Riesgo de depresión durante el embarazo en la atención prenatal de riesgo habitual / Risk of depression during pregnancy in usual risk antenatal care / Risco de depressão na gravidez na assistência pré-natal de risco habitual

Objetivo: identificar el riesgo de depresión durante el embarazo en gestantes de riesgo habitual incluidas en el control prenatal y los factores asociados. Método: estudio transversal, realizado con 201 gestantes, en el consultorio de prenatal de riesgo habitual de una maternidad universitaria. Para la recolección de datos se utilizó un formulario electrónico que contenía un instrumento de caracterización y la Escala de Riesgo de Depresión del Embarazo. La variable dependiente fue el riesgo de depresión en el embarazo. El análisis estadístico se realizó mediante el cálculo de la razón de posibilidades (Odds Ratio) y utilizando las pruebas de Chi-cuadrado y exacta de Fischer. Resultados: entre las participantes, 68,2% tenían mayor riesgo de depresión durante el embarazo. Hubo asociación estadísticamente significativa entre mayor riesgo de depresión durante el embarazo y la variable ocupación (p=0,04), o sea, la ausencia del trabajo (OR = 2,00) duplicó la probabilidad de ocurrencia. Conclusión: la alta prevalencia de riesgo de depresión durante el embarazo destaca la necesidad de planificación, priorización e integración de la salud mental en los servicios de salud prenatal, especialmente en el ámbito de la Atención Primaria de Salud, por parte de los gestores de salud y de los formuladores de políticas.

Objective: to identify the risk of depression during pregnancy among pregnant women receiving routine prenatal care and the associated factors. Method: a cross-sectional study, carried out with 201 pregnant women, in a routine prenatal clinic of a university maternity hospital. Data were collected using an electronic form containing a characterization instrument and the Escala de Risco de Depressão na Gravidez (Depression during Pregnancy Scale). The dependent variable was the risk of depression during pregnancy. Statistical analysis was performed by calculating the Odds Ratio and using the Chi-square and Fischer's Exact tests. Results: among the participants, 68.2% had a higher risk of depression during pregnancy. There was a statistically significant association between a higher risk of depression during pregnancy and occupation (p=0.04), that is, unemployment (OR=2.00) doubled the risk of depression. Conclusion: the high prevalence of the risk of depression during pregnancy indicates the necessity of planning, prioritizing, and integrating mental health into prenatal health services, especially in the primary healthcare environment, by health managers and policymakers.

Objetivo: identificar o risco de depressão na gravidez entre gestantes inseridas na assistência pré-natal de risco habitual e os fatores associados. Método: estudo transversal, realizado com 201 gestantes, no ambulatório de pré-natal de risco habitual de uma maternidade universitária. A coleta de dados utilizou um formulário eletrônico contendo um instrumento de caracterização e a Escala de Risco de Depressão na Gravidez. A variável dependente foi o risco de depressão na gravidez. A análise estatística deu-se pelo cálculo da razão de chances (Odds Ratio) e pelos testes Qui-quadrado e Exato de Fischer. Resultados: entre as participantes, 68,2% apresentaram maior risco de depressão na gravidez. Houve associação estatisticamente significativa entre o maior risco de depressão na gravidez e a variável ocupação (p=0,04), ou seja, a ausência de emprego (OR = 2,00) aumentou em duas vezes a chance de ocorrência. Conclusão: a alta prevalência de risco de depressão na gravidez evidencia a necessidade de planejamento, priorização e integração da saúde mental nos serviços de saúde pré-natal, principalmente no ambiente da Atenção Primária à Saúde, por parte de gestores de saúde e formuladores de políticas.

Delayed Diagnosis of Primary Hyperparathyroidism: A Case Report.

Primary hyperparathyroidism (PHPT) is characterized by an elevation in serum calcium levels, sometimes leading to aggravated clinical conditions, namely nephrolithiasis, nephrocalcinosis, and/or fractures. A 55-year-old patient was admitted to the hospital with acute obstructive pyelonephritis in March 2021, having another episode one year later. Initial blood and urine analysis detected inflammatory markers, namely C-reactive protein, and the presence of leucocytes and blood in the urine. The renal computed tomography scan exhibited renal asymmetry, nephrocalcinosis, and multiple kidney stones. The patient was scheduled for a follow-up one year later to perform blood and urine analysis to uncover the cause of nephrocalcinosis, displaying high serum calcium and parathyroid hormone (PTH) levels. The thyroid ultrasound revealed a parathyroid adenoma, which was removed through a right lower parathyroidectomy, improving the symptoms. The clinical condition described here is an atypical manifestation of this disease because PHPT is normally asymptomatic. In the present case study, nephrocalcinosis and nephrolithiasis were strong indicators of the underlying disease. However, the delay in the follow-up consultation resulted in complications for the patient, such as microabscesses in the kidneys, which could lead to reduced renal function in the future. Early detection of key aspects of the disease could avoid further complications and suffering for the patient. For example, the family physician's follow-up of the patient's condition could surpass the waiting time between consultations with different specialties, and promote early treatment.

