Prospective memory instruments for the assessment of children and adolescents: a systematic review.

BACKGROUND: Prospective memory is the ability to engage in an intention to be performed in the future. The main objective of this study was to identify instruments that assess both time-based and event-based prospective memory in children and adolescents and that have the potential to be clinically applicable. METHOD: Three databases (PubMed, Scopus, and PsycINFO) were searched to identify existing PM measures in original articles published until 2022. Literature searches were conducted using the following terms: (prospective memor* OR memor* for intentions) AND (neuropsychological assessment) AND (test* OR instrument* OR questionnaire* OR task*) AND (psychometric properties) AND (child* OR adolescen*). Relevant studies identified in the reference lists were also included in the review. RESULTS: Ten instruments were identified and classified into three categories: (a) test batteries, (b) experimental procedures, and (c) questionnaires. All the instruments identified were described concerning their content and the psychometric properties available. Some of the instruments presented empirical evidence regarding validity and reliability, but no one provided normative data. CONCLUSION: Besides the recent progress regarding studies publishing the development of a variety of novel measures, there are still many limitations surrounding the assessment of PM in the youth population because of the yet incipient psychometric properties presented by the majority of the PM instruments. Recommendations for a gold-standard PM instrument for assessing children and adolescents are provided.

Perinatal mortality, severe maternal morbidity and maternal near miss: protocol of a study integrated with the Birth in Brazil II survey. / Mortalidade perinatal, morbidade materna grave e near miss materno: protocolo de um estudo integrado à pesquisa Nascer no Brasil II.

Brazil presents high maternal and perinatal morbidity and mortality. Cases of severe maternal morbidity, maternal near miss, and perinatal deaths are important health indicators and share the same determinants, being closely related to living conditions and quality of perinatal care. This article aims to present the study protocol to estimate the perinatal mortality rate and the incidence of severe maternal morbidity and maternal near miss in the country, identifying its determinants. Cross-sectional study integrated into the research Birth in Brazil II, conducted from 2021 to 2023. This study will include 155 public, mixed and private maternities, accounting for more than 2,750 births per year, participating in the Birth in Brazil II survey. We will collect retrospective data from maternal and neonatal records of all hospitalizations within a 30-day period in these maternities, applying a screening form to identify cases of maternal morbidity and perinatal deaths. Medical record data of all identified cases will be collected after hospital discharge, using a standardized instrument. Cases of severe maternal morbidity and maternal near miss will be classified based on the definition adopted by the World Health Organization. The perinatal deaths rate and the incidence of severe maternal morbidity and maternal near miss will be estimated. Cases will be compared to controls obtained in the Birth in Brazil II survey, matched by hospital and duration of pregnancy, in order to identify factors associated with negative outcomes. Results are expected to contribute to the knowledge on maternal morbidity and perinatal deaths in Brazil, as well as the development of strategies to improve care.

O Brasil apresenta elevada morbimortalidade materna e perinatal. Casos de morbidade materna grave, near miss materno e óbitos perinatais são indicadores importantes de saúde e compartilham dos mesmos determinantes sociais, tendo estreita relação com as condições de vida e qualidade da assistência perinatal. Este artigo pretende apresentar o protocolo de estudo que visa estimar a taxa de mortalidade perinatal e a incidência de morbidade materna grave e near miss materno no país, assim como identificar seus determinantes. Trata-se de estudo transversal integrado à pesquisa Nascer no Brasil II, realizada entre 2021 e 2023. Serão incluídas neste estudo 155 maternidades públicas, mistas e privadas, com mais de 2.750 partos por ano, participantes do Nascer no Brasil II. Nessas maternidades, será realizada coleta retrospectiva de dados de prontuário materno e neonatal de todas as internações ocorridas num período de 30 dias, com aplicação de uma ficha de triagem para identificação de casos de morbidade materna e de óbito perinatal. Dados de prontuário de todos os casos identificados serão coletados após a alta hospitalar, utilizando instrumento padronizado. Casos de morbidade materna grave e near miss materno serão classificados por meio da definição adotada pela Organização Mundial da Saúde. Será estimada a taxa de mortalidade perinatal e a incidência de morbidade materna grave e near miss materno. Os casos serão comparados a controles obtidos na pesquisa Nascer no Brasil II, pareados por hospital e duração da gestação, visando a identificação de fatores associados aos desfechos negativos. Espera-se que os resultados deste artigo contribuam para o conhecimento sobre a morbidade materna e a mortalidade perinatal no país, bem como para a elaboração de estratégias de melhoria do cuidado.

