Spatial patterns and temporal tendency of mortality related to Chagas disease in an endemic area of northeastern Brazil.

OBJECTIVE: To analyse spatial patterns and the temporal tendency of mortality related to Chagas disease, in order to identify priority control areas in the state of Sergipe, Northeast Brazil. METHODS: We conducted an ecological and time-series study with spatial analysis techniques on deaths from Chagas disease in the state of Sergipe (1996-2016). We used data from the Mortality Information System (SIM). The temporal analysis was performed using a statistical technique capable of describing changes in the trend pattern for the period. Thematic maps were elaborated from point and polygonal analyses. RESULTS: There were 247 deaths related to Chagas disease, with a mean of 11.7 deaths/year, most of them male (64%), and aged 50-59 years (21%) and 60-69 years (26%). Two segments with increasing, non-constant and significant trends were identified: 1996-2005 (APC = 21.6%; P = 0.01) and 2005-2016 (APC = 4.4%; P = 0.01), with APPC = 11.8% (P = 0.01). A positive and significant spatial autocorrelation with areas of higher risk of death was found in the southern region of the state. CONCLUSIONS: The trend of mortality related to Chagas disease in the state of Sergipe was increasing during the period analysed, with a heterogeneous distribution of cases. A main risk area was identified in the southern region of the state.

OBJECTIF: Analyser les profils spatiaux et la tendance temporelle de la mortalité liée à la maladie de Chagas, afin d'identifier les domaines de priorité de lutte dans l'Etat de Sergipe, dans le nord-est du Brésil. MÉTHODES: Nous avons mené une étude écologique et de séries chronologiques avec des techniques d'analyse spatiale sur les décès dus à la maladie de Chagas dans l'état de Sergipe (1996-2016). Nous avons utilisé les données du système d'information sur la mortalité (SIM). L'analyse temporelle a été réalisée à l'aide d'une technique statistique capable de décrire les changements dans le profil de tendance pour la période. Des cartes thématiques ont été élaborées à partir d'analyses ponctuelles et polygonales. RÉSULTATS: Il y a eu 247 décès liés à la maladie de Chagas, avec une moyenne de 11,7 décès/an, pour la plupart de sexe masculin (64%), et âgés de 50 à 59 ans (21%) et de 60 à 69 ans (26%). Deux segments avec des tendances à la hausse, non constantes et significatives ont été identifiés: 1996-2005 (APC = 21,6%; p = 0,01) et 2005-2016 (APC = 4,4%; p = 0,01), avec APPC = 11,8% (p = 0,01). Une autocorrélation spatiale positive et significative avec des zones à haut risque de décès a été trouvée dans la région sud de l'Etat. CONCLUSIONS: La tendance de la mortalité liée à la maladie de Chagas dans l'état de Sergipe a augmenté au cours de la période analysée , avec une répartition hétérogène des cas. Une principale zone à risque a été identifiée dans la région sud de l'Etat.

Pharmacologic Treatment of Vitiligo in Children and Adolescents: A Systematic Review.

BACKGROUND: The true pathogenic mechanism of vitiligo is still unknown. About half of the patients with this disease have onset before the age of 20 years, making it a serious dermatologic disorder in childhood. OBJECTIVES: The objective of this study was to review the literature in a systematic way and identify the main pharmacologic treatments and outcomes in children and adolescents with vitiligo. METHODS: Four databases-the National Library of Medicine (MEDLINE-PubMed), Web of Science, Scopus, and Latin American and Caribbean Health Sciences (LILACS)-were used for the search up to January 2015. All electronic search titles, selected abstracts and full-text articles were independently reviewed by a minimum of two reviewers. RESULTS: There were 15 articles from 13 different countries: 3 were retrospective and 12 were prospective; the number of participants in the studies varied between 9 and 400, ages ranged from 0 to 18 years, and the duration of disease ranged from 1 to 17 years. The most commonly used drugs were tacrolimus alone (or combined with clobetasol), pimecrolimus, corticosteroids, and calcipotriol. Treatment duration ranged from 10 days to 6 months with a topical route of administration. CONCLUSIONS: The main outcome measurements were morphometric analysis performed using a computer program, hematologic or biochemical change, and photography (predominant). It is unclear which was the most effective treatment for vitiligo, however, it was found that these therapies are all promising in the treatment of the disease. With proper care, disease control and repigmentation, even if partial, can be achieved.

Educational interventions for the prevention and management of adverse events following immunisation: a systematic review. / Intervenções educativas para prevenção e conduta dos eventos adversos pós-vacinação: uma revisão sistemática.

