Knowledge and attitudes of rural healthcare providers regarding domestic violence against women: a systematic review

ABSTRACT BACKGROUND: Specific types of violence such as intimate partner sexual violence and intimate partner homicide occur more frequently in rural areas. OBJECTIVE: This study aimed to systematically review the literature on the knowledge and attitudes of rural healthcare providers regarding cases of domestic violence against women. DESIGN AND SETTING: Systematic review developed at Universidade Federal de Uberlândia. METHODS: We conducted an electronic search of six databases, which only included observational studies, regardless of the year, language, or country of publication, except for studies that used secondary data and were exclusively qualitative. Two reviewers performed the selection, data extraction, and risk of bias assessment using a specific Joanna Briggs Institute tool. RESULTS: Six studies met the inclusion criteria. All the studies had a low risk of bias. Approximately 38% of these professionals identified injuries caused by violence in patients. When asked about knowing the correct attitude to take in cases of confirmed violence, between 12% and 64% of rural healthcare providers answered positively; most of them would refer to specialized institutions and promote victim empowerment and counseling. The number of professionals with an educational background in the field ranged from 16% to 98%. CONCLUSIONS: The evident disparity across studies shows that some professionals have suboptimal knowledge and require training to adopt the correct attitude when identifying female victims of domestic violence in clinical practice. SYSTEMATIC REVIEW REGISTRATION: This systematic review was registered in the Open Science Framework Database under the registration http://doi.org/10.17605/OSF.IO/B7Q6S.

Knowledge and attitudes of rural healthcare providers regarding domestic violence against women: a systematic review.

BACKGROUND: Specific types of violence such as intimate partner sexual violence and intimate partner homicide occur more frequently in rural areas. OBJECTIVE: This study aimed to systematically review the literature on the knowledge and attitudes of rural healthcare providers regarding cases of domestic violence against women. DESIGN AND SETTING: Systematic review developed at Universidade Federal de Uberlândia. METHODS: We conducted an electronic search of six databases, which only included observational studies, regardless of the year, language, or country of publication, except for studies that used secondary data and were exclusively qualitative. Two reviewers performed the selection, data extraction, and risk of bias assessment using a specific Joanna Briggs Institute tool. RESULTS: Six studies met the inclusion criteria. All the studies had a low risk of bias. Approximately 38% of these professionals identified injuries caused by violence in patients. When asked about knowing the correct attitude to take in cases of confirmed violence, between 12% and 64% of rural healthcare providers answered positively; most of them would refer to specialized institutions and promote victim empowerment and counseling. The number of professionals with an educational background in the field ranged from 16% to 98%. CONCLUSIONS: The evident disparity across studies shows that some professionals have suboptimal knowledge and require training to adopt the correct attitude when identifying female victims of domestic violence in clinical practice. SYSTEMATIC REVIEW REGISTRATION: This systematic review was registered in the Open Science Framework Database under the registration http://doi.org/10.17605/OSF.IO/B7Q6S.

[Analysis of characteristics of elderly patients admitted to an intensive care unit during six waves of the SARS-CoV-2 pandemic: Implications for medical care]. / Análisis de las características de los pacientes mayores que ingresaron en una unidad de cuidados intensivos durante las 6 olas de la pandemia por SARS-CoV-2: implicaciones para la atención médica.

OBJECTIVE: To analyze the characteristics of seriously ill elderly patients during the six waves of the COVID-19 pandemic. METHOD: Retrospective, observational and analytical study of patients over 70 years of age admitted to the ICU (March-2020 to March-2022). Patients were categorized into three groups based on age: 70-74 years; 75-79 years; and >80 years. A descriptive and comparative analysis of the sample was initially performed; and a 28-, 60- and 90-day survival analysis using the Kaplan-Meier method. Multivariate survival analysis was performed by fitting a Cox model. RESULTS: Of 301 patients, the lowest number of admissions occurred during the first wave (20 (6%)), compared to the wave with the highest number of admissions: the sixth wave (76 (25%)). The survival curves at 28 days, 60 days and 90 days showed a higher probability of survival in the younger age groups (P<.01 and P=.01, respectively). Troponin at admission (per unit, ng/l) showed a significant association with 28- and 60-day mortality (HR: 1.00; 95% CI: 1.00-1.01; P<.05). Taking the 1st wave of the pandemic as a reference, admission in the 3rd wave behaved as a protective factor against mortality at 28 and 60 days of follow-up (HR: 0.18; 95% CI: 0.02-0.64; P<.05; HR: 0.13; 95% CI: 0.02-0.64; P<.05, respectively). CONCLUSIONS: The time of admission and biomarkers, such as troponin, constitute prognostic markers independent of age in the elderly population.

