Higher-Dose Primaquine to Prevent Relapse of Plasmodium vivax Malaria.

BACKGROUND: In most of the Americas, the recommended treatment to prevent relapse of Plasmodium vivax malaria is primaquine at a total dose of 3.5 mg per kilogram of body weight, despite evidence of only moderate efficacy. METHODS: In this trial conducted in Brazil, we evaluated three primaquine regimens to prevent relapse of P. vivax malaria in children at least 5 years of age and in adults with microscopy-confirmed P. vivax monoinfection. All the patients received directly observed chloroquine for 3 days (total dose, 25 mg per kilogram). Group 1 received a total primaquine dose of 3.5 mg per kilogram (0.5 mg per kilogram per day) over 7 days with unobserved administration; group 2 received the same regimen as group 1 but with observed administration; and group 3 received a total primaquine dose of 7.0 mg per kilogram over 14 days (also 0.5 mg per kilogram per day) with observed administration. We monitored the patients for 168 days. RESULTS: We enrolled 63 patients in group 1, 96 in group 2, and 95 in group 3. The median age of the patients was 22.4 years (range, 5.4 to 79.8). By day 28, three P. vivax recurrences were observed: 2 in group 1 and 1 in group 2. By day 168, a total of 70 recurrences had occurred: 24 in group 1, 34 in group 2, and 12 in group 3. No serious adverse events were noted. On day 168, the percentage of patients without recurrence was 58% (95% confidence interval [CI], 44 to 70) in group 1, 59% (95% CI, 47 to 69) in group 2, and 86% (95% CI, 76 to 92) in group 3. Survival analysis showed a difference in the day 168 recurrence-free percentage of 27 percentage points (97.5% CI, 10 to 44; P<0.001) between group 1 and group 3 and a difference of 27 percentage points (97.5% CI, 12 to 42; P<0.001) between group 2 and group 3. CONCLUSIONS: The administration of primaquine at a total dose of 7.0 mg per kilogram had higher efficacy in preventing relapse of P. vivax malaria than a total dose of 3.5 mg per kilogram through day 168. (Supported by the U.S. Agency for International Development; ClinicalTrials.gov number, NCT03610399.).

The extent of chloroquine underdosing in adult patients with malaria by Plasmodium vivax from an endemic area of the Brazilian Amazon basin.

OBJECTIVES: To evaluate the extent of chloroquine underdosing and to measure the concentrations of chloroquine and desethylchloroquine in adult patients with P. vivax malaria in the Brazilian Amazon basin. METHODS: Prospective study of cases in male adult patients with malaria by Plasmodium vivax treated with a total dose of 1500 mg chloroquine over three days and a short course of primaquine. Patients were weighed at admission, and the dose per mg/kg was determined. Blood samples were collected at 24 and 168 h after enrolment, and the concentrations of chloroquine and desethylchloroquine were measured in plasma by high-performance liquid chromatography with fluorescence detection. RESULTS: Of 61 patients were included in the study, and 60% received a total dose of chloroquine below 25 mg/kg. Plasma chloroquine concentrations ranged from 90 to 184 ng/ml and from 175 to 827 ng/ml at 24 and 168 hours. For desethylchloroquine, the values ranged from 32 to 144 ng/ml and from 90 to 440 ng/ml at 24 and 168 h. There were no significant correlations between the plasma levels of chloroquine and the doses administered (mg/kg) at 24 and 196 h. Similar results were found for desethylchloroquine. CONCLUSION: There is widespread suboptimal dosing of chloroquine that is probably due to the dosing regimen based on patient age, which reduces the drug exposure with a possible influence on parasite clearance.

OBJECTIFS: Evaluer l'impact du sous-dosage de la chloroquine et mesurer les concentrations de chloroquine et de déséthylchloroquine chez les patients adultes atteints de paludisme à P. vivax dans le bassin de l'Amazonie brésilienne. MÉTHODES: Nous avons mené une étude prospective de cas chez des patients adultes de sexe masculin atteints de paludisme par Plasmodium vivax traités avec une dose totale de 1500 mg de chloroquine sur trois jours et une courte cure de primaquine. Les patients ont été pondérés à l'admission et la dose par mg/kg a été déterminée. Des échantillons de sang ont été prélevés 24 et 168 heures après l'enrôlement dans l'étude, et les concentrations de chloroquine et de déséthylchloroquine ont été mesurées dans le plasma par chromatographie liquide à haute performance avec détection par fluorescence. RÉSULTATS: Un total de 61 patients a été inclu dans l'étude et 60% ont reçu une dose totale de chloroquine en dessous de 25 mg/kg. Les concentrations plasmatiques de chloroquine variaient de 90 à 184 ng/ml et de 175 à 827 ng/ml à 24 et 168 heures. Pour la déséthylchloroquine, les valeurs variaient de 32 à 144 ng/ml et de 90 à 440 ng/ml à 24 et à 168 heures. Il n'y avait pas de corrélation significative entre les taux plasmatiques de chloroquine et les doses administrées (mg/kg) à 24 et à 168 heures. Des résultats similaires ont été trouvés pour la déséthylchloroquine. CONCLUSION: Il existe un dosage sous-optimal répandu de chloroquine qui est probablement dû au schéma posologique basé sur l'âge du patient, ce qui réduit l'exposition au médicament avec une influence possible sur la clairance des parasites.

