second dose of rotavirus vaccine had the lowest (74.2%). In Campo Grande, no vaccine reached coverage above 90%, with BCG (82.9%) and hepatitis B (82.1%) standing out. Campo Grande and Brasília had the worst vaccination coverage in the high social stratum (24 months of age). Conclusion Vaccination coverage in the Midwest was below 80%, falling short of the recommended target and associated with socioeconomic factors.

ABSTRACT Objective To estimate vaccination coverage and analyze sociodemographic factors associated with non-vaccination in children born in 2017 and 2018 in the state capitals of Northeast Brazil. Methods A household survey using cluster sampling was conducted from 2020-2022 to estimate vaccination coverage and hesitancy. Factors associated with non-vaccination were analyzed using logistic regression to calculate Odds Ratios (OR) and their Confidence Intervals (95%CI). Results Natal was the capital with the lowest vaccination coverage, below 75.0% for most immunizers. Teresina had rates equal to or greater than 90.0% for all vaccines. Among those interviewed, 99.1% (95%CI 98.9;99.3) believe that vaccines are important for health; 95.4% (95%CI 95.0;95.8) trust immunobiologicals and 79.6% (95%CI% 78.8;80.3) are not afraid of reactions. Belonging to the highest socioeconomic stratum (adjusted OR: 1.34 – 95%CI 1.20;1.50) was as a factor associated with non-vaccination. Conclusion Low coverage highlights the need for a better understanding of regional specificities and social inequalities.

Abstract Objective: To compare access and suitability of antenatal care between years 2020 and 2022 among postpartum individuals at a Hospital in Florianopolis, and evaluate factors associated with antenatal suitability. Methods: Observational, cross-sectional, and quantitative study carried out in 2022. Collected data were compared with the database of a previous similar study carried out in the same setting in 2020. Data were extracted from medical records and prenatal booklets, in addition to a face-to-face questionnaire. Adequacy was measured using the Carvalho and Novaes index and health access was qualitatively evaluated. Socio-demographic and antenatal variables were analyzed. A statistical significance level of 0.05 was considered. Open-ended questions were categorized for analysis. Results: 395 postpartum individuals were included. Antenatal care was adequate for 48.6% in 2020 and 69.1% in 2022. Among the barriers to access, 56% reported difficulty in scheduling appointments and/or exams and 23% complained of reduced healthcare staff due to strikes, COVID-19, among others. Adequate antenatal care was associated with being pregnant in 2022, being referred to high-risk units (PNAR), and not reporting difficulties in access. Also, it was associated with twice the chance of investigation for gestational diabetes (GDM) and syphilis. Conclusion: The 2022 post-vaccination period showed higher antenatal adequacy. The main difficulty for postpartum individuals was scheduling appointments and/or exams. Having antenatal care in 2022, no reports of difficulty in access, and follow-up at a high-risk unit were associated with antenatal adequacy.

ABSTRACT: The main transmission route of bovine coronavirus (BCoV) is direct contact with secretions and feces, and potentially also via contaminated surfaces. Following PRISMA guidelines, a systematic review was conducted to evaluate the presence of BCoV on environmental surfaces. A literature search, conducted between March and April 2023, utilized databases including Web of Science, PubMed, Scopus, Science Direct, and Springer. The review adhered to the PEO structure: Population - environmental surfaces; Exposure - contact with BCoV; Outcome - identification of presence or infectivity. Primary data were recorded using an extraction form organizing methods for detecting BCoV presence, assessing BCoV infectivity, types of surfaces evaluated, and study type. Search terms “Bovine coronavirus” and “BCoV” yielded 2703 articles. After removing 964 duplicates and excluding 1546 articles not mentioning BCoV in titles, 193 studies underwent abstract reading. Following exclusion criteria not addressing BCoV presence in the environment, three articles were selected for comprehensive review. These articles identified BCoV presence on various types of surfaces, with detection possible up to 81 hours after contamination, depending on surface type. Despite limited studies on BCoV presence on surfaces, findings suggested potential transmission via contaminated surfaces due to the virus’s ability to remain infectious for up to 24 hours on fomites. This review underscores the need for further research on BCoV persistence in farm environments, an area currently lacking focused studies.

Introduction In 2021, among French women who smoked when they knew they were pregnant, 59% still smoked at the end of pregnancy. Support for pregnant women to stop smoking must include a structured organisational perspective. The main objective of the study is to evaluate the effectiveness of the 5A-QUIT-N organisational intervention on smoking cessation at delivery among pregnant women who smoke during pregnancy.Methods and analysis The overarching goal of the 5A-QUIT-N intervention, which aims to organise the healthcare professionals monitoring pregnancy, specialists in addiction and tobacco use, and clinical and training tools, using the 5As method. The 5A-QUIT-N intervention will be evaluated in a pragmatic stepped-wedge cluster randomised trial. Within each cluster, during the 6 months before (control) and after (intervention) the intervention, women who smoke tobacco during pregnancy will be enrolled during their maternity stay after delivery. A transition period is planned between the control and intervention periods to deploy the intervention. All participating women will be interviewed using a heteroquestionnaire to assess smoking cessation, tobacco use monitoring by healthcare professionals and individual factors associated with tobacco use during pregnancy. The primary outcome was the point prevalence of abstinence at delivery, which is the proportion of women reporting abstinence from smoking for at least 7 days at delivery. 4200 women who smoked tobacco during pregnancy will be recruited over the entire study period (33 months) to evaluate the effectiveness. An estimated 4585 participants will be included for all aims.Ethics and dissemination The study will be implemented in accordance with French regulations. The study including the consent process has been independently reviewed and approved by the French ethical board ‘CPP Ile de France I’ on 10 February 2022 (No CPPIDF1-2022-DI08-cat.2). The results will be disseminated on various academic and non-academic platforms. The results will be reported in international peer-reviewed journals and presented at international and national conferences.

Introdução: A mobilização e participação da comunidade é fundamental em programas de prevenção/controlo de doenças transmitidas por vetores. Em Portugal, mosquitos do género Aedes aegypti estão estabelecidos na Ilha da Madeira, tendo ocorrido em 2012 o primeiro surto de febre de dengue (DENV-1) nesta região, com 1084 casos confirmados laboratorialmente. Objetivos do estudo: Caracterizar opiniões e atitudes da população madeirense face à utilização de mosquitos geneticamente modificados (MGM) como estratégia de controlo vetorial. Materiais e métodos: Foi aplicado um questionário a adultos residentes nas freguesias com cota abaixo dos 200 metros do município do Funchal, Região Autónoma da Madeira (S.Martinho, Stª Maria Maior, Sé, S.Pedro, Stª Luzia, Imaculado Coração de Maria) em março-abril 2019. Selecionaram-se aleatoriamente as residências para aplicação do questionário; em cada residência foi selecionado aleatoriamente um indivíduo; utilizou-se uma amostragem estratificada por sexo. Os participantes indicaram o seu grau de concordância com afirmações existentes no questionário. Resultados: Participaram no estudo 1270 indivíduos, idade média 53,5 anos, 44,6% do género masculino, 52,4% com ≥ 12 anos de escolaridade. Concordância com as afirmações: “Se libertassem MGM na minha rua, sentiria receio” concordam (C) 58,8%, discordam (D) 16,8, indiferente (I) 8%; “O medo dos efeitos da utilização dos MGM faz com que prefira técnicas tradicionais” C 46,8%, D 20,5%, I 13,4%; “os MGM devem ser rejeitados por não serem naturais” C 33,7%, D 29,6%, I 11,9%; “Como a maioria dos casos de dengue não são graves devemos continuar a utilizar estratégias tradicionais” C 47,9%, D 30,5%, I 8,3%. As mulheres (p = 0,017) e os menos letrados (p < 0,001) mostram mais receio da utilização de MGM. A análise conjunta das 4 questões indica que 37% têm atitude anti-MGM, 17% são moderadamente contra MGM, 7% mostra atitude moderadamente favorável, 16% são totalmente a favor, 23% têm atitude indiferente/indefinida. 53/151 respondentes (35,1%) consideravam que após libertação de MGM a população pode sentir-se mais incomodada/picada. Conclusões: Mais de metade dos participantes no estudo encontra-se no espetro anti-MGM e 1/4 tem uma atitude indefinida quanto à utilização de MGM para controlo de vetores. Se no futuro se optar por esta estratégia de controlo de vetores na Madeira há que compreender os motivos geradores desta atitude de oposição e desenvolver ações educativas abrangentes. Palavras-chave: Dengue, Ilha da Madeira, Controlo Vetorial, Atitudes. Conflitos de interesse: Sem qualquer conflito de interesses para nenhum dos autores. Ética e financiamentos: Sem qualquer conflito de interesses para nenhum dos autores.

