Search

Abstract Introduction The introduction of clacitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) has revolutionized the treatment of migraines. In clinical practice gepants might be considered as a valid option to treat acute attacks in patients with migraine who are treated with mAbs. However, the safety and tolerability of such a combination is not well addressed in the real-world setting. We designed this study to evaluate the safety and tolerability of combining CGRP mAbs with gepants in the management of migraines. Methods This was a retrospective, real-world, exploratory study. The participants included within the study were adult (≥ 18 years) patients diagnosed with migraine. Screening for patients who were treated with at least one GCRP mAbs was done. Data was collected from one site, the American Center for Psychiatry and Neurology, Abu Dhabi UAE. A total of 516 patients taking CGRP mAbs were identified. Extracted data from patients’ electronic medical records included patient demographics, migraine characteristics, prescribed treatments, and adverse events (AEs). The tolerability and safety of the combination therapy was evaluated on the basis of documented AEs. Results Among the identified 516 patients, 234 were administered gepants in addition to the CRGP mAb (215, rimegepant; 19, ubrogepant). Eleven of the 234 patients switched from rimegepant to urogepant as a result of lack of efficacy; one patient switched from urogepant to zolmitriptan because of the lack of insurance coverage of the former medication. Among all the patients included in this study, three AEs were documented. These AEs were generally mild and transient and hence did not lead to discontinuation of treatment. Moreover, 42 of the 234 (17.9%) patients were switched from one class of CGRP mAbs to another at least once while continuing treatment with the assigned gepants. Conclusion The findings of this study demonstrate that combining CGRP mAbs with gepants is a safe and well-tolerated treatment approach for migraine. Future studies are warranted to further validate these findings and explore long-term outcomes.

Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) have shown promising effectiveness in migraine management compared to other preventative treatment options. Many questions remain regarding switching between antibody classes as a treatment option in patients with migraine headaches. This preliminary retrospective real-world study explored the treatment response of patients who switched between CGRP mAb classes due to lack of efficacy or poor tolerability. A total of 53 patients with migraine headache switched between three of the CGRP mAbs types due to lack of efficacy of the original prescribed CGRP mAbs, specifically eptinezumab, erenumab, and galcanezumab. Fremanezumab was not included due to unavailability in the UAE. Galcanezumab and eptinezumab target the CGRP ligand (CGRP/L), while erenumab targets CGRP receptors (CGRP/R). The analysis of efficacy demonstrated that some improvements were seen in both class switch cohorts (CGRP/R to CGRP/L and CGRP/L to CGRP/R). The safety of switching between CGRP classes was well observed, as any adverse events presented before the class switch did not lead to the discontinuation of treatment following the later switch. The findings of this study suggest that switching between different classes of CGRP mAbs is a potentially safe and clinically viable practice that may have some applications for those experiencing side effects on their current CGRP mAb or those witnessing suboptimal response.

Police officers (POs) frequently encounter high stress and burnout risks in their demanding professional environment. This study delves into the relationship between physical activity (PA), health-related quality of life (HRQoL), and job performance among POs. A cross-sectional survey was conducted involving 1175 POs, with 691 providing complete responses. The survey included questions on biosocial and professional characteristics; the International Physical Activity Questionnaire—short form; the Short Form Health Survey version 2.0; and a qualitative job performance evaluation. The key findings highlight that vigorous PA significantly enhances job performance. About 46.2% of POs engage in vigorous PA, with a notable 73.7% participating in some form of PA weekly. This study also found that age and gender considerably impact the HRQoL, especially in mental health aspects like vitality and social functioning. Vigorous PA is linked to higher job performance ratings, especially when practised consistently. In conclusion, this research underscores the importance of vigorous PA in improving job performance among POs. We suggest that institutions prioritise facilitating environments that encourage regular PA, recognising its substantial benefits in both professional effectiveness and the overall health of POs. This study contributes to understanding the critical role of physical fitness in enhancing the occupational well-being of law enforcement personnel.

Police work demands a high level of physical fitness (PF) and psychosocial well-being (PSWB) to cope with the challenges and demands of the profession. The profession has historically been male-dominated, and female police officers (POs) face unique challenges and stereotypes. This study aims (i) to identify the PF and PSWB attributes that significantly distinguish the women from three different professional training courses (agents, chiefs, and officers) and (ii) to assess the significance of PF and PSWB attributes on the likelihood that women in professional training courses belonging to a special bodyguard police sub-unit. A cross-sectional analytical study was conducted, involving 102 female POs (professional PO training courses, n = 94; special bodyguard police sub-unit, n = 8). PF (morphology; fitness, including endurance, strength, and flexibility tests) and PSWB (measured through scales for grit and dispositional resilience) attributes were assessed. Significant differences were observed in age, morphological (height and waist-to-hip ratio), fitness (horizontal jump and endurance tests), and PSWB (perseverance in effort and alienation) attributes among the three professional training courses. Stepwise discriminant analysis revealed that waist-to-hip ratio, waist-to-height ratio, relative fat mass, relative muscle mass, horizontal jump, and endurance on exertion significantly distinguished between the three groups. Complementarily, it was observed that the waist-to-hip ratio and sit-up attributes influence the probability of women from the professional training courses joining the special bodyguard police sub-unit. The study highlights that (i) female POs in different professional training courses showed distinct PF and PSWB profiles, and (ii) only two PF attributes (waist-to-hip ratio and sit-up) were predictors for the special bodyguard police sub-unit. In accordance, these findings provide valuable insights for designing training programs to support female POs in improving their PF, psychological well-being, and overall performance in the police profession.

Abstract Introduction Eptinezumab is a humanized IgG1 immunoglobulin monoclonal antibody administered intravenously as a preventative migraine treatment. Previously conducted randomized, double-blind, placebo-controlled trials exhibited significant reductions in monthly migraine frequency among adults experiencing episodic and chronic migraine. The present study seeks to expand upon the current findings and to evaluate eptinezumab’s efficacy as a preventative treatment for chronic and episodic migraine patients in the United Arab Emirates. This study is intended to represent the first real-world evidence and will hopefully serve as a valuable complement to the existing literature on the subject. Methods This was a retrospective exploratory study. The participants included within the study were adult (≥ 18 years) patients diagnosed with either episodic or chronic migraine. Patients were categorized according to their history of previous preventative treatment failure. For the final assessment of treatment efficacy, we included only patients with a minimum of 6 months of clinical follow-up data. Patients were assessed at baseline for their monthly migraine frequency and assessed again at months 3 and 6. The primary objective was to evaluate the efficacy of eptinezumab in reducing migraine frequency among chronic and episodic migraine patients. Results A total of 100 participants were identified, of whom 53 completed the study protocol at month 6. Of the total, 40 (75.47%) were female, 46 (86.79%) were Emirati locals, and 16 (30.19%) were pharmaceutically naïve, having never tried any prior preventative therapy. Additionally, 25 (47.17%) patients met the criteria for chronic migraine (CM), whereas the remaining 28 (52.83%) were diagnosed with episodic migraine (EM). The baseline monthly migraine frequency (MMD) was 12.23 (4.97) days across all participants, 15.56 (3.97) for CM patients, and 9.25 (3.76) for EM patients; by month 6, these frequencies reduced to 3.66 (4.21), 4.76 (5.32), and 2.68 (2.61), respectively. Overall, 58.49% of those enrolled experienced > 75% reduction in MMD frequency by month 6. Conclusion Patients enrolled in this trial experienced clinically significant reductions in MMD by month 6. Eptinezumab was well tolerated and with one AE of significance that led to discontinuation from the study.

