Search

Abstract Background Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent psychiatric disorder in children, characterized by inattention, hyperactivity, and impulsivity. This neurobehavioral disorder often persists into adulthood, presenting significant challenges when undiagnosed and untreated, due to potential long-term implications and comorbidities, including anxiety, mood instability, and mixed symptoms along the bipolar spectrum. Case presentation A 49-year-old married male patient presented with anxiety and recurrent depressive episodes, initially diagnosed as major depressive disorder. His mood symptoms fluctuated between depressive lows, irritability, and impulsivity. His diagnosis was revised to ADHD with comorbid bipolar spectrum disorder. The patient exhibited lifelong ADHD symptoms affecting academic performance, relationships, and job responsibilities. Cognitive-behavioral therapy (CBT) was employed to manage symptoms and enhance coping strategies. Despite progress in controlling anger and impulsivity, challenges persisted in inhibitory control and negative triggers, causing impulsive decisions. The patient reported a restless mind, depressive mood, and a sense of inadequacy. Improvements were noted in anxiety regulation, concentration, and sleep quality, though deficits in cognitive and behavioral domains remained. The patient faced challenges in academic performance, information processing speed, attention, and executive functions. Conclusion This case underscores the importance of accurately diagnosing ADHD and its comorbidities in adults to ensure effective treatment. Delayed diagnosis can have lasting impacts, emphasizing the need for further research and personalized therapeutic approaches. The insights from this case serve as a valuable resource for healthcare professionals enhancing their understanding of the diverse manifestations of ADHD, aiding in better diagnosis and management strategies.

Abstract Background The pathophysiology of migraine remains poorly understood, yet a growing number of studies have shown structural connectivity disruptions across large-scale brain networks. Although both structural and functional changes have been found in the cerebellum of migraine patients, the cerebellum has barely been assessed in previous structural connectivity studies of migraine. Our objective is to investigate the structural connectivity of the entire brain, including the cerebellum, in individuals diagnosed with episodic migraine without aura during the interictal phase, compared with healthy controls. Methods To that end, 14 migraine patients and 15 healthy controls were recruited (all female), and diffusion-weighted and T1-weighted MRI data were acquired. The structural connectome was estimated for each participant based on two different whole-brain parcellations, including cortical and subcortical regions as well as the cerebellum. The structural connectivity patterns, as well as global and local graph theory metrics, were compared between patients and controls, for each of the two parcellations, using network-based statistics and a generalized linear model (GLM), respectively. We also compared the number of connectome streamlines within specific white matter tracts using a GLM. Results We found increased structural connectivity in migraine patients relative to healthy controls with a distinct involvement of cerebellar regions, using both parcellations. Specifically, the node degree of the posterior lobe of the cerebellum was greater in patients than in controls and patients presented a higher number of streamlines within the anterior limb of the internal capsule. Moreover, the connectomes of patients exhibited greater global efficiency and shorter characteristic path length, which correlated with the age onset of migraine. Conclusions A distinctive pattern of heightened structural connectivity and enhanced global efficiency in migraine patients compared to controls was identified, which distinctively involves the cerebellum. These findings provide evidence for increased integration within structural brain networks in migraine and underscore the significance of the cerebellum in migraine pathophysiology.