Brasil tiene una alta morbimortalidad materna y perinatal. Los casos de morbilidad materna severa, maternal near miss y muertes perinatales son importantes indicadores de salud y comparten los mismos determinantes sociales, y tienen una estrecha relación con las condiciones de vida y la calidad de la asistencia perinatal. Este artículo pretende presentar el protocolo de estudio que tiene como objetivo estimar la tasa de mortalidad perinatal y la incidencia de morbilidad materna severa y maternal near miss en el país, así como identificar sus determinantes. Se trata de un estudio transversal integrado a la investigación Nacer en Brasil II, realizada entre el 2021 y el 2023. Este estudio incluirá 155 maternidades públicas, mixtas y privadas, con más de 2.750 partos al año, que participan en el Nacer en Brasil II. En estas maternidades, se realizará una recopilación retrospectiva de datos de las historias clínicas maternas y neonatales de todas las hospitalizaciones ocurridas en un período de 30 días, con la aplicación de un formulario de triaje para identificar casos de morbilidad materna y de muerte perinatal. Los datos de las historias clínicas de todos los casos identificados se recopilarán tras el alta hospitalaria, mediante un instrumento estandarizado. Los casos de morbilidad materna severa y maternal near miss se clasificarán por medio de la definición adoptada por la Organización Mundial de la Salud. Se estimará la tasa de mortalidad perinatal y la incidencia de morbilidad materna severa y maternal near miss. Los casos se compararán con los controles obtenidos en el estudio Nacer en Brasil II, emparejados por hospital y duración del embarazo, para identificar factores asociados con desenlaces negativos. Se espera que los resultados de este artículo contribuyan al conocimiento sobre la morbilidad materna y la mortalidad perinatal en el país, así como a la elaboración de estrategias para mejorar el cuidado.

Birth in Brazil II: a postpartum maternal, paternal and child health research protocol. / Nascer no Brasil II: protocolo de investigação da saúde materna, paterna e da criança no pós-parto.

Pregnancy, parturition and birth bring major changes to the lives of mothers and fathers. This article presents a research protocol for estimating the prevalence of postpartum mental health outcomes in mothers and fathers, abuse and satisfaction in delivery/abortion care, and the correlations between them and socioeconomic, obstetric, and child health factors. As a 2-component research, it consists of a prospective cohort study with all postpartum women interviewed in the 465 maternity hospitals included at the Birth in Brazil II baseline survey conducted from 2021 to 2023, and a cross-sectional study with the newborns' fathers/partners. Interviews will be conducted via telephone or self-completion link sent by WhatsApp with the mother at 2 and 4 months after delivery/abortion. Partners will be approached three months after birth (excluding abortions, stillbirths and newborn death) using the telephone number informed by the mother at the maternity ward. Postpartum women will be inquired about symptoms of depression, anxiety and post-traumatic stress disorder, abuse during maternity care and quality of the mother-newborn bond. Maternal and neonatal morbidity, use of postnatal services, and satisfaction with maternity care are also investigated. Fathers will be asked to report on symptoms of depression and anxiety, and the quality of the relationship with the partner and the newborn. The information collected in this research stage may help to plan and improve care aimed at the postpartum health of the mother-father-child triad.

A gravidez, o parto e o nascimento são momentos de grandes mudanças na vida das mães e dos pais. Este artigo tem como objetivo apresentar o protocolo da pesquisa para estimar a prevalência dos desfechos em saúde mental nas mães e pais no pós-parto, dos maus tratos e satisfação na atenção ao parto/abortamento, e as inter-relações entre eles e fatores socioeconômicos, obstétricos e da saúde da criança. A pesquisa tem dois componentes: estudo de coorte prospectiva com todas as puérperas entrevistadas nas 465 maternidades incluídas na linha de base da pesquisa Nascer no Brasil II realizada entre 2021 e 2023, e estudo seccional com os companheiros/pais dos bebês. As entrevistas são realizadas por ligação telefônica ou link de autopreenchimento enviado por WhatsApp com as puérperas aos 2 e 4 meses após o parto/aborto. Os companheiros são abordados três meses após o nascimento (excluídos os abortos, natimortos e neomortos), a partir do telefone informado pela puérpera na maternidade. As entrevistas abordam, entre as puérperas, sintomas de depressão, ansiedade e transtorno de estresse pós-traumático, maus-tratos na atenção na maternidade e qualidade do vínculo mãe-bebê. São investigados também a presença de morbidade materna e neonatal, utilização de serviços pós-natais, e satisfação com o atendimento na maternidade. Entre os pais, é abordada a ocorrência de sintomas de depressão e ansiedade, e a qualidade do relacionamento com a esposa/companheira e o bebê. As informações coletadas nessa etapa da pesquisa poderão subsidiar o planejamento e melhoria do cuidado voltado para a saúde da tríade mãe-pai-filho após o nascimento.

El embarazo, el parto y el nacimiento son momentos de grandes cambios en la vida de madres y padres. Este artículo tiene como objetivo presentar el protocolo de investigación para estimar la prevalencia de los resultados de la salud mental en madres y padres en el posparto, maltratos y la satisfacción durante la atención del parto/aborto, y las interrelaciones entre ellos y los factores socioeconómicos, obstétricos y de salud infantil. La investigación tiene dos componentes: un estudio de cohorte prospectivo con todas las puérperas entrevistadas en las 465 maternidades incluidas en la línea de base de la encuesta Nacer en Brasil II realizada entre 2021 y 2023, y un estudio seccional con las parejas/padres de los bebés. Las entrevistas se efectúan mediante llamada telefónica o enlace de autocumplimentación enviado vía WhatsApp a las puérperas a los 2 y 4 meses después del parto/aborto. El contacto con la pareja se hace a los tres meses del nacimiento (excluyendo abortos, mortinatos y muertes de recién nacidos), a través del teléfono facilitado por la puérpera en la sala de maternidad. Las entrevistas abordan, entre las puérperas, los síntomas de depresión, ansiedad y trastorno de estrés postraumático, maltrato durante la atención en la maternidad y la calidad del vínculo madre-bebé. También se investiga la presencia de morbilidad materna y neonatal, uso de servicios posnatales y satisfacción con la atención en la maternidad. Entre los padres, se aborda la ocurrencia de síntomas de depresión y ansiedad, y la calidad de la relación con la esposa/pareja y el bebé. La información recopilada en esta etapa de la investigación puede apoyar la planificación y mejora de la atención dirigida a la salud de la tríada madre-padre-hijo después del nacimiento.