Introdução: Em 2005 foram detetados, pela primeira vez, mosquitos da espécie Aedes aegypti em Portugal, na Região Autónoma da Madeira. Em 2012 a região sofreu um surto de dengue, sendo registados 1084 casos. É consensual a necessidade do envolvimento das comunidades nas intervenções de controlo vetorial. Objetivos do estudo: Caracterizar conhecimentos da população da Madeira sobre a utilização de mosquitos geneticamente modificados (MGM) como estratégia de controlo vetorial. Materiais e métodos: Foi aplicado um questionário a adultos residentes nas freguesias do município do Funchal com cota abaixo dos 200 metros (São Martinho, Santa Maria Maior, Sé, São Pedro, Santa Luzia, Imaculado Coração de Maria) em março-abril 2019. Selecionaram-se aleatoriamente as residências para aplicação do questionário; em cada residência foi selecionado aleatoriamente um indivíduo; utilizou-se uma amostragem estratificada por sexo. Resultados: Participaram no estudo 1270 indivíduos, idade média 53,5 anos, 44,6% do género masculino, 29% com 12° ano de escolaridade, 23,4% com licenciatura/mestrado. No subgrupo (11,9%, IC a 95% [10,2; 13,8] 151/1270) que ouviu falar/leu sobre MGM, 42% conhecem as técnicas de supressão e 36% as de substituição; Fontes de informação: TV 57,6%, internet 51%, jornais 40,4%. Respostas: “Os MGM não são compatíveis com uso de estratégias tradicionais” Desconheço (D) 15,2%, verdade (V) 16,5%, falso (F) 56,3%, possível (P) 6,6%; “Libertar MGM pode não ser suficiente para controlar o número de mosquitos e de doentes” D 5,3%, V 61,5%, F 3,3%, P 25,2%; “Utilizar MGM diminui o número de mosquitos e doentes apenas em situações/lugares específicos” D 13,9%, V 43%, F 11,3%, P 25,8%; “Com o tempo os MGM perdem eficácia” D 35,7%, V 15,2%, F 23,2%, P 17,2%; “Os custos de libertação de MGM são superiores aos das estratégias tradicionais” D 32%, V 43%, F 16%. Quem tem maior nível de escolaridade ouviu falar/leu sobre MGM (p < 0,001) e responde mais vezes adequadamente às questões colocadas (p < 0,005). Conclusões: A grande maioria da população da Madeira nunca ouviu falar/leu sobre MGM. Verifica-se elevado nível de desconhecimento do possível controlo de vetores com utilização de MGM e compatibilidade com as estratégias tradicionais. Torna-se essencial aumentar a informação da população para garantir os pressupostos de transparência, entendimento mútuo e envolvimento ativo da comunidade se no futuro se desejar utilizar esta abordagem de controlo de vetores no território. Palavras-chave: Dengue, Ilha da Madeira, Controlo Vetorial, Conhecimentos. Conflito de interesse: Sem qualquer conflito de interesses para nenhum dos autores. Ética e financiamentos: Sem qualquer conflito de interesses para nenhum dos autores.

Introduction Post-COVID-19 condition, or syndrome, also known as long COVID, is an infection-associated chronic condition that can develop after a SARS-CoV-2 infection and last at least 3 months to years. Despite representing a high burden for the Unified Health System (SUS), which has affected millions of Brazilians, it has received limited attention in Brazil. Prevalence studies to date have failed to include a broad representation of the population, and there has been insufficient exploration of the impact on people’s lives and the burden of and barriers to accessing health services. This article presents the research protocol for the quantitative component of a mixed methods project to produce evidence to inform SUS’s provision of care for long COVID. The protocol was designed to study long COVID in SUS patients hospitalised for COVID-19 in a large city in Southeast Brazil to capture symptoms and factors associated with the syndrome, effects on quality of life and employment, health needs, use of health services and barriers to accessing necessary healthcare.Methods and analysis An ambidirectional cohort study to capture data retrospectively and prospectively from adults previously discharged from SUS hospitals for COVID-19. The study involves up to two telephone surveys with the patients or proxies selected from a sampling plan for population estimates. Survey questions include baseline and follow-up data on demographic, socioeconomic, comorbidities, work status, health-related quality of life, vaccination status, long COVID symptoms, healthcare needs, use and barriers to access. Descriptive and appropriate multivariable analyses will be employed.Ethics and dissemination The project was approved by the Research Ethics Committees of participant institutions and by the Brazilian National Research Ethics Commission. All participants provided verbal consent. We plan to publish articles in scientific journals and multimedia resources for SUS professionals and the general population.

Due to the environmental problems caused by polymers, it is desirable to use biodegradable biopolymers such as vegetable polyurethane and sugar cane bagasse fibers. Therefore, the work aimed at the development of biodegradable biocomposites of sugarcane bagasse fibers for application in orthoses and evaluated their viability through mechanical, chemical, biodegradation and computational simulation tests. It was possible to obtain PU composites with sugarcane bagasse, which showed good interaction through the analysis of scanning electron microscopy images. It was observed that the addition of sugar cane bagasse fibers to the PU increased impact resistance, Young's modulus, there was a decrease in elongation and hardness and that the addition of fibers maintained the maximum tension value. The water absorption test showed that the fibers increased water absorption and biodegradation compared to polyurethane, which is advantageous for the orthosis, as it causes less accumulation of water between the patient's skin and the orthosis and reduces problems of infections and wounds. The computational simulation showed that it would be possible to make an orthosis with the PU composite with sugarcane bagasse and that for that it would be necessary to optimize the design of the orthosis. The use of PU composite with sugarcane bagasse in the medical field is promising, as it is a non-toxic material, from a renewable source and that uses agro-industrial waste with low added value, also presenting the advantage of providing better comfort to the patient

BackgroundCOVID-19-related restrictions led to an increase in overall loneliness and social isolation. Before the pandemic, care partners reported higher levels of loneliness and higher loneliness prevalence compared to non-care partners. Because of the spread and severity of the infections, and the access to support spread, we expect a different impact of the COVID-19 pandemic on LATAM care partners.ObjectivesTo describe the loneliness levels of LATAM caregivers and to identify socioeconomic and health factors associated.DesignAn international online cross-sectional survey for care partners, embedded within the ‘Coping with Loneliness and Isolation during COVID-19’ (CLIC) Study conducted between June 2020– and November 2020.SettingWe analysed data from 246 family care partners living in Latin American countries (46% Mexico, 26% Chile,18% Brazil, and 10% from Argentina, Peru, Venezuela, Panama, Guatemala y Costa Rica).MeasurementsWe assessed loneliness using the 6-items of De Jong Gierveld loneliness Scale. We described the levels of overall, emotional, and social loneliness pre and during Covid, and reported the distribution of care partners who improved, worsened or maintained their levels of loneliness. Moreover, we used longitudinal multiple linear regression models with bootstraps errors of 1,000 iterations to identify factors associated with the levels of overall, emotional, and social loneliness during the pandemic.ResultsParticipants were mostly women, 50 years and older, in a partnership, highly educated and with finances meeting their needs, with good to excellent physical and mental health. Among the total of care partners, 55% perceived higher overall loneliness, 56% higher emotional loneliness, and 21% higher social loneliness during the pandemic in comparison with pre-COVID-19 levels. Perceived mental health was associated with the overall, emotional, and social loneliness.ConclusionsRegardless of their living and health situation, during the pandemic, loneliness increased in all groups of care partners. These should be taken in consideration when planning public health approaches for crises such as pandemics or other large-scale disruptive events.

