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Outbreaks of Guillain-Barré syndrome (GBS) are uncommon. In May 2019, national surveillance in Peru detected an increase in GBS cases in excess of the expected incidence of 1.2 cases/100,000 population. Several clinical and epidemiologic findings call into question the suggested association between this GBS outbreak and Campylobacter.

BackgroundCentral nervous system infections (CNSI) are diseases with high morbidity and mortality, and their diagnosis in the intensive care environment can be challenging. Objective: To develop and validate a diagnostic model to quickly screen intensive care patients with suspected CNSI using readily available clinical data.MethodsDerivation cohort: 783 patients admitted to an infectious diseases intensive care unit (ICU) in Oswaldo Cruz Foundation, Rio de Janeiro RJ, Brazil, for any reason, between 01/01/2012 and 06/30/2019, with a prevalence of 97 (12.4%) CNSI cases. Validation cohort 1: 163 patients prospectively collected, between 07/01/2019 and 07/01/2020, from the same ICU, with 15 (9.2%) CNSI cases. Validation cohort 2: 7,270 patients with 88 CNSI (1.21%) admitted to a neuro ICU in Chicago, IL, USA between 01/01/2014 and 06/30/2019. Prediction model: Multivariate logistic regression analysis was performed to construct the model, and Receiver Operating Characteristic (ROC) curve analysis was used for model validation. Eight predictors-age 2 cells/mm3, fever (≥38°C/100.4°F), focal neurologic deficit, Glasgow Coma Scale ResultsThe pool data's model had an Area Under the Receiver Operating Characteristics (AUC) curve of 0.892 (95% confidence interval 0.864-0.921, PConclusionsA promising and straightforward screening tool for central nervous system infections, with few and readily available clinical variables, was developed and had good accuracy, with internal and external validity.

BackgroundBeginning August 2017, we conducted a prospective case-control investigation in Monterrey, Mexico to assess the association between Zika virus (ZIKV) and Guillain-Barré syndrome (GBS).MethodsFor each of 50 GBS case-patients, we enrolled 2-3 afebrile controls (141 controls in total) matched by sex, age group, and presentation to same hospital within 7 days.ResultsPCR results for ZIKV in blood and/or urine were available on all subjects; serum ZIKV IgM antibody for 52% of case-patients and 80% of controls. Subjects were asked about antecedent illness in the two months prior to neurological onset (for case-patients) or interview (for controls). Laboratory evidence of ZIKV infection alone (PCR+ or IgM+) was not significantly different between case-patients and controls (OR: 1.26, 95% CI: 0.45-3.54) but antecedent symptomatic ZIKV infection [a typical ZIKV symptom (rash, joint pain, or conjunctivitis) plus laboratory evidence of ZIKV infection] was higher among case-patients (OR: 12.45, 95% CI: 1.45-106.64). GBS case-patients with laboratory evidence of ZIKV infection were significantly more likely to have had typical ZIKV symptoms than controls with laboratory evidence of ZIKV infection (OR: 17.5, 95% CI: 3.2-96.6). This association remained significant even when only GBS case-patients who were afebrile for 5 days before onset were included in the analysis, (OR 9.57 (95% CI: 1.07 to 85.35).ConclusionsDuring ZIKV epidemics, this study indicates that increases in GBS will occur primarily among those with antecedent symptomatic ZIKV.