This study investigated educational interventions for the prevention and management of adverse events following immunisation. This a systematic review was conducted by examining observational studies, with no restriction as to language or year, registered in PROSPERO with the identifier CRD42022313144 and by searching the MEDLINE, LILACS, Embase, CINAHL and Scopus databases. Two researchers selected the studies, extracted the data and assessed the risk of study bias; disagreements were resolved by a third researcher. A total of six articles met the inclusion criteria of the systematic review and the studies reported significant post-intervention improvements in staff conduct in relation to immunisation. It was concluded that educational strategies that lead to continued professional development in relation to vaccination in primary care were effective in reducing and/or eradicating immunisation errors and adverse events following immunisation.

O estudo tem como objetivo investigar as intervenções educativas para a prevenção e conduta dos eventos adversos pós-vacinação. Trata-se de uma revisão sistemática realizada por meio da análise de estudos observacionais sem restrição de idioma e ano com registro no PROSPERO pelo identificador CRD42022313144 e busca nas bases de dados MEDLINE, LILACS, Embase, CINAHL e Scopus. Dois pesquisadores selecionaram os estudos, extraíram os dados e avaliaram o risco de viés, as discordâncias foram resolvidas por um terceiro pesquisador. Atenderam os critérios de inclusão da revisão sistemática um total de seis artigos e os estudos apresentaram melhoras significativas pós-intervenção na conduta dos profissionais em relação à imunização. Conclui-se que o fornecimento de estratégias educativas de educação permanente no âmbito vacinal da atenção primária é eficaz para reduzir e/ou erradicar os erros de imunização e eventos adversos pós-vacinação.

Integrative nursing in the Brazilian northeast: introduction, potential, and challenges.

OBJECTIVE: to describe the introduction, potential, and challenges experienced by nurses in the provision of Integrative and Complementary Health Practices in the northeast f Brazil. METHOD: A qualitative study conducted from June to December 2022 with 15 northeastern nurses qualified in Integrative and Complementary Practices. The data were produced through individual online interviews and submitted to content analysis. RESULTS: 15 nurses participated, and 23 integrative practices were cited, with a predominance of auriculotherapy, greater introduction in primary care and private nursing offices, highlighting labor and personal benefits. Their potential includes technical qualification for the practice and interest in continuing education. The hospital-centric view of professionals, the low diffusion on the theme in teaching, as well as the difficulty in pricing procedures and in developing clinical reasoning in other medical rationalities were cited as the main challenges. CONCLUSION: Despite the challenges still faced, northeastern nurses are offering integrative practices to complement user care.

Educational Nursing Intervention in Reducing Hospital Readmission and the Mortality of Patients with Heart Failure: A Systematic Review and Meta-Analysis.

(1) Background: Heart failure (HF) represents a public health problem due to its high morbidity and mortality, increased consumption of health resources, prolonged hospitalization, and frequent readmissions. This study was conducted to evaluate the effectiveness of a nursing educational intervention using home visits (HV) combined with telephone contact in reducing hospital readmission and the mortality of patients with HF. (2) Methods: This is systematic review and meta-analysis of randomized controlled trials (RCTs). The databases used were CINAHL, Cochrane, PubMed and SciELO. A gray literature search included Google Scholar, OpenThesis, Clinical trials and reference lists of eligible studies. RCTs of patients diagnosed with HF were included, distributed between the control group (CG) and intervention (IG), in which the IG was submitted to the nursing intervention with HV and telephone contact in association and analyzed the result of readmission and mortality. (3) Results: The search resulted in 2528 articles and, after following steps, 11 remained for final analysis. A total of 1417 patients were analyzed and distributed: 683 in the IG and 734 in the CG. As a primary outcome, the meta-analysis identified a 36% reduction in the risk of readmission [RR 0.64, 95% CI, 0.54−0.75, p < 0.01] and a 35% reduction in mortality in the IG [RR 0.65, 95% CI, 0.50−0.85, p < 0.01]. Heterogeneity was moderate for readmission and homogeneous for mortality. (4) Conclusions: HV and telephone contact are an effective intervention strategy for nurses' educational practice.

Plasma concentrations of efavirenz are associated with body weight in HIV-positive individuals.