Abstract Background Lung cancer mortality in European countries shows different epidemiological patterns according to sex and socioeconomic variables. Some countries show decreasing rates in both sexes, while others show a delayed profile, with increasing mortality in women, inconsistently influenced by socioeconomic status. Our aim was to evaluate the effect of age, period and birth cohort on lung cancer mortality inequalities in men and women in Andalusia, the southernmost region in Spain. Methods We used the Longitudinal Database of the Andalusian Population, which collects demographic and mortality data from the 2001 census cohort of more than 7.35 million Andalusians, followed up between 2002 and 2016. Mortality rates were calculated for men and women by educational level, and small-area deprivation. Poisson models were used to assess trends in socioeconomic inequalities in men and women. Finally, age-period-cohort (APC) models were used separately for each educational level and gender. Results There were 39,408 lung cancer deaths in men and 5,511 in women, yielding crude mortality rates of 78.1 and 11.4 × 105 person-years, respectively. In men higher mortality was found in less educated groups and inequalities increased during the study period: i.e. the rate ratio for primary studies compared to university studies increased from 1.30 (CI95:1.18–1.44) to 1.57 (CI95:1.43–1.73). For women, educational inequalities in favour of the less educated tended to decrease moderately. In APC analysis, a decreasing period effect in men and an increasing one in women were observed. Cohort effect differed significantly by educational level. In men, the lower the educational level, the earlier the peak effect was reached, with a 25-year difference between the least-educated and college-educated. Conversely, college-educated women reached the peak effect with a 12-year earlier cohort than the least-educated women. The decline of mortality followed the same pattern both in men and women, with the best-educated groups experiencing declining rates with earlier birth cohorts. Conclusions Our study reveals that APC analysis by education helps to uncover changes in trends occurring in different socioeconomic and gender groups, which, combined with data on smoking prevalence, provide important clues for action. Despite its limitations, this approach to the study of lung cancer inequalities allows for the assessment of gaps in historical and current tobacco policies and the identification of population groups that need to be prioritised for public health interventions.

O Afroempreendedorismo ou Empreendedorismo Negro é um movimento que cresce com o apoio coletivo, traço histórico do povo preto, que nos últimos anos tem assumido uma proposta decolonial, constantemente atravessado por questões interseccionais que dificultam a vida, sobretudo, da mulher negra empreendedora. Este artigo objetiva descrever os resultados alcançados em duas edições do projeto de extensão sobre afroempreendedorismo feminino, financiado pelo Programa Afirma (PROAF/UNEB), observando as limitações e avanços, reiterados pelo relato de experiência de alunas bolsistas. Importa destacar que foi utilizado a Interseccionalidade como método analítico fundamental nas duas edições do projeto (CRENSHAW, 1989). Os resultados alcançados no edital nº 64/2020, no auge pandêmico, e do edital nº 73/2022, em andamento, apontam incentivo ao domínio teórico e metodológico, protagonismo em trabalhos científicos, participação em eventos e ações extensionistas. Por sua vez, os relatos de experiência das bolsistas, estruturados por meio de um formulário autoinstrucional, revelaram o impacto que o letramento racial e o olhar interseccional causaram nas decisões profissionais, acadêmicas e pessoais das discentes e das já graduadas. Em suma, a educação para as relações étnico-raciais na extensão possui uma função formadora na articulação entre saberes e conhecimento de atrizes e atores envolvidos.

Law enforcement officers (LEOs) must maintain a certain level of physical fitness to perform occupational tasks successfully. Because of the wide variation among operators, there does not appear to be a standard fitness test battery that is appropriate to assess occupational fitness for different groups of law enforcement officers. Therefore, multi-faceted fitness assessments are important to evaluate tactical personnel’s various essential fitness components, which are often unique to each environment. Fitness standards and training protocols must be developed for each law enforcement agency and customised to the specific audience. This article aims to systematically review the relevant literature to identify biomotor abilities associated with occupational physical ability. This study examined the results of 17 international studies to ultimately synthesise information that (i) aids in the selection of the most used biomotor abilities and occupational physical abilities for LEOs and (ii) serves as a starting point for the development of occupational physical abilities assessment protocols. In conclusion, this study underscores the complex and diverse physical demands on LEOs, advocating for tailored fitness programs and policy reforms to enhance their operational readiness and long-term health.

Introdução: A leptospirose é uma doença causada pela bactéria Leptospira interrogans, sendo transmitida ao ser humano através da urina de roedores, em que indivíduos tenham contato com o meio contaminado. No Brasil, essa doença é considerada endêmica, porém em período chuvoso, sua alta incidência está associada as condições de vida precária da população, ausência de saneamento básico e contato com água, solo ou alimentos contaminados. Objetivo: O objetivo do trabalho foi realizar um estudo epidemiológico da mortalidade por leptospirose no estado de Sergipe, no período de 2016 a 2020. Metodologia: Trata-se de um estudo descritivo e retrospectivo, os dados obtidos foram através do Sistema de Informação de Agravo de Notificação, disponível no Departamento de Informática do Sistema Único de Saúde (DATASUS). Na análise dos dados foi utilizado o programa Microsoft Excel 2013. Resultados: No período de estudo, foram notificados 121 casos de leptospirose no estado de Sergipe, sendo que em 2016 foram registrados 17% (21/121) dos casos, em 2017 foram 27% (33/121), 2018 19% (23/121), 2019 22% (27/121) e em 2020 foram 14% (17/121) dos casos. Ao analisar a taxa de mortalidade por leptospirose, observou-se que 24 indivíduos morreram por essa doença, em 2016 foram 21% (5/24) dos óbitos registrados, 2017 foram 25% (6/24), 2018 12% (3/24), 2019 21% (5/24), 2020 21% (5/24). Em relação ao gênero dos casos de óbitos notificados, 8% (2/24) pertenciam ao sexo feminino e 92% (22/24) eram do sexo masculino. Conclusão: Portanto, foi observado que o maior número de casos por leptospirose ocorreu no ano de 2017, consequentemente gerando um maior número de óbitos. Além disso, foi encontrado que houve maior taxa de mortalidade em indivíduos do sexo masculino. Então, é necessária uma maior eficácia dos programas de saúde pública para que o percentual de mortalidade diminua cada vez mais.

Aqueous Two Phase Systems (ATPS) composed of 2-propanol + inorganic salt (Na2SO4/MgSO4) + water, at different temperatures T = (20, 30, 40 and 50) °C were applied in the partition studies of the textile dyes Yellow, Blue Royal and Red Dianix CC. The thermodynamic parameters of the free transfer energy (∆Gtr), enthalpy (∆Htr) and entropy (∆Str), respectively, were determined for dye partitioning, using the Van’t Hoff equation. The values of the partition coefficients of textile dyes Yellow, Royal Blue and Red Dianix CC, ranged from 14.21 to 1610.00, 15.15 to 994.00 and 17.32 to 311.75, respectively; and with dye extraction yields ranging from 93.17 to 99.93; 94.53 to 99.89 and 97.19 to 99.64, respectively. Based on the ∆Gtr results, it was verified that the dyes partition process was thermodynamically spontaneous, in all evaluated systems. For the 2-propanol + sodium sulfate ATPS, there was a prevalence of the enthalpic contribution over the entropic contribution (∆Htr > ∆Str), while for the 2-propanol + magnesium sulfate systems, a greater predominance of the entropic contribution was observed (∆Htr < ∆Str). The recovery yields (Y) values obtained were above 90% for all systems.

This study examines the effect of gender, age, and a 4-year training course for police officers (CFOP) on the physical fitness attributes of Portuguese police academy cadets. This longitudinal cohort study considered 686 police cadets (female, n = 131; male, n = 555 male), corresponding to 2578 fitness assessments (female, n = 509; male, n = 2069). The database of police cadets’ physical fitness evaluations (from 2004/2005 to 2019/2020) comprises body size, speed, agility, strength, flexibility, and aerobic capacity first assessment (T0) and evaluations at the end of the first four years of the CFOP (T1, T2, T3, T4). Results showed that (i) female cadets are younger (p < 0.05), shorter, lighter, less fast, less agile, less strong, and perform worse in aerobic capacity assessments than male cadets (all, p < 0.001) but perform better in the flexibility assessment (p < 0.001); (ii) female cadets > 29 years are significantly heavier, slower, jump less, perform fewer sit-ups, and perform less on the Cooper test (but they have more handgrip strength), and male cadets > 29 years are significantly heavier, slower, jump less, perform fewer sit-ups, and have less flexibility and aerobic capacity (still, they have superior back and lumbar strength and handgrip strength); and (iii) from T0 to T4 (Δ), female cadets are significantly faster (60 m, −0.32 s; slalom, −0.78 s), jump further (+4 cm), have more abdominal strength endurance (+2.6 repetitions) and more back and lumbar strength (+89.8 kg), and male cadets are significantly heavier (+3.27 kg), faster (60 m, −0.23 s; 30 m, −0.15 s; slalom, −0.91 s), jump further (+8 cm), complete more repetitions in the sit-ups (+4.9 repetitions) and in pull-ups (+2.5 repetitions) and have more back and lumbar strength (+92.1 kg) and handgrip strength (+8.6 kg) but a lower aerobic capacity (Cooper test, −74.8 m; VO2max, −1.3 mL/kg/min) when compared to T0. The study’s findings lead to widely accepted conclusions within the discipline. Nevertheless, this work provides valuable insights into the impact of various factors on the physical fitness of Portuguese police academy cadets, i.e.: (i) it is an essential study with practical implications for recruitment, training, and the ongoing development of Portuguese police academy cadets and police officers; and (ii) these results can also assist in tailoring training programs to different age groups and genders, which is crucial in police training.

