[Risk of developing diabetes mellitus in primary care health users: a cross-sectional study]. / Risco para desenvolvimento do diabetes mellitus em usuários da atenção primária a saúde: um estudo transversal.

OBJECTIVE: to identify the risk of developing diabetes mellitus among primary care users in a municipality of the Southern Brazil. METHOD: data were collected from October 2013 to April 2014 by applying the Finnish Diabetes Risk Score questionnaire on 189 users. RESULTS: the majority of the interviewees presented a slight moderate to moderate risk of developing diabetes mellitus (63.5%). There was a greater prevalence of high risk among the men. The variables with a significant prevalence ratio for high risk were age, obesity, abdominal circumference, sedentarism and family history of diabetes mellitus. CONCLUSION: the identified risk factors for diabetes reveal the importance of the health team and how it can intervene to prevent disease.

Factors associated with loss to follow-up in tuberculosis treatment in Brazil: a retrospective cohort study.

OBJECTIVE: To analyze the factors associated with loss to follow-up in tuberculosis cases among adults in Brazil in 2020 and 2021. METHOD: Retrospective cohort with secondary data from the Brazilian Notifiable Diseases Information System. A total of 24,344 people diagnosed with tuberculosis whose information was complete in the database were included. Adjusted odds ratios and confidence intervals were estimated by binary logistic regression. RESULTS: Higher odds of loss to follow-up were observed for males, non-white ethnicity/color, with lower education level, homeless or deprived of liberty, who used drugs, alcohol and/or tobacco, with admission due to recurrence or re-entry after abandonment, and with unknown or positive serology for HIV. On the other hand, older age, extrapulmonary tuberculosis, deprivation of libertyand supervised treatment were associated with lower odds of loss to follow-up. CONCLUSION: Demographic, socioeconomic and clinical-epidemiological factors were associated with the loss to follow-up in tuberculosis cases, which reiterates the various vulnerabilities intertwined with the illness and treatment of this disease. Therefore, there is a need to promote strategies aimed at adherence and linkage to the care for groups most vulnerable to loss to follow-up in tuberculosis treatment in Brazil.

Exploring New Tools for Risk Classification among Adults with Several Degrees of Obesity.

The epidemic of obesity worldwide has been recognized as a very important challenge. Within its complexity, the identification of higher-risk patients is essential, as it is unsustainable to offer access to treatment to all people with obesity. Several new approaches have recently been presented as important tools for risk stratification. In this research, we applied several of these tools in a cross-sectional study involving adults with obesity classes I, II, III, and super-obesity. The participants had their cardiometabolic risk profiles assessed. The study included adults with obesity aged 18 to 50 years (n = 404), who were evaluated using anthropometric, body composition, hemodynamic, physical fitness, and biochemical assessments. These variables were used to identify the prevalence of risk factors for cardiometabolic diseases according to the classes of obesity by gender and age group. The results showed high prevalence of risk factors, especially among the upper classes of obesity (BMI > 35 kg/m2) using single parameters as the waist circumference, with almost 90% above the cut-off point. For smaller numbers such as Glycated Hemoglobin, however, the prevalence was around 30%. Indexes such as the atherogenic index of plasma (AIP) had the highest prevalence, with 100% of the male participants identified as being at increased risk for cardiovascular disease.

Assessment of the attributes of Primary Health Care with women of reproductive age.

OBJECTIVES: to evaluate the quality of Primary Health Care attributes according to the characterization and perspective of women of reproductive age. METHODS: descriptive, quantitative, cross-sectional study, with 397 women of reproductive age from six municipalities in the 16th Health Region of the state of Paraná, with variables for sociodemographic characterization and the Primary Care Assessment Tool (PCATool). RESULTS: mean age, 30.43 years old, most were married, 70.2% worked outside the home and 55.5% had completed high school. The highest average score of the eight domains evaluated was "Family Guidance" and "Coordination - Integration of Care", with averages of 5.86 and 4.89. Domains "Integrality - Services Provided" and "Community Orientation" had lower averages (3.32 and 3.76). CONCLUSIONS: the study allowed tracing the characterization of the participants and identifying that the attributes of Primary Care are unsatisfactory, making it necessary to expand access to the services offered and to qualify the comprehensive care for women's health.

Multiprofessional intervention and telenursing in the treatment of obese people in the COVID-19 pandemic: a pragmatic clinical trial.

OBJECTIVES: to analyze the effects of a multiprofessional remote intervention and telenursing in the treatment of obesity. METHODS: pragmatic clinical trial of intervention, conducted with obese adults. The multiprofessional remote intervention with a nurse occurred for 16 weeks through a messaging application. The application analyzed body composition, hemodynamic and laboratory variables, comparing the results obtained with the group that participated in face-to-face multiprofessional intervention without a nurse. The study investigated the effects of the intervention comparing the intervention groups and the moments through the ANOVA test for repeated measures. RESULTS: Group 1 obtained significance in the variables: percentage of body fat (p = 0.008); blood glucose (p = 0.014); insulin (p = 0.001); abdominal and waist circumference; and HDL cholesterol (p = 0.000). CONCLUSIONS: the effects of multiprofessional remote intervention and telenursing significantly decreased the risk variables for metabolic syndrome in the treatment of obesity.

Stress level and heart rate variability in police post-occurrence of bank robbery: an experience report.

Introduction: The expectation of armed confrontation is among the most stressful elements in police work. Knowledge about perceived stress and cardiovascular markers in police officers comes from simulations. However, to date, information about psychophysiological responses during high-risk occurrences is scarce. Objectives: To assess stress levels and heart rate variability in policemen before and afer atending a bank robbery. Methods: Elite police officers (30.4 ± 3.7yrs) filled in a stress questionnaire and had their heart rate variability monitored at the beginning (7:00 am) and at the end (7:00 pm) of a work shif. At about 5:30 pm, these policemen were called to respond to a bank robbery in progress. Results: No significant changes in sources or symptoms of stress were found between before and afer the incident. However, statistical reductions were found in heart rate range interval (R-R interval [-13.6%]), pNN50 (-40.0%), and low frequency (-28%) and the low frequency/high frequency ratio increased (200%). These results suggest that although no change in the level of perceived stress was found, a significant reduction in heart rate variability may be atributed to a reduction in activation of the parasympathetic system. Conclusions: The expectation of armed confrontation is among the most stressful occurrences in police work. Research knowledge about perceived stress and cardiovascular markers in police officers comes from simulations. Data on psychophysiological responses post-occurrence of high-risk scenarios are scarce. This research may help law enforcement organizations find means to monitor police officers' acute stress levels afer any high-risk occurrences.