Doses of chloroquine in the treatment of malaria by Plasmodium vivax in patients between 2 and 14 years of age from the Brazilian Amazon basin.

BACKGROUND: A total dose of chloroquine of 25 mg/kg is recommended by the World Health Organization (WHO) to treat malaria by Plasmodium vivax. In several endemic areas, including the Brazilian Amazon basin, anti-malarial drugs are dispensed in small plastic bags at a dosing regimen based on age. This practice can lead to suboptimal dosing of the drug, which can impact treatment outcomes. The aim of the present study was to estimate the extent of sub-dosing of chloroquine in children and adolescents with vivax malaria using an age-based dose regimen, in addition to investigating the influence of age on the plasma concentrations of chloroquine and desethylchloroquine. METHODS: A study of cases was conducted with male patients with a confirmed infection by P. vivax, ages 2 to 14 years, using a combined regimen of chloroquine and primaquine. Height, weight and body surface area were determined at admission on the study. The total dose of chloroquine administered was estimated based on the weight and on the body surface area of the study patients. Chloroquine and desethylchloroquine were measured on Day 7 in each patient included in the study by a high-performance liquid chromatographic method with fluorescence detection. RESULTS: A total of 81 patients were enrolled and completed the study. The median age was 9 years (2-14 years). All patients presented negative blood smears at 42 days follow-up. The total dose of chloroquine ranged from 13.1 to 38.1 mg/kg. The percentage of patients with a total dose of the drug below 25 mg/kg ranged from 29.4 to 63.6%. The total dose of chloroquine administered based on BSA ranged from 387 to 1079 mg/m2, increasing with age. Plasma chloroquine concentrations ranged from 107 to 420 ng/ml, increasing with age. For desethylchloroquine, the plasma concentrations ranged from 167 to 390 ng/ml, with similar values among age-groups. CONCLUSION: The data demonstrated the widespread exposure of children and adolescents to suboptimal doses of chloroquine in the endemic area investigated.

Metal-Free Insertion Reactions of Diazo Carbonyls to Azlactones.

Insertion reactions of diazo carbonyls to azlactones in basic conditions have been performed. The developed method allows the preparation of a wide range of oxazole derivatives in yields ranging from 74 to 98%. Different substituents on both azlactone rings and diazo carbonyls do not compromise the methodology, even those containing stereogenic centers. Isotopic labeling experiments revealed the mechanism may proceed through a rare diazo carbonyl activation by an ammonium salt derivative.

Permanent education actions of nurse facilitators at a nursing education centre. / Ações de educação permanente dos enfermeiros facilitadores de um núcleo de educação em enfermagem.

OBJECTIVE: To identify actions of nurse facilitators of a permanent healthcare education centre of a teaching hospital. METHODS: A single case study with a qualitative approach conducted with eight nurses from a hospital in the state of Rio Grande do Sul, Brazil. The data were generated through document analysis, systematic observation, and a focus group from April to September 2013. RESULTS: The study produced the following categories: powerful strategies to promote permanent healthcare education actions from facilitating nurses and limitations for the development of these actions. CONCLUSIONS: The establishment of a permanent nursing education centre can trigger the Permanent education actions of nurses in teaching hospitals.

Effect of chronic administration of the vinyl chalcogenide 3-methyl-1-phenyl-2-(phenylseleno)oct-2-en-1-one on oxidative stress in different brain areas of rats.