In the original publication [...]

Abstract Background Labor, although natural and physiological, is a period that can be marked by stress, pain, anxiety, suffering, fear, and anguish for a woman. Thus, non-pharmacological methods that reduce pain during labor are important to allow a better experience without the use of medications. Therefore, the aim of this study is to evaluate the effects of non-pharmacological pain relief methods, added or not to the application of transcutaneous electrical stimulation (TENS), on pain, satisfaction with the childbirth, duration of labor, and newborn conditions. Methods This is a randomized controlled clinical trial, with a non-probabilistic convenience sample, composed of women in the first active stage of labor, admitted to a public institution. The parturients will be divided into 3 groups: group 1 (n = 36) composed of parturients who will have continuous support and will be encouraged to walk, adopting different positions with the use of the Swiss ball and receiving back massage for 30 min; group 2 (n = 36) composed of parturients who will also have continuous support and will be encouraged to walk, adopt different positions using the Swiss ball, and will receive the application of TENS for 30 min; and group 3 (n = 36) composed of parturients who will have continuous support and will be encouraged to walk, adopting different positions with the use of the Swiss ball, and will receive placebo TENS application for 30 min. The outcomes evaluated in the study will be pain intensity assessed by the visual analog scale of pain applied before, immediately after, and 30 min and 1 h after the interventions; Experience and Satisfaction with Childbirth Questionnaire (QESP) applied 12 to 24 h after delivery; and data regarding delivery (type of delivery, total duration of labor, and possible obstetric complications) and neonate (weight, height, possible complications, Apgar score in the first and fifth minutes). Discussion With this research, it is expected to understand the effects of the intervention through TENS electrostimulation added to other non-pharmacological methods for pain management during labor. Trial registration Brazilian Registry of Clinical Trials (REBEC) RBR-68kh6j . Registered on March 17, 2020

Introdução – Na correção de miopias elevadas, a cirurgia por implante de lente intraocular fáquica tem tido progressivamente uma maior adesão em relação à cirurgia por laser. Compara-se a acuidade visual (AV) antes e após a cirurgia implanto-refrativa, verificando-se a efetividade deste método no incremento da visão em miopias elevadas. Metodologia – Foram analisados, retrospetivamente, 70 olhos de 41 pacientes, com miopia elevada, entre os 20 e 50 anos, submetidos a cirurgia implanto-refrativa entre 2009 e 2012. Resultados – Um dia após cirurgia, 42,86% da amostra melhorou a AV, 34,29% manteve e 22,85% diminuiu. Após 30 dias observou-se um aumento generalizado da quantidade de visão, sendo que: 64,29% atingiu os 10/10 de AV, 24,29% alcançou entre 9/10-7/10 e 11,42% entre 6/10-4/10. Conclusão – Comprovou-se a efetividade desta técnica cirúrgica, verificando-se o aumento da AV em 52,86% da amostra.

Introdução: O Brasil está entre os 30 países de alta carga para TB e TB-HIV considerados prioritários pela OMS para o controle da doença. Dos casos notificados em 2017, 77,8% foram testados para HIV, 9,5% com coinfecção. Objetivo: Relatar caso de diagnóstico de coinfecção recente HIV/TB com tuberculomas de apresentação atípica e múltipla. Método: Paciente de 48 anos, masculino, com teste rápido para HIV reagente, confusão mental, alteração de marcha, tosse e perda ponderal de 20 kg. Exame com ataxia de marcha, alterações de comportamento, tosse seca e taquipneia sem uso de musculatura acessória. Iniciou dessaturação dois dias após, atribuída à pneumocistose. Iniciado tratamento com sulfametoxazol + trimetoprim. Precisou de ventilação mecânica dois dias depois, por piora da insuficiência respiratória. Baciloscopia na secreção traqueal foi positiva, sendo iniciado tratamento para tuberculose com RIPE. Ressonância (RNM) de encéfalo identificou mais de 25 imagens córtico-subcorticais, com alto sinal em halo, realce anelar ao meio de contraste, sem alvo excêntrico definido, sugeridas pela radiologia como tuberculomas. Foi descartada toxoplasmose pela radiologia, dadas imagens. O líquido cérebro raquidiano (LCR) demonstrou 13 células com proteína de 44 e glicose de 41. A reação em cadeia de polimerase no LCR para M. tuberculosis veio negativa. A contagem de linfócitos T CD4 era de 21 cél/mm3 com 3.870.000 cópias. Paciente fez tratamento da tuberculose por um ano, considerando que as lesões do sistema nervoso central eram típicas de tuberculoma, mesmo sem encefalite (o que pode ocorrer nestes casos). Repetiu RNM encéfalo após o final do tratamento com desaparecimento de todas as lesões, à exceção das talâmicas cicatriciais, justificando comportamento pueril e alterações de memória sequelares. Conclusão: A tuberculose no SNC causa mais frequentemente meningoencefalite. Entretanto, pacientes com contagem de CD4 abaixo de 50 cél/mm3 tem maior predisposição a formar tuberculomas. É essencial nestes casos realizar exames de imagem que consigam descartar lesões causadas pelo M. tuberculosis, fazendo diagnóstico diferencial com outras lesões focais oportunistas, como toxoplasmose e leucoencefalopatia multifocal progressiva.

Summary: Background: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p

Physical fitness tests are a standard means of evaluating the competence of police officers. This qualitative review aims (i) to document, compare, and examine the reference values available in the current literature regarding fitness tests for Law Enforcement Officers (LEOs), and (ii) to define reference values for the most used fitness tests to assess and predict police officer performance. A total of 1879 records were collected for review from two major literature databases, PubMed and ScienceDirect. After applying our exclusion criteria, a total of 19 studies were considered. All studies demonstrated acceptable methodological quality in fitness assessment, and the most used components were muscle strength, muscular endurance, muscle power, aerobic and anaerobic capacity, flexibility, and agility. This review provides (i) a methodological definition for the physical fitness assessment that helps select the most used fitness tests, (ii) a standardised methodology for establishing reference data for fitness tests appropriate for LEOs; and (iii) aggregate reference values for selected fitness tests. This may improve selection and retention procedures, considering that this group performs its duties in an environment and under conditions that differ from those of other occupational groups. Complementarily, this qualitative review also provides a foundation for developing effective interventions to improve each aspect of fitness testing for police officers.

Cardiovascular events are the leading cause of on-duty deaths among firefighters. Screening firefighters for risk of sudden cardiac event is a critical element of a comprehensive medical program. Although intense physical exertion has been shown to trigger sudden cardiac events in the general population, it is unclear how hemodynamic responses following clinical exercise testing compare to that of performing firefighting tasks in personal protective equipment. Therefore, the purpose of this study was to compare hemodynamic responses following rescue simulation (RS) and maximal exercise in firefighters. This was a cross-over repeated measures study. Thirty-eight professional firefighters (31.8 ± 5.2 yr; VO2peak: 57.9 mL/kg/min) completed a maximal aerobic exercise test (MAET) and an RS. Pulse wave velocity (PWV), pulse pressure (PP), and brachial and central mean arterial pressure (MAP) were measured before and 5 and 15 min post-exercise. The findings indicated that femoral PWV decreased after MAET and RS at both time points (p < 0.005). No significant differences were found in aortic and carotid PWV over time or between conditions (p ≥ 0.05). Significant increases in brachial and central PP and MAP were noted 5 min post-MAET and RS (p = 0.004). In conclusion, the present study demonstrated that peripheral arterial stiffness (AS) decreased in firefighters following both conditions, with no differences in central AS. Our findings provide valuable information on hemodynamic responses similar between RS and MAET, and are important for controlling CVD risk and the AS response.