O artigo problematiza a aprendizagem autoral no contexto de uma Plataforma Educacional (PE). O objetivo da pesquisa é analisar se, na visão de profissionais que atuam na área da Educação, as ferramentas, que integram a PE investigada, possibilitam interação, usabilidade, engajamento e comprometimento entre os sujeitos, promovendo a autoralidade do aprendiz. É fundamental entender que o processo de aprendizagem é orientado pelas habilidades, conhecimentos e atitudes de cada indivíduo (Brasil, 2018), sendo papel da educação potencializar esse conjunto de competências. Isso é possível através do educar pela/para a pesquisa, no qual, dentre seus princípios, estão a autoralidade, autenticidade e protagonismo do aprendiz, garantidos no paradigma da aprendizagem (Demo, 2011; 2018). A pesquisa desenvolvida é de abordagem qualitativa, caracterizada como exploratória de campo. A coleta de dados foi realizada por meio de entrevista semiestruturada, com doze profissionais da educação, denominados Especialistas. Os resultados demonstraram que, na compreensão dos Especialistas, a PE avaliada tem potencial para transformar as práticas pedagógicas, possibilitando a autoralidade dos aprendizes e o protagonismo responsável, em suas aprendizagens. Pretende-se, com a pesquisa, contribuir para as discussões a respeito da aprendizagem autoral, especialmente na sua relação com as tecnologias. Ainda pode fornecer parâmetros de análise a Plataformas Educacionais a serem implementadas em sistemas públicos e privados de educação, seguindo a Política Nacional de Educação Digital (PNED) (Brasil, 2023).

Objective: To evaluate, among the most prescribed medications in the Intensive Care Units (ICU) of a public teaching hospital, those that require dose adjustment according to renal function, and to present the role of the pharmacist in this care setting. Methods: A cross-sectional observational study was conducted, with data collected from medication prescriptions through reports generated by the institution’s Hospital Information System from 2015 to 2019. Step 1: Based on the list of all medications prescribed during this period in two ICUs of the institution, the prevalence of prescription was calculated. For the 100 most used medications, a search was conducted on the Uptodate platform regarding the need for dose adjustment based on renal function. The data were compiled into a Microsoft Excel spreadsheet. Step 2: The compiled data were presented to five clinical pharmacists from the institution, who assessed the severity and likelihood of occurrence of potential nonadjustment of doses for the 10 most prevalent medications that require it, using the Hazard Score Matrix. Results: Of the 100 most prevalent, a total of 34 medications were identified that require dose adjustment, with the most predominant classes being antimicrobials (41.2%), followed by those related to the cardiovascular system (20.6%) and the central nervous system (17.6%). The medications that scored highest when evaluated by the Hazard Score Matrix were morphine and regular insulin, followed by enoxaparin and potassium chloride. It was noted that dose adjustment is necessary not only to reduce adverse reactions or nephrotoxicity but also to ensure therapeutic effectiveness. Conclusion: This study emphasized the importance of adjusting medication doses in critically ill patients with renal dysfunction. Many frequently prescribed medications require dose modifications to ensure safety and effectiveness, particularly those classified as ‘high-alert’ due to their narrow therapeutic range. Collaboration between physicians and pharmacists is essential for minimizing risks in this context. Additionally, the use of risk analysis tools, such as HFMEA, facilitates the implementation of preventive interventions and dose adjustment protocols.

Several protocols have been developed with the aim of characterizing glial and immune cells from the central and peripheral nervous systems. However, a small number of these protocols have demonstrated the ability to yield satisfactory results following conventional isolation. Considering this necessity and the difficulties encountered in enzymatic and bead isolation, our work proposes a method for the isolation of glial and immune cells from the spinal cord utilizing a Percoll gradient. For this purpose, C57BL/6J spinal cords were dissected, and the lumbar intumescence was dissociated and subjected to a Percoll gradient centrifugation (70%, 50%, 37%, and 10%). Each layer was then separated and labeled for astrocytes (anti-GFAP, TNF-α, IFN-γ, IL-10, IL-4), microglia (anti-CD45, CD11b, CD206, CD68, TNF-α, IFN-γ), and lymphocytes (anti-CD3, CD4, IFN-γ, IL-4). The gate detections were mathematically performed by computational analysis utilizing the K-means clustering algorithm. The results demonstrated that astrocytes were concentrated at the Percoll 10/37 interface, microglia at the Percoll 37/50 layer, and lymphocytes at the Percoll 50/70 layer. Our findings indicate that astrocytes in healthy animals are putative of the A1 profile, while microglia and lymphocytes are more frequently labeled with M1 and Th1 markers, suggesting a propensity towards inflammatory responses. The computational method enabled the semi-autonomous gate detection of flow cytometry data, which might facilitate and expedite the processing of large amounts of data.

