Knowledge in Inflammatory Bowel Disease: Translation to Portuguese, Validation, and Clinical Application of the IBD-KNOW Questionnaire.

Background/Aims: Inflammatory bowel disease (IBD)-related knowledge empowers patients, providing the development of adaptative coping strategies. Recently, a more comprehensive questionnaire for evaluating IBD-related knowledge was developed, the IBD-KNOW. The main aim of our study was to translate to Portuguese and validate the IBD-KNOW questionnaire. We also explored the predictors of high scores of disease-related knowledge and the effect of knowledge on health-related quality of life (HRQoL) and therapeutic adherence. Methods: This is an observational, unicentric, and cross-sectional study. We translated and adapted the original English version of the IBD-KNOW questionnaire into Portuguese. Afterwards, IBD patients in the outpatient clinics were invited to fill out a multimodal form including the Portuguese version of IBD-KNOW, a visual analogue scale (VAS) of self-perceived knowledge, the Portuguese version of Short IBD Questionnaire (SIBDQ) and the Portuguese version of Morisky Adherence Scale 8-item (MMAS-8). Demographic and disease characteristics were collected. We assessed validity (through discriminate validity among non-IBD volunteers and correlation between IBD-KNOW and VAS) and reliability (through internal consistency, test-retest, and intraclass correlation). Statistical analysis was performed using SPSS version 25.0. Results: The mean IBD-KNOW score was significantly different among non-IBD validation group (doctors: 23, nurses: 18, and non-medical volunteers: 12, p < 0.001). IBD-KNOW showed a high internal consistency (Cronbach's α 0.78) and intraclass correlation (0.90). As expected, the IBD-KNOW score was positively correlated with VAS for self-perceived knowledge (r = 0.45, p < 0.001). One hundred and one patients with IBD (54 with ulcerative colitis and 47 with Crohn's disease) completed the questionnaire at baseline. Multivariate analyses showed that a high IBD-KNOW score was associated with longer disease duration (OR: 2.59 [CI 1.11-5.74]; p = 0.04), previous hospitalization (OR: 3.63 [CI 1.301-9.96]; p = 0.01), current biologic treatment (OR: 3.37 [CI 1.31-8.65]; p = 0.02), and higher educational level (OR: 4.66 [CI 1.74-10.21]; p = 0.02). Moreover, there was no significant correlation between overall IBD-KNOW and SIBDQ, nor between IBD treatment adherence (MMAS-8 = 8) and a higher mean IBD-KNOW score (p = 0.552). Conclusion: The Portuguese version of IBD-KNOW is a simple, valid, and reliable tool for assessing IBD-related knowledge. Longer disease duration, hospitalization, use of biologics, and higher educational level are associated with higher levels of knowledge. Higher patient knowledge was not associated with higher HRQoL and adherence to therapy.

Introdução/objetivos: O conhecimento relacionado com a Doença Inflamatória Intestinal (DII) visa capacitar os doentes, proporcionando o desenvolvimento de estratégias adaptativas de coping. Recentemente, foi desenvolvido um questionário mais abrangente para avaliar os conhecimentos relacionados com a DII, o IBD-KNOW. O principal objetivo do nosso estudo foi traduzir para português e validar o questionário IBD-KNOW. Também explorámos os preditores de um elevado nível de conhecimento relacionado com a DII e avaliámos o impacto do conhecimento na qualidade de vida associada a cuidados de saúde (QVACS) e na adesão terapêutica. Métodos: Este é um estudo observacional, unicêntrico e transversal. Traduzimos e adaptámos para português a versão original inglesa do questionário IBD-KNOW. Posteriormente, os doentes com DII de ambulatório foram convidados a preencher um questionário multimodal que incluía, a versão portuguesa do IBD-KNOW, uma escala visual analógica (EVA) de autoperceção do conhecimento, a versão portuguesa do Short IBD Questionnaire (SIBDQ) e a versão portuguesa do Morisky Adherence Scale 8-item (MMAS-8). Foram colhidos dados referentes a aspetos demográficos e da doença. Avaliámos a validade (através da validade discriminatória entre voluntários sem DII e da correlação entre IBD-KNOW e a EVA) e a fiabilidade (através da consistência interna, do teste-reteste e da correlação intraclasse). A análise estatística foi realizada utilizando a versão 25.0 do SPSS. Resultados: A pontuação média do IBD-KNOW foi significativamente diferente entre os voluntários não-DII (médicos: 23, enfermeiros: 18 e voluntários não-médicos: 12, p < 0,001). O IBD-KNOW mostrou uma elevada consistência interna (Cronbach's α 0,78) e uma correlação intraclasse (0,90). Como esperado, a pontuação IBD-KNOW correlacionou-se positivamente com a EVA de autoperceção do conhecimento (r=0,45, p < 0,001). Cento e um doentes com DII (54 com colite ulcerosa e 47 com doença de Crohn) preencheram o questionário. A análise multivariada mostrou valores médios de IBD-KNOW superiores em indivíduos com doença de longa duração (OR: 2,59; [IC 1,11-5,74] p=0,04), hospitalização prévia (OR 3,63 [IC 1,301-9,96]; p=0,01), sob tratamento biológico atual (OR 3,37 [1,31-8,65]; p=0,02) e com nível educacional superior (OR 4,66 [IC 1,74-10,21]; p=0,02). Além disso, não houve correlação significativa entre IBD-KNOW e SIBDQ, nem entre a adesão ao tratamento IBD (MMAS-8=8) e um IBD-KNOW acima da média (p=0,552). Conclusão: A versão portuguesa do IBD-KNOW é uma ferramenta simples, válida e fiável para avaliar os conhecimentos relacionados com a DII. Uma maior duração da doença, hospitalização, utilização de biológicos e um nível de educação mais elevado estão associados a níveis de conhecimento mais elevados. Na nossa coorte, níveis superiores de conhecimento não se associaram a melhor qualidade de vida nem a maior adesão à terapêutica.

Impacts of industrial actions, protests, strikes and lockouts by health and care workers during COVID-19 and other pandemic contexts: a systematic review.

