Clinical Implications of Over- and Under-Triage Using Need for Trauma Intervention and Cribari Indices.

BACKGROUND: Need for Trauma Intervention (NFTI) score was proposed to help identify injured trauma patients while minimizing under (UT) and over triage (OT). Using a national database, we aimed to describe UT and OT of NFTI vs standard Cribari method (CM) and hypothesized triage sensitivity remains poor. METHODS: The 2021 Trauma Quality Improvement Program (TQIP) database was queried. Demographics, mechanism, verification level, interfacility transfer (IF), and level of activation were collected. Patients were stratified by both NFTI [+ vs -] and CM [Injury severity score (ISS) < 15 vs > 15]. UT was defined as NFTI + or ISS >15 without full trauma activation. RESULTS: 1,030,526 patients were identified in TQIP. 84,969 were UT and 97,262 were OT using NFTI while 94,020 were UT and 108,823 were OT using CM. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NFTI is 49%, 89%, 45%, and 90%, respectively vs 43%, 87%, 39%, and 89% of CM, respectively. Age was higher in the UT group using both scores (52 vs 42, P < .0001 and 54 vs 42, P < .0001, respectively). Using MLR, level 2 and 3 verification, blunt mechanism, female, IF, and older age were associated with UT in both NFTI and CM. Level 1 verification, penetrating mechanism, male, no IF, and younger age were associated with OT. CONCLUSIONS: Current prehospital triage criteria have poor sensitivity for identifying severely injured trauma patients by both NFTI and CM. UT increases as age of the patient increases. Further studies are needed to improve triage.

Inhalation Injury, Respiratory Failure, and Ventilator Support in Acute Burn Care.

Sustaining an inhalation injury increases the risk of severe complications and mortality. Current evidential support to guide treatment of the injury or subsequent complications is lacking, as studies either exclude inhalation injury or design limit inferences that can be made. Conventional ventilator modes are most commonly used, but there is no consensus on optimal strategies. Settings should be customized to patient tolerance and response. Data for pharmacotherapy adjunctive treatments are limited.

Patient reported outcomes of emergency general surgery procedures.

BACKGROUND: Emergency general surgery (EGS) involves care of a patient's often previously unknown disease in the setting of an unplanned interaction with the healthcare system. This leads to challenges collecting and interpreting patient reported outcome measures (PROMs). METHODS: We performed a qualitative and mixed methods study using semi-structured interviews during the index hospitalization and at 6-12 months to capture peri-operative patient experiences. We compared interview findings to clinical characteristics. RESULTS: Among 30 patients, two-thirds reported feeling no choice but to pursue emergency surgery with many reporting exclusion from decision-making. Females reported these themes more commonly. Patients with minor complications less frequently reported trust in their team and discussed communication issues and delays in care (all p â€‹< â€‹0.05). Patients with major complications more frequently reported confidence in their team and gratefulness, but also communication limitations (all p â€‹< â€‹0.05). Patients not admitted to the ICU more frequently discussed good communication and expeditious treatment. CONCLUSIONS: PROMs developed for EGS patients should consider patient outcomes and reflections that they felt excluded from decision-making. Severity of complications may also differentially impact PROMs.

Educational interventions for cervical cancer prevention: a scoping review.

OBJECTIVES: to identify, map and describe characteristics of educational interventions for cervical cancer prevention in adult women. METHODS: a scoping review conducted on eleven databases and the gray literature, including studies that described educational interventions aimed at preventing cervical cancer in adult women. RESULTS: thirty-three articles with 151,457 participants were analyzed. The most used educational strategies were participatory discussions and educational leaflets. Most of the interventions took place in a single session, ranging from 40 to 60 minutes. The most used theoretical model in interventions to improve women's compliance with Pap smear was the Health Belief Model. CONCLUSIONS: group discussions, lectures and educational brochures can increase knowledge and reduce barriers to cervical cancer prevention. Theory-based and culturally sensitive interventions can have a positive impact on women's health.

Characterization of the Escherichia coli XPD/Rad3 iron-sulfur helicase YoaA in complex with the DNA polymerase III clamp loader subunit chi (χ).