This review aims (i) to identify and analyze the physical training programs used for tactical personnel (TP) and (ii) to understand the effects of physical training programs on the health and fitness, and occupational performance of tactical personnel. A literature search used the keywords ‘Physical Training Program’, ‘Police’, ‘Law Enforcement’, and ‘Firefighter’. A total of 23 studies out of 11.508 analyzed were included. All studies showed acceptable methodological quality in assessing physical fitness (PF), and training programs’ effect sizes (Cohen’s d) on PF attributes were calculated. The results showed that physical training programs (duration > four weeks) can improve (medium-to-large effects) (i) measures of physical fitness and (ii) performance in simulations of occupationally specific tasks. This review provides summary information (i) to help select (or adjust) physical training programs for TP and (ii) to clarify the effect of different occupational-specific training interventions on fitness measures and health-related parameters for TP.

Abstract Background Neurogenic bladder (NB) can affect people after stroke episodes. NB features changes in the normal voiding pattern at the bladder filling and emptying phases. Overactive NB is characterized by urgency symptoms, with or without urinary incontinence, caused by NB. This disorder affects many domains of life (physical, social, psychological, domestic, sexual) that limit personal autonomy and degrade the quality of life. Among the several treatments available, the conservative physical therapy intervention through tibial nerve electrostimulation (TNES) and parasacral electrostimulation (PSES) can help improve patient conditions with a smaller number of collateral effects than those of interventions based on medication. The aim of the present study is to compare the effects of TNES and PSES techniques in women with overactive NB after stroke episodes to assess the impact of urinary incontinence in these women, on their number of incontinence episodes, daytime and nocturnal urinary frequency, and quality of life. Methods This is a prospective clinical study to compare two randomized groups based on parallel and blind conditions. Forty-four women who have had a stroke episode at least 30 days before the trial and who have developed overactive NB will be recruited for the trial. All patients will be subjected to initial evaluation and randomly divided into two groups, TNES and PSES. Subsequently, the two groups will be subjected to a 12-session intervention protocol, twice a week. A new evaluation will be performed after the intervention. Discussion The results of this study will contribute to the physiotherapeutic treatment of women with NB after a stroke episode since such results will add information about the benefits of this treatment, urinary control, and the improvements in the quality of life of these women. Trial registration Brazilian Registry of Clinical Trials (REBEC) RBR-2bn2z4 . Registered on December 11, 2018

The present study sought to compare the mental health and family climate indicators of black elderly women with that of elderly people in other family settings. For that, it used a sociodemographic questionnaire, the Geriatric Depression Scale, the Beck Anxiety Inventory - BAI and the Family Climate Inventory. This study included 134 elderly, registered in a Basic Health Unit, interviewed at home. It was observed that matriarcality was associated with greater anxiety, especially in the context of low family support. The family atmosphere of the elderly matriarch group did not differ significantly from the elderly group in other family settings. Mental health indicators were related to support and cohesion in the elderly group in other family settings, while conflict and hierarchy seem to have different impacts for each group. Further studies within Psychology that seek a non-pathologizing understanding of black family models headed by women, their strengths and their risks are suggested.

Introduction: Defecation disorders, whether anal incontinence or chronic intestinal constipation, are frequent pelvic floor alterations in the general population and are more common in those with risk factors,i.e., in the elderly, women with an obstetric background, and those with comorbidities, history of pelvic radiotherapy, diabetics, the bedridden, or those with history of orifice surgery, among others. Objective: To analyze the incidence of defecation disorders in geriatric patients treated at the Medical Specialties Outpatient Service (MSOS) of Hospital Santa Marcelina. Methods: Prospective, randomized study that interviewed the same patients in two moments: 1) subjective anamnesis through spontaneous history and 2) objective anamnesis with specific questionnaires to assess anal incontinence and chronic constipation. Results: Between March 2016 and June 2017, 149 patients were analyzed, of whom 114 (76.5%) were female, with a similar mean age between genders; 51.67% had symptoms of anal incontinence and/or chronic constipation. Only 35.5% of patients with complaints of fecal leakage or flatus spontaneously reported them, while 87.1% of constipated patients did so. In the present study, no significant correlation was observed between the mode of delivery (p = 0.106), pregnancy (p = 0.099), and the number of deliveries (p = 0.126) with anal incontinence. In turn, there was no higher incidence of chronic intestinal constipation in females (p = 0.099) and most patients with this complaint had Bristol type 1 or 2 stools. Conclusion: The incidence of defecation disorders in the geriatric population is high and, most notably, anal incontinence is not spontaneously reported by most patients. Resumo: Introdução: Os distúrbios da evacuação, seja a incontinência anal ou a constipação intestinal crônica, representam alterações do assoalho pélvico bastante frequente na população em geral e mais comumente naqueles com fatores de risco, ou seja, em idosos, mulheres com passado obstétrico, comorbidades, antecedente de radioterapia pélvica, diabéticos, acamados, história de cirurgias orificiais, dentre outros. Objetivo: Analisar a incidência de distúrbios defecatórios em pacientes geriátricos atendidos no Ambulatório de Especialidades Médicas (AME) do Hospital Santa Marcelina. Metodologia: Estudo prospectivo e aleatório com a entrevista do mesmo paciente em dois momentos: 1) Anamnese subjetiva através da história espontânea e 2) Anamnese objetiva com questionários específicos para avaliação de incontinência anal e constipação intestinal crônica. Resultados: Foram analisados 149 pacientes entre Março de 2016 e Junho de 2017, sendo 114 (76,5%) do sexo feminino com média de idade semelhante entre os sexos; 51,67% apresentavam sintomas de incontinência anal e/ou constipação intestinal crônica. Apenas 35,5% dos pacientes com queixas de escape de fezes ou flatos relataram de forma espontânea e 87,1% dos pacientes constipados o fizeram. No presente estudo não se verificou correlação significativa entre via de parto p = 0,106, gestação p = 0,099 e número de partos p = 0,126 com incontinência anal. Por outro lado, não se verificou maior incidência de constipação intestinal crônica no sexo feminino p = 0,099 e a maioria dos pacientes com essa queixa apresentavam fezes ressecadas tipo Bristol 1 ou 2. Conclusão: Incidência de distúrbios da defecação na população geriátrica é elevada e, notadamente a IA não é referida de forma espontânea pela maioria dos pacientes.

A infecção pelo vírus da Chikungunya, responsável por uma doença febril de espectro clínico variado, teve grande aumento na incidência nos últimos anos, sobretudo em regiões de clima tropical, a exemplo da microrregião de Campina Grande - PB. A artralgia é uma queixa importante e de grande prevalência. Em alguns casos, ocorrem acometimentos pouco comuns, como a miosite. Nesse sentido, o presente trabalho foi elaborado através da análise de prontuário, descrevendo evolução, diagnóstico, tratamento e intervenção terapêutica. Relata-se o caso de um homem de 27 anos que foi internado no serviço no 5º dia de febre elevada, cefaleia, mialgia intensa e rash cutâneo difuso, com artralgia e diminuição progressiva de força em membros inferiores. Exames laboratoriais demonstravam leucopenia, linfopenia, elevação considerável de transaminases e creatinofosfoquinase. O IgM para Chikungunya foi reagente. No período permaneceu com hidratação e sintomáticos. No 11º dia após os sintomas iniciais, apresentava-se afebril e com recuperação quase completa da paresia de membros inferiores, com resolução da leucopenia, queda de CPK e de transaminases. Recebeu alta, evoluindo para remissão completa do quadro após 7 dias, permanecendo assintomático. Trata-se de um caso de miosite associada à Chikungunya, doença que deve ser considerada no diagnóstico diferencial da miosite aguda benigna.