BackgroundElevated phenylalanine serum level is a surrogate marker of whole-body proteolysis and has been associated with increased mortality in critically ill patients. Tyrosine is a metabolite of phenylalanine and serves as a precursor of thyroid hormones and catecholamines with important functions in the oxidative stress response among others. Herein, we examined the prognostic significance of phenylalanine, tyrosine, as well as its metabolites nitrotyrosine, L-3,4-dihydroxyphenylalanine (DOPA), and dopamine regarding clinical outcomes and response to nutritional therapy in patients at nutritional risk.MethodsThis is a secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a randomized controlled trial investigating individualized nutritional support compared to standard care in patients at risk of malnutrition. The primary outcome was 30-day all-cause mortality.ResultsWe analyzed data of 238 patients and found a significant association between low plasma levels of phenylalanine [adjusted HR 2.27 (95% CI 1.29 to 3.00)] and tyrosine [adjusted HR 1.91 (95% CI 1.11 to 3.28)] with increased 30-day mortality. This association persisted over a longer period, extending to 5 years. Additionally, trends indicated elevated mortality rates among patients with low nitrotyrosine and high DOPA and dopamine levels. Patients with high tyrosine levels showed a more pronounced response to nutritional support compared to patients with low tyrosine levels (HR 0.45 versus 1.46, p for interaction = 0.02).ConclusionIn medical inpatients at nutritional risk, low phenylalanine and tyrosine levels were associated with increased short-and long-term mortality and patients with high tyrosine levels showed a more pronounced response to nutritional support. Further research is warranted to gain a deeper understanding of phenylalanine and tyrosine pathways, their association with clinical outcomes in patients at nutritional risk, as well as their response to nutritional therapy.Clinical trial registrationwww.clinicaltrials.gov, identifier NCT02517476.

Readiness to practice is the state of being prepared and capable of engaging in professional activities in a specific field. Graduates of healthcare professions require a diverse set of skills, knowledge and attitudes to meet the demands of complex healthcare settings. This systematic review provides a comprehensive analysis of readiness for professional practice among graduates of health professions education. It encompasses a wide range of articles published between 2013 and 2024, incorporating various health professions and utilizing a combination of quantitative, qualitative, and mixed methods designs. The review identified 93 studies from 32 diverse countries. The review revealed that factors influencing readiness to practice, include individual capabilities, the workplace context, and educational provision. It also explored strategies to enhance readiness to practice. The findings underscore the significance of addressing challenges such as lack of confidence, stress, communication, time management, job satisfaction, clinical experience, academic workload, teaching quality, mentorship and curriculum design. This comprehensive analysis serves as a valuable resource for healthcare educators, policymakers, and practitioners seeking to optimize the preparedness of graduates for the complexities of contemporary healthcare environments. Future studies should explore the interactions between readiness to practice stakeholders’ perception of the educational curriculum, and the quality of support in the professional practice environment.

La Meseta Central Santacruceña fue ocupada productivamente con ovinos a fines de 1800 y principios de 1900. La productividad inicial del pastizal natural, que soportó altas cargas instantáneas, llevó a no tener en cuenta el impacto que el pastoreo año redondo trajo consigo y que llevaría, en años posteriores, al agotamiento de ese recurso. Además, también generó un agudo proceso de desertificación, lo que terminaría comprometiendo seriamente la sostenibilidad de la producción ovina de manera extensiva. Se realizó una somera revisión de características del ambiente natural de la Meseta (suelo, vegetación, agua y clima), y dentro de esta área ecológica, un recorte territorial en el Departamento Magallanes (esta división territorial se consideró como una muestra de la diversidad de ambientes que contiene la Meseta). Allí, se definió un polígono en el cual se concentraron los esfuerzos de observación e intervención, orientados a sopesar la problemática de la desertificación y la centralidad que adquiere el guanaco, herbívoro nativo, considerado por los productores como uno de los factores centrales de la crítica situación actual de la ganadería ovina extensiva. Se utilizó el método del pentágono de capitales que permitió abordar dimensiones clave y su interrelación en un área específica de observación. Además, permitió analizar las posibilidades de llevar adelante una producción sostenible.

En la región semiárida central de Argentina, los pastizales de los bosques de caldén han sido pastoreados con cargas superiores a su receptividad. Actualmente poseen grandes extensiones de pajonales entre los que se encuentra los de Amelichloa brachychaeta, cuya estrategia reproductiva dificulta su manejo y control. El trabajo se centró en determinar cómo responden los pajonales de A. brachychaeta a una presión de pastoreo alta y frecuente durante un periodo corto de tiempo. En un potrero con bosque de Neltuma caldenia con pajonal, se definieron 4 tratamientos de carga animal para el seguimiento del pajonal durante un año. Se partió con el pajonal pastoreado con muy alta carga. Luego, sobre una superficie de 4 ha próximas a la aguada, se establecieron 8 parcelas de 5000 m2 cada una. Allí se definieron los tratamientos con: 4, 6, 10 y 14 animales. ha-1 (n=2; N=8). Los pastoreos se realizaron una vez que los rebrotes de A. brachychaeta alcanzaron 15 cm de altura. En cada parcela se realizó la evaluación florística del pajonal sobre superficies de ¼ m2 dispuestas sobre dos líneas al azar (n=60; N=480). Se determinaron: cobertura de vegetación total, broza y suelo sin cobertura; cobertura de A. brachychaeta y de las forrajeras perennes; también se evaluó la fitomasa aérea producida. Se realizaron 4 pastoreos y el tiempo de permanencia de los animales estuvo relacionado con el tratamiento de carga y el momento del pastoreo, entre 4 y 7 días en aquellos de mayor carga y 7 y 14 días en aquellos de menor. Las áreas pastoreadas presentaron mayor riqueza, menor cobertura de vegetación, mayor proporción de suelo sin cobertura y mayor broza con respecto al área sin pastoreo. La tasa de crecimiento llegó al máximo antes del segundo pastoreo para la carga 6 animales.ha-1 que, además, tuvo la mayor disponibilidad de rebrotes en el 2do y 3ero evento de pastoreo. En el área pastoreada se registró la disminución del pajonal en todo el ensayo y el ingreso de otras especies. Este tipo de pastoreo con alta cargas y frecuente durante un periodo corto de tiempo se presenta como una opción viable para el manejo de pajonales de A. brachychaeta.

Introdução: As práticas de parto no Brasil sofreram grandes transformações ao longo dos anos, com um alto processo de medicalização incluído, principalmente em meados do século XX. Desse modo, percebe-se a necessidade de compreender quais os elementos que compõem a decisão da mulher no direcionamento da escolha para o parto domiciliar planejado. Objetivo: Analisar os elementos que conduzem as gestantes na escolha pelo parto domiciliar planejado. Método: Revisão de literatura do tipo Scoping Review, realizado a partir de busca em maio de 2023 no Portal de Periódicos CAPES, nas bases: MEDLINE, CINAHL e SCOPUS, com a utilização dos descritores “normal delivery”, “natural delivery”, “homebirth”, “free birth”, “unassisted home birth” e dos operadores booleanos and e or. Resultados: Os trinta e dois estudos incluídos nesta pesquisa, evidenciaram a descredibilização da mulher no processo de parto hospitalar, e a possibilidade de ser sujeito ativo no seu processo de parto. Conclusão: Os elementos que conduzem as gestantes na escolha e preferência pelo parto domiciliar planejado decorrem da descredibilização da parturiente no processo de parto/nascimento no hospital vivenciado ou percebido e da possibilidade de Ser sujeito ativo no processo de parto/nascimento no PDP.

