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Carla de Sanctis Pecora,1 Maria Valéria Bussamara Pinheiro,1 Karin Ventura Ferreira,1 Gisele Jacobino de Barros Nunes,1 Hélio Amante Miot2 1Dermatologie - Clinica, Cirurgia, Cosmiatria e Laser, São Paulo, SP, Brazil; 2Departamento de Dermatologia da FMB-Unesp, Botucatu, SP, BrazilCorrespondence: Carla de Sanctis Pecora Dermatologie - Clinica, CirurgiaCosmiatria e Laser, Avenida Ibirapuera, 2907, Conj 901, São Paulo, SP, CEP 04029-200, BrazilTel/Fax +551150420872Email carla@dermatologie.com.brPurpose: Botulinum toxin type A is an effective treatment for glabellar dynamic wrinkles. As the muscular group involved in the contraction of the glabella varies among people, individualized treatment can achieve optimal results. This study evaluates a customized assessment for the treatment of glabellar lines with Incobotulinumtoxin-A, leading to an individualized points distribution and dosage.Patients and Methods: A single-center, evaluator-blinded, therapeutic cohort study enrolled 130 women with moderate or severe glabellar wrinkles. They underwent Incobotulinumtoxin-A injection following the standard 5-point injection at the glabellar muscles (n = 65) or an individualized assessment and scheme treatment based on anatomical references of contraction, the One21 technique (n = 65). All the patients were photographed under maximum contraction before treatment (T0) and after 4 weeks (T28). The photos were randomly assessed by two blinded, experienced raters to consensually grade the severity according to the Merz Aesthetics Scales (MAS). The primary clinical efficacy was defined as a 2-point reduction in the MAS score, on Day 28.Results: The groups were homogeneous regarding age, phototype, and baseline MAS scores. On Day 28 (T28), 64 (98.5%) patients from the One21 group and 52 (80%) from the 5-point group reduced the MAS score by at least two points (p < 0.01). When adjusted by age and phototype, both groups reduced the MAS score at T28 (p < 0.01); nevertheless, patients from the One21 group significantly performed better (p < 0.01), with a much higher rate response rate at T28, in comparison to the 5-point group. Of patients enrolled in the 5-point group, 83.1% utilized muscle groups other than the procerus and corrugator in glabellar wrinkle formation, and 17 (24.6%) presented asymmetrical contraction. Patients from the 5-point group with glabellar asymmetry and those who utilized the frontalis and orbicularis presented inferior performance (p < 0.05), reinforcing the importance of an individualized assessment and treatment plan.Conclusion: The One21 technique yielded better results than the standard 5-point treatment in reducing glabellar dynamic lines with Incobotulinumtoxin-A, especially for asymmetric lines of the glabella or the involvement of muscle groups other than the procerus and corrugator.Keywords: botulinum toxin type A, incobotulinumtoxinA, evaluation studies as a topic, face, muscle contraction, treatment, glabella

To identify the most efficient methods for evaluating the effectiveness of teaching materials in Primary Health Care, aimed at school-age youngsters, Scoping Review. Our leading question was: Which are the evaluation methodologies of the teaching-learning process in health education in schools in Primary Health Care used with kids and teenagers (schooling age youngsters)? The search occurred on the National Library of Medicine (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Search for an Author Profile (SCOPUS), and Scientific Electronic Library Online (Scielo). Among the 285 studies found, 13 (100%) constituted our sample for answering our leading question. Among the 13 studies analyzed, 9 (69,24%) were published in the past 9 years and 4 (30,76%) between 1991 and 1999. All were in English, and most were on eating and physical habits (30,7%). Concerning the learning-teaching process, the most effective strategies included family and community and/or aimed to develop students' autonomy. Most were based on self-made questionnaires to evaluate health education activities, except for the studies on feeding/nutrition and physical activities, which frequently used anthropometric data. Due to its newness, most of the work on the subject was from abroad. The authors created most of the evaluation methodologies, and nutrition and feeding were the main topics investigated. Teaching-learning strategies were more effective among teenagers. [ABSTRACT FROM AUTHOR]