Nos últimos anos, houve uma crescente incidência de doenças exantemáticas associadas às arboviroses, sobretudo aquelas causadas pelos vírus da Zika, Dengue e Chikungunya. Apesar de autolimitadas, tais doenças podem resultar diversas complicações pós-infecciosas, a exemplo das afecções neurológicas, mais raras, conhecidas há cerca de 40 anos. Nesse sentido, o presente trabalho foi elaborado através da análise de prontuário, descrevendo evolução, diagnóstico, tratamento e intervenção terapêutica. Relata-se o caso de uma paciente de 30 anos, com quadro inicial de febre, mialgia, vômitos, cefaléia, hiperestesia em hemicorpo direito e poliartralgia há 15 dias. Persistindo com o quadro poliarticular, no 15° dia iniciou hemiparesia e hiperestesia difusa ascendente do membro inferior esquerdo, apresentando melhora parcial com Prednisona 60mg/dia e Gabapentina 1800mg/dia. Após sete dias, evoluiu com paraparesia, hipoestesia ascendente bilateral e retenção urinária, concomitante à neuralgia do Nervo Trigêmeo. Ressonância Nuclear Magnética (RNM) de encéfalo apresentava raros e diminutos focos de alteração de sinal localizados na substância branca hemisférica à direita, relacionados à gliose ou rarefação mielínica. RNM da coluna vertebral sem alterações. À punção lombar, líquor sem alterações. ELISA IGM para Dengue foi indeterminado. As sorologias para Chikungunya, Epstein-barr, Citomegalovirus, HTLV 1 e 2, HIV e Treponema resultaram negativas. Sorologia para Zika reagente. Realizou pulsoterapia com metilprednisolona por 3 dias, com melhora da neuralgia e da artralgia, mas com persistência da retenção urinária e da paraparesia, evoluindo com melhora total após acompanhamento nos 6 meses subsequentes. Trata-se de um caso de mielopatia aguda pós-infecciosa ocasionado pelo vírus Zika, complicado com neuralgia do trigêmeo, bexiga neurogênica e paraparesia. A importância do diagnóstico e seguimento precoces influenciam fortemente no prognóstico e nas sequelas.

This paper will discuss the current ruling of the Federal Supreme Court (STF) under the Default Omission Action (ADO) 26and the Injunction Warrant (MI) 4473 regarding the equation of LGBTFOBIA crime with racism. Firstly, it discusses the three hypotheses made by Minister Celso de Mello regarding legislative omission, the concept of LGBTFOBIA and the prescription of criminal prosecution. Secondly, it addresses some studies that have shown some difficulties with regard to the criminalization of “racism” in the context of state action and its possible rebounds in labor law, especially as regards the principle of jus postulandiwhich is one of the principles that guarantee the autonomy of this branch of law. The research framework is centered on historical institutionalism, notably that of poststructuralist influence, centered on the analyzes of Michel Foucault and Gilles Deleuze. The research method is centered on the analysis of jurisprudence of the Supreme Court. The objective of the research is to analyze some possible effects of the “Labor Reform” carried out in 2017, by means of an STF decision that reformulated the “Ris Theory” and that possibly “impacted” the “Company Theory”. , the Consumer Protection Code and the performance of the Public Prosecution Service and the Public Defender's Office.

Objetivo: avaliar a situação nutricional e dietética de idosos hospitalizados. Método: pesquisa do tipo descritiva, exploratória, transversal e quantitativa. Foi realizada com 44 idosos hospitalizados, de ambos os sexos, atendidos em um hospital público da cidade de Bocaiúva, Minas Gerais, Brasil. Para avaliar a situação nutricional e dietética dos idosos hospitalizados utilizou-se a mini avaliação nutricional. Resultados: verifica-se que 55% dos idosos apresentaram-se com baixo peso, com maior quantitativo no sexo masculino. Observou-se prevalência de hipertensão, diabetes e insuficiência cardíaca congestiva. Entre os participantes, 25% informaram que possuem alguma restrição na motilidade. Identificou que mais de 60% dos idosos utilizam acima de três medicamentos e bebem menos de cinco copos de água por dia. Conclusão: a realização de pesquisas sobre o estado nutricional de idosos e a associação de fatores que contribuem para agravar o quadro de desnutrição é fundamental para definir e acompanhar a qualidade de vida, bem como sustentar projetos terapêuticos.

BackgroundCancer patients appear to be at a higher risk of complications from coronavirus disease 2019 (COVID-19). Specific data related to lung cancer (LC) patient management, active treatment, and/or recent diagnosis are still very limited. Here, we aimed to investigate the clinical presentation, baseline features, and clinical outcomes of LC patients with COVID-19.MethodsA retrospective case study was performed at Centro Hospitalar Universitário de São Joao, a tertiary hospital in the North of Portugal. Data from LC patients diagnosed with COVID-19 were collected during the first 10 months of the COVID-19 pandemic (March 2020–January 2021).ResultsTwenty-eight patients with active LC were diagnosed with COVID-19, being adenocarcinoma the most common histological type present (n = 13, 46.4%). Sixteen patients had metastatic stage IV LC (61.5%). Twenty-five patients (89.3%) had relevant comorbidities including hypertension (39.3%) and chronic obstructive pulmonary disease (32.1%). For patients undergoing antineoplastic treatment, the median time from the last chemotherapy administration to COVID-19 diagnosis was of 16 days (interquartile range = 13–41 days). Half of patients were previously on corticosteroid therapy. Twenty patients (71.4%) needed hospitalization, 18 received oxygen therapy (64.3%), 3 (10.7%) of them received high-flow nasal cannula with good tolerability, and 1 (3.6%) needed non-invasive ventilation. Hydroxychloroquine and antibiotics were given to 4 (14.3%) and 12 (42.9%) patients, respectively. Seven patients (25%) died at a median time of 5 days following COVID-19 diagnosis.ConclusionThis is one of the first studies reporting the adverse outcomes associated with COVID-19 in LC patients at same time that adds evidence regarding the need to create protocols and guidelines to reduce the infection risk in such patients.

Telemedicine has proven to be an important tool for the assistance continuity facing the current COVID-19 pandemic. We discussed the role of tele-interconsultation and remote matrix support as resources, within the scope of the Unified Health System, in supporting primary care teams, aiming at maintaining quality and resolution, increasing demand for services, as well as the limitations to their implementation. There are difficulties in access by the population, the need for investment and resistance by professionals and managers. It is still necessary regulation of telemedicine activity in the country, given that the permission by the Federal Council of Medicine occured only during the pandemic. The ability to fill gaps and deficiencies left by specialized services and reference centers stands out, since there is an increase in demand in several areas. In addition, the opportunity for learning, safety in conduct and empowerment of primary care professionals is investigated.

Background: Osimertinib efficacy in pre-treated patients with epidermal growth factor receptor (EGFR) T790M-mutated non-small cell lung cancer (NSCLC) has been demonstrated in clinical trials, but real-world data, particularly regarding resistance profile, remains limited. This study aims to analyze the resistance mechanisms acquired after treatment with Osimertinib.Methods: Clinical outcomes and molecular results from re-biopsies at the time of osimertinib progression of EGFR T790M-mutated NSCLC patient were analyzed.Results: Twenty-one patients with stage IV adenocarcinoma were included [median 69 years; 57.1% female; 85.7% never-smokers; 23.8% ECOG performance status (PS) ≥2]. Median PFS and OS were 13.4 (95% CI: 8.0–18.9) and 26.4 (95% IC: 8.9–43.8) months, respectively. At the time of analysis, 10 patients had tumor progression (47.6%). T790M loss occurred in 50%, being associated with earlier progression (median PFS 8.1 vs. 21.4 months, p = 0.011). Diverse molecular alterations were identified, including C797S mutation (n = 1), PIK3CA mutation (n = 2), MET amplification (n = 1), CTNNB1 mutation (n = 1), and DCTN1-ALK fusion (n = 1). Histological transformation into small cell carcinoma occurred in one patient.Conclusions: This real-world life study highlights the relevance of re-biopsy at the time of disease progression, contributing to understand resistance mechanisms and to guide treatment strategies.

Objetivo: avaliar o perfil hídrico e o consumo de suplementos de pessoas fisicamente ativas inseridas em academias da cidade Montes Claros, Minas Gerais, Brasil. Método: Trata-se de estudo transversal, realizado com praticantes de atividade física, em 2018. Participaram da pesquisa 200 pessoas, maiores de 20 anos, de ambos os sexos, frequentadores de academias. Realizou-se a avaliação nutricional dos participantes, com aplicação de questionário estruturado, contendo questões relacionadas à prática de atividade física, ingestão hídrica e uso de suplementos alimentares. Resultados: dentre os participantes, 52,5% era do sexo feminino e 65% estavam com peso adequado. Verificou-se que a 71% da população estuda consumia mais que dois litros de água por dia. Dentre os praticantes de atividade física, 60,5% e 99% não faziam o uso de suplementos e anabolizantes, respectivamente. Além disso, 96% não utilizavam ergogênicos. Conclusão: este estudo demonstrou que a população estudada possui ingestão adequada de água e baixo consumo de suplementos, anabolizantes e ergogênicos.

