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Abstract Background Nigeria’s under-five health outcomes have improved over the years, but the mortality rates remain unacceptably high. The qualitative component of Nigeria’s 2019 verbal and social autopsy (VASA) showed that caregivers’ health beliefs about causes of illnesses and efficacious treatment options contribute to non-use/delay in use of facility-based healthcare for under-five children. This study explored how these health beliefs vary across zones and how they shape how caregivers seek healthcare for their under-five children. Methods Data for this study come from the qualitative component of the 2019 Nigeria VASA, comprising 69 interviews with caregivers of under-five children who died in the five-year period preceding the 2018 Nigeria Demographic and Health Survey (NDHS); and 24 key informants and 48 focus group discussions (FGDs) in 12 states, two from each of the six geo-political zones. The transcripts were coded using predetermined themes on health beliefs from the 2019 VASA (qualitative component) using NVivo. Results The study documented zonal variation in belief in traditional medicine, biomedicine, spiritual causation of illnesses, syncretism, and fatalism, with greater prevalence of beliefs discouraging use of facility-based healthcare in the southern zones. Driven by these beliefs and factors such as availability, affordability, and access to and perceived quality of care in health facilities, caregivers often choose one or a combination of traditional medicines, care from medicine vendors, and faith healing. Most use facility-based care as the last option when other methods fail. Conclusion Caregivers’ health beliefs vary by zones, and these beliefs influence when and whether they will use facility-based healthcare services for their under-five children. In Nigeria’s northern zones, health beliefs are less likely to deter caregivers from using facility-based healthcare services, but they face other barriers to accessing facility-based care. Interventions seeking to reduce under-five deaths in Nigeria need to consider subnational differences in caregivers’ health beliefs and the healthcare options they choose based on those beliefs.

ABSTRACT: Background: Despite all efforts, the demand for organs increases. New and better strategies are still needed, critical in a crisis like pandemics. Methodology: A mathematical approach that integrates need, Opportunity, and Accessibility to kidney transplantation, was created. NOA method, corresponds to the lateral surface area of a trigonal pyramid with the need, Opportunity, and Accessibility as axis, resulting in an intuitional chart output (NOA chart) and a percentage score (NOA score). Higher NOA scores are associated with larger NOA chart areas. Method Application: We found some natural variability among the European Member States regarding Need, Opportunity, and Accessibility to kidney transplantation, concomitant with NOA scores. In 2019, in the European Union, 129 patients pmp on the waiting list for a kidney transplant were registered, 47 kidneys pmp were procured, and 36 kidneys pmp were transplanted, corresponding to 25% of kidney transplantation's response capacity. Conclusion: Transplantation is frequently the better treatment for end-stage kidney failure. NOA method may be, in the future, an indicator for evaluating the overall transplantation performance regarding the need for it and a tool for policy definition. With NOA method we seek to contribute for: • A transplantation overall performance normalizing score; • Transplantation response capacity evaluation.

O presente artigo se propõe a apresentar estudos sobre as paisagens a partir das imagens, sejam elas pinturas, gravuras ou fotografias, desde o enfoque da História Ambiental. Serão analisadas imagens relacionadas a áreas de conservação que indicam transformações pretéritas em suas paisagens, compreendendo essas transformações como fruto da interação entre seres humanos e universo biofísico ao longo do processo histórico. Igualmente, se busca apresentar como essas imagens podem servir como fontes históricas que auxiliam no trabalho de investigação sobre os estudos de paisagem.

Citostatic agents are widely used for cancer disease treatment and some of these compounds, as methotrexate, are also used for treatment of autoimmune pathologies such as rheumatoid arthdtis and psoriasis. Citostatic agents have a remarkable toxicological potential that can affect the professional handler, the patient and the environment. These compounds have mutagenic, carcinogenic, teratogenic and embryotoxic activity in animal models. The clinical manifestations of exposure in professional handlers include local reactions as skin pigmentation, dermatitis, mucositis, burnlogs, allergies, headache, nausea and vertigo; the last ones pointing to its systemic absorption. Citostatic agents should not be handled by gestating women, women planning pregnancy, lactating mothers, mothers having children with genetic malformations, women with miscarriage history, allergic persons and those who are under treatment with ionizing radiation or receiving citostatic agents. The personnel who handles citostatic drugs should use sterilized coat, clinical mask, head cap and security lenses. When exposure to citostatic agents occurs, the subject should be carefully evaluated because symptoms are vage and unspecific. [ABSTRACT FROM AUTHOR]