Objective: To construct and validate educational pamphlets on oral antineoplastic therapy for patients with oncologic or hematologic diseases treated on an outpatient basis. Method: We carried out this research on two stages: a) Elaboration of educational pamphlets by the researchers, containing information regarding indication, administration mode, adverse effects, storage, and other precautions for the listed oral antineoplastics: Anagrelide, Cyclophosphamide, Chlorambucil, Melphalan, Lomustine, Mercaptopurine, Methotrexate, Mitotane, Pazopanib, Sorafenib, Temozolomide, Thioguanine, Ruxolitinib, and Tretinoin; b) Validation of the developed materials through a median grade among experts in the field (oncology and/or hematology pharmacists), using the Delphi Method, evaluating layout and content through a Likert scale. Data dispersion was assessed through the interquartile range (IQR), and adequate grade was defined as a median above 3. Results: The educational pamphlets were developed using national and international references, encompassing necessary information for the adequate and safe use of medications by patients. The initial validation involved 19 pharmacists specialized in oncology and/or hematology, spread across the national territory. In the first evaluation round, there was disagreement among experts on two issues, both related to the material’s content (highlighted sections and language used). After addressing points of disagreement, the pamphlets were validated by adequate grade among eight experts who remained in the study for the second round. Conclusion: It was possible to validate by experts the educational content of booklets containing written guidance on pharmacotherapy that will be delivered to the patient/caregiver, covering topics relevant to different medications, containing information with assertive scientific evidence, combining illustrations and language that is easy to understand by the population.

Introdução: O aumento da prevalência global de distúrbios cognitivos, incluindo o comprometimento cognitivo leve (CCL) e a demência, exige intervenções eficazes. Esta revisão da literatura examina o impacto da atividade física e do exercício em indivíduos com CCL e demência. Objetivo e método: Foi realizada uma pesquisa abrangente da literatura e uma revisão narrativa para explorar a influência da atividade física na saúde cognitiva, enfatizando mecanismos como o aumento do fluxo sanguíneo cerebral e fatores neurotróficos. Resultados e discussão: Os estudos revisados sugerem que a atividade física regular pode afetar positivamente a função cognitiva e pode servir como um componente valioso em estratégias abrangentes para a prevenção e o gerenciamento de distúrbios cognitivos. As evidências destacam o papel potencial da atividade física na redução do risco de demência e na diminuição do declínio cognitivo. Conclusão: A integração da atividade física e do exercício nas rotinas diárias e nas estratégias de saúde é fundamental para enfrentar o desafio crescente dos distúrbios cognitivos, potencialmente melhorando a qualidade de vida dos indivíduos afetados e reduzindo a carga social associada a eles.

Abstract Producers of fish have been looking for viable alternatives for the management of Colossoma macropomum (tambaqui) in confinement systems in order to avoid the harm and subsequent losses caused by parasitic diseases. One alternative used by farmers is pesticides, such as trichlorfon, which has a genotoxic effect. Thus, this study aimed to evaluate the changes in gene expression due to the side effects of trichlorfon in tambaqui. Two treatments were used based on LC50-96h of 0.870 mg/L using 30% and 50% trichlorfon with exposure periods of 48, 72 and 96 h. For differential expression of the genes in the liver, real-time PCR was performed for the AChE, GST, CYP2J6, CYP2C8, 18S and GAPDH genes. After 96 h of exposure to trichlorfon, an alteration in the gene expression profile of the antioxidant defense system (GST) of the tambaqui was observed. It was also observed that this organophosphate did not affect the expression of genes related to the isoenzymes that are responsible for the biotransformation of xenobiotics in phase I (2J6 and 2C8) and cholinesterase AChE. It was concluded that the reduction in gene expression of GST suggests a decrease in metabolization capacity in phase II.

