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The present study has had as survey question the modalities of assistance of health institutions from the National Health System (SUS) and their interrelations. So, it has been objectified to identify the different modalities of assistance for the client from SUS offered by institutions/organizations and health services in the municipal district of Rio Grande, understand the relations which they have, and the way that has been processed their interrelations in the health services and health actions. It has been built a theorical referential to support the development of the survey, by the perspective of health as a system, and having as a reference the theory of systems with approach by Bronfenbrenner (l996), among others. To obtain information it has been used as methodological way the qualitative survey, descriptive, and explanatory. The collect of data was obtained from the method of semistructured interview being developed from August to September of 2006, with fourteen subjects: coordinators of several services to provide entrance and routing for the clients from SUS in the municipal district of Rio Grande. The last question of the interview has been left opened, creating an opportunity for the interviewees to give pertinent suggestions. The process of analysis has taken into account the categories previously established: modalities of assistance, multi-professional team and interrelations between modalities of assistance. It has been evidenced, during the analysis and interpretation of data, the different modalities of assistance offered to the users of SUS, showing that each one presents its own peculiarities and the unknowledgement of others, and maybe this is the reason for not offering them, because they could help in the offer of more actions and services to this group of clients, bringing solutions for the repressed demand and reducing the cost of hospitalizations. It has been noticed the constant presence of the multi-professional team as a fundamental element in the execution of actions and services, standing out the strong participation of the nurses. Although it has been initially presupposed that the institutions/ organizations/ services offer the modalities in a disarticulated way, it has been noticed during the development of this work, that it does not happen this way. In the three health institutions there is a great effort by workers to get the routing of the clients for exams and for a possible hospitalization or for another kind of assistance to be offered by the institutions which integrate SUS. It has been evidenced, however, that there are not formal and computerized articulations, of reference and counter-reference that could facilitate the interrelations between the services of SUS. [ABSTRACT FROM AUTHOR]

The lack of synthesized information regarding biodiversity is a major problem among researchers, leading to a pervasive cycle where ecologists make field campaigns to collect information that already exists and yet has not been made available for a broader audience. This problem leads to long-lasting effects in public policies such as spending money multiple times to conduct similar studies in the same area. We aim to identify this knowledge gap by synthesizing information available regarding two Brazilian long-term biodiversity programs and the metadata generated by them. Using a unique dataset containing 1904 metadata, we identified patterns of metadata distribution and intensity of research conducted in Brazil, as well as where we should concentrate research efforts in the next decades. We found that the majority of metadata were about vertebrates, followed by plants, invertebrates, and fungi. Caatinga was the biome with least metadata, and that there's still a lack of information regarding all biomes in Brazil, with none of them being sufficiently sampled. We hope that these results will have implications for broader conservation and management guiding, as well as to funding allocation programs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: To identify the risk factors for the nursing diagnosis of fall risk in adults (00303) in elderly people in the community-dwelling., Method: This is a methodological study, with a quantitative approach, carried out with elderly people living in the city of Ribeirão Preto, SP, Brazil, from February to December 2018. For data collection, the demographic profile, Mini-Mental State Examination, diseases self-reported, functional independence measure, Lawton and Brody scale, geriatric depression scale, and self-perception of gait instruments were used. Tests of accuracy and association of risk factors with p ≤ 0.05 were performed., Findings: A total of 262 elderly people, aged over 80 years (55.7%), 71% of which were female and 42.7% were widowed, were included in the sample. A total of 82.1% had vascular diseases, 72.1% had diabetes, and 20.6% had depression. The predominant risk factors were difficulty performing instrumental activities of daily living (58.8%), cognitive dysfunction (43.5%), and depressive symptoms (26.3%). Difficulty performing instrumental activities of daily living had a sensitivity greater than 60%. The positive and negative predictive values were mostly greater than 50%. In the regression analysis, it was found that the elderly have a higher risk of suffering a fall if they present anxiety (p = 0.05), impaired physical mobility (p = 0.02), and difficulty to perform instrumental activities of daily living as risk factors (p = 0.03)., Conclusion: It was possible to identify the presence of risk factors for the diagnosis fall risk in adults (00303) in the clinical context of the elderly in home settings and contribute to the clinical validation of the taxonomy, increase the evidence and importance of the diagnosis, and generate new knowledge for gerontological nursing., Implications for Nursing Practice: To help nurses identify risk factors that lead elderly people to suffer falls at home and to implement preventive actions in their community with the support of their families., (© 2024 NANDA International, Inc.)

Infection and clinical cases of leishmaniasis caused by Leishmania infantum in cats have been increasingly reported in several countries, including Brazil. In this study, we used an enzyme-linked immunosorbent assay (ELISA) and an immunochromatographic test (ICT) based on a recombinant antigen (rKDDR-plus) to detect anti-Leishmania antibodies in cats from an animal shelter in northeastern Brazil. We compared the results with an ELISA using L. infantum crude antigen (ELISA-CA). We also investigated the presence of Leishmania DNA in blood or ocular conjunctival samples as well as the association between Leishmania PCR positivity and serological positivity to feline immunodeficiency virus (FIV), feline leukemia virus (FeLV) and Toxoplasma gondii. Concerning serological assays, a higher positivity was detected using the ICT-rKDDR-plus (7.5%; 7/93) as compared to ELISA-rKDDR-plus (5.4%; 5/93) and ELISA-CA (4.3%; 4/93). Upon PCR testing, 52.7% (49/93) of the ocular conjunctival swabs and 48.3% (44/91) of the blood samples were positive. Together, PCR and serological testing revealed overall positivities of 73.1% (68/93) and 12.9% (12/93), respectively. Among PCR-positive samples, 45.5% (31/68) showed co-infection with FIV, 17.6% (12/68) with FeLV, and 82.3% (56/68) with T. gondii. More than half of the PCR-positive cats showed at least one clinical sign suggestive of leishmaniasis (58.8%; 40/68) and dermatological signs were the most frequent ones (45.5%; 31/68). Both tests employing the recombinant antigen rKDDR-plus (i.e., ICT-rKDDR-plus and ELISA-rKDDR-plus) detected more positive cats than the ELISA-CA but presented low overall accuracy. PCR testing using either blood or ocular conjunctival samples detected much more positive cats than serological tests., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: This study comprehensively analyzed the temporal and spatial dynamics of COVID-19 cases and deaths within the obstetric population in Brazil, comparing the periods before and during mass COVID-19 vaccination. We explored the trends and geographical patterns of COVID-19 cases and maternal deaths over time. We also examined their correlation with the SARS-CoV-2 variant circulating and the social determinants of health., Study Design: This is a nationwide population-based ecological study., Methods: We obtained data on COVID-19 cases, deaths, socioeconomic status, and vulnerability information for Brazil's 5570 municipalities for both the pre-COVID-19 vaccination and COVID-19 vaccination periods. A Bayesian model was used to mitigate indicator fluctuations. The spatial correlation of maternal cases and fatalities with socioeconomic and vulnerability indicators was assessed using bivariate Moran., Results: From March 2020 to June 2023, a total of 23,823 cases and 1991 maternal fatalities were recorded among pregnant and postpartum women. The temporal trends in maternal incidence and mortality rates fluctuated over the study period, largely influenced by widespread COVID-19 vaccination and the dominant SARS-CoV-2 variant. There was a significant reduction in maternal mortality due to COVID-19 following the introduction of vaccination. The geographical distribution of COVID-19 cases and maternal deaths exhibited marked heterogeneity in both periods, with distinct spatial clusters predominantly observed in the North, Northeast, and Central West regions. Municipalities with the highest Human Development Index reported the highest incidence rates, while those with the highest levels of social vulnerability exhibited elevated mortality and fatality rates., Conclusion: Despite the circulation of highly transmissible variants of concern, maternal mortality due to COVID-19 was significantly reduced following the mass vaccination. There was a heterogeneous distribution of cases and fatalities in both periods (before and during mass vaccination). Smaller municipalities and those grappling with social vulnerability issues experienced the highest rates of maternal mortality and fatalities., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objective: To map home-based educational interventions for family caregivers of older adults after stroke., Method: Scoping review based on the JBI methodology, carried out on May 23, 2023. The Rayyan application and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews were used., Results: Of the 1,705 studies, nine published from 2006 to 2020 were included: 44% of interventions were theoretical-practical educational; 77.7% were randomized clinical trials; and the "in-person" intervention (56%) was the most common, carried out by nurses in 88.9% of cases. Three to 15 42-minute sessions were carried out. The educational contents were organized into ten categories, divided into education aimed at caring for older adults and self-care for caregivers., Conclusion: Identified educational interventions strengthen participants' knowledge and skills in areas such as education, care, communication, self-management, rehabilitation and nutrition as well as self-care to safely assist older adults in their activities of daily living.