Introdução: No trabalho policial, a expectativa do confronto armado está entre as ocorrências mais estressantes. O conhecimento sobre as alterações dos níveis de estresse e marcadores cardiovasculares são oriundas de condições simuladas. Até o momento, a descrição das reações psicofsiológicas após ocorrência de alto risco são escassas. Objetivos: Verificar o nível de estresse e a variabilidade da frequência cardíaca em policiais após uma ocorrência de roubo a banco. Métodos: Oito policiais de elite (30,4±3,7 anos) preencheram um questionário de estresse e tiveram sua variabilidade da frequência cardíaca monitoradas no início (7h) e no final (19h) do turno de trabalho. Entretanto, por volta das 17h30, esses policiais atenderam uma ocorrência de roubo a banco. Resultados: Não foram encontradas alterações significantes entre o início e o final do plantão para as fontes e sintomas de estresse. Entretanto, houve redução significante para o intervalo da variação de frequência cardíaca [intervalo R-R (-13.6%)], pNN50 (-40.0%), baixa frequência (-28%) e aumento para razão baixa frequência/alta frequência (+200%). Dessa forma, nossos resultados sugerem que embora nenhuma mudança no nível de estresse percebido tenha sido encontrada, uma redução importante na variabilidade da frequência cardíaca pode ser atribuída a uma redução na ativação do sistema parassimpático. Conclusões: A associação de indicadores qualitativos e quantitativos (questionário e variabilidade da frequência cardíaca) contribui para um melhor entendimento de como gerenciar e treinar as habilidades emocionais dos policiais. Esta pesquisa pode ajudar as organizações de aplicação da lei a encontrar propostas para monitorar os níveis de estresse agudo dos policiais após qualquer ocorrência de alto risco.

Post-acute COVID and long-COVID among adults and older adults in the State of Paraná, Brazil: protocol for an ambispective cohort study.

INTRODUCTION: Since 2020, the world has been going through a viral pandemic with a high morbidity and mortality rate along with the potential to evolve from an acute infection to post-acute and long-COVID, which is still in the process of elucidation. Diagnostic and prognostic research is essential to understand the complexity of factors and contexts involving the illness's process. This protocol introduces a study strategy to analyse predictors, sequelae, and repercussions of COVID-19 in adults and older adults with different disease severities in the State of Paraná, Brazil. METHODS AND ANALYSIS: A mixed-methods sequential explanatory design. The quantitative data will be conducted by an ambispective cohort study, which will explore the manifestations of COVID-19 for 18 months, with nearly 3000 participants with confirmed diagnoses of COVID-19 (reverse transcription-PCR test) between March and December of 2020, retrieved from national disease reporting databases, over 18 years old, living in a Brazilian State (Paraná) and who survived the viral infection after being discharged from a health service. Data collection will be conducted through telephone interviews, at two different occasions: the first will be a recall 12 months after the acute phase as a retrospective follow-up, and the second will be another prospective interview, with data of the following 6 months. For the qualitative step, Grounded Theory will be used; participants will be selected from the cohort population. The first sample group will be composed of people who were discharged from the intensive care unit, and other sample groups will be composed according to theoretical saturation. The qualitative data will follow the temporal design and classification of the disease provided for in the cohort. ETHICS AND DISSEMINATION: Ethics approval was granted by the State University of Maringá, under opinion number: 4 165 272 and CAAE: 34787020.0.0000.0104 on 21 July 2020, and Hospital do Trabalhador (Worker's Hospital), which is accountable for the Health Department of the State of Paraná, under opinion number: 4 214 589 and CAAE: 34787020.0.3001.5225 on 15 August 2020. The participants will verbally consent to the research, their consent will be recorded, and the informed consent form will be sent by mail or email. Outcomes will be widely disseminated through peer-reviewed manuscripts, conference presentations, media and reports to related authorities.

Abortion in women partners of inmates: prevalence and associated factors.

OBJECTIVE: To analyze factors and behaviors associated with the prevalence of abortion in female partners of prisoners. METHODS: Descriptive, cross-sectional study with a quantitative approach carried out with 349 women of inmates in three penitentiaries in the State of Paraná. For data collection, it was used validated instrument BSSB - Brazilian Study on Sexual Behavior. Descriptive analyzes were processed, and through the Chi-square test, the occurrence of abortion and the researched variables were associated. RESULTS: (38.3%) of the women reported abortion throughout their lives, there was an association between women under the age of 30 (p=<0.001), who reported smoking (p=<0.044), not using condoms (p=<0.001), who suffered sexual violence (p = <0.050) and who reported a diagnosis of Sexually Transmitted Infections (p=<0.001). CONCLUSION: The present study showed associated factors for high prevalence of abortion in women partners of inmates. Abortion is considered an important public health problem and needs to be treated with priority by public health policies in different population groups.

Perceptions of adults with obesity about multiprofessional remote monitoring at the beginning of the COVID-19 pandemic.

OBJECTIVE: To understand the perception of adults with obesity about remote monitoring at the beginning of the pandemic of COVID-19. METHODS: A descriptive-exploratory, qualitative study with participants in remote monitoring of a multi-professional treatment program in southern Brazil. Data was collected through digital platforms with interviews in written or audio-recorded records. The results were submitted to content analysis, thematic modality. RESULTS: 26 women participated, emerging the thematic category "Difficulties and potentialities in adherence to lifestyle changes during the pandemic. Among the difficulties are the change of routine and increased anxiety; and, among the potentialities are the multi-professional accompaniment, decreased tension, and weight control. FINAL CONSIDERATIONS: The participants' perception showed considerable weaknesses in adhering to the program, caused by social distance. Studies with remote interventions are essential to improve the quality of this type of health care.

Effectiveness of a dietary re-education and physical activity program on obesity.