BACKGROUND: Public health emergencies of international concern (PHEICs) as the COVID-19 pandemic and others that have occurred since the early 2000s put enormous pressure on health and care systems. This is being a context for protests by health and care workers (HCWs) because of additional workload, working conditions and effects on mental and physical health. In this paper, we intended to analyze the demands of HCWs associated with industrial actions, protests, strikes and lockouts (IAPSLs) which occurred during COVID-19 pandemic and other PHEICs; to identify the impact of these grievances; and describe the relevant interventions to address these IAPSLs. METHODS: We included studies published between January 2000 and March 2022 in PubMed, Embase, Scopus, BVS/LILACS, WHO's COVID-19 Research Database, ILO, OECD, HSRM, and Google Scholar for grey literature. Eligibility criteria were HCWs as participants, IAPSLs as phenomenon of interest occurring in the context of COVID-19 and other PHEICs. GRADE CERQual was used to assess risk of bias and confidence of evidence. RESULTS: 1656 records were retrieved, and 91 were selected for full-text screening. We included 18 publications. A system-wide approach, rather than a limited approach to institutions on strike, makes it possible to understand the full impact of the strike on health and care services. PHEICs tend to aggravate already adverse working conditions of HCWs, acting as drivers for HCWs strikes, leading to staff shortages, and financial issues, both in the North and in the Global South, particularly evident in Asia and Africa. In addition, issues related to deficiencies in leadership and governance in heath sector and lack of medical products and technologies (e.g., lack of personal protective equipment) were the main drivers of strikes, each contributing 25% of the total drivers identified. CONCLUSIONS: It is necessary to focus on the preparedness of health and care systems to respond adequately to PHEICs, and this includes being prepared for HCWs' IAPSLs, talked much in the context of COVID-19 pandemic. Evidence to assist policymakers in defining strategies to respond adequately to the health and care needs of the population during IAPSLs is crucial. The main impact of strikes is on the disruption of health care services' provision. Gender inequality being a major issue among HCWs, a proper understanding of the full impact of the strike on health and care services will only be possible if gender lens is combined with a systemic approach, rather than gender-undifferentiated approaches limited to the institutions on strike.

An engineered POSS drug delivery system for copper(II) anticancer metallodrugs in a selective application toward melanoma cells.

In this work, a polyhedral silsesquioxane (POSS) was used as an engineered drug delivery system for two oxindolimine-copper(II) anticancer complexes, [Cu(isaepy)]+ and [Cu(isapn)]+. The interest in hybrid POSS comes from the necessity of developing materials that can act as adjuvants to improve the cytotoxicity of non-soluble metallodrugs. Functionalization of POSS with a triazole ligand (POSS-atzac) permitted the anchorage of such copper complexes, producing hybrid materials with efficient cytotoxic effects. Structural and morphological characterizations of these copper-POSS systems were performed by using different techniques (IR, NMR, thermogravimetric analysis). A combination of continuous-wave (CW) and pulsed EPR (HYSCORE) spectroscopies conducted at the X-band have enabled the complete characterization of the coordination environment of the copper ion in the POSS-atzac matrix. Additionally, the cytotoxic effects of the loaded materials, [Cu(isapn)]@POSS-atzac and [Cu(isaepy)]@POSS-atzac, were assessed toward melanomas (SK-MEL), in comparison to non-tumorigenic cells (fibroblast P4). Evaluation of their nuclease activity or ability to facilitate cleavage of DNA indicated concentrations as low as 0.6 µg mL-1, while complete DNA fragmentation was observed at 25 µg mL-1. By using adequate scavengers, investigations on active intermediates responsible for their cytotoxicity were performed, both in the absence and in the presence of ascorbate as a reducing agent. Based on the observed selective cytotoxicity of these materials toward melanomas, investigations on the reactivity of these complexes and corresponding POSS-materials with melanin, a molecule that contributes to melanoma resistance to chemotherapy, were carried out. Results indicated the main role of the binuclear copper species, formed at the surface of the silica matrix, in the observed reactivity and selectivity of these copper-POSS systems.

Two-Dimensional Shear-Wave Elastography of the Thyroid in Clinically Healthy Dogs in Different Age Groups.

The thyroid of dogs has not been extensively studied in 2D shear-wave elastography, making it challenging to apply this technique in the diagnosis of thyroid diseases in a non-invasive manner. The aim of this study is to evaluate the thyroid glands of healthy dogs using 2D shear-wave elastography in order to establish qualitative and quantitative parameters of tissue stiffness in dogs in different age groups. A total of 31 dogs of various breeds, sexes, and sizes were evaluated. Animals with clinical signs or ultrasound findings indicative of endocrine disease or thyroid lesions were excluded from the study. The shear-wave velocity data in meters per second (m/s) and color elastograms were evaluated and calculated using QelaXto™ 2D software. A healthy thyroid exhibits a blue-color elastogram, indicative of low stiffness. The reference range for the shear-wave velocity of thyroid tissue assessed by 2D shear-wave elastography can be between 1.6 and 2.0 m/s, with a variation of ±0.889 in adult and senior dogs.

Comparison between melatonin versus melatonin and photobiomodulation versus photobiomodulation in the treatment of Alopecia X in German Spitz dogs: Clinical, randomized, double-blind, parallel, non-inferiority protocol.

Canine Alopecia X is a non-inflammatory hair loss disorder of unknown etiology that predominantly affects German Spitz dogs. Treatment modalities include hormone and/or melatonin supplementation and low trauma microneedling. Melatonin influences hair growth and pigmentation in several species and presents a low risk of adverse effects when used in dogs with Alopecia X. Photobiomodulation (PBM) is frequently used in human androgenetic alopecia and alopecia areata; despite this, PBM remains unexplored in canine Alopecia X. To address this knowledge gap, sixty dogs of both sexes will be randomly assigned to three groups: (i) melatonin only group (3 mg/Kg, n = 20); (ii) PBM only group (diode laser, wavelength 660nm, 100mw power, with 3 J/point, 2 sessions/week for 3 months, n = 20); (ii) PBM + melatonin group (n = 20). The objective is to determine the potential of PBM alone or in conjunction with melatonin supplementation in promoting hair regrowth (hair density and diameter) by means of dermatoscopy and planimetry over a period of 90 days.

Effect of photobiomodulation in the balance between effector and regulatory T cells in an experimental model of COPD.