Protocol of Birth in Brazil II: National Research on Abortion, Labor and Childbirth. / Protocolo do Nascer no Brasil II: Pesquisa Nacional sobre Aborto, Parto e Nascimento.

Brazil has made advances in obstetric care in public and private hospitals; however, weaknesses in this system still require attention. The Brazilian Ministry of Health, aware of this need, funded the second version of the Birth in Brazil survey. This study aimed to evaluate: prenatal, labor and birth, postpartum, and abortion care, comparing the results with those of Birth in Brazil I; and analyze the main determinants of perinatal morbidity and mortality; evaluate the care structure and processes of obstetrics and neonatology services in maternity hospitals; analyze the knowledge, practices, and attitudes of health professionals who provide birth and abortion care; and identify the main barriers and facilitators related to care of this nature in Brazil. With a national scope and a 2-stage probability sample: 1-hospitals and 2-women, stratified into 59 strata, 465 hospitals were selected with a total planned sample of around 24,255 women - 2,205 for abortion reasons and 22,050 for labor reasons. Data collection was conducted using six electronic instruments during hospital admission for labor or abortion, with two follow-up waves, at two and four months. In order to expand the number of cases of severe maternal morbidity, maternal and perinatal mortality, three case control studies were incorporated into Birth in Brazil II. The fieldwork began in November 2021 and is scheduled to end in 2023. It will allow a comparison between current labor and birth care results and those obtained in the first study and will evaluate the advances achieved in 10 years.

Com o passar do tempo, o Brasil vem apresentando avanços na assistência obstétrica em hospitais públicos e privados; no entanto, ainda existem pontos frágeis que necessitam de atenção. O Ministério da Saúde, ciente dessa necessidade, financiou a segunda versão da pesquisa Nascer no Brasil. Os objetivos gerais são: avaliar a assistência pré-natal, ao parto e nascimento, ao puerpério e ao aborto, comparando com os resultados do Nascer no Brasil I, e analisar os principais determinantes da morbimortalidade perinatal; avaliar a estrutura e processos assistenciais dos serviços de obstetrícia e neonatologia das maternidades; analisar os conhecimentos, atitudes e práticas de profissionais de saúde que prestam assistência ao parto e ao aborto; e identificar as principais barreiras e facilitadores para essa assistência no país. Com escopo nacional e amostra probabilística em dois estágios (1-hospitais e 2-mulheres), dividida em 59 estratos, foram selecionados 465 hospitais com total planejado de, aproximadamente, 24.255 mulheres, 2.205 por motivo de aborto e 22.050 por motivo de parto. A coleta de dados, realizada por meio de seis instrumentos eletrônicos, ocorre durante a internação hospitalar para o parto ou aborto, com duas ondas de seguimento, aos dois e quatro meses. Com o intuito de expandir o número de casos de morbidade materna grave, mortalidade materna e perinatal, três estudos caso controle foram incorporados ao Nascer no Brasil II. O trabalho de campo foi iniciado em novembro de 2021 com término previsto para 2023. Os resultados permitirão comparar a atenção atual ao parto e ao nascimento com a retratada no primeiro inquérito e, com isso, avaliar os avanços alcançados no decorrer desses 10 anos.

Aunque Brasil ha presentado avances en la atención obstétrica en hospitales públicos y privados, todavía hay puntos débiles que necesitan atención. El Ministerio de Salud, consciente de esta necesidad, financió la segunda versión de la encuesta Nacer en Brasil. Los objetivos generales son: evaluar la atención prenatal, el parto y el nacimiento, el puerperio y el aborto, comparando con los resultados del Nacer en Brasil I, y analizar los principales determinantes de la morbimortalidad perinatal; evaluar la estructura y los procesos de atención de los servicios de obstetricia y neonatología en las maternidades; analizar los conocimientos, prácticas y actitudes de los profesionales de la salud que brindan atención para el parto y el aborto; e identificar las principales barreras y facilitadores para esta atención en el país. Tiene un alcance nacional y muestra probabilística en dos etapas (1-hospitales y 2-mujeres), la cual se dividió en 59 estratos; y se seleccionaron 465 hospitales con un total planificado de aproximadamente 24.255 mujeres, de las cuales 2.205 tuvieron procedimientos por aborto y 22.050 por parto. Para la recolección de datos se aplicó seis instrumentos electrónicos, que se realizó durante la hospitalización por parto o aborto, con dos rondas de seguimiento, a los dos y cuatro meses. Con el fin de ampliar el número de casos de morbilidad materna grave, mortalidad materna y perinatal, se incorporaron tres estudios de casos y controles en Nacer en Brasil II. El trabajo de campo comenzó en noviembre de 2021 y finalizará en 2023. Los resultados nos permitirán evaluar la atención al parto y al nacimiento actual con lo que se retrató en la primera encuesta, de esta manera se podrá evaluar los avances alcanzados a lo largo de estos 10 años.

