Acceptability and consumers' willingness to pay for comprehensive medication management services in Brazil.

Aim: Comprehensive medication management (CMM) is a clinical service that aims to optimize the therapeutic results of patients at the individual level. Studies carried out in Brazil and in several parts of the world have found a positive impact of the service, mainly in the resolution of drug therapy problems and in improving clinical outcomes and patients' quality of life. This service is not widespread and its acceptability and willingness to pay were not defined by the population yet. Objective: This work aims to conduct a study with users of private health services to determine the acceptability and willingness to pay for CMM services. Methods: This is a cross-sectional survey conducted through face-to-face interviews, among residents over 18 years of age of the metropolitan region of Belo Horizonte, capital of Minas Gerais State, Brazil. Results: For this study, 563 individuals were interviewed. Most respondents were female (55.1%), had completed high school (46.8%) and were employed (62.5%). The acceptability for the service was 93,25%, and among all respondents, 37 would not accept the service even if it was free. The amount of consumers' willingness to pay for the CMM service was estimated at $17.75 (40.00 BRL). Conclusion: The research results show that most people are willing to pay for the CMM service. This study can contribute to the decision-making regarding the implementation and pricing of the service in Brazil.

A composite index; socioeconomic deprivation and coverage of reproductive and maternal health interventions.

Objective: To examine inequalities in the coverage of reproductive and maternal health interventions in low- and middle-income countries and territories using a composite index of socioeconomic deprivation status. Methods: We obtained data on education and living standards from national household surveys conducted between 2015 and 2019 to calculate socioeconomic deprivation status. We assessed the coverage of reproductive and maternal health interventions, using three indicators: (i) demand for family planning satisfied with modern methods; (ii) women who received antenatal care in at least four visits; and (iii) the presence of a skilled attendant at delivery. Absolute and relative inequalities were evaluated both directly and using the slope index of inequality and the concentration index. Findings: In the 73 countries and territories with available data, the median proportions of deprivation were 41% in the low-income category, 11% in the lower-middle-income category and less than 1% in the upper-middle-income category. The coverage analysis, conducted for 48 countries with sufficient data, showed consistently lower median coverage among deprived households across all health indicators. The coverage of skilled attendant at delivery showed the largest inequalities, where coverage among the socioeconomically deprived was substantially lower in almost all countries. Antenatal care visits and demand for family planning satisfied with modern methods also showed significant disparities, favouring the less deprived population. Conclusion: The findings highlight persistent disparities in the coverage of reproductive and maternal health interventions, requiring efforts to reduce those disparities and improve coverage, particularly for skilled attendant at delivery.

Telemedicine pre-screening for blood donor.

INTRODUCTION: The COVID-19 pandemic had an important impact on blood bank services. The onset of the pandemic led to a decrease in the number of blood donors. A remote interview would avoid deferred donors from having to travel to the blood bank. We evaluate the feasibility of using telemedicine as an alternative to a face-to-face interview as a first blood donor screening. METHODS: Our retrospective study included 404 whole blood and platelets donors, who underwent the clinical interview remotely via telemedicine. The deferred donor would not need to go to the blood bank and eligible candidates were required to donate within 7 days. On the day of donation, a mini-interview was held to ensure donor and blood safety. RESULTS: The appointments were made from June 2020 to June 2022, including 263 candidates for whole blood (WB) and 141 for platelets (PLTs). At the end of the telemedicine interview, 285 (70.6 %) candidates were considered eligible. Telemedicine was not performed for 60 (14.8 %) candidates due to technical problems (with audio or video) or absences. The deferral rate among candidates who underwent telemedicine pre-screening was 14.6 % and, among eligible donors after telemedicine, only 7 (2.9 %) were unable to donate blood. CONCLUSION: Telemedicine is a viable alternative and a welcome convenience for potential donors to avoid unnecessary travel.

ICNP® terminological subset for preventing falls in the elderly in primary care.