Introduction: Currently, Chronic Obstructive Pulmonary Disease (COPD) has a high impact on morbidity and mortality worldwide. The increase of CD4+, CD8+ cells expressing NF-κB, STAT4, IFN-γ and perforin are related to smoking habit, smoking history, airflow rate, obstruction and pulmonary emphysema. Furthermore, a deficiency in CD4+CD25+Foxp3+ regulatory T cells (Tregs) may impair the normal function of the immune system and lead to respiratory immune disease. On the other hand, the anti-inflammatory cytokine IL-10, produced by Treg cells and macrophages, inhibits the synthesis of several pro-inflammatory cytokines that are expressed in COPD. Therefore, immunotherapeutic strategies, such as Photobiomodulation (PBM), aim to regulate the levels of cytokines, chemokines and transcription factors in COPD. Consequently, the objective of this study was to evaluate CD4+STAT4 and CD4+CD25+Foxp3+ cells as well as the production of CD4+IFN- γ and CD4+CD25+IL-10 in the lung after PBM therapy in a COPD mice model. Methods: We induced COPD in C57BL/6 mice through an orotracheal application of cigarette smoke extract. PMB treatment was applied for the entire 7 weeks and Bronchoalveolar lavage (BAL) and lungs were collected to study production of IFN- γ and IL-10 in the lung. After the last administration with cigarette smoke extract (end of 7 weeks), 24 h later, the animals were euthanized. One-way ANOVA followed by NewmanKeuls test were used for statistical analysis with significance levels adjusted to 5% (p < 0.05). Results: This result showed that PBM improves COPD symptomatology, reducing the number of inflammatory cells (macrophages, neutrophils and lymphocytes), the levels of IFN-γ among others, and increased IL-10. We also observed a decrease of collagen, mucus, bronchoconstriction index, alveolar enlargement, CD4+, CD8+, CD4+STAT4+, and CD4+IFN-γ+ cells. In addition, in the treated group, we found an increase in CD4+CD25+Foxp3+ and CD4+IL-10+ T cells. Conclusion: This study suggests that PBM treatment could be applied as an immunotherapeutic strategy for COPD.

Prioritization criteria in policies and management of human resources for health: a proposal for a validated methodology.

Objective: To create and validate criteria for prioritizing problems related to policies and management of the health workforce. Methods: This methodological study was divided into three stages. First, the criteria were elaborated by means of a systematized literature review. Second, the criteria were evaluated online by a committee of judges comprised of eight specialists. In the third stage, an evaluation was carried out by the target audience in a hybrid workshop. The participants evaluated the material using the Suitability Assessment of Materials instrument, adapted for the research. Results: Three prioritization criteria (relevance, window of opportunity and acceptability) and a scoring scale were developed based on the literature review. In the evaluation by the committee of judges, the approval percentage of the criteria and prioritization method was 84%. Modifications were made based on suggestions in relation to the material presented to the specialists. In the pre-test stage, the approval percentage varied by item, with six of them reaching a maximum approval of 100% (corresponding to approximately 46% of the items), four reaching 92% and three achieving 83% each, indicating positive results. Conclusions: The developed criteria were considered valid for use in the context of policies and management in the area of human resources for health.

Photobiomodulation mitigates Bothrops jararacussu venom-induced damage in myoblast cells by enhancing myogenic factors and reducing cytokine production.

BACKGROUND: Photobiomodulation has exhibited promise in mitigating the local effects induced by Bothrops snakebite envenoming; however, the mechanisms underlying this protection are not yet fully understood. Herein, the effectiveness of photobiomodulation effects on regenerative response of C2C12 myoblast cells following exposure to Bothrops jararacussu venom (BjsuV), as well as the mechanisms involved was investigated. METHODOLOGY/PRINCIPAL FINDINGS: C2C12 myoblast cells were exposed to BjsuV (12.5 µg/mL) and irradiated once for 10 seconds with laser light of 660 nm (14.08 mW; 0.04 cm2; 352 mW/cm2) or 780 nm (17.6 mW; 0.04 cm2; 440 mW/ cm2) to provide energy densities of 3.52 and 4.4 J/cm2, and total energies of 0.1408 and 0.176 J, respectively. Cell migration was assessed through a wound-healing assay. The expression of MAPK p38-α, NF-Кß, Myf5, Pax-7, MyoD, and myogenin proteins were assessed by western blotting analysis. In addition, interleukin IL1-ß, IL-6, TNF-alfa and IL-10 levels were measured in the supernatant by ELISA. The PBM applied to C2C12 cells exposed to BjsuV promoted cell migration, increase the expression of myogenic factors (Pax7, MyF5, MyoD and myogenin), reduced the levels of proinflammatory cytokines, IL1-ß, IL-6, TNF-alfa, and increased the levels of anti-inflammatory cytokine IL-10. In addition, PBM downregulates the expression of NF-kB, and had no effect on p38 MAKP. CONCLUSION/SIGNIFICANCE: These data demonstrated that protection of the muscle cell by PBM seems to be related to the increase of myogenic factors as well as the modulation of inflammatory mediators. PBM therapy may offer a new therapeutic strategy to address the local effects of snakebite envenoming by promoting muscle regeneration and reducing the inflammatory process.

Effects of cancer-induced cachexia and administration of L-glutathione on the intestinal mucosa in rat.

Walker-256 tumor is an experimental model known to promote cachexia syndrome, oxidative stress, and systemic inflammation. This study evaluated the duodenal mucosa of rats with Walker-256 tumor administered with 1% L-glutathione, intending to evaluate the damage caused by cancer-associated cachexia in the gastrointestinal tract and the effects of antioxidant administration on mucosal protection. Twenty-four 55-day-old male Wistar rats were distributed into four groups: control (C); control administered with 1% L-glutathione (C-GSH); Walker-256 tumor (W) and Walker-256 tumor administered with 1% L-glutathione (W-GSH). After 14 days of treatment, the duodenum was harvested for morphometric analysis of the mucosa, proliferation, apoptosis, immunostaining of varicosities immunoreactive (IR) to vasoactive intestinal peptide (VIP) and 5-HT-IR cells, and quantification of mast cells and goblet cells. Walker-256 tumor-bearing rats showed cachexia syndrome, mucosal atrophy, reduced cell proliferation, reduced 5-HT-IR cells, and increased goblet cells and VIPergic varicosities, which were not reversed by L-glutathione. On the other hand, L-glutathione caused a reduction of cells in apoptosis and mast cell recruitment, demonstrating a partial recovery of the damage detected in the intestinal mucosa.