Challenges to implementing planning processes in Brazilian health regions.

OBJECTIVE: To recognize elements that facilitated or hindered the PlanificaSUS implementation stages. METHODS: A multiple case study was carried out in four pre-selected health regions in Brazil-Belo Jardim (PE), Fronteira Oeste (RS), Sul-Mato-Grossense (MT) and Valença (BA) using systemic arterial hypertension and maternal and child care as tracer conditions. Participant observation (in regional interagency commissions) and in-depth interviews with key informants from state and municipal management and primary health care and specialized outpatient care service professionals within the project were carried out in these four regions. Analysis was built according to political, technical-operational, and contextual dimensions. RESULTS: The political dimension evinced that the regions found the project an opportunity to articulate states and municipalities and an important political bet to build networks and lines of care but that there remained much to be faced in the disputes related to building the Unified Health System (SUS). In the technical operational dimension, it is important to consider that primary health care stimulated a culture of local planning and favored traditional tools to organize and improve it, such as organizing registrations, agendas, and demands. However, centralized training and planning-inducing processes fail to always respond to local needs and can produce barriers to implementation. CONCLUSIONS: It is worth considering the central and regional role of state managers in the commitment related to the project and the effect of mobilizing primary health care and expanding its power. There remains much to be faced in the disputes at stake in bullring SUS.

An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals.

BACKGROUND: Brazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project ("Projeto Parto Adequado"- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication. This research aims to evaluate the implementation of PPA in private hospitals in Brazil. METHOD: Evaluative hospital-based survey, carried out in 2017, in 12 private hospitals, including 4,322 women. We used a Bayesian network strategy to develop a theoretical model for implementation analysis. We estimated and compared the degree of implementation of two major driving components of PPA-"Participation of women" and "Reorganization of care" - among the 12 hospitals and according to type of hospital (belonging to a health insurance company or not). To assess whether the degree of implementation was correlated with the rate of vaginal birth data we used the Bayesian Network and compared the difference between the group "Exposed to the PPA model of care" and the group "Standard of care model". RESULTS: PPA had a low degree of implementation in both components "Reorganization of Care" (0.17 - 0.32) and "Participation of Women" (0.21 - 0.34). The combined implementation score was 0.39-0.64 and was higher in hospitals that belonged to a health insurance company. The vaginal birth rate was higher in hospitals with a higher degree of implementation of PPA. CONCLUSION: The degree of implementation of PPA was low, which reflects the difficulties in changing childbirth care practices. Nevertheless, PPA increased vaginal birth rates in private hospitals with higher implementation scores. PPA is an ongoing quality improvement project and these results demonstrate the need for changes in the involvement of women and the care offered by the provider.

Counts of mesophilic aerobic, mesophilic anaerobic, thermophilic aerobic sporeforming bacteria and persistence of Bacillus cereus spores throughout cocoa powder processing chain.

Sporeforming bacteria are a concern in some food raw materials, such as cocoa powder. Samples (n = 618) were collected on two farms and at several stages during cocoa powder manufacture in three commercial processing lines to determine the impact of each stage on bacterial spore populations. Mesophilic aerobic, mesophilic anaerobic, thermophilic aerobic, and Bacillus cereus spore populations were enumerated in all the samples. Genetic diversity in B. cereus strains (n = 110) isolated from the samples was examined by M13 sequence-based PCR typing, partial sequencing of the panC gene, and the presence/absence of ces and cspA genes. The counts of different groups of sporeforming bacteria varied amongst farms and processing lines. For example, the counts of mesophilic aerobic spore-forming (MAS) populations of cocoa bean fermentation were lower than 1 log spore/g in Farm 1 but higher than 4 log spore/g in Farm 2. B. cereus isolated from cocoa powder was also recovered from cocoa beans, nibs, and samples after roasting, refining, and pressing, which indicated that B. cereus spores persist throughout cocoa processing. Phylogenetic group IV was the most frequent (73%), along with processing. Strains from phylogenetic group III (14 %) did not show the ces gene's presence.

Chemical Profile and Biological Activities Of Piper mikanianum (Kunth) Steud Essential Oil for Development and Improvement of Oral Rinse.

INTRODUCTION: Studies prove that the use of medicinal plants is a custom carried out by man since ancient times, the evolution of the pharmaceutical industry makes more people consume more natural products. Currently, we can observe that mouthwashes containing natural compounds have shown a growth in demand in the markets and in the professional community. OBJECTIVE: The present study aims to carry out the chemical characterization and microbiological potential of Piper mikanianum (Kunth) Steud essential oil (EOPm), providing data that allows the development of a low-cost mouthwash formulation aimed at vulnerable communities. METHODS: The evaluation of the antibacterial activity and modulator of bacterial resistance was performed by the microdilution method to determine the minimum inhibitory concentration (MIC). The chemical components were characterized by gas chromatography coupled to mass spectrometry, identified 28 constituents, in which Safrole Phenylpropanoid is the major compound, representing 72.6 % of the total composition, followed by α-pinene (10.7 %), Limonene (2 %), ß-caryophyllene (2 %), E-nerolidol (1.9 %), spathulenol (1.3 %) and camphene (1.1 %). RESULTS: The EOPm showed a MIC minimum inhibitory concentration≥1024 µg/mL for all bacterial strains used in the tests. When the EOPm modulating activity combined with chlorhexidine, mouthwash, ampicillin, gentamicin and penicillin G was evaluated against bacterial resistance, the oil showed significant synergistic activity, reducing the MIC of the products tested in combination, in percentage between 20.6 % to 98 .4 %. CONCLUSIONS: We recommend the expansion of tests with greater variation of EOPm concentration combinations and the products used in this study, as well as toxicity evaluation and in vivo tests, seeking the development of a possible low-cost mouthwash formulation accessible to the most vulnerable population.