OBJECTIVE: Build and validate a terminological subset of ICNP® for the prevention of falls in the elderly in the context of primary health care, in light of the Self-Care Deficit Theory. METHOD: Methodological study developed in accordance with ICN recommendations and the Brazilian method for constructing terminological subsets, in two stages: 1) construction of ICNP® statements of nursing diagnoses, outcomes, and interventions; 2) content validation of statements by specialist nurses. RESULTS: A total of 182 diagnoses/outcomes and 321 nursing interventions were constructed, which were subjected to content validation by 28 experts, being validated with a Content Validity Index ≥ 0.80. After validation, the statements were organized according to self-care requirements and the majority of diagnoses/outcomes (51.6%) and interventions (52.7%) were classified under health deviation requirements. CONCLUSION: It was possible to construct and validate a terminological subset of ICNP® with a predominance of statements related to health deviation requirements, standing out for being the first terminological subset for the prevention of falls in the elderly in the context of primary care.

Reliability and validity of cross­culturally adapted oral health­related quality­of­Life instruments for Brazilian children and adolescents: a systematic review.

OBJECTIVE: This systematic review aimed to review the reliability and validity of oral health-related quality of life (OHRQoL) questionnaires for Brazilian children and adolescents. Also, the cross-cultural adaptation was evaluated. METHODS: This systematic review is registered in PROSPERO (CRD42022300018) and was performed based on the COSMIN guideline. Electronic searches were performed in the PubMed/MEDLINE, Web of Science, Lilacs, BVS (BIREME), Scielo, and Embase databases until March 2023 by two independent reviewers. There was no restriction on time or language. The following studies were included: validation studies and cross-cultural adaptation of OHRQoL instruments into Brazilian Portuguese; studies that evaluated the measurement properties of OHRQoL questionnaires in children and adolescents and that reported at least one of the measurement properties: reliability, internal consistency, error measurement, content validity, construct validity, criterion validity, discriminant validity, and/or convergent validity. The following were excluded: studies of systematic reviews of OHRQoL measures; studies reporting OHRQoL assessment through instruments; construction (development) and validation of a new instrument; questionnaires that had a single item; and validation for Portuguese from Portugal. The cross-cultural adaptation process and psychometrics of the included studies were verified. RESULTS: 6556 articles were identified, and 19 manuscripts were included. All studies were conducted in Brazil, and the age of the participants ranged from 2 to 15.42 years old. Sixteen articles presented the cross-cultural validation steps. Cronbach's alpha of the revised instruments ranged from 0.59 to 0.86. CONCLUSIONS: It can be concluded that most studies provided information and evidence regarding validity, reliability, translation, and cultural adaptation.

The impacts of violence among women in intimate relationships: an integrative literature review. / Os impactos da violência entre mulheres em relação íntima: uma revisão integrativa da literatura.

The aim is to identify cultural, social and health impacts caused by intimate partner violence (IPV) in homoaffective (MOH) and biaffective (MOB) women. This is an integrative literature review that sought and analyzed studies indexed in the PubMed and Lilacs databases, considering the following languages. The study sought to answer the following research question: "What impacts does IPV bring to MOB and MOH?". Forty two studies were found and after applying the exclusion criteria, 19 went into the final sample. Data were analyzed using the content analysis methodology, Bardin's thematic analysis modality (2009). The full analysis of the articles revealed two categories: 1) Intimate partner violence and sociocultural impacts; and 2) Intimate partner violence and health impacts. The experience of situations of violence in intimate partnerships between homo and/or biaffective women affect their sociocultural and health dimensions, since they are under the bias of double vulnerability: women in homo/biaffective relationships. There is also an invisibility of the phenomenon in health services, since professionals are not trained to address the different sexual orientations among women and even less the situations of violence resulting from these relationships.