IntroductionEnfortumab vedotin (EV) is an antibody drug conjugate approved for advanced urothelial cancer, consisting of a monomethyl auristatin E payload linked to a human monoclonal antibody targeting nectin-4. No validated biomarker predictive of or correlated with response exists for EV. Cutaneous toxicity is among the most common EV-related toxicities and typically emerges in early cycles. This retrospective experience of patients with urothelial cancer treated with EV monotherapy evaluated whether EV-related cutaneous toxicity correlated with improved outcomes including progression-free (PFS) and overall (OS) survival and overall response rate (ORR).Patients and methodsPatients treated with EV monotherapy at Johns Hopkins were identified, and baseline characteristics, treatment, and toxicity details were extracted through chart review. Univariable Cox hazard ratios (HRs) were calculated for assessing the effect of baseline patient characteristics and cutaneous toxicity in PFS and OS. Based on the univariable analysis and known risk factors, all subsequent analyses were adjusted for: Eastern Cooperative Oncology Group performance status, visceral metastases at baseline, gender as well as EV dose, and weight to account for dosing differences. Multivariable Cox proportional HRs were used for comparing PFS and OS between patients with and without cutaneous toxicity, assessing toxicity and EV dose as a time-dependent variables. Adjusted p-values were calculated to compare ORR and disease control rate (DCR) between groups using the Poisson regression model.ResultsOf the 78 patients analyzed, 42 (53.8%) experienced EV-related cutaneous toxicity that appeared early during treatment (median time to occurrence 0.5 months from EV initiation). Cutaneous toxicity correlated with significantly improved OS [HR, 0.48; 95% confidence interval (CI), 0.25, 0.9; P = 0.0235], ORR (68.3% vs. 20.7%, P = 0.0033) and DCR (82.9% vs. 48.3%, P = 0.0122). Median PFS was numerically longer in the cutaneous toxicity group (6.3 vs. 1.7 months), although no significance was achieved in the multivariable analysis (HR, 0.62; 95% CI: 0.35, 0.108; P = 0.0925).ConclusionIn this retrospective study, EV-related cutaneous toxicity was associated with improved patient outcomes. Confirming this observation and understanding its mechanism could lead to discovery of a new clinical biomarker of EV response that can emerge in the first cycle.

O presente artigo se caracteriza como uma pesquisa de campo, de caráter qualitativo e tem como objetivo principal apresentar um estudo de dois anos sobre como o ensino de Astronomia é ofertado na educação básica do município de São Borja, Rio Grande do Sul. Obrigatória nos documentos oficiais da educação brasileira, a Astronomia ainda é um tópico a ser descoberto pelos alunos da educação básica do Brasil, bem como, a inserção do debate nos cursos de formação inicial de professores-licenciaturas. A pesquisa se desenvolveu através de um questionário aplicado a treze professores do município da rede básica de ensino. Verificou-se que a temática “Astronomia” é praticamente inexiste nas escolas, principalmente, pela precária formação inicial dos professores de Ciências no que se refere aos tópicos relacionados ao assunto. Após a coleta de dados, os autores/pesquisadores decidiram optar pela construção de uma ferramenta pedagógica: o blog Divulga Astronomia. Ele tem como propósito ensinar Astronomia em sala de aula, subsidiando assim os professores da rede da educação básica a repensarem suas práticas docentes relacionadas ao ensino da Astronomia em sala de aula. Após a apresentação do blog nas escolas, verificou-se que esta ferramenta se constituiu como dinâmica e colaborativa ao auxiliar os professores a cumprirem as exigências mínimas contidas nos documentos legais da Base Nacional Comum Curricular (BNCC) do sistema educacional.

Este artigo debruça-se sobre Hadji Murat (1912), novela póstuma de Tolstói, em que o autor revisita o topus do Cáucaso e recria os últimos meses de vida do lendário herói da resistência. A leitura que se faz aqui desta obra singular, e das sucessivas revisões por que passou até chegar à sua forma definitiva, tem como ponto de partida a reflexão de Simone Weil sobre a Ilíada como um “poema da força”.