Dental care for persons with disabilities: discretion on the frontline.

OBJECTIVE: To depict the influence of discretionary actions exercised by frontline professionals and organizations on the implementation of diverse modalities of access to specialized dental care within the Care Network for Persons with Disabilities. METHODS: A case study conducted in two Brazilian health regions characterized by distinct means of access to specialized dental care employing documentary analysis and interviews with key stakeholders across the period spanning from July to December 2019. RESULTS: In the referenced access region, there was a notable centrality of Primary Health Care (PHC) in caregiving, wherein planning and assessment were integral components of institutional routines. Where spontaneous demand scheduling was accepted, sporadic exchanges of information were evident between PHC units and specialized facilities. The coordination role in caregiving was not vested in PHC teams, and activities such as planning and assessment were not assimilated into organizational routines. CONCLUSIONS: The implementation of policies for specialized dental care for persons with disabilities relied on the coordination furnished by PHC and the orchestration of planning and assessment endeavors aimed at establishing an integrated care network. This implementation proved subject to the discretionary authority of frontline professionals and organizations, highlighting the significant role of relational and institutional environments in the context of public policy implementation within a decentralized and regionalized healthcare system.

Macronutrient distribution in soil subjected to raw sanitary sewage application by closed-end furrows.

This work aimed to evsaluate the influence of raw sanitary sewage (RS) application in closed-end and level-bottom furrows on the distribution of macronutrients and sodium in the soil along its depth. The applied amount of RS was controlled due to the harmful effect of sodium, with a weekly application over three consecutive years. The experimental design consisted of two experimental plots receiving RS, one with alternating the site of effluent application (alternation of inlet and outlet-TFA) and the other without alternating the site of application (only inlet-TFN); and two experimental plots receiving conventional mineral fertilization, both irrigated with public water supply, where one alternated the site of water application (alternation of inlet and outlet-TWA) and the other without alternating the site of application (only inlet-TWN). The inversion of the flow direction with RS application in the closed-end furrows (TFA) provided a better distribution of nutrients in the soil along its length. There was no significant difference in the levels of macronutrients and sodium between the initial and final regions of the furrow soil. In contrast, the fixed flow direction experimental unit (TFN) exhibit a significant difference between the initial and final levels of total nitrogen, phosphorus, potassium and sodium in the closed furrows with mean concentrations of 265.2, 16.2, 46.7 and 110.0 mg dm-3, respectively.

Worldwide Prevalence of Polypharmacy: A Systematic Review.

INTRODUCTION: The present study has compiled the prevalence of polypharmacy worldwide and assessed the prevalence of polypharmacy in different populations, including community-dwelling individuals, hospitalized patients, and institutionalized patients. METHODS: This systematic review was conducted and reported according to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A systematic search of electronic databases, including PubMed, Web of Science, and Scielo, was performed in March 2021 without any date and language restrictions. Combinations of the following keywords were used for the search strategy: polypharmacy OR multiple medications OR multiple medicines OR multiple drug AND prevalence. Based on the search and inclusion criteria, two hundred and eight studies (73,076,167 individuals) were selected for inclusion in the systematic review. It was observed that there is a wide variation in the prevalence of polypharmacy between studies. RESULTS: The prevalence of polypharmacy was found to be 30.2%, 61.7%, and 56.9% for community-dwelling individuals, hospitalized patients, and institutionalized patients, respectively. CONCLUSION: Based on the analyses, this systematic review has demonstrated a wide variation in the prevalence of polypharmacy between studies and countries and a high prevalence of polypharmacy in institutionalized and hospitalized patients.

Vestibulocochlear Delineation for Vestibular Schwannoma Treated With Radiation Therapy.

Purpose: To develop a specialist-based consensus of cochlear contouring to be used in patients undergoing stereotactic radiosurgery (SRS) treatment for vestibular schwannoma. Methods and Materials: Representative computed tomography (CT) and magnetic resonance imaging (MRI) were used for cochlear contouring. The semicircles, cochlea, vestibule, and internal acoustic meatus were delineated by 7 radiation oncology department physicians and reviewed by neuroradiologists. A total of 12 cases accrued from a single academic institution were studied for a similarity analysis by the Dice coefficient. Results: The suggested guideline is an easily reproductive tool that allows radiation oncologists to accurately contour the vestibulocochlear system to avoid toxicity due to inadequate dosimetry of organs at risk. This could be a useful tool even for non-vestibular schwannoma radiation therapy. The Dice coefficient suggests reproducible results as long as the following contouring recommendations are observed. Conclusions: The template for vestibulocochlear delineation may be useful for an adequate organs at risk definition. Future studies are required to find specific constraints for each segment of the vestibulocochlear system, and to mitigate interobserver variations.