Escherichia coli YoaA aids in the resolution of DNA damage that halts DNA synthesis in vivo in conjunction with χ, an accessory subunit of DNA polymerase III. YoaA and χ form a discrete complex separate from the DNA polymerase III holoenzyme, but little is known about how YoaA and χ work together to help the replication fork overcome damage. Although YoaA is predicted to be an iron-sulfur helicase in the XPD/Rad3 helicase family based on sequence analysis, the biochemical activities of YoaA have not been described. Here, we characterize YoaA and show that purified YoaA contains iron. YoaA and χ form a complex that is stable through three chromatographic steps, including gel filtration chromatography. When overexpressed in the absence of χ, YoaA is mostly insoluble. In addition, we show the YoaA-χ complex has DNA-dependent ATPase activity. Our measurement of the YoaA-χ helicase activity illustrates for the first time YoaA-χ translocates on ssDNA in the 5' to 3' direction and requires a 5' single-stranded overhang, or ssDNA gap, for DNA/DNA unwinding. Furthermore, YoaA-χ preferentially unwinds forked duplex DNA that contains both 3' and 5' single-stranded overhangs versus duplex DNA with only a 5' overhang. Finally, we demonstrate YoaA-χ can unwind damaged DNA that contains an abasic site or damage on 3' ends that stall replication extension. These results are the first biochemical evidence demonstrating YoaA is a bona fide iron-sulfur helicase, and we further propose the physiologically relevant form of the helicase is YoaA-χ.

Contributions of Surgical Critical Care Program Directors Society to the training of surgeons.

BACKGROUND: In 1986, Surgical Critical Care (SCC) was formally recognized as a specialty by the American Board of Surgery (ABS), however it took another two decades to develop a formal national training structure in SCC. In 2003, the program directors of SCC fellowships began to meet and the Surgical Critical Care Program Directors Society (SCCPDS) was officially formed in 2004, with recognition of the SCCPDS as a non-profit organization in 2008. Over the next several years, and in conjunction with other interested groups, such as the American Association for the Surgery of Trauma (AAST) and the Society of Critical Care Medicine (SCCM), SCCPDS created a formal curriculum, developed a unified system for the fellowship application process, and increased recruitment and match such that now approximately 1 in 6 general surgery graduates are pursuing training in SCC. In discussion with past and present leadership of SCCPDS, there are several ongoing initiatives to further improve the educational opportunities of the fellows and increase inclusion of other organizations and other specialties interested in SCC. The purpose of this article is to discuss the role of SCCPDS in the development and evolution of SCC and Acute Care Surgery (ACS) training. LEVEL OF EVIDENCE: Expert Opinion; Level V.

Educational interventions for cervical cancer prevention: a scoping review / Intervenciones educativas para la prevención del cáncer cervicouterino: revisión del alcance / Intervenções educativas para prevenção do câncer do colo do útero: revisão de escopo

ABSTRACT Objectives: to identify, map and describe characteristics of educational interventions for cervical cancer prevention in adult women. Methods: a scoping review conducted on eleven databases and the gray literature, including studies that described educational interventions aimed at preventing cervical cancer in adult women. Results: thirty-three articles with 151,457 participants were analyzed. The most used educational strategies were participatory discussions and educational leaflets. Most of the interventions took place in a single session, ranging from 40 to 60 minutes. The most used theoretical model in interventions to improve women's compliance with Pap smear was the Health Belief Model. Conclusions: group discussions, lectures and educational brochures can increase knowledge and reduce barriers to cervical cancer prevention. Theory-based and culturally sensitive interventions can have a positive impact on women's health.

RESUMEN Objetivos: identificar, mapear y describir las características de las intervenciones educativas para la prevención del cáncer de cuello uterino en mujeres adultas. Métodos: revisión de alcance, realizada en once bases de datos y en la literatura gris, incluyendo estudios que describían intervenciones educativas dirigidas a la prevención del cáncer de cuello uterino en mujeres adultas. Resultados: se analizaron 33 artículos con 151.457 participantes. Las estrategias educativas más utilizadas fueron las discusiones participativas y los folletos educativos. La mayoría de las intervenciones se realizaron en una sola sesión, con una duración de 40 a 60 minutos. El modelo teórico más utilizado en las intervenciones para mejorar la adherencia de las mujeres al Papanicolaou fue el Modelo de Creencias de Salud. Conclusiones: las discusiones grupales, las conferencias y los folletos educativos pueden aumentar el conocimiento y reducir las barreras para la prevención del cáncer de cuello uterino. Las intervenciones basadas en teorías y culturalmente sensibles pueden tener un impacto positivo en la salud de las mujeres.