The possible impacts of nano and microplastics on human health: lessons from experimental models across multiple organs.

The widespread production and use of plastics have resulted in accumulation of plastic debris in the environment, gradually breaking down into smaller particles over time. Nano-plastics (NPs) and microplastics (MPs), defined as particles smaller than 100 nanometers and 5 millimeters, respectively, raise concerns due to their ability to enter the human body through various pathways including ingestion, inhalation, and skin contact. Various investigators demonstrated that these particles may produce physical and chemical damage to human cells, tissues, and organs, disrupting cellular processes, triggering inflammation and oxidative stress, and impacting hormone and neurotransmitter balance. In addition, micro- and nano-plastics (MNPLs) may carry toxic chemicals and pathogens, exacerbating adverse effects on human health. The magnitude and nature of these effects are not yet fully understood, requiring further research for a comprehensive risk assessment. Nevertheless, evidence available suggests that accumulation of these particles in the environment and potential human uptake are causes for concern. Urgent measures to reduce plastic pollution and limit human exposure to MNPLs are necessary to safeguard human health and the environment. In this review, current knowledge regarding the influence of MNPLs on human health is summarized, including toxicity mechanisms, exposure pathways, and health outcomes across multiple organs. The critical need for additional research is also emphasized to comprehensively assess potential risks posed by degradation of MNPLs on human health and inform strategies for addressing this emerging environmental health challenge. Finally, new research directions are proposed including evaluation of gene regulation associated with MNPLs exposure.

Cancer-induced morphological changes in enteric glial cells in the jejunum of Walker-256 tumor-bearing rats.

Cancer-induced cachexia is associated with systemic inflammation and gastrointestinal dysfunction. How changes to cells of the enteric nervous system contribute to gut dysfunction in tumor development and cancer cachexia is unknown. Here, we tested the hypothesis that changes to enteric glia, a type of peripheral glia that surround enteric neurons and regulate gut homeostasis, are associated with tumor development and that supplementing with the antioxidant L-glutathione is protective against the changes induced. Immunohistochemistry for neurons, enteric glial cells and immune cells was performed in whole-mount preparations and frozen histological sections of the jejunum from 20 Wistar rats, distributed in 4 groups: control, tumor of Walker-256, control administered with 1 % L-glutathione, and tumor of Walker-256 administered with 1 % L-glutathione. Morphoquantitative analyses were made using Image-Pro® Plus 4.5 and ImageJ® 1.43° software. Tumor development significantly reduced neuronal and glial cell populations in the myenteric and submucosal plexuses and enlarged glial cell body area in the submucosal plexus. In contrast, tumors increased glia in the jejunal mucosa and this effect was accompanied by B-lymphocyte recruitment. GSH-supplemented diet was not sufficient to protect against changes to neurons and glia in the submucosal plexus but was partially protective in the myenteric plexus. L-glutathione had no effect on physiological parameters of cachexia but was sufficient to preserve enteric glial cell density in the myenteric plexus. These results suggest that changes to both enteric neurons and glia likely contribute to the gastrointestinal effects of tumor development and that oxidative stress contributes to these effects in the enteric nervous system.

[Respiratory changes in children exposed to dust from mining waste in Brumadinho, Minas Gerais State, Brazil: Bruminha Project]. / Alterações respiratórias em crianças expostas à poeira de resíduos de mineração em Brumadinho, Minas Gerais, Brasil: Projeto Bruminha.

This study aimed to investigate the occurrence of respiratory diseases in children exposed to dust from mining waste after the Brumadinho dam disaster, Minas Gerais State, Brazil. The study population included children aged 0-6 years, living in three communities exposed to mining waste dust (Córrego do Feijão, Parque da Cachoeira, and Tejuco) and one unexposed community (Aranha). Data were collected from July 19 to 30, 2021, using questionnaires that addressed sociodemographic information and a recall survey on signs, symptoms, and respiratory diseases. A total of 217 children were evaluated, 119 living in the exposed communities and 98 in the non-exposed community. The residents in the exposed communities reported an increase in the frequency of home cleaning (p = 0.04) and in vehicular traffic (p = 0.03). Among children aged four, a higher frequency of upper (p = 0.01) and lower (p = 0.01) airway disorders, as well as respiratory allergy (p = 0.05) was observed. The exposed group had 1.5 times more reports of respiratory allergy (75%; p = 0.02) compared to the non-exposed group (50.5%). Children living in communities exposed to waste dust were three times more likely (adjusted OR = 3.63; 95%CI: 1.37; 9.57) to have respiratory allergies than those not exposed. Two years and six months after the environmental disaster occurred, children living in the communities affected by waste from mining and remediation activities remained exposed to dust with harmful effects on respiratory health.

Este estudo teve como objetivo investigar a ocorrência de afecções respiratórias em crianças expostas à poeira de resíduos de mineração após o desastre do rompimento da barragem em Brumadinho, Minas Gerais, Brasil. A população de estudo incluiu crianças com idades entre 0 e 6 anos, residentes em três comunidades expostas à resíduos de poeira de mineração (Córrego do Feijão, Parque da Cachoeira e Tejuco) e uma comunidade não exposta (Aranha). A coleta de dados ocorreu entre 19 e 30 de julho de 2021, por meio de questionários que abordavam informações sociodemográficas e um inquérito recordatório sobre sinais, sintomas e doenças respiratórias. Foram avaliadas 217 crianças, sendo 119 das comunidades expostas e 98 da comunidade não exposta. Os residentes nas comunidades expostas relataram aumento na frequência de faxina em suas residências (p = 0,04) e no tráfego de veículos (p = 0,03). Entre as crianças de 4 anos, foi observada uma maior frequência de afecções das vias aéreas superiores (p = 0,01) e inferiores (p = 0,01), bem como de alergia respiratória (p = 0,05). O grupo exposto apresentou 1,5 vez mais relatos de alergia respiratória (75%; p = 0,02) em comparação com o não exposto (50,5%). Crianças que viviam nas comunidades expostas à poeira de resíduos apresentaram três vezes mais chance (OR ajustada = 3.63; IC95%: 1,37; 9,57) de ocorrência de alergia respiratória em comparação com as não expostas. Dois anos e seis meses após a ocorrência do desastre ambiental, as crianças das comunidades afetadas pelos resíduos das atividades de mineração e remediação permaneciam expostas à poeira com efeitos tóxicos sobre a saúde respiratória.