Objective: The objective of this study was to evaluate the relationship between quality of life, perceived stress, anxiety, and depression in medical students and the university teaching method: traditional method versus active methodology., Methods: Four questionnaires were administered to volunteer students (n=361) enrolled in two institutions that employ active (Universidade Tiradentes) or traditional (Faculdade de Medicina do ABC) teaching methodology: socioeconomic level; brief quality of life (World Health Organization Quality of Life-Bref); perceived stress scale (PSS10); and depression and anxiety scale (hospital anxiety and depression scale)., Results: Of the students who responded to the questionnaires (226 UNIT and 135 FMABC), 70% were female and 67% were White. The majority did not use medication for depression (90%), anxiety (81%), and stress management (91%). Regarding anxiety, it was found: absence in the traditional method and moderate anxiety in the active methodology (26% UNIT×13% FMABC) (p<0.001). Regarding quality of life, it was found to be better quality of life in the environment domain at FMABC (78.12%) versus 71.88% at the UNIT (p<0.001). There was no difference between the institutions in relation to depression and perceived stress, and in quality of lifethere was only a difference in the environmental domain (p<0.001). In relation to gender, stress was higher in females (93.7%) than males (79.6%) with p<0.001., Conclusion: Differences were recorded between the groups regarding anxiety, with a predominance in UNIT students (active methodology), and no differences were recorded in relation to depression, perceived stress, and quality of life in all domains, except for the environment domain, which was higher in the traditional methodology, although about one-third of participants used medication for anxiety/depression.

This study comprehensively analyzed cases of scorpion envenomation in Brazil, exploring the temporal trends and geographic patterns of such incidents between January 1, 2012, and December 31, 2022. Simultaneously, we assessed the correlation between scorpion envenomation and social determinants of health and social vulnerability. We conducted a population-based ecological study, gathering information on the number of scorpion envenomation cases in Brazil, as well as socioeconomic data and social vulnerability indicators across the 5,570 Brazilian municipalities. The season-trend model, based on the classical additive decomposition method, informed estimations of scorpion envenomation variations over time. The spatial correlation of scorpion envenomation with socioeconomic and vulnerability indicators was assessed using the Bivariate Moran's I. A total of 1,343,224 cases of scorpion envenomation were recorded in Brazil from Jan 2012 to Dec 2022. A single increasing time trend was observed for the entire country for this period (APC 8.94, P < 0.001). The seasonal analysis was significant for Brazil as a whole and all regions (p < 0.001), with peaks evident between October and November. The spatial distribution of cases was heterogeneous, with spatial clusters concentrated in the high-risk Southeast and Northeast regions. There was a high incidence of scorpion envenomation in municipalities facing social vulnerability, and, paradoxically, in those with better sanitation and waste collection. Our study revealed a heterogeneous geographical distribution of scorpion accidents in Brazil. Municipalities with higher social vulnerability exhibited a high incidence of scorpion envenomation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The sugarcane billbug, Sphenophorus levis Vaurie 1978, is a key soil-dwelling insect pest of sugarcane in Brazil and greatly affects plant development and yield. This insect presents an aggregated distribution pattern in production fields. The reasons for such behavior include intraspecific communication and attractivity due to the fermentation of sugar in stalk residues. During mechanized harvesting, part of the harvested material usually falls in the load transfer sites, becoming a potential source for increasing the infestation. We therefore evaluated whether producing areas near the harvest load transfer sites are more prone to S. levis injury., Results: There are greater chances of finding billbug injury within a radius of 740 m from the harvest load transfer site. Additionally, injured areas are estimated to expand 11.96% each growing season. Our spatiotemporal models support higher injured areas surrounding the harvest load transfer site and show clear and significant signs of increased injury levels compared to the initial growing season surveyed., Conclusion: Our results reinforce the importance of harvest transfer sites in the dispersion and propagation of the sugarcane billbug. Based on this knowledge, sugarcane millers and growers can adopt preventive and remedial practices within the loading sites that can potentially contribute to the successful management of this insect pest. © 2023 Society of Chemical Industry., (© 2023 Society of Chemical Industry.)

Objective: to map scientific knowledge on nursing students' attitudes and perceptions regarding ageism., Method: scoping review according to the recommendations of the Joanna Briggs Institute. The study question was: What are scientific evidence available on the attitudes and perceptions of nursing students regarding ageism? The search was conducted in 12 databases using the Rayyan application and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The studies were selected by two reviewers using a data extraction tool., Results: of the 4,595 files, 46 that were published between 1984 and 2022 were selected, and the quantitative method was the most used. The most commonly used instrument was the Kogan's Attitudes Toward Old People Scale. Positive, negative, mixed, neutral, and inconclusive attitudes and perceptions were identified., Conclusion: attitudes and perceptions about ageism are diverse and not conclusive. Future intervention studies are recommended to detect changes in the behavior of nursing students in the face of ageism., Background: (1) Attitudes and perceptions about ageism are diverse and not conclusive., Background: (2) Importance of discussing ageism in the training of nursing students., Background: (3) Intervention studies to identify paradigm shifts in nursing students.

Sporothrix brasiliensis is the most pathogenic species, responsible for the Brazilian cat-transmitted sporotrichosis hyperendemic. In this scenario, an investigation of the pathogen-host interaction can provide relevant information for future treatment strategies. To this end, the invertebrate Galleria mellonella has proven to be a suitable alternative for evaluating the virulence of pathogenic fungi, since the insect immune system is similar to the mammalian innate immune response. The aim of this work was to investigate phenotypic and molecular aspects of the immune response of G. mellonella throughout the S. brasiliensis infection. Hemocyte density and the evolution of the fungal load were evaluated. In parallel, RT-qPCR expression analysis of genes encoding antimicrobial peptides ( Gallerimycin and Galiomycin ) and stress management genes ( C7 Contig 15362 and C8 Contig 19101 ) was conducted. The fungal load and hemocyte densities increased simultaneously and proportionally to the deleterious morphological events and larvae mortality. Gallerimycin , C7 Contig 15362 and C8 Contig 19101 genes were positively regulated (p < 0.05) at distinct moments of S. brasiliensis infection, characterizing a time-dependent and alternately modulated profile. Galiomycin gene expression remained unchanged. Our results contribute to the future proposal of potential alternative pathways for treating and consequently controlling S. brasiliensis zoonosis, a major public health issue in Latin America.