Selenium (Se) is an essential mineral for mammals. It is a nutrient related to the complex metabolic and enzymatic functions. Although Se has important physiological functions in the cells, organic compounds of Se can be extremely toxic, and may affect the central nervous system. This study aims to investigate the effect of the chronic treatment with the vinyl chalcogenide 3-methyl-1-phenyl-2-(phenylseleno)oct-2-en-1-one on some parameters of oxidative stress in the brain of rats. Animals received the vinyl chalcogenide (125, 250 or 500 µg/kg body weight) intraperitoneally once a day during 30 days. The cerebral cortex, the hippocampus, and the cerebellum were dissected and homogenized in KCl. Afterward, thiobarbituric acid reactive substances (TBARS), carbonyl, sulfhydryl, catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities were measured in the brain. Results showed that the organoselenium enhanced TBARS in the cerebral cortex of rats but the compound was not able to change carbonyl levels. Furthermore, the organoselenium reduced thiol groups measured by the sulfhydryl assay in all tissues studied. The activity of the antioxidant enzyme CAT was increased by the organochalcogen in the cerebral cortex and in the cerebellum, and the activity of SOD was increased in the hippocampus. On the other hand, the activity of the antioxidant enzyme GPx was reduced in all brain structures. Our findings indicate that this organoselenium compound induces oxidative stress in different brain regions of rats, corroborating to the fact that this tissue is a potential target for organochalcogen action.

Synopsis of the genus Pseudocriopsis (Insecta: Coleoptera: Cerambycidae).

A synopsis of the flat-faced longhorned beetle genus Pseudocriopsis Melzer, 1931 is presented. Pseudocriopsis abare sp. nov. is described from Rio de Janeiro, Brazil. Pseudocriopsis arthuri Audureau, 2017 is transferred to Leptostylus LeConte, 1852, as Leptostylus arthuri comb. nov.

Absence of gender influence on the pharmacokinetics of chloroquine combined with primaquine in malaria vivax patients.

Chloroquine is the first-line therapy against the asexual stages of Plasmodium vivax . There is a high variation of chloroquine plasma levels after therapeutic doses, which can lead to inadequate exposure to the drug. The gender influence was low regarding the disposition of the drug, which is relevant as there are significant physiological variations between male and female patients. The objective of the study was to investigate whether gender modifies the pharmacokinetics parameters of chloroquine in patients with malaria vivax. A prospective study was performed in male and female adult patients using chloroquine (total dose of 25 mg/kg for three days) combined with primaquine. Serial blood samples were collected at admission and up to 672 h post-administration of the drugs. Chloroquine was measured in plasma samples by high-performance liquid chromatography with fluorescence detection. A non-compartmental analysis was used for modeling the data. A total of 26 male and 25 female patients were enrolled in the study. The pharmacokinetic parameters of chloroquine were similar between male and female patients: a half-life of 9.5 days and 10.2 days, maximum concentration (Cmax) of 1295 ng/ml and 1220 ng/ml, area-under-the-curve (AUC 0-28) of 241 µg/mL h and 237 µg/mL h, observed clearance (CL/f) of 5.8 and 5.5 L/h and the volume of distribution (V/f) of 1869 L and 1936 L. The study results suggest that a similar dose regimen of chloroquine combined with primaquine provides a comparable pattern of exposure in male and female patients.

Relationships between substance use, anxiety, depression and stress by public university workers.

OBJECTIVE: To evaluate the relationship between psychoactive substance use, anxiety, depression and stress by workers at a Brazilian public university. METHODS: This is a cross-sectional study with a quantitative approach, carried out with 345 workers from a public higher education institution, located in a city in the interior of the state of Rio Grande do Sul, Brazil. RESULTS: Professionals with an average age of 38.9 years, 187 (54.2%) were women, 163 (47.2%) were single, 186 (53.9%) professed the Catholic religion, 223 (64.8%) had graduate school education. Of the workers, 122 (35.4%) considered their work to be stressful. The use of alcohol in the binge pattern (monthly) and heavy episodic drinking (weekly) were higher among workers with higher levels of anxiety, depression and stress. CONCLUSION: The use of alcohol in its different forms, stress, depression and anxiety show particularities that must be evaluated and recognized among the worker's health problems.

Doses of primaquine administered to children with Plasmodium vivax according to an age-based dose regimen.

Primaquine is still the first-line drug to eliminate hypnozoites of Plasmodium vivax. The therapeutic efficacy is related to the total dose administered. In several endemic areas, the drug is administered for children in an age-based regimen, which can lead to inadequate exposure, increasing the rates of recurrence of the infection. The present study aims to describe the mg/kg total dose of primaquine administered to children for treatment for vivax malaria when an age-based regimen is used and to measure the plasma concentrations of primaquine and carboxyprimaquine. A total of 85 children were included in the study. The total dose of primaquine administered based on mg/kg had a median value of 3.22 mg/kg. The percentage of patients with a total dose below the required dose of 3.5 mg/kg was 55.75%. The median primaquine maximum concentration was 94 ng/ml. For carboxy-primaquine, the median maximum concentration was 375 ng/ml. The results suggest that age-based dosing regimens likely lead to substantial under-dosing of primaquine, which is evident in the youngest children and is reflected in decreased levels of primaquine and carboxy-primaquine in plasma samples 13.