Representações sociais de enfermeiros acerca do processo de descentralização do atendimento ao HIV: abordagem estrutural / Social representations of nurses about the decentralization process of HIV care: A structural approach / Representaciones sociales de enfermeros sobre el proceso de descentralización de la atención al VIH: un enfoque estructural

Objetivo: analisar a representação social de enfermeiros sobre o atendimento ao HIV na atenção primária à saúde através de uma abordagem estrutural. Método: Trata-se de um estudo descritivo, exploratório, com abordagem qualitativa e caráter estrutural, com 160 enfermeiros, no período entre dezembro de 2019 a março de 2020 nas unidades de saúde da família do município de Recife, Pernambuco, Brasil. Realizou-se entrevistas semiestruturadas, com a Técnica de Associação Livre de Palavras, e questionário sociodemográfico. Os dados foram processados pelo software IRAMUTEQ, sendo ancorados pela Teoria das Representações Sociais. Aprovado pelo Comitê de Ética em Pesquisa. Resultados: O estímulo à pergunta indutora originou 188 palavras diferentes com frequência mínima de 5 evocações e máxima de 64. Observa-se expressivamente termos associados a fatores subjetivos. Considerações finais: Evidenciou-se que as representações sociais são relevantes e diversas, relacionadas com a atuação dos enfermeiros frente ao atendimento prestado às pessoas vivendo com HIV.

Objective: to analyze nurses' social representation of HIV care in primary health care through a structural approach. Method: This is a descriptive, exploratory study, with a qualitative and structural approach, with 160 nurses, between December 2019 and March 2020 in the family health units of the municipality of Recife, Pernambuco, Brazil. Semi-structured interviews were conducted with the Free Word Association Technique and a sociodemographic questionnaire. The data were processed by the IRAMUTEQ software, being anchored by the Theory of Social Representations. Theone proven by the Research Ethics Committee. Results: The stimulus to the inducing question originated 188 different words with a minimum frequency of 5 evocations and a maximum of 64. Terms associated with subjective factors are significantly observed. Final considerations: It was evidenced that social representations are relevant and diverse, related to the performance of nurses in relation to the care provided to people living with HIV.

Objetivo: analizar la representación social de los enfermeros sobre el cuidado del VIH en la atención primaria de salud a través de un enfoque estructural. Método: Se trata de un estudio descriptivo, exploratorio, con enfoque cualitativo y estructural, con 160 enfermeras, entre diciembre de 2019 y marzo de 2020 en las unidades de salud familiar del municipio de Recife, Pernambuco, Brasil. Se realizaron entrevistas semiestructuradas con la Técnica de Asociación de Palabras Libres y un cuestionario sociodemográfico. Los datos fueron procesados por el software IRAMUTEQ, siendo anclados por la Teoría de las Representaciones Sociales. El comprobado por el Comité de Ética en Investigación. Resultados: El estímulo a la pregunta inductora originó 188 palabras diferentes con una frecuencia mínima de 5 evocaciones y un máximo de 64. Los términos asociados con factores subjetivos se observan significativamente. Consideraciones finales: Se evidenció que las representaciones sociales son relevantes y diversas, relacionadas con el desempeño de las enfermeras en relación con la atención brindada a las personas que viven con VIH.

Epidemiological clinical profile and closure of chronic plantar ulcers in patients with leprosy sequelae undergoing orthopedic surgery in a municipality in western Amazon.

INTRODUCTION: Chronic plantar ulcers in leprosy are lesions resulting from motor and sensory alterations caused by Mycobacterium leprae. They are lesions refractory to conventional dressings and present high recurrence rates. OBJECTIVE: To evaluate the epidemiological clinical profile of patients with chronic plantar ulcers associated with bony prominences in the lesion bed and to evaluate the efficacy of orthopedic surgical treatment of these lesions. METHODS: This is a descriptive and analytical retrospective study with the evaluation of medical records of patients undergoing surgical treatment of chronic plantar ulcers from 2008 to 2018. The surgical technique applied consisted of corrective resection of bone prominences and the primary closure of the lesion with bipediculated local flap. RESULTS: 234 patients were submitted to surgery, 55.1% male with an average age of 69.5 years old. Of these, 82.9% were illiterate; and 88.5% with open lesions over 10 years. After surgical treatment, total wound healing occurred in an average time of 12 weeks. The variables that contributed to shorter healing time were: Patients' lower age group; regular use of orthopedic shoes and insoles and dressings performed by nurse aides in health units before surgery. Obesity was the factor that correlated with the delay of healing time. CONCLUSION: A higher incidence was observed in males and male and female illiterate patients. The regular use of shoes and insoles and dressings performed by nurse aides in health units contributed to shorter postoperative healing time. Orthopedic surgical treatment with corrective resection of bony prominences proved to be an efficient therapeutic method for the closure of chronic plantar ulcers. It is a reproducible method, justifying the importance of the orthopedic surgeon in the context of the multidisciplinary team to cope with these complex lesions.

Animal models of kidney iron overload and ferroptosis: a review of the literature.

In recent years, it has been identified that excess iron contributes to the development of various pathologies and their complications. Kidney diseases do not escape the toxic effects of iron, and ferroptosis is identified as a pathophysiological mechanism that could be a therapeutic target to avoid damage or progression of kidney disease. Ferroptosis is cell death associated with iron-dependent oxidative stress. To study the effects of iron overload (IOL) in the kidney, numerous animal models have been developed. The methodological differences between these models should reflect the IOL-generating mechanisms associated with human IOL diseases. A careful choice of animal model should be considered for translational purposes.

