The hidden severity of the COVID-19 pandemic in children and adolescents in Brazil: a territorial analysis of hospital mortality. / A gravidade oculta da pandemia de COVID-19 em crianças e adolescentes no Brasil: uma análise territorial da mortalidade hospitalar.

This article aims to describe the geographical distribution of hospital mortality from COVID-19 in children and adolescents during the 2020-2021 pandemic in Brazil. Ecological, census study (SIVEP GRIPE) with individuals up to 19 years of age, hospitalized with SARS due to COVID-19 or SARS not specified in Brazilian municipalities, stratified in two ways: 1) in the five macro-regions and 2) in three urban agglomerations: capital, municipalities of the metropolitan region and non-capital municipalities. There were 44 hospitalizations/100,000 inhabitants due to COVID-19 and 241/100,000 when including unspecified SARS (estimated underreporting of 81.8%). There were 1,888 deaths by COVID-19 and 4,471 deaths if added to unspecified SARS, estimating 57.8% of unreported deaths. Hospital mortality was 2.3 times higher in the macro-regions when considering only the cases of COVID-19, with the exception of the North and Center-West regions. Higher hospital mortality was also recorded in non-capital municipalities. The urban setting was associated with higher SARS hospital mortality during the COVID-19 pandemic in Brazil. Living in the North and Northeast macro-regions, and far from the capitals offered a higher risk of mortality for children and adolescents who required hospitalization.

O objetivo deste artigo é descrever a distribuição geográfica da mortalidade hospitalar por COVID-19 em crianças e adolescentes durante a pandemia de 2020-2021 no Brasil. Estudo ecológico, censitário (SIVEP GRIPE), de indivíduos até 19 anos, internados com SRAG por COVID-19 ou SRAG não especificada, em municípios brasileiros, estratificados de duas formas: 1) nas cinco macrorregiões e 2) em três aglomerados urbanos: capital, municípios da região metropolitana e do interior. Verificou-se 44 internações/100 mil habitantes por COVID-19 e 241/100 mil ao se incluir a SRAG não especificada (subnotificação estimada de 81,8%). Ocorreram1.888 óbitos por COVID-19 e 4.471 óbitos se somados à SRAG não especificada, estimando-se subnotificação de 57,8% dos óbitos. A mortalidade hospitalar foi 2,3 vezes maior nas macrorregiões quando considerados apenas os casos de COVID-19, com exceção das regiões Norte e Centro-Oeste. Registrou-se também maior mortalidade hospitalar em municípios do interior. O contexto urbano esteve associado à maior mortalidade hospitalar por SRAG durante a pandemia de COVID-19 no Brasil. Residir nas macrorregiões Norte e Nordeste, e distante das capitais, ofereceu maior risco de mortalidade para crianças e adolescentes que necessitaram hospitalização.

Chronic Pancreatitis in a Large Developing Country: Temporal Trends of Over 64,000 Hospitalizations from 2009 to 2019.

BACKGROUND/OBJECTIVES: Chronic pancreatitis (CP) is a progressive inflammatory disorder associated with marked morbidity and mortality and frequently requires hospitalization. This study aimed to investigate the time trends and geographical distribution of hospital admissions, the lethality rate of CP across Brazil, and the potential relationship with social indicators and associated risk factors. METHODS: Data were retrospectively obtained from the Brazilian Public Health System Registry between January 2009 and December 2019. The prevalence and lethality rates of CP per 100,000 inhabitants in each municipality were estimated from hospitalizations to in-hospital deaths and classified by age, sex, and demographic features. RESULTS: During the study period, 64,609 admissions were retrieved, and most of the patients were males (63.54%). Hospitalization decreased by nearly half (-54.68%) in both sexes. CP rates in males were higher in all age groups. The greatest reduction in admissions (- 64%) was also noted in patients ≥ 70y. CP In-hospital lethality remained stable (5-6%) and similar for males and females. Patients ≥ 70y showed the highest lethality. The greatest increase in CP lethality rates (+ 10%) was observed in municipalities integrated into metropolises, which was mainly driven by small-sized municipalities (+ 124%). CONCLUSIONS: CP hospitalizations decrease in both urban and rural areas, particularly in the North, Northeast, and Central-West regions, and in those above 70 years of age, but are not correlated with lethality rates in the South. This suggests ongoing changes in the environmental and socioeconomic factors in Brazil.

Patients hospitalized with active tuberculosis and Covid-19 coinfection: A matched case-control from the Brazilian Covid-19 Registry.

Although control of Covid-19 has improved, the virus continues to cause infections, such as tuberculosis, that is still endemic in many countries, representing a scenario of coinfection. To compare Covid-19 clinical manifestations and outcomes between patients with active tuberculosis infection and matched controls. This is a matched case-control study based on data from the Brazilian Covid-19 Registry, in hospitalized patients aged 18 or over with laboratory confirmed Covid-19 from March 1, 2020, to March 31, 2022. Cases were patients with tuberculosis and controls were Covid-19 patients without tuberculosis. From 13,636 Covid-19, 36 also had active tuberculosis (0.0026%). Pulmonary fibrosis (5.6% vs 0.0%), illicit drug abuse (30.6% vs 3.0%), alcoholism (33.3% vs 11.9%) and smoking (50.0% vs 9.7%) were more common among patients with tuberculosis. They also had a higher frequency of nausea and vomiting (25.0% vs 10.4%). There were no significant differences in in-hospital mortality, mechanical ventilation, need for dialysis and ICU stay. Patients with TB infection presented a higher frequency of pulmonary fibrosis, abuse of illicit drugs, alcoholism, current smoking, symptoms of nausea and vomiting. The outcomes were similar between them.

Antimicrobial resistance of Enterobacteriaceae and Staphylococcus spp. isolated from raw cow's milk from healthy, clinical and subclinical mastitis udders.