Transcultural adaptation of the Competency Evaluation Questionnaire - Brazilian version. / Adaptação transcultural do Competency Evaluation Questionnaire - versão brasileira.

OBJECTIVE: Describe the process of translation and adaptation to Brazilian culture of the Competency Evaluation Questionnaire for hospital nurses. METHOD: Methodological study of translation and cross-cultural adaptation, including the steps translation of the original instrument into Portuguese, consensual evaluation of translated versions, back - translation, validation by judges and pilot with 29 hospital nurses. RESULTS: They presented the stages of process of cross-cultural adaptation of the instrument, with adjustments proposed by a Judges Committee, composed of 27 items distributed in five domains of competencies for hospital nurses. The instrument adapted to Portuguese presented semantic, idiomatic, experimental and conceptual equivalence with the original, and the total value of the Cronbach Alpha 0.932, in addition to the relative validation. CONCLUSIONS: The Competency Evaluation Questionnaire has been shown to be a reliable instrument that can be used but does not exclude the need for future statistical tests aiming at psychometric validity.

Tecnologias da informação e comunicação: educação em saúde e educação permanente voltadas à COVID-19 / Information and comunication technologies: health education and permanent education focused on COVID-19 / Tecnologías de la información y de la comunicación: educación en salud y educación permanente dirigidas a la COVID-19

Objetivo: relatar a experiência de um Programa de Extensão no desenvolvimento de ações de Educação em Saúde e de Educação Permanente em Saúde voltadas à COVID-19, utilizando Tecnologias da Informação e Comunicação. Método: relato de experiência de docentes, discentes de graduação e de pós-graduação acerca do desenvolvimento de um Programa de Extensão de uma Instituição de Ensino Superior pública localizada no Rio Grande do Sul. Resultados: foram produzidos e compartilhados nas plataformas digitais seis Produtos Técnicos e Tecnológicos Audiovisuais, sendo que quatro deles abordaram medidas e orientações de educação em saúde, e dois orientações para a Rede de Atenção Primária à Saúde de diferentes municípios. Considerações finais: o programa possibilitou articular ensino, pesquisa e extensão, contribuindo para a difusão do conhecimento como veículo de transformação social frente à pandemia de COVID-19 (AU).

Objective: to report the experience of an Extension Program in the development of Health Education and Permanent Health Education actions aimed at COVID-19, using Information and Communication Technologies. Method: experience report of professors, undergraduate and graduate students about the development of an Extension Program of a public Higher Education Institution located in Rio Grande do Sul. Results: Six Technical and Technological Audiovisual Products were produced and shared on digital platforms, four of which addressed measures and guidelines for health education, and two guidelines for the Primary Health Care Network in different municipalities. Furthermore, two infographics were designed and implemented for professionals in the Primary Health Care Units of Santa Maria. Conclusion: The program made it possible to articulate teaching, research and extension, contributing to the dissemination of knowledge as a vehicle for social transformation in the face of the COVID-19 pandemic (AU).

Objetivo: reportar la experiencia de un Programa de Extensión en el desarrollo de acciones de Educación para la Salud y de Educación Permanente en Salud dirigidas al COVID-19, utilizando Tecnologías de la Información y de la Comunicación. Método: relato de experiencia de profesores, estudiantes de pregrado y posgrado sobre el desarrollo de un Programa de Extensión de una Institución de Educación Superior pública ubicada en Rio Grande do Sul. Resultados: se produjeron y compartieron seis Productos Audiovisuales Técnicos y Tecnológicos en plataformas digitales, cuatro de los cuales abordaron medidas y lineamientos para la educación en salud, y dos lineamientos para la Red de Atención Primaria de Salud en diferentes municipios. Además, se diseñaron e implementaron dos infografías para profesionales de las Unidades de Atención Primaria de Salud de Santa María. Consideraciones finales: El programa permitió articular la docencia, la investigación y la extensión, contribuyendo a la difusión del conocimiento como vehículo de transformación social frente a la pandemia de COVID-19 (AU).