O objetivo é identificar impactos culturais, sociais e de saúde causadas pela violência na parceria íntima (VPI) em mulheres homoafetivas (MOH) e biafetivas (MOB). Estudo de revisão integrativa da literatura que buscou e analisou estudos indexados nas bases de dados PubMed e Lilacs, sendo considerados os idiomas: inglês, português e espanhol. O estudo buscou responder a seguinte pergunta de pesquisa: "Quais impactos a VPI traz para as MOB e MOH?". Foram encontrados 42 estudos e após aplicado os critérios de exclusão, 19 compuseram a amostra final. Os dados foram analisados a partir da metodologia de análise de conteúdo, modalidade análise temática de Bardin (2009). A análise na íntegra dos artigos revelou duas categorias: 1) A violência na parceria íntima e os impactos socioculturais; e 2) A violência na parceira íntima e os impactos na saúde. A vivência de situações de violência na parceria íntima entre mulheres homo e/ou biafetivas afeta suas dimensões socioculturais e de saúde, já que elas estão sob o viés da dupla vulnerabilidade: mulher em relações homo/biafetivas. Existe também invisibilidade do fenômeno nos serviços de saúde já que os profissionais não são formados para abordar as diferentes orientações sexuais entre mulheres e menos ainda as situações de violência advindas dessas relações.

Prognostic Value of Preoperative Electrocardiogram in Low-Risk Patients Undergoing Surgical Intervention and General Anesthesia. / Importância Prognóstica do Eletrocardiograma Pré-Operatório em Pacientes de Baixo Risco Submetidos à Intervenção Cirúrgica sob Anestesia Geral.

BACKGROUND: Patients aged over 50 years require four times more surgical interventions than younger groups. Many guidelines recommend the performance of preoperative electrocardiogram (ECG) in this population. OBJECTIVES: To determine the value of preoperative ECG in patients aged over 50 years and classified as ASA I-II (surgical risk). METHODS: Patients older than 50 years, without comorbidities, who underwent surgical intervention and general anesthesia were included in the study. Patients were randomized to undergo ECG (group A, n=214) or not (group B, n=213) in the preoperative period. The following variables were analyzed: sex, age, ECG, chest x-ray and laboratory tests results, surgical risk, surgery duration, adverse events and in-hospital mortality. The level of significance was set at 5%. RESULTS: Adverse outcomes were reported in 23 (5.4%) patients, with a significant number of adverse events in male patients (OR=7.91 95%CI 3.3-18.90, p<0.001) and in those undergoing major surgeries (OR=30.02 95%CI 4.01-224.92, p<0.001). No differences were observed between patients who underwent ECG and those who did not (OR=1.59, 95%CI, 0.67-3.75, p=0.289). No significant differences were found in the other variables. In multivariate logistic regression, male sex (OR = 6.49; 95%CI 2.42-17.42, p<0.001) and major surgery (OR=22.62; 95%CI 2.95-173.41, p=0.002) were independent predictors of adverse outcomes, whereas undergoing (or not) ECG (OR=1.09; IC95% 0.41-2.90, p=0.867) remained without statistical significance. CONCLUSION: Our findings suggest that preoperative ECG could not predict an increased risk of adverse outcomes in our study population during the hospital phase.

FUNDAMENTO: Pacientes com idade superior a 50 anos requerem quatro vezes mais intervenções cirúrgicas que o grupo mais jovem. Muitas diretrizes recomendam a realização do eletrocardiograma pré-operatório nessa faixa etária. OBJETIVOS: Determinar a importância do ECG pré-operatório em pacientes com idade superior a 50 anos e com classificação de risco cirúrgico ASA I e II. MÉTODOS: Foram recrutados pacientes com idade superior a 50 anos, sem comorbidades, submetidos à intervenção cirúrgica sob anestesia geral. Os pacientes foram randomizados para a realização (grupo A n=214) ou não (grupo B n=213) do ECG pré-operatório. Foram analisadas as variáveis: sexo, idade, resultado do ECG, da radiografia do tórax e dos exames laboratoriais, risco cirúrgico, duração do procedimento, eventos adversos e mortalidade intra-hospitalar. O nível de significância estatística adotado foi de 5%. RESULTADOS: Houve ocorrência de desfechos adversos em 23 (5,4%) pacientes, com um número significante de eventos adversos nos pacientes do sexo masculino (OR=7,91, IC95% 3,3-18,90, p<0,001) e naqueles com intervenções de maior porte cirúrgico (OR=30,02, IC95% 4,01-224,92, p<0,001). Não houve diferença entre os grupos que realizaram ou não o ECG (OR=1,59, IC95% 0,67-3,75, p=0,289). As demais variáveis não mostraram diferenças significantes. Na regressão logística multivariada o sexo masculino (OR=6,49; IC95% 2,42-17,42, p<0,001) e o porte cirúrgico (OR=22,62; IC95% 2,95-173,41, p=0,002) foram preditores independentes de desfechos adversos, enquanto realizar ou não ECG (OR=1,09; IC95% 0,41-2,90, p=0,867) permaneceu sem significância estatística. CONCLUSÕES: Os resultados sugerem que o ECG pré-operatório não foi capaz de predizer aumento do risco de desfechos adversos nos pacientes estudados, durante a fase hospitalar.

