The impact of cardiopulmonary bypass time on the Sequential Organ Failure Assessment score after cardiac surgery.

OBJECTIVES: Postoperative organ dysfunction is common after cardiac surgery, particularly when cardiopulmonary bypass (CPB) is used. The Sequential Organ Failure Assessment (SOFA) score is validated to predict morbidity and mortality in cardiac surgery. However, the impact of CPB duration on postoperative SOFA remains unclear. METHODS: This is a retrospective study. Categorical values are presented as percentages. The comparison of SOFA groups utilized the Kruskal-Wallis chi-squared test, complemented by ad hoc Dunn's test with Bonferroni correction. Multinomial logistics regressions were employed to evaluate the relationship between CPB time and SOFA. RESULTS: A total of 1032 patients were included. CPB time was independently associated with higher postoperative SOFA scores at 24 h. CPB time was significantly higher in patients with SOFA 4-5 (**P = 0.0022) or higher (***P < 0.001) when compared to SOFA 0-1. The percentage of patients with no/mild dysfunction decreased with longer periods of CPB, down to 0% for CPB time >180min (50% of the patients with >180m in of CPB presented SOFA ≥ 10). The same trend is observed for each of the SOFA variables, with higher impact in the cardiovascular and renal systems. Severe dysfunction occurs especially >200 min of CPB (cardiovascular system >100 min; other systems mainly >200 min). CONCLUSIONS: CPB time may predict the probability of postoperative SOFA categories. Patients with extended CPB durations exhibited higher SOFA scores (overall and for each variable) at 24 h, with higher proportion of moderate and severe dysfunction with increasing times of CPB.

Machine learning-based soil quality assessment for enhancing environmental monitoring in iron ore mining-impacted ecosystems.

In November 2015, a catastrophic rupture of the Fundão dam in Mariana (Brazil), resulted in extensive socio-economic and environmental repercussions that persist to this day. In response, several reforestation programs were initiated to remediate the impacted regions. However, accurately assessing soil health in these areas is a complex endeavor. This study employs machine learning techniques to predict soil quality indicators that effectively differentiate between the stages of recovery in these areas. For this, a comprehensive set of soil parameters, encompassing 3 biological, 16 chemical, and 3 physical parameters, were evaluated for samples exposed to mining tailings and those unaffected, totaling 81 and 6 samples, respectively, which were evaluated over 2 years. The most robust model was the decision tree with a restriction of fewer levels to simplify the tree structure. In this model, Cation Exchange Capacity (CEC), Microbial Biomass Carbon (MBC), Base Saturation (BS), and Effective Cation Exchange Capacity (eCEC) emerged as the most pivotal factors influencing model fitting. This model achieved an accuracy score of 92% during training and 93% during testing for determining stages of recovery. The model developed in this study has the potential to revolutionize the monitoring efforts conducted by regulatory agencies in these regions. By reducing the number of parameters that necessitate evaluation, this enhanced efficiency promises to expedite recovery monitoring, simultaneously enhancing cost-effectiveness while upholding the analytical rigor of assessments.

Clinical, Economic, and Humanistic Impact of Short-Bowel Syndrome/Chronic Intestinal Failure in Portugal (PARENTERAL Study).

Introduction: This study aimed to assess the clinical, economic, and humanistic impact of short-bowel syndrome/chronic intestinal failure (SBS/CIF) in Portugal. Methods: This is a retrospective multicenter cohort chart review study, with a cross-sectional component for quality-of-life (QoL) evaluation. Inclusion criteria comprised patients with SBS/CIF, aged ≥1 year, with stable parenteral nutrition (PN). Data collection included patient chart review over a 12-month period and patient/caregiver self-report and SF-36/PedsQL™ questionnaires. Main endpoints comprised clinical and PN characterization, healthcare resource use (HRU), direct costs, and patient QoL. Results: Thirty-one patients were included (11 adults and 20 children). Patients' mean age (standard deviation [SD]) was 57.9 (14.3) years in adults and 7.5 (5.0) years in children, with a mean time since diagnosis of 10.2 (5.9) and 6.6 (4.2) years, respectively. PN was administered for a mean of 5.2 and 6.6 days/week in adults and children, respectively; home PN occurred in 81.8% of adults and 90.0% of children for a mean of 9.6 and 10.8 months/year, respectively. The mean annual number of hospitalizations was 1.9 and 2.0 which lasted for a mean of 34.0 and 29.4 days in adults and children, respectively. Twenty-one and forty hospitalization episodes were reported in adults and children, respectively, of which 71.4% and 85.0% were due to catheter-related complications. Mean annual direct costs per patient amounted to 47,857.53 EUR in adults and 74,734.50 EUR in children, with PN and hospitalizations as the main cost-drivers. QoL assessment showed a clinically significant impaired physical component in adults and a notable deterioration in the school functioning domain in children. Conclusion: In Portugal, SBS/CIF patient management is characterized by a substantial therapeutic burden and HRU, translating into high direct costs and a substantial impairment of the adults' physical function and children's school functioning.