Objetivo: Correlacionar a alimentação emocional e a satisfação com a imagem corporal. Materiais e métodos: Estudo com abordagem quantitativa, de caráter transversal. Realizado com homens e mulheres, de 18 a 40 anos de idade. Foram usados os questionários Body Shape Questionnaire (BSQ) e o Questionário de Apetite Emocional (QUEAPEM), os quais abordam questões sobre satisfação corporal e comportamentos alimentares. Resultados: Participaram da pesquisa 142 indivíduos com prevalência de estado nutricional inadequado (53,5%) de acordo com o IMC. Encontrou-se que as mulheres apresentam maior apetite emocional relacionado às emoções negativas que os homens (p=0,011) e maior distorção na percepção da imagem corporal (p=0,000). Os participantes com IMC classificado como inadequado apresentaram maiores médias referentes ao BSQ (p=0,007). Conclusão: De modo geral, não foi encontrada forte correlação entre satisfação com a imagem corporal e a alimentação emocional. No entanto, a presença de alimentação emocional e a maior distorção da imagem corporal ocorreu em maior parte nas mulheres. E indivíduos com IMC inadequado apresentaram as maiores médias referentes a insatisfação corporal. Sugerindo que grupos específicos tendem a demostrar uma maior correlação entre apetite emocional e imagem corporal.

OBJECTIVES: evaluate the profile of children exposed intrauterine to HIV born in a tertiary hospital in southern Brazil, describe the prevalence of children classified as high risk and the rate of vertical transmission in this population. METODOLOGY: cross-sectional analytical-observational study. All HIV-exposed children born in 2019 and 2020 at the Clinical Hospital of the Federal University of Paraná were included. Data were collected from the hospitals operating systems, physical records and SISCEL. Study approved by the hospital ethics committee. RESULTS: 142 patients were included. Among the mothers, 26.06% had a detectable viral load in the last trimester, of which 54.05% were above 1000 copies; 37.32% were diagnosed during pregnancy; 40% of women who were diagnosed during pregnancy had a detectable viral load in the 3rd trimester (p=0.01). Of those who had a detectable viral load in the third trimester, 88.89% used ART irregularly or did not use (p < 0.01); 44.37% of newborns were classified as high risk by the current protocol in the period, while with the current new protocol would be 63.38%. The vertical transmission rate was 1.41%. There was 42.26% of loss of follow-up. CONCLUSION: the prevalence of vertical transmission was low, comparable to developed countries. Quality prenatal care, early diagnosis and adherence to ART are factors that modify the rates of vertical transmission of HIV due to the reduction of maternal viral load in the third trimester.

Abstract An increasing number of manuscripts related to digital and computational pathology are being submitted to The Journal of Pathology: Clinical Research as part of the continuous evolution from digital imaging and algorithm‐based digital pathology to computational pathology and artificial intelligence. However, despite these technological advances, tissue analysis still relies heavily on pathologists' annotations. There are three crucial elements to the pathologist's role during annotation tasks: granularity, time constraints, and responsibility for the interpretation of computational results. Granularity involves detailed annotations, including case level, regional, and cellular features; and integration of attributions from different sources. Time constraints due to pathologist shortages have led to the development of techniques to expedite annotation tasks from cell‐level attributions up to so‐called unsupervised learning. The impact of pathologists may seem diminished, but their role is crucial in providing ground truth and connecting pathological knowledge generation with computational advancements. Measures to display results back to pathologists and reflections about correctly applied diagnostic criteria are mandatory to maintain fidelity during human–machine interactions. Collaboration and iterative processes, such as human‐in‐the‐loop machine learning are key for continuous improvement, ensuring the pathologist's involvement in evaluating computational results and closing the loop for clinical applicability. The journal is interested particularly in the clinical diagnostic application of computational pathology and invites submissions that address the issues raised in this editorial.

