Virus adsorbent systems based on Amazon holocellulose and nanomaterials.

The environment preservation has been an important motivation to find alternative, functional, and biodegradable materials to replace polluting petrochemicals. The production of nonbiodegradable face masks increased the concentration of microplastics in the environment, highlighting the need for sustainable alternatives, such as the use of local by-products to create efficient and eco-friendly filtering materials. Furthermore, the use of smart materials can reduce the risk of contagion and virus transmission, especially in the face of possible mutations. The development of novel materials is necessary to ensure less risk of contagion and virus transmission, as well as to preserve the environment. Taking these factors into account, 16 systems were developed with different combinations of precursor materials (holocellulose, polyaniline [ES-PANI], graphene oxide [GO], silver nanoparticles [AgNPs], and activated carbon [AC]). Adsorption tests of the spike protein showed that the systems containing GO and AC were the most efficient in the adsorption process. Similarly, plate tests conducted using the VSV-IN strain cultured in HepG2 cells showed that the system containing all phases showed the greatest reduction in viral titer method. In agreement, the biocompatibility tests showed that the compounds extracted from the systems showed low cytotoxicity or no significant cytotoxic effect in human fibroblasts. As a result, the adsorption tests of the spike protein, viral titration, and biocompatibility tests showed that systems labeled as I and J were the most efficient. In this context, the present research has significantly contributed to the technological development of antiviral systems, with improved properties and increased adsorption efficiency, reducing the viral titer and contributing efficiently to public health. In this way, these alternative materials could be employed in sensors and devices for filtering and sanitization, thus assisting in mitigating the transmission of viruses and bacteria. RESEARCH HIGHLIGHTS: Sixteen virus adsorbent systems were developed with different combinations of precursor materials (holocellulose, polyaniline (ES-PANI), graphene oxide (GO), silver nanoparticles (AgNPs), and activated carbon (AC)). The system that included all of the nanocomposites holocellulose, PANI, GO, AgNPs, and AC showed the greatest reduction in viral titration. The biocompatibility tests revealed that all systems caused only mild or moderate cytotoxicity toward human fibroblasts.

Nutrition and Food Literacy: Framing the Challenges to Health Communication.

Nutrition and food literacy are two important concepts that are often used interchangeably, but they are not synonymous. Nutrition refers to the study of how food affects the body, while food literacy refers to the knowledge, skills, and attitudes necessary to make informed decisions about food and its impact on health. Despite the growing awareness of the importance of food literacy, food illiteracy remains a global issue, affecting people of all ages, backgrounds, and socioeconomic status. Food illiteracy has serious health implications as it contributes to health inequities, particularly among vulnerable populations. In addition, food literacy is a complex and multidisciplinary field, and there are numerous challenges to health communication that must be addressed to effectively promote food literacy and improve health outcomes. Addressing food illiteracy and the challenges to health communication is essential to promote health equity and improve health outcomes for all populations.

Cuide, movimente, evite lesão por pressão no seu paciente: um relato de experiência / Care, move, avoid pressure injury in your patient: an experience report / Cuidar, mover, evitar lesiones por presión en su paciente: informe de una experiencia

Introdução: As lesões por pressão (LPP) correspondem a danos na pele ou em tecidos moles encobertos, geralmente em áreas de proeminências ósseas, ou associado ao uso de dispositivo médico ou outro tipo de artefato. Diante disso, a enfermeira deve desenvolver sua prática, baseada em evidências científicas e priorizar a prevenção da formação das lesões na pele. Objetivo: Relatar a experiência de estudantes de Enfermagem sobre o desenvolvimento de ações de promoção do cuidado seguro relacionado à prevenção de LPP em pacientes internados em um hospital público pediátrico na Bahia. Metodologia: Trata-se de um estudo de caráter descritivo, do tipo relato de experiência, realizado por seis estudantes de Enfermagem em um hospital estadual pediátrico localizado no estado da Bahia, no período de novembro 2022. Principais resultados: Percebeu-se que existem profissionais de enfermagem que possuem interesse em obter mais conhecimento sobre o assunto, porém ainda há lacunas de conhecimento por parte da equipe sobre alguns assuntos abordados, tais como a escala de Braden e a utilização do colchão caixa de ovo para todas as faixas etárias. Foi possível perceber que os passos para prevenir a lesão por pressão não são cumpridos por parte da equipe e isso pode dificultar a prevenção das lesões de forma efetiva. Conclusão: Recomenda-se, portanto, que as unidades assistenciais, juntamente com suas respectivas coordenadoras, realizem ações contínuas de educação permanente, a fim de contribuir para uma melhor qualificação profissional, promovendo, acima de tudo, a segurança do paciente.

Introduction: Pressure lesions (PPL) correspond to damage to the skin or covert soft tissue, usually in areas of bony prominence, or associated with the use of a medical device or other type of artifact. Therefore, nurses should develop their practice, based on scientific evidence and prioritize the prevention of skin lesion formation. Objective: To report the experience of nursing students on the development of actions to promote safe care related to the prevention of PPL in patients admitted to a pediatric public hospital in Bahia. Methodology: This is a descriptive study, of the type of experience report, conducted by six nursing students in a pediatric state hospital located in the state of Bahia, in the period of November 2022. Main results: It was noticed that there are nursing professionals who have an interest in obtaining more knowledge about the subject, but there are still gaps in knowledge on the part of the team on some subjects addressed, such as the Braden scale and the use of the egg box mattress for all age groups. It was possible to notice that the steps to prevent pressure injury are not met by the team and this can hinder the prevention of injuries effectively. Conclusion: It is recommended, therefore, that the care units, together with their respective coordinators, carry out continuous actions of continuing education, in order to contribute to a better professional qualification, promoting, above all, patient safety.