Introdução: Este estudo teve como objetivo avaliar o impacto clínico, económico e social da síndrome do intestino curto/falência intestinal crónica (SIC/FIC) em Portugal. Métodos: Estudo de coorte retrospectivo e multicêntrico de revisão dos processos clínicos incluindo uma componente transversal para avaliação da qualidade de vida (QV). Os critérios de elegibilidade incluíram doentes com SIC/FIC, idade ≥1 ano, em nutrição parenteral (NP) e clinicamente estáveis. A recolha de dados incluiu a revisão dos processos clínicos ao longo de um período de 12 meses e a aplicação de questionários auto-administrados a doentes e cuidadores e de questionários de QV (SF-36/PedsQL™). Os indicadores principais foram a caracterização clínica e da NP, a utilização de recursos de saúde, custos diretos e QV dos doentes. Resultados: Foram incluídos 31 doentes (11 adultos e 20 crianças). A idade média (desvio padrão: DP) foi de 57.9 (14.3) anos nos adultos e de 7.5 (5.0) nas crianças com um tempo médio desde o diagnóstico de 10.2 (5.9) e 6.6 (4.2) anos, respetivamente. A NP foi administrada durante uma média de 5.2 e 6.6 dias por semana, em adultos e crianças respetivamente, em 81.8% e 90.0% dos adultos/crianças foi feita em casa durante uma média de 9.6 ou 10.8 meses por ano, respetivamente. O número médio anual de hospitalizações foi de 1.9 (1.6) e 2.0 (1.5) com uma duração média de 34.0 (47.4) e 29.4 (32.3) dias, em adultos e crianças, respetivamente. Foram reportados 21 e 40 episódios de hospitalização em adultos/crianças, dos quais 71.4% e 85.0% foram devido a complicações relacionadas ao uso de cateter. Os custos diretos anuais médios por doente ascenderam a 47,857.53 EUR nos adultos e a 74,734.50 EUR nas crianças, sendo que os maiores responsáveis foram a NP e as hospitalizações. A avaliação da QV mostrou um comprometimento clinicamente significativo da componente física nos adultos e uma deterioração relevante da dimensão escolar nas crianças. Conclusões: A gestão dos doentes com SIC/FIC em Portugal é caracterizada por uma sobrecarga substancial a nível terapêutico e de utilização de recursos de saúde, o que se traduz em elevados custos diretos e comprometimento substancial da componente física nos adultos e do desempenho escolar nas crianças.

Spin-orbit torque flash analog-to-digital converter.

Although analog-to-digital converters (ADCs) are critical components in mixed-signal integrated circuits (IC), their performance has not been improved significantly over the last decade. To achieve a radical improvement (compact, low power and reliable ADCs), spintronics can be considered as a proper candidate due to its compatibility with CMOS and wide applications in storage, neuromorphic computing, and so on. In this paper, a proof-of-concept of a 3-bit spin-CMOS Flash ADC using in-plane-anisotropy magnetic tunnel junctions (i-MTJs) with spin-orbit torque (SOT) switching mechanism is designed, fabricated and characterized. In this ADC, each MTJ plays the role of a comparator whose threshold is set by the engineering of the heavy metal (HM) width. Such an approach can reduce the ADC footprint. Monte-Carlo simulations based on the experimental measurements show the process variations/mismatch limits the accuracy of the proposed ADC to 2 bits. Moreover, the maximum differential nonlinearity (DNL) and integral nonlinearity (INL) are 0.739 LSB (least significant bit) and 0.7319 LSB, respectively.