BACKGROUND: Efavirenz is among the most widely used antiretroviral drugs. Increased efavirenz exposure has been associated with CNS side effects and also with the chance of emergence of resistance upon treatment interruptions. The objective of this study was to evaluate factors associated with efavirenz plasma concentrations in a cohort of HIV-infected individuals. METHODS: From July 2009 to March 2010, HIV-infected patients with efavirenz as part of antiretroviral therapy (600 mg at night), undetectable viral load for at least 1 year and CD4 cell count >200 cells/mm(3) were consecutively enrolled at the HIV/AIDS ambulatory care unit in southern Brazil. Plasma samples were taken 18-23 h after efavirenz last dose and analysed by validated ultra-performance liquid chromatography. RESULTS: Forty-one subjects were included (21 females). Mean age and weight were 45.4 years and 70.9 kg, respectively. Mean efavirenz plasma concentration was 2.20 ±â€Š2.17 mg/L. Most plasma concentrations (73%) were within the therapeutic window (1-4 mg/L); 17% were below and 10% above the limits. There were no significant associations between efavirenz concentration and age, CD4 cell count, time on antiretroviral treatment and gender. There was significant and inverse correlation between efavirenz concentrations and body weight (P = 0.013) and body mass index (P = 0.001). CONCLUSIONS: In this cohort of well-controlled HIV-positive individuals, patients with lower weight or body mass index had a higher chance of presenting elevated plasma concentrations of efavirenz. Therapeutic drug monitoring to adjust dose might be a helpful tool to decrease efavirenz dose in order to minimize costs and adverse effects.

Quality of basic health care and social vulnerability: a spatial analysis.

OBJECTIVE: To analyze the association between quality of basic health care and social vulnerability in municipalities of the Brazilian northeast. METHOD: Ecological study with spatial analysis using univariate global and local Moran's indexes. Bivariate analyses were employed to examine the relationship between the quality of basic health care and the Social Vulnerability Index in the Northeast. The dependent variable corresponded to the final scores of certifications of teams of basic health care in the Northeast that had participated in the third cycle of the Brazilian Program for the Improvement of Access and Quality of Basic Health Care. The independent variable was the Social Vulnerability Index of the municipality. RESULTS: The bivariate analysis has pointed out the presence of areas of low vulnerability with high quality basic health care in the municipalities in the states of Piauí, Ceará, Rio Grande do Norte, Pernambuco, and Bahia. The state of Maranhão is emphasized for its low performance in basic health care in a large number of municipalities with high vulnerability. CONCLUSION: The study has revealed a spatial relation between the indicators of social vulnerability and quality of basic health care in the Northeast, suggesting that limitations in access to health resources and services may be related to social and health determinants.

Spatiotemporal clustering, social inequities and the risk of leptospirosis in an endemic area of Brazil: a retrospective spatial modelling.

BACKGROUND: Leptospirosis is an endemic disease in Brazil of social and economic relevance related to behavioural and socioenvironmental factors. This study aimed to analyse the spatiotemporal distribution of the incidence of leptospirosis and its association with social determinants in health in a state of northeastern Brazil. METHODS: An ecological study of temporal series with techniques of spatial analysis using secondary data of the cases of leptospirosis notified in the Information System of Notifiable Diseases of the state of Sergipe (2008-2017) was conducted. The analysis of temporal trends was performed using Poisson regression. Spatial analyses were performed using the Moran index, the local empirical Bayesian model, scan statistics and spatial regression. RESULTS: The incidence rate decreased from 3.66 to 1.44 cases per 100 000 inhabitants in 2008 and 2017, respectively. Leptospirosis was associated with social inequities, mostly affecting males aged 20-49 y living in urban areas. The space-time scan indicated the formation of a risk cluster in municipalities in the metropolitan region of the state. CONCLUSIONS: The data indicated the persistence of leptospirosis transmission, maintaining a pattern of high endemicity in some municipalities associated with social inequities. The study showed the temporal and spatial dynamics of the disease to better target specific actions for prevention and control.

Ideação suicida e fatores associados em estudantes de ciências da saúde nos tempos de pandemia / Suicidal ideation and associated factors among health sciences students in the pandemic times / Ideación suicida y factores asociados en estudiantes de ciencias de la salud durante la pandemia

RESUMO Objetivo: verificar a existência de associação entre a ideação suicida, o suporte social e os sintomas ansiosos-depressivos entre os estudantes de Ciências da Saúde. Método: estudo quantitativo e transversal. A coleta de dados ocorreu de novembro de 2020 a julho de 2021, em Sergipe - Brasil, utilizando-se o Questionário Sociodemográfico, Questionário de Ideação Suicida, Escala de Satisfação com o Suporte Social e Escala de Ansiedade, Depressão e Estresse. Foram estimados coeficientes de regressão linear simples e múltipla e razões de chance. Resultados: dos 190 entrevistados, 57 (30%) apresentaram baixa satisfação com o suporte social, 66 (34,8%) relataram sintomas de depressão grave ou muito grave, 32 (16,8%) possuíam potencial risco de suicídio, podendo ser aumentada em 18% em pessoas com depressão. Conclusão: estresse, ansiedade e depressão, são os fatores de risco para a ideação suicida em estudantes da saúde. O suporte social torna-se um aliado no controle emocional, na diminuição do sofrimento psíquico e a precipitação de transtornos mentais de estudantes.