O objetivo deste trabalho é analisar o emprego do “mas” como recurso atenuador na língua brasileira de sinais (Libras) em conversações entre pessoas surdas. O aporte teórico está fundamentado em Quadros (2006, 2015, 2016, 2017, 2019), Quadros e Karnopp (2004), Góes e Campos (2021), Gesser (2012), Leite (2008, 2013), Mccleary e Viotti (2007, 2011), Brito (1995), Negreiros e Barros (2017), Rosa (1992), Galembeck (1999) e Urbano (1998), entre outros. O corpus desta pesquisa é formado por vídeos disponíveis na internet pelo projeto da Universidade Federal de Santa Catarina denominado Corpus de Libras. De acordo com os resultados, a partícula “mas” auxilia o sinalizante na arquitetura dos enunciados, servindo como um anúncio, uma espécie de preparação que atenua, por antecipação, o conteúdo do que será expresso.

ABSTRACT A meta-analysis was employed to assess the effects of phytogenic feed additives and antibiotics on the performance and intestinal morphometry of unchallenged weanling pigs. The database included 41 articles published between 2004 and 2017, comprising 5,197 unchallenged nursery piglets. Piglets had 7.7 to 13.8 kg body weight and were assessed at 27.3 to 47.8 days of age, distributed into 156 experimental groups. All treatments were categorized into negative control, phytogenic additive (PA), and antibiotics (ATB) groups. The meta-analysis followed two sequential analyses: graphical and variance-covariance. Age and body weight were the factors that highly influenced the model. Piglets that received antibiotics had a higher (12.2%) daily weight gain than piglets in the control group. Phytogenic additives in diets enhanced intestinal morphometry in unchallenged piglets. Antibiotics increased (by 12.7%) the crypt depth of jejunum in comparison to the control treatment. Animals on PA had an 11.1% increment in villus height:crypt depth ratio than those on antibiotics. Phytogenic additives and antibiotics boost nursery piglet performance. Antibiotics advances the performance of unchallenged nursery piglets, but increases crypt depth in the jejunum. Performance of nursery piglets is better with combined phytogenic additives than with the isolated use of plant extracts.

Conclusions: WES found potentially deleterious rare variants in MODY genes in 8.1% of EOT1D, occurring in the context of a T1D genetic background. Such genetic variants may contribute to disease precipitation by a β-cell dysfunction mechanism. This supports the concept of different endotypes of T1D, and WES at T1D onset may be a prerequisite for the implementation of precision therapies in children with autoimmune diabetes.

Background. Ageing is associated with structural changes in brain regions and functional decline in cognitive domains. Noninvasive tools for identifying structural damage in the brains of older adults are relevant for early treatment. Aims. This study aims to evaluate and compare the accuracy of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA©) in identifying gray and white matter brain damage in older individuals with varying degrees of cognitive impairment. Methods. Ninety older adults (62 women) with an average age of 69 ± 7 years were enrolled and categorized as having no cognitive impairment (NCI), mild cognitive impairment (MCI), or moderate cognitive impairment (MoCI). Magnetic resonance imaging (MRI) was utilized to assess the number, volume, and distribution of brain damage. The Fazekas and Scheltens scales were applied to the brain MRIs, and inferential statistics were employed to compare variables among the groups. Results. Cognitive impairment was observed in 56.7% of the participants (95% confidence interval (CI): 46.4–66.4%), with thirty-six older adults (40%) classified as MCI and 15 (17%) as MoCI. Cognitive impairment and medial temporal lobe (MTL) atrophy were found to be associated (p=0.001), exhibiting higher mean volume scales of the MTL atrophied area in the MoCI group (p