El objetivo de este estudio fue investigar la ocurrencia de enfermedades respiratorias en niños expuestos al polvo de residuos de la minería tras el desastre del colapso de la represa en Brumadinho, Minas Gerais, Brasil. La población de estudio incluyó niños que tenían entre 0 y 6 años, que viven en tres comunidades expuestas a residuos de polvo de la minería (Córrego do Feijão, Parque da Cachoeira y Tejuco) y una comunidad no expuesta (Aranha). Se recolectaron los datos entre el 19 y el 30 de julio de 2021, a través de cuestionarios que abordaban informaciones sociodemográficas y una encuesta recordatoria acerca de los señales, síntomas y enfermedades respiratorias. Se evaluaron 217 niños, de los cuales 119 viven en las comunidades expuestas y 98 viven en la comunidad no expuesta. Los residentes de las comunidades expuestas relataron un aumento en la frecuencia de limpieza de sus casas (p = 0,04) y en el tráfico de vehículos (p = 0,03). Entre los niños de 4 años, se observó una frecuencia más alta de enfermedades de las vías aéreas superiores (p = 0,01) e inferiores (p = 0,01), así como de alergia respiratoria (p = 0,05). El grupo expuesto presentó 1,5 veces más relatos de alergia respiratoria (el 75%; p = 0,02) en comparación con el grupo no expuesto (el 50,5%). Niños que vivían en las comunidades expuestas al polvo de residuos presentaron tres veces más probabilidad (OR ajustada = 3,63; IC95%: 1,37; 9,57) de ocurrencia de alergia respiratoria en comparación con los niños que no se expusieron. Dos años y seis meses tras el desastre ambiental, los niños que viven en las comunidades afectadas por los residuos de las actividades de minería y descontaminación permanecían expuestos al polvo con efectos tóxicos para la salud respiratoria.

Impacts for health and care workers of Covid-19 and other public health emergencies of international concern: living systematic review, meta-analysis and policy recommendations.

BACKGROUND: Health and care workers (HCW) faced the double burden of the SARS-CoV-2 pandemic: as members of a society affected by a public health emergency and as HWC who experienced fear of becoming infected and of infecting others, stigma, violence, increased workloads, changes in scope of practice, among others. To understand the short and long-term impacts in terms of the COVID-19 pandemic and other public health emergencies of international concern (PHEICs) on HCW and relevant interventions to address them, we designed and conducted a living systematic review (LSR). METHODS: We reviewed literature retrieved from MEDLINE-PubMed, Embase, SCOPUS, LILACS, the World Health Organization COVID-19 database, the ClinicalTrials.org and the ILO database, published from January 2000 until December 2021. We included quantitative observational studies, experimental studies, quasi-experimental, mixed methods or qualitative studies; addressing mental, physical health and well-being and quality of life. The review targeted HCW; and interventions and exposures, implemented during the COVID-19 pandemic or other PHEICs. To assess the risk of bias of included studies, we used the Johanna Briggs Institute (JBI) Critical Appraisal Tools. Data were qualitatively synthetized using meta-aggregation and meta-analysis was performed to estimate pooled prevalence of some of the outcomes. RESULTS: The 1013 studies included in the review were mainly quantitative research, cross-sectional, with medium risk of bias/quality, addressing at least one of the following: mental health issue, violence, physical health and well-being, and quality of life. Additionally, interventions to address short- and long-term impact of PHEICs on HCW included in the review, although scarce, were mainly behavioral and individual oriented, aimed at improving mental health through the development of individual interventions. A lack of interventions addressing organizational or systemic bottlenecks was noted. DISCUSSION: PHEICs impacted the mental and physical health of HCW with the greatest toll on mental health. The impact PHEICs are intricate and complex. The review revealed the consequences for health and care service delivery, with increased unplanned absenteeism, service disruption and occupation turnover that subvert the capacity to answer to the PHEICs, specifically challenging the resilience of health systems.

Testicular adrenal rest tumors - Epidemiology, diagnosis and treatment.

INTRODUCTION: Testicular adrenal rest tumors (TART) are common in males suffering from congenital adrenal hyperplasia (CAH). Correct and timely diagnosis is important for differential diagnosis with malignant testis tumors, related infertility and as TART may worsen in time, especially in the absence of adequate and continuous hormonal control. The rarity of the disease, predominance of small cohorts and case reports and research heterogeneity (concerning type of CAH, patients' age and specific focus of the paper) complicate the understanding of this condition. OBJECTIVES: To review epidemiological and clinical aspects of TART, including treatment and prognosis. METHODS: Non-systematic review of CAH-related TART research. RESULTS: TART's prevalence grows progressively over time, predominating after puberty, affecting a mean of 20-40 % of CAH males. There is no proof of more frequent proportional affection of specific CAH phenotypes or types of enzyme deficiency, but cases of TART among non-classic CAH patients have been rarely reported. Chronic undertreated are more frequently affected and present larger tumors. Systematic ultrasound screening of CAH males is the state-of-the art for diagnosis, but TART are still often diagnosed in CAH adults seeking infertility treatment. TART are usually asymptomatic and present normal testicular volume. Biopsies are not recommended, except when the differential diagnosis between TART and testicular tumors cannot be guaranteed. Abnormal semen analysis is common. Leydig cell tumors are the main differential diagnosis, due to histological similarities to TART. Misdiagnosis may lead to unnecessary orchiectomies. Preservation of gonadal functions is inversely proportional to the total tumor volume. Tumors tend to regress under adequate adrenal suppression with steroids. Surgery in not indicated to treat TART. DISCUSSION: The reported prevalence of TART depends on age, usage of systematic follow-up ultrasound, and adequate CAH control. Timely detection of the disease is important to avoid irreversible gonadal dysfunction (not clinically apparent, due to high serum levels of androgen) and infertility. The relationship between TART and specific CAH phenotypes/genotypes has not been proved, and some cases do not present abnormal serum ACTH levels. Knowledge about TART should be disseminated among non-experts, to avoid unnecessary orchiectomies and false diagnosis of malignant testis tumors. Infertility is frequent, but has not been not satisfactorily addressed by physicians, even among experts. Sperm cryopreservation should be early offered to CAH adult males, but there are offer problems related to high cost.