Mastitis is the most common disease of dairy cattle and can be manifested in clinical and subclinical forms. The overuse of antimicrobials in the treatment and prevention of mastitis favours antimicrobial resistance and milk can be a potential route of dissemination. This study aimed to evaluate the biological quality of bulk tank milk (BTM) and the microbiological quality and signs of mastitis of freshly milked raw milk. In addition, to evaluate antimicrobial resistance in Enterobacteriaceae and Staphylococcus spp. isolated from freshly milked raw milk. None of the farms were within the official Brazilian biological quality limits for BTM. Freshly milked raw milk with signs of clinical (CMM), subclinical (SCMM) and no signs (MFM) of mastitis were detected in 6.67%, 27.62% and 65.71% samples, respectively. Most samples of freshly milked raw milk showed acceptable microbiological quality, when evaluating the indicators total coliforms (78.10%), Escherichia coli (88.57%) and Staphylococcus aureus (100%). Klebsiella oxytoca and S. aureus were the most prevalent microorganisms in SCMM and MFM samples. Antimicrobial resistance and multidrug resistance (MDR) were observed in 65.12% and 13.95% of Enterobacteriaceae and 84.31% and 5.88% of Staphylococcus spp., respectively, isolated from both SCMM and MFM samples. Enterobacteriaceae resistant to third-generation cephalosporin (3GCR) (6.98%) and carbapenems (CRE) (6.98%) and methicillin-resistant S. aureus (MRSA) (4.88%) were observed. Antimicrobial-resistant bacteria can spread resistance genes to previously susceptible bacteria. This is a problem that affects animal, human and environmental health and should be evaluated within the one-health concept.

Differential Proteomic Analysis of Human Sperm: A Systematic Review to Identify Candidate Targets to Monitor Sperm Quality.

PURPOSE: The advent of proteomics provides new opportunities to investigate the molecular mechanisms underlying male infertility. The selection of relevant targets based on a single analysis is not always feasible, due to the growing number of proteomic studies with conflicting results. Thus, this study aimed to systematically review investigations comparing the sperm proteome of normozoospermic and infertile men to define a panel of proteins with the potential to be used to evaluate sperm quality. MATERIALS AND METHODS: A literature search was conducted on PubMed, Web of Science, and Scopus databases following the PRISMA guidelines. To identify proteins systematically reported, first the studies were divided by condition into four groups (asthenozoospermia, low motility, unexplained infertility, and infertility related to risk factors) and then, all studies were analysed simultaneously (poor sperm quality). To gain molecular insights regarding identified proteins, additional searches were performed within the Human Protein Atlas, Mouse Genome Informatics, UniProt, and PubMed databases. RESULTS: Thirty-two studies were included and divided into 4 sub-analysis groups. A total of 2752 proteins were collected, of which 38, 1, 3 and 2 were indicated as potential markers for asthenozoospermia, low motility, unexplained infertility and infertility related to risk factors, respectively, and 58 for poor sperm quality. Among the identified proteins, ACR, ACRBP, ACRV1, ACTL9, AKAP4, ATG3, CCT2, CFAP276, CFAP52, FAM209A, GGH, HPRT1, LYZL4, PRDX6, PRSS37, REEP6, ROPN1B, SPACA3, SOD1, SPEM1, SPESP1, SPINK2, TEKT5, and ZPBP were highlighted due to their roles in male reproductive tissues, association with infertility phenotypes or participation in specific biological functions in spermatozoa. CONCLUSIONS: Sperm proteomics allows the identification of protein markers with the potential to overcome limitations in male infertility diagnosis and to understand changes in sperm function at the molecular level. This study provides a reliable list of systematically reported proteins that could be potential targets for further basic and clinical studies.

Hospital mortality from covid-19 in children and adolescents in Brazil in 2020-2021.

OBJECTIVE: To describe cases, deaths, and hospital mortality from covid-19 in children and adolescents in Brazil, according to age group, during the evolving phases of the pandemic in 2020 and 2021. METHODS: Census of patients aged up to 19 committed with severe acute respiratory syndrome, due to covid-19 or unspecified, notified to the Brazilian Influenza Epidemiological Surveillance Information System, from January 1, 2020, to December 31, 2021. The two years were divided into six phases, covering the spread of the disease-first, second and third wave-as well as the impact of vaccination. The pediatric population was categorized into infants, preschoolers, schoolchildren, and adolescents. Hospital mortality was assessed by pandemic phase and age group. RESULTS: A total of 144,041 patients were recorded in the two years, 18.2% of whom had confirmed cases of covid-19. Children under 5 years old (infants and preschoolers) accounted for 62.8% of those hospitalized. A total of 4,471 patients died, representing about 6.1 deaths per day. Infants were the ones who most progressed to the intensive care unit (24.7%) and had the highest gross number of deaths (n = 2,012), but mortality was higher among adolescents (5.7%), reaching 9.8% in phase 1. The first peak of deaths occurred in phase 1 (May/2020), and two other peaks occurred in phase 4 (March/2021 and May/2021). There was an increase in cases and deaths for younger ages since phase 4. Hospital mortality in the pediatric population was higher in phases 1, 4, and 6, following the phenomena of dissemination/interiorization of the virus in the country, beginning of the second wave and beginning of the third wave, respectively. CONCLUSION: The absolute number of cases of covid-19 in children and adolescents is significant. Although complete vaccination in descending order of age provided a natural deviation in age range, there was a greater gap between the curve of new hospitalized cases and the curve of deaths, indicating the positive impact of immunization.

Serum Anti-Spike Antibodies Are Not Affected by Immunosuppressants in SARS-CoV-2 Vaccinations Given to Brazilian Patients with Inflammatory Bowel Disease.