ABSTRACT Objective: To verify the existence of an association between suicidal ideation, social support, and anxious-depressive symptoms among Health Sciences students. Method: Quantitative, cross-sectional study. Data collection took place from November 2020 to July 2021 in Sergipe - Brazil, using the Sociodemographic Questionnaire, Suicidal Ideation Questionnaire, Satisfaction with Social Support Scale, and Anxiety, Depression, and Stress Scale. Simple and multiple linear regression coefficients and odds ratios were estimated. Results: Of the 190 interviewees, 57 (30%) had low satisfaction with social support, 66 (34.8%) reported symptoms of severe or very severe depression, 32 (16.8%) had a potential risk of suicide, which can be increased by 18% in people with depression. Conclusion: Stress, anxiety, and depression are risk factors for suicidal ideation in health students. Social support becomes an ally in emotional control, in the reduction of psychological suffering, and in the precipitation of mental disorders in students.

RESUMEN Objetivo: Comprobar la existencia de una asociación entre la ideación suicida, el apoyo social y los síntomas ansioso-depresivos entre los estudiantes de Ciencias de la Salud. Método: cuantitativo, estudio transversal. La recogida de datos tuvo lugar de noviembre de 2020 a julio de 2021, en Sergipe - Brasil, utilizando el Cuestionario Sociodemográfico, el Cuestionario de Ideación Suicida, la Escala de Satisfacción con el Apoyo Social y la Escala de Ansiedad, Depresión y Estrés. Se estimaron los coeficientes de regresión lineal simple y múltiple y las odds ratio. Resultados: de los 190 entrevistados, 57 (30%) estaban poco satisfechos con el apoyo social, 66 (34,8%) presentaban síntomas de depresión grave o muy grave, 32 (16,8%) tenían un riesgo potencial de suicidio, que puede aumentar en un 18% en las personas con depresión. Conclusión: El estrés, la ansiedad y la depresión son factores de riesgo de ideación suicida en los estudiantes de sanidad. El apoyo social se convierte en un aliado en el control emocional, en la reducción del sufrimiento psicológico y en la precipitación de los trastornos mentales en los estudiantes.

Intervenções educativas para prevenção e conduta dos eventos adversos pós-vacinação: uma revisão sistemática / Educational interventions for the prevention and management of adverse events following immunisation: a systematic review

Resumo O estudo tem como objetivo investigar as intervenções educativas para a prevenção e conduta dos eventos adversos pós-vacinação. Trata-se de uma revisão sistemática realizada por meio da análise de estudos observacionais sem restrição de idioma e ano com registro no PROSPERO pelo identificador CRD42022313144 e busca nas bases de dados MEDLINE, LILACS, Embase, CINAHL e Scopus. Dois pesquisadores selecionaram os estudos, extraíram os dados e avaliaram o risco de viés, as discordâncias foram resolvidas por um terceiro pesquisador. Atenderam os critérios de inclusão da revisão sistemática um total de seis artigos e os estudos apresentaram melhoras significativas pós-intervenção na conduta dos profissionais em relação à imunização. Conclui-se que o fornecimento de estratégias educativas de educação permanente no âmbito vacinal da atenção primária é eficaz para reduzir e/ou erradicar os erros de imunização e eventos adversos pós-vacinação.

Abstract This study investigated educational interventions for the prevention and management of adverse events following immunisation. This a systematic review was conducted by examining observational studies, with no restriction as to language or year, registered in PROSPERO with the identifier CRD42022313144 and by searching the MEDLINE, LILACS, Embase, CINAHL and Scopus databases. Two researchers selected the studies, extracted the data and assessed the risk of study bias; disagreements were resolved by a third researcher. A total of six articles met the inclusion criteria of the systematic review and the studies reported significant post-intervention improvements in staff conduct in relation to immunisation. It was concluded that educational strategies that lead to continued professional development in relation to vaccination in primary care were effective in reducing and/or eradicating immunisation errors and adverse events following immunisation.

Restless Legs Syndrome in Dialysis Patients: Does the Dialysis Modality Influence Its Occurrence and Severity?

BACKGROUND: Restless legs syndrome (RLS) is more prevalent in chronic kidney patients than in the general population, but it is often diagnosed late and its predictors are unknown. PURPOSE: To diagnose RLS in a group of chronic kidney patients on dialysis, determine its frequency and severity, compare the prevalence and severity of the condition among dialytic modalities, and identify possible predictive factors in this population. METHODS: An observational and cross-sectional study with 326 patients who had been on dialysis for more than 3 months, 241 on hemodialysis (HD) and 85 on automatic peritoneal dialysis (APD), using the criteria established by the International Study Group on RLS for the diagnosis and the RLS Rating Scale to determine its severity. RESULTS: RLS was diagnosed in 19.3% of the patients, 52.4% with severe or very severe forms. Patients with and without RLS did not differ in clinical and demographic characteristics and dialytic modality; however, patients on APD presented higher RLS severity compared to the HD group. CONCLUSIONS: RLS is frequent in dialysis patients and occurs predominantly in its most severe forms; the dialytic modality seems to have no influence on its occurrence; however, it is more severe in patients on APD.