The automotive industry uses plastics in the manufacture of car components due to their benefits such as weight reduction, high friction resistance, energy absorption, and versatility in blending with other materials and in its processability. A wide variety of plastic are used in vehicles. Although up to 13 different types of polymers may be used in a single car model, the most common is Polypropylene (PP). Nowadays, mechanical recycling is the most common method for recycling plastic waste from end-of-life vehicles in the automotive industry. However, challenges arise from material heterogeneity, presence of paint or impurities which affect mechanical properties and quality of recycled materials. Various chemical and physical methods to remove these impurities but economic, technical and feasibility considerations influence the adoption of technology in the industry. The current paper focuses on mechanical-physical procedures for paint removal from recycled automotive thermoplastics, aiming to maintain the properties of the polymer matrix and overcome environmental, economic and complex barriers. The used methods have shown success in removing paint from PP surfaces, with the pressing machine method with the best efficiency at a 38 % reduction. Despite not achieving over 90 % paint removal, these procedures establish fundamental principles for effective industrial mechanical paint depainting.

Although HIV infection can be managed with antiretroviral drugs, there is no cure and therapy has to be taken for life. Recent successes in animal models with HIV-specific broadly neutralising antibodies (bNAbs) have led to long-term virological remission and even possible cures in some cases. This has resulted in substantial investment in human studies to explore bNAbs as a curative intervention for HIV infection. Emerging data are encouraging, but suggest that combinations of bNAbs with other immunomodulatory agents may be needed to induce and sustain long-term viral control. As a result, a number of clinical trials are currently underway exploring these combinations. If successful, the impact for the millions of people living with HIV could be substantial. Here, we review the background to the use of bNAbs in the search for an HIV cure and how different adjunctive agents might be used together to enhance their efficacy.

Num mundo inundado de informação, a necessidade de promover a literacia crítica, a cidadania digital plena e o envolvimento com as notícias está a tornar-se uma prioridade. Neste contexto, e considerando os resultados positivos já documentados em outras áreas, esta Revisão Sistemática da Literatura visou explorar o potencial impacto da Aprendizagem Baseada em Jogos (ABJ) na compreensão e no envolvimento dos jovens com o consumo noticioso e a cidadania digital, particularmente no contexto da diversidade societal e cultural. Através da seleção e análise sistemáticas de uma amostra de 33 estudos, foi possível sustentar o papel significativo da ABJ no reforço da literacia de notícias e das competências de cidadania digital, para enfrentar os desafios decorrentes da desinformação e garantir a tomada de decisão informada. Jogos que incluem simulação, role-playing e mecânicas baseadas em perguntas são os mais utilizados para cumprir tais objetivos educativos , nomeadamente considerando os diferentes níveis de competências de pensamento que são capazes de fomentar. Além disso, os resultados destacam a diversidade e a inclusão como preocupações críticas, enfatizando a necessidade de acesso equitativo e representação nas intervenções de ABJ.

C4 crops such as sorghum (Sorghum bicolor) and finger millet (Eleusine coracana) have played a significant role in the economic livelihood in arid and semi-arid zones of tropical and sub-tropical Africa since prehistoric times. However, to date, our knowledge of their past management practices is limited. Stable isotope analysis of archaeobotanical remains has been recognized as a valuable tool for reconstructing past agricultural practices, e.g. water management, and fertilization. Nonetheless, our limited understanding of the isotopic variability of C4 plants calls for further research on modern plant before application to archaeobotanical remains. In this paper, we aim to enhance our understanding of modern C4 botanical remains' isotopic variability by analyzing sorghum and finger millet plants. These crops were cultivated according to traditional local practices and collected from ten villages located in the Konso Zone (South Ethiopia) and Tigray Regional State (North Ethiopia), where they are among the daily ingredients for food, and traditional alcoholic and non-alcoholic drinks. We analyzed carbon and nitrogen stable isotopes of seeds and biosilica content in chaff, as it has been suggested that a relationship can exist between silicon and C:N. Carbon isotope values show significant variability, positively correlated with altitude. By demonstrating the sensitivity of C4 grain carbon stable isotope to altitude variations, which are likely connected to water availability, this study offers invaluable insights for the accurate assessment of isotopic values derived from ancient C4 crops. The absence of significant correlations with δ15N suggests that nitrogen isotope values may be less effective for understanding environmental variations in this kind of context. This highlights the limitations of nitrogen isotope data for interpreting ancient agricultural practices and underscores the importance of relying more on carbon isotopes for insights related to environmental conditions and altitude. Furthermore, we confirm that the amount of assimilated carbon may depend also on the biosilica content, which is in turn modulated by environmental parameters such as water availability or soil silicon levels.

Case summary An 8-month-old male neutered domestic shorthair cat presented for acute vomiting. Abdominal ultrasound examination revealed a jejunal foreign body, which was removed via enterotomy. Preoperatively, the patient was hypoglycaemic and, intraoperatively, a dopamine infusion was required to maintain a mean arterial pressure >60 mmHg. Despite glucose supplementation, the cat remained severely hypoglycaemic on recovery. Within 24 h postoperatively, despite euglycaemia and normalisation of the cardiovascular status, the patient developed progressive polyuria (up to 14 ml/kg/h). This was associated with neurological signs suggestive of diffuse brain disease, and absence of azotaemia or signs of overhydration. During the first 4 days of hospitalisation, any attempts to decrease intravenous fluid therapy were associated with hypotension, weight loss and clinical dehydration. Urine specific gravity (USG) during this time was in the range of 1.005–1.010 and failed to increase during fluid challenges. A presumptive diagnosis of central diabetes insipidus was made, and desmopressin (1 µg/cat SC) was administered on day 5 of hospitalisation. Consequently, the cat’s urinary output decreased and his weight increased within 4 h. The patient required a total of four doses of desmopressin during hospitalisation, but no further doses since discharge. Urinary output on discharge was 3 ml/kg/h. Three months later, the cat’s neurological signs and polyuria had completely resolved, and the USG was >1.050. Relevance and novel information In this case, a presumptive diagnosis of central diabetes insipidus was supported by clinical progression, neurological signs and the response to desmopressin. To our knowledge, this is the first report of reversible diabetes insipidus after diffuse brain injury secondary to hypotension and hypoglycaemia.

ABSTRACT Objective: This study was conducted to investigate the distribution of placental villous vessels in pregnant women with different degrees of hyperglycemia. Methods: A cross-sectional study was performed using placental samples from 30 pregnant women without diabetes (n=10), with gestational diabetes mellitus (n=10), and with previous diabetes (type 1 and type 2 diabetes; n=10). Maternal glycemic control was evaluated using the glycemic mean and glycated hemoglobin levels. Placental samples were obtained during elective cesarean sections and processed for villous vessel analysis using immunohistochemistry for Von Willebrand factor. Vessels within 10μm of the villus margin were classified as peripheral, and vessels at a distance greater than 10μm were classified as central. The number, area, and perimeter of all vessels were evaluated, and the relationship between vessel area and total area of placental villus was calculated. Results: Pregnant women with gestational diabetes mellitus and those with previous diabetes had higher glycated hemoglobin levels. The number of vessels was reduced in the villi of the previous Diabetes Group owing to peripheral reduction. Additionally, the area, perimeter, and percentage of peripheral blood were lower in the previous Diabetes Group than in the Non-Diabetic Group. Conclusion: Maternal glycemic levels can modify placental capillary distribution.