OBJECTIVE: To evaluate the effects on obesity of a weight loss method that associates dietary re-education and physical activity. METHOD: A retrospective, cross-sectional, and quantitative study using secondary data from individual follow-up forms of a weight loss clinic located in a municipality in northwestern Paraná, Brazil. Data collection took place in August 2018 through a checklist of anthropometric parameters, being stored in Excel spreadsheets and analyzed by descriptive statistics using the SPSS program. RESULTS: The mean weight loss was 15.22 kg, and the weight loss method was associated with beneficial results in relation to the following variables: weight, body mass index, body and visceral fat, muscle mass, basal metabolism rate, waist circumference, and hip circumference. CONCLUSION: The association of dietary re-education with regular physical exercise has a positive impact on obesity.

Sleep Hours: Risk behavior in adolescents from different countries.

The aim of this study was to verify sleep hours and associated factors among Brazilian and Spanish students. A cross-sectional study with students aged 11 to 16 years-old was carried out in Paranavaí, Brasil (n = 264) and Cáceres, Spain (n = 233) between 2013 and 2015. Sleeping hours were verified regarding time in minutes, sleep in weekdays, weekends and after lunch/Siesta. All data were checked for normality by the Kolmogorov-Smirnov test. Mann-Whitney U test, Chi-square test (X2) and Odds Ratio estimates were used (p < 0.05). High prevalence in both groups of sleeping 8 hours or more a night at the weekend. The prevalence of sleeping on weekdays, > 8 hours, 6 to 8 hours and < 6 hours among Spanish and Brazilian students, respectively. Nearly a quarter of each group responded that makes the siesta. Spanish students had 3 times higher chance to sleep < 8 hours a night in weekdays, among students from 14 to 16 years old and among the underactive. At the weekends the chance of sleeping < 8 hours is 2 times greater among the Spanish students. Simple guidelines could help so that sleep habits do not affect school development, such as practicing physical activity regularly, sleeping at least 8 hours a night, avoid excessive access to technology at night.

[Prevalence of physical inactivity and associated factors in adolescents]. / Prevalência de inatividade física e fatores associados em adolescentes.

OBJECTIVE: To estimate the prevalence of physical inactivity among adolescents (14-18 years) in the city of Maringá/PR and to explore its association with demographic, socioeconomic and behavioral, indicators of nutritional status variables. METHODS: Cross-sectional study with a representative sample of 991 adolescents (54.5% girls) from both public and private high schools selected through multi stage random sampling. The level of habitual physical activity was verified through the IPAQ modified for adolescents, using the last week as a reference period. Physical inactivity was defined as <300 min/wk of moderate and vigorous physical activity. The independent variables studied were: gender, age, type of high school, socioeconomic level, smoking, sedentary behavior (> 4 h/d), nutritional status and abdominal obesity. RESULTS: Prevalence of physical inactivity among adolescents was 56.9% (girls = 57.9%, boys = 55.7%, p =. 046). The risk factors associated with physical inactivity were belonging to the lower socioeconomic level, studying at public schools and being obese. CONCLUSION: We found a high prevalence of physical inactivity in the study. It is urgently necessary to develop strategies aimed at increasing physical activity, which can be achieved by development of an educational content that promotes healthy life styles.

Trend of hospitalizations and mortality from surgical causes in Brazil, 2008 to 2016. / Tendência de internações e mortalidade por causas cirúrgicas no Brasil, 2008 a 2016.

OBJECTIVE: to evaluate the trend of hospitalazions for surgical procedures and surgical mortality in Brazil, from 2008 to 2016. METHODS: we conducted an ecological, time-series study. We obtained the data on surgical hospitalizations and mortality between 2008 and 2016 from the Department of Informatics of the Unified Health System (SUS). We performed the trend analysis using polynomial regression models. RESULTS: in the period of the study, 37,565,785 surgical procedures were performed in the SUS, an average of 4,151,050 surgeries/year. The mean coefficient of the surgical procedures was 2.12 surgeries per 100 inhabitants/year, with a variation of 1.92 to 2.56 inhabitants/year among the country regions. The surgical mortality rate was 1.63%, ranging from 1.07% to 2.02% between the regions. CONCLUSION: there was a significant trend towards increasing number of surgical procedures carried out and of surgical mortality; however, the coefficient of surgical procedures is lower than recommended by international standards, with regional disparities in access to surgical care and mortality, which undermines the guarantee of universal health coverage expect from the Unified Health System.

OBJETIVO: analisar a tendência de internações para realização de procedimentos cirúrgicos e de mortalidade cirúrgica no Brasil, no período de 2008 a 2016. MÉTODOS: estudo ecológico, de séries temporais. Os dados sobre internações cirúrgicas e mortalidade entre 2008 e 2016 foram obtidos do Departamento de Informática do Sistema Único de Saúde. A análise de tendência foi realizada por meio de modelos de regressão polinomial. RESULTADOS: foram realizados no período do estudo, 37.565.785 procedimentos cirúrgicos pelo Sistema Único de Saúde, uma média anual de 4.151.050 cirurgias. A média do coeficiente dos procedimentos cirúrgicos foi de 2,12 cirurgias por 100 habitantes/ano, com variação de 1,92 a 2,56 habitantes/ano entre as regiões do país. A taxa de mortalidade cirúrgica foi de 1,63%, com variação de 1,07% a 2,02% entre as regiões. CONCLUSÃO: constatou-se tendência significativa crescente dos procedimentos cirúrgicos realizados e de mortalidade cirúrgica; entretanto, o coeficiente de procedimentos cirúrgicos realizados é inferior ao preconizado pela meta internacional, com disparidades regionais no acesso aos cuidados cirúrgicos e na mortalidade, o que compromete a garantia da cobertura universal da saúde preconizada pelo Sistema Único de Saúde.

Permanence, cost and mortality related to surgical admissions by the Unified Health System. / Permanência, custo e mortalidade relacionados às internações cirúrgicas pelo Sistema Único de Saúde.