Introduction: Venous thromboembolism (VTE) is a relatively common complication during hospital stay and determination of VTE risk is critical to choosing the best prophylactic strategy for each patient. Objectives: In the present study we studied the risk profile for VTE in hospitalized patients in a group of hospitals in Portugal. Methods: Based on an open cohort of 4248 patients hospitalized in surgical, internal medicine, orthopedic or oncology departments, we determined thromboembolic risk at admission by applying a new score, modified from the Caprini and Khorana scores. Thrombotic, embolic and bleeding events and death were assessed during hospital stay and at three and six months after discharge. Results: The median duration of hospital stay was five days and thromboembolic prophylaxis was implemented in 67.2% (n=2747) of the patients. A low molecular weight heparin was used as prophylaxis in the majority of cases (88.3%). Most patients were classified as high (68%) or intermediate risk (27%). The overall incidence of thromboembolic events was 1.5%. Major bleeding events were recorded in 3.89% of patients and all-cause mortality was 3.4%. Conclusions: In this study, we propose a modified VTE risk score that effectively risk-stratifies a mixed inpatient population during hospital stay. The use of this score may result in improvement of thromboprophylaxis practices in hospitals. Resumo: Introdução: O tromboembolismo venoso (TEV) é uma complicação relativamente frequente, complica o internamento hospitalar, e a determinação do risco da ocorrência de TEV é essencial, de molde a permitir a escolha da melhor estratégia de profilaxia para cada doente. Objetivo: Estudar o perfil de risco para TEV em doentes hospitalizados, num grupo de hospitais de Portugal. Métodos: Neste estudo, com a inclusão duma coorte aberta de 4248 doentes internados nos departamentos de cirurgia, medicina interna, ortopedia ou oncologia, foi determinado na admissão o risco tromboembólico de cada doente, através dum novo score, modificado dos scores de Caprini e de Khorana. Os eventos trombóticos, embólicos e hemorrágicos e morte foram registados durante o internamento e aos três e seis meses após a alta. Resultados: A mediana do tempo de internamento foi de cinco dias e foi administrada terapêutica de profilaxia tromboembólica em 67,2% (n=2747) dos doentes, foi usada uma heparina de baixo peso molecular em 59,3% dos casos. A maior parte dos doentes foi classificada com um risco elevado (68%) ou intermédio (27%). A incidência global de eventos tromboembólicos foi de 1,5%. Foram registados eventos hemorrágicos maiores em 3,89% dos doentes e a mortalidade por todas as causas foi de 3,4%. Conclusões: Neste estudo, os autores propõem um novo score para avaliação do risco de TEV que estratificou de modo efetivo uma população mista de doentes durante o internamento hospitalar. O uso desse score poderá resultar numa melhoria da prática da tromboprofilaxia nos nossos hospitais. Keywords: Venous thromboembolic risk, Prophylaxis, Epidemiology, Palavras-chave: Risco tromboembólico venoso, Profilaxia, Epidemiologia

Venous thromboembolism (VTE) risk assessment is a cornerstone for the achievement of best practices and outcomes. Epidemiologic data and practices related to venous thromboprophylaxis as considered by the global ENDORSE study, (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting), enrolled 68,183 patients from 32 countries, in which Portugal. Within ENDORSE, data from all participant countries analyzed to determine their risk of VTE and to evaluate the suitability of prophylaxis.European patients were enrolled from randomly selected hospitals in Portugal (European Hospital Register), according to ENDORSE study inclusion/exclusion criteria. The Seventh ACCP evidence-based consensus guidelines were employed to evaluate VTE risk and prophylaxis use.From a total of 3,145 beds assessed, 2,183 were considered eligible and 1,632 met all criteria. Of these, 860 (52.7%; 95% CI 50.3-55.1) were at risk of VTE: 525 surgical patients (68.9%; 95% CI 65.5-72.1) and 335 medical patients (38.5%; 95% CI 35.3-41.2). The rate of prophylaxis according to ACCP guidelines in overall patients at risk was 58.5% (503 patients). The prophylaxis rate for VTE was 59% (310 patients) in surgical patients and 57.6% (n=193) in medical patients. 39.7% of surgical patients and 39.4 % of medical patients who did not meet the criteria for prophylaxis were also on prophylaxis with an anticoagulant, which was considered to be inappropriate.More than a half of these hospitalized patients in Portugal were deemed at risk of VTE and less than two-thirds of them received appropriate prophylaxis. New strategies are required for implementation of venous thromboprophylaxis in Portuguese hospitals.

Venous thromboembolism is a frequent clinical condition with high impact on both morbidity and mortality. Venous thromboembolism risk is particularly high in hospitalized patients as well as in oncologic patients, being a factor of poor prognosis for the oncologic disease. Several clinical studies have shown the need to develop effective hospital strategies using a systematic and individualized assessment of venous thromboembolism risk, and additionally to optimize the institution of prophylaxis treatment and its proper use in the context of in-hospital and outpatient management. The ARTE national study is a non-interventional, multicentre, prospective study which is divided in two phases. In the first phase patients are followed in the hospital; in the second phase patients are followed in ambulatory context for a period of 6 months after discharge. Four thousand patients will be included, equally distributed over medical, surgical, oncologic and orthopaedic patients. Data will be collected from the patient's clinical files and through direct clinical evaluation of risk factors for venous thromboembolism, in the departments of medicine, oncology, surgery, and orthopaedics of the participating centres. The main objectives of the study are to assess the risk profile of venous thromboembolism of the study population using a risk assessment model adapted from the Caprini and Khorana et al models, and the validation of the score for the Portuguese population. Simultaneously, the secondary objectives are as follows: to determine the proportion of patients with venous thromboembolism risk, according to the risk assessment model, that are doing prophylaxis; to determine the duration of prophylaxis during the hospitalization; to determine the proportion of patients doing long-term prophylaxis, at the moment of the discharge; to determine the incidence of thromboembolic events (deep venous thrombosis; stroke; pulmonary thromboembolism; transient ischemic attack), haemorrhagic events (major and minor haemorrhages) and death at 6 months after discharge. Each patient will be contacted by telephone at 3 and 6 months after discharge, in order to assess the occurrence of thromboembolic and haemorrhagic events, as well as any readmission. This article describes the ARTE study's rationale, objectives, and methodology.