This study aimed to evaluate humoral responses after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of patients with inflammatory bowel disease (IBD). Patients with IBD enrolled in a tertiary outpatient unit were followed up between September 2021 and September 2022 via serial blood collection. Immunoglobulin G antibody titers against SARS-CoV-2 were measured before administration and 1 and 6 months after the administration of two doses of different vaccination regimens. The results were compared with those of a healthy control group obtained during the same period. The mean pre-vaccination antibody titers were 452.0 and 93.3 AU/mL in the IBD (n = 42) and control (n = 89) groups, respectively. After two doses of the vaccine, the titers significantly increased in both groups (IBD, 8568.0 AU/mL; control, 7471.0 AU/mL; p < 0.001). One month after the second dose, no significant differences were observed between the two groups (p = 0.955). Significant differences between vaccination schemes in the IBD group were observed, with higher titers in those who received Pfizer, younger patients (p < 0.005), and those with a previous coronavirus disease 2019 (COVID-19) infection (p < 0.012). The use of immunosuppressants and immunobiologicals did not affect the overall humoral response to COVID-19 vaccine in patients with IBD, but specific vaccine regimens, age, and previous coronavirus infection significantly did. This study reinforces the positive impact of booster doses and the safety of SARS-CoV-2 vaccination.

Hospital mortality from covid-19 in children and adolescents in Brazil in 2020-2021 / Mortalidade hospitalar por covid-19 em crianças e adolescentes no Brasil em 2020-2021

ABSTRACT OBJECTIVE To describe cases, deaths, and hospital mortality from covid-19 in children and adolescents in Brazil, according to age group, during the evolving phases of the pandemic in 2020 and 2021. METHODS Census of patients aged up to 19 committed with severe acute respiratory syndrome, due to covid-19 or unspecified, notified to the Brazilian Influenza Epidemiological Surveillance Information System, from January 1, 2020, to December 31, 2021. The two years were divided into six phases, covering the spread of the disease—first, second and third wave—as well as the impact of vaccination. The pediatric population was categorized into infants, preschoolers, schoolchildren, and adolescents. Hospital mortality was assessed by pandemic phase and age group. RESULTS A total of 144,041 patients were recorded in the two years, 18.2% of whom had confirmed cases of covid-19. Children under 5 years old (infants and preschoolers) accounted for 62.8% of those hospitalized. A total of 4,471 patients died, representing about 6.1 deaths per day. Infants were the ones who most progressed to the intensive care unit (24.7%) and had the highest gross number of deaths (n = 2,012), but mortality was higher among adolescents (5.7%), reaching 9.8% in phase 1. The first peak of deaths occurred in phase 1 (May/2020), and two other peaks occurred in phase 4 (March/2021 and May/2021). There was an increase in cases and deaths for younger ages since phase 4. Hospital mortality in the pediatric population was higher in phases 1, 4, and 6, following the phenomena of dissemination/interiorization of the virus in the country, beginning of the second wave and beginning of the third wave, respectively. CONCLUSION The absolute number of cases of covid-19 in children and adolescents is significant. Although complete vaccination in descending order of age provided a natural deviation in age range, there was a greater gap between the curve of new hospitalized cases and the curve of deaths, indicating the positive impact of immunization.

RESUMO OBJETIVO Descrever casos, óbitos e mortalidade hospitalar por covid-19 em crianças e adolescentes no Brasil, conforme faixa etária, durante as fases de evolução da pandemia em 2020 e 2021. MÉTODOS Censo de pacientes de até 19 anos internados com síndrome respiratória aguda grave, por covid-19 ou não especificada, notificados ao Sistema de Informação de Vigilância Epidemiológica da Gripe do Brasil, entre 1 de janeiro de 2020 e 31 de dezembro de 2021. Os dois anos foram divididos em seis fases, abrangendo a disseminação da doença − primeira, segunda e terceira onda −, bem como o impacto da vacinação. A população pediátrica foi categorizada em lactentes, pré-escolares, escolares e adolescentes. A mortalidade hospitalar foi avaliada por fase da pandemia e faixa etária. RESULTADOS Foram contabilizados 144.041 pacientes nos dois anos, sendo 18,2% casos de covid-19 confirmados. Menores de 5 anos (lactentes e pré-escolares) corresponderam a 62,8% dos hospitalizados. Evoluíram a óbito 4.471, representando cerca 6,1 óbitos por dia. Os lactentes foram os que mais evoluíram para unidade de terapia intensiva (24,7%) e apresentaram o maior número bruto de óbito (n = 2.012), porém a mortalidade foi maior entre os adolescentes (5,7%), chegando a 9,8% na fase 1. O primeiro pico de óbitos ocorreu na fase 1 (maio/2020), e outros dois picos ocorreram na fase 4 (março/2021 e maio/2021). Verificou-se avanço de casos e óbitos para as idades inferiores desde a fase 4. A mortalidade hospitalar na população pediátrica foi maior nas fases 1, 4 e 6, acompanhando os fenômenos de disseminação/interiorização do vírus no país, início da segunda onda e início da terceira onda, respectivamente. CONCLUSÃO O número absoluto de casos de covid-19 em crianças e adolescentes é expressivo. Embora a vacinação completa em ordem decrescente de idade tenha proporcionado um desvio natural de faixa etária, ocorreu um distanciamento maior entre a curva de novos casos hospitalizados e a curva de óbitos, indicando o impacto positivo da imunização.

Promoting adequate and healthy food in early childhood education: a systematic review / Promoção da alimentação adequada e saudável na educação infantil: uma revisão sistemática

Abstract Objectives: to identify and describe the characteristics of studies that address the promotion of adequate and healthy food in early childhood education units and their repercussions on the school community. Methods: the search and selection were performed according to the PRISMA recommendations in the Medline databases via OVID, EMBASE and LILACS. Data extraction took placeusing a table developed by the authors. The evaluation of the quality of the evidence of the studies was carried out through the risk of bias using an adapted scale. Result: twelve articles that met the eligibility criteria were selected. All studies were applied in public or private educational institutions with a median of 236 participants. In the analysis of food and nutrition education activities, the most adopted with preschoolers were playful; with the parents it was the meetings and counseling; and with the professionals it was the training. The methodological qualification of the studies was considered low, which may be related to their limitations included in this review, mainly due to the types of designs adopted, the time and lack of continuity of interventions and sample size. Conclusion: food and nutrition education activities seem to be a promising strategy in knowledge, adoption of healthy eating practices and transmission of values in the school community.