Purpose: Botulinum toxin type A is an effective treatment for glabellar dynamic wrinkles. As the muscular group involved in the contraction of the glabella varies among people, individualized treatment can achieve optimal results. This study evaluates a customized assessment for the treatment of glabellar lines with Incobotulinumtoxin-A, leading to an individualized points distribution and dosage. Patients and Methods: A single-center, evaluator-blinded, therapeutic cohort study enrolled 130 women with moderate or severe glabellar wrinkles. They underwent Incobotulinumtoxin-A injection following the standard 5-point injection at the glabellar muscles (n = 65) or an individualized assessment and scheme treatment based on anatomical references of contraction, the One21 technique (n = 65). All the patients were photographed under maximum contraction before treatment (T0) and after 4 weeks (T28). The photos were randomly assessed by two blinded, experienced raters to consensually grade the severity according to the Merz Aesthetics Scales (MAS). The primary clinical efficacy was defined as a 2-point reduction in the MAS score, on Day 28. Results: The groups were homogeneous regarding age, phototype, and baseline MAS scores. On Day 28 (T28), 64 (98.5%) patients from the One21 group and 52 (80%) from the 5-point group reduced the MAS score by at least two points (p < 0.01). When adjusted by age and phototype, both groups reduced the MAS score at T28 (p < 0.01); nevertheless, patients from the One21 group significantly performed better (p < 0.01), with a much higher rate response rate at T28, in comparison to the 5-point group. Of patients enrolled in the 5-point group, 83.1% utilized muscle groups other than the procerus and corrugator in glabellar wrinkle formation, and 17 (24.6%) presented asymmetrical contraction. Patients from the 5-point group with glabellar asymmetry and those who utilized the frontalis and orbicularis presented inferior performance (p < 0.05), reinforcing the importance of an individualized assessment and treatment plan. Conclusion: The One21 technique yielded better results than the standard 5-point treatment in reducing glabellar dynamic lines with Incobotulinumtoxin-A, especially for asymmetric lines of the glabella or the involvement of muscle groups other than the procerus and corrugator. [ABSTRACT FROM AUTHOR]

Background and Objectives: Over the last two decades, the prevalence of type2 diabetes (T2DM) has more than doubled worldwide. Researches have shown that with changes in lifestyle, especially diet, the incidence of complications of diabetes could be reduced. Understanding the beliefs of diabetic patients can result in more effective interventions to change their lifestyle. This study was performed to evaluate the health action process approach (HAPA) for explaining healthy dietary behavior in diabetics. Methods:The current study was conducted as a descriptive study according to the HAPA. Data were collected by psychometric scales administered to 141 diabetics living in Isfahan city. The studied constructs were intention, outcome expectancies, risk perception, action self-efficacy, action and coping planning, maintenance self-efficacy, and dietary style. Structural equation modeling was used to analyze the data. Results:The results of structural equation modeling revealed that the health action process approach adequately fits with the dietary behaviors in diabeticpatients. Action self-efficacy construct was the best predictor of intention. Action planning mediated the effect of intention on action behavior. The results indicated that action planning β)=0.019, p

Introduction: The European Medicines Agency (EMA) requires vaccine manufacturers to conduct enhanced safety surveillance (ESS) of seasonal influenza vaccines including a near real-time evaluation of collected data. The objective was to identify whether the use of passive surveillance or active surveillance provides different results of reported adverse events of interest (AEIs) by specified age strata and AEI type. We report the weekly incidence rates of AEIs within 7 days following seasonal influenza vaccination using passive and active surveillance.Methods: AEIs were collected within 7 days of vaccination from ten general practices predominantly administering inactivated quadrivalent influenza vaccine (IIV4, Fluarix Tetra, GSK). Vaccinees completed an adverse drug reaction (ADR) card. ADR card and medically attended AEIs data were recorded in practice electronic health records. We report the outcome of the first 5 weeks of safety surveillance (September 12, 2016-October 16, 2016); in an exploratory analysis, rates of AEI for IIV4 are compared to those passively reported through a sentinel network.Results: Practices vaccinated 13.1% (12,864/98,091) of their registered population; 5.6% (95% CI 5.20-6.00) of them reported AEIs, none serious. The most frequent were respiratory 2.60% (95% CI 2.33-2.88), musculoskeletal 1.82% (95% CI 1.59-2.05) and neurological 1.05% (95% CI 0.88-1.23). AEIs were more frequently reported for adults than for children; 5.91% (95% CI 5.49-6.34) compared to 1.49% (95% CI 0.69-2.29); 47.18% of the adults reported AEI using the ADR card, none were returned for subjects < 18 years old. The frequency of AEIs reporting was higher, 6.88% (95% CI 6.35-7.42) vs. 3.30% (95% CI 2.68-3.96, 100/3028, p < 0.000), through ESS than passive surveillance.Conclusion: The ESS did not reveal any safety signal and we demonstrated the feasibility of conducting ESS following EMA recommendations. The use of a customised ADR card led to a doubling of AEIs reports over passive surveillance in adults.Funding: GlaxoSmithKline Biologicals SA, Wavre, Belgium. [ABSTRACT FROM AUTHOR]