OBJECTIVE: to analyze the time trend of surgical admissions by the Unified Health System according to hospital stay, costs and mortality by subgroups of surgical procedures in Brazil. METHOD: ecological study of time series. The variables surgical hospitalization, permanence, cost and mortality were obtained from the Department of Informatics of the Unified Health System. The trend analysis used the polynomial regression model. RESULTS: in nine years, 37,565,785 surgical admissions were recorded. The mean duration of surgical admissions was constant (p = 0.449); the mean stay (3.8 days) was decreasing and significant (p <0.01); the mean cost (389.16 dollars) and mortality (1.63%) were increasing and significant (p <0.01). In subgroups of eye, thoracic, oncological and other surgeries, the temporal evolution of surgeries was increasing and significant (p <0.05). In contrast, endocrine glands, digestive tract, genitourinary, breast, reconstruction and buco-maxillofacial surgeries showed a significant trend of decline (p <0.05). In the other subgroups, the trend was constant. CONCLUSION: evidence shows the trend of surgical admissions in the last decade in the country and provide subsidies for the efficient elaboration of public policies, planning and management towards universal coverage in surgical care.

Time series of hospitalizations of adolescents due to mental and behavioral disorders.

OBJECTIVE: to analyze the trend of hospitalizations of adolescents due to mental and behavioral disorders in Paraná, from 1998 to 2015. METHOD: ecological study of time series. Data were analyzed by means of segmented linear regression modeling for time series, estimated for each of the four health macro-regions. RESULTS: the East macro-region showed a greater trend to increase hospitalizations from January 1998 to November 2003 (ß1=0.006, p<0.001). In other macro-regions, there were similar trends with a sudden increase in February 2010, but with a further gradual decrease until December 2015. In the quadrennium 2012-2015, 38.06% of the hospitalizations lasted 29 or more days, and in the Northwest macro-region, hospitalizations lasted for up to seven days. The main cause of hospitalization was the use of alcohol and other drugs. CONCLUSION: there is a need to strengthen health actions to prevent drug use and improvements in the care network.

Drogas na gestação em pré-natal de baixo risco e fatores associados / Drogas en embarazos en controles prenatales de bajo riesgo y factores asociados / Drugs during pregnancy in low-risk prenatal care and associated factors

Resumo Objetivo Identificar a prevalência do uso de drogas lícitas e ilícitas por gestantes que realizavam pré-natal na Atenção Primária à Saúde e fatores associados ao seu uso. Métodos Estudo transversal realizado por meio de roteiro estruturado, composto de variáveis sociodemográficas gestacionais e uso de drogas pela gestante e seus familiares, aplicado a 270 mulheres em pré-natal de baixo risco de 15 Unidades Básicas de Saúde, de dois municípios de uma região metropolitana do Sul do Brasil, onde existem diferenças socioeconômicas e demográficas negativas em relação a cidade-polo. A coleta de dados ocorreu no período de dezembro de 2019 a fevereiro de 2020. Os dados foram analisados por meio do teste do qui-quadrado de Pearson, sendo consideradas significativas as associações com valor de p<0,05. Resultados Jovens de 25 a 35 anos corresponderam a 77% da amostra; pardas/negras foram 60,4%; multigestas somaram 41,8% (com mais de três filhos). Tinham parceiro conjugal fixo 86,6%. A prevalência de uso atual de drogas foi de 46,2%. Houve associação estatisticamente significativa entre consumo de álcool e ter tido intercorrências gestacionais (razão de chance de 2,5; intervalo de confiança de 1,17-5,22); entre o consumo de maconha e a idade de 15 a 19 anos (razão de chance de 2,7; intervalo de confiança de 1,01- 7,03); entre consumo de tabaco e uso de drogas pelo esposo (razão de chance de 4,1; intervalo de confiança de 1,75- 9,55) e entre uso de tabaco e classificação familiar do tipo monoparental (razão de chance de 6,6; intervalo de confiança de 1,55 - 28,43). Conclusão A prevalência entre uso atual e uso na vida foi elevada. As gestantes eram multigestas em pré-natal de baixo risco. O uso de drogas esteve associado a intercorrências gestacionais, idade, uso de drogas pelo esposo e a classificação familiar do tipo monoparental.

Resumen Objetivo Identificar la prevalencia del consumo de drogas lícitas e ilícitas por mujeres embarazadas que realizaban control prenatal en la Atención Primaria de Salud y factores asociados a su uso. Métodos Estudio transversal realizado por medio de guion estructurado, compuesto por variables sociodemográficas gestacionales y el uso de drogas por parte de la mujer embarazada y sus familiares, aplicado a 270 mujeres en control prenatal de bajo riesgo de 15 Unidades Básicas de Salud, de dos municipios de una región metropolitana del sur de Brasil, donde existen diferencias socioeconómicas y demográficas negativas con relación a la ciudad principal. La recopilación de datos se llevó a cabo en el período de diciembre de 2019 a febrero de 2020. Los datos se analizaron mediante la prueba χ2 de Pearson, donde se consideraron significativas las relaciones con valor de p<0,05. Resultados Jóvenes de 25 a 35 años compusieron el 77 % de la muestra. El 60,4 % era parda/negra. El 41,8 % era multigesta (con más de tres hijos). El 86,6 % tenían pareja conyugal. La prevalencia de consumo actual de drogas fue del 46,2 %. Hubo asociación estadísticamente significativa entre el consumo de alcohol y haber tenido complicaciones gestacionales (razón de momios de 2,5; intervalo de confianza de 1,17-5,22); entre el consumo de marihuana y la edad de 15 a 19 años (razón de momios de 2,7; intervalo de confianza de 1,01-7,03); entre el consumo de tabaco y el consumo de drogas por parte del esposo (razón de momios de 4,1; intervalo de confianza de 1,75-9,55) y entre el consumo de tabaco y la clasificación familiar monoparental (razón de momios de 6,6; intervalo de confianza de 1,55-28,43). Conclusión La prevalencia entre el consumo actual y el consumo en la vida fue elevada. Las mujeres embarazadas eran multigestas con control prenatal de bajo riesgo. El consumo de drogas estuvo asociado a complicaciones gestacionales, edad, consumo de drogas por parte del esposo y la clasificación familiar monoparental.