Alterações respiratórias em crianças expostas à poeira de resíduos de mineração em Brumadinho, Minas Gerais, Brasil: Projeto Bruminha / Respiratory changes in children exposed to dust from mining waste in Brumadinho, Minas Gerais State, Brazil: Bruminha Project / Alteraciones respiratorias en niños expuestos al polvo de residuos de la minería en Brumadinho, Minas Gerais, Brasil: Proyecto Bruminha

Este estudo teve como objetivo investigar a ocorrência de afecções respiratórias em crianças expostas à poeira de resíduos de mineração após o desastre do rompimento da barragem em Brumadinho, Minas Gerais, Brasil. A população de estudo incluiu crianças com idades entre 0 e 6 anos, residentes em três comunidades expostas à resíduos de poeira de mineração (Córrego do Feijão, Parque da Cachoeira e Tejuco) e uma comunidade não exposta (Aranha). A coleta de dados ocorreu entre 19 e 30 de julho de 2021, por meio de questionários que abordavam informações sociodemográficas e um inquérito recordatório sobre sinais, sintomas e doenças respiratórias. Foram avaliadas 217 crianças, sendo 119 das comunidades expostas e 98 da comunidade não exposta. Os residentes nas comunidades expostas relataram aumento na frequência de faxina em suas residências (p = 0,04) e no tráfego de veículos (p = 0,03). Entre as crianças de 4 anos, foi observada uma maior frequência de afecções das vias aéreas superiores (p = 0,01) e inferiores (p = 0,01), bem como de alergia respiratória (p = 0,05). O grupo exposto apresentou 1,5 vez mais relatos de alergia respiratória (75%; p = 0,02) em comparação com o não exposto (50,5%). Crianças que viviam nas comunidades expostas à poeira de resíduos apresentaram três vezes mais chance (OR ajustada = 3.63; IC95%: 1,37; 9,57) de ocorrência de alergia respiratória em comparação com as não expostas. Dois anos e seis meses após a ocorrência do desastre ambiental, as crianças das comunidades afetadas pelos resíduos das atividades de mineração e remediação permaneciam expostas à poeira com efeitos tóxicos sobre a saúde respiratória.

This study aimed to investigate the occurrence of respiratory diseases in children exposed to dust from mining waste after the Brumadinho dam disaster, Minas Gerais State, Brazil. The study population included children aged 0-6 years, living in three communities exposed to mining waste dust (Córrego do Feijão, Parque da Cachoeira, and Tejuco) and one unexposed community (Aranha). Data were collected from July 19 to 30, 2021, using questionnaires that addressed sociodemographic information and a recall survey on signs, symptoms, and respiratory diseases. A total of 217 children were evaluated, 119 living in the exposed communities and 98 in the non-exposed community. The residents in the exposed communities reported an increase in the frequency of home cleaning (p = 0.04) and in vehicular traffic (p = 0.03). Among children aged four, a higher frequency of upper (p = 0.01) and lower (p = 0.01) airway disorders, as well as respiratory allergy (p = 0.05) was observed. The exposed group had 1.5 times more reports of respiratory allergy (75%; p = 0.02) compared to the non-exposed group (50.5%). Children living in communities exposed to waste dust were three times more likely (adjusted OR = 3.63; 95%CI: 1.37; 9.57) to have respiratory allergies than those not exposed. Two years and six months after the environmental disaster occurred, children living in the communities affected by waste from mining and remediation activities remained exposed to dust with harmful effects on respiratory health.

El objetivo de este estudio fue investigar la ocurrencia de enfermedades respiratorias en niños expuestos al polvo de residuos de la minería tras el desastre del colapso de la represa en Brumadinho, Minas Gerais, Brasil. La población de estudio incluyó niños que tenían entre 0 y 6 años, que viven en tres comunidades expuestas a residuos de polvo de la minería (Córrego do Feijão, Parque da Cachoeira y Tejuco) y una comunidad no expuesta (Aranha). Se recolectaron los datos entre el 19 y el 30 de julio de 2021, a través de cuestionarios que abordaban informaciones sociodemográficas y una encuesta recordatoria acerca de los señales, síntomas y enfermedades respiratorias. Se evaluaron 217 niños, de los cuales 119 viven en las comunidades expuestas y 98 viven en la comunidad no expuesta. Los residentes de las comunidades expuestas relataron un aumento en la frecuencia de limpieza de sus casas (p = 0,04) y en el tráfico de vehículos (p = 0,03). Entre los niños de 4 años, se observó una frecuencia más alta de enfermedades de las vías aéreas superiores (p = 0,01) e inferiores (p = 0,01), así como de alergia respiratoria (p = 0,05). El grupo expuesto presentó 1,5 veces más relatos de alergia respiratoria (el 75%; p = 0,02) en comparación con el grupo no expuesto (el 50,5%). Niños que vivían en las comunidades expuestas al polvo de residuos presentaron tres veces más probabilidad (OR ajustada = 3,63; IC95%: 1,37; 9,57) de ocurrencia de alergia respiratoria en comparación con los niños que no se expusieron. Dos años y seis meses tras el desastre ambiental, los niños que viven en las comunidades afectadas por los residuos de las actividades de minería y descontaminación permanecían expuestos al polvo con efectos tóxicos para la salud respiratoria.