Seasonal occurrence and risk assessment of endocrine-disrupting compounds in Tagus estuary biota (NE Atlantic Ocean coast).

Estuaries are continually threatened by anthropogenic pressures, consequently, a large group of contaminants harmful to human health affects the aquatic biota; therefore, it is necessary to monitor their quality. This study deals with the determination of a large group of compounds representing different endocrine-disrupting compounds (EDCs) classes [21 pesticides, 4 polycyclic musk fragrances, 4 UV-filters, 7 bisphenols, 6 polybrominated diphenyl ethers (PBDEs) and 8 of their methoxylated (MeO-BDEs)] in several estuarine species (fish, bivalves, crustaceans, earthworm, and macroalgae) collected seasonally along one year in two distinct areas of Tagus River estuary ("contaminated" vs. "clean" areas). The most abundant compounds found were galaxolide (HHCB) (81% positive samples; 0.04-74 ng/g ww), isoamyl 4-methoxycinnamate (IMC) (64%; 1.13-251 ng/g ww), alachlor (44%; 0.08-16 ng/g ww), and BDE-47 (36%; 0.06-2.26 ng/g ww). Polycyclic musks were the most frequent contaminants in fish (seabass, barbus, mullet, and sole) and macroalgae samples, while UV-filters were predominant in bivalves and crustaceans, and bisphenols in earthworms. Seasonal variation was verified for Σpesticides and Σmusks, with significantly higher levels in summer and autumn, whereas ΣUV-filters highest levels were found in spring and summer, and for ΣPBDEs statistically higher levels were registered in cold seasons (autumn and winter). Σbisphenols were significantly lower in spring than in the other seasons. In general, considering all species analysed in both areas, no statistically significant differences (p > 0.05) were verified between the two collection areas. Based on the estimated daily intake data, consumption of fish from this estuary is unlikely to be a human health concern, since the levels of contamination were below the toxicological threshold values. Overall, the data obtained in this study will allow regulatory authorities to identify and prioritize contaminants monitoring programs in estuaries, such as the case of bisphenol A, which was found, for the first time, in earthworm and clam species.

Occurrence and risk assessment of endocrine-disrupting compounds in fish muscle: The case study of the Douro River estuary (North East Atlantic Ocean).

This work was focused on evaluating the occurrence of endocrine-disrupting compounds (EDCs) in fish muscles, such as bisphenol analogues, personal care products, including some UV-filters and musk fragrances, and selected pesticides. A total of 238 muscle samples of three fish species (Platichthys flesus, Mugil cephalus, and Dicentrarchus labrax) of an important estuary ending in the North East Atlantic Ocean (Douro River estuary, Portugal), in different seasons of the year, was analysed. M. cephalus was the species with a greater occurrence of contaminants, mainly in fishes collected during the spring. Bisphenol A was the main bisphenol analogue detected with an average content of 23.1 µg/kg wet weight (w.w.). Among chemicals used in personal care products, galaxolide, tonalide, and 2-ethylhexyl salicylate, were the most often found, being present in 15.9% (2.2-538.4 µg/kg w. w.), 4.6% (1.1-57.8 µg/kg w. w.) and 3.4% (3.9-56.1 µg/kg w. w.) of the samples, respectively. About 14% of the samples contained residues of at least one pesticide, being alachlor, aldrin, p,p'-DDT, permethrin, and prochloraz the main chemicals observed, varying from 0.1 µg/kg w. w. (p,p'-DDT) to 37.8 µg/kg w. w. (prochloraz). The daily intake estimates of the most frequent EDCs found in the fish muscles suggested that there are no health concerns, based on the recommended weekly consumption of fish for adults.

Sequential Organ Failure Assessment Score in the ICU As a Predictor of Long-Term Survival After Cardiac Surgery.