Abstract Objective To identify the prevalence of the use of legal and illicit drugs by pregnant women who received prenatal care in Primary Health Care and factors associated with their usage. Methods Cross-sectional study carried out using a structured script, composed of gestational sociodemographic variables and drug use by pregnant women and their families, applied to 270 women undergoing low-risk prenatal care at 15 Basic Health Units, in two municipalities in a metropolitan region of Southern Brazil, where there are negative socioeconomic and demographic differences in relation to the hub city. Data collection took place from December 2019 to February 2020. Data were analyzed using Pearson's chi-square test, with associations with a value of p<0.05 being considered significant. Results Young people aged 25 to 35 accounted for 77% of the sample; brown/black were 60.4%; multigravidae accounted for 41.8% (with more than three children). 86.6% had a steady marital partner. The prevalence of current drug use was 46.2%. There was a statistically significant association between alcohol consumption and having had pregnancy complications (odds ratio of 2.5; confidence interval of 1.17-5.22); between marijuana consumption and the age of 15 to 19 years (odds ratio of 2.7; confidence interval of 1.01-7.03); between tobacco consumption and drug use by the husband (odds ratio of 4.1; confidence interval of 1.75-9.55) and between tobacco use and single-parent family classification (odds ratio of 6.6 ; confidence interval 1.55 - 28.43). Conclusion The prevalence between current usage and lifetime use was high. The multipregnancies in women were undergoing low-risk prenatal care. Drug use, age, drug use by the husband and single-parent family classification were associated with gestational complications.

Eficácia de um protocolo de laseracupuntura sobre a fadiga e alterações respiratórias pós- covid-19: estudo quase experimental / Effectiveness of a laseracupuncture protocol on post- covid-19 fatigue and lung capacity: a quasi-experimental study / Eficacia de un protocolo de laseracupuntura sobre cambios respiratorios de la fatiga y poscovida-19: estudio casi experimental

Objetivo: Estudo quase experimental aprovado pelo Comitê de Ética em Pesquisas com Seres Humanos ­ COPEP da Universidade Estadual de Maringá, sob Parecer nº. 5.262.784, cujo objetivo foi avaliar a segurança e eficácia da laseracupuntura como uma abordagem terapêutica complementar no tratamento da fadiga e capacidade pulmonar em pacientes pós-COVID. Materiais e método: Nos meses de fevereiro e maço de 2023, no ambulatório de enfermagem da Universidade Estadual do Paraná, Campus de Paranavaí, foram recrutados 23 pacientes da comunidade acadêmica (discentes, docentes e agentes universitários) da própria universidade, com idade mediana de 24 anos (IQR = 22,0, 32,0), com diagnóstico prévio de COVID-19 e que apresentavam sintomas de fadiga e queixa de desconforto respiratório por pelo menos quatro semanas após a recuperação da fase aguda da doença. Dados demográficos, socioeconômicos e de estado de saúde geral e relacionados à COVID-19 foram coletados. Os pacientes foram tratados com duas sessões semanais de laseracupuntura por um período de cinco semanas. Para identificação da presença e intensidade da fadiga, foi aplicada a Escala de Fadiga de Piper Revisada com 23 itens e dividida em três dimensões, no início e final do tratamento e realizados testes de função pulmonar por espirometria para descrição do padrão ventilatório dos voluntários, em todas as sessões. Resultados: Participaram 23 voluntários com idade mediana de 24 anos (IQR, 22-32) e predominantemente do sexo feminino (N= 15 [65%]) e da cor branca (N = 13 [56,4%]). A maioria dos voluntários tinha sobrepeso ou obesidade (N = 16 [79,6%]). Após a fase aguda da COVID-19, os sintomas mais relatados foram ansiedade (65%), queda de cabelo (35%) e dor de cabeça (30%). Todos os participantes apresentaram fadiga intensa pós-COVID (6,36 [IQR = 6,00 ­ 7,73]). Os resultados do estudo mostraram que o tratamento com a laseracupuntura resultou em redução significativa nas pontuações da escala de fadiga quanto à Dimensão comportamental (Diferença média [DM] = -1,65; IC 95%; 0,56-2,75; p < 0,001) Dimensão afetiva (DM = -2,43; IC 95%; 1,33-3,52; p < 0,001) e Dimensão sensorial (DM= -2,85; IC 95%; 2,08-3,63; p < 0,001), além do total geral de fadiga (-2,44; IC 95%; 1,63-3,24; p < 0,001), mas não apresentou qualquer efeito nas medidas de função pulmonar como Capacidade Vital Forçada (DM = -0,87; IC 95%; -4,24, 5,98); p = 0,727), manobra básica avaliada em espirometria e relação entre Volume expiratório forçado em 1 segundo (VEF1) e Capacidade vital forçada (CVF), o VEF1/CVF (DM = -1,00; IC 95%; -10,38-8,39; p = 0,828). Nenhum efeito colateral foi relatado durante o tratamento. Conclusão: O protocolo de laseracupuntura foi seguro e bem tolerado pelos pacientes, sem efeitos colaterais relatados durante o tratamento, sugerindo que a laseracupuntura pode ser uma opção segura para o tratamento da fadiga pós-COVID-19. Apesar da intervenção não ter provocado efeito nos padrões respiratórios dos voluntários, estes verbalizaram melhora da expansibilidade e dor torácica, aumento do fôlego e disposição. Sugere-se novos estudos controlados para melhor compreensão do manejo dos sintomas pós-agudos da COVID-19.

Objective: Quasi-experimental study approved by the Ethics Committee for Research with Human Beings ­ COPEP of the State University of Maringá, Opinion nº. 5,262,784, whose objective was to evaluate the safety and efficacy of laser acupuncture as a complementary therapeutic approach in the treatment of fatigue and lung capacity in post-COVID patients. Materials and method: In February and March 2023, at the nursing clinic of the State University of Paraná, Campus Paranavaí, 23 patients were recruited from the academic community (students, professors and university agents) of the university itself, with a median age of 24 years old (IQR = 22.0, 32.0), with a previous diagnosis of COVID-19 and who had symptoms of fatigue and a complaint of respiratory distress for at least four weeks after recovery from the acute phase of the disease. Demographic, socioeconomic, and general health and COVID-19 related data were collected. The patients were treated with two laseracupuncture sessions per week for a period of five weeks. To identify the presence and intensity of fatigue, the Revised Piper Fatigue Scale was applied, with 23 items and divided into three dimensions, at the beginning and end of treatment, and pulmonary function tests were performed by spirometry to describe the ventilatory pattern of the volunteers, in all sessions. Results: Participants were 23 volunteers with a median age of 24 years (IQR, 22-32) and predominantly female (N = 15 [65%]) and Caucasian (N = 13 [56.4%]). Most volunteers were overweight or obese (N = 16 [79.6%]). After the acute phase of COVID-19, the most reported symptoms were anxiety (65%), hair loss (35%) and headache (30%). All participants experienced severe post-COVID fatigue (6.36 [IQR = 6.00 ­ 7.73]). The results of the study showed that treatment with laser acupuncture resulted in a significant reduction in scores on the fatigue scale for the Behavioral Dimension (Mean difference [MD] = -1.65; CI 95%; 0.56-2.75; p < 0.001) Affective dimension (DM = -2.43; CI 95%; 1.33-3.52; p < 0.001) and Sensory dimension (DM = -2.85; CI 95%; 2.08-3, 63; p <0.001), in addition to the fatigue grand total (-2.44; 95% CI; 1.63-3.24; p < 0.001), but had no effect on measures of lung function such as Forced Vital Capacity (MD = -0.87; 95% CI; -4.24, 5.98); p = 0.727), basic maneuver evaluated in spirometry and ratio between Forced Expiratory Volume in 1 Second (FEV1) and Forced Vital Capacity (FVC), FEV1/FVC (DM = -1.00; CI 95%; -10.38 -8.39; p = 0.828). No side effects were reported during treatment. Conclusion: The laseracupuncture protocol was safe and well tolerated by patients, with no reported side effects during treatment, suggesting that laseracupuncture may be a safe option for treating post-COVID-19 fatigue. Although the intervention had no effect on the breathing patterns of the volunteers, they reported improvement in chest expansion and pain, increased breath and disposition. New controlled studies are suggested to better understand the management of post-acute symptoms of COVID-19.