BackgroundThis prospective cohort investigation analyzed the long-term functional and neurologic outcomes of patients with Zika virus-associated Guillain-Barré syndrome (GBS) in Barranquilla, Colombia.MethodsThirty-four Zika virus-associated GBS cases were assessed a median of 17 months following acute GBS illness. We assessed demographics, results of Overall Disability Sum Scores (ODSS), Hughes Disability Score (HDS), Zung Depression Scale (ZDS), and Health Related Quality of Life (HRQL) questionnaires; and compared outcomes indices with a normative sample of neighborhood-selected control subjects in Barranquilla without GBS.ResultsMedian age at time of acute neurologic onset was 49 years (range, 10-80); 17 (50%) were male. No deaths occurred. At long-term follow-up, 25 (73%) patients had a HDS 0-1, indicating complete / near complete recovery. Among the group, HDS (mean 1.4, range 0-4), ODSS (mean 1.9, range 0-9) and ZDS score (mean 34.4, range 20-56) indicated mild / moderate ongoing disability. Adjusting for age and sex, Zika virus-associated GBS cases were similar to a population comparison group (n = 368) in Barranquilla without GBS in terms of prevalence of physical or mental health complaints, though GBS patients were more likely to have an ODSS of ≥ 1 (OR 8.8, 95% CI 3.2-24.5) and to suffer from moderate / moderate-severe depression (OR 3.89, 95% CI 1.23-11.17) than the comparison group.ConclusionsLong-term outcomes of Zika virus-associated GBS are consistent with those associated with other antecedent antigenic stimuli in terms of mortality and ongoing long-term morbidity, as published in the literature. Persons with Zika virus-associated GBS more frequently reported disability and depression after approximately one year compared with those without GBS.

RESUMO Objetivou-se analisar aspectos da estrutura das unidades básicas e da organização do processo de trabalho das equipes de saúde relacionados com acessibilidade sócio-organizacional aos serviços de Atenção Primária à Saúde em municípios rurais do Brasil. Os dados deste estudo descritivo, de corte transversal, provêm do instrumento de avaliação externa do 3º ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, realizado em 2017, aplicado em 8.711 equipes de Saúde da Família de 2.940 municípios rurais. Os módulos que constituíram tal instrumento serviram de base para a construção de Modelo Lógico e definição de variáveis validadas por consenso de pesquisadores da área. Os dados estão apresentados em frequências absolutas e percentuais. Os resultados revelam aspectos que interferem na acessibilidade das pessoas aos serviços: deficiências na estrutura das unidades de saúde; no acesso a tecnologias de informação pelos profissionais; pouca disponibilidade de imunobiológicos e testes diagnósticos; e indicativos de problemas no processo de trabalho das equipes. A maioria dos municípios brasileiros de pequeno porte não dispõe de serviços dos outros níveis de atenção em seu território, inclusive aqueles localizados em áreas remotas e de difícil acesso encontram dificuldade para fixação de profissionais e outras carências de infraestrutura.

Goal: The purpose of this article is to analyze how digital transformation can contribute to increasing the sustainable competitiveness of the shipbuilding industry in a developing country like Brazil. Design / Methodology / Approach: To achieve this, a conceptual model was proposed, built from a literature review and interviews with 14 experts in the naval and offshore industry. The model was then validated through structural equation modeling, considering 326 responses from professionals in the researched sector. Results: As a result, a model was developed, suggesting that to establish a Shipyard 4.0, enhancing the sustainable competitiveness of shipbuilding, it is necessary to align corporate strategic management with sustainable management of complex projects. This alignment should focus on the qualification of specialized labor to execute the entire Smart product lifecycle, encompassing intelligent design, manufacturing, assembly, and operation, all of which are integral to a Shipyard 4.0. Limitations of the investigation: Bibliography searches on the topic were limited to thematic areas such as: digital shipyard, shipbuilding, digital transformation, intelligent manufacturing, automation, management, productivity, sustainability, people, security, labor, engineering, energy, computer science, economics, mathematics. The research aimed to provide results that characterized the application of a model that integrated digital transformation into the shipbuilding industry, in the thematic areas considered in the bibliographical research. Practical implications: It is expected that this model will be applied in a shipyard as a pilot for validation through a case study, aiming to enhance the competitiveness of companies in the sector while considering the sustainable aspects associated with such endeavors. Originality / Value: In this exploratory essay, we seek the intersection of themes such as Effective Management, Smart Manufacturing, Sustainable Project and Digital Shipyard. Brazil in 2018 had around 42 shipyards as Sinaval (2018) indicates on its website, through the map of shipyards and it is believed that the research can meet future demands of the sector. It is noted that there is no digital production line in Brazil at the end of 2018, therefore the thesis proposal is innovative.