Estado funcional e fatores associados em pessoas idosas residentes na ilha de Fernando de Noronha: um estudo seccional / Functional status and associated factors in older persons living on the island of Fernando de Noronha: a cross-sectional study

Resumo Objetivo Analisar o perfil do estado funcional e os fatores associados em pessoas idosas residentes na Ilha de Fernando de Noronha/Pernambuco, Brasil. Método Tratou-se de um estudo seccional, de caráter analítico, e a coleta de dados foi conduzida entre agosto e outubro de 2019. A população do estudo compreendeu 176 pessoas idosas residentes na ilha. O protocolo de coleta foi aplicado por meio de entrevista para resposta ao questionário de variáveis demográficas, sociais, clínicas e ambientais, e aos instrumentos de avaliação. O estado funcional foi determinado a partir da Análise de Classes Latentes, avaliada pelos protocolos dos domínios: cognição, humor, atividades instrumentais de vida diária, mobilidade e comunicação. Resultados O modelo da análise escolhido possuiu duas classes, nomeadas como: "Boa autonomia e independência" e "Moderada autonomia e dependência parcial". A maioria das pessoas idosas apresentou bom estado funcional e os fatores associados foram: pertencer ao sexo masculino, ser separado ou divorciado, viver sozinho, visitar os amigos ou parentes, ter trabalhado mais de 36 anos, ser alfabetizado, não ter deficiência visual ou auditiva, fazer uso de uma ou duas medicações e ter história de queda. Conclusão O estado funcional das pessoas idosas insulares se apresentou como um fenômeno multifatorial, pois fatores demográficos, sociais e clínicos estiveram associados de forma independente à boa funcionalidade. É importante que a manutenção do estado funcional seja incentivada na implementação de políticas públicas voltadas às especificidades das populações residentes em ilhas.

Abstract Objective To analyze the functional status profile and associated factors in older persons living on Fernando de Noronha Island/Pernambuco, Brazil. Method This was a cross-sectional, analytical study, and data collection was conducted between August and October 2019. The study population comprised 176 older persons living on the island. The collection protocol was applied through an interview to respond to the behavior of demographic, social, clinical and environmental variables, and to the assessment instruments. The functional status was determined from the Analysis of Latent Classes, evaluated by the protocols of the domains: cognition, mood, instrumental activities of daily living, mobility and communication. Results The chosen analysis model had two classes, named as: "Good autonomy and independence" and "Moderate autonomy and partial dependence". Most older persons had good functional status and the associated factors were: being male, being separated or divorced, living alone, visiting friends or relatives, having worked more than 36 years, being literate, not having a visual or hearing impairment, taking one or two medications and having a history of falls. Conclusion The functional status of island older persons was presented as a multifactorial phenomenon, as demographic, social and clinical factors remained independently associated with good functionality. It is important that the maintenance of the functional state is encouraged in the implementation of public policies aimed at the specificities of populations residing on islands.

Sonhos e utopias para a Rede de Atenção Psicossocial: perspectivas de trabalhadores* / Sueños y utopías para la Red de Atención Psicosocial: perspectivas de trabajadores / Dreams and utopias for the Psychosocial Care Network: perspectives of workers

Objetivo: identificar os sonhos dos trabalhadores sobre como poderia ser o futuro do trabalho na Rede de Atenção Psicossocial (RAPS). Método: pesquisa apreciativa, qualitativa, com abordagem participativa, orientada pelo Ciclo Descoberta, Sonho, Planejamento e Destino, articulada ao referencial teórico de Paulo Freire. Participaram 13 trabalhadores da RAPS de Santa Maria, Rio Grande do Sul, Brasil. A produção dos dados ocorreu de dezembro de 2019 a julho de 2020, com entrevistas semiestruturadas e grupos de discussão gravados. A análise dos dados foi realizada por meio da codificação, categorização e identificação de temas. Resultados: os trabalhadores sonham com uma Rede com recursos humanos e estruturais suficientes; fluxo assistencial definido coletivamente; aproximação com a gestão; trabalho no território; trabalhadores comprometidos, valorização e atenção à sua saúde mental. Conclusão: os sonhos convergiram com o que já é preconizado nas políticas públicas, mas requerem um coletivo organizado e comprometido, que lute pelas mudanças.

Objective: to identify the dreams of workers about how the future of work in the Psychosocial Care Network (RAPS - Rede de Atenção Psicossocial) could be. Method: appreciative, qualitative research, with a participatory approach, guided by the Discovery, Dream, Planning and Destination Cycle, articulated to the theoretical framework of Paulo Freire. Thirteen RAPS workers from Santa Maria, Rio Grande do Sul, Brazil participated. Data were produced from December 2019 to July 2020, with semi-structured interviews and recorded discussion groups. Data analysis was performed through coding, categorization and identification of themes. Results: workers dream of a network with sufficient human and structural resources; care flow defined collectively; approach to management; work in the territory; committed workers, appreciation and attention to their mental health. Conclusion: dreams converged with what is already advocated in public policies, but require an organized and committed collective that fights for change.