Objetivo: Estudio casi experimental aprobado por el Comité de Ética en Investigación con Seres Humanos - COPEP de la Universidad Estatal de Maringá, con arreglo a la Opinión No. 5,262,784, cuyo objetivo fue evaluar la seguridad y eficacia de la laseracupuntura como enfoque terapéutico complementario en el tratamiento de la fatiga y la capacidad pulmonar en pacientes post-COVID. Materiales y método: En los meses de febrero y marzo de 2023, en la clínica de enfermería de la Universidad Estatal de Paraná, Campus de Paranavaí, se reclutaron 23 pacientes de la comunidad académica (estudiantes, profesores y agentes universitarios) de la propia universidad, con una edad media de 24 años (IQR = 22,0, 32,0), con diagnóstico COVID y que muestren síntomas de fatiga y una queja de molestias respiratorias durante al menos cuatro semanas después de la recuperación de la fase aguda de la enfermedad. Se han recopilado datos demográficos, socioeconómicos y de salud general relacionados con el programa COVID-19. Los pacientes fueron tratados con dos sesiones de laseracupuntura por semana durante cinco semanas. Para la identificación de la presencia y la intensidad de la fatiga, se revisó la escala de fatiga de los piper con 23 elementos y se dividió en tres dimensiones, al inicio y al final del tratamiento, y se realizaron pruebas de función pulmonar mediante espirometría para describir el patrón de ventilación de los voluntarios, en todas las sesiones. Resultados: participaron 23 voluntarios con una edad media de 24 años (RCI, 22-32) y predominantemente mujeres (N = 15 [65%]) y blancas (N = 13 [56,4%]). La mayoría de los voluntarios presentaron sobrepeso u obesidad (N = 16 [79,6%]). Después de la fase aguda de COVID-19, los síntomas notificados más frecuentemente fueron ansiedad (65%), pérdida de pelo (35%) y dolor de cabeza (30%). Todos los participantes presentaron fatiga grave post-COVID (6,36 [IQR = 6,00 - 7,73]). Los resultados del estudio mostraron que el tratamiento con laseracupuntura dio lugar a una reducción significativa de las puntuaciones de la escala de fatiga para la dimensión conductual (Diferencia media [DM] = -1,65; IC del 95%; IC del 0,56-2,75; p < 0,001) La dimensión afectiva (DM = -2,43; IC del 95%: 1; 33-3,52; p < 0,001) y dimensión sensorial (DM = -2,85; IC del 95% 2,08-3,63; p < 0,001), además de la fatiga general (-2,44; IC del 95%: 1,63-3,24; p < 0,0 01), pero no tuvo efecto sobre las medidas de función pulmonar como capacidad vital forzada (DM = -0,87; IC del 95%; -4,24,5,98); p = 0,727), maniobra basal evaluada en espirometría y relación entre el volumen respiratorio forzado 1 segundo (VEF1) y la capacidad viciosa forzada (CVF), EF1/CVF (DM = -1,00; IC del 95%; -10,38-8,39; p = 0,828). No se notificaron efectos adversos durante el tratamiento. Conclusión: El protocolo de laseracupuntura fue seguro y bien tolerado por los pacientes, sin efectos secundarios notificados durante el tratamiento, lo que sugiere que la laseracupuntura puede ser una opción segura para el tratamiento de la fatiga post-COVID-19. Aunque la intervención no tuvo efecto sobre los patrones respiratorios de los voluntarios, verbalizaron mejoría en la capacidad de expansión y dolor torácico, dificultad respiratoria y disposición. Se sugieren nuevos estudios controlados para entender mejor el manejo de los síntomas post-agudos de COVID-19.

Laseracupuntura para o tratamento da ansiedade e depressão na síndrome pós-covid-19: resultados promissores de um estudo quase-experimental / Laseracupuncture for the treatment of anxiety and depression in post-covid-19 syndrome: promising results from a quasi-experimental study / Laseracupuntura para el tratamiento de la ansiedad y la depresión en el síndrome post-covid-19: resultados prometedores de un estudio quasi-experimental