Abstract Dental referrals to the Endodontics Specialty Clinic (ESC) are routine owing to the complexity of endodontic treatments. To obtain a better prognosis for treatment, students/dentists must perceive their technical limits. This study sought to investigate the referrals of patients to the ESC from different clinics of the Piracicaba Dental School, State University of Campinas - SP, Brazil, and check: a) the demographic profile of patients and the most commonly affected tooth; b) the clinic with the largest number of referrals; c) the reasons for referrals; d) the complexity of the cases; e) and the difficulty in assessing the referred cases based on the classification provided by the American Association of Endodontists (AAE) and Souza-Filho. The study sample consisted of patients’ electronic dental referral records from February 2015 to June 2019. A total of 1,707 patients were referred to the ESC during the study period, and 62.4% were female. Lower molars were the most frequently involved teeth (34.8%), and 60.7% of the cases were referred due to the presence of root curvature. The AAE classification showed prevalence of highly difficult cases (71.3%), whereas Souza-Filho classification demonstrated a high rate of class III cases (85.8%). This study highlights the difficulties encountered by undergraduate students before or during endodontic treatments, reinforcing the need for clear criteria for selecting cases appropriate for each education level, thus improving endodontic treatment prognosis.

ABSTRACT BACKGROUND: Specific types of violence such as intimate partner sexual violence and intimate partner homicide occur more frequently in rural areas. OBJECTIVE: This study aimed to systematically review the literature on the knowledge and attitudes of rural healthcare providers regarding cases of domestic violence against women. DESIGN AND SETTING: Systematic review developed at Universidade Federal de Uberlândia. METHODS: We conducted an electronic search of six databases, which only included observational studies, regardless of the year, language, or country of publication, except for studies that used secondary data and were exclusively qualitative. Two reviewers performed the selection, data extraction, and risk of bias assessment using a specific Joanna Briggs Institute tool. RESULTS: Six studies met the inclusion criteria. All the studies had a low risk of bias. Approximately 38% of these professionals identified injuries caused by violence in patients. When asked about knowing the correct attitude to take in cases of confirmed violence, between 12% and 64% of rural healthcare providers answered positively; most of them would refer to specialized institutions and promote victim empowerment and counseling. The number of professionals with an educational background in the field ranged from 16% to 98%. CONCLUSIONS: The evident disparity across studies shows that some professionals have suboptimal knowledge and require training to adopt the correct attitude when identifying female victims of domestic violence in clinical practice. SYSTEMATIC REVIEW REGISTRATION: This systematic review was registered in the Open Science Framework Database under the registration http://doi.org/10.17605/OSF.IO/B7Q6S.

OBJECTIVES: The purpose of the present study was to compare the plasma and serum monoamine levels in sedentary, untrained normotensive and hypertensive men at rest with levels measured after an acute bout of exercise and to compare similar measurements following a 12-week aerobic training program. PLACE OF STUDY: The data obtained for this study was collected from a clinic for the prevention of heart disease and cardiac rehabilitation (FITCOR) and analyzed in the Federal University of São Paulo (EPM), Laboratory of Experimental Neurology. SUBJECTS: Two groups of untrained male subjects, i.e., normotensive (N=16) and hypertensive (N=19), were submitted to an acute bout of exercise to analyze the acute effect of exercise on the monoamine levels.To study the chronic effect of exercise (physical training program), some individuals of each group were arranged in two other groups; normotensive (N=11) and hypertensive (N=8). MEASUREMENT: Plasma catecholamines and serum serotonin levels were determined by high performance liquid chromatography coupled with electrochemical detection. RESULTS: A significant reduction in diastolic blood pressure at rest was observed in the hypertensive group after the physical training program (p < 0.05). Only the mean plasma noradrenaline concentration increased significantly post-exercise in all groups of individuals (acute effect of exercise - p < 0.01 for untrained normotensive and hypertensive; chronic effect of exercise - p < 0.001 for untrained and trained normotensive, p < 0.01 for untrained and trained hypertensive). CONCLUSION: These data show the beneficial effect of physical exercise in reducing the blood pressure in hypertensive patients, which does not seem to be related to changes in circulating monoamines.