Reações de hipersensibilidade a vacinas / Hypersensitivity reactions to vaccines

O desenvolvimento e a ampliação do uso das vacinas durante décadas contribuíram para o controle e erradicação de doenças infecciosas, causando um grande impacto na saúde pública no mundo. A análise de segurança das vacinas percorre criteriosos processos e fases dos estudos clínicos, um dos pilares essenciais para aprovação regulatória e utilização do produto na população. O evento supostamente atribuído à vacinação e imunização (ESAVI), terminologia atual, é definido como qualquer ocorrência médica indesejada após a vacinação que possui, ou não, uma relação causal com o uso de uma vacina ou outro imunobiológico. Cabe ressaltar que eventos adversos mais raros ou inesperados, incluindo os eventos de hipersensibilidade, poderão ocorrer na fase pós-comercialização, quando as vacinas são aplicadas em milhões de pessoas. Neste artigo, serão discutidos os principais aspectos relacionados aos eventos adversos de hipersensibilidade pós-vacinais de interesse do especialista, e os desafios frente ao reconhecimento do agente causal e conduta a ser adotada. Além disso, serão revisados os potenciais alérgenos presentes nas vacinas de uso rotineiro para auxiliar o profissional de saúde na identificação de pacientes com potencial de risco de ESAVI por tais componentes. A atualização do conhecimento acerca da segurança e dos benefícios das vacinas pelos profissionais de saúde, sobretudo em populações especiais, contribui para condutas em imunização mais apropriadas, reduzindo o risco de exposição a um possível alérgeno em pessoas comprovadamente alérgicas às vacinas ou a alguns dos seus componentes, além de evitar contraindicações desnecessárias em eventos coincidentes ou não graves.

The expansion of vaccine use and development in recent decades has contributed to the control and eradication of infectious diseases, causing a major impact on public health worldwide. Vaccine safety analysis, which involves careful processes and clinical study, is one of the essential pillars of regulatory approval and use in the population. In current terminology, events supposedly attributable to vaccination and immunization (ESAVI) are defined as any unwanted medical occurrence after vaccination that may or may not have a causal relationship with vaccines or other immunobiologicals. It is noteworthy that rare or unexpected adverse events, including hypersensitivity, can occur during the post-marketing phase, when vaccines are administered to millions of people. In this article, we will discuss the main aspects of post-vaccine hypersensitivity events of interest to specialists and challenges to recognizing the causal agent and appropriate clinical practice. Potential allergens in routine vaccines will also be reviewed to help health professionals identify patients with a potential risk of ESAVI due to such components. Updating health professionals' knowledge about the safety and benefits of vaccines, particularly in special populations, can contribute to more appropriate clinical practice regarding immunization, reducing the risk of exposure to possible allergens in people with allergies to vaccines or their components, avoiding unnecessary contraindications in coincidental or non-serious events.

Risco de depressão na gravidez na percepção dos profissionais de saúde / Risk of depression in pregnancy in the perception of health professionals / Riesgo de depresión en el embarazo en la percepción de los profesionales de la salud

Objetivo: Identificar os fatores de risco para a depressão na gravidez na percepção dos profissionais de saúde. Métodos: Trata-se de estudo descritivo e exploratório, com abordagem qualitativa, realizado com profissionais de saúde especialistas em obstetrícia e saúde mental. Coleta de dados com entrevista individual, orientada por roteiro semiestruturado. Os dados foram gravados, transcritos na íntegra, sistematizados, categorizados e organizados pelo método de Análise de conteúdo de Bardin. A abordagem fundamentada no referencial teórico nacional e internacional sobre a depressão na gravidez ancorou as análises e discussões. Resultados: Foram identificados 24 fatores de risco distribuídos em quatro categorias: socioeconômica, psíquica; obstétrica/materna e psicossocial. Conclusão: Na percepção dos profissionais de saúde, fatores de risco socioeconômicos, psíquicos, obstétricos/maternos e psicossociais estão associados ao desenvolvimento de depressão na gravidez. Os fatores de risco identificados corroboram com a literatura, evidenciando o alinhamento profissional com as evidências científicas, o que reafirma a necessidade de ampliação da discussão acerca da importância da instrumentalização dos profissionais de saúde. (AU)

Objective: To identify risk factors for depression in pregnancy in the perception of health professionals. Methods: This is a descriptive and exploratory study, with a qualitative approach, carried out with health professionals who are specialists in obstetrics and mental health. Data collection with individual interviews, guided by a semi-structured script. Data were recorded, transcribed in full, systematized, categorized and organized by Bardin's Content Analysis method. The approach based on the national and international theoretical framework on depression in pregnancy anchored the analyzes and discussions. Results: 24 risk factors were identified and distributed into four categories: socioeconomic, psychological; obstetric/ maternal and psychosocial. Conclusion: In the perception of health professionals, socioeconomic, psychological, obstetric/maternal and psychosocial risk factors are associated with the development of depression during pregnancy. The identified risk factors corroborate the literature, evidencing professional alignment with scientific evidence, which reaffirms the need to expand the discussion on the importance of providing health professionals with instruments. (AU)