OBJECTIVES: The Sequential Organ Failure Assessment (SOFA) score is a predictor of mortality in ICU patients. Although it is widely used and has been validated as a reliable and independent predictor of mortality and morbidity in cardiac ICU, few studies correlate early postoperative SOFA with long-term survival. DESIGN: Retrospective observational cohort study. SETTING: Tertiary academic cardiac surgery ICU. PATIENTS: One-thousand three-hundred seventy-nine patients submitted to cardiac surgery. INTERVENTIONS: SOFA 24 hours, SOFA 48 hours, mean, and highest SOFA scores were correlated with survival at 12 and 24 months. Wilcoxon tests were used to analyze differences in variables. Multivariate logistic regressions and likelihood ratio test were used to access the predictive modeling. Receiver operating characteristic curves were used to assess accuracy of the variables in separating survivor from nonsurvivors. MEASUREMENTS AND MAIN RESULTS: Lower SOFA scores have better survival rates at 12 and 24 months. Highest SOFA and SOFA at 48 hours showed to be better predictors of outcome and to have higher accuracy in distinguishing survivors from nonsurvivors than initial SOFA and mean SOFA. A decreasing score during the first 48 hours had mortality rates of 4.9%, while an unchanged or increased score was associated with a mortality rate of 5.7%. CONCLUSIONS: SOFA score in the ICU after cardiac surgery correlated with survival at 12 and 24 months. Patients with lower SOFA scores had higher survival rates. Differences in survival at 12 months were better correlated with the absolute value at 48 hours than with its variation. SOFA score may be useful to predict long-term outcomes and to stratify patients with higher probability of mortality.

Vulnerabilidades de mulheres em situação de rua: marcadores sociais de gênero e raça/cor / Vulnerabilities of homeless women: social markers of gender and race/color

RESUMO Objetivo desvelar as vulnerabilidades de mulheres em situação de rua vinculadas aos marcadores sociais de gênero e raça/cor. Métodos estudo qualitativo, desenvolvido com dez mulheres em situação de rua por meio de observação participante, diário de campo e aplicação de questionário sociodemográfico, sistematizados com base na análise de conteúdo. Resultados verificou-se que a identidade de gênero e a raça/cor atuam como potencializadores da situação de vulnerabilidade das mulheres. Acredita-se que o racismo estrutural e o machismo se retroalimentam nas ruas e se perpetuam em um ciclo perverso de negação de direitos às mulheres, que se potencializa pela omissão do Estado e extensa desigualdade social e econômica. Conclusão o gênero e a raça/cor potencializam as vulnerabilidades de mulheres em situação de rua que interseccionam as condições sociais precárias, a negação de direitos e favorecem o adoecimento. Contribuições para a prática: apresentar informações que possibilitem reflexões e criação de estratégias de cuidado dispensado às mulheres em situação de rua, compreendidas em suas singularidades.

ABSTRACT Objective to unveil the vulnerabilities of homeless women linked to the social markers of gender and race/color. Methods qualitative study, developed with ten homeless women through participant observation, field diary, and sociodemographic questionnaire, systematized based on content analysis. Results it was found that gender identity and race/color act as potentiators of the situation of vulnerability of women. It is believed that structural racism and machismo feed back into the streets and perpetuate themselves in a perverse cycle of denial of women's rights, which is potentiated by the omission of the State and extensive social and economic inequality. Conclusion gender and race/color potentiate the vulnerabilities of homeless women that intersect precarious social conditions, denial of rights, and favor illness. Contributions to practice: to present information that enables reflections and creation of care strategies for homeless women, understood in their singularities.

An Up-Scalable and Cost-Effective Methodology for Isolating a Polypeptide Matrix Metalloproteinase-9 Inhibitor from Lupinus albus Seeds.