Background: The immunopathology during malaria depends on the level of inflammatory response generated. In this scenario, the TREM-1 has been associated with the severity of infectious diseases and could play an important role in the inflammatory course of malaria. We aimed to describe the allelic and genotypic frequency of four polymorphisms in the trem-1 gene in Plasmodium vivax-infected patients and to verify the association of these polymorphisms with clinical and immunological factors in a frontier area of the Brazilian Amazon., Methods: We included 76 individuals infected with P. vivax and 144 healthy controls living in the municipality of Oiapoque, Amapá, Brazil. The levels of TNF-α, IL-10, IL-2, IL-4, IL-5, and IFN-γ were measured by flow cytometry, while IL-6, sTREM-1, and antibodies against PvMSP-1 19 were evaluated by ELISA. The SNPs were genotyped by qPCR technique. Polymorphisms analysis, allelic and genotype, frequencies, and HWE calculation were determined by x 2 test in R Software. The association between the parasitemia, gametocytes, antibodies, cytokines, and sTREM-1 with the genotypes of malaria and control groups was performed using the Kruskal-Wallis test, these analyzes were conducted in SPSS Software, at 5% significance level., Results: All SNPs were successfully genotyped. Allelic and genotypic distribution was in Hardy-Weinberg Equilibrium. Furthermore, several associations were identified between malaria and control groups, with increased levels of IL-5, IL-6, IL-10, TNF-α, and IFN-γ in the infected individuals with rs6910730A, rs2234237T, rs2234246T, rs4711668C alleles compared to the homozygous wild-type and heterozygous genotypes of the controls (p-value < 0.05). No association was found for these SNPs and the levels of IL-2, and sTREM-1., Conclusions: The SNPs on the trem-1 gene are associated with the effector molecules of the innate immunity and may contribute to the identification and effective participation of trem-1 in the modulation of the immune response. This association may be essential for the establishment of immunization strategies against malaria., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The COVID-19 pandemic received widespread media coverage due to its novelty, an early lack of data, and the rapid rise in deaths and cases. This excessive coverage created a secondary "infodemic" that was considered to be a serious public and mental health problem by the World Health Organization and the international scientific community. The infodemic particularly affected older individuals, specifically those who are vulnerable to misinformation due to political positions, low interpretive and critical analysis capacity, and limited technical-scientific knowledge. Thus, it is important to understand older people's reaction to COVID-19 information disseminated by the media and the effect on their lives and mental health., Objective: We aimed to describe the profile of exposure to COVID-19 information among older Brazilian individuals and the impact on their mental health, perceived stress, and the presence of generalized anxiety disorder (GAD)., Methods: This cross-sectional, exploratory study surveyed 3307 older Brazilians via the web, social networks, and email between July 2020 and March 2021. Descriptive analysis and bivariate analysis were performed to estimate associations of interest., Results: Major proportions of the 3307 participants were aged 60 to 64 years (n=1285, 38.9%), female (n=2250, 68.4%), and married (n=1835, 55.5%) and self-identified as White (n=2364, 71.5%). Only 295 (8.9%) had never started or completed a basic education. COVID-19 information was mainly accessed on television (n=2680, 81.1%) and social networks (n=1943, 58.8%). Television exposure was ≥3 hours in 1301 (39.3%) participants, social network use was 2 to 5 hours in 1084 (32.8%) participants, and radio exposure was ≥1 hour in 1223 (37%) participants. Frequency of exposure to social networks was significantly associated with perceived stress (P=.04) and GAD (P=.01). A Bonferroni post hoc test revealed significantly different perceived stress in participants who were exposed to social networks for 1 hour (P=.04) and those who had no exposure (P=.04). A crude linear regression showed that "some" social media use (P=.02) and 1 hour of exposure to social media (P<.001) were associated with perceived stress. Adjusting for sociodemographic variables revealed no associations with this outcome variable. In a crude logistic regression, some social media use (P<.001) and 2 to 5 hours of exposure to social media (P=.03) were associated with GAD. Adjusting for the indicated variables showed that some social network use (P<.001) and 1 hour (P=.04) and 2 to 5 hours (P=.03) of exposure to social media were associated with GAD., Conclusions: Older people, especially women, were often exposed to COVID-19-related information through television and social networks; this affected their mental health, specifically GAD and stress. Thus, the impact of the infodemic should be considered during anamnesis for older people, so that they can share their feelings about it and receive appropriate psychosocial care., (©Patricia Rodrigues Braz, Tiago Ricardo Moreira, Andréia Queiroz Ribeiro, Luciane Ribeiro de Faria, Fabio da Costa Carbogim, Vilanice Alves de Araújo Püschel, Jack Roberto Silva Fhon, Eduarda Rezende Freitas, Ione Carvalho Pinto, Fabiana Costa Machado Zacharias, Gylce Eloisa Cabreira Panitz Cruz, Richardson Miranda Machado, Rosimere Ferreira Santana, Priscilla Alfradique de Souza, Graziele Ribeiro Bitencourt, Alexandre Favero Bulgarelli, Ricardo Bezerra Cavalcante. Originally published in JMIR Aging (https://aging.jmir.org), 17.05.2023.)

With the aging process, elderly people present changes in their bodies that can lead them to suffer several geriatric syndromes. The present study aimed to analyze and synthesize the literature produced concerning the association of sarcopenia with falls in elderly people with cognitive impairment. This is a systematic review study on etiology and risk, conducted according to the JBI methodology using the Medline (Pubmed), Cinahl, Embase, Scopus, and Web of Science databases. The gray literature search was conducted in the CAPES Brazilian Digital Library of Theses and Dissertations, Google Scholar, Networked Digital Library of Theses and Dissertations (NDLTD), EBSCO Open Dissertations, DART-e, and ACS Guide to Scholarly Communication. The identification of the association between the variables was extracted from the articles themselves (Odds Ratio and the 95% Confidence Intervals). Four articles published between 2012 and 2021 were included in this review. A prevalence of falls was identified, ranging from 14.2% to 23.1%, of cognitive impairment ranging from 24.1% to 60.8%, and of sarcopenia ranging from 6.1 to 26.6%. The meta-analysis found that elderly people with cognitive impairment who suffer falls are at a 1.88 times greater risk of presenting sarcopenia ( p = 0.01). There is evidence of an association between the variables, but it is necessary to conduct follow-up studies to support this association as well as other factors that may influence the senescence and senility process.

Schistosomiasis is a neglected tropical disease (NTD) caused by blood flukes from the genus Schistosoma. Brazil hosts the main endemic area in the Americas, where Schistosoma mansoni is the only species causing the disease. Kato-Katz (KK) thick smear is the WHO recommended screening test for populational studies, but there is growing evidence for the sensitivity limitations associated with KK, especially in areas with low parasite loads. Helmintex (HTX) is another highly sensitive egg-detection method, based on the magnetic properties of S. mansoni eggs and their isolation in a magnetic field. The objective of this study is to evaluate both KK and HTX in a moderate endemic locality, Areia Branca, located in the municipality of Pacatuba, in the state of Sergipe in northeastern Brazil. From 234 individual fecal samples, two KK thick smears were prepared and evaluated for each sample. Similarly, 30 g of each fecal sample was processed by HTX protocol. Eggs were detected in 80 (34.18%) residents. Twenty-three (9.83%) samples were positive for eggs (only by KK), and 77 (32.91%) samples showed positive for eggs (only by HTX). Sensitivity, specificity, and accuracy estimates gave values of 28.75%, 100% and 75.64%, respectively, for KK, and 96.25%, 100% and 98.72% respectively, for HTX. The positive predictive value was 100% for both methods, while the negative predictive value was 72.99% for KK and 98.09% for HTX. Overall, HTX presented a superior performance compared to the one sample, two slides KK examination. The study confirms the role of HTX as a reference method for the definition of true-positive samples in comparative accuracy studies and its potential role in the late stages when the certification of schistosomiasis transmission interruption is required. Diagnostic tests are important tools for the elimination of this NTD, besides the effective implementation of safe water, basic sanitation, snail control, and the treatment of infected populations.