RESUMO Objetivos: identificar, mapear e descrever as características de intervenções educativas para a prevenção do câncer cervical em mulheres adultas. Métodos: revisão de escopo, conduzida em onze bases de dados e na literatura cinzenta, incluindo estudos que descreveram intervenções educativas voltadas à prevenção do câncer cervical em mulheres adultas. Resultados: 33 artigos com 151.457 participantes foram analisados. As estratégias educativas mais utilizadas foram as discussões participativas e folhetos educativos. A maior parte das intervenções ocorreu em sessão única, com variação de 40 a 60 minutos. O modelo teórico mais utilizado nas intervenções para melhorar a adesão das mulheres ao exame Papanicolau foi o Modelo de Crenças em Saúde. Conclusões: discussões em grupo, palestras e folhetos educativos podem aumentar o conhecimento e reduzir barreiras para a prevenção do câncer do colo do útero. Intervenções baseadas em teoria e culturalmente sensíveis podem ter impacto positivo na saúde das mulheres.

Brief multidisciplinary intervention for chronic pain management: pilot feasibility study / Intervenção multidisciplinar breve para manejo da dor crônica: estudo piloto de viabilidade

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic pain has a negative impact on the quality of life of individuals and requires multidisciplinary attention. The aim of this study was to assess the feasibility of a brief multidisciplinary intervention for the management of chronic pain. METHODS: A pilot feasibility study. The participants were individuals with chronic pain. The intervention had a psychoeducational focus and was carried out in a group for six weeks, with a two-hour weekly meeting. Participants received education on pain management, practiced stretching and relaxation techniques. The intervention was applied by two nurses, a psychologist and a physical therapist. The specific objective of this study was to assess the feasibility of the intervention through indicators of acceptability and feasibility. RESULTS: Forty-eight people with chronic pain eligible to participate in the study were identified. Among the acceptability indicators, the acceptance rate to participate in the intervention was 52% and the retention rate among participants was 60%. The rate of adherence to the recommendations was moderate for walking (53.3%) and satisfactory for stretching (100%) and relaxation (73.3%). As for the feasibility indicators, the following aspects were considered "great": access to the intervention site (83.3%), the intervention room (66.6%), the intervention content (86.6%) and the number of sessions (46.6%). All participants (100%) suggested increasing the number of sessions. CONCLUSION: The brief multidisciplinary intervention for chronic pain management was considered feasible and should be tested and implemented in primary care services and outpatient services specialized in pain management.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor crônica provoca impacto negativo na qualidade de vida dos indivíduos e requer atenção multidisciplinar. O objetivo deste estudo foi avaliar a viabilidade de uma intervenção multidisciplinar breve para manejo da dor crônica. MÉTODOS: Estudo clínico de viabilidade. Os participantes foram pessoas com dor crônica. A intervenção teve foco psicoeducativo e foi realizada em grupo, por seis semanas, com um encontro semanal de duas horas. Os participantes receberam educação sobre manejo da dor, praticaram alongamento e técnicas de relaxamento. A intervenção foi aplicada por duas enfermeiras, uma psicóloga e uma fisioterapeuta. O objetivo específico deste estudo foi avaliar a viabilidade da intervenção por meio de indicadores de aceitabilidade e viabilidade. RESULTADOS: Identificaram-se 48 pessoas com dor crônica elegíveis para participar do estudo. Entre os indicadores de aceitabilidade, a taxa de aceitação para participar da intervenção foi de 52% e a taxa de retenção foi de 60%. A taxa de adesão às recomendações foi moderada para caminhada (53,3%) e satisfatória para alongamento (100%) e relaxamento (73,3%). Quanto aos indicadores de viabilidade, foram considerados "ótimos": o acesso ao local da intervenção (83,3%), a sala da intervenção (66,6%), o conteúdo da intervenção (86,6%) e o número de sessões (46,6%). Todos os participantes (100%) sugeriram aumentar o número de sessões. CONCLUSÃO: A intervenção multidisciplinar breve para manejo da dor crônica foi considerada viável e deve ser testada e implantada em serviços de atenção primária e serviços ambulatoriais especializados no tratamento da dor.