Objetivo: identificar los sueños de los trabajadores sobre cómo podría ser el futuro del trabajo en la Red de Atención Psicosocial (RAPS). Método: investigación apreciativa, cualitativa, con abordaje participativo, orientada por el Ciclo Descubrimiento, Sueño, Planificación y Destino, articulada al referencial teórico de Paulo Freire. Participaron 13 trabajadores de la RAPS de Santa Maria, Rio Grande do Sul, Brasil. La producción de los datos tuvo lugar de diciembre de 2019 a julio de 2020, con entrevistas semiestructuradas y grupos de discusión grabados. El análisis de los datos fue realizado por medio de la codificación, categorización e identificación de temas. Resultados: los trabajadores sueñan con una Red con recursos humanos y estructurales suficientes; flujo asistencial definido colectivamente; aproximación con la gestión; trabajo en el territorio; trabajadores comprometidos, valorización y atención a su salud mental. Conclusión: los sueños convergieron con lo que ya es preconizado en las políticas públicas, pero requieren un colectivo organizado y comprometido, que luche por los cambios.

Care actions for family members of users of psychoactive substances: intentions/expectations.

OBJECTIVE: to understand the professionals' intentions and family members' expectations about care actions developed to the relatives of users of psychoactive substances. METHOD: a social phenomenology approach according to Alfred Schütz, performed in a Psychosocial Care Center for Alcohol and Drugs. Interviews were performed with 13 professionals and 12 family members. RESULTS: there is a reciprocity of perspectives between the professionals' intentions and the relatives' expectations, described by the effectiveness of the treatment of the user (typical of the action of both). The family members seek for care actions, expecting to improve the user's treatment. FINAL CONSIDERATIONS: the findings provide reflections for professionals about the health care actions and the organization of the service for the family's mental health.

Capacidade funcional e fatores associados em idosos insulares: uma revisão sistemática da literatura / Functional capacity and associated factors in island elderly: a systematic review of the literature

Objetivo: o objetivo foi realizar uma revisão sistemática da literatura sobre a capacidade funcional e os fatores associados de idosos residentes em ilhas. Estratégia de pesquisa: a busca ocorreu pela combinação dos descritores "comunicação", "senso de humor e humor como assunto", "atividades cotidianas", "limitação da mobilidade", "autonomia pessoal", "cognição", "ilhas", "idoso" e "idoso de 80 anos ou mais" e dos correspondentes na língua inglesa, nas bases de dados: PubMed, Scopus, Web of Science e Lilacs. Resultados: dos 4761 artigos encontrados, 20 foram selecionados. Fatores individuais, clínicos e os relacionados ao estilo de vida foram identificados. Conclusão: a capacidade funcional de idosos é um fenômeno multifatorial. Poucos artigos são realizados em ilhas e a abordagem do contexto espacial, ambiental dos indivíduos idosos é escassa. Mais estudos com foco nos aspectos ambientais devem ser realizados em ilhas, principalmente nas pequenas em extensão, remotas e com pequenas populações.(AU)

Objective: The objective was to conduct a systematic review of the literature on the functional capacity and associated factors of elderly people living on islands. Research strategy: The search took place by combining the descriptors "communication", "sense of humor and humor as a subject", "daily activities", "limited mobility", "personal autonomy", "cognition", "islands", "elderly" and "elderly aged 80 years or more" and correspondents in the English language, in the databases: PubMed, Scopus, Web of Science and Lilacs. Results: Of the 4761 articles found, 20 were selected. Individual, clinical and lifestyle factors were identified. Conclusion: The functional capacity of the elderly is a multifactorial phenomenon. Few articles are conducted on islands, and the spatial and environmental context of elderly individuals is scarce. More studies focusing on environmental aspects should be carried out on islands, mainly in small ones, remote and with small populations.(AU)

Levels of primaquine and carboxyprimaquine in patients with malaria vivax from the Brazilian Amazon basin.

In the last two years, a substantial increase in the number of malaria vivax cases has occurred in the Brazilian Amazon basin. The adequate exposure of hypnozoites to primaquine is a matter of interest as these dormant forms are responsible for the maintenance or even the increase of malaria burden in endemic areas. The aim of this study was to estimate the levels of primaquine and carboxyprimaquine in whole blood samples of patients with P. vivax treated with chloroquine and an abbreviated regimen of primaquine (0.5 mg/kg/d for 7 days), with adequate clinical and parasitological outcomes after 180 days of follow-up. A total of 40 male patients met the criteria for inclusion in the study. Primaquine and carboxyprimaquine were measured by high-performance liquid chromatography. The levels of primaquine in whole blood samples ranged from 40-238 ng/mL, 42-196 ng/mL and 42-150 ng/mL on days 1, 3 and 7. The levels of carboxyprimaquine in whole blood samples ranged from 87-234 ng/mL, 96-252 ng/mL and 74-448 ng/mL on days 1, 3 and 7. These data provide a reliable estimation of exposure of the infecting parasite to primaquine. Based on the regional pattern of relapse, the estimated blood levels of primaquine can be considered effective against hypnozoites of the local circulating strains of P. vivax.