Resumo Objetivos: identificar e descrever as características de estudos que abordam a promoção da alimentação adequada e saudável em unidades de educação infantil e suas repercussões na comunidade escolar. Métodos: a busca e seleção foram realizadas segundo as recomendações do PRISMA nas bases de dados Medline via OVID, EMBASE e LILACS. A extração de dados ocorreu utilizando uma tabela elaborada pelas autoras. A avaliação da qualidade das evidências dos estudos foi realizada por meio do risco de viés utilizando uma escala adaptada. Resultados: foram selecionados 12 artigos que atenderam aos critérios de elegibilidade. Todos os estudos foram aplicados em instituições de ensino públicas ou privadas com uma mediana de 236 participantes. Na análise das atividades de educação alimentar e nutricional, as mais adotadas com os pré-escolares foram as lúdicas; com os pais foram as reuniões e aconselhamentos; e com os profissionais foram as capacitações. A qualificação metodológica dos estudos foi considerada baixa, podendo estar relacionada às limitações dos próprios estudos incluídos nesta revisão, principalmente pelos tipos de desenhos adotados, o tempo e a falta de continuidade das intervenções e tamanho amostrai. Conclusão: atividades de educação alimentar e nutricional parecem ser uma estratégia promissora na disseminação do conhecimento, adoção de práticas alimentares saudáveis e transmissão de valores na comunidade escolar.

Incidence of retinoblastoma in children and adolescents in Brazil: A population-based study.

Objective: To estimate the incidence of retinoblastoma in children and adolescents in Brazil based on Population-Based Cancer Registry (PBCR), describing temporal trends and some quality indicators of this registry. Methods: Based on secondary data from the PBCR of the National Institute of Cancer (INCA) (2000-2018), by selecting the morphological code of retinoblastoma, the annual incidences per million (0-19 years of age) in each local PBCR were estimated by sex and age group, global combined and by region, in addition to the percentage of diagnosis only by death certificate (DC) or not informed (NI), and the male/female ratio (M/F). An annual incidence trend in the five Brazilian geographic regions was also analyzed using the inflection point regression technique. Results: 675 patients were identified in 28 PBCR, 91% between 0 and 4 years of age. The overall combined incidence per million by age group was: 7.02 (0-4 years old), ranging from 5.25 in the Midwest to 11.26 in the Northeast; 0.46 (5-9 years old); 0.05 (10-14 years old) and 0.03 (15-19 years old). The combined incidence per million, adjusted for the world population, was 2.23 (0-14 years old) and 2.24 (0-19 years old). The DC and NI percentages were 13% and 18%, respectively; the M/F ratio was 1.3. The incidence remained stable throughout the study period, except for the city of São Paulo, where there was a significant reduction of 3.4% per year. Conclusions: In Brazil, except for the Northeast region, the incidences of retinoblastoma were lower than those reported in several countries worldwide, suggesting possible underreporting, and the time series analysis showed a stable trend. Although this pioneering study brings a recent panel of available data on retinoblastoma in Brazil, more precise estimates are needed and welcome for better planning of onco-ophthalmologic care in the country.

[Economic crisis and disparities in spending, supply, and use of public and private health services in Brazil from 2011 to 2019]. / Crise econômica e disparidades no gasto, oferta e utilização de serviços públicos e privados de saúde no Brasil no período entre 2011 e 2019.

This study sought to analyze the repercussions of the economic crisis on the public and private sectors of the Brazilian health system and perform a trend analysis of economic and care indicators, based on secondary data from official public sources related to spending, the economic performance of health plans and insurance, and the supply and use of services. The results showed stagnation of public spending on health, as well as reduction of per capita public spending and of access to public health services. On the contrary, in a context of falling income and employment, health plans retained customers, increased revenues, profits, and their care production. The positive performance of companies, before and after the crisis, can be explained by the trend of maintaining public subsidies for the private sector and by financialized business strategies. We conclude that the actions of the Brazilian government during the crisis deepened the restriction of resources to the public sector and favored the expansion of private services, which thus contributed to increase the discrepancy in access to public and private health services in the country.

Buscou-se analisar as repercussões da crise econômica sobre os setores público e privado do sistema de saúde brasileiro e realizar uma análise de tendência de indicadores econômicos e assistenciais, elaborados a partir de dados secundários de fontes públicas oficiais, relacionados ao gasto, ao desempenho econômico de planos e seguros de saúde, à oferta e utilização de serviços. Os resultados demonstraram estagnação do gasto público em saúde, redução do gasto público per capita e do acesso aos serviços públicos de saúde. Contrariamente, em um contexto de queda da renda e do emprego, os planos de saúde mantiveram clientes, ampliaram as receitas, os lucros e a produção assistencial. O desempenho positivo das empresas, antes e a partir da crise, pode ser explicado pela tendência de manutenção de subsídios públicos para o setor privado e pelas estratégias empresariais financeirizadas. Conclui-se que a atuação do Estado brasileiro durante a crise aprofundou a restrição de recursos ao setor público e favoreceu a expansão dos serviços privados, o que contribuiu para aumentar a discrepância no acesso a serviços públicos e privados de saúde no país.

Se pretende analizar las repercusiones de la crisis económica en los sectores público y privado del sistema de salud brasileño y realizar un análisis de tendencia de los indicadores económicos y asistenciales, con base en datos secundarios de fuentes públicas oficiales relacionados con el gasto, el desempeño económico de los planes y seguros de salud, a la oferta y uso de servicios. Los resultados mostraron estancamiento del gasto público en salud, reducción del gasto público per cápita y del acceso a los servicios públicos de salud. Por el contrario, en un contexto de descenso de ingresos y de empleo, los seguros médicos mantuvieron sus clientes, aumentaron los ingresos, las ganancias y la producción asistencial. El buen desempeño de las empresas antes y después de la crisis se debe a la tendencia a mantener los subsidios públicos en el sector privado y a las estrategias empresariales financiarizadas. Se concluye que las acciones del Estado brasileño durante la crisis profundizaron la restricción de recursos al sector público y favorecieron la expansión de los servicios privados, lo que contribuyó a aumentar la discrepancia en el acceso a los servicios de salud públicos y privados en el país.