[Retrospective study of the effect of vaccination against SARS-CoV-2 in seriously ill patients admitted to an intensive care unit]. / Estudio retrospectivo del efecto de la vacunación frente al SARS-CoV-2 en enfermos graves que ingresan en una unidad de cuidados intensivos.

BACKGROUND AND OBJECTIVE: Our study aims to compare the clinical and epidemiological characteristics, length of stay in the ICU, and mortality rates of COVID-19 patients admitted to the ICU who are fully vaccinated, partially vaccinated, or unvaccinated. PATIENTS AND METHODS: Retrospective cohort study (March 2020-March 2022). Patients were classified into unvaccinated, fully vaccinated, and partially vaccinated groups. We initially performed a descriptive analysis of the sample, a multivariable survival analysis adjusting for a Cox regression model, and a 90-day survival analysis using the Kaplan-Meier method for the death time variable. RESULTS: A total of 894 patients were analyzed: 179 with full vaccination, 32 with incomplete vaccination, and 683 were unvaccinated. Vaccinated patients had a lower incidence (10% vs. 21% and 18%) of severe ARDS. The survival curve did not show any differences in the probability of surviving for 90 days among the studied groups (p = 0.898). In the Cox regression analysis, only the need for mechanical ventilation during admission and the value of LDH (per unit of measurement) in the first 24 hours of admission were significantly associated with mortality at 90 days (HR: 5.78; 95% CI: 1.36-24.48); p = 0.01 and HR: 1.01; 95% CI: 1.00-1.02; p = 0.03, respectively. CONCLUSIONS: Patients with severe SARS-CoV-2 disease who are vaccinated against COVID-19 have a lower incidence of severe ARDS and mechanical ventilation than unvaccinated patients.

Caracterización de pacientes no adherentes al tratamiento de hipertensión arterial / Characterization of patients not adherent to high blood pressure treatment

Introducción. La falta del cumplimiento terapéutico es un problema en el control de la hipertensión arterial. Objetivo. Caracterizar los pacientes no adherentes al tratamiento de hipertensión arterial en pobladores de la V Región Sanitaria del Paraguay. Material y Métodos: Estudio transversal que incluyó pacientes hipertensos conocidos que se encontraban en tratamiento para la hipertensión arterial. Se utilizó la Escala de adherencia a la medicación de Morisky 8 ítems que mide comportamientos de adherencia específicos asociados a la ingesta de medicamentos. Resultados. Se incluyeron163 pacientes, todos considerados no adherentes al tratamiento según la Escala Morinsky MMAS-8. El 52,2% tenía más de 40 años, 66,3% del sexo femenino, 40,5% de nivel universitario, 57,1% casado y el 87,7% vive con la familia. El 66,9% informó trabajar hasta 8 horas por día y el 58,3% con ingresos mayores a 2 salarios mínimos. En cuanto al conocimiento el 53,9% fue alto. El 50% de los pacientes declaró utilizar plantas medicinales para su tratamiento, el 7,4% con depresión frecuentemente o casi siempre y el 22,1% ansiedad frecuentemente o casi siempre. En cuanto a las preguntas de no adherencia, el 53,4% olvidó tomar alguna vez su medicación o dejar de tomarla cuando siente que está bajo control (53,3%),el 44,2% deja de tomar su medicación porque se siente peor con ella y el 46,5% la olvida cuando viaja. Conclusión. La no adherencia en los pacientes de la V Región fue alarmante, por tanto, se deben de realizar medidas de acción respecto a las mismas. Palabras Clave: hipertensión; presión arterial; cumplimiento y adherencia al tratamiento; epidemiologia

Introduction. The lack of therapeutic compliance is a problemto control high blood pressure.Objective. To characterize patients who do not adhere to the treatment of arterial hypertension in the Vsanitary region of Paraguay. Material and Methods: A cross-sectional study was carried out in known hypertensive patients who were undergoing treatment for high blood pressure. The 8-item Morisky Medication Adherence Scale was used, which measures specific adherence behaviors associated with medication intake. Results.163 patients were included, all considered non-adherent to treatment according to the Morinsky MMAS-8 Scale. 52.2% were over 40 years old, 66.3% female, 40.5% with university level, 57.1% married, and 87.7% lived with their family. 66.9% reported working up to 8 hours per day and 58.3% with income greater than 2 minimum wages. Regarding knowledge, 53.9% was high. 50% of the patients declared using medicinal plants for their treatment, 7.4% with depression frequently or almost always and 22.1% with anxiety frequently or almost always. Regarding the non-adherence questions, 53.4% ever forgot to take their medication or stopped taking it when they feel they are under control (53.3%), 44.2% stop taking their medication because they feel worse with it and 46.5% forget it when traveling. Conclusion. The non-adherence in patients from Region V was alarming, therefore, action measures must be taken regarding them. Key words:hypertension; blood pressure; treatment adherence and compliance; epidemiology

Diagnostic performance of convolutional neural networks for dental sexual dimorphism.