Abstract Background Benefits from cardiac rehabilitation (CR) programs are evidence-based and widely recognized. Less than 50% of people who participate in hospital-based CR programs maintain an exercise regime for as long as six months after completion. Little is known about interventions making the patients continue to exercise after the hospital-based formal program has ended. Methods to ensure sustained benefits of CR need to be tackled. Exercise periodization is a method typically used in sports training, but the impact of periodized exercise to yield optimal beneficial effects in cardiac patients is unclear. Therefore, the purpose of this trial is to evaluate the effects of a long-term exercise periodization on health-related physical fitness components such as cardiorespiratory endurance, muscular strength, skeletal muscle function, and body composition. Methods Fifty patients with coronary artery disease will be recruited among those who underwent the hospital-based CR phase. These patients will be randomized (1:1) into one of the following exercise groups: (1) periodized group; and (2) non-periodized group (exercise prescription based on standard guidelines). There will be four assessment time points: at baseline, and 3, 6, and 12 months after starting the exercise training program. At each time point, maximal and submaximal cardiorespiratory fitness, skeletal muscle deoxygenation dynamics, body composition by dual energy radiographic absorptiometry, functional fitness, maximal isometric and dynamic strength, physical activity, and quality of life will be assessed. This experimental design will last for 48 weeks with a frequency of three times per week for both groups. Discussion Most medium- to long-term exercise-based CR programs do not employ periodization or exercise progression. Randomized controlled trials are necessary to evaluate long-term periodization outcomes and assess the length of change observed in supervised CR programs. This study will contribute to generate evidence-based exercise prescription approaches to prolong the exercise training after the end of hospital-based CR programs. Trial registration ClinicalTrials.gov, NCT03335319. Registered on 22 October 2017.

Abstract This study reports the complete chloroplast sequences of three Spondias species. The genome sequences were obtained for Spondias tuberosa, Spondias bahienses, and Spondias mombin using the Illumina sequencing technology by a combination of de novo methods and a reference-guided assembly using Sapindus mukorossi as reference. The genomes of S. tuberosa, S. bahiensis, and S. mombin had 162,036, 162,218, and 162,302 bp, respectively. The coding regions exhibited 130 genes, including 34–35 tRNAs and 4 rRNAs. The results revealed synteny among the genomes, with high conservation in the gene order and content and CG content. The inverted repeat regions (IRA and IRB) and the large and small single copies were very similar among the three genomes. The phylogenomic analysis reported similar topologies as that of previous studies, which used partial chloroplast, wherein S. mombin was the first diverging lineage, while S. tuberosa and S. bahiensis were derived, indicating that the phylogenetic analysis using partial or complete genome produces similar results. In summary, (1) we presented the first complete chloroplast genome for the genus Spondias, (2) phylogenies analyzed using the complete chloroplast genomes revealed a robust phylogenetic topology for Spondias, and (3) gene order, content, and orientation in Spondias are highly conserved.

This review aims (i) to identify and analyze the most used physical fitness tests for police officers (from international and Portuguese studies) and (ii) to understand the health-related physical fitness requirements according to the job descriptions of police officers. A total of 29 studies were included. Eighteen were from around the world and eleven were related to Portuguese police officers. All studies showed acceptable methodological quality in the assessment of physical fitness, and the most used fitness components were muscular strength, endurance, power, aerobic and anaerobic capacity, flexibility, and agility. For the analysis of health parameters, they are insufficient at the international level, while at the Portuguese level we have an acceptable sample. We try to analyze the relationship between physical fitness and health, but the studies conducted so far are insufficient. This review provides summary information (i) to help select the most used fitness measures and health-related parameters for police officers, and (ii) that will serve as a starting point for evaluating the relationship between the health and physical fitness of police officers.

Resenha da mostra Charif Benhelima: Polaroids, 1998-2012, Museu Oscar Niemeyer, Curitiba.

Introduction: There is a lack of consensus on the definition of response to cardiac resynchronization therapy (CRT), and it is not clear which response criteria have most influence on cardiac event-free survival. Objectives: To assess the predictive value of various response criteria in patients undergoing CRT and the agreement between them. Methods: We performed a secondary analysis of the BETTER-HF trial. Patient response was classified at six months after CRT according to eleven criteria used in previous trials. The predictive value of response criteria for survival free from mortality, cardiac transplantation and heart failure hospitalization was assessed by Cox regression analysis. Agreement between the different response criteria was assessed using Cohen's kappa (κ). Results: A total of 115 patients were followed for a mean of 25 months. During follow-up, 15 deaths occurred (13%) and 29 patients had at least one adverse cardiac event (25%). Only five of the eleven response criteria were predictors of event-free survival. The most powerful isolated clinical and echocardiographic predictors were a reduction of ≥1 NYHA functional class (HR 0.39 for responders; 95% CI 0.18-0.83, p=0.014) and an increase of at least 15% in left ventricular ejection fraction (HR 0.43, 95% CI 0.20-0.90, p=0.024), respectively. Agreement between the different response criteria was poor. Conclusions: Most currently used response criteria do not predict clinical outcomes and have poor agreement. It is essential to establish a consensus on the definition of CRT response in order to standardize studies. Resumo: Introdução: Não existe consenso na definição de respondedor à ressincronização cardíaca (TRC), e desconhece-se qual o critério de resposta que poderá ter maior influência na sobrevida livre de eventos cardíacos. Objectivos: Avaliar o valor preditivo de vários critérios de resposta em doentes submetidos à TRC, e analisar a concordância entre eles. Métodos: Subanálise do ensaio BETTER-HF. Os doentes foram classificados aos seis meses após TRC em respondedores, de acordo com onze critérios utilizados na literatura. O valor preditivo dos diferentes critérios de resposta para uma sobrevida livre de morte, transplante cardíaco e hospitalização por insuficiência cardíaca foi avaliado usando a regressão de Cox. A concordância entre os diferentes critérios foi avaliada usando o coeficiente k de Cohen. Resultados: 115 doentes foram seguidos durante um período médio de 25 meses. Durante o follow-up ocorreram 15 mortes (13%) e 29 doentes tiveram, pelo menos, um evento cardíaco adverso (25%). Apenas cinco dos onze critérios de resposta foram preditores de sobrevida livre de eventos. Os preditores clínicos e ecocardiográficos isolados mais poderosos foram a redução de, pelo menos, uma classe funcional de NYHA (HR 0,39; IC 95% 0,18-0,83, p=0,014) e um aumento de, pelo menos, 15% na fração de ejeção ventricular esquerda (FEVE) (HR 0,43; IC 95% 0,20-0,90, p=0,024), respetivamente. A concordância entre os diferentes critérios de resposta foi fraca. Conclusão: A maioria dos critérios de resposta utilizados não prevê outcomes clínicos e têm fraca concordância. É essencial criar um consenso na definição de resposta à TRC de forma a uniformizar os estudos. Keywords: Cardiac resynchronization therapy, Heart failure, Predictors of events, Response criteria, Palavras-chave: Terapia de ressincronização cardíaca, Insuficiência cardíaca, Preditores de eventos, Critérios de resposta

O artigo apresenta algumas reflexões acerca da relação estabelecida entre História e Direito desde a perspectiva de uma educação antirracista. Neste sentido, o artigo apresenta algumas considerações sobre o processo de implementação da Lei n°. 10.639/2003, que altera a Lei de Diretrizes e Bases da Educação Nacional (Lei n°. 9394/1996), acrescentando em seu texto os artigos 26-A e 79-B.

Liquid biopsy is an emerging technology with a potential role in the screening and early detection of lung cancer. Several liquid biopsy-derived biomarkers have been identified and are currently under ongoing investigation. In this article, we review the available data on the use of circulating biomarkers for the early detection of lung cancer, focusing on the circulating tumor cells, circulating cell-free DNA, circulating micro-RNAs, tumor-derived exosomes, and tumor-educated platelets, providing an overview of future potential applicability in the clinical practice. While several biomarkers have shown exciting results, diagnostic performance and clinical applicability is still limited. The combination of different biomarkers, as well as their combination with other diagnostic tools show great promise, although further research is still required to define and validate the role of liquid biopsies in clinical practice.