We analyzed the knowledge, attitudes and practices (KAP) of schistosomiasis mansoni prevention in an endemic area of Brazil. This cross-sectional study was conducted between March and May 2021, with 412 participants living in the municipality of Feira Grande, Alagoas, Brazil. Data collection occurred through visits to the Health Center Urbano II and Massapê, through an interview with a structured questionnaire to identify the levels of KAP regarding schistosomiasis prevention. Of all respondents, 70.87% lived in rural areas, 22.66% reported a history of past schistosomiasis and 52.71% never participated in schistosomiasis control program actions. Factors associated with better KAP scores were being part of an older age group, not using rainwater and having no history of past schistosomiasis. Specifically, among the domains, attitude was the highest score and knowledge was the lowest. Participation in a health intervention program, knowing someone who had schistosomiasis and having been informed through a public health program seemed to have an important impact on the population's KAP. Our results contributed to broadening perceptions about schistosomiasis prevention, highlighting the positive impacts that health programs and interventions have on disease control.

Objective: This study aimed to investigate the spatial clusters of high and low COVID-19 vaccination rates among children and adolescents across Brazilian municipalities and their relationship to social determinants of health., Study Design: This is a nationwide population-based ecological study., Methods: We have obtained for each of the 5570 Brazilian municipalities data on the COVID-19 vaccination rate of children and adolescents by August 16, 2022, the Gini index, the social vulnerability index and the municipal human development index. A Bayesian empirical local model was used to identify fluctuations in the COVID-19 vaccination rates. Spatial clusters were identified using scan spatial statistic tests. The relationship among COVID-19 vaccination rates and social determinants of health was explored by using multiple linear regression models., Results: Overall, 52.1% of children aged 5-11 years and 72.8% of adolescents aged 12-17 years have been fully vaccinated against COVID-19 in Brazil by mid-August 2022. There was spatial dependence on the smoothed rates for both children (I Moran 0.66; P < 0.001) and adolescent (I Moran 0.65; P < 0.001) groups. The lowest rates occurred in municipalities in the North and Northeast regions. Municipalities with a higher Gini Index, higher social vulnerability index and lower municipal human development index were more likely to have a lower COVID-19 vaccination rate for both children and adolescent groups., Conclusion: COVID-19 vaccination of children and adolescents was heterogeneously distributed, with spatial clusters of the lowest vaccination rates occurring mainly in municipalities with marked socio-economic disparities and social vulnerability, especially in the North and Northeast regions., (Copyright © 2022 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

During the pandemic, the elderly population was the most exposed to disease and changes in their daily lives. The objective was to determine the association between demographic factors, access to health services, sources of information, and physical symptoms in the mental health of the elderly during the COVID-19 pandemic-a study with 3828 older adults residing in nine cities in Peru. The data was collected using a web-based survey, and the instruments of demographic data; exposure to information (radio, television, and internet); and presence of physical symptoms, anxiety, and perceived stress were used. Descriptive and analytical analysis was performed. Female sex, those aged between 60 and 79 years old, those with secondary education, those in their own home, those residing in an urban area, and those using public services of health predominated in this study. Likewise, 62.9% presented depressive symptoms; on the stress scale, an average of 27.81 (SD = 8.71), and on the anxiety scale, an average of 27.24 (SD = 6.04). Moreover, 65.1% reported fatigue, 62.2% had a headache, and 61.2% lack of energy. There is an association between demographic variables and the physical and psychological symptoms of stress, anxiety, and depressive symptoms in the elderly during the pandemic.

Population aging challenges healthcare systems, requiring gerontological advanced practice nurses (GAPN) to address specific and complex care requirements of older adults. GAPN implement evidence-based practices directed to patients and families, focusing on health promotion and protection, disease prevention, recovery, and rehabilitation. In competence-based gerontological advanced practice, comprehensive geriatric assessment is essential for implementing the care plan. In this theoretical essay we reflect about the role of assessment in competence-based advanced nursing practice directed to the care of older adults. From our perspective, geriatric assessment for a high-quality practice must be comprehensive, multidimensional, interdisciplinary, and planned. GAPN must have solid competencies for clinical skills and caring practices; education for health literacy; collaborative care; system management for continuity of care; ethics, advocacy, and moral agency; and evidenced-based practice inquiry. Gerontological models of care and GAPN competencies serve as frameworks to guide practice while assessment is fundamental for providing age-friendly care to older adults.

Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Published by Elsevier Inc.)

Background: Data regarding the geographical distribution of cases and risk factors for COVID-19 death in children and adolescents are scarce. We describe the spatial distribution of COVID-19 cases and deaths in paediatric population and their association with social determinants of health in Brazil., Methods: This is a population-based ecological study with a spatial analysis of all cases and deaths due to COVID-19 in Brazil among children and adolescents aged 0-19 years from March 2020 to October 2021. The units of analysis were the 5570 municipalities. Data on COVID-19 cases and deaths, social vulnerability, health inequities, and health system capacity were obtained from publicly available databases. Municipalities were stratified from low to very high COVID-19 incidence and mortality using K-means clustering procedures, and spatial clusters and relative risks were estimated using spatial statistics with Poisson probability models. The relationship between COVID-19 estimates and social determinants of health was explored by using multivariate Beta regression techniques., Findings: A total of 33,991 COVID-19 cases and 2424 deaths among children and adolescents aged 0-19 years were recorded from March 2020 to October 2021. There was a spatial dependence for the crude mortality coefficient per 100,000 population in the paediatric population aged 0-19 years (I Moran 0·10; P < 0·001). Forty municipalities had higher mortality rates, of which 20 were in states from the Northeast region. Seven spatial clusters were identified for COVID-19 mortality, with four clusters in the Northeast region and three in the North region. Municipalities with higher social inequality and vulnerability had higher COVID-19 mortality in the paediatric population., Interpretation: The main clusters of risk for mortality among children and adolescents were identified in municipalities in the North and Northeast regions, which are the regions with the worst socioeconomic indicators and greatest health disparities in the country. Our findings confirmed the higher burden of COVID-19 for Brazilian paediatric population in municipalities with higher social inequality and vulnerability and worse socioeconomic indicators. To reduce the burden of COVID-19 on children, mass immunisation is necessary., Funding: None., Competing Interests: The authors declare that there is no conflict of interest., (© 2022 The Author(s).)

Objective: To characterize and identify depressive symptoms, anxiety, and stress associated with the COVID-19 Infodemic in the elderly from São Paulo., Method: Exploratory and cross-sectional study with the elderly in the capital of São Paulo who had internet access. The sociodemographic profile, the COVID-19 infodemic, depressive symptoms, stress, and anxiety were analyzed., Results: A total of 411 older people participated in the study. There was a predominance of women (76.4%), with higher education (57.9%), using private health services, and with little income variation. Older people were more exposed to news or information about COVID-19 on the internet (45.3%), followed by television (34.5%), and radio (11.4%). The average stress was 19.96 points; 33.1% had anxiety, and 39.7% had depressive symptoms. The greater the number of people living with the elderly, the greater the stress (p = 0.001) and anxiety (p = 0.02). The hours of exposure to information on the internet led to stress (p = 0.001), depressive symptoms (p = 0.02), and anxiety (p = 0.02) in the elderly., Conclusion: During the pandemic, exposure to information on the internet triggered anxiety, stress, and depressive symptoms in the elderly. The findings highlight the need for multi and interdisciplinary interventions to mitigate such repercussions on the elderly's health.