Trend and spatial analysis of prostate cancer mortality in the state of Sergipe, Brazil.

This is an ecological study with exploratory analysis of spatial and temporal data based on mortality data with respect to prostate cancer obtained from the Mortality Information System concerning residents of the state of Sergipe, Brazil between 2000 and 2015. The analysis of temporal trends was performed using the Joinpoint Regression Program through Poisson regression. Spatial analysis was performed using the empirical Bayesian model, Kernel analysis, Global Moran and Local indices. There were 1,986 deaths due to prostate cancer, most of which occurring after 60 years of age. An increasing, non-constant but significant trend in mortality rates was noted. The kernel density estimator showed hotspot densities of the highest rates of prostate cancer mortality in the north-eastern and central regions of the state. High-risk clusters were identified for prostate cancer mortality (I = 0.55, P<0.01). There was an increase in prostate cancer mortality rates and a heterogeneous geographic distribution of risk areas, with high-risk priority areas identified in certain regions of the state. These priority areas include the municipalities located in the Northeast (Amparo do São Francisco, Aquidabã, Canhoba, Cedro de São João and Telha), the West (Frei Paulo and Pedra Mole) and the south-western region of the state (Poço Verde and Simão Dias).

DADOS-Survey: an open-source application for CHERRIES-compliant Web surveys.

BACKGROUND: The Internet has been increasingly utilized in biomedical research. From online searching for literature to data sharing, the Internet has emerged as a primary means of research for many physicians and scientists. As a result, Web-based surveys have been employed as an alternative to traditional, paper-based surveys. We describe DADOS-Survey, an open-source Web-survey application developed at our institution that, to the best of our knowledge, is the first to be compliant with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). DADOS-Survey was designed with usability as a priority, allowing investigators to design and execute their own studies with minimal technical difficulties in doing so. RESULTS: To date, DADOS-Survey has been successfully implemented in five Institutional Review Board-approved studies conducted by various departments within our academic center. Each of these studies employed a Web-survey design as their primary methodology. Our initial experience indicates that DADOS-Survey has been used with relative ease by each of the investigators and survey recipients. This has been further demonstrated through formal and field usability testing, during which time suggestions for improvement were incorporated into the software design. CONCLUSION: DADOS-Survey has the potential to have an important role in the future direction of Web-survey administration in biomedical research. This CHERRIES-compliant application is tailored to the emerging requirements of quality data collection in medicine.

Diagnósticos de enfermagem relacionados a agravos cardiovasculares na população em situação de rua de São Paulo / Nursing diagnoses related to cardiovascular diseases in the homeless population of São Paulo

OBJETIVO: Elencar diagnósticos de enfermagem que relacionem a falta de conhecimento e as dificuldades de acesso aos serviços de saúde com o desenvolvimento de doenças cardiovasculares. MÉTODO: Estudo exploratório, transversal e quantitativo realizado em São Paulo. Foi aplicado um questionário a 173 voluntários em situação de rua. Os dados foram analisados e associados a Taxonomia de Diagnósticos de Enfermagem Internacional NANDA I, 2018/2020. RESULTADOS: Foi encontrado uma elevação na média de pressão arterial dos estudados. Houve uma grande variação da escolaridade. Foram relatados diversos impedimentos de acesso aos serviços de saúde. Os principais diagnósticos de enfermagem encontrados foram: Conhecimento Deficiente e Saúde deficiente da comunidade. CONCLUSÃO: Com os resultados obtidos, notou-se uma elevação nos valores pressóricos dos voluntários, sendo elencados diagnósticos de enfermagem. Evidenciou-se a necessidade de intervenções em educação, promoção e prevenção a saúde para que, dessa maneira, essa população tenha seus direitos a saúde garantidos.(AU)

OBJECTIVE: To list nursing diagnoses that relate lack of knowledge and difficulties in access to health services to the development of cardiovascular disease. METHODS: Exploratory, cross-sectional and quantitative study conducted in São Paulo. A questionnaire was applied to 173 homeless volunteers. Data were analyzed and associated with NANDA I International Nursing Diagnostic Taxonomy, 2018/2020. RESULTS: An elevation in the mean blood pressure of those studied was found. There was a wide variation in education. Various impediments to accessing health services were reported. The main nursing diagnoses found were Poor Knowledge and Poor Community Health. CONCLUSION: With the results obtained, an elevation in the blood pressure values of the volunteers was noted, and nursing diagnoses were listed. The need for interventions in health education, promotion and prevention was evident, so that this population can have its health rights guaranteed.(AU)