A pandemia da COVID-19, provocou um grande impacto na saúde mental das pessoas, mesmo após a fase aguda da doença, resultando em altas taxas de ansiedade e depressão, tornando necessário o desenvolvimento e a avaliação de tratamentos, não farmacológicos, eficazes para aliviar esses sintomas. Este estudo quase-experimental, aberto, unicêntrico, realizado nos meses de fevereiro e março de 2023, no ambulatório de enfermagem da Universidade Estadual do Paraná, campus de Paranavaí, teve como objetivo avaliar a eficácia da Laseracupuntura, para o tratamento de ansiedade e depressão, na Síndrome Pós-COVID-19. O estudo foi aprovado pelo Comitê de Ética (Parecer nº. 5.262.784). Foram coletados dados demográficos, socioeconômicos e de estado de saúde. A presença e a intensidade de ansiedade e depressão foram verificadas no início e, ao final, do tratamento, por meio do Inventário de Ansiedade de Beck (21 itens) e Inventário de Depressão de Beck (21 itens). Ao todo, 23 voluntários receberam até 10 sessões, de um protocolo de Laseracupuntura, para tratar ansiedade e depressão pós-COVID-19. Os pontos P1, PC6, E36, E25, VC6, VC12, VC17 e Yintang, foram estimulados por luz de laser infravermelho sobre a pele. Os participantes eram predominantemente, mulheres, de raça/cor branca e tinham sobrepeso ou obesidade. Os sintomas pós-agudos da COVID-19, mais relatados, foram: ansiedade, queda de cabelo e dor de cabeça. A mediana inicial de pontuação das escalas de ansiedade e depressão foram de 23,00 (IQR, 13,50 ­ 27,50) e 22,00 (IQR, 11,50 ­ 26,50), respectivamente. A intervenção resultou em reduções significativas, nas pontuações de duas escalas: de ansiedade (DM = -9,74; IC 95%, 4,88 ­ 14,60; p < 0,001) e depressão (DM = -9,87; IC 95%; 5,53 ­ 14,21; p < 0,001). Nenhum efeito colateral foi relatado durante o tratamento. Os resultados obtidos neste estudo, sugerem que, a Laseracupuntura pode ser uma terapia eficaz e segura para tratar sintomas de ansiedade e depressão em pacientes pós-COVID-19. Além disso, o uso da laseracupuntura, tem a vantagem adicional de ser menos invasiva que a Acupuntura tradicional, tornando-a uma opção atraente para pessoas que buscam tratamentos integrativos para saúde mental, sem os riscos presentes em terapias medicamentosas tradicionais. Recomenda-se a realização de mais estudos ­ principalmente ensaios clínicos randomizados ­, para confirmar a eficácia da Laseracupuntura.

The COVID-19 pandemic has had a major impact on people's mental health even after the acute phase of the disease, resulting in high rates of anxiety and depression, making it necessary to develop and evaluate treatments, non- pharmacological, effective to alleviate these symptoms. This quasi-experimental, open- label, unicentric study, conducted in February and March 2023, at the nursing outpatient clinic at Paraná State University, Paranavaí campus, aimed to evaluate the effectiveness of Laseracupuncture, for the treatment of anxiety and depression, in Post-COVID-19 Syndrome. The study was approved by the Ethics Committee (Opinion No. 5 262 784). Demographic, socioeconomic and health status data were collected. The presence and intensity of anxiety and depression were verified at the beginning and at the end of the treatment, through the Beck Anxiety Inventory (21 items) and Beck Depression Inventory (21 items). In all, 23 volunteers received up to 10 sessions of a Laseracupuncture protocol to treat post-COVID-19 anxiety and depression. The points P1, PC6, E36, E25, VC6, VC12, VC17 and Yintang, were stimulated by infrared laser light on the skin. Participants were predominantly women of white race/color and were overweight or obese. The most reported post-acute symptoms of COVID-19 were: anxiety, hair loss, and headache. The median baseline scores for the anxiety and depression scales were 23.00 (IQR, 13.50 - 27.50) and 22.00 (IQR, 11.50 - 26.50), respectively. The intervention resulted in significant reductions in the scores of two scales: anxiety (DM = -9.74; 95% CI, 4.88 - 14.60; p < 0.001) and depression (DM = -9.87; 95% CI; 5.53 - 14.21; p < 0.001). No side effects were reported during treatment. Results obtained in this study suggest that Laseracupuncture may be an effective and safe therapy for treating symptoms of anxiety and depression in post-COVID-19 patients. In addition, the use of laseracupuncture has the additional advantage of being less invasive than traditional Acupuncture, making it an attractive option for people seeking integrative treatments for mental health, without the risks present in traditional drug therapies. Further studies - mainly randomized clinical trials - are recommended to confirm the efficacy of Laseracupuncture.

La pandemia COVID-19 ha tenido un gran impacto en la salud mental de las personas, incluso después de la fase aguda de la enfermedad, dando lugar a altas tasas de ansiedad y depresión, lo que hace necesario desarrollar y evaluar tratamientos no farmacológicos eficaces para el alivio de estos síntomas. Este estudio casi experimental, abierto y unicéntrico, realizado en los meses de febrero y marzo de 2023 en la clínica de enfermería de la Universidad Estatal de Paraná, campus Paranavaí, tuvo como objetivo evaluar la eficacia de la Laseracupuntura, para el tratamiento de la ansiedad y la depresión, en el Síndrome Post-COVID-19. El estudio fue aprobado por el Comité de Ética (Opinión No. 5 262 784) Se han reunido datos demográficos, socioeconómicos y de salud. La presencia y la intensidad de la ansiedad y la depresión se verificaron al principio y al final del tratamiento, mediante el Inventario de ansiedad Beck (21 artículos) y el Inventario de depresión Beck (21 artículos). En total, 23 voluntarios recibieron hasta 10 sesiones, de un protocolo de Laseracupuntura, para tratar la ansiedad y la depresión post- COVID-19. Los puntos P1, PC6, E36, E25, VC6, VC12, VC17 y Yintang fueron estimulados por luz láser infrarroja en la piel. Los participantes fueron predominantemente mujeres blancas/de raza y tenían sobrepeso u obesidad. Los síntomas post-agudos más frecuentemente notificados de COVID-19 fueron ansiedad, pérdida de pelo y dolor de cabeza. La mediana inicial de la puntuación de ansiedad y depresión osciló entre 23,00 (RPI, 13,50 - 27,50) y 22,00 (RI, 11,50 - 26,50), respectivamente. La intervención dio lugar a reducciones significativas en las puntuaciones de dos escalas: ansiedad (DM = -9,74; IC del 95%, 4,88 - 14,60; p < 0,001) y depresión (DM = -9,87; IC del 95%; IC del 5,53 al 14,21; p < 0,00 1. No se notificaron efectos adversos durante el tratamiento. Los resultados de este estudio sugieren que Laseracupuntura puede ser una terapia eficaz y segura para tratar los síntomas de ansiedad y depresión en pacientes post- COVID-19. Además, el uso de laseracupuntura tiene la ventaja adicional de ser menos invasiva que la acupuntura tradicional, lo que la convierte en una opción atractiva para las personas que buscan tratamiento integrador para la salud mental, sin los riesgos presentes en los medicamentos tradicionales. Se recomiendan otros estudios, principalmente ensayos clínicos aleatorizados, para confirmar la eficacia de Laseracupuntura.