Global and transcription-coupled repair of 8-oxoG is initiated by nucleotide excision repair proteins.

UV-DDB, consisting of subunits DDB1 and DDB2, recognizes UV-induced photoproducts during global genome nucleotide excision repair (GG-NER). We recently demonstrated a noncanonical role of UV-DDB in stimulating base excision repair (BER) which raised several questions about the timing of UV-DDB arrival at 8-oxoguanine (8-oxoG), and the dependency of UV-DDB on the recruitment of downstream BER and NER proteins. Using two different approaches to introduce 8-oxoG in cells, we show that DDB2 is recruited to 8-oxoG immediately after damage and colocalizes with 8-oxoG glycosylase (OGG1) at sites of repair. 8-oxoG removal and OGG1 recruitment is significantly reduced in the absence of DDB2. NER proteins, XPA and XPC, also accumulate at 8-oxoG. While XPC recruitment is dependent on DDB2, XPA recruitment is DDB2-independent and transcription-coupled. Finally, DDB2 accumulation at 8-oxoG induces local chromatin unfolding. We propose that DDB2-mediated chromatin decompaction facilitates the recruitment of downstream BER proteins to 8-oxoG lesions.

Brief interprofessional intervention for chronic pain management: a pilot study / Breve intervención interprofesional para el manejo del dolor crónico: un estudio piloto / Intervenção interprofissional breve para manejo da dor crônica: estudo piloto

ABSTRACT Objective: To test the effects of a brief interprofessional intervention for chronic pain management. Methods: Before and after pilot study. The brief interprofessional intervention had a psychoeducational focus and was based on the Self-Efficacy Theory, using Cognitive-Behavioral Therapy strategies. The intervention aimed to improve the management of chronic pain. It was conducted in group, over six weeks, with a two-hour weekly meeting, including educational strategies on pain management, stretching, and relaxation techniques. Self-efficacy, pain intensity, disability, fatigue, and depressive symptoms were assessed. Data were analyzed using the paired t-test and Pearson's correlation. Results: Adults with moderate to severe pain took part in the study. Post-intervention analysis showed significant improvement in self-efficacy (p = 0.004) and significant reduction in pain intensity (p = 0.024), disability (p = 0.012), fatigue (p = 0.001), and depressive symptoms (p = 0.042). Conclusion: The effects of brief interprofessional intervention were positive for chronic pain management. We suggest the conduction of studies with more robust designs and a larger sample to confirm these findings.

RESUMEN Objetivo: Probar los efectos de una breve intervención interprofesional en el manejo del dolor crónico. Método: Estudio piloto, de tipo antes y después. La breve intervención interprofesional, de enfoque psicoeducativo, estuvo basada en la Teoría de la Autoeficacia, con el uso de estrategias de Terapia Cognitivo-Conductual. La intervención tuvo como propósito mejorar el manejo del dolor crónico. Se realizó en grupo durante seis semanas, con una reunión semanal de dos horas, incluidas estrategias educativas sobre el manejo del dolor, estiramiento y técnicas de relajación. Se evaluaron la autoeficacia, la intensidad del dolor, la discapacidad, la fatiga y los síntomas depresivos. Los datos se analizaron utilizando la prueba t pareada y la correlación de Pearson. Resultados: En el estudio participaron adultos con dolor de moderado a severo. El análisis posintervención apuntó a una mejora significativa en la autoeficacia (p = 0,004) y una significativa reducción en la intensidad del dolor (p = 0,024), discapacidad (p = 0,012), fatiga (p = 0,001) y síntomas depresivos (p = 0,042). Conclusión: Los efectos de la breve intervención interprofesional fueron positivos en el manejo del dolor crónico. Se sugieren estudios con diseños más robustos y una muestra más grande para confirmar estos hallazgos.