Dynamics of local productive arrangements in the municipalities of Mato Grosso do Sul considering the transformations of the Bioceanic Corridor.

The Bioceanic Corridor is an international land route under implementation, which aims to connect the State of Mato Grosso do Sul, in Brazil, to the ports of Northern Chile. This new route could shorten the transport time between South America and Asia by approximately two weeks. This paper's purpose is to contextualize, map, identify, and analyze the effects of this new logistics network designed by the Bioceanic Route over the Local Productive Arrangements (LPA) in the State of Mato Grosso do Sul. To achieve these goals, a spatial econometric methodology was adopted to determine the State's productive concentration. The results indicate that this route will bring many development opportunities. However, for that to happen, favorable policies are essential and must be developed to facilitate an integration that allows for competitiveness in the State's economic activities. However, mere unplanned integration will potentially only lead to the reinforcement of already existing regional inequalities in the State.

Influence of mode of delivery on satisfaction with hospitalization for childbirth in the study Birth in Brazil.

Controversial results have been reported on the association between mode of delivery and patient satisfaction. This study investigates which mode of delivery leads to greater satisfaction with hospital admission for childbirth. A cohort study was conducted with data from the Birth in Brazil study, which began in 2011. A total of 23,046 postpartum women were included from a random sample of hospitals, selected by conglomerates with a three level stratification. At the first follow-up, 15,582 women were re-interviewed. Mode of delivery, dichotomized into vaginal or cesarean section, and confounders were collected before hospital discharge. The outcome maternal satisfaction, investigated as a 10-item unidimensional construct, was measured by the Hospital Birth Satisfaction Scale up to six months after discharge. We used a directed acyclic graph to define minimal adjustment variables for confounding. The effect of mode of delivery on satisfaction was estimated using a structural equation model with weighting by the inverse of the probability of selection, considering the complex sampling design. The weight was estimated considering the different sample selection probabilities, the losses to follow-up, and the propensity score, which was estimated in a logistic regression model. The analysis revealed no significant difference in satisfaction with hospitalization for childbirth between respondents who had vaginal delivery and cesarean section in the adjusted analysis (standardized coefficient = 0.089; p-value = 0.056). Therefore, women who had vaginal delivery and cesarean section were equally satisfied with their hospitalization for childbirth.

Breastfeeding in the first hour of life in Brazilian private hospitals participating in a quality-of-care improvement project.

BACKGROUND: The Baby-Friendly Hospital Initiative's Step 4 recommends: "support mothers to start breastfeeding as soon as possible after birth", thus contributing to the reduction of neonatal mortality. The objective of this study is to estimate the prevalence of breastfeeding in the first hour of life in private maternity hospitals participating in the "Adequate Childbirth Project", a quality-of-care improvement project, and to analyze determinants of this outcome. METHODS: Secondary analysis of data collected by the cross-sectional evaluative "Healthy Birth Study", conducted in 2017 in 12 maternity hospitals participating in the Adequate Childbirth Project, where 4800 mothers were interviewed, and hospital records were observed. Conditions that prevented breastfeeding at birth, such as maternal HIV-infection and newborns' severe malformations, were excluded. Multiple logistic regression was performed according to a hierarchical theoretical model. RESULTS: The prevalence of breastfeeding in the first hour of life was 58% (CI 95% 56.6-59.5%). Lower maternal education (aOR 0.643; CI 95% 0.528-0.782), lower economic status (aOR 0.687; CI 95% 0.504-0.935), cesarean section delivery (ORa 0.649; CI 95% 0.529-0.797), preterm birth (aOR 0.660; CI 95% 0.460-0.948) and non-rooming-in at birth (aOR 0.669; CI 95% 0.559-0.800) were negatively associated with the outcome. Receiving information during prenatal care about the importance of breastfeeding at birth (aOR 2.585; CI 95% 2.102-3.179), being target of the quality-of-care improvement project (aOR 1.273; CI 95% 1.065-1.522), skin-to-skin contact at birth (aOR 2.127; CI 95% 1.791-2.525) and female newborn (aOR 1.194; CI 95% 1.008-1.415) were factors positively associated with the outcome. CONCLUSIONS: The private maternities participating in the Healthy Birth Study showed a good prevalence of breastfeeding in the first hour of life, according to WHO parameters. Prenatal guidance on breastfeeding at birth, being target of the quality-of-care improvement project and skin-to-skin contact at birth contributed to breastfeeding in the first hour of life.