Gestão de casos por enfermeiro na redução de complicações neonatais: estudo quase-experimental / Gestión de casos por enfermeros en la reducción de complicaciones neonatales: estudio cuasi experimental / Nurse case management in reducing neonatal complications: a quasi-experimental study

Resumo Objetivo Analisar o efeito da gestão de casos mediada por enfermeiro na prematuridade, baixo peso ao nascer e mortalidade neonatal. Métodos Pesquisa clínica pragmática, de caráter quase-experimental, com braço único, realizada em um município no sul do Brasil, com aplicação interventiva do modelo de gestão de casos mediada por enfermeiro durante dez meses, em amostra composta por 91 gestantes; a intervenção incluiu: consulta de enfermagem e multiprofissional, ações educativas, visita domiciliar e abordagem telefônica. Os dados do grupo intervenção foram comparados aos dados dos nascimentos ocorridos no período de 2016 a 2018 no município do estudo com cálculo do Risco Relativo, Redução do Risco Absoluto e Número Necessário para Tratar. Resultados Identificaram-se 4,4% (IC 95% 0,18%; 8,61%) de partos prematuros. A eficácia da gestão de casos na prematuridade foi de 62%; a cada 14 gestantes do grupo intervenção, um parto prematuro foi evitado. Elas apresentaram uma Redução do Risco Absoluto de 7,3% comparadas aos números anteriores do município. Nasceram com baixo peso (<2500g) 8,9% dos neonatos (p=0,975) e não houve mortalidade neonatal no grupo intervenção (p=0,850). Conclusão A gestão de casos mediada por enfermeiro durante a gestação apresentou-se como estratégia de prevenção da prematuridade e evidenciou a magnitude na mortalidade neonatal. Sobre o peso ao nascer, este modelo não causou efetividade. É fundamental a presença regular do enfermeiro para a melhoria do cuidado durante a gestação. Registro Brasileiro de Ensaios Clínicos - ReBEC: RBR-1073gcfm

Resumen Objetivo Analizar el efecto de la gestión de casos mediada por enfermeros en la prematuridad, bajo peso al nacer y mortalidad neonatal. Métodos Estudio clínico pragmático, de carácter cuasi experimental, de un solo brazo, realizado en un municipio del sur de Brasil, con aplicación de intervención del modelo de gestión de casos mediada por enfermeros durante diez meses, con una muestra compuesta por 91 mujeres embarazadas. La intervención incluyó: consulta de enfermería y multiprofesional, acciones educativas, visita domiciliaria y contacto telefónico. Los datos del grupo experimental fueron comparados con los datos de los nacimientos ocurridos en el período de 2016 a 2018 en el municipio del estudio con cálculo del riesgo relativo, reducción del riesgo absoluto y número necesario para tratar. Resultados Se identificaron 4,4 % (IC 95 % 0,18 %; 8,61 %) de partos prematuros. La eficacia de la gestión de casos en la prematuridad fue del 62 %; de cada 14 mujeres embarazadas del grupo experimental, un parto prematuro fue evitado. Presentaron una reducción del riesgo absoluto del 7,3 % comparado con los números anteriores del municipio. El 8,9 % de los neonatos (p=0,975) nacieron con bajo peso (<2500 g) y no hubo mortalidad neonatal en el grupo experimental (p=0,850). Conclusión La gestión de casos mediada por enfermeros durante la gestación demostró ser una estrategia de prevención de prematuridad y evidenció la magnitud en la mortalidad neonatal. Respecto al peso al nacer, este modelo no causó efectividad. La presencia regular de los enfermeros es fundamental para mejorar los cuidados durante la gestación.

Abstract Objective To analyze the impact of nurse-mediated case management on prematurity, low birth weight, and neonatal mortality. Methods A pragmatic, quasi-experimental, single-arm, clinical trial, conducted in a city in the south of Brazil, with implementation of the nurse-mediated case management model as an intervention during ten months, in a sample of 91 pregnant women. The intervention consisted of nursing and multi-professional appointments, educational actions, home visits, and a telephone call. The data of the intervention group were compared to the data of births from 2016 to 2018 in the city, with calculation of the relative risk, the absolute risk reduction and the number needed to treat. Results Premature births accounted for 4.4% (95% CI 0.18%; 8.61%). Case management effectiveness in prematurity was 62%; for every 14 pregnant women in the intervention group, one premature birth was avoided. An absolute risk reduction of 7.3% was identified compared to previous city numbers. Newborns with low birth weight (<2500g) (p=0.975) were 8.9% of the total of neonates born, and neonatal mortality in the intervention group was not identified (p=0,850). Conclusion Nurse-mediated case management during pregnancy proved to be a strategy for prevention of prematurity and demonstrated the magnitude in neonatal mortality. However, regarding the birth weight, this model had no effectiveness. The regular presence of nurses is fundamental to improve the care during pregnancy. Brazilian Registry of Clinical Trials - ReBEC: RBR-1073gcfm

Sexual behavior and sexually transmitted diseases among the female partners of inmates.

OBJECTIVE: to analyze the sexual behavior of the female partners of inmates and estimate the prevalence of sexually transmitted diseases. METHOD: cross-sectional, quantitative study involving 349 female partners of inmates. The Estudo de Comportamento Sexual [Sexual Behavior Study], an instrument validated in Brazil, was used to collect the data. The Statistical Package for the Social Sciences, version 20 was used in the statistical analysis. RESULTS: 41.2% of the female partners of inmates reported a prior history of sexually transmitted disease. Association was found between having more than one partner in the last 12 months (<0.006), sexual violence (<0.001), having sex for money (<0.001), under the influence of alcohol (<0.001), and under the influence of drugs (<0.005). The variables associated with sexually transmitted infections in the logistic regression were: having more than one partner in the last 12 months, sexual violence, sex for money, and under the effect of alcohol or drugs. CONCLUSION: The number of partners, sexual violence, sex for money, and under the influence of alcohol or drugs are sexual risk behaviors that increase the prevalence of sexually transmitted infections among the female partners of inmates.