Objetivo: Identificar los factores de riesgo de depresión en el embarazo en la percepción de los profesionales de la salud. Métodos: Se trata de un estudio descriptivo y exploratorio, con abordaje cualitativo, realizado con profesionales de la salud especialistas en obstetricia y salud mental. Recolección de datos con entrevistas individuales, guiada por un guión semiestructurado. Los datos fueron registrados, transcritos en su totalidad, sistematizados, categorizados y organizados utilizando el método de Análisis de Contenido Bardin. El enfoque basado en el marco teórico nacional e internacional sobre la depresión en el embarazo anclado los análisis y discusiones. Resultados: se identificaron 24 factores de riesgo y se distribuyeron en cuatro categorías: socioeconómico, psicológico; obstétrico/materno y psicosocial. Conclusión: En la percepción de los profesionales de la salud, los factores de riesgo socioeconómico, psicológico, obstétrico/materno y psicosocial están asociados al desarrollo de la depresión durante el embarazo. Los factores de riesgo identificados corroboran la literatura, evidenciando alineación profesional con la evidencia científica, lo que reafirma la necesidad de ampliar la discusión sobre la importancia de dotar de instrumentos a los profesionales de la salud. (AU)

Amyloidosis Localized to the Sinonasal Tract: From the Diagnosis to Management of Disease.

Amyloidosis is a mainly systemic rare disease and its localized presentation is even less frequent. Systemic forms are often associated with other conditions or entities (such as neoplasms), and a correct etiological study of patients with this disease is essential. A localized presentation has a better prognosis compared to systemic forms, which underlines the importance of a correct diagnosis. Primary localized amyloidosis in the head and neck region is a rare entity. Primary amyloidosis localized to the sinonasal tract is extremely rare. Although uncommon, case reports have been increasing in the face of new endoscopic and imaging techniques, and the report of these cases is crucial for a better characterization of this entity. Symptoms may include epistaxis, nasal obstruction, facial deformity, and vision changes. A 72-year-old female with a history of frequent nasal congestion with two years' duration showed no improvement following symptom management. She was referred for nasal endoscopy and biopsy, thereby confirming the diagnosis of amyloidosis. Further diagnostic testing did not show evidence of systemic disease. This case report was previously presented as a poster presentation at the 19th European Congress of Internal Medicine in March 2021.

Distribuição da COVID-19 e dos recursos de saúde na Amazônia Legal: uma análise espacial / Distribution of COVID-19 cases and health resources in Brazil's Amazon region: a spatial analysis

Resumo O método de análise espacial permite mensurar a acessibilidade espacial dos serviços de saúde para alocação dos recursos de forma eficiente e eficaz. Diante disso, o objetivo deste estudo foi analisar a distribuição espacial das taxas de COVID-19 e dos recursos de saúde na Amazônia Legal. Estudo ecológico realizado com casos de COVID-19 e os recursos de saúde nos 772 municípios em dois picos da pandemia. Utilizou-se o método bayesiano global e local para elaboração de mapas coropléticos, com cálculo do índice de Moran para análise da dependência espacial e utilização do Moran map para identificação dos clusters da doença. Os índices de Moran calculados para os dois períodos demonstraram autocorrelação espacial positiva dessa distribuição e dependência espacial entre os municípios nos dois períodos, sem muita diferença entre os dois estimadores. Evidenciaram-se maiores taxas da doença nos estados do Amapá, Amazonas e Roraima. Em relação aos recursos de saúde, observou-se alocação de forma ineficiente, com maior concentração nas capitais.

Abstract Spatial analysis can help measure the spatial accessibility of health services with a view to improving the allocation of health care resources. The objective of this study was to analyze the spatial distribution of COVID-19 detection rates and health care resources in Brazil's Amazon region. We conducted an ecological study using data on COVID-19 cases and the availability of health care resources in 772 municipalities during two waves of the pandemic. Local and global Bayesian estimation were used to construct choropleth maps. Moran's I was calculated to detect the presence of spatial dependence and Moran maps were used to identify disease clusters. In both periods, Moran's I values indicate the presence of positive spatial autocorrelation in distributions and spatial dependence between municipalities, with only a slight difference between the two estimators. The findings also reveal that case rates were highest in the states of Amapá, Amazonas, and Roraima. The data suggest that health care resources were inefficiently allocated, with higher concentrations of ventilators and ICU beds being found in state capitals.

Eventos virtuais promovidos pela liga de cuidados à saúde da mulher na pandemia de covid-19 / Eventos virtuales promovidos por care league a la salud de la mujer en la pandemia de covid-19 / Virtual events promoted by the women's health care league during the covid-19 pandemic

Resumo Objetivo analisar a percepção dos participantes sobre os eventos online promovidos durante o primeiro ano da pandemia da Covid-19 pela Liga de Cuidados à Saúde das Mulheres (LCSM). Métodos estudo transversal, descritivo, de abordagem quantitativa e qualitativa, desenvolvido de forma online com 90 participantes em dez eventos sobre a temática relativa à saúde da mulher, promovidos pela LCSM no ano de 2020. Os dados foram coletados por um formulário semi-estruturado online no período de julho a novembro de 2021. Para a análise de dados, utilizou-se o IBM SPSS, por meio de estatística descritiva das variáveis qualitativas e para a análise dos dados qualitativos utilizou-se a análise temática. Resultados 98,89% dos participantes responderam que os eventos da LCSM no formato online influenciaram de forma positiva na vida acadêmica, profissional ou pessoal. A análise das respostas permitiu a identificação de três categorias: sentimento de "aproximação" à Universidade, descrição das influências positivas, e conhecimentos para além da sala de aula. Conclusão e implicações para a prática Os dados do presente estudo permitem inferir o importante e necessário papel da tecnologia da informação e das ligas acadêmicas na construção do conhecimento e no aprofundamento das reflexões e do debate sobre os cuidados à saúde das mulheres.