RESUMO Objetivo: Testar os efeitos de uma intervenção interprofissional breve para manejo da dor crônica. Método: Estudo piloto do tipo antes e depois. A intervenção interprofissional breve teve enfoque psicoeducativo e foi baseada na Teoria da Autoeficácia, com utilização de estratégias da Terapia Cognitivo-Comportamental. A finalidade da intervenção foi melhorar o manejo da dor crônica. Realizada em grupo, ao longo de seis semanas, com um encontro semanal de duas horas, incluindo estratégias educativas sobre manejo da dor, alongamento e técnicas de relaxamento. Autoeficácia, intensidade da dor, incapacidade, fadiga e sintomas depressivos foram avaliados. Os dados foram analisados por meio do teste t-pareado e correlação de Pearson. Resultados: Participaram do estudo adultos com dor moderada a intensa. A análise pós-intervenção mostrou melhora significativa da autoeficácia (p = 0,004) e redução significativa da intensidade da dor (p = 0,024), incapacidade (p = 0,012), fadiga (p = 0,001) e sintomas depressivos (p = 0,042). Conclusão: Os efeitos da intervenção interprofissional breve foram positivos para manejo da dor crônica. Sugere-se estudos com desenhos mais robustos e amostra ampliada para confirmar estes achados.

Salivary Interleukin-6 and C-Reactive Protein/Mean Platelet Volume Ratio in the Diagnosis of Late-Onset Neonatal Pneumonia.

Neonatal pneumonia is a serious respiratory infectious disease with a high rate of case fatality in developing countries. Salivary cytokines could serve as interesting noninvasive markers in the diagnosis of neonatal pneumonia. The aim was to assess the diagnostic role of salivary and serum interleukin-6 (IL-6), C-reactive protein/mean platelet volume (CRP/MPV) ratio, and the combination of these markers in the diagnosis of late-onset neonatal pneumonia in full-term neonates. Seventy full-term neonates, 35 with late-onset neonatal pneumonia and 35 controls, were enrolled in this prospective case-control study. Complete blood count (CBC), salivary and serum IL-6, and CRP concentrations were measured for all the study subjects. The sensitivity, specificity, positive predictive value, and negative predictive value of salivary IL-6, serum IL-6, and CRP/MPV ratio for the diagnosis of late-onset neonatal pneumonia were determined. At the cutoff point of >34 pg/ml, salivary IL-6 showed 82.86% sensitivity and 91.43% specificity. CRP/MPV ratio showed a sensitivity of 97.14% and specificity of 85.71% at a cutoff value > 0.88. The combination of salivary IL-6 and CRP/MPV ratio improved the sensitivity and specificity to 100%. The current study shows for the first time that both salivary IL-6 and CRP/MPV ratio are suitable markers for the diagnosis of late-onset neonatal pneumonia in full-term neonates.

Cross-cultural adaptation and content validity evidence of the Brazilian version of the Nociception Coma Scale-revised / Adaptação transcultural e evidência de validade de conteúdo da versão brasileira da Nociception Coma Scale-revised

ABSTRACT BACKGROUND AND OBJECTIVES: There are communication barriers to assess pain in patients with consciousness and cognitive disorders. This study aimed to make the cross-cultural adaptation of the Nociception Coma Scale-Revised (NCS-R) to the Portuguese language and check the validation evidence of the content of the NCR-R Brazilian version in non-communicative patients with consciousness and cognitive disorders. METHODS: This is a methodological study to check the cross-cultural adaptation of the NCR-R, divided into two stages: cross-cultural adaptation and check of the content validity. The cross-cultural adaptation phase included an initial translation, synthesis of translations, back-translation, expert committee, and cognitive debriefing based on Beaton and Price. A second expert committee evaluated the translated and adapted version to check the content validity index RESULTS: The NCS-R scale was translated and cross-culturally adapted, presenting good evidence of content validity with a Content Validity Index of 0.86. CONCLUSION: The NCS-R is translated and transculturally adapted and has good evidence of content validity.

RESUMO JUSTIFICATIVA E OBJETIVOS: Em pacientes com desordens de consciência e distúrbios cognitivos há barreiras de comunicação para a avaliação da dor. O objetivo deste estudo foi realizar a adaptação transcultural da Nociception Coma Scale-revised (NCS-R) para a língua portuguesa e verificar as evidências de validade de conteúdo da versão brasileira da NCS-R em pacientes não comunicativos com desordens de consciência e distúrbios cognitivos. MÉTODOS: Estudo metodológico para adaptação transcultural da NCS-R dividido em duas etapas: adaptação transcultural e verificação da validade de conteúdo. A fase de adaptação transcultural incluiu a tradução inicial, síntese das traduções, retrotradução, comitê de especialista e debriefing cognitivo baseado em Beaton e Price. A versão traduzida e adaptada foi avaliada por um segundo comitê de especialistas para a avaliação do índice de validade de conteúdo. RESULTADOS: A NCS-R foi traduzida, adaptada do ponto de vista transcultural e apresentou boa evidência de validade de conteúdo com Índice de Validade de Conteúdo de 0,86. CONCLUSÃO: A NCS-R encontra-se traduzida e adaptada do ponto de vista transcultural, e possui boa evidência de validade de conteúdo.