Psychobehavioral factors and family functioning in mucopolysaccharidosis: preliminary studies.

Introduction: Mucopolysaccharidoses (MPS) constitute a group of progressive and multisystemic inherited metabolic diseases that profoundly affect both the mental health of patients and the wellbeing of their families. This study aims to evaluate the impact of MPS on family functioning and related factors. Methods and results: Twenty-five patients with MPS, including types I (n = 4), II (n = 11), IIIB (n = 2), IVA (n = 3), and VI (n = 5), and their families participated in this study. The mean patient age was 13 years [standard deviation (SD): 7.7 years]. Behavioral and emotional problems were noted in 9.1% of all patients. While the type of MPS did not directly influence mental problems, the presence of neuronal involvement did (p = 0.006). Patients with MPS III exhibited difficulties primarily in emotional areas, conduct, hyperactivity, and peer problems. Importantly, both patients with MPS II and those with MPS III experienced a significant impact on communication [mean scores for communication domain: MPS II, 35.6 (SD: 24.3); MPS III, 35.0 (SD: 22.6)]; poorer communication was directly linked to worse adaptive behavior (p = 0.012), and worse adaptive behavior was associated with lower quality of life (p = 0.001). Quality of life and caregiver burden among family members did not significantly differ across MPS types; however, higher caregiver burden was negatively associated with quality of life (p = 0.002). Concerning family functioning, the most impacted domains included independence, intellectual/cultural orientation, activity/recreation, and expressiveness. Domain scores did not vary based on MPS type, treatment, or neurological involvement. Quality-of-life scores were positively associated with the cultural/intellectual domain score. Conclusion: The impacts of quality of life and family extend beyond clinical characteristics and MPS type, strongly influenced by patient cognition and communication, as well as type of family functioning, especially those with greater cultural/intellectual skills of their family members. A multidisciplinary approach addressing the broader needs of individuals with MPS becomes essential. Techniques aimed at improving communication, including prompt interventions such as speech therapy and augmentative and alternative communication strategies, can contribute to overall family functioning improvement.

Motivational drivers for health professionals in a large quality improvement collaborative project in Brazil: a qualitative study.

BACKGROUND: The success of collaborative quality improvement (QI) projects in healthcare depends on the context and engagement of health teams; however, the factors that modulate teams' motivation to participate in these projects are still unclear. The objective of the current study was to explore the barriers to and facilitators of motivation; the perspective was health professionals in a large project aiming to implement evidence-based infection prevention practices in intensive care units of Brazilian hospitals. METHODS: This qualitative study was based on content analysis of semistructured in-depth interviews held with health professionals who participated in a collaborative QI project named "Improving patient safety on a large scale in Brazil". In accordance with the principle of saturation, we selected a final sample of 12 hospitals located throughout the five regions of Brazil that have implemented QI; then, we conducted videoconference interviews with 28 health professionals from those hospitals. We encoded the interview data with NVivo software, and the interrelations among the data were assessed with the COM-B model. RESULTS: The key barriers identified were belief that improvement increases workload, lack of knowledge about quality improvement, resistance to change, minimal involvement of physicians, lack of supplies, lack support from senior managers and work overload. The primary driver of motivation was tangible outcomes, as evidenced by a decrease in infections. Additionally, factors such as the active participation of senior managers, teamwork, learning in practice and understanding the reason for changes played significant roles in fostering motivation. CONCLUSION: The motivation of health professionals to participate in collaborative QI projects is driven by a variety of barriers and facilitators. The interactions between the senior manager, quality improvement teams, and healthcare professionals generate attitudes that modulate motivation. Thus, these aspects should be considered during the implementation of such projects. Future research could explore the cost-effectiveness of motivational approaches.