Resumen Objetivo analizar la percepción de los participantes de los eventos online promovidos durante el primer año de la pandemia del Covid-19 por la Liga para el Cuidado de la Salud de la Mujer (LCSM). Método estudio transversal, descriptivo, con abordaje cuantitativo y cualitativo, desarrollado online con 90 participantes en diez eventos sobre el tema salud de la mujer, promovidos por la LCSM en 2020. Los datos fueron recogidos a través de un formulario semi-estructurado en línea de julio a noviembre de 2021. Para el análisis de datos se utilizó IBM SPSS, a través de estadística descriptiva de variables cualitativas y para el análisis de datos cualitativos se utilizó análisis temático. Resultados El 98,89% de los participantes respondieron que los eventos LCSM en formato online influyeron positivamente en su vida académica, profesional o personal. El análisis de las respuestas permitió identificar tres categorías: sentirse "más cerca" de la Universidad, descripción de influencias positivas y conocimiento más allá del aula. Conclusión e implicaciones para la práctica Los datos del presente estudio permiten inferir el importante y necesario papel de las tecnologías de la información y de las ligas académicas en la construcción del conocimiento y en la profundización de la reflexión y el debate sobre el cuidado de la salud de las mujeres.

Abstract Objective to analyze the participants' perception of the online events promoted during the first year of the Covid-19 pandemic by the Women's Health Care League (LCSM). Methods cross-sectional, descriptive study, with a quantitative and qualitative approach, developed online with 90 participants in ten events on the theme of women's health, promoted by LCSM in 2020. Data were collected using a semi-structured online form from July to November 2021. For data analysis, IBM SPSS was used, through descriptive statistics of qualitative variables and for the analysis of qualitative data, thematic analysis was used. Results 98,89% of the participants answered that the LCSM events in online format had a positive influence on their academic, professional or personal life. The analysis of the responses allowed the identification of three categories: feeling of "closeness" to the University, description of positive influences, and knowledge beyond the classroom. Conclusion and implications for practice The data from this study allow us to infer the important and necessary role of information technology and academic leagues in the construction of knowledge and in the deepening of reflections and debate on women's health care.

Development and validation of an instrument for the evaluation of HIV care in Primary Health Care / Construcción y validación de un instrumento para la evaluación de la atención del VIH en la Atención Primaria de Salud / Construção e validação de instrumento avaliativo para atendimento ao HIV na Atenção Primária à Saúde

ABSTRACT Objective: To develop and validate an instrument to evaluate the decentralization process of care for People Living with HIV in Primary Health Care. Method: Methodological study, developed in four stages: elaboration of the logical model based on the triad Structure-Process-Outcomes; development of the instrument; content validation by expert judges and technical reviewers; and semantic validation. Online questionnaires were used, and the Kappa index was used for analysis. Results: The instrument with 68 items and 8 factors was submitted to validation by expert judges who recommended the exclusion of 3 items and the alteration of 2 factors. In the validation by technical reviewers, 2 items were excluded and 6 factors were highlighted; the agreement index was ≥0.75. In the semantic validation, 87.3% of the judges answered "totally agree" for the items presented. Conclusion: The instrument is validated for its content, has 63 items and has the potential to assess the care provided for people living with HIV in Primary Health Care.

RESUMEN Objetivo: Construir y validar un instrumento para la evaluación del proceso de descentralización de la atención a personas conviviendo con VIH en la Atención Primaria de Salud. Métodos: Es un estudio metodológico desarrollado en cuatro etapas: elaboración del modelo lógico basado en la tríada Estructura-Proceso-Resultados; construcción del instrumento; validación del contenido por jueces especialistas y revisores técnicos; y validación semántica. Se utilizaron cuestionarios en línea y el índice de Kappa para el análisis. Resultados: El instrumento con 68 ítems y 8 factores fue sometido a validación por jueces expertos que recomendaron la exclusión de 3 ítems y el cambio de 2 factores. En la validación por parte de los revisores técnicos, se excluyeron 2 ítems y se puntuaron 6 factores; el índice de acuerdo fue ≥0,75. En la validación semántica, el 87,3% respondió "totalmente de acuerdo" a los ítems presentados. Conclusiones: El instrumento se encuentra validado cuanto al contenido, posee 63 ítems y potencial para la evaluación de la atención de personas conviviendo con VIH en la Atención Primaria de Salud.