[Food consumption and anthropometry related to the frailty syndrome in low-income community-living elderly in a large city]. / Consumo alimentar e antropometria relacionados à síndrome de fragilidade em idosos residentes em comunidade de baixa renda de um grande centro urbano.

The aim of this study was to describe anthropometric and food intake data related to the frailty syndrome in the elderly. This was a cross-sectional study in individuals ≥ 60 years of age in a household survey in the Manguinhos neighborhood of Rio de Janeiro, Brazil (n = 137). Frailty syndrome was diagnosed according to Fried et al., anthropometric measures were taken, and a food frequency questionnaire was applied and the results compared to Brazilian Ministry of Health guidelines. In the pre-frail and frail groups, body mass index and measures of central adiposity showed higher levels, while lean muscle parameters showed lower values, proportional to the syndrome's gradation. Frail elderly consumed higher amounts of grains and lower amounts of beans and fruit; pre-frail elderly consumed more vegetables, dairy products, and high-sugar and high-fat foods; the two groups consumed similar amounts of meat. Thus, diagnosis of the syndrome, anthropometric evaluation, and dietary assessment should be included in health policies for the elderly, since they assist in early identification of risk and favor interventions for disease prevention and health and nutritional promotion.

Use of psychoactive substances and mental health in university students during the covid-19 pandemic / Consumo de sustancias psicoactivas y salud mental de los estudiantes universitarios durante la pandemia de covid-19 / Uso de substâncias psicoativas e saúde mental de estudantes universitários durante a pandemia da covid-19

ABSTRACT Objective: to measure the level of psychoactive substance dependence of healthcare students from a public federal university and to verify relationships with mental health during the COVID-19 pandemic. Method: a cross-sectional study with a quantitative approach carried out with 527 students from seven undergraduate courses in the health area at a federal public university in the Brazilian South region. Collection was carried out virtually by means of a questionnaire for sociodemographic and academic characterization, the Alcohol, Smoking and Substance Involvement Screening Test and the Mental Health Inventory. Descriptive and inferential statistics was used for data analysis. Results: during the COVID-19 pandemic, most of the students presented occasional and suggestive of abuse consumption of tobacco products, alcoholic beverages, marijuana and hypnotics/sedatives. The lowest mean mental health scores corresponded to the students who had their addiction level classified as suggestive of abuse, and the highest mean scores were found in those who did not use these substances during the pandemic (no consumption/pandemic). Conclusion: given that higher mean scores point to better mental health, it can be inferred that worse mental health is associated with higher psychoactive substance consumption.

RESUMEN Objetivo: medir el nivel de dependencia de sustancias psicoactivas entre estudiantes de salud de una Universidad Pública Federal y verificar las relaciones con la salud mental durante la pandemia de COVID-19. Método: Estudio transversal con enfoque cuantitativo realizado con 527 alumnos de siete cursos de pregrado del área de salud de una Universidad Pública Federal del sur de Brasil. La recogida se realizó de forma virtual a través de un cuestionario de caracterización sociodemográfica y académica, el Test de Detección de Consumo de Alcohol, Tabaco y Sustancias, y el Inventario de Salud Mental. Para el análisis de los datos se utilizaron estadísticas descriptivas e inferenciales. Resultados: la mayoría de los estudiantes durante la pandemia de COVID-19 tenían un consumo ocasional y sugestivo de productos de tabaco, bebidas alcohólicas, marihuana e hipnóticos/sedantes. Las puntuaciones medias de salud mental más bajas fueron las de los estudiantes cuyo nivel de dependencia se clasificó como sugestivo de abuso, y las puntuaciones más altas las de aquellos que no consumieron durante la pandemia (sin consumo/pandemia). Conclusión: teniendo en cuenta que las medias más altas apuntan a una mejor salud mental, se puede deducir que una peor salud mental está asociada a un mayor consumo de sustancias psicoactivas.