Effect of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy on Quality of Life in Patients with Peritoneal Mesothelioma.

INTRODUCTION: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is an accepted treatment for peritoneal mesothelioma. In this study, we evaluated QOL after HIPEC for peritoneal mesothelioma. METHODS: This was a prospective study performed after HIPEC for peritoneal mesothelioma between 2002 and 2015. Patients completed QOL surveys, including the Short Form-36 (SF-36), Functional Assessment of Cancer Therapy + Colon (FACT-C), Brief Pain Inventory (BPI), and Center for Epidemiologic Studies Depression Scale (CES-D) preoperatively and at 3, 6, 12, and 24 months postoperatively. RESULTS: Overall, 46 patients underwent HIPEC for peritoneal mesothelioma and completed QOL surveys. Mean age was 52.8 ± 13.8 years and 52% were male. Good preoperative functional status was 70%. Median survival was 3.4 years, and 1, 3, and 5-year survivals were 77.4, 55.2, and 36.5%, respectively. CES-D score decreased at 3 months postoperatively, but increased at 24 months (p = 0.014); SF-36 physical functioning scale decreased at 3 months but returned to baseline at 12 months (p = 0.0045); and the general health scale decreased at 3 months, then improved by 6 months (p = 0.0034). Emotional well-being (p = 0.0051), role limitations due to emotional problems (p = 0.0006), social functioning (p = 0.0022), BPI (p = 0.025), least pain (p = 0.045), and worst pain (p < 0.0001) improved. FACT-C physical well-being decreased at 3 months but returned to baseline at 6 months (p = 0.020), and total FACT-C score improved at 6 months (p = 0.052). CONCLUSION: QOL returned to baseline or improved from baseline between 3 months and 1 year following surgery. Despite the risks associated with this operation, patients may tolerate HIPEC well and have good overall QOL postoperatively.

Intervenção interprofissional breve para manejo da dor crônica: estudo piloto / Brief interprofessional intervention for chronic pain management: pilot study

Introdução: A dor crônica provoca impacto negativo na qualidade de vida dos indivíduos e requer atenção interprofissional. Objetivo: Avaliar a aceitabilidade e viabilidade da intervenção interprofissional Programa de Controle da Dor Crônica; Avaliar os efeitos da intervenção na crença de autoeficácia, na intensidade da dor, incapacidade, fadiga e sintomas depressivos de pessoas com dor crônica; Verificar a correlação da incapacidade com a crença de autoeficácia, intensidade da dor, fadiga e sintomas depressivos. Método: Estudo quase-experimental do tipo piloto que incluiu adultos com dor crônica de intensidade moderada a intensa. A intervenção foi elaborada com base na Teoria da Autoeficácia e Classificação das Intervenções de Enfermagem e utilizou estratégias educativas e Cognitivo-Comportamentais. O Programa foi realizado em grupo, ao longo de seis semanas, com um encontro semanal de duas horas de duração, aplicado por duas enfermeiras, uma psicóloga e uma fisioterapeuta. O conteúdo do Programa incluiu estratégias educativas sobre o manejo da dor, alongamento e técnicas de relaxamento. A aceitabilidade da intervenção foi analisada por meio da taxa de aceitação em participar do estudo, taxa de retenção (frequência nas sessões), taxa de adesão às recomendações e satisfação por autorrelato. A viabilidade foi analisada pela exequibilidade da implementação da intervenção, disponibilidade, qualificação e treinamento das interventoras, recursos materiais, contexto, fidelidade ao manual da intervenção e alcance da população alvo. Os participantes foram avaliados antes e após a intervenção por meio do Questionário de Autoeficácia sobre Dor, Escala Visual Numérica de dor, Questionário de incapacidade relacionada à dor, Pictograma de fadiga e Inventário de Depressão de Beck. Os dados foram analisados por meio do teste t pareado e correlação de Pearson. Resultados: Entre 48 participantes elegíveis, 25 iniciaram o programa (taxa de aceitação = 52%), 15 concluíram (taxa de retenção = 60%) e 56% participaram de quatro a seis sessões. A taxa de adesão às recomendações do Programa foi muito boa para o alongamento (100%), relaxamento (73,3%) e moderada para caminhada (53,3%). Os participantes consideraram ótimo: acesso ao local (83,3%), sala (66,6%), conteúdo abordado (86,6%) e número de sessões (46,6%). Todos os participantes (100%) afirmaram que o programa deveria ter mais sessões ou poderia ser uma atividade contínua. A análise pós intervenção mostrou aumento significativo da autoeficácia (p=0,004) e redução significativa da intensidade da dor (p=0,024), incapacidade (p=0,012), fadiga (p=0,001) e sintomas depressivos (p=0,042). A análise da correlação entre incapacidade e as demais variáveis mostrou correlação negativa moderada entre incapacidade e autoeficácia (r = -0,601; p<0,001) e positiva moderada entre incapacidade e fadiga (r = 0,603; p<0,001) e incapacidade e sintomas depressivos (r = 0,545; p<0,001). Não se observou correlação significativa entre incapacidade e intensidade da dor. Conclusões: A intervenção interprofissional breve foi considerada aceitável e viável para pacientes com dor crônica. Além disso, contribuiu para melhorar a percepção de autoeficácia e reduzir a incapacidade, intensidade da dor, fadiga e sintomas depressivos. Esta intervenção pode ser aplicada na atenção primária e em serviços ambulatoriais especializados, devendo ser testada em ensaios clínicos randomizados com amostras maiores.