Influence of mode of delivery on satisfaction with hospitalization for childbirth in the study Birth in Brazil / Influência do tipo de parto na satisfação com a internação para o parto na pesquisa Nascer no Brasil / Influencia del tipo de parto en la satisfacción con la hospitalización para el parto en la encuesta Nacer en Brasil

Controversial results have been reported on the association between mode of delivery and patient satisfaction. This study investigates which mode of delivery leads to greater satisfaction with hospital admission for childbirth. A cohort study was conducted with data from the Birth in Brazil study, which began in 2011. A total of 23,046 postpartum women were included from a random sample of hospitals, selected by conglomerates with a three level stratification. At the first follow-up, 15,582 women were re-interviewed. Mode of delivery, dichotomized into vaginal or cesarean section, and confounders were collected before hospital discharge. The outcome maternal satisfaction, investigated as a 10-item unidimensional construct, was measured by the Hospital Birth Satisfaction Scale up to six months after discharge. We used a directed acyclic graph to define minimal adjustment variables for confounding. The effect of mode of delivery on satisfaction was estimated using a structural equation model with weighting by the inverse of the probability of selection, considering the complex sampling design. The weight was estimated considering the different sample selection probabilities, the losses to follow-up, and the propensity score, which was estimated in a logistic regression model. The analysis revealed no significant difference in satisfaction with hospitalization for childbirth between respondents who had vaginal delivery and cesarean section in the adjusted analysis (standardized coefficient = 0.089; p-value = 0.056). Therefore, women who had vaginal delivery and cesarean section were equally satisfied with their hospitalization for childbirth.

Estudos mostram resultados controversos sobre a associação entre o tipo de parto e a satisfação da paciente. Este estudo investiga qual tipo de parto traz maior satisfação com a internação hospitalar para o parto. Foi realizado um estudo de coorte com dados da pesquisa Nascer no Brasil, iniciada em 2011. Foram incluídas 23.046 puérperas de uma amostra aleatória de hospitais, por conglomerados, com estratificação em três níveis. No primeiro seguimento, 15.582 mulheres foram reentrevistadas. Coletou-se antes da alta hospitalar dados sobre o tipo de parto, dicotomizado em vaginal e cesáreo, e fatores de confusão. O desfecho satisfação materna, avaliado como um construto unidimensional de 10 itens, foi mensurado pela Escala de Satisfação com a Hospitalização para o Parto até seis meses após a alta. As variáveis mínimas de ajuste para confusão foram definidas em um gráfico acíclico direcionado. O efeito do tipo de parto sobre a satisfação foi estimado em um modelo de equação estrutural com ponderação pelo inverso da probabilidade de seleção, considerando o desenho amostral complexo. A ponderação foi estimada considerando as diferentes probabilidades de seleção da amostra, as perdas de seguimento e o escore de propensão. O escore de propensão foi estimado em um modelo de regressão logística. Não houve diferenças na satisfação com a internação para o parto entre as entrevistadas que tiveram partos vaginais e cesáreos na análise ajustada (coeficiente padronizado = 0,089; p = 0,056). As mulheres que tiveram partos vaginais e cesáreos ficaram igualmente satisfeitas com a hospitalização para o parto.

Los estudios muestran resultados controvertidos en cuanto a la asociación entre el tipo de parto y la satisfacción de la paciente. Este estudio investiga qué tipo de parto presenta mayor satisfacción con la hospitalización para el parto. Se realizó un estudio de cohorte con los datos de la encuesta Nacer en Brasil, que había comenzado en 2011. Se incluyeron a 23.046 puérperas de una muestra aleatoria de hospitales, por conglomerados, con estratificación en tres niveles. En el primer seguimiento se volvió a entrevistar a 15.582 mujeres. Los datos sobre el tipo de parto, ya sea por cesárea o vaginal, y los factores de confusión se recogieron antes del alta hospitalaria. El resultado de satisfacción materna, evaluado como un constructo unidimensional de diez ítems, se midió con la Escala de Satisfacción con la Hospitalización por Parto hasta seis meses después del alta. Las variables de ajuste mínimo de confusión se definieron en un gráfico acíclico dirigido. El efecto del tipo de parto sobre la satisfacción se estimó en un modelo de ecuaciones estructurales ponderadas por la inversa de la probabilidad de selección, considerando el diseño de muestreo complejo. La ponderación se estimó con diferentes probabilidades de selección de la muestra, pérdidas de seguimiento y puntuación de propensión. La puntuación de propensión se estimó mediante el modelo de regresión logística. No hubo diferencias en la satisfacción con la hospitalización por parto entre las encuestadas que tuvieron partos vaginales o por cesárea en el análisis ajustado (coeficiente estandarizado = 0,089; p = 0,056). Tanto las mujeres que tuvieron partos vaginales como las que tuvieron por cesárea estaban igualmente satisfechas con su hospitalización por parto.

Percepções de familiares sobre as práticas de intervenção precoce na infância em um centro especializado de reabilitação / Family perceptions about early intervention practices in specialized rehabilitation center

Resumo A intervenção precoce centrada na família tem sido considerada entre os pesquisadores como o atual paradigma para o cuidado à infância. Este artigo tem por objetivo apresentar e discutir percepções de familiares sobre as práticas de intervenção precoce e participação ativa da família, realizadas pela equipe de um Centro Especializado de Reabilitação (CER) no atendimento de crianças com Transtorno do Espectro Autista (TEA). Participaram da pesquisa nove familiares de crianças com TEA, de zero a quatro anos e 11 meses, inseridas no serviço. Foram realizadas entrevistas com os participantes para investigar o conhecimento das famílias e suas expectativas sobre a participação nas intervenções, e após a coleta de dados foi feito a análise temática de conteúdo. A prática da equipe desse serviço não está relacionada exclusivamente a um único modelo de apoio às famílias, com a participação família sendo, em sua maioria, alinhada ao modelo de apoio focado na família. Espera-se que este estudo possa contribuir e fomentar discussões sobre a intervenção precoce, dos modelos de apoio à família, e em especial das crianças com TEA.