Effects of exercise-based interventions on gluteal tendinopathy. Systematic review with meta-analysis.

The objective of this review was to evaluate the effect of exercise on pain intensity, function, and quality of life in individuals with gluteal tendinopathy. Searches were carried out in PUBMED, EMBASE, CINAHL, Cochrane Library, and PEDro databases. Randomized or quasi-randomized controlled trials were included. Five studies met the eligibility criteria, comparing exercise-based interventions with minimal interventions and/or corticosteroid injections. Three studies, involving 383 participants, were included in the quantitative analysis. Meta-analyses showed that exercise is superior to minimal intervention for function in short-term [mean difference (MD) = 10.24; 95% confidence interval (95%CI) = 5.98, 14.50) and long-term (MD = 6.54; 95%CI = 1.88, 11.21]). However, no difference was observed for quality of life in the short [standardized mean difference (SMD) = 0.33; 95%CI = -0.29, 0.94] and long-term (SMD = 0.11; 95%CI = -0.16, 0.37). The effect of exercise was no different from that of corticosteroid injections for pain intensity in the short (MD = 1.25; 95%CI = -3.56, 6.05) and long-term (MD = -1.37; 95%CI = -3.72, 0.98]). In conclusion, exercise is superior to minimal interventions for function in the short- and long-term in individuals with gluteal tendinopathy. Exercise and corticosteroid injections had similar effects on pain intensity, however, exercise showed a higher treatment success rate when compared to corticosteroid injections in this population. The GRADE analysis revealed that the certainty of the evidence ranges from low to very low, therefore, large high-quality randomized controlled trials are recommended.PROSPERO registration number: CRD42021242853.

Prevalence of clinical forms of Chagas disease: a systematic review and meta-analysis - data from the RAISE study.

Background: There is a lack of up-to-date estimates about the prevalence of Chagas disease (ChD) clinical presentations and, therefore, we aimed to assess the prevalence of clinical forms of ChD among seropositive adults, pooling available data. Methods: A systematic review was conducted in Medline, Embase, Biblioteca Virtual em Saúde and Cochrane databases looking for studies published from 1990 to August 2023, which investigated the prevalence of ChD clinical forms among seropositive adults, including: (i) indeterminate phase, (ii) chronic Chagas cardiomyopathy (CCM), (iii) digestive and (iv) mixed (CCM + digestive) forms. Pooled estimates and 95% confidence intervals (CI) were calculated using random-effects models. Studies quality and risk of bias was assessed with the Leboeuf-Yde and Lauritsen tool. Heterogeneity was assessed with the I2 statistic. The study was registered in the PROSPERO database (CRD42022354237). Findings: 1246 articles were selected for screening and 73 studies were included in the final analysis (17,132 patients, 44% men). Most studies were conducted with outpatients (n = 50), followed by population-based studies (n = 15). The pooled prevalence of the ChD clinical forms was: indeterminate 42.6% (95% CI: 36.9-48.6), CCM 42.7% (95% CI: 37.3-48.3), digestive 17.7% (95% CI: 14.9-20.9), and mixed 10.2% (95% CI: 7.9-13.2). In population-based studies, prevalence was lower for CCM (31.2%, 95% CI: 24.4-38.9) and higher for indeterminate (47.2%, 95% CI: 39.0-55.5) form. In meta-regression, age was inversely associated with the prevalence of indeterminate (ß = -0.05, P < 0.001) form, and directly associated with CCM (ß = 0.06, P < 0.001) and digestive (ß = 0.02, P < 0.001) forms. Heterogeneity was overall high. Interpretation: Compared to previous publications, our pooled estimates show a higher prevalence of CCM among ChD seropositive patients, but similar rates of the digestive form. Funding: This study was funded by the World Heart Federation, through a research collaboration with Novartis Pharma AG.