RESUMO Objetivo: mensurar o nível de dependência de substâncias psicoativas dos estudantes da área da saúde de uma universidade pública federal e verificar relações com a saúde mental durante a pandemia da COVID-19. Método: estudo transversal com abordagem quantitativa realizado com 527 estudantes de sete cursos de graduação da área da saúde de uma universidade pública federal da região Sul do Brasil. A coleta foi realizada de forma virtual por meio de um questionário de caracterização sociodemográfica e acadêmica, o Alcohol, Smoking and Substance Involvement Screening Test e o Mental Health Inventory. Para análise dos dados, foi utilizada a estatística descritiva e inferencial. Resultados: a maioria dos estudantes, durante a pandemia da COVID-19, apresentou uso ocasional e sugestivo de abuso para derivados do tabaco, bebidas alcoólicas, maconha e hipnóticos/sedativos. As menores médias de saúde mental foram dos estudantes que tiveram seu nível de dependência classificado como sugestivo de abuso, e as maiores médias foram dos que não fizeram uso dessas substâncias durante a pandemia (sem uso/pandemia). Conclusão: tendo em vista que médias mais elevadas apontam para uma melhor saúde mental, pode-se inferir que uma pior saúde mental está associada ao maior uso de substâncias psicoativas.

Protocolos de Enfermagem no município de Jaraguá do Sul/SC: estratégia transformadora para atenção primária / Nursing protocols in the municipality of jaraguá do sul/sc: transforming strategy for primary care / Protocolos de enfermería en el municipio de jaraguá do sul / sc: estratégia transformadora para la atención primaria

Objetivo: relatar a implantação e os impactos advindos dos Protocolos de Enfermagem no contexto da Atenção Primária à Saúde do município de Jaraguá do Sul, Santa Catarina,. Método: Trata de um estudo descritivo do tipo relato de experiência. Resultados: O Fluxo de implantação foi desenvolvido com a instituição de uma Comissão de Implantação, Monitoramento e Avaliação dos Protocolos. Após a ampla divulgação, sensibilização e publicitação para a população do município, iniciou-se a implantação nas Unidades Básicas de Saúde, gerando impacto direto nos 12.765 pacientes que aguardavam a primeira consulta médica. Com a implantação dos protocolos, em um mês, houve redução de 74,71% (9.538 pacientes) e em sete meses, houve o resultado prospectado de zerar as filas de primeira consulta da Atenção Primária. Considerações Finais: a implementação dos Protocolos de Enfermagem, propicia mais segurança para a atuação dos enfermeiros da rede municipal e reduz a fila de espera na Atenção Primária. A consulta de Enfermagem e a prescrição de exames e medicamentos essenciais para a população, bem como o processo de acolhimento nas unidades de saúde, foram incorporados na rotina de trabalho dos enfermeiros, proporcionando maior resolutividade das demandas de saúde. (AU)

Objective: To report the implementation and impacts arising from the Nursing Protocols in the context of Primary Health Care in the municipality of Jaraguá do Sul, Santa Catarina. Methods: This is a descriptive study of the experience report type. Results: The Implementation Flow was developed with the institution of a Protocol Implementation, Monitoring and Evaluation Committee. After wide dissemination, awareness and publicity for the population of the city, the implementation of Basic Health Units began, generating a direct impact on the 12,765 patients who were waiting for their first medical appointment. With the implementation of the protocols, in one month, there was a reduction of 74.71% (9,538 patients) and in seven months, there was the prospected result of clearing the queues for the first consultation in Primary Care. Conclusion: The implementation of Nursing Protocols provides more security for the work of nurses in the municipal network and reduces the waiting list in Primary Care. Nursing consultation and the prescription of tests and essential medications for the population, as well as the reception process in health units, were incorporated into the nurses' work routine, providing greater resolution of health demands. (AU)

Objetivo: Reportar la implementación e impactos derivados de los Protocolos de Enfermería en el contexto de la Atención Primaria de Salud en el municipio de Jaraguá do Sul, Santa Catarina. Métodos: Se trata de un estudio descriptivo del tipo relato de experiencia. Resultados: El Flujo de Implementación fue desarrollado con la institución de una Comisión de Implementación, Monitoreo y Evaluación del Protocolo. Luego de una amplia difusión, sensibilización y publicidad para la población de la ciudad, se inició la implementación de Unidades Básicas de Salud, generando un impacto directo en los 12.765 pacientes que esperaban su primera cita médica. Con la implementación de los protocolos, en un mes hubo una reducción del 74,71% (9.538 pacientes) y en siete meses, se logró el resultado esperado de despejar las colas para la primera consulta en Atención Primaria. Conclusion: La implementación de Protocolos de Enfermería brinda mayor seguridad para el trabajo de los enfermeros en la red municipal y reduce la lista de espera en Atención Primaria. La consulta de enfermería y la prescripción de pruebas y medicamentos esenciales para la población, así como el proceso de recepción en las unidades de salud, se incorporaron a la rutina de trabajo de las enfermeras, brindando una mayor resolución de las demandas de salud. (AU)