Convolutional neural networks (CNN) led to important solutions in the field of Computer Vision. More recently, forensic sciences benefited from the resources of artificial intelligence, especially in procedures that normally require operator-dependent steps. Forensic tools for sexual dimorphism based on morphological dental traits are available but have limited performance. This study aimed to test the application of a machine learning setup to distinguish females and males using dentomaxillofacial features from a radiographic dataset. The sample consisted of panoramic radiographs (n = 4003) of individuals in the age interval of 6 and 22.9 years. Image annotation was performed with V7 software (V7labs, London, UK). From Scratch (FS) and Transfer Learning (TL) CNN architectures were compared, and diagnostic accuracy tests were used. TL (82%) performed better than FS (71%). The correct classifications of females and males aged ≥ 15 years were 87% and 84%, respectively. For females and males < 15 years, the correct classifications were 80% and 83%, respectively. The Area Under the Curve (AUC) from Receiver-operating Characteristic (ROC) curves showed high classification accuracy between 0.87 and 0.91. The radio-diagnostic use of CNN for sexual dimorphism showed positive outcomes and promising forensic applications to the field of dental human identification.

Effects of physical distancing by COVID-19 pandemic on diet quality, neurological and immunological markers, and fecal microbiota of Brazilian older women.

Physical distancing was used to prevent transmission of COVID-19, however there are concerns that this may promote harmful impacts on health, such as reduced levels of physical practice and changes in food intake and gut microbiota composition. This study evaluated the impacts of 6 months physical distancing on Brazilian older women upon body mass index (BMI), strength, physical activity level (IPAQ), eating habits, neurological markers (brain-derived neurotrophic factor-BDNF and cortisol), cytokines (IL-2, IL-5, IL-6, IL-10, interferon-IFN-γ, tumor necrosis factor-TNF-α), aging-associated markers (vascular endothelial growth factor-VEGF, insulin-like growth factor-IGF-1, klotho and thymic stromal lymphopoietin-TSLP), besides specific groups of fecal microbiota. Fifteen women, over 60 years old, residents of São Paulo state (Brazil), were evaluated in March and in September 2020. The older adult women, with a mean age 66 ± 6.2 years presented significantly increased BMI and high effect size for non-protective foods consumption, reduced light physical activity and strength 6 months following the physical distancing. Furthermore, the serum concentration of IFN-γ, IGF-1, and IFN-γ/IL-5 were significantly higher, while lower concentration of IL-2 and IL-5 were observed 6 months after the physical distancing. Significant increase was noted only to Blautia spp. abundance after 6 months of physical distancing. Several correlations were observed at both before and after physical distancing, however, interestingly, many of them were lost or inverted 6 months following, while new ones emerged. Taken together, these results showed that lifestyle changes and stress conditions addressed by physical distancing from the COVID-19 pandemic impacted the health of older women included in the present study. Therefore, future follow-up studies are essential to propose interventions in order to restore the health conditions observed before the pandemic period, and thus to maintain the quality of life of older adults in different socioeconomic contexts.

Wound ballistics and the unusual injuries of the tandem bullet phenomenon: A systematic review of case-specific characteristics.

This study revisited the forensic literature to compile case-specific characteristics of the tandem-bullet phenomenon (TBP). A systematic review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and The Joanna Briggs Institute's manual. The protocol was registered in Open Science Framework. Ten primary databases and two sources of grey literature were searched, with descriptive studies on TBP, with information about the victim, weapon, ammunition and injuries, being included. From an initial sample of 2360 studies, 13 were eligible. The studies reported 11 male and 2 female victims, with ages between 14 and 63 years (mean = 39.45 ± 14.51 years); seven were victims of suicide (or suicide attempt); most of the victims (69.23%) were shot in the head and neck; and most (84.61%) had an entry and exit wound ratio of 1:0, respectively. The use of image exams to assess injuries and bullets was reported in 12 cases (92.30%). The most frequent reasons for the TBP were the mismatch between weapon and ammunition and the use of defective cartridges (76.92%). Forensic professionals must be aware of the case-specific characteristics of the TBP to overcome confounding factors in wound ballistics and medicolegal examinations.