Sleep apnea and sudden death in the non-cardiac population: A systematic review.

INTRODUCTION: Obstructive sleep apnea (OSA) is one of the main risk factors for cardiovascular diseases and is associated with both morbidity and mortality. OSA has also been linked to arrhythmias and sudden death. OBJECTIVE: To assess whether OSA increases the risk of sudden death in the non-cardiac population. METHODS: This is a systematic review of the literature. The descriptors "sudden death" and "sleep apnea" and "tachyarrhythmias" and "sleep apnea" were searched in the PubMed/Medline and SciELO databases. RESULTS: Thirteen articles that addressed the relationship between OSA and the development of tachyarrhythmias and/or sudden death with prevalence data, electrocardiographic findings, and a relationship with other comorbidities were selected. The airway obstruction observed in OSA triggers several systemic repercussions, e.g., changes in intrathoracic pressure, intermittent hypoxia, activation of the sympathetic nervous system and chemoreceptors, and release of catecholamines. These mechanisms would be implicated in the appearance of arrhythmogenic factors, which could result in sudden death. CONCLUSION: There was a cause-effect relationship between OSA and cardiac arrhythmias. In view of the pathophysiology of OSA and its arrhythmogenic role, studies have shown a higher risk of sudden death in individuals who previously had heart disease. On the other hand, there is little evidence about the occurrence of sudden death in individuals with OSA and no heart disease, and OSA is not a risk factor for sudden death in this population.

Combination of 5% cysteamine and 4% nicotinamide in melasma: Efficacy, tolerability, and safety.

BACKGROUND: Melasma is a chronic dermatosis that impacts the patient's quality of life and can present considerable challenges in terms of effective treatment. OBJECTIVE: To evaluate the effectiveness, tolerability, and safety of 5% cysteamine combined with 4% nicotinamide in female subjects with melasma. METHODS: This single-center, single-arm, prospective, open-label study evaluated patients with melasma using a combination cream of 5% cysteamine and 4% nicotinamide in a progressive regimen (60 min in the first month, 120 min in the second month, and 180 min in the third month). RESULTS: Overall, 35 treated subjects exhibited reduced modified Melasma Area and Severity Index (mMASI) (p < 0.001) and decreased MelasQoL scores (p < 0.001), accompanied by improved brightness, luminosity, homogeneity, and spot intensity (p < 0.001). Photographic and colorimetric analysis revealed smaller spots and improved homogeneity. LIMITATIONS: Adherence to progressive daily treatment could not be evaluated long-term. CONCLUSION: A combination cream comprising 5% cysteamine and 4% nicotinamide was effective, tolerable, and safe for treating melasma.

Black transmasculine bodies in aesthetic intersections: an interview with Leonardo Peçanha. / Corpos transmasculinos negros em intersecções estéticas: entrevista com Leonardo Peçanha.

This opinion article consists of an interview with Leonardo Peçanha, a Black trans man, a human rights and trans people rights activist and a researcher in Collective Health. In this interview, he reflects intersectionally on the place of beauty, body changes, and physical activity in the gender transition process of trans and transmasculine men. He discusses the (im)possibilities of trans people in high-performance sports and tells us about the Mister Trans Brazil beauty pageant contest.

Este artigo de opinião consiste em uma entrevista realizada com Leonardo Peçanha, um homem negro trans, ativista no campo dos direitos humanos e dos direitos das pessoas trans e pesquisador do campo da Saúde Coletiva. Na conversa que se segue Leonardo Peçanha, de forma interseccional, reflete sobre o lugar da beleza, modificações corporais e atividade física no processo de transição de gênero de sujeitos homens trans e transmasculinos, como também toca no tema das (im)possibilidades das pessoas trans no campo dos esportes de alto rendimento e nos conta sobre o concurso de beleza Mister Trans Brasil.