ABSTRACT: This study explored the use only of ultrasound (US) for extracting proteins from grass carp (Ctenopharyngodon idella) backbones at low temperature and examined its impact on hydrophobicity, solubility, electrophoretic profile, and sulfhydryl levels. Backbones were treated with 35 and 130 kHz for 20, 30, and 40 minutes at 14 ºC, resulting in two protein fractions: solid (TPS) and liquid (TPL). US increased yield compared to the non-sonicated fraction. TPL (35 kHz) exhibited a 16% reduction in total and free sulfhydryl levels and a 25% increase in hydrophobicity. US induced protein conformation and band intensity alterations, particularly between 25 to 100 kDa for TPL at 130 kHz and below 30 kDa for TPS at 35 kHz. This study demonstrated the efficacy of US for protein extraction from fish by-products and its capacity to modify protein characteristics, facilitating the development of innovative food products.

Resumo: O objetivo deste estudo é descrever as ações de vigilância e segurança da vacina contra a mpox (Jynneos) no Brasil, de 2022 a 2023. Realizou-se estudo descritivo dos casos de mpox e dos eventos supostamente atribuíveis à vacinação e/ou imunização para vacina Jynneos, registrados nos sistemas de informação. Foram calculadas frequências absolutas e relativas e coeficientes de notificação de eventos supostamente atribuíveis à vacinação e/ou imunização por mil doses administradas. Foram registrados 9.596 casos de mpox e distribuídas 49 mil doses de vacina; dessas, 14.395 (31%) doses foram administradas e 65 eventos supostamente atribuíveis à vacinação e/ou imunização (4,5 por mil doses administradas) foram notificados. Todos os eventos supostamente atribuíveis à vacinação e/ou imunização foram não graves e 22 (33,8%) casos apresentaram reações relacionadas ao produto. Os resultados estão dentro da frequência esperada. No entanto, o número de doses administradas pode não ter sido suficiente para detectar eventos raros ou inusitados. Portanto, a vigilância contínua é necessária para garantir a efetividade e a segurança da vacinação, especialmente entre os grupos de maior risco.

ABSTRACT Objective To estimate vaccination coverage in children born between 2017-2018, living in urban areas of state capitals, the Federal District and 12 inland municipalities in Brazil, and to identify associated factors. Methods This was a household survey conducted between 2020-2022, among children up to 24 months old. Vaccination coverage was estimated according to family, maternal and child characteristics. Results Among the 37,801 children in the sample, complete coverage (doses administered) was 60.1% (95%CI 58.6;61.6) and 6.1% (95%CI 5.4;7.0) had not received any vaccines. Coverage was lower among children of mothers with lower level of education (OR = 0.70; 95%CI 0.54;0.90) and in those who experienced delays in receiving any vaccine by 6 months old (OR = 0.28; 95%CI 0.24;0.32). Conclusion Vaccination coverage is below the expected levels. Effective communication strategies are needed to reinforce the importance of routine vaccination, prevent delays and abandonment of the vaccination schedule, in order to recover the high coverage levels achieved in past decades.

ABSTRACT Objective To describe the distribution of nutritional status and food insecurity among the adult transgender population in the Baixada Santista region of the state of São Paulo and to identify associated factors. Methods This was a cross-sectional study using data from the research project entitled Mapping the Transgender Population in Baixada Santista of the state of São Paulo, conducted through a structured questionnaire administered between August and December 2023. The outcomes were nutritional status and food and nutrition insecurity (FNI). The association analysis was performed using Fisher’s exact test. Results A total of 237 people took part in the study. High prevalence of FNI was associated with an income of less than 2 minimum wages (p < 0.001), difficulty finding a job (p < 0.001) and lack of family support related to gender (p = 0.001). Difficulty reading/writing (p = 0.025) and proximity to an open-air market (p = 0.033) were negatively or positively associated with adequate nutritional status, respectively. Conclusion The high prevalence of FNI among the most vulnerable population and the adequate nutritional status associated with proximity to open-air markets indicate the need for policies aimed at reducing inequities and expand access to adequate food.

Purpose: The aim of this study was to assess the prognostic performance of the 70-gene signature, MammaPrint, in an Italian single-center prospective cohort of early-stage intermediate-risk breast cancer (BC) patients. Methods: A total of 195 eligible early BC cases were tested for genomic risk between 2006 and 2013. In this retrospective analysis, the association of genomic risk with distant metastasis-free survival (DMFS) and overall survival (OS) were assessed using Cox regression models, adjusting for clinical and pathological tumor characteristics. Results: MammaPrint identified 118 (60.5 %) patients with genomically Low Risk tumors and 77 (39.5 %) patients with genomically High Risk tumors. Age, menopausal status, tumor size, receptor status, and nodal status were comparable between MammaPrint Risk categories. The median follow-up was 8.4 years for DMFS and 9.3 years for OS; 8-year follow-up was reported for both endpoints. The 8-year DMFS was 90.4 % (95 % CI 84.9–95.9) in patients with MammaPrint Low Risk tumors compared to 60.8 % (95 % CI 49.8–71.8) for patients with High Risk tumors. Patients with MammaPrint Low Risk tumors exhibited significantly superior 8-year OS (97.3 %; 95 % CI 94.4–100) compared with MammaPrint High Risk tumors (89.5 %; 95 % CI 82.6–96.4; p = 0.028). Multivariate analyses identified MammaPrint as significantly associated with 8-year DMFS and MammaPrint together with Progesterone Receptor positivity with 8-year OS. Conclusion: The prognostic performance of MammaPrint was demonstrated in early-stage clinically intermediate to high-risk BC patients. Moreover, patients with MammaPrint Low Risk tumors had good outcome regardless of treatment regimen, thus supporting personalized treatment choices.

Growing evidence suggests that opioid analgesics modulate angiogenesis during pathophysiological processes. Vascular endothelial growth factor-A (VEGF-A) was recently proposed to be involved in pain development. To date, no anti-angiogenic drug is used for pain management. When administered in a bioavailable formulation, (i.e., ultramicronized) N-palmitoylethanolamine (PEA) delays the onset of morphine tolerance, improves morphine analgesic activity and reduces angiogenesis in in vivo models. This study aimed at investigating whether VEGF-A is involved in PEA-induced delay of morphine tolerance. The anti-VEGF-A monoclonal antibody bevacizumab was used as a reference drug. Preemptive and concomitant treatment with ultramicronized PEA delayed morphine tolerance and potentiated the analgesic effect of morphine, while counteracting morphine-induced increase of VEGF-A in the nervous system. Similar results were obtained when bevacizumab was administered together with morphine. Of note, bevacizumab showed an analgesic effect per se. In equianalgesic treatment regimens (obtained through increasing morphine doses and associating PEA), PEA resulted in lower expression of VEGF-A in dorsal root ganglia (DRG) and spinal cord compared to morphine alone. Similar results were observed for plasma levels of the soluble VEGF receptor 1 (sFLT-1). Moreover, in morphine-treated animals, two pain-related genes (i.e., Serpina3n and Eaat2) showed a more than 3-fold increase in their expression at spinal cord and DRG level, with the increase being significantly counteracted by PEA treatment. This study supports the hypothesis that the effects of PEA on morphine analgesia and tolerance may be mediated by the down-modulation of VEGF-A and sFLT-1 in the nervous system and plasma, respectively.