One of the most challenging problems with food-borne bioactive compounds is that there are commonly no cost-effective, generally recognized as safe (GRAS) methods for obtaining gram quantities of their purified forms. Here we aimed at developing a method to isolate deflamin, an oligomeric protein from lupin seeds with anti-inflammatory and anticancer activity through matrix metalloprotease (MMP)-9 inhibition. Our goal was to develop a GRAS method that could be easily up-scalable whilst maintaining deflamin's activity. A sequential precipitation methodology was developed, using an aqueous extraction, followed by heat denaturation, acid precipitation and solubilization in ethanol. A final precipitation with 90% ethanol yielded a purified protein which was sequenced through mass spectrometry and tested for its MMP inhibitory activity using the Dye-quenched (DQ) gelatin assay and the standard wound healing assay in HT29 cells. The developed method yielded a purified oligomer, which represented 0.1% (w/w) of total dry seed weight and was positively confirmed to be deflamin. It further showed to effectively reduce MMP-9 gelatinolytic activity as well as colon cancer cell migration, hence corroborating the effectiveness of our method. Overall, this is the first reported method for isolating an MMP-9 inhibitor from legume seeds, which is up-scalable to an industrial level, in a cost-effective manner.

Patient-Physician discordance in assessment of disease activity in Rheumatoid Arthritis patients.

BACKGROUND: In rheumatoid arthritis (RA), global disease activity is commonly evaluated, from the patient's and the physician's perspective, through a 100mm visual analogue scale (VAS) and plays an important role in the assessment of diseases activity and treatment decisions. Our aim was to determine patient-physician discordance in the assessment of disease activity and to explore its determinants. METHODS: Cross sectional study including RA patients (ACR/EULAR 2010 classification criteria). The discrepancy between patients-physicians (∆PPhGA) was defined as PGA minus PhGA, and a difference > |20mm| was considered as "discordant". Correlation between ∆PPhGA and other variables was assessed through Pearson's correlation and comparison between groups through t-test. Variables with p < 0.05 or considered clinically relevant were included in multivariable linear regression analysis to identify determinants for ∆PPhGA. A p < 0.05 was considered statistically significant. RESULTS: In total, 467 patients with RA were included (81.2% female; mean age 63.9% ± 12.2 years). PGA and PhGA were discordant in 61.7% of the cases. The proportion of concordance increased (p < 0.01) when considering only patients in remission (DAS 28 3V < 2.6). In multivariable analysis (R2adjusted=0.27), VAS-pain-patient (ß 0.74, 95% CI 0.62-0.88, p=0.00) and TJC (ß 0.16, 95% CI 0.45-0.48, p=0.02) remained associated with a higher ∆PPhGA. CONCLUSION: Our study confirmed that a significant discrepancy between patients and physicians in the assessment of global disease activity is frequent in clinical practice, and is probably due to valorization of different parameters by the two groups.

High patient global assessment scores in patients with rheumatoid arthritis otherwise in remission do not reflect subclinical inflammation.

OBJECTIVES: To assess whether high patient global assessment (PGA) scores by patients with rheumatoid arthritis (RA) otherwise in remission reflect subclinical inflammation. METHODS: Cross-sectional, single-center study, including consecutive RA patients. Remission states were defined based on the ACR/EULAR Boolean definition: 4V-remission (tender and swollen 28-joint counts (TJC28/SJC28), C-reactive protein (CRP), and PGA all≤1), PGA-near-remission (the same, except PGA>1), and non-remission (any of TJC28, SJC28, CRP>1). A blinded expert musculoskeletal ultrasonographer scanned 44 joints, 38 tendon sheaths, 4 bursae on the same day of the clinical evaluation. Each structure was assessed for the presence of Grey Scale synovial hypertrophy (GS) and Power Doppler (PD), both scored using a semi-quantitative scale (0-3 points). The Global OMERACT-EULAR Synovitis Score (GLOESS, 0-132, primary outcome), and a global tenosynovitis/bursitis score (GTBS) were compared between remission states, using non-parametric tests. Different sensitivity analyses comparing GS and PD subscores were performed. RESULTS: In total, 130 patients (mean age 63 years, 86% female, average disease duration 14 years) were included 40 being in 4V-remission, 40 in PGA-near-remission, 50 in non-remission. 4v-remission and PGA-near-remission presented similar median (IQR) GLOESS, [6 (5-11) and 4 (1-7), P>0.05, respectively] and GTBS [0 (0-1) and 0 (0-2), P>0.05, respectively]. The same was observed in GS, PD scores, and in global synovitis score considering only the 16 joints not included in 28-joint counts. These observations were confirmed in patients with≤5 years disease duration. CONCLUSIONS: Subclinical inflammation is not present among persons with elevated PGA who are otherwise in remission. PGA-near-remission patients would be exposed to the risk of overtreatment if current treatment recommendations were strictly followed. This study supports the need to reconsider the role of PGA in definitions used to target immunosuppressive therapy and to provide a separate and enhanced focus to the patient's experience of the disease.