Procedures and measurement properties of the 6-min step test: A systematic review with clinical recommendations.

OBJECTIVE: To provide information regarding the procedures, safety, tolerability, and measurement properties of the 6-min step test. DATA SOURCES: MEDLINE, EMBASE, CINAHL, and SPORTDiscus (from inception until January 2024). REVIEW METHODS: Studies that examined adults with acute or chronic diseases, and outcomes related to procedures, safety, tolerability, or measurement properties of the 6-min step test were included. Outcome data were summarized and combined in meta-analyses. The quality of included studies was assessed by the Consensus-based Standards for the selection of health Measurement Instruments checklist, and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS: Fourteen studies, involving 847 participants, were included. All studies performed the 6-min step test in 6 min; however, some studies varied the step height and the use of upper limb support. The test appears to be safe and well tolerated by individuals. Moderate- to high-quality evidence demonstrated appropriate results for test-retest reliability (4 studies; Intraclass correlation coefficient 0.96; 95% CI 0.91-0.98; n = 125), criterion validity (4 studies; r = 0.53; 95% CI 0.30-0.71; n = 307), and construct validity (4 studies; r = 0.63; 95% CI 0.52-0.73; n = 233). CONCLUSION: This review provides recommendations for applying the 6-min step test in clinical and research settings. No adverse events were reported, and the test appears to be well tolerated. Adequate results were found for test-retest reliability, criterion validity, and construct validity. REVIEW REGISTRATION: PROSPERO (CRD42022347744).

Empathic Care of Neonates: A Critical Literature Review.

Clinical empathy is a multidimensional ability to feel the patient's suffering, branched into components such as cognitive, emotional, and action, which results in benefits for patients, parents, health professionals, medical students, and others. The authors performed a critical review of the literature about empathy in neonatal care, in 2 databases, and analyzed the co-occurrence of keywords in the last 10 years. Nine articles were included in the qualitative synthesis. They highlight the interconnection between empathy, communication, ethics, and palliative care. Empathy was analyzed in situations that included pain, death, and suffering in the neonate, especially related to critically ill neonates. Strategies such as self-reflection and digital storytelling may help increase the clinical empathy education of health professionals. There are gaps in research considering the measurement of clinical empathy in neonatal care, and this measurement should be encouraged. To change care practices, education on empathy for health professionals, especially physicians, should be improved.

Ravulizumabe no tratamento da hemoglobinúria paroxística noturna / Ravulizumabe not treated for paroxysmal nocturnal hemoglobinuria

INTRODUÇÃO: A Hemoglobinúria Paroxística Noturna (HPN) é uma doença rara, com incidência anual estimada de 1,3 novos casos por um milhão de indivíduos. Esta se caracteriza pela ativação descontrolada do complemento, que pode levar à hemólise intravascular (que por sua vez causa os episódios de hemoglobinúria), danos a órgãos (por exemplo, insuficiência renal e hipertensão pulmonar), eventos trombóticos, aumento da morbidade e mortalidade. Inibidores do C5 são opções de tratamento primário para esta doença, tendo sido o primeiro desta classe licenciado no mundo o eculizumabe em 2007. Em 2019 foi lançado o PCDT da HPN, que conta com a inclusão do eculizumabe. Dados de uma coorte nacional de pacientes com HPN mostram que 16% dos pacientes tiveram síndrome mielodisplásica e cerca de metade da amostra apresentava outras anemias aplásticas e/ou outras síndromes de falha de produção de outras linhas celulares sanguíneas (plaquetas e leucócitos). Embolia venosa e trombose venosa ocorreram em 4

Hidroxiureia 100 mg e 1000 mg para o tratamento de pacientes com doença falciforme com pelo menos 9 meses de idade / Hydroxyureia 100 mg and 1000 mg for the treatment of patients with sickle cell disease with hair less than 9 months old