Background & Aims: Transforming growth factor β (TGF-β) plays an oncogenic role in advanced cancer by promoting cell proliferation, metastasis and immunosuppression. PMEPA1 (prostate transmembrane protein androgen induced 1) has been shown to promote TGF-β oncogenic effects in other tumour types. Thus, we aimed to explore the role of PMEPA1 in hepatocellular carcinoma (HCC). Methods: We analysed 1,097 tumours from patients with HCC, including discovery (n = 228) and validation (n = 361) cohorts with genomic and clinicopathological data. PMEPA1 levels were assessed by qPCR (n = 228), gene expression data (n = 869) and at the single-cell level (n = 54). Genetically engineered mouse models overexpressing MYC+PMEPA1 compared to MYC were generated and molecular analyses were performed on the HCCs obtained. Results: PMEPA1 was overexpressed in 18% of HCC samples (fold-change >2; n = 201/1,097), a feature associated with TGF-β signalling activation (p

Many patients with cancer experience cancer-related cognitive decline (CRCD). Previous studies have shown that elevated S100β, a calcium-binding protein commonly found in glial cells, can exhibit neurotoxic effects, including disruption of the blood-brain barrier (BBB). We studied changes in S100β levels in patients with breast cancer receiving chemotherapy, and the relationship to changes in cognitive function. A total of 505 women with breast cancer (mean (sd) age; 53.4 (53.6)) and 336 age-matched controls without cancer (52.8 (10.3)) were included from a nationwide study as part of the National Cancer Institute Community Oncology Research Program (NCORP). Both groups provided blood samples and completed neurocognitive assessments within 7 days before the patients with breast cancer received their first chemotherapy dose (pre-chemotherapy; T1) and within 1 month of their last chemotherapy administration (post-chemotherapy; T2). Utilizing a linear mixed model, multivariate linear regressions, and Spearman rank correlations (rs), we investigated longitudinal changes in serum S100β concentrations and their relationships to changes in neurocognitive outcomes over time. We observed an increase in S100β for patients with breast cancer (p = 0.002), but not for controls without cancer over time (p = 0.683). Additionally, we identified subtle relationships between increases in serum S100β and worsening in cognitive performance on the Backward Counting test (rs = 0.11, p = 0.041) and self-reported FACT-Cog Perceived Cognitive Abilities (rs = −0.10, p = 0.025). Regression analyses adjusted for age, race, body-mass index (BMI), education, menopausal status, anxiety, and depression revealed a trend remained for the relationship of S100β with Backward Counting. In conclusion, we found that patients with breast cancer experience a significant increase in concentration of serum S100β over the course of chemotherapy. This increase is correlated with worsening in some neurocognitive outcomes from pre-to post-chemotherapy, with trending results remaining following adjustment for covariates.

Background: Seafood allergy (SA), including allergy to shellfish (crustacean and mollusks) and fish, is among the 4 most common food allergies causing anaphylaxis, but there are limited data showing SA clinical management in different countries. Objective: We sought to characterize a large cohort of patients with fish and shellfish allergy and to facilitate standardization of future care for this increasingly common allergic disease. Methods: We performed a retrospective, observational, noninterventional study from 945 patients from 2015 to 2019 in 7 hospitals in the United States and the United Kingdom to evaluate SA. A chi-square test was used to detect differences in family history, medical history, and current symptoms between patients in 2 countries. Results: Underdiagnosed anaphylaxis in patients with SA was associated with underuse of epinephrine (adrenaline) autoinjectors in both countries. Oral food challenge was used only when skin or serologic test results were negative. Asthma and allergic rhinitis were more common in the US patients with SA, but eczema was more common in UK patients with SA (P < .001). Respiratory, gastrointestinal, and neurological symptoms were higher in UK patients with SA than in US patients with SA (P < .001). Conclusions: In international multicenter cohorts of patients with fish and shellfish allergy, there are opportunities for improvement in management. Physician identification of anaphylaxis, use of diagnostic oral food challenges, and anaphylaxis treatment with epinephrine are areas with significant knowledge gaps in need of improvement in the United Kingdom and the United States. There is an opportunity for the development of unified, standardized diagnostic protocols for SA with distribution for allergists and trainees.

Promethazine (PMZ) is metabolized in the liver giving rise to chiral metabolites, including promethazine sulfoxide (PMZSO) and desmonomethyl promethazine (DMPMZ). Other metabolites, such as dioxopromethazine (DOPMZ), hydroxy promethazine (PMZOH), N-desmethyl-promethazine sulfoxide, and promethazine N-oxide (PMZNO) can also be formed, but information about them is limited. In this work, the enantiomeric metabolic profile of PMZ in ultra-pool human liver microsomes (HLM) was evaluated. For that, a novel enantioselective analytical method, by liquid chromatography coupled with high-resolution mass spectrometry was established and employed to monitor the enantiomers of PMZ and the formation of its main metabolites PMZSO and DMPMZ in two-hours assay with HLM. The enantioseparation optimized conditions were achieved with two immobilized carbamate amylose-based (3‑chloro-5-methylphenylcarbamate) columns: Lux® 3 µm i-Amylose-3 and Chiralpak® IG-U 1.6 µm. The optimized mobile phase for enantioseparation used buffer and ethanol, a green organic solvent, in a low flow rate. The sample preparation was based only in liquid-liquid extraction. (R)-PMZ consistently exhibited higher concentrations than (S)-PMZ, indicating less extension in metabolization. Regarding the metabolites, PMZSO exhibited higher concentrations compared to DMPMZ. A higher concentration for (S)-PMZSO was found when compared to the (R)-PMZSO and (R)-DMPMZ showing higher concentration compared to (S)-DMPMZ, indicating enantioselectivity in the metabolization process. The metabolites, PMZOH or PMZNO and DOPMZ were also identified. The second enantiomer of DOPMZ also showed a higher proportion than the first eluted enantiomer. These results demonstrated enantioselectivity of liver metabolism of PMZ, as well as confirmed PMZOH, PMZNO, and DOPMZ metabolites formation.

Durante la primera ocupación militar norteamericana en Cuba (1899-1902) y los primeros años de la República Neocolonial (1902-1925), se observó una significativa penetración de elementos culturales estadounidenses en la vida cultural cubana, lo que incidió en áreas como la educación, el arte, el deporte y la arquitectura. La reforma educativa impulsada por Estados Unidos buscaba americanizar a los maestros cubanos y la enseñanza; ello generó un debate sobre la identidad nacional y la posible anexión. Frente a este escenario, las manifestaciones artísticas y sus creadores reflejaron la resistencia nacional y el deseo de independencia. No obstante, nuestra la cultura popular se enriqueció con la introducción de deportes como el béisbol y el boxeo, que se convirtieron en símbolos de la identidad nacional. También, la arquitectura adoptó estilos, especialmente entre la burguesía y clase media. El idioma inglés ganó prominencia, convirtiéndose en un símbolo de estatus social. La influencia cultural norteamericana generó tensiones entre la herencia hispana y la nueva identidad cultural emergente, lo que marcó un período de ambivalencia y resistencia en la formación de la cubanidad.

El propósito de la presente investigación consistió en determinar las cantidades de cadmio y plomo presentes en muestras de soya (Glycine max L) recolectadas en el cantón Mocache, Ecuador. Se tomaron muestras de cuatro tiendas de alimento y una plantación durante los meses de febrero, marzo y abril. Utilizando la espectrometría de absorción con llama y el método "NMLK-AOAC 999.11" en un espectrómetro Perkin Elmer HGA-500, se determinaron concentraciones promedio de 0,22 ± 0,37 mg/kg y 0,21 ± 0,03 mg/kg para cadmio y plomo respectivamente. Estas cifras excedieron los límites máximos permitidos según las normativas internacionales. Los resultados resaltan una preocupante situación de seguridad alimentaria en la localidad, subrayando la urgencia de implementar estrategias efectivas de gestión y control de metales tóxicos en la producción y comercialización de soya.