Revisiting the use of remission criteria for rheumatoid arthritis by excluding patient global assessment: an individual meta-analysis of 5792 patients.

OBJECTIVES: To determine the impact of excluding patient global assessment (PGA) from the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean remission criteria, on prediction of radiographic and functional outcome of rheumatoid arthritis (RA). METHODS: Meta-analyses using individual patient data from randomised controlled trials testing the efficacy of biological agents on radiographic and functional outcomes at ≥2 years. Remission states were defined by 4 variants of the ACR/EULAR Boolean definition: (i) tender and swollen 28-joint counts (TJC28/SJC28), C reactive protein (CRP, mg/dL) and PGA (0-10=worst) all ≤1 (4V-remission); (ii) the same, except PGA >1 (4V-near-remission); (iii) 3V-remission (i and ii combined; similar to 4V, but without PGA); (iv) non-remission (TJC28 >1 and/or SJC28 >1 and/or CRP >1). The most stringent class achieved at 6 or 12 months was considered. Good radiographic (GRO) and functional outcome (GFO) were defined as no worsening (ie, change in modified total Sharp score (ΔmTSS) ≤0.5 units and ≤0.0 Health Assessment Questionnaire-Disability Index points, respectively, during the second year). The pooled probabilities of GRO and GFO for the different definitions of remission were estimated and compared. RESULTS: Individual patient data (n=5792) from 11 trials were analysed. 4V-remission was achieved by 23% of patients and 4V-near-remission by 19%. The probability of GRO in the 4V-near-remission group was numerically, but non-significantly, lower than that in the 4V-remission (78 vs 81%) and significantly higher than that for non-remission (72%; difference=6%, 95% CI 2% to 10%). Applying 3V-remission could have prevented therapy escalation in 19% of all participants, at the cost of an additional 6.1%, 4.0% and 0.7% of patients having ΔmTSS >0.0, >0.5 and >5 units over 2 years, respectively. The probability of GFO (assessed in 8 trials) in 4V-near-remission (67%, 95% CI 63% to 71%) was significantly lower than in 4V-remission (78%, 74% to 81%) and similar to non-remission (69%, 66% to 72%). CONCLUSION: 4V-near-remission and 3V-remission have similar validity as the original 4V-remission definition in predicting GRO, despite expected worse prediction of GFO, while potentially reducing the risk of overtreatment. This supports further exploration of 3V-remission as the target for immunosuppressive therapy complemented by patient-oriented targets.

Patient Global Assessment of Disease Activity and Radiographic Progression in Early Arthritis: Three-Year Results From the ESPOIR Cohort.

OBJECTIVE: To determine whether patient global assessment of disease activity (PtGA) over the first year of disease course, as part of a Boolean-based definition of remission and considered individually, had a significant relationship with structural progression over 3 years in patients with early arthritis. METHODS: We conducted a prospective, observational study using ESPOIR (Étude et Suivi des Polyarthrites Indifférenciées Récentes) cohort data. Remission states were defined as 1) 4-variable remission, which included a tender joint count in 28 joints, a swollen joint count in 28 joints (SJC28), a C-reactive protein (CRP; mg/dl) level, and PtGA (scored 0-10, all scores of ≤1); 2) PtGA near remission, which included the same parameters as 4-variable remission with only PtGA >1 (of a maximum possible score of 10); 3) 3-variable remission (sum of the proportion of patients in 4-variable remission and the proportion of patients in PtGA near remission); or 4) nonremission. The strictest status satisfied both at 6 and 12 months was considered. Radiographic progression was determined as a change of ≥5 points in the total Sharp/van der Heijde score (ΔSHS) from baseline to 3 years. The predictive capacities for radiographic damage of different remission definitions were assessed by odds ratio (OR). The association between each individual component of remission with ΔSHS was tested through multivariate linear regression analyses. RESULTS: Among 520 patients, 7% achieved 4-variable remission and 12% achieved PtGA near remission. Radiographic progression was observed in 29% of patients who achieved 4-variable remission (OR versus nonremission; OR 0.32 [95% confidence interval (95% CI) 0.15, 0.68]) and in 45% of patients with PtGA near remission (OR 0.65 [95% CI 0.38, 1.11]); the comparison was not statistically different (OR 0.49 [95% CI 0.20, 1.18]). In 3-variable remission, radiographic progression was observed in 39%. Of the individual components, only the SJC28 and CRP level were associated with radiographic progression. CONCLUSION: All definitions of remission led to low structural degradation in early arthritis, and 4-variable remission led to less radiographic progression than PtGA near remission, but without a statistically significant difference. Both 4-variable remission and 3-variable remission appear to be useful targets when aiming for structural nonprogression.