Time trends and geographic distribution of hepatocellular carcinoma in Brazil: An ecological study.

The incidence of hepatocellular carcinoma (HCC) is increasing globally, and HCC is the fourth leading cause of cancer-related death. This ecological study aimed to investigate the time trends and geographic distribution of HCC in Brazil. Data from the Brazilian Health Public System were retrospectively collected from January 2005 to December 2018. Hospitalization and intrahospital lethality rates for HCC were stratified by age and sex. Hospitalization rates and associated lethality per 100,000 inhabitants in each municipality were included in a worksheet to build maps displaying the estimates and the geographic distribution of HCC. From 2005 to 2018, a total of 75,466 admissions for HCC were registered and the mean hospitalizations increased from 2.1 to 5.8/100,000 inhabitants (176%). The greatest increase occurred among patients older than 50, particularly in males above 70 years old. Prevalence rates increased throughout the country, with the highest levels detected in the South and Southeast. However, the increase was proportionally higher in the Northeast (377%), especially in municipalities not integrated into metropolitan regions. The HCC lethality rate remained relatively stable in both sexes, ranging from 21% to 25% (19%), but it was higher among older patients. The length of hospital stay did not differ between survivors and nonsurvivors throughout the study period. HCC hospitalizations are rising, particularly above 50 years of age and in rural areas, not paralleled by lethality rates. This suggests ongoing changes in environmental and socioeconomic factors in Brazil.

Antibiotic Consumption and Deviation of Prescribed Daily Dose From the Defined Daily Dose in Critical Care Patients: A Point-Prevalence Study.

Background: The consumption of antibiotics is one of the metrics used to evaluate the impact of antimicrobial stewardship programs (ASP). The aim of this study was to determine the prevalence of antibiotic consumption in Brazilian intensive care units (ICUs) and estimate the deviation of the prescribed daily dose (PDD) from the defined daily dose (DDD). Methods: This is a multicenter, observational, point-prevalence study carried out in adult ICUs of 8 Brazilian hospitals from August 2019, to February 2020. We collected data on the patient's demographic and clinical characteristics, antibiotic therapy, classification and site of infections. The DU90 (antibiotic accounting for 90% of the volume utilized) was calculated, and the antibiotics were classified by the Anatomical Therapeutic Chemical (ATC) Index and the World Health Organization (WHO) Access, Watch, Reserve (AWaRe) groups. For the most prevalent antibiotics, the deviation of PDD from DDD was determined. Results: Three hundred thirty-two patients from 35 ICUs were analyzed. The prevalence of antibiotic use was 52.4%. The patients in use of antibiotics were predominantly over 60 years of age (81.6%) with pulmonary infections (45.8%). A predominance of empirical regimens was observed (62.6%) among antibiotic therapies. The highest frequencies of prescriptions observed were for piperacillin + tazobactam (16.1%), meropenem (13.3%), amoxicillin + clavulanate (7.2%), azithromycin (7.2%), and teicoplanin (6.1%). The watch (64.2%) and reserve (9.6%) categories of the AWaRe classification accounted for 73.8% of all antibiotics, and they were prescribed alone or in combinations. High variability of doses was observed for the most prescribed antibiotics, and large deviations of PDD from the DDD were observed for meropenem, teicoplanin, and tigecycline. Conclusions: The high prevalence of antibiotic prescription was related to a predominance of empirical regimens and antibiotics belonging to the WHO Watch classification. High variability of doses and large deviations of PDD from DDD for meropenem, teicoplanin, and tigecycline was observed, suggesting that DDD may be insufficient to monitor the consumption of these antibiotics in the ICU population. The variability of doses found for the most prescribed antibiotics suggests the need for monitoring and intervention targets for antibiotic stewardship teams.

Sustainable and Active Program-Development and Application of SAVING Methodology.

The SAVING project aimed to create a sustainable and active aging program to promote the transition to sustainable aging in residential structures for the elderly (RSEs), developing research activities to apply the best strategies and good practices regarding the promotion of an active, healthy, and sustainable aging regarding social, economic, environmental, and pedagogic aspects. All this innovative methodology was built on a living-lab approach applied in one RSE, that was used as a case study. The results showed that the creation of the SAVING Brigade allowed not only increased reflection and mutual learning, but also created better conditions to face uncertainties and obstacles. Moreover, the use of indicators supported the basic themes and enabled comparison with other studies, between institutions or programs. Finally, the Action Plan acted as a tool for the development of previously defined strategies. It is possible to conclude that the breadth of the concept of quality of life encompasses the physical health of the individual, their psychological state, their social relationships, their perceptions, and the relationship with the characteristics of the context in which they are inserted. Therefore, active, sustainable, and healthy aging should be the goal.

Validação de Instrumento em uma População Brasileira de Adolescentes em Conflito com a Lei / Validation of Instrument in a Brazilian Population of Adolescents in Conflict with the Law / Validación de Instrumento en una Población Brasileña de Adolescentes en Conflicto con la Ley

Este estudo teve como objetivo a construção de um software, a partir da testagem adaptativa informatizada para computadores e dispositivos móveis, como possível ferramenta para a avaliação neuropsicológica do controle inibitório. Foi realizado estudo empírico com 70 adolescentes entre 14 e 18 anos que cumpriam medida socioeducativa em complexo de reabilitação. Foi empreendida uma análise via TRI através da constatação do modelo logístico de três parâmetros (3PL); os itens foram ajustados apresentando confiabilidade (Alfa de Cronbach = 0,909). Outra análise constatou a relação entre a tarefa construída e o Five Digit Test (teste que avalia construtos similares). Os resultados apontaram que a tarefa construída tem potencial para avaliar o CI, considerando que a correlação dos escores entre os instrumentos obteve níveis consideráveis de significância (no nível de 0,05). Além disso, verificou-se que o uso da tecnologia da informação no processo de avaliação neuropsicológica torna o processo mais dinâmico e atrativo para o avaliado, além de mais prático e econômico para o avaliador.