RESUMO Objetivo: construir e validar um instrumento de avaliação do processo de descentralização do atendimento às pessoas vivendo com HIV para Atenção Primária à Saúde. Métodos: estudo metodológico, desenvolvido em quatro etapas: elaboração do modelo lógico baseado na tríade Estrutura-Processo-Resultados; construção do instrumento; validação de conteúdo por juízes especialistas e revisores técnicos; e validação semântica. Utilizaram-se questionários on-line e, para análise, o índice de Kappa. Resultados: o instrumento, com 68 itens e 8 fatores, foi submetido à validação por juízes especialistas que recomendaram a exclusão de 3 itens e mudança de 2 fatores. Na validação por revisores técnicos, foram excluídos 2 itens e pontou-se 6 fatores, o índice de concordância foi ≥0,75. Na validação semântica 87,3% responderam "concordo totalmente" para os itens apresentados. Conclusões: O instrumento encontra-se validado quanto ao conteúdo, possui 63 itens e potencial para avaliação do atendimento às pessoas vivendo com HIV na Atenção Primária à Saúde.

Construct elaboration and validity of the Pregnancy Depression Risk Scale / Elaboración y validación del constructo de la Escala de Riesgo de Depresión en el Embarazo / Elaboração e validação de construto da Escala de Risco de Depressão na Gravidez

ABSTRACT Objectives: to elaborate and analyze the Pregnancy Depression Risk Scale psychometric properties. Methods: methodological research, in six steps: theoretical model empirical definition; elaboration of scale items with literature review; consultation with five professional health experts and 15 pregnant women; content validity with six experts; pre-test-semantic validity with 24 pregnant women; scale factor structure definition with 350 pregnant women; pilot study with 100 pregnant women, totaling 489 pregnant women and 11 experts. Data were analyzed by content analysis, exploratory factor analysis, multitrait-multimethod analysis and internal consistency. Results: sixty-eight risk factors were identified for item formulation. The final version of the scale consisted of 24 items in five domains. The scale demonstrated satisfactory construct content, semantic, validity and reliability. Conclusions: the scale proved to be valid in terms of content and semantics, with a factor structure defined according to the adopted theoretical model and satisfactory psychometric properties.

RESUMEN Objetivos: elaborar y analizar las propiedades psicométricas de la Escala de Riesgo de Depresión en el Embarazo. Métodos: investigación metodológica, en seis etapas: definición empírica del modelo teórico; elaboración de ítems de escala con revisión de literatura; consulta con cinco profesionales de la salud y 15 mujeres embarazadas; validación de contenido con seis expertos; pre-prueba-validación semántica con 24 gestantes; definición de la estructura factorial de la escala con 350 gestantes; estudio piloto con 100 gestantes, totalizando 489 gestantes y 11 especialistas. Los datos fueron analizados por análisis de contenido, análisis factorial exploratorio, análisis multirrasgo-multimétodo y consistencia interna. Resultados: se identificaron 68 factores de riesgo para la formulación de los ítems. La versión final de la escala constaba de 24 ítems en cinco dominios. La escala demostró validez de contenido, semántica, de constructo y confiabilidad satisfactoria. Conclusiones: la escala se mostró válida en contenido y semántica, con estructura factorial definida según el modelo teórico adoptado y propiedades psicométricas satisfactorias.

RESUMO Objetivos: elaborar e analisar as propriedades psicométricas da Escala de Risco de Depressão na Gravidez. Métodos: pesquisa metodológica, em seis etapas: definição empírica do modelo teórico; elaboração dos itens da escala com revisão da literatura; consulta a cinco especialistas profissionais de saúde e 15 gestantes; validação de conteúdo com seis especialistas; pré-teste-validação semântica com 24 gestantes; definição da estrutura fatorial da escala com 350 gestantes; estudo piloto com 100 gestantes, totalizando 489 gestantes e 11 especialistas. Os dados foram analisados pela análise de conteúdo, análise fatorial exploratória, análise multitraço-multimétodo e consistência interna. Resultados: 68 fatores de risco foram identificados para formulação dos itens. A versão final da escala foi composta por 24 itens em cinco domínios. A escala demonstrou validade de conteúdo, semântica, de construto e fidedignidade satisfatória. Conclusões: a escala mostrou-se válida em conteúdo e semântica, com estrutura fatorial definida segundo modelo teórico adotado e propriedades psicométricas satisfatórias.

Chemotherapy Drugs Act Differently in the Expression and Somatic Mobilization of the mariner Transposable Element in Drosophila simulans.

Transposable elements (TEs) are abundant in genomes. Their mobilization can lead to genetic variability that is useful for evolution, but can also have deleterious biological effects. Somatic mobilization (SM) has been linked to degenerative diseases, such as Alzheimer's disease and cancer. We used a Drosophila simulans strain, in which SM can be measured by counting red spots in the eyes, to investigate how chemotherapeutic agents affect expression and SM of the mariner TE. Flies were treated with Cisplatin, Dacarbazine, and Daunorubicin. After acute exposure, relative expression of mariner was quantified by RT-qPCR and oxidative stress was measured by biochemical assays. Exposure to 50 and 100 µg/mL Cisplatin increased mariner expression and ROS levels; catalase activity increased at 100 µg/mL. With chronic exposure, the number of spots also increased, indicating higher mariner SM. Dacarbazine (50 and 100 µg/mL) did not significantly alter mariner expression or mobilization or ROS levels, but decreased catalase activity (100 µg/mL). Daunorubicin (25 and 50 µM) increased mariner expression, but decreased mariner SM. ROS and catalase activity were also reduced. Our data suggest that stress factors may differentially affect the expression and SM of TEs. The increase in mariner transposase gene expression is necessary, but not sufficient for mariner SM.