Radiographic assessment of third molar development in a Russian population to determine the age of majority.

OBJECTIVE: To test the applicability of "Gleiser and Hunt dental staging system modified by Kohler" (GHK) to assess third molar (3 M) development in a Russian population in order to determine the age of majority. DESIGN: The sample consisted of 918 panoramic radiographs from Russian females (n = 551) and males (n = 367) within the age interval between 8 and 23 years. On each radiograph, 3 M development was classified based on the GHK technique. Statistics tested the data for normality. Mean age and standard deviation were described for each 3 M position. Ordinal logistic regression tested the performance of the technique to classify individuals below or above the 18-year threshold. Receiver Operating Characteristic (ROC) curves were used. RESULTS: The mean ages and standard deviation (SD) for apex closure in females were 21,11 (SD = 1,47), 21,11 (SD = 1,43), 21,24 (SD = 1,39), and 21,29 (SD = 1,28) years for the teeth #18, 28, 38, and 48, respectively. Among males, the same teeth showed mean closure ages of 20,57 (SD = 1,69), 20,64 (SD = 1,76), 20,68 (SD = 1,68), and 20,81 (SD = 1,62) years, respectively. Area under the curve (AUC) reached 0.904 and 0.915 for classifying females and males below or above the 18-year threshold. CONCLUSION: The GHK technique was able to describe 3 M development in a Russian population. The statistic model was able to classify individuals below or above the 18-year threshold. However, the outcomes must be carefully interpreted, especially in borderline cases (17-19-year spectrum).

Unusually Low Heat of Adsorption of CO2 on AlPO and SAPO Molecular Sieves.

The capture of CO2 from post-combustion streams or from other mixtures, such as natural gas, is an effective way of reducing CO2 emissions, which contribute to the greenhouse effect in the atmosphere. One of the developing technologies for this purpose is physisorption on selective solid adsorbents. The ideal adsorbents are selective toward CO2, have a large adsorption capacity at atmospheric pressure and are easily regenerated, resulting in high working capacity. Therefore, adsorbents combining molecular sieving properties and low heats of adsorption of CO2 are of clear interest as they will provide high selectivities and regenerabilities in CO2 separation process. Here we report that some aluminophosphate (AlPO) and silicoaluminophosphate (SAPO) materials with LTA, CHA and AFI structures present lower heats of adsorption of CO2 (13-25 kJ/mol) than their structurally analogous zeolites at comparable framework charges. In some cases, their heats of adsorption are even lower than those of pure silica composition (20-25 kJ/mol). This could mean a great improvement in the regeneration process compared to the most frequently used zeolitic adsorbents for this application while maintaining most of their adsorption capacity, if materials with the right stability and pore size and topology are found.

Case-specific characteristics of pink teeth in dental autopsies - A systematic review.

The cadaveric alterations that derive from the decomposition of the human body are often investigated and examined in medical autopsies together with any other evidence of thanatological interest. This study aimed to systematically review case-specific characteristics of dental autopsies that reported the pink tooth phenomenon (PTP). The review was performed in October/2018 and followed PRISMA and Cochrane guidelines. Seven databases were searched as primary study sources (PubMed, Scopus, LILACS, SciELO, Web of Science, Science Direct and Embase) and three (OATD, Open Grey and Open Thesis) were searched for "grey literature". Only descriptive studies were collected, namely case reports and case series. The risk of bias among the studies was assessed with The Joanna Briggs Institute Critical Appraisal tool. From each case, the sex and age of the victims were registered, together with the place of body recovery, time of death, cadaveric status, cause of death, and number and position of pink teeth. Additionally, a supplemental quantitative analysis was conducted within a sampled subgroup. Poisson regression with robust variance was used to analyze relative risks of presenting pink teeth according to age and tooth position. Eleven studies out of 1004 were eligible. In total 71 cases of cadavers with pink teeth were reported. Two (2.81%) victims had unknown sex, while 17 (23.95%) were females and 52 (73.24%) were males. The victims were aged between 4 and 85 years (mean age 31.13 ±â€¯13.32). Dental autopsies registered 331 pink teeth (163 anterior, 87 premolars and 81 molars). The age did not influence on presenting an additional pink tooth, regardless of tooth position (p > 0.05). Forensic dentists must be aware of pink teeth in dental autopsies. This is an unspecific phenomenon and must not be misinterpreted in medico-legal investigations.