Background: Cutaneous silent period (CSP) is the interruption in muscle activity after painful stimulation of a sensory nerve., Objective: The aim of the present study is to assess CSP changes in patients with polyneuropathy (PNP)., Methods: The present study was carried out to assess CSP in individuals with diabetes (DM) and Charcot-Marie-Tooth (CMT) disease. The sample comprised 24 individuals with DM, 10 individuals with CMT1 disease, and 10 individuals with CMT2 disease. The control group (CG) consisted of 59 individuals., Results: The mean latencies recorded for the upper limbs in the CG were 79.2 milliseconds (onset latency), 69.3 milliseconds (50% reduction latency), 112.2 milliseconds (end latency), and 33.1 milliseconds (CSP duration). On the other hand, the mean latencies recorded for the lower limbs were 99.0 milliseconds (onset latency), 85.0 milliseconds (50% reduction latency), 136.9 milliseconds (end latency), and 38.2 milliseconds (CSP duration). The mean latencies recorded for the CG were significantly lower than the ones recorded for other groups, both in the upper and lower limbs., Conclusions: Cutaneous silent period values recorded for the CG in the present study were close to the ones reported in studies available in the literature. Abnormal CSP parameters were observed in the group of individuals with PNP. The end latency in the lower limbs helped differentiating the demyelinating subgroup from the axonal one., Competing Interests: The authors have no conflict of interests to declare., (Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

(1) Background: Quality of life (QOL) is used as a health indicator to assess the effectiveness and impact of therapies in certain groups of patients. This study aimed to analyze the QOL of patients with acute coronary syndrome (ACS) who received medical treatment by a public or private health care system. (2) Methods: This observational, prospective, longitudinal study was carried out in four referral hospitals providing cardiology services in Sergipe, Brazil. QoL was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey. The volunteers were divided into two groups (public or private health care group) according to the type of health care provided. Multiple linear regression models were used to evaluate QoL at 180 days after ACS. (3) Results: A total of 581 patients were eligible, including 44.1% and 55.9% for public and private health care, respectively. At 180 days after ACS, the public health care group had lower QoL scores for all domains (functional capacity, physical aspects, pain, general health status, vitality, social condition, emotional profile, and health) (p < 0.05) than the private group. The highest QoL level was associated with male sex (p < 0.05) and adherence to physical activity (p ≤ 0.003) for all assessed domains. (4) Conclusions: This shows that social factors and health status disparities influence QoL after ACS in Sergipe.

Background: Dactylopius opuntiae (Cockerell) (carmine cochineal) is an insect pest highly noxious that has spread through cactus pear crops in the Brazilian semiarid region. Knowledge of diversity and genetic relationships of the cactus pear accessions is fundamental to create new varieties resistance to carmine cochineal. Therefore, this investigation was undertaken to assess the genetic diversity and genetic relationships that existed among cactus pear accessions of Nopalea sp. and Opuntia spp. with contrasting resistance to D. opuntiae., Methods and Results: We conducted a molecular analysis in seven cactus pear accessions from the "reference collection" of the Agronomic Institute of Pernambuco, Brazil using RAPD, ISSR and ITS molecular markers. A total of 242 bands were detected from 26 polymorphic primers. The high percentage of polymorphism by RAPD (89.8%), ISSR (81.2%) and ITS (75%) markers suggests that the cactus pear accessions have high genetic diversity. The combined analysis of markers systems enabled the accessions discrimination of about the genus and ploidy, but were incongruous in relation to resistance level to D. opuntiae., Conclusions: Genetic diversity, discrimination of about the genus and ploidy was confirmed by merging information from ISSR, RAPD and ITS markers systems. The IPA-200016, IPA-200149, IPA-100004, IPA-200205 accessions are genetically divergent, therefore could be potentially incorporated into any further breeding programs directed to create new varieties of cactus pear resistant to D. opuntiae., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: The coronavirus disease 2019 (COVID-19) pandemic has demonstrated the importance of implementing strategic management that prioritizes the safety of frontline nurse professionals. In this sense, this research was aimed at identifying factors associated with the illness of nursing professionals caused by COVID-19 according to socio-demographic, clinical, and labor variables., Methods: A cross-sectional study was conducted in three Brazilian university hospitals with 859 nursing professionals, which include nurses, technicians, and nursing assistants, between November 2020 and February 2021. We present data using absolute and relative frequency. We used Chi-square test for hypothesis testing and multiple logistic regression for predictive analysis and chances of occurrence., Results: The rate of nursing professionals affected by COVID-19 was 41.8%, and the factors associated with contamination were the number of people in the same household with COVID-19 and obesity. Being a nurse was a protective factor when the entire nursing team was considered. The model is significant, and its variables represent 56.61% of the occurrence of COVID-19 in nursing professionals., Conclusion: Obesity and living in the same household as other people affected by COVID-19 increases the risk of contamination by this new coronavirus., Competing Interests: The authors report no biomedical financial interests or potential conflicts of interest., (© 2022 Occupational Safety and Health Research Institute.)

Background: Monitoring the characteristics and associated factors for death among pregnant and postpartum women with coronavirus disease 19 (COVID-19) is necessary. We investigated the clinical characteristics and risk factors associated with maternal deaths in a nationwide cohort of Brazil., Methods: This was a population-based cohort of all pregnant and postpartum women hospitalised with COVID-19 notified to the Sistema de Informação de Vigilância Epidemiológica da Gripe of Brazil (SIVEP-Gripe), from February 2020 to September 2021. The primary outcome was time to in-hospital death, with risk factors analysed with univariable and multivariable Cox proportional hazards regression models., Results: Cumulative observation time was 248 821 person-days from hospital admission to the end of follow-up for 15 105 individuals. There were 1858 deaths (12.3%) for a maternal mortality rate of 7.5 (95% CI 7.1-7.8) per 1000 patients-days. The cumulative mortality increased over time. Black/Brown ethnicity had a higher risk of death than women self-identifying as White. Women in the North, Northeast, Central-West and Southeast regions had higher risk of death than women in the South region. The characteristics independently associated with death were a postpartum status on admission [adjusted hazard ratio, HR 1.4 (95% confidence interval, CI 1.2-1.6)], pre-existing clinical conditions [adjusted HRs 1.2 (95%CI 1.1-1.3) for one and 1.3 (95%CI 1.1-1.5) for two comorbidities], hypoxaemia on admission [adjusted HR 1.2 (95%CI 1.1-1.4)] and requiring non-invasive [adjusted HR 2.6 (95%CI 2.1-3.3)] or invasive ventilatory support [adjusted HR 7.1 (95%CI 5.6-9.2)]., Conclusion: In Brazil, the in-hospital maternal mortality rate due to COVID-19 is high and the risk of death increases with the length of hospitalisation. Socio-demographic and biological factors are associated with an increased risk of maternal death. The presence of respiratory signs and symptoms should be considered early markers of disease severity and an adequate management is necessary. Our findings reinforce the need for vaccination of pregnant and postpartum women against COVID-19., (© The Author(s) 2022. Published by Oxford University Press on behalf of International Society of Travel Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: to determine the relationship between quality of life and functional dependence, family functioning and social support in older adults in northeastern Mexico., Method: this is a quantitative, descriptive and analytical study, with 205 older adults. The Barthel Index, Lawton and Brody Scale, APGAR test, Multidimensional Scale of Perceived Social Support and WHOQOL-BREF were applied., Results: the physical, psychological and social dimensions of quality of life are related to functional capacity, family functioning and social support (p< 0.05). Functional capacity and social support predict physical and psychological quality of life. Basic activities, family function and social support predict social quality of life. Instrumental activities and social support predict environmental quality of life., Conclusion: quality of life depends on functional independence, family function and positive perceived health. Independence in basic activities and adequate social support improve physical quality of life. Being independent in basic activities and social support improve psychological quality of life. When presenting a decrease in independence in instrumental activities, perceived quality of life decreases.