Introduction: Chronic pain causes negative impact on quality of life and requires interprofessional attention. Objective: To evaluate the acceptability and feasibility of a brief intervention Chronic Pain Management Program; To evaluate the effects of the intervention on self-efficacy, pain, disability, fatigue and depressive symptoms in chronic pain patients; To assess the correlation between disability and self-efficacy, pain, fatigue and depressive symptoms. Method: A quasi-experimental pilot study that included chronic pain adults with moderate to severe pain. The intervention was based on Self-efficacy Theory, Nursing Interventions Classification, educative, and Cognitive Behavioral strategies. The Program was delivered in group, during six weeks, with two hours sessions, once a week, conducted by two nurses, a physiotherapist and a psychologist. The program content included educational strategies about pain management, stretching, and relaxation techniques. Acceptability analyzes the enrollment rate to participate on the study, retention rate (frequency in session), recommendation adherence rate and satisfaction by self-report. Feasibility analyzes the practicality of implementing the intervention through availability, quality, and training of interventionists, material resources, context, fidelity to intervention manual, and reach to the target population. The patients were evaluated before and after the intervention by the Pain Self-Efficacy Questionnaire, Visual Numerical Pain Scale, Pain Disability Questionnaire, The Fatigue Pictogram, and Beck Depression Inventory. The data were analyzed using the paired t test and Pearson\'s correlation. Results: Between 48 eligible patients, 25 began the program (enrollment rate = 52%), 15 completed (retention rate = 60%) and 56% has participated on 4 6 sessions. The recommendation adherence rate was good for stretching (100%) and relaxation technique (73.3%), moderate to walking (53.3%). The participants considered as Great: access to the meeting room (83.3%), room (66.6%), information content (86.6%) and number of sessions (46.6%). All participants (100%) stated that the program should have more sessions or could be a continuous activity. The analysis after intervention showed significant increase in self-efficacy (p=0.004) and significant decrease in pain intensity (p=0.024), disability (p=0.012), fatigue (p=0.001) and depressive symptoms (p=0.042). Correlations between disability and other variables showed moderate negative correlation between disability and self-efficacy (r=-0.601; p<0.001) and moderate positive correlations between disability and fatigue (r=0.603; p<0.001) and disability and depressive symptoms (r=0.545; p<0.001). There was no significant correlation between disability and pain intensity. Conclusion: The brief interprofessional intervention was considered acceptable and feasible to chronic pain patients. Furthermore, contributed to increase self-efficacy belief and to decrease disability, pain intensity, fatigue, and depressive symptoms. This intervention can be applied in primary health care or specialized outpatients settings and should be tested in randomized clinical trials with larger samples.