Abstract Family-centered early intervention has been considered by researchers as the current paradigm for childcare. This article aims to present and discuss perceptions of family members about early intervention practices and active family participation, carried out by the team of a Specialized Rehabilitation Center (CER) in the care of children with Autistic Spectrum Disorder (ASD). Nine family members of children with ASD, from zero to four years and 11 months, included in the service, participated in the research. Interviews were conducted with the participants to investigate the families' knowledge and their expectations about participating in the interventions, and after data collection, thematic content analysis was performed. The practice of the team at this service is not exclusively related to a single model of support for families, with family participation being, for the most part, aligned with the support model focused on the family. It is hoped that this study can contribute and encourage discussions about early intervention, family support models, and especially children with ASD.

Dental care for persons with disabilities: discretion on the frontline / Assistência odontológica à pessoa com deficiência: discricionariedade na linha de frente

ABSTRACT OBJECTIVE To depict the influence of discretionary actions exercised by frontline professionals and organizations on the implementation of diverse modalities of access to specialized dental care within the Care Network for Persons with Disabilities. METHODS A case study conducted in two Brazilian health regions characterized by distinct means of access to specialized dental care employing documentary analysis and interviews with key stakeholders across the period spanning from July to December 2019. RESULTS In the referenced access region, there was a notable centrality of Primary Health Care (PHC) in caregiving, wherein planning and assessment were integral components of institutional routines. Where spontaneous demand scheduling was accepted, sporadic exchanges of information were evident between PHC units and specialized facilities. The coordination role in caregiving was not vested in PHC teams, and activities such as planning and assessment were not assimilated into organizational routines. CONCLUSIONS The implementation of policies for specialized dental care for persons with disabilities relied on the coordination furnished by PHC and the orchestration of planning and assessment endeavors aimed at establishing an integrated care network. This implementation proved subject to the discretionary authority of frontline professionals and organizations, highlighting the significant role of relational and institutional environments in the context of public policy implementation within a decentralized and regionalized healthcare system.

RESUMO OBJETIVO Descrever a influência da discricionariedade dos profissionais e organizações da linha de frente na implementação de diferentes formas de acesso à assistência odontológica especializada na Rede de Cuidados à Pessoa com Deficiência. MÉTODOS Estudo de caso em duas regiões de saúde brasileiras cujo acesso à assistência odontológica especializada era distinto, com análise documental e entrevista com atores-chave, entre julho e dezembro de 2019. RESULTADOS Na região com acesso referenciado, observou-se que a atenção primária à saúde (APS) tinha centralidade no cuidado e o planejamento/avaliação faziam parte da rotina institucional dos serviços. Na região onde o agendamento era possível por demanda espontânea, notou-se trocas episódicas de informação entre as unidades de APS e as especializadas; o papel de coordenação do cuidado não era um atributo das equipes de APS e as atividades de planejamento/avaliação não estavam incorporadas à rotina das organizações. CONCLUSÕES A implementação da política de assistência odontológica especializada à pessoa com deficiência se mostrou dependente da coordenação da APS e da condução de atividades de planejamento/avaliação voltadas à construção de uma rede de cuidados integrada e sujeita ao poder discricionário dos profissionais e das organizações da linha de frente, sugerindo que o ambiente relacional e institucional possui um papel importante no processo de implementação de políticas públicas em um sistema descentralizado e regionalizado de saúde.

Family Benefits of Early Intervention: A Scoping Review / Benefícios Familiares da Intervenção Precoce: Uma Revisão de Escopo

ABSTRACT Early Intervention (EI) is aimed at children with developmental delays through actions that include families and their context. The objective of this study was to conduct a scoping review based on The Protocols of the Joanna Briggs Institute and PRISMA-Scr, answering the question: How do families of children with special needs understand the benefits (support or assistance received) of Early Intervention Services? 54 articles were found and analyzed, and four different nuclei were organized: EI team, skills, and collaborative practices; Family empowerment and self-efficacy; Participation, personal needs, and Quality of Family Life; Access to information and services. We concluded that family benefits are indicators of the effectiveness of early intervention.

RESUMO A Intervenção Precoce (IP) é destinada à crianças com atrasos no desenvolvimento através de ações que incluam as famílias e seu contexto. O objetivo desse estudo foi realizar uma revisão de escopo a partir dos protocolos do Joannna Briggs Institute e PRISMA-Scr, respondendo à pergunta: Como os familiares de crianças com necessidades especiais compreendem os benefícios (apoio ou assistência recebida) dos serviços de intervenção precoce? Foram encontrados e analisados 54 artigos, sendo organizados quatro diferentes núcleos: Equipe de IP, competências e práticas colaborativas; Empoderamento e autoeficácia familiar; Participação, necessidades pessoais e Qualidade de Vida Familiar; Acesso à informação e aos serviços. Concluiu-se que os benefícios familiares são indicadores de eficácia da intervenção precoce.