Physical therapy performance in post-COVID-19 rehabilitation: knowledge and experience of physiotherapists / Actuación de la fisioterapia en la rehabilitación post-COVID-19: conocimientos y experiencia de los fisioterapeutas / Atuação fisioterapêutica na reabilitação pós-COVID-19: conhecimento e experiência de fisioterapeutas

ABSTRACT After the acute phase of COVID-19, many patients have persistent symptoms or develop sequelae, which leads them to seek physiotherapy rehabilitation services. Therefore, this study aimed to investigate the knowledge and experience of physiotherapists on the assessment and treatment of post-COVID-19 patients. The cross-sectional observational study was carried out with 73 physiotherapists using an online questionnaire about academic background, areas of expertise, knowledge about COVID-19, and knowledge and experience of assessment and treatment resources in post-COVID-19 rehabilitation, in addition to barriers to the care of these patients in the ambulatory care. Most physiotherapists had heard of post-COVID-19 syndrome, however, only 44% felt sufficiently informed about post-COVID-19 rehabilitation. There was a discrepancy between the degree of importance and experience with the frequency of use of assessment resources, especially the use of specific assessment instruments for skeletal muscle strength, mobility, and respiratory function, in addition to scales and questionnaires to assess disabilities, quality of life, and sleep quality. On the other hand, most reported the importance and had sufficient experience to treat post-COVID-19 patients using cheap and accessible resources. However, less than half use techniques related to respiratory muscle training and/or more sophisticated equipment. Thus, we conclude that most physiotherapists recognize the importance and report sufficient experience to assess and treat post-COVID-19 patients, however, there is a discrepancy between the assessment in the biopsychosocial context of the patient and the treatment process.

RESUMEN Terminada la fase aguda de la COVID-19, muchos pacientes presentan síntomas persistentes o desarrollan secuelas, lo que requiere servicios de rehabilitación fisioterapéutica. Ante esto, el objetivo de este estudio fue identificar los conocimientos y la experiencia de los fisioterapeutas respecto a la evaluación y el tratamiento de los pacientes post-COVID-19. Este estudio observacional transversal se llevó a cabo con 73 profesionales, mediante un cuestionario en línea sobre formación académica, áreas de actuación, conocimientos sobre la COVID-19 y experiencia con los recursos de evaluación y tratamiento en la rehabilitación post-COVID-19, además de las barreras para la atención de estos pacientes en el ámbito ambulatorio. Aunque la mayoría de los fisioterapeutas tenían algún conocimiento sobre el síndrome post-COVID-19, solamente el 44% de ellos se sentían suficientemente informados sobre la rehabilitación post-COVID-19. Se observa una discrepancia entre el grado de importancia y experiencia y la frecuencia de uso de los recursos de evaluación, especialmente el uso de herramientas de evaluación específicas para la fuerza muscular esquelética, la movilidad y la función respiratoria, además de escalas y cuestionarios para evaluar la discapacidad, la calidad de vida y la calidad del sueño. Por otro lado, la mayoría informó de la importancia de este tratamiento, afirmando tener experiencia suficiente para tratar a los pacientes post-COVID-19 utilizando recursos baratos y accesibles. Así, menos de la mitad de los profesionales utilizan técnicas vinculadas al entrenamiento de la musculatura respiratoria y/o equipos más sofisticados. Por lo tanto, se concluye que la mayoría de los fisioterapeutas reconocen la importancia de tratar a los pacientes post-COVID-19 y declaran tener experiencia suficiente para evaluarlos y tratarlos; sin embargo, hay una discrepancia entre el proceso de evaluación en el contexto biopsicosocial del paciente y el proceso de tratamiento.

RESUMO Após a fase aguda da COVID-19, muitos pacientes apresentam persistência de sintomas ou desenvolvem sequelas, o que os leva a procurar serviços de reabilitação fisioterapêutica. Sendo assim, o objetivo deste estudo foi investigar o conhecimento e a experiência de fisioterapeutas sobre a avaliação e tratamento de pacientes pós-COVID-19. O estudo observacional transversal foi realizado com 73 profissionais, por meio de um questionário online sobre formação acadêmica, áreas de atuação, conhecimento sobre a COVID-19 e experiência sobre recursos de avaliação e tratamento na reabilitação pós-COVID-19, além de barreiras para o atendimento desses pacientes no ambiente ambulatorial. A maioria dos fisioterapeutas já tinham ouvido falar da síndrome pós-COVID-19, no entanto, apenas 44% se sentiam suficientemente informados sobre a reabilitação pós-COVID-19. Houve uma discrepância entre o grau de importância e experiência e a frequência da utilização dos recursos de avaliação, principalmente o uso de instrumentos específicos de avaliação para força muscular esquelética, mobilidade e função respiratória, além de escalas e questionários para avaliar incapacidades, qualidade de vida e qualidade do sono. Em contrapartida, a maioria relatou a importância deste tratamento, alegando ter grau de experiência suficiente para tratar os pacientes pós-COVID-19 com a utilização de recursos baratos e acessíveis. Dessa forma, menos da metade dos profissionais realiza técnicas vinculadas ao treinamento muscular respiratório e/ou equipamentos mais sofisticados. Concluímos, então, que a maioria dos fisioterapeutas reconhece a importância do tratamento de pacientes pós-COVID-19 e relata uma experiência suficiente para avaliá-los e tratá-los, entretanto, há uma discrepância entre o processo de avaliação no contexto biopsicossocial do paciente e o processo de tratamento.

Prioritization criteria in policies and management of human resources for health: a proposal for a validated methodology / Criterios para la asignación de prioridades en materia de políticas y gestión de recursos humanos para la salud: propuesta de una metodología validada / Critérios de priorização em políticas e gerenciamento de recursos humanos em saúde: proposta para uma metodologia validada

ABSTRACT Objective. To create and validate criteria for prioritizing problems related to policies and management of the health workforce. Methods. This methodological study was divided into three stages. First, the criteria were elaborated by means of a systematized literature review. Second, the criteria were evaluated online by a committee of judges comprised of eight specialists. In the third stage, an evaluation was carried out by the target audience in a hybrid workshop. The participants evaluated the material using the Suitability Assessment of Materials instrument, adapted for the research. Results. Three prioritization criteria (relevance, window of opportunity and acceptability) and a scoring scale were developed based on the literature review. In the evaluation by the committee of judges, the approval percentage of the criteria and prioritization method was 84%. Modifications were made based on suggestions in relation to the material presented to the specialists. In the pre-test stage, the approval percentage varied by item, with six of them reaching a maximum approval of 100% (corresponding to approximately 46% of the items), four reaching 92% and three achieving 83% each, indicating positive results. Conclusions. The developed criteria were considered valid for use in the context of policies and management in the area of human resources for health.