Objetivos: La anomalía de Ebstein es un defecto congénito caracterizado por falta de deslaminación y desplazamiento apical de la válvula tricúspide, insuficiencia tricúspidea, agrandamiento auricular derecho y disfunción ventricular. Con el propósito de analizar los resultados y evolución de las distintas estrategias quirúrgicas se recolectaron datos de 45 operados durante 1990-2018. Se incluyeron 26 pacientes con una edad mediana en la cirugía inicial de 11.3 años (rango: 13 días-18.6 años). Método: Los procedimientos fueron plastia 10 pacientes (38%), reconstrucción con técnica del cono 11 (42%) y reemplazo 5 (19%). Requirieron intervenciones adicionales 7 pacientes: anastomosis cavo-pulmonar 4 y Cox-maze 4. El 34.6% (9) requirió reoperación por insuficiencia tricúspidea importante. Presentaban plastia previa seis, bioprótesis dos y cono, uno. Resultados: La mortalidad global fue del 11.5% (3 pacientes) a una media de 10.1 años posquirúrgicos (rango: 5.7-10.12) asociada a arritmias (p = 0.05), disfunción ventricular derecha (p = 0.008), izquierda (p = 0.0001) y reoperaciones (p = 0.03). Ninguno fue cono previo. La mediana de seguimiento fue de 6.5 años (rango: 1-29.1). El 91.6% se encontraban en clase funcional I/II y el 79.2% en ritmo sinusal. Conclusiones: Los resultados de las diferentes técnicas clásicas fueron similares aunque no exentas de complicaciones y reoperaciones. La reconstrucción del cono resultó ser efectiva, de baja mortalidad quirúrgica, menor requerimiento de reoperaciones y duradera en el mediano plazo.

The significance of schools' self-evaluation is intrinsically linked to their autonomy and responsibility in interpreting and executing educational tasks. However, this authority is influenced by both European and national policies. This paper aims to compare the policies and practices underlying the process of school self-evaluation in Slovakia and Portugal. Employing a qualitative approach rooted in comparative research, this study involves analyzing legal documents and field notes collected through informal conversations with school board directors in both countries. While both nations demonstrate some influence from European recommendations in their objectives and procedures, disparities exist in their approaches and emphases. Notably, variations are evident in the purposes of schools' self-evaluation and the teams responsible for conducting it. Nevertheless, both countries underscore the importance of students' achievements within the framework of school self-evaluation.

Introduction Breast cancer progression involves physiological mechanisms such as metastasis. Delays in diagnosis and treatment increase the risk of mortality and are associated with barriers to healthcare access. In Chile, breast cancer is highly prevalent, and early diagnosis has improved, although disparities in the disease evolution persist. This study characterized diagnostic and staging tests, waiting times, and sociodemographic profiles to identify delays and inequities in care. Methods Survey study. Using a non-probabilistic sample, a questionnaire was applied in an encrypted platform with prior informed consent. The instrument collected data on requested tests, associated times, staging, and sociodemographic characteristics. These variables were analyzed using descriptive statistics, tests of association, confidence intervals, and comparison tests using bootstrapping. Results A sample of 263 persons was obtained. The most requested tests were biopsy (99.62%) and blood tests (80.23%). The median number of tests requested was six (Q1:4, Q3:8), with a mean of 5.87 (standard deviation: 2.24). No significant differences were observed in the percentage of persons from whom the total number of examinations were requested according to the studied variables. The day-hour-result intervals ranged from 1 to 365 days. The median day-hour-result of the biopsy was 15 days (Q1:10, Q3:30). People between 40 and 49 years old, non-residents of the capital city, belonging to income quintile I, with high school education, from the public health system, with late-stage diagnosis had higher median day-hour-result in biopsy. There was no significant difference in the number of requested tests according to staging (I and II, or III and IV). Conclusions Biopsy in Chile is the test of choice for diagnostic confirmation in breast cancer. Other tests are requested regardless of the diagnosis stage, contrary to the recommendations of clinical guidelines. Cancer prognosis is crucial, especially in countries with greater inequalities.

Our current global Food System is facing extraordinary challenges in both size and severity, including a rise in unsustainable consumption behaviours, continued environmental degradation, growing food insecurity, and widening social inequalities. A Food System transformation is now both critically important and overwhelmingly complex, requiring nothing less than a complete overhaul of the entire value chain. Everyone is needed: Small Medium Enterprises (SMEs) with technological solutions, Non-Governmental Organisations (NGOs) with social innovations, researchers with novel methodologies, governments with food policy advancements, professionals with varying expertise, and last but not least, empowered and informed citizens with the ability and resources for better decision-making. Living Labs offer a holistic, place-based approach needed to facilitate multi-actor inputs on various levels, specifically Food System Living Labs (FSLLs) like the ones established as part of the FoodSHIFT 2030 Project. Nine front-runner Food System Living Labs were operationalised alongside a novel framework merging high-level interdisciplinary initiatives with a diverse set of innovative approaches towards more Sustainable Food Systems (SFS). The FoodSHIFT Approach concept was praised by external evaluators for its ground-breaking framework, and the nearly completed project has been listed as a best practice. However, positive applications alone will not ensure a cross-sector European-wide Food System transformation, and the following text offers a critical reflection coupled with experience-based solutions to further improve the FoodSHIFT Approach.

Abstract The aim of this study was to detect trypomastigote forms of Trypanosoma vivax, in blood smears, DNA of T. vivax and anti-T. vivax antibodies in samples from buffalos reared in the lowlands of Maranhão, Brazil. Blood samples were collected from 116 buffalos and 25 ectoparasite specimens. Blood smears were produced to diagnose forms compatible with Trypanosoma spp.; the indirect enzyme-linked immunosorbent assay (iELISA) and lateral-flow immunochromatography (Imunotest®) serological tests were used; and the polymerase chain reaction (PCR) was used to make molecular diagnoses. No forms compatible with Trypanosoma spp. were observed in blood smears. Among the 116 serum samples analyzed, 79.31% and 76.72% were positive in the ELISA and rapid tests, respectively. One sample was positive in the molecular test. Twenty-five lice of the species Haematopinus tuberculatus were collected. When subjected to PCR for detection of DNA of T. vivax, all of them were negative. The louse specimens were negative for T. vivax. There were no statistically significant differences (p < 0.05) in the presence of T. vivax in this region, in relation to the animals’ age and sex. It can be concluded that these protozoa are circulating in the buffalo herd of the lowlands of Maranhão displaying crypitc parasitemias.

Resumo Introdução: Diante da intensa medicalização do parto, evidencia-se a necessidade de profissionais orientadas pela normalidade desse evento, como parteiras diplomadas, sejam elas enfermeiras obstetras ou obstetrizes. Apesar da reconhecida importância, certas especificidades da atuação dessas profissionais ainda permanecem pouco elucidadas. Objetivo: Buscou-se identificar as ferramentas presentes na valise de parteiras diplomadas formadas pelo curso de Obstetrícia da Universidade de São Paulo. Metodologia: Trata-se de estudo descrito-exploratório, com abordagem qualitativa. Foram realizadas entrevistas semiestruturadas com cinco obstetrizes entre agosto de 2020 e maio de 2021, em ambiente virtual. O material foi analisado por meio de mapas dialógicos. Resultados: Na valise das entrevistadas, identificou-se tecnologias leves, leve-duras e duras. Entre as tecnologias leves encontram-se o afeto, a comunicação (saber falar, saber ouvir) e o vínculo. As tecnologias leve-duras incluem disciplinas básicas, evidências científicas, experiência e intuição. Por fim, as tecnologias duras contemplam instrumentos produzidos pela atividade humana, além do uso da materialidade do corpo. Conclusões: Verificou-se que as obstetrizes recorrem a tecnologias duras à medida que não conseguem atingir o fim desejado com tecnologias leves, embora utilizem os recursos relacionais de maneira transversal a todo o processo. Para empregar tais recursos tecnológicos, as profissionais utilizam saberes muito distintos, sem necessariamente hierarquizá-los.

Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by the presence of antiphospholipid antibodies and venous and arterial thrombotic events, including obstetric complications. We describe the case of a 56-year-old female diagnosed with APS with triple antibody positivity and multiple disease-associated manifestations, namely recurrent purpuric lesions, adrenal insufficiency due to infarction, acalculous cholecystitis, and three spontaneous abortions. Her follow-up was marked by severe thrombotic and haemorrhagic events, notably splanchnic vein thrombosis and haemorrhagic shock after a renal biopsy, as well as the diagnosis of systemic lupus erythematosus 8 years after the APS diagnosis. Chronic anticoagulation with enoxaparin, with dosage guided by anti-factor Xa activity, resulted in stability without complications over 17 years. This case emphasizes the importance of personalized therapeutic strategies and close monitoring in patients with APS.

Respiratory alkalosis is associated with central nervous system (CNS) diseases, drugs, lung diseases and others. Safinamide is a recent anti-parkinsonian drug with anti-dyskinetic properties and a good adjunct to L-dopa therapy during the activation period, with no significant adverse effects described. The authors present a case of a 71-year-old woman, with Parkinson’s disease treated with levodopa/benserazide, safinamide, amitriptyline, sertraline and diazepam. She made multiple visits to the emergency department due to progressive dyspnoea and asthenia, with primary respiratory alkalosis, which was thought to be caused by anxiety-induced hyperventilation and treated accordingly. After a comprehensive study, it was determined that the most probable cause of the respiratory alkalosis was pharmacological. There was a clinical and temporal agreement with the introduction of safinamide.

Introduction Hypertension and type 2 diabetes mellitus (T2DM) are two highly prevalent non-communicable diseases worldwide, both leading to disability and premature mortality in low-and-middle-income countries (LMICs). Nutritional interventions towards a healthier dietary pattern or food and nutrients intake have an important role on the management of this disease. This systematic review aims to evaluate the effect of nutritional interventions on the management of blood pressure and glycaemia in adults with hypertension and T2DM from LMICs.Methods and analysis We will conduct a systematic review of randomised controlled trials (RCTs) on the effect of nutritional interventions on blood pressure and glycaemia in adult patients with hypertension and T2DM. Literature search will be conducted in MEDLINE, EMBASE, Scopus, Cochrane and Web of Science databases from anytime until April 2024. Nutritional interventions would have been applied in addition to regular or standard treatment, which is prescribed and/or provided by the healthcare system. Studies in English and Spanish will be selected and reviewed by two independent reviewers. Risk of bias will be assessed using the Cochrane tool for RCTs. Heterogeneity and publication bias will be estimated using the I2 and Egger’s test, respectively.Ethics and dissemination Ethics approval was not required for this systematic review, considering there was no direct data collection or participation of patients. The investigators will write a manuscript of the final detailed report with the study development and main findings to be published in a peer- reviewed journal. The main findings may be shared with academia partners and groups working on similar topics in LMICs, in addition to policymakers and authorities in these countries.PROSPERO registration number CRD42023483847.

El artículo presenta una reflexión derivada de una revisión sistemática (RS) de literatura sobre formación inicial docente (FID) y la implementación de controversias sociocientíficas (CSC), como herramienta esencial en la FID de profesores de ciencias, con énfasis en profesores de química en formación, como población estudio, del proyecto de investigación que sustenta esta reflexión. Las CSC se destacan como una oportunidad para contribuir a la alfabetización científica (AC) con fines democratizantes de la ciencia, más allá de la AC funcional, especialmente en un contexto post-pandemia, caracterizado por la necesidad de innovar en metodologías para desarrollar motivación y pensamiento crítico, valorando el conocimiento científico en contexto y territorio, para una ciudadanía responsable. La integración de CSC en la FID, desafía las prácticas tradicionales y dogmáticas, transitando a una educación contextualmente relevante. La reflexión está situada en el contexto chileno, con el objetivo de tensionar la FID en ciencias y su propósito.

Introdução: Estudos mostraram que a pré-eclâmpsia (PE) ou os distúrbios hipertensivos da gravidez foram significativamente mais comuns em gestantes com infecção por SARS-CoV-2 do que em gestantes sem essa infecção. Objetivo: Avaliar a associação da infecção pelo SARS-CoV-2 durante a gravidez com o desenvolvimento de PE; determinar se essa associação difere de acordo com o período da gravidez em que ocorreu a infecção. Método: Estudo de coorte retrospectivo, a partir de prontuário eletrônico, incluído mulheres cujo parto foi realizado em uma maternidade pública de São Bernardo do Campo - SP, de julho de 2021 a janeiro de 2023. Todas as gestantes receberam a oferta de testes para COVID-19 nas seguintes circunstâncias: durante o atendimento pré-natal na presença de sintomas de COVID-19; quando houve contato com pessoa com COVID-19; na admissão para o parto, independentemente de serem sintomáticas. Foram excluídas as mulheres com menos de 18 anos e as que não fizeram o teste de COVID-19. A análise estatística foi realizada com o software STATA, versão 17.0, com análise de regressão logística multivariável para detectar fatores associados à PE. Um valor de p < 0,05 foi considerado significativo. Resultados: Incluídas 1.575 gestantes: 288(18,3%) tiveram infecção por SARS-CoV-2 e 53(3,4%) tiveram diagnóstico de PE. Na análise bivariada, de todo o grupo de mulheres com PE, a associação de PE e COVID-19 não foi significativa (p = 0,17). Considerando apenas o grupo de PE sobreposta à hipertensão crônica, também não houve associação estatisticamente significativa (p = 0,77). Com isso, foi decidido realizar o restante das análises excluindo as mulheres com PE sobreposta e foi encontrada uma associação significativa entre infecção por SARS-CoV-2 e pré-eclâmpsia “pura”, OR 2,0 (IC 95% 1,14 - 3,84; p = 0,017); além disso, houve significância estatística entre a associação de COVID-19 no primeiro trimestre e desenvolvimento de PE, com um N de 3 gestantes (p = 0,02). Conclusão: Houve uma associação significativa entre infecção por SARS-CoV-2 e PE “pura”. A COVID-19 no primeiro trimestre da gravidez gerou um risco maior de PE do que uma infecção no segundo e terceiro trimestres. Perante os resultados apresentados, mais estudos sobre esse assunto precisam ser desenvolvidos.

Introdução: A automação de laboratório permitiu que a mão de obra especializada concentrasse mais tempo e energia na garantia de qualidade dos processos. Dentro da biologia molecular, a automatização de processos é um dos pilares que garantem a alta produtividade de um laboratório clínico. Pensando nisso, a escolha por plataformas de ''carregamento contínuo'' ou de único flow são os alvos para se atingir tais requisitos, principalmente em testes de carga viral que necessitam de prioridade no resultado, já que são importantes para monitorar a progressão de doenças virais, como HIV-1 e hepatite C. Objetivo: As plataformas de carregamento contínuo realizam todo o processo em menos de duas horas, com capacidade de executar amostras em Statim (STAT). A implementação da plataforma permite 900 testes em até 24 horas e processamento de vários testes de carga virais simultaneamente, como HIV e hepatites B e C. Método: : Este estudo foi realizado em um laboratório de grande porte em parceria com o setor de Planejamento e Controle da Produção (PCP) antes e após a implementação de um sistema totalmente automatizado e integrado para detecção de carga viral. Foi possível observar uma redução da mão de obra em cerca de 42% para cada amostra que permitiu o aumento na capacidade produtiva em 41%. Resultados: Anteriormente eram processados 5235 testes de carga viral em cerca de 228 horas mensais e atualmente é processado 7398 amostras em cerca de 247 horas mensais. Conclusão: De modo geral, a implementação de uma plataforma de carregamento contínuo em testes de carga viral, pode ter impactos positivos significativos nas operações do laboratório, incluindo maior rendimento, segurança, melhor custo-benefício, redução de prazo e flexibilidade para acomodar requisitos em constante mudança.