Objectives: Develop and semantically validate an instrument to assess the knowledge and attitudes of adolescents towards cardiopulmonary resuscitation (CPR)., Methods: Validation study of an instrument to evaluate the knowledge and attitudes of adolescents towards CPR, developed in three phases: (i) development of the evaluation instruments by the authors; (ii) content validation performed by 14 expert judges in the area using the content validity index for analysis; and (iii) semantic validation carried out with the participation of 30 adolescents between 11 and 13 years old., Results: In the content validation, the questions on CPR knowledge obtained a content validity index (CVI) between 0.92 and 1.00, with a general index of 0.98; and the questions about attitudes obtained an IVC between 0.85 and 1.00, with a general index also of 0.98. Regarding semantic validation, three questions were modified in the knowledge assessment instruments and five in the attitude assessment instrument., Conclusions: Semantic and content validation of the instruments studied showed that they are suitable for assessing the knowledge and attitudes of adolescents related to CPR, so their use is recommended in the evaluation of training actions in this population group., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright� by the Universidad de Antioquia.)

Objectives: to analyze the sociodemographic and clinical variables related to the adherence to self-care activities in people with diabetes mellitus type 2., Methods: quantitative, cross-sectional study, carried out with 270 people with diabetes from December 2019 to October 2020, in São Luís, Maranhão., Results: the adherence to self-care was greater when it comes to medications (Md=7.0) and foot care (Md= 6.0), but lower in regard to blood sugar testing (Md=1.0), exercise (Md=2,0), and diet (general) (Md=4.0). The variables age group (p=0.007), educational level (p=0.015), body mass index (p=0.035), complications with diabetes (p=0.009), and nutritional follow-up (p=0.000) had associations with self-care activities., Conclusions: identifying the factors related to the adherence to self-care was found to be essential to strengthen the line of care in chronic diseases and to direct educational actions, aiming to improve the quality of life of people with diabetes.

Objective: to identify factors associated with infection and hospitalization due to COVID-19 in nursing professionals., Method: a cross-sectional study carried out with 415 nursing professionals in a hospital specialized in cardiology. The sociodemographic variables, comorbidities, working conditions and issues related to illness due to COVID-19 were evaluated. Chi-Square, Fisher's, Wilcoxon, Mann-Whitney and Brunner Munzel tests were used in data analysis, as well as Odds Ratio for hospitalization, in addition to binary logistic regression., Results: the rate of nursing professionals affected by COVID-19 was 44.3% and the factors associated with infection were the number of people living in the same household infected by COVID-19 (OR 36.18; p<0.001) and use of public transportation (OR 2.70; p=0.044). Having severe symptoms (OR 29.75), belonging to the risk group (OR 3.00), having tachypnea (OR 6.48), shortness of breath (OR 5.83), tiredness (OR 4.64), fever (OR 4.41) and/or myalgia (OR 3.00) increased the chances of hospitalization in professionals with COVID-19., Conclusion: living in the same household as other people with the disease and using public transportation increased the risk of infection by the new coronavirus. The factors associated with the hospitalization of contaminated professionals were presence of risk factors for the disease, severity and type of the symptoms presented.

Objective: To identify and analyze the sociodemographic and health factors and the social support network of the elderly associated with frailty in the assessments carried out between 2007/2008 and 2018., Methods: This is a longitudinal study with elderly people aged ≥65 years living in the community. The instruments used were those for Demographic Profile, the Mini Mental State Examination, the Functional Independence Measure, Lawton and Brody Scale, Geriatric Depression Scale, Minimum Relationship Map for the Elderly, and Edmonton Frail Scale. Descriptive analysis and linear regression were used, all tests with p < 0.05., Results: Of the 189 elderly in the study period (2007/2008-2018), most were 80 years old and over, with an average of 82.31 years old; they were women, with no partner, who lived with other family members and were retired. In the final analysis, regardless of age and sex, a decrease in functional independence, an increase in depressive symptoms, an increase in the number of self-reported illnesses, and an increase in the frailty score were observed., Conclusion: The factors that were associated with the increase in frailty of the elderly during the study period were age, female sex, and no partner. The health team, which includes nurses, shall be aware of changes and develop care plans to prevent or avoid their progression.

We compare the relative efficacy of virtual reality therapy exposure (VRET) versus in vivo therapy exposure among individuals suffering from phobias. A systematic search was completed up to 03 April 2020, using the following databases: ACM Digital Library, ResearchGate, IEEE, Science Direct, MIT PressJournals, Center for Direct Scientific Communication (CCSD) and Mary Ann Liebert Publishers. Five authors searched the databases using the following terms: Virtual Reality, Phobia, Mental health, Computing, Therapy, HMD, CAVE, Virtual ambient, in virtuo, Avoidance, Exposure, VRET, in vivo, Anxiety, Agoraphobia, Social Phobia, Stimuli, Cognitive-behaviour. All studies that evaluate the effect of in virtuo exposure towards phobia rehabilitation were selected. By reviewing the article, each author then applied the inclusion and exclusion criteria, and 30 articles were selected. Data extracted included the number of samples, amount of sessions, study variables that may affect the final outcome, therapy technology. The data provided was synthesized using a meta-analysis based on the results. The results demonstrated a positive outcome of Virtual Reality Exposure Treatment in the treatment of most phobias. In contrast, some of these treatments did not work for a few specific phobias in which the standard procedures were more effective. The findings suggest that for some specific phobias treatment, Virtual Reality Exposure Treatment does not reach the in vivo exposure level of immersion and presence. Further research is needed to perform studies with higher-dimension samples, since many papers report a low sample size and that is probably why many of them have inconclusive results., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

There is not a described method to count the core label of c-Fos-positive neurons, avoiding false-positive and false-negative results. The aim of this manuscript is to provide guidelines for a secure and accurate method to calculate a threshold to select which core of c-Fos-positive neurons marked by immunofluorescence has to be scored. A background percentage was calculated by dividing the intensity value (0 to 255) of the core of c-Fos-positive neurons by its surrounding background from the 8-bit images obtained in a previous study. Using the background percentage from 20% up to 98%, raising 2% once for each score, as threshold to choose which core has to be counted, a script was written for the R program to count the number of the c-Fos-positive neurons and the comparison between control and experimental groups. The differences of the average number of the core counted c-Fos-positive neurons between control and experimental groups, at all thresholds studied, showed a rising value related to an increase of the background percentage threshold as well as a decrease of its p value related to an increase of the threshold of background percentage. For the smallest thresholds (high intensity of label), the differences between groups are suppressed (false negative). However, for the biggest thresholds (nonspecific label), these differences are always the same (false positive). Therefore, to avoid the false-negative and the false-positive values, it was chosen as the threshold of 62% the inflection point of the linear regression, which is equally different from the biggest and smallest values of the differences between groups., Competing Interests: The authors report no conflict of interest., (Copyright © 2021 Wellington José da Silva et al.)