Effects of a nursing intervention in the control of symptoms in patients with fibromyalgia. Case report / Efeitos de uma intervenção de enfermagem no controle de sintomas de pacientes com fibromialgia. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Fibromyalgia is a non-inflammatory rheumatic syndrome, characterized by diffuse chronic musculoskeletal pain, usually accompanied by other symptoms not related to the locomotor system such as depression, fatigue, cognitive alterations, impaired sleep quality, and headache. This study aimed to evaluate the impact of a nursing intervention in the control of pain and depressive symptoms of patients with fibromyalgia. METHODS: A quasi-experimental study conducted through the electronic database review of a private chronic patients monitoring service. The sample included 353 patients with fibromyalgia who were attended in the period from 2014 to 2017. The nursing intervention included a home visit and the application of educational strategies over the telephone for 6 months. Participants were assessed using the verbal numerical rating scale and the Patient Health Questionnaire scale. The comparison between the continuous variables was performed by the t-paired test, and the comparison between the categorical variables was performed using the McNemar-Bowker test. The level of significance was set at p<0.05. RESULTS: Nursing intervention promoted a significant reduction in the average pain intensity (p<0.001) after the intervention. The reduction in the average depression score, however, was not significant (p=0.093), but the intervention significantly reduced the cases of moderate and very severe depression (p=0.01). CONCLUSION: Nursing intervention by telephone showed a positive impact on pain control and reduction of depressive symptoms in patients with fibromyalgia.

RESUMO JUSTIFICATIVA E OBJETIVOS: A fibromialgia é uma síndrome reumatológica não inflamatória, caracterizada por dor musculoesquelética crônica e difusa, geralmente acompanhada por outros sintomas não relacionados ao aparelho locomotor como depressão, fadiga, alterações cognitivas, qualidade de sono prejudicada e cefaleia. O objetivo deste estudo foi avaliar o impacto de uma intervenção de enfermagem no controle da dor e nos sintomas depressivos de pacientes com fibromialgia. MÉTODOS: Estudo quase-experimental realizado por meio da revisão de banco de dados eletrônico de um serviço privado de monitoramento de pacientes crônicos. A amostra incluiu 353 pacientes com fibromialgia, atendidos no período de 2014 a 2017. A intervenção de enfermagem incluiu uma visita domiciliar e a aplicação de estratégias educativas por telefone ao longo de 6 meses. Os participantes foram avaliados por meio da escala numérica verbal de dor e pela escala Patient Health Questionnaire. A comparação entre as variáveis contínuas foi realizada pelo teste t-pareado e a comparação entre as variáveis categóricas foi realizada por meio do teste McNemar-Bowker. O nível de significância foi estabelecido com valor de p<0,05. RESULTADOS: A intervenção de enfermagem promoveu redução significativa na intensidade média da dor (p<0,001) após a intervenção. A redução do escore médio de depressão, no entanto, não foi significativa (p=0,093), mas a intervenção reduziu significativamente os casos de depressão moderada e muito grave (p=0,01). CONCLUSÃO: A intervenção de enfermagem por telefone demonstrou impacto positivo no controle da dor e na redução dos sintomas depressivos de pacientes com fibromialgia.

Silica-volatile interaction and the geological cause of the Xuan Wei lung cancer epidemic.

Parts of Xuan Wei County, Yunnan Province, China have the highest known lung cancer mortality in nonsmoking women. This high mortality displays a clear spatial relationship to the mines producing coal from the uppermost Permian. Geochemical, petrographic, and grainsize analyses were undertaken on a set of coal samples from Xuan Wei. Results demonstrate that the single geochemical property that makes this coal unusual is its high concentration of quartz (13.5 wt %) of which 35-55% occurs as <10 microm grains. We propose the potential for silica-volatile interaction (PSVI) as a new method for assessing the combined influence of silica and volatile organic matter and use this as a basis for re-evaluating existing ecological data. Published lung cancer mortality values are more strongly correlated with PSVI values for Xuan Wei coal than with volatiles or silica alone and the PSVI values measured are distinct from those of other coals. Finally we propose that the localization of this epidemic to Xuan Wei results from enhanced weathering of the local Emeishan basalts as a consequence of geochemical perturbations at the Permo-Triassic Boundary.