This study aimed to build a software from computerized adaptive testing for computers and mobile devices as a possible tool for the neuropsychological assessment of inhibitory control. An empirical study was carried out with 70 teenagers between 14 and 18 years old who were completing socio-educational measures in a rehabilitation complex. An analysis was carried out via IRT through the verification of the logistic model of three parameters (ML3), the items were adjusted showing reliability (Cronbach's alpha = 0.909). Another analysis found the relationship between the constructed task and the Five Digit Test (a test that assesses similar constructs). The results showed that the constructed task has the potential to assess the IC, considering that the correlation of scores between the instruments obtained considerable levels of significance (at the level of 0.05). Furthermore, it was found that the use of information technology in the neuropsychological assessment process makes the process more dynamic and attractive for the individual, in addition to being more practical and economical for the assessor.

Este estudio tuvo como objetivo construir un software, a partir de pruebas adaptativas computarizadas para computadoras y dispositivos móviles como una posible herramienta para la evaluación neuropsicológica del control inhibitorio. Se realizó un estudio empírico con 70 adolescentes entre 14 y 18 años que estaban completando medidas socioeducativas en un complejo de rehabilitación. Se realizó un análisis vía TRI mediante la verificación del modelo logístico de tres parámetros (3PL), los ítems fueron ajustados mostrando confiabilidad (alfa de Cronbach = 0.909). Otro análisis encontró la relación entre la tarea construida y la prueba de cinco dígitos (una prueba que evalúa constructos similares). Los resultados señalaron que la tarea construida tiene potencial para evaluar el CI, considerando que la correlación de puntajes entre los instrumentos obtuvo niveles considerables de significancia (al nivel de 0.05). Además, se encontró que el uso de la tecnología de la información en el proceso de evaluación neuropsicológica hace que el proceso sea más dinámico y atractivo para el individuo, además de ser más práctico y económico para el evaluador.

Geographic Distribution and Time Trends of Colorectal Cancer in Brazil from 2005 to 2018.

BACKGROUND: Colorectal cancer (CRC) is the third most common malignancy and the second leading cause of cancer-related death in the world. The aim of this study was to investigate the geographic distribution and time trends of CRC in Brazil. METHODS: Data were retrospectively retrieved from January 2005 to December 2018 from the Brazilian Public Health System. The incidence and lethality rates of CRC per 100,000 inhabitants in each municipality were estimated from hospitalizations and in-hospital deaths and were classified by age, sex, and demographic features. RESULTS: During the study period, the mean incidence of CRC estimated from hospitalizations and adjusted to available hospital beds more than tripled from 14.6 to 51.4 per 100,000 inhabitants (352%). Increases in CRC incidence were detected in all age ranges, particularly among people aged 50-69 years (266%). Incidence rates increased in all 5 macroregions, with a clear South to North gradient. The greatest changes in incidence and lethality rates were registered in small-sized municipalities. CRC lethality estimated from in-hospital deaths decreased similarly in both sexes, from 12 to 8% for males and females, from 2005 to 2018. The decline in lethality rates was seen in all age ranges, mainly in people aged 50 to 69 years (- 38%). CONCLUSIONS: CRC incidence is increasing, predominantly above fifty years of age, and also in areas previously considered as having low incidence, but the increase is not paralleled by lethality rates. This suggests recent improvements in CRC screening programs and treatment, but also supports the spread of environmental risk factors throughout the country.

Geosocial Features and Loss of Biodiversity Underlie Variable Rates of Inflammatory Bowel Disease in a Large Developing Country: A Population-Based Study.

BACKGROUND: The epidemiology of inflammatory bowel disease (IBD) in developing countries may uncover etiopathogenic factors. We investigated IBD prevalence in Brazil by investigating its geographic, spatial, and temporal distribution, and attempted to identify factors associated with its recent increase. METHODS: A drug prescription database was queried longitudinally to identify patients and verify population distribution and density, race, urbanicity, sanitation, and Human Development Index. Prevalence was calculated using the number of IBD patients and the population estimated during the same decade. Data were matched to indices using linear regression analyses. RESULTS: We identified 162 894 IBD patients, 59% with ulcerative colitis (UC) and 41% with Crohn's disease (CD). The overall prevalence of IBD was 80 per 100 000, with 46 per 100 000 for UC and 36 per 100 000 for CD. Estimated rates adjusted to total population showed that IBD more than triplicated from 2008 to 2017. The distribution of IBD demonstrated a South-to-North gradient that generally followed population apportionment. However, marked regional differences and disease clusters were identified that did not fit with conventionally accepted IBD epidemiological associations, revealing that the rise of IBD was variable. In some areas, loss of biodiversity was associated with high IBD prevalence. CONCLUSIONS: When distribution is considered in the context of IBD prevalence, marked regional differences become evident. Despite a background of Westernization, hotspots of IBD are recognized that are not explained by population density, urbanicity, sanitation, or other indices but apparently are explained by biodiversity loss. Thus, the rise of IBD in developing countries is not uniform, but rather is one that varies depending on yet unexplored factors like geoecological conditions.

The analysis of a large population of inflammatory bowel disease (IBD) patients in a developing country reveals that the rising prevalence of IBD is not uniform and is linked to factors not traditionally associated with IBD, such as geosocial features and loss of biodiversity.