OBJETIVO: Enumerar los diagnósticos de enfermería que relacionan el desconocimiento y las dificultades de acceso a los servicios sanitarios con el desarrollo de enfermedades cardiovasculares. MÉTODOS: Estudio exploratorio, transversal y cuantitativo realizado en São Paulo. Se aplicó un cuestionario a 173 voluntarios sin hogar. Los datos fueron analizados y asociados a la Taxonomía Internacional de Diagnóstico de Enfermería NANDA I, 2018/2020. RESULTADOS: Se encontró una elevación de la presión arterial media de los estudiados. Había una gran variación en la educación. Se señalaron varios impedimentos para acceder a los servicios sanitarios. Los principales diagnósticos de enfermería encontrados fueron: Conocimiento deficiente y Salud comunitaria deficiente. CONCLUSIÓN: Con los resultados obtenidos, se observó una elevación de los valores de presión de los voluntarios y se enumeraron los diagnósticos de enfermería. Se evidenció la necesidad de intervenciones en educación, promoción y prevención de la salud, para que esta población tenga garantizados sus derechos sanitarios.(AU)

Perfil sociodemográfico e de dependência química dos usuários de um Centro de Atenção Psicossocial especializado / Sociodemographic and chemical-dependency profile of users at a specialized Psychosocial Care Center / Perfil sociodemográfico y de dependencia química de los usuarios de un Centro de Atención Psicosocial especializado

OBJETIVO: identificar o perfil sociodemográfico e de dependência química dos usuários de um Centro de Atenção Psicossocial Álcool e Outras Drogas. MÉTODO: estudo transversal e retrospectivo realizado por meio de consulta a 360 prontuários. RESULTADOS: a maioria dos usuários era do sexo masculino (91,1%; n = 328), analfabeta/Ensino Fundamental (70,8%; n = 255), vivia sem companheira(o) (76,9%; n = 277) e morava na zona urbana (63,3%; n = 228). O uso simultâneo de múltiplas drogas foi encontrado em 43,5% (n = 157) e a dependência exclusiva de álcool em 40,4% (n = 146). CONCLUSÃO: evidenciou-se predomínio de homens solteiros com baixa escolaridade e em dependência de múltiplas drogas e/ou de álcool. Esse conhecimento é relevante para propostas de estratégias baseadas em evidências.

OBJECTIVE: to identify the sociodemographic and chemical-dependency profile of users at a Psychosocial Care Center - Alcohol and Other Drugs. METHOD: a retrospective and cross-sectional study carried out by referring to 360 medical records. RESULTS: the majority of users were males (91.1%, n = 328), illiterate/Elementary School (70.8%, n = 255), without a partner (76.9%, n = 277), and lived in urban areas (63.3%, n = 228). Simultaneous use of multiple drugs was found in 43.5% (n = 157) and exclusive alcohol dependency in 40.4% (n = 146). CONCLUSION: the predominance of single men with low schooling and dependency on multiple drugs and/or alcohol was found. This knowledge is relevant to evidence-based strategy proposals.

OBJETIVO: identificar el perfil sociodemográfico y de dependencia química de los usuarios de un centro de atención psicosocial alcohol y otras drogas. MÉTODO: estudio retrospectivo y transversal realizado por medio de consulta a 360 prontuarios. RESULTADOS: la mayoría de los usuarios eran del sexo masculino (91,1%, n = 328), analfabeto/enseñanza fundamental (70,8%, n = 255), vivía sin compañera (76,9%; n = 277) y vivía en la zona urbana (63,3%, n = 228). El uso simultáneo de múltiples drogas se encontró en el 43,5% (n = 157) y la dependencia exclusiva de alcohol en el 40,4% (n = 146). CONCLUSIÓN: se evidenció predominio de hombres solteros con baja escolaridad y en dependencia de múltiples drogas y/o de alcohol. Este conocimiento es relevante para propuestas de estrategias basadas en evidencias.

Quality of basic health care and social vulnerability: a spatial analysis / Calidad de la atención básica y vulnerabilidad social: un análisis espacial / Qualidade da atenção básica à saúde e vulnerabilidade social: uma análise espacial

ABSTRACT Objective: To analyze the association between quality of basic health care and social vulnerability in municipalities of the Brazilian northeast. Method: Ecological study with spatial analysis using univariate global and local Moran's indexes. Bivariate analyses were employed to examine the relationship between the quality of basic health care and the Social Vulnerability Index in the Northeast. The dependent variable corresponded to the final scores of certifications of teams of basic health care in the Northeast that had participated in the third cycle of the Brazilian Program for the Improvement of Access and Quality of Basic Health Care. The independent variable was the Social Vulnerability Index of the municipality. Results: The bivariate analysis has pointed out the presence of areas of low vulnerability with high quality basic health care in the municipalities in the states of Piauí, Ceará, Rio Grande do Norte, Pernambuco, and Bahia. The state of Maranhão is emphasized for its low performance in basic health care in a large number of municipalities with high vulnerability. Conclusion: The study has revealed a spatial relation between the indicators of social vulnerability and quality of basic health care in the Northeast, suggesting that limitations in access to health resources and services may be related to social and health determinants.