INTRODUÇÃO: Atualmente, a hidroxiureia é disponibilizada no SUS como cápsula de 500 mg, entretanto, foram submetidas para a análise do Comitê de Medicamentos da Conitec duas demandas para a incorporação desse medicamento nas formas farmacêuticas de comprimidos de 100 e 100 mg, o que motivou a elaboração desse relatório técnico. A primeira demanda partiu do grupo de especialistas que participam do processo de atualização do Protocolo Clínico e Diretrizes Terapêuticas de Doença Falciforme (PCDTDF). Para essa primeira demanda, o objetivo foi analisar somente o impacto orçamentário de uma possível incorporação da hidroxiureia nas concentrações de 100 e 1000 mg para o tratamento de indivíduos com pelo menos 9 meses de idade. A análise apenas do impacto orçamentário foi realizada porque o referido grupo elaborador do PCDTDF também solicitou a avaliação da ampliação de uso da hidroxiureia para todas as crianças entre 9 meses e 2 anos de idade independentemente de critérios de inclusão, que hoje é a regra para o fornecimento de hidroxiureia nesta

Hidroxiureia para o tratamento de pacientes com doença falciforme (SS, Sbeta0 e SD Punjab), entre 9 e 24 meses de idade, sem sintomas e complicações / Hydroxyureia for the treatment of patients with sickle cell disease (SS, Sbeta0 and SD Punjab), between 9 and 24 months of age, without symptoms and complications

INTRODUÇÃO: As manifestações clínicas da doença falciforme (DF) estão relacionadas à anemia hemolítica e aos efeitos da falcização intravascular repetida, resultando em vasooclusão e lesão isquêmica, além de morbidade e mortalidade consideráveis em idade precoce. Atualmente, a hidroxiureia é o padrão de tratamento para prevenir crises de dor vasoclusivas na DF, sendo recomendada para crianças entre 9 e 24 meses de idade, quando apresentam determinados sintomas ou complicações. Considerando que o uso precoce desta tecnologia (antes de 2 anos de idade) pode evitar o comprometimento a longo prazo relacionados à evolução da DF, o objetivo do presente relatório é analisar as evidências científicas sobre eficácia, efetividade, segurança, bem como evidências econômicas relacionadas ao uso de hidroxiureia para o tratamento de indivíduos com doença falciforme (SS, Sbeta0 e SD Punjab) entre 9 e 24 meses de idade, independentemente de sintomas e complicações. PERGUNTA: O uso de h

Prevalence, pain intensity and symptoms associated with primary dysmenorrhea: a cross-sectional study.

BACKGROUND: Primary dysmenorrhea (PD) is an etiological cyclic pelvic pain related to the menstrual period; it can negatively impact women's quality of life and productivity. The aim of the present study was to estimate the prevalence of PD and analyze associated symptoms in Brazilian women. METHODS: An online cross-sectional study was carried out in Brazil, with a structured questionnaire regarding dysmenorrhea and associated symptoms. PD intensity was measured with the Numerical Rating Scale for Pain and classified as mild (1-3), moderate (4-7) and severe (> 8). The association between qualitative variables was performed using Pearson's Chi-Square Test. The quantification of this association was measured using multinomial logistic regression models, with calculation of Odds Ratio and confidence interval. A significance level of 5% was considered. RESULTS: A total of 10,070 women were included. Most participants classified PD intensity as moderate (40.4%, 41.9% and 49.7%) and severe (21.2%, 24.8% and 28.4%) in the previous month, 3 months and 5 years, respectively. The most common symptoms associated with PD were irritability, abdominal distension sensation, anxiety and feeling more emotional. The increased of the risk (OR > 1.0) for moderate and severe PD-related pain intensity is related to age, nulliparity and presence PD since adolescence. CONCLUSION: There is a high prevalence of PD among Brazilian women, and the most common symptoms reported were irritability, abdominal distension sensation, anxiety and feeling more emotional.