A educação equitativa e de qualidade para todos os cidadãos é uma das mais importantes formas de ultrapassagem das desigualdades que ainda se fazem sentir fortemente nas sociedades. A qualidade dos professores é uma dimensão central dos processos educativos, a qual depende em grande parte da qualidade da formação inicial. Este artigo apresenta uma pesquisa desenvolvida com o objetivo de explorar as características das identidades de professores formadores e dos climas de formação que formam professores focados na inclusão social e na humanização. Teoricamernte o estudo ancora-se no conceito de identidade profissional. Metodologicamente, a pesquisa segue uma orientação qualitativa que se estrutura através de entrevista em grupo com professoras formadoras de um curso de ensino da educação física em uma universidade portuguesa e de análise documental sobre o ensino superior em Portugal a nível nacional e a nível da instituição das pessoas em estudo. A instituição foi escolhida devido à qualidade reconhecida de seu curso. Para dar conta da identidade dos formadores, a entrevista considerou o percurso profissional dos professores formadores e a sua perspectiva sobre a formação inicial; os documentos incluíram legislação, planos de estudos, ementas de documentos de auto e hétero avaliação do curso. A análise sugere que é possível a academia formar professores para a inclusão e a humanização, nomeadamente em certas condições: (i) existência de identidades duais (de registro acadêmico e profissional) e (ii) existência de verdadeiras comunidades de prática de professores formadores, professores cooperantes e estudantes estagiários. Palavras-chave: Formação de Professor. Percurso Profissional. Ensino da Educação Física. Can the academy train teachers? An experience of training physical education teachers at the university ABSTRACT Equitable and quality education for all citizens is one of the most important ways to overcome the inequalities that are still strongly felt in societies. The quality of teachers is a central dimension of educational processes, which largely depends on the quality of initial training. This article presents a research developed with the objective of exploring the characteristics of the identities of teacher educators and the training climates that form teachers focused on social inclusion and humanization. Theoretically, the study is based on the concept of professional identity. Methodologically, the research follows a qualitative orientation that is structured through a group interview with teachers who teach a physical education teaching course at a Portuguese university and documentary analysis on higher education in Portugal on national level and on studied people institutional level. The institution was chosen due to the recognized quality of its course. To account for the identity of the trainers, the interview considered the professional path of the teacher educators and their perspective on initial training; the documents included legislation, study plans, menus for self and straight course evaluation documents. The analysis suggests that it is possible for the academy to train teachers for inclusion and humanization, namely under certain conditions: (i) existence of dual identities (of academic and professional record) and (ii) existence of true communities of practice for teacher educators, cooperating teachers and student trainees. Keywords: Teacher Training. Professional Path. Physical Education Teaching. ¿Puede la academia formar profesores? Una experiencia de formación de profesores de educación física en la universidad RESUMEN La educación equitativa y de calidad para todos los ciudadanos es una de las formas más importantes de superar las desigualdades que aún se sienten con fuerza en las sociedades. La calidad de los docentes es una dimensión central de los procesos educativos, que depende en gran medida de la calidad de la formación inicial. Este artículo presenta una investigación desarrollada con el objetivo de explorar las características de las identidades de los formadores de docentes y los climas de formación que forman los docentes enfocados en la inclusión social y la humanización. Teóricamente, el estudio se basa en el concepto de identidad profesional. Metodológicamente, la investigación sigue una orientación cualitativa que se estructura a través de una entrevista grupal con profesores que imparten un curso de docencia de educación física en una universidad portuguesa y un análisis documental sobre la educación superior en Portugal a nivel nacional y a nivel institucional. La institución fue elegida por la reconocida calidad de su curso. Para dar cuenta de la identidad de los formadores, la entrevista consideró la trayectoria profesional de los formadores de docentes y su perspectiva sobre la formación inicial; los documentos incluían legislación, planes de estudio, menús para autoevaluación y documentos de evaluación del curso. El análisis sugiere que es posible que la academia capacite a los docentes para la inclusión y la humanización, es decir, bajo ciertas condiciones: (i) existencia de identidades duales (de expediente académico y profesional) y (ii) existencia de verdaderas comunidades de práctica para los formadores de docentes, profesores colaboradores y alumnos en formación. Palabras clave: Formación Docente. Carrera. Enseñanza de la Educación Física.