RESUMO Objetivo: realizar a tradução e adaptação cultural da Spiritual Care Competence Scale para uso entre estudantes de graduação em Enfermagem e verificar evidências de validade da versão adaptada dessa escala. Método: estudo metodológico conduzido com 266 estudantes de Enfermagem, em uma universidade pública brasileira do estado de São Paulo. A escala foi submetida a um processo de tradução e adaptação cultural e análise das propriedades psicométricas (validade de construto e fidedignidade). Resultados: as equivalências linguística e conceitual foram obtidas; a escala mostrou boa aceitação entre os estudantes; seis subescalas foram obtidas pela análise fatorial exploratória, com cargas fatoriais dos itens superiores a 0,46; alguns itens foram realocados diferentemente da escala original. A consistência interna avaliada pelo alfa de Cronbach das subescalas, a partir da distribuição obtida pela análise fatorial exploratória, variou de 0.54 a 0.87. O indicador AC1 Gwet evidenciou correlação entre os momentos teste e reteste para todos os itens (p

Abstract Repetitive DNA is an important component of eukaryotic genomes, accounting for more than 90% of the genome size of some species, including mobile elements and satellite DNA sequences. The aim of study was to characterize the genome of Hancornia speciosa Gomes using C-value genome size estimate and repetitive DNA sequences analysis. The genome size estimate was obtained by flow cytometry and the repetitive DNA sequences were accessed using graph-based clustering. Evolutionary relationships among species of Apocynaceae was obtained using reads of Catharanthus roseus L., Rhayza stricta Decne, and Asclepias syriaca L. from the NCBI and analyzed by graph-based clustering. The genome size estimates in two botanical varieties showed 2C-values ranging from 0.88 to 1.08 pg, indicating small genome size. Clusters representing repeats making up at least 0.01% of the genome revealed the proportion of repetitive DNA ranging from 19.87% (H. speciosa) to 51.674% (A. syriaca), of which the mobile elements were more abundant. Satellite DNA sequences were not found in H. speciosa and R. stricta, while at least one satellite was detected in C. roseus and A. syriaca, suggesting that the LTR retrotransposon Ty3/Gypsy/Chromovirus may have replaced the satellite DNA in H. speciosa and R. stricta.

The province of Cadiz, Spain, is a highly industrialized area with numerous registered industrial plants, which has led to major concern regarding the possible influence of these facilities on the high rate of cancer-related mortality observed. Our objective was to evaluate the association between digestive cancer mortality and proximity to industrial installations in the province of Cadiz over the period 1992-2014 and to analyse this risk according to different categories of carcinogenic substances. An ecological study at the census tract level was carried out. Mortality due to digestive cancer (involving the oral cavity, pharynx, oesophagus, stomach, liver, pancreas, gallbladder, colon and rectum) was analysed. Using the spatial Besag, York and Mollié (BYM) approach, we assessed the relative risk of dying from these cancers for people living between 500 m and 5 km from industrial installations. The models were adjusted to account for socioeconomic deprivation. We detected a significant, excess risk of dying due to cancer in the following organs (expressed as relative risk with 95% confidence intervals): colon/rectum (1.13; 1.04-1.22 at 4 km), stomach (1.13; 1.00-1.29 at 2 km), liver (1.28; 1.02-1.61 at 1 km), pancreas (1.19; 1.03-1.39 at 2 km), oral and pharyngeal (1.40; 1.08-1.82 at 1 km), oesophagus (2.05; 1.18-3.56 at 500 m) and gallbladder (2.80; 1.14-6.89 at 500 m) for men; and from colorectal (1.21; 1.00-1.46 at 1 km), stomach (1.15; 1.01-1.31 at 4 km) and liver (1.58; 1.20- 2.07 at 1 km) cancers for women. The results support the hypothesis of an association between several digestive cancers and proximity to polluting industrial plants.

A criação de pequenos ruminantes tem se expandido em todos os estados brasileiros e, independentemente do objetivo da exploração, tem muito a contribuir para o desenvolvimento socioeconômico do país. Entretanto, esse setor enfrenta constantes desafios, como, por exemplo, a falta de informações e acesso às tecnologias, sendo a ausência de informatização uma das principais limitações para o registro de dados no campo. Dessa forma, objetivou-se, com esta revisão da literatura, compilar informações a respeito da utilização de ferramentas informatizadas aplicadas aos controles zootécnico e genético e à seleção de acasalamentos em pequenos ruminantes. Constatou-se que a adoção dessas ferramentas na ovinocultura e caprinocultura ainda é bastante limitada.

INTRODUCTION:Geographical variations in cancer mortality can be explained, in part, by their association with social inequalities. The objective of our study was to analyse the spatial pattern of mortality in relation to the most common causes of cancer in the Spanish autonomous community of Andalusia and its possible association with social inequalities. MATERIALS AND METHODS:A small area cross-sectional study in Andalusia, with census tracts as units of spatial analysis, for the period 2002-2013. Cases and person-years, sex and age group came from the Longitudinal Population Database of Andalusia. Standardized mortality rates and smoothed risk ratios were calculated using the Besag, York and Mollié model for lung, colorectal, breast, prostate, bladder and stomach cancer. In order to evaluate the association with social inequalities we included the deprivation index of the census tract as a covariate. RESULTS:The results show an East-West mortality pattern with higher risk in the west for lung and bladder cancer among men, and breast cancer among women. For all of Andalusia, the association between deprivation index of the census tract and mortality relative risks is positive and significant for lung, stomach and bladder cancers in men, while in women we observed a negative association for lung cancer and a positive for stomach cancer. CONCLUSIONS:Knowledge regarding the spatial distribution of cancer mortality and the socioeconomic inequalities related should contribute to the design of specific health and social policies-aimed at tackling cancer mortality and social inequalities in areas of high mortality and/or levels of deprivation.

Introdução: Os linfomas são um conjunto de neoplasias linfoides em que há o acúmulo de linfócitos malignos nos linfonodos, causando linfonodomegalia. Os linfomas são responsáveis por 3% a 4% dos cânceres no mundo. Estimativa mundial apontou 390 mil novos casos e 199 mil óbitos por linfoma não Hodgkin e 65 mil novos casos e 25 mil óbitos por Linfoma de Hodgkin no ano de 2012. Sendo a busca por cuidados terapêuticos e a tentativa de solucionar problemas de saúde conduzem indivíduo e familiares por caminhos compreendidos como itinerário terapêutico Objetivo: Conhecer o itinerário terapêutico de pacientes portadores de linfoma atendidos na rede pública por serviço de saúde especializado. Material e Métodos: Estudo prospectivo e descritivo com dados coletados em um hospital de referência em oncologia na Zona da Mata Mineira, no estado de Minas Gerais, Brasil. Resultados: Participaram do estudo 32 pacientes, sendo 18 do sexo masculino (56,3%), com idade entre 7 e 80 anos, caracterizados principalmente por baixos níveis de escolaridade e renda. Prevaleceu o linfoma não Hodgkin representado por 23 sujeitos (71,9%). Um total de 24 pacientes (75%) necessitou passar por três ou mais médicos até a obtenção do diagnóstico definitivo. O tempo médio entre o aparecimento dos sintomas e a realização do diagnóstico foi de 9,77 meses. A baixa renda dos pacientes contribuiu para a demora na busca ou obtenção do primeiro atendimento à saúde (p = 0,05) e consequente diagnóstico do linfoma. Conclusão: A dificuldade de acesso aos serviços de atenção à saúde e a baixa suspeita diagnóstica para a doença por parte dos profissionais possivelmente influenciaram o atraso no estabelecimento do diagnóstico.

Resumo Introdução A raiva é uma infecção zoonótica transmitida pela inoculação do vírus através da saliva e secreções de animais infectados. O trabalho avaliou o perfil dos agravos e a conduta do atendimento antirrábico humano pós-exposição, entre 2006 e 2013, em Cuité-PB. Método Foram avaliadas 184 fichas dos agravos incluídos no SINAN (Sistema de Informações de Agravos de Notificação). Utilizou-se o teste qui-quadrado e calcularam-se a razão de prevalência (RP) e os intervalos de confiança (IC). Resultados Na análise dos acidentes, 53,3% eram do sexo feminino e 39,1% tinham entre 20 e 59 anos. A mordedura foi a agressão mais frequente (72,3%), e as lesões graves foram 41,5% das agressões. Os cães foram responsáveis por 66,1% das agressões. Foram registradas agressões por gatos, primatas e raposas. Verificou-se associação entre a espécie agressora e o sexo dos indivíduos (p=0,019) e maior frequência de agressões por cães em homens (RP= 1,587, IC=1,039-2,422) e por gatos em mulheres (RP=1,415, IC=1,080-1,855). Observou-se associação entre agressões por cães em membros inferiores (p=0,008, RP=2,065, IC=1,138-3,749) e por gatos em mãos/pés (p=0,001, RP=2,045, IC=1,340-3,123). 59,8% das condutas foram observação+vacina e 59,2% seguiram o protocolo do Ministério da Saúde. Conclusão deve haver uma melhora na indicação dos tratamentos e no registro dos agravos.