IntroductionEarly-onset Type 1 diabetes (EOT1D) is considered a disease subtype with distinctive immunological and clinical features. While both Human Leukocyte Antigen (HLA) and non-HLA variants contribute to age at T1D diagnosis, detailed analyses of EOT1D-specific genetic determinants are still lacking. This study scrutinized the involvement of the HLA class II locus in EOT1D genetic control.MethodsWe conducted genetic association and regularized logistic regression analyses to evaluate genotypic, haplotypic and allelic variants in DRB1, DQA1 and DQB1 genes in children with EOT1D (diagnosed at ≤5 years of age; n=97), individuals with later-onset disease (LaOT1D; diagnosed 8-30 years of age; n=96) and nondiabetic control subjects (n=169), in the Portuguese population. ResultsAllelic association analysis of EOT1D and LaOT1D unrelated patients in comparison with controls, revealed that the rare DRB1*04:08 allele is a distinctive EOT1D susceptibility factor (corrected p-value=7.0x10-7). Conversely, the classical T1D risk allele DRB1*04:05 was absent in EOT1D children while was associated with LaOT1D (corrected p-value=1.4x10-2). In corroboration, HLA class II haplotype analysis showed that the rare DRB1*04:08-DQ8 haplotype is specifically associated with EOT1D (corrected p-value=1.4x10-5) and represents the major HLA class II genetic driver and discriminative factor in the development of early onset disease.DiscussionThis study uncovered that EOT1D holds a distinctive spectrum of HLA class II susceptibility loci, which includes risk factors overlapping with LaOT1D and discriminative genetic configurations. These findings warrant replication studies in larger multicentric settings encompassing other ethnicities and may impact target screening strategies and follow-up of young children with high T1D genetic risk as well as personalized therapeutic approaches.

The relevance of the quality of parent-child interactions for child development has long been established. Nevertheless, research on beliefs about maternal sensitivity is still scarce, to an even greater extent in the context of child disability. This inquiry aimed to describe beliefs about sensitive parenting among mothers of children with developmental disabilities and to examine how those beliefs relate to sociodemographic factors and perceived stress. Participants included 40 mothers with a child up to 7 years of age with a developmental disability. Mothers reported on sociodemographic factors and daily hassles and sorted an adapted version of the Maternal Behavior Q-Sort. Results revealed a strong convergence between maternal beliefs about the ideal mother and the attachment theory's concept of sensitivity. Daily hassles predicted beliefs about the ideal mother. These results underline the importance of implementing interventions in the context of child disability aimed at reducing parental stress.

Objetivo: Analisar a relação entre os Problemas Relacionados a Medicamentos (PRM) e os medicamentos identificados no processo de revisão da farmacoterapia (RF) de um hospital universitário. Método: Trata-se de um estudo observacional retrospectivo e transversal. Os registros de PRM do período do estudo (2019-2020) foram coletados de um banco de dados de RF hospitalar e classificados conforme a Pharmaceutical Care Network Europe (PCNE). Em seguida, um painel de especialistas (farmacêuticos e médicos) analisou a significância clínica do PRM incluído, em formulário online, com base no Hazard Scoring Matrix (HSM). Utilizando o software Gephi foram construídas duas redes para visualização da relação entre os PRM e os medicamentos nas seguintes perspectivas: (i) dos farmacêuticos do hospital; e (ii) do painel de especialistas. Resultados: 1250 PRM relacionados a 177 medicamentos diferentes foram incluídos e compilados em 202 combinações diferentes de “PRM-medicamento”. Pelo PCNE 41,6% dos PRM foram classificados como classe C1 (seleção do medicamento), 20,32% como C5 (dispensação) e 13,76% da classe C3 (seleção de dose). Pelo painel de especialistas, a combinação de “seleção de dose- antibiótico” foi a que apresentou maior risco na análise global e de farmacêuticos. Para os médicos, a combinação “monitoramento - anticoagulantes antagonistas de vitamina K” foi classificada com o maior risco. Em contrapartida, a combinação “seleção do medicamento- antiulcerosos”, que foi a mais encontrada na base de dados foi classificada pelos especialistas com escore de risco baixo (HSM 6). Conclusão: A significância das combinações “PRM-medicamento” foi diferente quando comparados os resultados pré e pós análise de risco. Assim, demonstrou-se que o HSM pode ser uma ferramenta útil para melhorar a avaliação do PRM e padronizar os serviços de RF, orientando os farmacêuticos para situações de maior significância clínica e aumentando sua eficácia na melhoria dos resultados de saúde.