O adoecimento dos trabalhadores de enfermagem e os riscos psicossociais no trabalho / Enfermedades de los trabajadores de enfermería y riesgos psicosociales en el trabajo / Work-related disorders and psychosocial risks in nursing professionals

Resumo Objetivo Analisar o adoecimento físico e psicossocial decorrente do trabalho do profissional de enfermagem que atua em ambulatório de hospital universitário e sua inter-relação com os riscos psicossociais. Métodos Estudo epidemiológico transversal, realizado com 388 profissionais de enfermagem de ambulatórios universitários, no município do Rio de Janeiro, RJ. Utilizou-se um questionário para caracterização dos participantes e a Escala de Danos Físicos e Psicossociais no Trabalho, a coleta de dados ocorreu de julho a dezembro de 2018. Realizou-se análise descritiva das variáveis e a classificação de risco dos danos. Para a análise estatística bivariada, utilizou-se a medida de associação razão de chances, com intervalo de confiança de 95%, nível de significância de 5%. Resultados O contexto de trabalho ambulatorial da enfermagem põe em risco a saúde física dos profissionais; porém, há de se considerar também o seu perfil, que, além de uma longa trajetória na enfermagem, aponta para a sua rotatividade pelos setores do hospital, finalizando no ambulatório. Partindo dessa perspectiva, esses profissionais podem já estar adoecidos fisicamente ao serem alocados nos ambulatórios, para desenvolverem suas atividades laborais. Conclusão Os danos físicos receberam as piores avaliações, dados corroborados pela literatura nacional e internacional, os quais estiveram associados aos desfechos investigados, destacando-se a presença de doenças crônicas e o absenteísmo por doenças.

Resumen Objetivo Analizar las enfermedades físicas y psicosociales resultantes del trabajo de profesionales de enfermería que trabajan en el ambulatorio de un hospital universitario y su interrelación con los riesgos psicosociales. Métodos Estudio epidemiológico transversal, realizado con 388 profesionales de enfermería de ambulatorios universitarios en el municipio de Rio de Janeiro, estado de Rio de Janeiro. Se utilizó un cuestionario para la caracterización de los participantes y la Escala de Daños Físicos y Psicosociales en el Trabajo. La recopilación de datos se llevó a cabo de julio a diciembre de 2018. Se realizó el análisis descriptivo de las variables y la clasificación de riesgo de los daños. Para el análisis estadístico bivariado, se utilizó la medida de asociación razón de momios, con intervalo de confianza del 95 %, nivel de significancia del 5 %. Resultados El contexto de trabajo en un ambulatorio de enfermería pone en riesgo la salud física de los profesionales. Sin embargo, se debe considerar también su perfil, que, además de una larga trayectoria en enfermería, indica una rotación por los sectores del hospital, que termina en el ambulatorio. Partiendo de esa perspectiva, estos profesionales pueden ya estar enfermos físicamente al ser destinados a los ambulatorios para que desarrollen sus actividades laborales. Conclusión Los daños físicos recibieron las peores evaluaciones, datos corroborados por la literatura nacional e internacional, que estuvieron asociados a los desenlaces investigados, con énfasis en la presencia de enfermedades crónicas y ausentismo por enfermedad.

Abstract Objective To analyze the physical and psychosocial work-related disorders of nursing professionals working in the outpatient clinic of a university hospital, and its interrelationship with psychosocial risks. Methods An epidemiological and cross-sectional study was conducted with 388 nursing professionals from outpatient clinics of a university hospital in the city of Rio de Janeiro, RJ, Brazil. A questionnaire was used to characterize the participants and the Work-Related Physical and Psychosocial Disorder Scale (WRDS). Data collection occurred from July to December of 2018. Descriptive analysis of the variables and the risk classification of the disorder were performed. For the bivariate statistical analysis, the odds ratio association measure was obtained, using a 95% confidence interval, 5% significance level. Results The outpatient nursing work context jeopardizes the physical health of professionals at risk; however, it is also necessary to understand their profile, which, in addition to a long trajectory in nursing, points to their constant rotation among the sectors of the hospital, ending up in the outpatient setting. From this perspective, these professionals may already be physically unhealthy, when they are allocated to the outpatient clinics. Conclusion Physical disorders received the worst evaluations, data supported by national and international literature, which were associated with the outcomes investigated, highlighting the presence of chronic diseases and absence due to illness.

Crise econômica e disparidades no gasto, oferta e utilização de serviços públicos e privados de saúde no Brasil no período entre 2011 e 2019 / Economic crisis and disparities in spending, supply, and use of public and private health services in Brazil from 2011 to 2019 / Crisis económica y disparidades en el gasto, oferta y uso de los servicios de salud públicos y privados en Brasil en el período 2011-2019

Buscou-se analisar as repercussões da crise econômica sobre os setores público e privado do sistema de saúde brasileiro e realizar uma análise de tendência de indicadores econômicos e assistenciais, elaborados a partir de dados secundários de fontes públicas oficiais, relacionados ao gasto, ao desempenho econômico de planos e seguros de saúde, à oferta e utilização de serviços. Os resultados demonstraram estagnação do gasto público em saúde, redução do gasto público per capita e do acesso aos serviços públicos de saúde. Contrariamente, em um contexto de queda da renda e do emprego, os planos de saúde mantiveram clientes, ampliaram as receitas, os lucros e a produção assistencial. O desempenho positivo das empresas, antes e a partir da crise, pode ser explicado pela tendência de manutenção de subsídios públicos para o setor privado e pelas estratégias empresariais financeirizadas. Conclui-se que a atuação do Estado brasileiro durante a crise aprofundou a restrição de recursos ao setor público e favoreceu a expansão dos serviços privados, o que contribuiu para aumentar a discrepância no acesso a serviços públicos e privados de saúde no país.