Objective: Features of colorectal cancer such as natural history, molecular, chromosomal, and epigenetic alterations have been well described. However, there is still a lack of accurate prognostic markers, which is evident by the lower overall survival rates of patients with advanced cancer. Although alterations in parkin protein expression have been described in colorectal cancer, the functional significance of this protein remains unknown. The present study aimed to investigate the involvement of parkin expression in colorectal adenocarcinoma development and progression by evaluating the association between its expression, clinicopathological parameters, and expression of known proteins involved in colorectal cancer. Methods: Tissue microarrays consisting of 73 tumor and 64 normal tissue samples were generated to examine parkin expression and localization by immunohistochemistry. Results: A positive correlation of parkin and APC expression was observed in the superficial, intermediate, and profound regions of all cases (ρ = 0.37; P = 0.001). Parkin expression was also significantly associated with tumors in men (P = 0.049), those of the mucinous subtype (P = 0.028), and of advanced stage (III + IV, P = 0.041). In addition, increased parkin expression was observed in the invasive front tumor region (P = 0.013). More importantly, a positive correlation was found between parkin expression and the overall survival of patients with advanced colorectal cancer (P = 0.019). Multivariate analysis showed that parkin expression was independent of any of the clinicopathological parameters evaluated in relation to patient survival. Conclusions: These results suggest that parkin expression status can be used as a potential independent prognostic marker of survival in advanced colorectal cancer.

Introduction: The benefits of cardiac resynchronization therapy (CRT) documented in heart failure (HF) may be influenced by atrial fibrillation (AF). We aimed to compare CRT response in patients in AF and in sinus rhythm (SR). Methods: We prospectively studied 101 HF patients treated by CRT. Rates of clinical, echocardiographic and functional response, baseline NYHA class and variation, left ventricular ejection fraction, volumes and mass, atrial volumes, cardiopulmonary exercise test (CPET) duration (CPET dur), peak oxygen consumption (VO2max) and ventilatory efficiency (VE/VCO2 slope) were compared between AF and SR patients, before and at three and six months after implantation of a CRT device. Results: All patients achieved ≥95% biventricular pacing, and 5.7% underwent atrioventricular junction ablation. Patients were divided into AF (n=35) and SR (n=66) groups; AF patients were older, with larger atrial volumes and lower CPET dur and VO2max before CRT. The percentages of clinical and echocardiographic responders were similar in the two groups, but there were more functional responders in the AF group (71% vs. 39% in SR patients; p=0.012). In SR patients, left atrial volume and left ventricular mass were significantly reduced (p=0.015 and p=0.021, respectively), whereas in AF patients, CPET dur (p=0.003) and VO2max (p=0.001; 0.083 age-adjusted) showed larger increases. Conclusion: Clinical and echocardiographic response rates were similar in SR and AF patients, with a better functional response in AF. Improvement in left ventricular function and volumes occurred in both groups, but left ventricular mass reduction and left atrial reverse remodeling were seen exclusively in SR patients (ClinicalTrials.gov identifier: NCT02413151; FCT code: PTDC/DES/120249/2010). Resumo: Introdução: Os benefícios da terapêutica de ressincronização cardíaca (TRC), documentados na insuficiência cardíaca (IC), poderão ser influenciados pela fibrilhação auricular (FA). Pretendemos avaliar comparativamente efeitos TRC em doentes em FA e em ritmo sinusal (RS). Métodos: Foram estudados prospetivamente 101 doentes submetidos a TRC. Percentagens de respondedores clínicos, ecocardiográficos e funcionais, valores basais e variação de classe NYHA, fração de ejeção, volumes e massa ventriculares esquerdos, volumes auriculares, duração da prova de esforço cardiorrespiratória (PECR dur), consumo pico de oxigénio (VO2p) e eficiência ventilatória de esforço (VE/VCO2) foram comparados entre grupos FA e RS, pré-implantação TRC e nos seis meses após implantação. Resultados: Os doentes tiveram percentagens de pacing biventricular ≥95%, com 5,7% de ablação auriculoventricular juncional. Definimos grupo FA (n=35) e grupo RS (n=66), tendo os doentes com FA idade superior, maiores volumes auriculares, menores PECR dur e VO2p pré-CRT. Percentagens de respondedores clínicos e ecocardiográficos foram idênticas nos dois grupos, mas de respondedores funcionais foram superiores nos doentes FA (71 versus 39% no grupo RS; p=0,012). Nos doentes RS verificou-se a redução significativa do volume auricular esquerdo e da massa ventricular esquerda (p=0,015 e p=0,021, respetivamente) e nos doentes com FA maior aumento da PECR dur (p=0,003) e VO2p (p=0,001; p=0,083 ajustado para idade). Conclusão: As respostas clínica e ecocardiográfica à TRC foram semelhantes nos doentes FA e RS, com resposta funcional superior em FA. A melhoria de função e dimensões ventriculares esquerdas foi idêntica nos dois grupos, contudo redução de massa ventricular esquerda e remodelagem inversa auricular esquerda foram exclusivas de doentes RS (ClinicalTrials.gov Identifier: NCT02413151; FCT code: PTDC/DES/120249/2010). Keywords: Heart failure, Cardiac resynchronization, Atrial fibrillation, Responder, Palavras-chave: Insuficiência cardíaca, Ressincronização cardíaca, Fibrilhação auricular, Respondedor

A implantação do Sistema de Gestão por Competência é uma ferramenta moderna da gestão de pessoas, que engloba desde o procedimento gerencial, da migração dos cargos e funções até a validação dos resultados desejados. O estudo ora apresentado propõe a implantação do modelo de gestão por competência na empresa Alfa, considerada de pequeno porte. A pesquisa foi realizada por meio da metodologia qualitativa e descritiva, a estratégia de estudo de caso único, com técnica de coleta de dados a entrevista semiestruturada, observação direta e análise de documentos. Conclui-se que, a gestão por competência é resultado do processo construído por meio das informações levantadas na organização que serviram para aplicação de teorias aqui desenvolvidas, demonstrando o interesse na aprendizagem para adequação das competências e melhorias no desempenho dos colaboradores, transparência nas relações de trabalho, por meio da participação dos envolvidos no processo de mapeamento na organização.

Introduction: Cardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. Aims: To identify baseline characteristics that might influence echocardiographic response to CRT. Methods and Results: We performed a prospective single-center hospital-based cohort study of consecutive HF patients selected to CRT (NYHA class II-IV, left ventricular ejection fraction (LVEF)

Objetivo: Analisar a qualidade da alimentação de universitários como fator de risco para câncer de intestino. Métodos: Estudo transversal com 100 universitários do curso de Gastronomia de uma instituição de ensino privada em Montes Claros, Minas Gerais. Aferiu-se o índice de massa corporal (IMC). Coletaram-se o comportamento alimentar, prática de atividade física e a frequência alimentar. Utilizou-se a análise descritiva. Resultados: A partir dos resultados, verificou-se que 46% (n=46) dos estudantes estavam com a massa corporal elevada, ou seja, IMC ≥ 25 kg/m2 (sobrepeso e obesidade). A análise dos hábitos alimentares demonstrou mudança de peso corporal em 44% dos entrevistados, destes 25% apresentou ganho de massa corporal. Dentre os entrevistados, 41% alegou consumir embutidos, pizzas e fast foods dentre outros, e 57% relatou consumir alimentos industrializados de 1 a 3 vezes por semana. Os alimentos ricos em açúcar (café com açúcar, refrigerantes e chocolate) eram consumidos diariamente por 71%, 30% e 24% dos participantes. O consumo de grãos (chia, linhaça e quinoa) foi relatado por 7%. Conclusão: Observou-se alto consumo de alimentos processados e/ou industrializados com alto teor de gorduras e açúcares, juntamente com uma baixa ingestão de grãos. Essa conjuntura alimentar associada a um estilo de vida sedentário são fatores de risco para a instalação de um quadro de neoplasia.