RESUMEN Objetivo: Analizar la asociación entre la calidad de la atención básica y la vulnerabilidad social en municipios del Nordeste de Brasil. Método: Estudio ecológico con análisis espacial, utilizando índices de Moran globales y locales univariados. Se emplearon análisis bivariados para examinar la relación entre la calidad de la atención básica y el Índice de Vulnerabilidad Social en el Nordeste. La variable dependiente fue las puntuaciones finales de las certificaciones de los equipos de asistencia básica del Nordeste que participaron en el tercer ciclo del Programa Nacional de Mejoramiento del Acceso y la Calidad de la Atención Básica. La variable independiente fue el Índice de Vulnerabilidad Social municipal. Resultados: El análisis bivariado mostró la presencia de áreas de baja vulnerabilidad con alta calidad de atención básica en los municipios de los estados de Piauí, Ceará, Rio Grande do Norte, Pernambuco y Bahia. El estado de Maranhão se destacó por presentar un bajo desempeño de la atención básica en un gran número de municipios con alta vulnerabilidad. Conclusión: El estudio reveló la relación espacial entre los indicadores de vulnerabilidad social y la calidad de la atención básica en el Nordeste, sugiriendo que las limitaciones en el acceso a los recursos y servicios de salud pueden estar relacionadas con los determinantes sociales de la salud.

RESUMO Objetivo: Analisar a associação entre a qualidade da atenção básica e a vulnerabilidade social nos municípios do Nordeste brasileiro. Método: Estudo ecológico com análise espacial, utilizando os índices de Moran global e local univariados. As análises bivariadas foram empregadas para examinar a relação entre a qualidade da atenção básica e o Índice de Vulnerabilidade Social no Nordeste. A variável dependente correspondeu às notas finais de certificações das equipes de atenção básica do Nordeste que participaram do terceiro ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. A variável independente foi o Índice de Vulnerabilidade Social municipal. Resultados: A análise bivariada apontou presença de áreas de baixa vulnerabilidade com alta qualidade da atenção básica em municípios dos estados do Piauí, Ceará, Rio Grande do Norte, Pernambuco e Bahia. O Maranhão destacou-se por apresentar baixo desempenho da atenção básica em um grande número de municípios com alta vulnerabilidade. Conclusão: O estudo revelou a relação espacial entre indicadores de vulnerabilidade social e qualidade da atenção básica no Nordeste, sugerindo que limitações no acesso a recursos e serviços de saúde podem estar relacionados a determinantes sociais de saúde.

Synthetic drugs for the treatment of vitiligo: a patent review (2010-2015).

INTRODUCTION: Vitiligo is one of the most important acquired depigmentation disorders, with an average worldwide prevalence of 0.5-2.0%. The exact etiology of vitiligo is not fully understood, but the principle theories focus on the mechanism responsible for the destruction of melanocytes, which is proposed to be autoimmune, neurogenic, or self-destructive. There is no cure for vitiligo and the results of current treatments vary between individuals, being unsatisfactory in most cases. Despite being a cosmetic disease, the disorder can be psychologically devastating and stigmatizing. Areas covered: In this review, the authors summarize new synthetic drugs for the treatment of vitiligo developed between 2010 and 2015, which include MC1 R agonists and peptides, as well as considering new approaches and strategies using existing drugs. Expert opinion: In conclusion, we found significant advancement in this field of research, demonstrating the growing interest of academic and industrial groups in developing successful products for the treatment of vitiligo. New therapeutic options could contribute to improving the quality of life of patients and advance the search for a truly effective treatment of vitiligo.