Aims To evaluate the effect of participation in a simulation exercise, on Bachelor of Pharmacy (B.Pharm.) undergraduates׳ attitudes and beliefs toward those living in poverty. To explore the acceptability of the simulation to students and their perception of how it related to their future practice. Method Second-year B.Pharm. undergraduates participated in the Community Action Poverty Simulation (CAPS), designed to allow participants to experience aspects of what it is like to live in poverty. Students completed the Short Form of the Attitude Toward Poverty Scale (ATP-SF) anonymously one week prior- and post-participation to examine the effect of the simulation. A paired comparison of the ATP-SF score and its subscales was undertaken. Free-text questions examined students׳ opinions of the simulation, what they learned from participating and how it could be improved. Results In total, 76 pairs of complete questionnaires were analyzed. A trend toward improvement in attitudes toward those living in poverty was seen (change in ATP-SF total score, P = 0.07). This appeared to be associated with changes in the structural perspective subscale (implying more attribution of poverty to societal structures) post-simulation ( P < 0.01). No statistically significant changes were seen on the other two subscales (“personal deficiencies” and “stigma”). Thematic analysis of free-text responses indicated that participating in the simulation challenged the veracity of some negative attitudes and beliefs about poverty, and increased understanding and empathy. Conclusion Participation in the simulation had some positive effects on student attitudes, empathy, and beliefs related to those of low socioeconomic status. [ABSTRACT FROM AUTHOR]

Health Informatics frameworks have been created surrounding the implementation, optimization, adoption, use and evaluation of health information technology including electronic health record systems and medical devices. In this contribution, established health informatics frameworks are presented. Important considerations for each framework are its purpose, component parts, rigor of development, the level of testing and validation its undergone, and its limitations. In order to understand how to use a framework effectively, it's often necessary to seek additional explanation via literature, documentation, and discussions with the developers. [ABSTRACT FROM AUTHOR]

Background: The Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) was established to monitor national testing and test outcomes for blood-borne viruses (BBVs) and sexually transmissible infections (STIs) in key populations. ACCESS extracts deidentified data from sentinel health services that include general practice, sexual health, and infectious disease clinics, as well as public and private laboratories that conduct a large volume of BBV/STI testing. An important attribute of ACCESS is the ability to accurately link individual-level records within and between the participating sites, as this enables the system to produce reliable epidemiological measures.Objective: The aim of this study was to evaluate the use of GRHANITE software in ACCESS to extract and link deidentified data from participating clinics and laboratories. GRHANITE generates irreversible hashed linkage keys based on patient-identifying data captured in the patient electronic medical records (EMRs) at the site. The algorithms to produce the data linkage keys use probabilistic linkage principles to account for variability and completeness of the underlying patient identifiers, producing up to four linkage key types per EMR. Errors in the linkage process can arise from imperfect or missing identifiers, impacting the system's integrity. Therefore, it is important to evaluate the quality of the linkages created and evaluate the outcome of the linkage for ongoing public health surveillance.Methods: Although ACCESS data are deidentified, we created two gold-standard datasets where the true match status could be confirmed in order to compare against record linkage results arising from different approaches of the GRHANITE Linkage Tool. We reported sensitivity, specificity, and positive and negative predictive values where possible and estimated specificity by comparing a history of HIV and hepatitis C antibody results for linked EMRs.Results: Sensitivity ranged from 96% to 100%, and specificity was 100% when applying the GRHANITE Linkage Tool to a small gold-standard dataset of 3700 clinical medical records. Medical records in this dataset contained a very high level of data completeness by having the name, date of birth, post code, and Medicare number available for use in record linkage. In a larger gold-standard dataset containing 86,538 medical records across clinics and pathology services, with a lower level of data completeness, sensitivity ranged from 94% to 95% and estimated specificity ranged from 91% to 99% in 4 of the 6 different record linkage approaches.Conclusions: This study's findings suggest that the GRHANITE Linkage Tool can be used to link deidentified patient records accurately and can be confidently used for public health surveillance in systems such as ACCESS. [ABSTRACT FROM AUTHOR]

ABSTRACT Educational Product and Technical-Technological Product constitute a specificity of postgraduate programs in the professional modality, a product that must be carefully evaluated by the programs and recorded on platforms of evaluating bodies. In 2019, a working group from the teaching area was assembled to create a Validation Form for these products. Thus, this article aims to present a proposal for improving this Validation Form for Educational/Technical-Technological Products, based on reflections treated in scientific articles and scientific events from the area, focusing on the relevance and need for this type of evaluation in a standardized way. It is intended to collaborate with the improvement of the evaluation processes and procedures of Educational/Technical-Technological Products for the necessary accuracy, representativeness, and homogeneity, which will allow the real dimensioning of the contributions of these products. This involves not only training qualified professionals, but also transforming practices in the Sistema Único de Saúde (SUS) [Brazil's Unified Health System], promoting advances in science and in its fields of application.