Capsaicin Decreases Kidney Iron Deposits and Increases Hepcidin Levels in Diabetic Rats with Iron Overload: A Preliminary Study.

Iron overload (IOL) increases the risk of diabetes mellitus (DM). Capsaicin (CAP), an agonist of transient receptor potential vanilloid-1 (TRPV1), reduces the effects of IOL. We evaluated the effects of chronic CAP administration on hepcidin expression, kidney iron deposits, and urinary biomarkers in a male Wistar rat model with IOL and DM (DM-IOL). IOL was induced with oral administration of iron for 12 weeks and DM was induced with streptozotocin. Four groups were studied: Healthy, DM, DM-IOL, and DM-IOL + CAP (1 mg·kg-1·day-1 for 12 weeks). Iron deposits were visualized with Perls tissue staining and a colorimetric assay. Serum hepcidin levels were measured with an enzyme-linked immunosorbent assay. Kidney biomarkers were assayed in 24 h urine samples. In the DM-IOL + CAP group, the total area of iron deposits and the total iron content in kidneys were smaller than those observed in both untreated DM groups. CAP administration significantly increased hepcidin levels in the DM-IOL group. Urinary levels of albumin, cystatin C, and beta-2-microglobulin were similar in all three experimental groups. In conclusion, we showed that in a DM-IOL animal model, CAP reduced renal iron deposits and increased the level of circulating hepcidin.

Insight into the Burden of Malignant Respiratory Tumors and their Relationship with Smoking Rates and Lead Contamination in Mexico.

We aimed to report the results from the Global Burden of Disease Study 2019 related to respiratory malignant tumors (tracheal, bronchial, and lung) in Mexico. We also evaluated the relationship between the burden of these neoplasms and the proportion of daily smokers and total lead emissions in 2019. A cross-sectional analysis of ecological data was performed. The burden of these tumors was 152,189 disability-adjusted life-years (DALYs), and years of life lost (YLL) contributed to 99% of them. The highest DALYs rates (per 100,000) were observed in the states of Sinaloa, Chihuahua, Baja California Sur, Sonora, and Nayarit. We documented a linear relationship between the DALYs rates and the prevalence of daily smokers (ß = 8.50, 95% CI 1.58-15.38) and the total lead emissions (tons/year: ß = 4.04, 95% CI 0.07-8.01). If later replicated, our study would provide insight into the major relevance of regulating tobacco use and the activities associated with the production of lead dust and other hazardous contaminants.

Implementação da consulta de enfermagem do adolescente em um Ambulatório Escola: relato de experiência

Resumo Objetivo: relatar a implementação da consulta de enfermagem do adolescente em um ambulatório escola de uma Instituição de Ensino Superior na cidade de Petrópolis/RJ. Método: tratou-se de relato de experiência, desenvolvido nos seguintes momentos: identificação de necessidades; concepção; aprovação junto à IES; estabelecimento de parcerias; divulgação para o público-alvo; e operacionalização da consulta. Resultados: no período de julho a dezembro de 2016 foram realizados 64 atendimentos no ambulatório, além de diversas salas de espera e de ações de educação em saúde em escolas. Mediante trabalho em equipe multidisciplinar foi possível planejar e oferecer um serviço bem estruturado com vistas ao acompanhamento efetivo dos adolescentes. Além disso, houve criação de vínculos e confiança com a comunidade e aprimoramento da formação dos estudantes de Enfermagem. Como esforço coletivo e grande impacto dessa medida, têm-se uma demanda que segue em crescimento. Conclusões: a implementação da consulta de enfermagem do adolescente foi essencial no Ambulatório Escola, pois os adolescentes necessitavam de cuidados e de um espaço onde pudessem ser ouvidos, acolhidos e empoderados quanto ao seu autocuidado e sua saúde nessa fase de mudanças, questionamentos e possíveis vulnerabilidades.

Decreased Expression of Sam68 Is Associated with Insulin Resistance in Granulosa Cells from PCOS Patients.

BACKGROUND AND OBJECTIVE: Polycystic ovary syndrome (PCOS) is a complex metabolic disorder associated with ovulatory dysfunction, hyperandrogenism, obesity, and insulin resistance, which leads to subfertility. PCOS is the most frequent metabolic disorder in women and the major cause of infertility. Susceptibility to developing PCOS is determined by a complex interaction between environmental and genetic factors. Although different mechanisms have been proposed to explain PCOS manifestations, defects in insulin actions or in the insulin signaling pathways are central in the pathogenesis of the syndrome. However, the mechanisms (molecular players and signaling pathways) underlying its primary origin still remain an unsolved issue. Current research is increasingly focusing on the discovery of novel biomarkers to further elucidate the complex pathophysiology of PCOS. Sam68, an RNA-binding protein, is recruited to insulin signaling, mediating different insulin actions. We aimed to investigate the role of Sam68 in insulin signaling and the possible implications of Sam68 in the insulin resistance in PCOS. MATERIALS AND METHODS: Granulosa cells were taken from women with PCOS (n = 25) and healthy donors (n = 25) and, within the age range of 20 to 42 years, from GINEMED, Assisted Reproduction Centre, Seville, Spain. The Sam68 expression level was analyzed both by qPCR and immunoblot. Statistical significance was assessed by one-way ANOVA, followed by a post-hoc test. A p value of < 0.05 was considered statistically significant. RESULTS: We found that insulin stimulation increases the phosphorylation and expression level of Sam68 in granulosa cells from normal donors. The downregulation of Sam68 expression resulted in a lower activation of both the MAPK and the PI3K pathways in response to insulin. Moreover, the granulosa cells from the women with PCOS presented a lower expression of Sam68, as well as insulin receptor and insulin receptor substrate-1 (IRS-1). In these cells, the overexpression of Sam68 resulted in an increased activation of both the MAPK and the PI3K pathways in response to insulin. CONCLUSIONS: These results suggest the participation of Sam68 in insulin receptor signaling, mediating the insulin effect in granulosa cells, and they suggest the possible role of Sam68 in the insulin resistance of PCOS.