Fatores associados ao conhecimento de pessoas leigas sobre suporte básico de vida / Factores asociados con el conocimiento de los laicos sobre el soporte vital básico / Factors associated with lay people's knowledge about basic life support

Resumo Analisar os fatores associados ao conhecimento de pessoas leigas acerca do suporte básico de vida. Estudo epidemiológico, descritivo, de corte transversal, desenvolvido com 65 funcionários de um Campus da Universidade do Estado da Bahia. Os dados foram coletados nos meses de fevereiro e março de 2019 e tabulados no software IBM SPSS versão 21.0. A análise foi realizada através de frequências descritivas, teste qui-quadrado de Pearson e Exato de Fisher, adotando um grau de significância de 95% e valor de p <0,05. Observou-se que 67,7% dos participantes não sabem o que é suporte básico de vida, 61,5% não se sentem preparadas para agir em emergência, 58,5% não saberia como facilitar a respiração de uma vítima, 64,7% não sabem a quantidade de compressões realizadas por minuto e 86,2% não sabem a função do desfibrilador externo automático. No que se refere aos fatores associados, o conhecimento sobre suporte básico está associado a ser docente, (p=0,005), sentirse preparado para atuar em situações de emergência (p=0,001), saber como facilitar a respiração da vítima (p=0,000), saber o local de realização das compressões torácicas (p=0,013). O estudo levanta a necessidade de maior capacitação de pessoas leigas acerca do suporte básico de vida para que possam assistir adequadamente as vítimas de parada cardíaca em ambiente extra-hospitalar.

Abstract To analyze the factors associated with the knowledge of lay people about basic life support. This is a descriptive cross-sectional epidemiological study, conducted with 65 employees from a Campus at the State University of Bahia. Data were collected in February and March 2019 and tabulated in IBM SPSS version 21.0 software. The analysis was performed using descriptive frequencies, Pearson's chi-square test and Fisher's exact test, adopting a significance level of 95% and p value <0.05. It was observed that 67.7% of participants do not know what is basic life support, 61.5% do not feel prepared to act in emergency, 58.5% would not know how to facilitate the breathing of a victim, 64.7% do not know the amount of compressions performed per minute and 86.2% do not know the function of the automatic external defibrillator. Regarding associated factors, knowledge about basic support is associated with being a teacher (p = 0.005), feeling prepared to act in emergency situations (p = 0.001), knowing how to facilitate the victim's breathing (p = 0.001). = 0.000), know the location of the chest compressions (p = 0.013). The study raises the need for greater training of lay people about basic life support so that they can adequately assist victims of cardiac arrest in an out-of-hospital setting.