Preenchimento inadequado de dados cirúrgicos para segurança do paciente: opinião de profissionais da saúde / Inadequate completion of surgical data for patient safety: opinion of health professionals

RESUMO Objetivo investigar variáveis relacionadas com o preenchimento inadequado de dados cirúrgicos para a segurança do paciente no contexto hospitalar na opinião de profissionais de saúde. Métodos estudo retrospectivo em 180 prontuários de pacientes cirúrgicos em um hospital público, com aplicação de questionário estruturado aos profissionais assistenciais responsáveis pelo preenchimento de dados cirúrgicos. Realizou-se análise estatística descritiva. Resultados os prontuários apresentaram incompletude nos registros cirúrgicos nos períodos pré-operatório (61%), intraoperatório (66%) e pós-operatório imediato (87%). Os profissionais referiram desconhecer o protocolo para cirurgia segura (62%) e o formulário de segurança cirúrgica da instituição (68%), sendo que 87% não receberam capacitação para utilização do checklist intraoperatório, 66% consideraram o dimensionamento de pessoal inadequado e 55%, a comunicação ineficaz. Conclusão na opinião dos profissionais de saúde, conhecimento profissional insuficiente, ausência de capacitação, dimensionamento de pessoal inadequado e comunicação ineficaz podem estar relacionados com o preenchimento inadequado dos dados cirúrgicos e segurança do paciente.

ABSTRACT Objective to investigate variables related to inadequate completion of surgical data for patient safety in the hospital setting in the opinion of health professionals. Methods retrospective study in 180 medical records of surgical patients in a public hospital and application of a structured questionnaire to caregivers responsible for filling out the surgical data of patients. Descriptive statistical analysis was performed. Results the medical records showed incomplete surgical records in the preoperative period (61%), intraoperative period (66%) and immediate postoperative period (87%). Professionals reported not knowing the protocol for safe surgery (62%) and the institution's surgical safety form (68%), 87% were not trained to use the intraoperative checklist, 66% considered the number of staff inadequate and 55% considered communication ineffective. Conclusion in the opinion of health professionals, insufficient professional knowledge, lack of training, inadequate staffing and ineffective communication may be related to inadequate completion of surgical data and patient safety.

Cross-cultural adaptation and validation of the Brazilian Portuguese version of the short musculoskeletal function assessment questionnaire: the SMFA-BR.

BACKGROUND: This study was designed to translate, culturally adapt, and validate a Brazilian Portuguese version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA-BR). METHODS: The SMFA was translated from English into Brazilian Portuguese. Translations were synthesized, translated back into English, and then submitted to a committee of clinical, psychometric, and language experts. The questionnaire was then administered to 220 trauma patients at a midsize hospital in southern Brazil. Test-retest reliability was examined at one and seven days. Scale reliability and validity were assessed, and factor structure was analyzed. RESULTS: Patients with only one region of dysfunction reported less dysfunction than did patients with two or three regions of dysfunction. Both the SMFA-BR dysfunction and the SMFA-BR bother scores had significant correlations with all Brazilian Short Form-36 (SF-36) subscales except for bodily pain. Test-retest reliabilities, as determined by intraclass correlation analyses, were 0.99 (95% confidence interval, 0.97, 1.00) at one day (n = 10) and 0.99 (95% confidence interval, 0.96, 1.00) at seven days (n = 17) for the dysfunction index and 0.99 (95% confidence interval, 0.98, 1.00) at one day (n = 10) and 0.97 (95% confidence interval, 0.97, 1.00) at seven days (n = 17) for the bother index. Cronbach alpha reliabilities were 0.95 (95% confidence interval, 0.93, 0.97) and 0.91 (95% confidence interval, 0.89, 0.94) for the dysfunction and bother indices, respectively. Minimal ceiling and floor effects were observed for the bother subscale only. Exploratory factor analysis yielded a three-factor structure: upper-extremity dysfunction, lower-extremity dysfunction, and bother. CONCLUSIONS: A reliable and valid Brazilian Portuguese version of the SMFA was developed. It will facilitate the examination of functional performance within a large patient population as well as allow cross-cultural comparisons.

Manuscript Architect: a Web application for scientific writing in virtual interdisciplinary groups.

BACKGROUND: Although scientific writing plays a central role in the communication of clinical research findings and consumes a significant amount of time from clinical researchers, few Web applications have been designed to systematically improve the writing process. This application had as its main objective the separation of the multiple tasks associated with scientific writing into smaller components. It was also aimed at providing a mechanism where sections of the manuscript (text blocks) could be assigned to different specialists. Manuscript Architect was built using Java language in conjunction with the classic lifecycle development method. The interface was designed for simplicity and economy of movements. Manuscripts are divided into multiple text blocks that can be assigned to different co-authors by the first author. Each text block contains notes to guide co-authors regarding the central focus of each text block, previous examples, and an additional field for translation when the initial text is written in a language different from the one used by the target journal. Usability was evaluated using formal usability tests and field observations. RESULTS: The application presented excellent usability and integration with the regular writing habits of experienced researchers. Workshops were developed to train novice researchers, presenting an accelerated learning curve. The application has been used in over 20 different scientific articles and grant proposals. CONCLUSION: The current version of Manuscript Architect has proven to be very useful in the writing of multiple scientific texts, suggesting that virtual writing by interdisciplinary groups is an effective manner of scientific writing when interdisciplinary work is required.