Cluster de fatores de risco modificáveis e sua associação com percepção negativa de saúde em idosos / Cluster of modifiable risk factors and its association with negative perception of health in the elderly

Resumo Introdução A exposição a múltiplos fatores de riscos de forma simultânea podem repercutir negativamente no estado de saúde de pessoas idosas. Objetivo Identificar a presença simultânea de fatores de risco modificáveis e sua associação com a autopercepção negativa de saúde de idosos. Método Trata-se de estudo transversal com 310 idosos do município de Ibicuí-BA. Foram coletadas informações sobre fatores de riscos - consumo regular de álcool, tabagismo, inatividade física no lazer (IFL), consumo inadequado de frutas, verduras e legumes (CIFVL) - por meio de entrevistas. Na análise dos dados foram utilizados procedimentos da estatística descritiva e inferencial. Resultados Maiores escores de cluster foram observados na combinação do consumo regular de álcool e CIFVL em homens e a combinação de tabagismo e IFL entre as mulheres. A presença cumulativa de fatores de risco incrementou a probabilidade de autopercepção negativa do estado de saúde. Contudo, não houve associação entre as variáveis. Conclusão Houve diferença entre as principais combinações de cluster entre homens e mulheres. As combinações de fatores de riscos relacionadas à percepção negativa de saúde podem contribuir para o desenvolvimento de ações de promoção da saúde para a população idosa.

Abstract Background Exposure to multiple risk factors simultaneously can negatively impact the health status of older people. Objective To identify the simultaneous presence of modifiable risk factors and their association with the negative self-perception of elderly health. Method This is a cross-sectional study with 310 elderly people in the city of Ibicuí-BA. Information on risk factors - regular consumption of alcohol, smoking, leisure-time physical inactivity (IFL), inadequate consumption of fruits and vegetables (CIFVL) - was collected through interviews. In the data analysis procedures of descriptive and inferential statistics were used. Results Highest cluster scores were observed for the combination of regular alcohol consumption and CIFVL in men and the combination of smoking and IFL among women. The cumulative presence of risk factors increased the probability of negative self-perception of health status, although there was no statistically significant association. Conclusion There was a difference between the main cluster combinations between men and women. The combination of risk factors related to negative perception of health can contribute to the development of health promotion actions for the elderly population.

Risk of depression in pregnancy among pregnant women undergoing high-risk prenatal care.

OBJECTIVE: to identify the risk of depression in pregnancy among pregnant women undergoing follow-up in high-risk prenatal care, to assess the factors associated with higher risk of depression in pregnancy and to compare the risk of depression in each gestational trimester. METHOD: this is a descriptive, correlational, cross-sectional study, conducted with 151 pregnant women in prenatal care in a high-risk pregnancy outpatient clinic at a university hospital in the state of São Paulo, Brazil. Data were collected through an online form. Chi-square and Fisher's exact tests were performed. After the bivariate analysis, the variables were included in the logistic regression model. In the final model, the Odds Ratio was calculated. RESULTS: 118 (78.1%) pregnant women had a higher risk of depression during pregnancy, which was higher in the first trimester, but without statistical significance. The number of pregnancies (OR = 0.32) and marital status (OR = 0.07) remained significantly associated with higher risk of depression during pregnancy as protective factors. CONCLUSION: the results elucidate the importance of screening for depression risk and the significant need to improve access to effective interventions for preventing prenatal depression and promoting mental health.

The mesenchymal potential of trunk neural crest cells.

It has long been held that the main difference between cranial and trunk neural crest (CNC and TNC, respectively) was the potential of CNC to originate mesenchymal cell types, especially skeletogenic. This is an age-old question that continues to challenge researchers, even today. Unfortunately, to date, no consensus has concluded the extent of TNC mesenchymal potential, nor has a systematic review been conducted to organize current knowledge about this fascinating question. However, the number of studies related to this question have expanded and deepened considerably in the last few years thanks to several new different species of vertebrates employed, the generation of transgenic animal strains, the combination of cell markers, and also the improvement of cell culture conditions through the use of different substrates and signaling molecules. Therefore, this review summarizes the literature showing that TNCCs can generate a broad range of mesenchymal cell types, including skeletogenic. This potential can be unveiled by certain favorable in vitro conditions, but it also seems to be expressed in some animal structures in vivo, to which TNCCs contribute. We also present several works that offer a contrary view and do not detect any mesenchymal/skeletogenic contribution of TNCCs in vivo. Perhaps, it is the controversy itself that makes this subject even more exciting.