Background: Detailed information on how socio-economic characteristics are related to COVID-19 incident cases and maternal deaths is needed. We investigated the spatial distribution of COVID-19 cases and maternal deaths in Brazil and their association with social determinants of health., Methods: This was a population-based ecological study with a spatial analysis of all cases and deaths of COVID-19 in the obstetric population. Data on COVID-19 cases and deaths in the obstetric population, social vulnerability, health inequities, and health system capacity at the municipal level were obtained from several publicly sources in Brazil. A Bayesian empirical local model was used to identify fluctuations of the indicators. Spatial statistic tests were used to identity the spatial clusters and measure the municipalities' risk of COVID-19 in the obstetric population. Beta regression was used to characterise the association between socio-economic indicators and the burden of COVID-19., Findings: A total of 13,858 cases and 1,396 deaths due to COVID-19 were recorded in Brazil from March 2020 to June 2021. There was a variation in the number of cases per municipality, with 105 municipalities with rates from 2,210 to 3,884 cases and 45 municipalities with rates from 3,884 to 7,418 cases per 100,000 live births. The maternal mortality ratio also varied widely across municipalities. There was a spatial dependence on smoothed maternal mortality rates (I Moran 0•10; P = 0•010), and 15 municipalities had higher risk of maternal deaths. Municipalities characterized by lower health resources and higher socioeconomic inequalities presented the highest rates of incidence and maternal mortality by COVID-19., Interpretation: In Brazil, COVID-19 cases and deaths in the obstetric population had a heterogeneous geographical distribution, with well-defined spatial clusters mostly located in the countryside. Municipalities with a high degree of socioeconomic dissimilarities showed higher maternal mortality rates than areas with better social and infrastructure indicators., Funding: None., Competing Interests: The authors declare that there is no conflict of interest., (© 2021 The Author(s). Published by Elsevier Ltd.)

Background and Objectives : In severe obesity, a relevant weight loss can promote the reduction of comorbidities, such as systemic arterial hypertension (SAH), dyslipidemia, and diabetes mellitus (DM2). Bariatric surgery (BS) has been an essential resource in the therapy of this disease with a short-term reduction of cardiometabolic risk (CR). This study aimed to evaluate the reduction of factors associated with the CR in patients undergoing BS at a 5-year follow-up. Materials and Methods: This is a longitudinal, retrospective study carried out with patients undergoing BS by the Brazilian Public Healthcare System (PHS). Anthropometric and clinical parameters related to the CR (DM2, dyslipidemia, and SAH), quantified by the Assessment of Obesity-Related Comorbidities (AORC) score, were evaluated at the following moments: admission and preoperative and postoperative returns (3 months, 6 months, 1 to 5 years). Results: The sample had a mean age of 44.69 ± 9.49 years and were predominantly in the age group 20-29 years (34.80%) and women (72.46%). At admission to the service, 42.3% had DM2, 50.7% dyslipidemia, and 78.9% SAH. Regarding BS, the gastric bypass technique was used in 92.86% of the sample, and the waiting time for the procedure was 28.3 ± 24.4 months. In the pre- and postoperative period of 3 months, there was a significant reduction in the frequency of DM2 ( p < 0.003), dyslipidemia ( p < 0.000), and SAH ( p < 0.000). However, at postoperative follow-up from 6 months to 5 years, there was no significant reduction in the comorbidities studied. After five years, 35.7% had total remission of DM2 and 2.9% partial remission of DM2, 44.2% had control and remission of dyslipidemia, and 19.6% of SAH (AORC score ≤ 2 for the comorbidities) . Conclusion: BS promoted a reduction of the CR in the first three months after BS in severely obese PHS users.

The procedures to be performed after sudden engine failure of a single-engine helicopter impose high workload on pilots. The maneuver to regain aircraft control and safe landing is called autorotation. The safety limits to conduct this maneuver are based on the aircraft height versus speed diagram, which is also known as "Dead Man's Curve". Flight-test pilots often use subjective methods to assess the difficulty to conduct maneuvers in the vicinity of this curve. We carried out an extensive flight test campaign to verify the feasibility of establishing quantitative physiological parameters to better assess the workload endured by pilots undergoing those piloting conditions. Eleven pilots were fully instrumented with sensors and had their physiological reactions collected during autorotation maneuvers. Our analyses suggested that physiological measurements (heart rate and electrodermal activity) can be successfully recorded and useful to capture the most effort-demanding effects during the maneuvers. Additionally, the helicopter's flight controls displacements were also recorded, as well as the pilots' subjective responses evaluated by the Handling Qualities Rate scale. Our results revealed that the degree of cognitive workload was associated with the helicopter's flight profile concerning the Height-Speed diagram and that the strain intensity showed a correlation with measurable physiological responses. Recording flight controls displacement and quantifying the pilot's subjective responses show themselves as natural effective candidates to evaluate the intensity of cognitive workload in such maneuvers., (© 2021. The Author(s).)

Chrysodeixis includens is a polyphagous pest restricted to the American continent. The occurrence of C. includens is allied, among other factors, by favorable conditions such as temperature, humidity, presence of hosts, and migratory behavior. In this work, we built spatiotemporal species distribution models at continental and global levels for the distribution of C. includens using CLIMEX to determine times and regions favorable for year-round survival and migration of this species and in case of invasion on other continents to apply timely and right phytosanitary measures. Our models estimated high climate suitability for C. includens in Central and large proportions of South America throughout the year. Moreover, there is suitability for C. includens growth in all months of the year in Central and northern part of South America. In the northern hemisphere, these conditions range from April to October, while in mid-southern parts of South America, favorable periods comprise October through June. The countries with the highest suitability for C. includens outside the American continent are located on the African and Asian continents. Our results show variable climate suitability for C. includens during the year that help to understand likely migration pattern in North America. This information would direct efforts for appropriate C. includens management during warm and moist periods of the year. Furthermore, our models notify the need for the development of strategies for the inspection and interception of C. includens especially in central Africa, India, South and Southeast Asia, and Northeast Australia.

Background: Steroid use for coronavirus disease 2019 (COVID-19) is based on the possible role of these drugs in mitigating the inflammatory response, mainly in the lungs, triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to evaluate the efficacy of methylprednisolone (MP) among hospitalized patients with suspected COVID-19., Methods: A parallel, double-blind, placebo-controlled, randomized, Phase IIb clinical trial was performed with hospitalized patients aged ≥18 years with clinical, epidemiological, and/or radiological suspected COVID-19 at a tertiary care facility in Manaus, Brazil. Patients were randomly allocated (1:1 ratio) to receive either intravenous MP (0.5 mg/kg) or placebo (saline solution) twice daily for 5 days. A modified intention-to-treat (mITT) analysis was conducted. The primary outcome was 28-day mortality., Results: From 18 April to 16 June 2020, 647 patients were screened, 416 were randomized, and 393 were analyzed as mITT, with 194 individuals assigned to MP and 199 to placebo. SARS-CoV-2 infection was confirmed by reverse transcriptase polymerase chain reaction in 81.3%. The mortality rates at Day 28 were not different between groups. A subgroup analysis showed that patients over 60 years old in the MP group had a lower mortality rate at Day 28. Patients in the MP arm tended to need more insulin therapy, and no difference was seen in virus clearance in respiratory secretion until Day 7., Conclusions: The findings of this study suggest that a short course of MP in hospitalized patients with COVID-19 did not reduce mortality in the overall population., Clinical Trials Registration: NCT04343729., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Objective: to analyze the spatial distribution of elder abuse in Ribeirão Preto-SP, according to victims' place of residence and event., Method: an ecological study that analyzed 1,153 elder abuse police reports (2009 to 2013). Local gross and empirical Bayesian rates and Local Moran's I were calculated., Results: there was a heterogeneous distribution of concentration of sectors with a high incidence rate surrounded by neighbors with also high rates, considering place of residence. In contrast, analysis by place of occurrence showed a greater concentration in the central areas of the municipality. More than 80% of cases of violence occurred at their own homes and with spatial dependence on distribution by occurrence up to a 5,000 m distance from their places of residence., Conclusion: data reinforce that violence is a complex phenomenon, affecting several social strata, including in central urban areas and in elderly people families' own context.