This study sought to analyze the repercussions of the economic crisis on the public and private sectors of the Brazilian health system and perform a trend analysis of economic and care indicators, based on secondary data from official public sources related to spending, the economic performance of health plans and insurance, and the supply and use of services. The results showed stagnation of public spending on health, as well as reduction of per capita public spending and of access to public health services. On the contrary, in a context of falling income and employment, health plans retained customers, increased revenues, profits, and their care production. The positive performance of companies, before and after the crisis, can be explained by the trend of maintaining public subsidies for the private sector and by financialized business strategies. We conclude that the actions of the Brazilian government during the crisis deepened the restriction of resources to the public sector and favored the expansion of private services, which thus contributed to increase the discrepancy in access to public and private health services in the country.

Se pretende analizar las repercusiones de la crisis económica en los sectores público y privado del sistema de salud brasileño y realizar un análisis de tendencia de los indicadores económicos y asistenciales, con base en datos secundarios de fuentes públicas oficiales relacionados con el gasto, el desempeño económico de los planes y seguros de salud, a la oferta y uso de servicios. Los resultados mostraron estancamiento del gasto público en salud, reducción del gasto público per cápita y del acceso a los servicios públicos de salud. Por el contrario, en un contexto de descenso de ingresos y de empleo, los seguros médicos mantuvieron sus clientes, aumentaron los ingresos, las ganancias y la producción asistencial. El buen desempeño de las empresas antes y después de la crisis se debe a la tendencia a mantener los subsidios públicos en el sector privado y a las estrategias empresariales financiarizadas. Se concluye que las acciones del Estado brasileño durante la crisis profundizaron la restricción de recursos al sector público y favorecieron la expansión de los servicios privados, lo que contribuyó a aumentar la discrepancia en el acceso a los servicios de salud públicos y privados en el país.

Psychosocial risks related to the organization of outpatient nursing work / Riesgos psicosociales relacionados con la organización del trabajo de enfermería ambulatoria / Riscos psicossociais relacionados à organização do trabalho da enfermagem ambulatorial

ABSTRACT Objective: to analyze the psychosocial risks related to the organization of nursing work in outpatient clinics of university hospitals. Method: cross-sectional epidemiological study developed in 11 outpatient units linked to the three public universities of the city of Rio de Janeiro, Brazil. Participants were 388 nursing professionals who worked in patient care at the time of the research. Data were collected from July to December 2018, using a self-applicable instrument. A questionnaire was used for sociodemographic, occupational and health characterization, and the Work Organization Scale. The bivariate analyses were performed using the odds ratio (OR), with a confidence interval of 95%, significance level of 5%. Results: the organization of nursing work received an assessment of medium psychosocial risk by the professionals participating in the research, demanding interventions in the short and medium term. There was no association between sociodemographic, occupational and health characteristics and the organization of outpatient work. Conclusion: interventional measures should be performed in the psychosocial risk factors presented in this research, with a view to improving the work environment, so that the importance of maintaining satisfactory material conditions is considered, as well as the adequate quantity of human resources. In addition, it aims to expand the spaces of nursing participation in decision-making, strengthening its autonomy as a profession.

RESUMEN Objetivo: analizar los riesgos psicosociales relacionados con la organización del trabajo de enfermería en las consultas externas de los hospitales universitarios. Método: estudio epidemiológico transversal desarrollado en 11 unidades ambulatorias vinculadas a las tres universidades públicas de la ciudad de Río de Janeiro, Brasil. Los participantes fueron 388 profesionales de enfermería que trabajaban en la atención al paciente en el momento de la investigación. Los datos se recolectaron de julio a diciembre de 2018, utilizando un instrumento autoaplicable. Se utilizó un cuestionario para la caracterización sociodemográfica, ocupacional y de salud, y la Escala de Organización del Trabajo. Los análisis bivariados se realizaron utilizando el odds ratio (OR), con un intervalo de confianza del 95%, nivel de significancia del 5%. Resultados: la organización del trabajo de enfermería recibió una evaluación del riesgo medio psicosocial por parte de los profesionales participantes en la investigación, exigiendo intervenciones en el corto y mediano plazo. No hubo asociación entre las características sociodemográficas, ocupacionales y de salud y la organización del trabajo ambulatório. Conclusión: se deben realizar medidas de intervención en los factores de riesgo psicosocial presentados en esta investigación, con miras a mejorar el clima laboral, a fin de considerar la importancia de mantener condiciones materiales satisfactorias, así como la cantidad adecuada de recursos humanos. Además, se busca ampliar los espacios de participación de la enfermería en la toma de decisiones, fortaleciendo su autonomía como profesión.

RESUMO Objetivo: analisar os riscos psicossociais relacionados à organização do trabalho de enfermagem em ambulatórios de hospitais universitários. Método: estudo epidemiológico transversal desenvolvido em 11 unidades ambulatoriais vinculadas às três universidades públicas do município do Rio de Janeiro, Brasil. Participaram 388 trabalhadores de enfermagem, que atuavam na assistência à época da pesquisa. A coleta de dados foi realizada no período de julho a dezembro de 2018, por meio de um instrumento autoaplicável. Utilizou-se um questionário para caracterização sociodemográfica, ocupacional e de saúde, e a Escala de Organização do Trabalho. As análises bivariadas foram realizadas utilizando a razão de chances, odds ratio (OR), com intervalo de confiança de 95%, nível de significância de 5%. Resultados: a organização do trabalho de enfermagem recebeu avaliação de risco psicossocial médio pelos profissionais participantes da pesquisa, demandando intervenções a curto e médio prazo. Não houve associação entre as características sociodemográficas, ocupacionais e de saúde e a organização do trabalho ambulatorial. Conclusão: medidas interventivas devem ser realizadas nos fatores de risco psicossocial apresentados nesta pesquisa, na perspectiva de melhorar o ambiente de trabalho, de forma que se considere a importância da manutenção de condições materiais satisfatórias, bem como o quantitativo adequado de recursos humanos. Além disso, visa-se ampliar os espaços de participação da enfermagem na tomada de decisão, fortalecendo sua autonomia enquanto profissão.