Resumen Analizar los factores asociados con el conocimiento de los laicos sobre el soporte vital básico. Este es un estudio epidemiológico descriptivo de corte transversal, realizado con 65 empleados de un campus de la Universidad Estatal de Bahía. Los datos se recopilaron en febrero y marzo de 2019 y se tabularon en el software IBM SPSS versión 21.0. El análisis se realizó utilizando frecuencias descriptivas, la prueba de chi-cuadrado de Pearson y la prueba exacta de Fisher, adoptando un nivel de significación del 95% y un valor de p <0,05. Se observó que el 67.7% de los participantes no sabe qué es el soporte vital básico, el 61.5% no se siente preparado para actuar en caso de emergencia, el 58.5% no sabe cómo facilitar la respiración de una víctima, el 64,7% desconoce la cantidad de compresiones realizadas por minuto y el 86,2% desconoce la función del desfibrilador externo automático. Con respecto a los factores asociados, el conocimiento sobre el apoyo básico se asocia con ser un maestro (p = 0.005), sentirse preparado para actuar en situaciones de emergencia (p = 0.001), saber cómo facilitar la respiración de la víctima (p = 0.001). = 0.000), conoce la ubicación de las compresiones torácicas (p = 0.013). El estudio plantea la necesidad de una mayor capacitación de los laicos sobre el soporte vital básico para que puedan ayudar adecuadamente a las víctimas de un paro cardíaco en un entorno fuera del hospital.

Percepção de enfermeiros acerca da demanda social à luz do princípio da integralidade / Nurses' perception about social demand in the light of the principle of integrality / Percepción de enfermeros sobre la demanda social a la luz de la integralidad

Objetivo: Identificar a percepção de enfermeiros acerca da demanda social e da aplicação do princípio da integralidade na Estratégia Saúde da Família. Métodos: Trata-se de um estudo qualitativo e descritivo, desenvolvido com 20 enfermeiras em um município referência do Território Sertão Produtivo da Bahia, Brasil. Os dados foram coletados através de entrevista norteada por um roteiro semiestruturado e sistematizados através da análise de conteúdo temático. Resultados: Verificou-se dubiedade nas interpretações acerca da demanda social da população na Estratégia Saúde da Família, pois uma parcela dos enfermeiros tem dificuldade em compreender as necessidades da comunidade, enquanto outros possuem uma percepção holística acerca da temática. Além disso, percebeu-se que a integralidade pode ser utilizada pelos profissionais como instrumento da prática diária para a compreensão, reflexão e ação diante das demandas sociais apresentadas pela população. Conclusão: Constatou-se que, através da integralidade, o profissional pode compreender as questões sociais, econômicas, políticas e culturais da população, algo determinante na construção de intervenções efetivas e específicas para cada realidade.

Objective: To identify nurses' perception of social demand and the application of the principle of integrality in the Family Health Strategy. Methods: This is a qualitative and descriptive study, carried out with 20 nurses in a reference municipality in the Territorio Sertão Productivo da Bahia, Brazil. The data were collected through interviews guided by a semi-structured script and systematized through the analysis of thematic content. Results: There was doubt in the interpretations about the social demand of the population in the Family Health Strategy, as a portion of nurses has difficulty in understanding the needs of the community, while others have a holistic perception of the theme. Besides, it was realized that integrality could be used by professionals as an instrument of daily practice for understanding, reflection, and action in the face of social demands presented by the population. Conclusion: It was found that, through comprehensiveness, the professional can understand the social, economic, political, and cultural issues of the population, something decisive in the construction of effective and specific interventions for each reality.

Objetivo: Identificar la percepción de enfermeros sobre la demanda social y de la aplicación del principio de la integralidad de la Estrategia Salud de la Familia. Métodos: Se trata de un estudio cualitativo y descriptivo desarrollado con 20 enfermeros de un municipio referencia del Territorio Campo Productivo de Bahía, Brasil. Se ha recogido los datos a través de entrevista norteada por una guía semiestructurada y sistematizada a través del análisis de contenido temático. Resultados: Se verificó la ambigüedad de las interpretaciones sobre la demanda social de la población de la Estrategia Salud de la Familia pues una parte de los enfermeros tienen dificultad para la comprensión de las necesidades de la comunidad mientras otros tienen una percepción integral de la temática. Además, se ha visto que la integralidad puede ser utilizada por los profesionales como instrumento de práctica diaria para la comprensión, la reflexión y la acción ante las demandas sociales presentadas por la población. Conclusión: Se constató que, a través de la integralidad, el profesional puede comprender las cuestiones sociales, económicas, políticas y culturales de la población que son determinantes para la construcción de intervenciones efectivas y específicas de cada realidad.