Objectives: To identify overload and associated factors among caregivers of adult patients receiving palliative care., Methods: Descriptive, quantitative, and cross-sectional study addressing 40 adults under palliative care and their respective caregivers enrolled in the Home Care System in Ribeirão Preto, Brazil. Data concerning the patients included demographic profile and Mini-Mental State Examination. A form was used to collect the caregivers' demographic data along with the Zarit Burden Interview Scale, Self-Reporting Questionnaire, Beck Depression Inventory, and Coping Strategies Inventory., Results: Regarding the patients, 84.2% were women, 52.6% were over 80, 65.8% had no partner, and 76.3% presented cognitive impairment. The caregivers were mostly women (84.5%), aged 56.67 years old on average, were the patients' children (42.5%); had no partner (55%), and lived with the patient (77.5%). The mean score obtained in the burden scale was 28.78 points, 32.5% had stress, and 42.5% depression. Regarding coping strategies, the ones most frequently used were positive reappraisal (12.8), withdrawal (10.2), and problem solution (9.7). A positive and statistically significant correlation was found between time spent with care (days and hours) and escape/avoidance with overload. Linear regression analysis revealed an association between being a woman (p=0.002), number of days spent with care (p=0.004), and depression (p<0.001) with overload., Conclusions: Being a woman, spending more days providing care, and depressive symptoms were associated with caregiver overload., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright by the Universidad de Antioquia.)

Objective: to analyze the newspaper articles on hospital care for elderly COVID-19 patients in online newspapers., Method: documentary, retrospective, descriptive and exploratory research. The data were collected from articles published on open-access websites of 12 newspapers from the following countries: Brazil, Spain, United States, France, Italy and Portugal., Results: out of 4,220 newspaper articles identified in this regard, 101 were selected after applying the inclusion criteria, the majority coming from Italy. The data analysis revealed three thematic categories: the care for patients with COVID-19 in the health system; the work process of the health team and its concern with contagion; and ethical dilemma in care for the elderly during hospitalization., Conclusion: the COVID-19 pandemic presented itself quickly and was widely reported in all countries. The health systems need to reorganize for care to the global population, especially the elderly, considering their weaknesses and also the lack of prior professional training to offer care to this population.

Objective: To analyze the association between adherence to antihypertensive treatment and frailty syndrome in hypertensive older adults., Method: A descriptive, cross-sectional study with a quantitative approach with older adults. The data collection took place between November 2017 and March 2018, evaluating sociodemographic information, adherence to antihypertensive treatment, lifestyle and frailty through the Edmonton Frail Scale. The Kruskal-Wallis test and the Chi-squared test were used for data analysis, considering a 95% confidence interval and a significance level of p<0.05., Results: There were 193 older adults who participated in the study. The average age was 80.94 (sd ± 7.17) years, with a predominance of females (72%) and widows (43.5%). The factors which were associated with adherence to treatment were diastolic blood pressure, education and the time that the older adult had smoked (p<0.05). Frailty was not associated with treatment adherence levels (p=0.095)., Conclusion: There was no association between frailty scores and control of arterial hypertension; however, adequate monitoring and nursing care are essential in assessing adherence to treatment in order to reduce the aggravations of the disease and frailty syndrome development.

Objective: to synthesize the knowledge about the association of frailty syndrome and cognitive impairment in older adults., Method: the Joanna Briggs Institute's systematic review of etiology and risk factors was adopted. The search for the studies was conducted by two independent reviewers in the databases MEDLINE, Embase, CINAHL and LILACS and by manual search was performed by tow reviewers independently. The measures of association Odds Ratio and Relative Risk were used in the meta-analysis. The software R version 3.4.3 and the meta-analysis package Metafor 2.0 were used for figure analysis., Results: three studies identified the association of frailty syndrome and cognitive impairment through Odds Ratio values show that frail older adults are 1.4 times more likely to present cognitive impairment than non-frail older adults. Four studies analyzed the association through the measure of Relative Risk and found no statistical significance, and four studies used mean values., Conclusion: despite of the methodological differences of the studies and the lack of definition of an exact proportion in the cause and effect relationship, most studies indicate Frailty Syndrome as a trigger for Cognitive decline.

Objective: To evaluate the adherence of pregnant women to personal protective measures against mosquito bites, recommended by the Ministry of Health, and to investigate the factors associated with the non-adoption of these measures., Methods: We interviewed 177 pregnant women between November 2016 and February 2017 in the 10 basic health units of the municipality of Propriá, state of Sergipe, two located in the rural area and eight in the urban area, during prenatal appointments, to raise information about the use of preventive measures against the vector transmission of Zika virus. Data were analyzed using descriptive statistical methods, chi-square test or Fisher's exact test, and the odds ratio was calculated. The independent variables were grouped by the analysis of principal components, and the dependents (the use of repellent, mosquito nets, garments, screens and insecticides) were analyzed using the logistic regression method., Results: Among the measures recommended by the Ministry of Health, mosquito nets were the most used by pregnant women living in rural areas and with low education level, while the repellents were more used by women in the urban area and with higher education level. Women in a vulnerable socio-economic situation presented a risk 2.4 times higher for not using screens in their homes, 1.9 times higher for not changing clothes and 2.5 times higher for not using repellent than pregnant women in better economic conditions., Conclusions: The socioeconomic status of pregnant women, especially among the less privileged, influenced the use of protective measures against Zika virus, from the purchase of repellent, clothing, insecticides to other resources in the municipality of Propriá, SE.

Objective: Most reports on serious infections (SI) in rheumatoid arthritis (RA) patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) are from the USA and Western Europe. Data from other regions are largely missing. We report data from South American countries with different backgrounds and health-care systems but similar registries., Methods: We merged 2010-2016 data from two registries, BIOBADABRASIL (Brazil) and BIOBADASAR (Argentina), which share the same protocol, online platform and data monitoring process. Patients with active RA were included when they began the first bDMARD or a conventional synthetic DMARD (csDMARD, control group). The SI incidence rate (IR) per 1000 patient/years and adjusted IR ratio (aIRR) were estimated for bDMARDs and csDMARDs., Results: Data were analysed for 3717 RA patients with an exposure of 13,380 patient/years. The 2591 patients treated with bDMARDs (64% tumour necrosis factor-α inhibitors (TNFi)) had a follow-up of 9300 years, and the 1126 treated with csDMARDs had an exposure of 4081 patient/years. The SI IR was 30.54 (CI 27.18-34.30) for all bDMARDs and 5.15 (CI 3.36-7.89) for csDMARDs. The aIRR between the two groups was 2.03 ([1.05, 3.9] p = 0.034) for the first 6 months of treatment but subsequently increased to 8.26 ([4.32, 15.76] p < 0.001). The SI IR for bDMARDs decreased over time in both registries, dropping from 36.59 (28.41-47.12) in 2012 to 7.27 (4.79-11.05) in 2016., Conclusion: While SI remains a major concern in South American patients with RA treated with bDMARDs, a favourable trend toward a reduction was observed in the last years.Key Points• New comprehensive data on biologic drugs safety from international collaboration in South America.• First proposal for national registries data merging in South America.• Serious infections remain a major concern in RA patients treated with biologics.• A significant reduction of serious infections in RA patients exposed to biologics was observed over a 7 years period.

Objective: To analyze a historical series of cases of elder abuse as described in police reports., Method: Descriptive, retrospective and documentary study based on police reports issued at the older adult police department whose information was collected through an instrument developed by the researchers., Results: Five categories were identified: 1 - physical violence; 2 - violence report; 3 - psychological violence; 4 - habits related to psychoactive substance use; 5 - reasons for violence., Conclusion: Elder abuse is a complex issue that requires intervention on the part of nurses by the report of incidents and provision of support to the victim., (Copyright © 2019. Published by Elsevier Inc.)