RESUMEN Objetivo. Crear y validar criterios para priorizar los problemas relacionados con las políticas y la gestión de los recursos humanos para la salud. Métodos. Este estudio metodológico se dividió en tres etapas. En la primera se elaboraron los criterios mediante una revisión sistematizada de la bibliografía. En la segunda un comité de ocho especialistas evaluó en línea los criterios. Y la tercera consistió en una evaluación por parte del público destinatario en un taller híbrido. Los participantes evaluaron el material utilizando el instrumento de evaluación de la idoneidad de los materiales, que fue adaptado para la investigación. Resultados. Sobre la base de la revisión de la bibliografía, se elaboraron tres criterios para la asignación de prioridades (relevancia, ventana de oportunidad y aceptabilidad) y una escala de puntuación. En la evaluación realizada por el comité de especialistas, el porcentaje de aprobación de los criterios y del método de asignación de prioridades fue del 84%. Se realizaron modificaciones basadas en sugerencias planteadas con respecto al material presentado a los especialistas. En la etapa posterior de prueba preliminar, el porcentaje de aprobación varió en los distintos puntos, de tal manera que en seis puntos (es decir, en aproximadamente el 46% de los puntos) se alcanzó una aprobación máxima del 100%, en cuatro una aprobación del 92% y en tres una aprobación del 83% en cada uno, lo que indica unos resultados positivos. Conclusiones. Se consideró que los criterios elaborados son válidos para su uso en el contexto de las políticas y la gestión en el ámbito de los recursos humanos para la salud.

RESUMO Objetivo. Criar e validar critérios para priorizar problemas relacionados a políticas e gerenciamento da força de trabalho em saúde. Métodos. O presente estudo metodológico foi dividido em três fases. Primeiro, foram elaborados critérios por meio de revisão sistematizada da literatura. A seguir, os critérios foram avaliados on-line por uma comissão de juízes composta por oito especialistas. Na terceira fase, o público-alvo fez uma avaliação dos critérios em uma oficina de formato híbrido. Os participantes avaliaram o material usando o instrumento Suitability Assessment of Materials, adaptado para esta pesquisa. Resultados. Com base na revisão da literatura, foram elaborados três critérios de priorização (relevância, janela de oportunidade e aceitabilidade) e uma escala de pontuação. Na avaliação da comissão de juízes, a porcentagem de aprovação dos critérios e do método de priorização foi de 84%. Foram feitas alterações com base em sugestões relacionadas ao material apresentado aos especialistas. Na fase de pré-teste, a porcentagem de aprovação variou de acordo com o item. Seis deles (aproximadamente 46% dos itens) atingiram aprovação máxima de 100%, quatro atingiram 92% e três atingiram 83%, indicando resultados positivos. Conclusões. Os critérios desenvolvidos foram considerados válidos para uso no contexto de políticas e gerenciamento na área de recursos humanos em saúde.

Resource utilization and costs related to the management of obstructive hypertrophic cardiomyopathy under the Brazilian supplementary healthcare system´s perspective: results from a modified Delphi panel / Utilização de recursos e custos relacionados ao manejo da cardiomiopatia hipertrófica obstrutiva sob a perspectiva do sistema de saúde suplementar brasileiro: resultados de um painel Delphi modificado

Objective: To generate data on the costs associated with the diagnosis and treatment of obstructive ypertrophic cardiomyopathy (HCM) from the perspective of the private health system in Brazil. Methods: A modified Delphi panel including seven different specialists (three clinical cardiologists with experience in obstructive HCM, two hemodynamicists with experience in septal ablation and two cardiac surgeons with expertise in myectomy), from two Brazilian states (São Paulo and Pernambuco), was conducted between August and November 2022. Two rounds of questions about the use of healthcare resources according to the functional class (NYHA I-IV) and a panel in a virtual platform were conducted to obtain the final consensus. Micro-costing defined costs and unit values were determined based on official price lists. Results: The total diagnosis cost per patient was estimated at BRL 11,486.81. The obstructive HCM management costs analysis showed average annual costs per patient of BRL 17,026.74, BRL 19,401.46, BRL 73,310.07, and BRL 94,885.75 for the functional classes NYHA I, NYHA II, NYHA III, and NYHA IV, respectively. The average costs per patient related to procedures in a year were BRL 12,698.53, BRL 13,462.30, BRL 58,841.67, and BRL 75,595.90 for the functional classes NYHA I, II, III, and IV, respectively. Conclusions: The annual costs of HCM management increased according to the functional class, highlighting the need for safe and effective strategies to improve patient's NYHA functional class while promoting a decrease in the need for invasive therapies.

Objetivo: Gerar dados acerca dos custos associados ao diagnóstico e tratamento da cardiomiopatia hipertrófica (CMH) obstrutiva, sob a perspectiva do sistema de saúde privado no Brasil. Métodos: Um painel Delphi modificado incluindo sete especialistas (três cardiologistas clínicos com experiência em CMH obstrutiva, dois hemodinamicistas com experiência em ablação de septo e dois cirurgiões cardíacos com experiência em miectomia) de dois estados brasileiros (São Paulo e Pernambuco) foi conduzido entre agosto e novembro de 2022. Foram realizadas duas rodadas de perguntas acerca da utilização de recursos de acordo com a classe funcional (NYHA I-IV) e uma reunião virtual para obtenção do consenso final. Os custos foram definidos por meio de microcusteio, e os valores unitários foram definidos com base em listas de preço oficiais. Resultados: O custo total do diagnóstico por paciente foi estimado em R$ 11.486,81. A análise de custos de manejo da CMH obstrutiva mostrou custos médios anuais por paciente de R$ 17.026,74, R$ 19.401,46, R$ 73.310,07 e R$ 94.885,75 para as classes funcionais NYHA I, NYHA II, NYHA III e NYHA IV, respectivamente. Os custos médios por paciente relacionados a procedimentos em um ano foram de R$ 12.698,53, R$ 13.462,30, R$ 58.841,67 e R$ 75.595,90 para as classes NYHA I, II, III e IV, respectivamente. Conclusões: Os custos anuais com o manejo da CMH aumentam de acordo com a classe funcional, destacando a necessidade de estratégias seguras e eficazes capazes de melhorar a classe funcional NYHA do paciente, ao mesmo tempo que promove diminuição da necessidade de terapias invasivas.