Introducción: Las lesiones por presión (LPP) corresponden a lesiones en la piel o tejidos blandos encubiertos, generalmente en zonas de prominencia ósea, o asociadas al uso de un dispositivo médico u otro tipo de artefacto. Por ello, el personal de enfermería debe desarrollar su práctica, basándose en la evidencia científica y priorizando la prevención de la formación de lesiones cutáneas. Objetivo: Relatar la experiencia de estudiantes de enfermería sobre el desarrollo de acciones para promover cuidados seguros relacionados a la prevención de PPL en pacientes internados en un hospital público pediátrico de Bahía. Metodología: Se trata de un estudio descriptivo, del tipo relato de experiencia, realizado por seis estudiantes de enfermería en un hospital público pediátrico localizado en el estado de Bahía, en el período de noviembre de 2022. Principales resultados: Se observó que hay profesionales de enfermería que tienen interés en obtener más conocimientos sobre el tema, pero todavía hay lagunas de conocimiento por parte del equipo en algunos temas abordados, como la escala de Braden y el uso del colchón caja de huevos para todos los grupos de edad. Se pudo notar que los pasos para prevenir lesiones por presión no son cumplidos por el equipo y esto puede dificultar la prevención de lesiones de forma efectiva. Conclusiones: Se recomienda, por lo tanto, que las unidades asistenciales, junto con sus respectivos coordinadores, realicen acciones continuas de formación continuada, con el fin de contribuir a una mejor cualificación profesional, promoviendo, sobre todo, la seguridad del paciente.

Diagnostic accuracy of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) to estimate disability after stroke.

PURPOSE: To analyze WHODAS 2.0's diagnostic capacity and accuracy in stroke survivors. METHODS: Cross-sectional methodological study, in which individuals with chronic stroke were evaluated. Disability was considered the outcome variable, being evaluated by WHODAS 2.0; the modified Rankin scale (mRS) was used as the parameter variable. Disability was categorized in two levels being: "No or mild disability" (mRS 0-2) and "Moderate to severe disability" (mRS 3-5). To identify the cutoff point, a Receiver-Operating Characteristic (ROC) curve was constructed with a confidence interval (CI) of 95% and considering sensitivity and specificity. RESULTS: The cutoff point >39.62 proved acceptable for distinguishing individuals with moderate/severe disability from individuals with no or mild disability (≤39.62 points), with 66.22% sensitivity, 72.41% specificity, positive predictive value (PPV) of 45.45%, and negative predictive value (NPV) of 84.74%. The area under the curve (AUC) was 0.747 (CI 95%: 0.65-0.83; p < 0.001). CONCLUSION: WHODAS 2.0 demonstrated acceptable diagnostic capacity and the cutoff point of 39.62 proved suitable for distinguishing individuals with moderate/severe disability from those with no or mild disability after stroke.Implications for rehabilitationWHODAS 2.0 demonstrated acceptable diagnostic capacity.The WHODAS 2.0 cut-off point of >39.62 allows stratification of post-stroke disability into two different levels (no/mild disability versus moderate/severe disability).These results facilitate clinical decision-making by rehabilitation professionals.

Cost-effectiveness of an exercise-based cardiovascular rehabilitation program in patients with chronic Chagas cardiomyopathy in Brazil: An analysis from the PEACH study.

OBJECTIVES: The present study aimed to perform a cost-effectiveness analysis of an exercise-based cardiovascular rehabilitation (CR) program in patients with chronic Chagas cardiomyopathy (CCC). METHODS: Cost-effectiveness analysis alongside a randomised clinical trial evaluating the effects of a 6-month exercise-based CR program. The intervention group underwent 3 weekly exercise sessions. The variation of peak oxygen consumption (VO2peak ) was used as a measurement of clinical outcome. Cost information from all healthcare expenses (examinations, healthcare visits, medication and hospitalisation) were obtained from the medical records in Brazilian reais (R$) and transformed into dollars using the purchasing power parity ($PPP). The longitudinal costs variation was evaluated through linear mixed models, represented by ß coefficient, adjusted for the baseline values of the dependent variable. The cost-effectiveness evaluation was determined through an incremental cost-effectiveness ratio using the HEABS package (Stata 15.0). RESULTS: The intervention group presented higher costs with healthcare visits (ß = +3317.3; p < 0.001), hospitalisation (ß = +2810.4; p = 0.02) and total cost (ß = +6407.9; p < 0.001) after 3 months of follow-up. Costs related to healthcare visits (ß = +2455.8; p < 0.001) and total cost (ß = +4711.4; p < 0.001) remained higher in the intervention group after 6 months. The CR program showed an incremental cost-effectiveness ratio (ICER) of $PPP 1874.3 for each increase of 1.0 ml kg-1  min-1 of VO2peak . CONCLUSIONS: The CR program can be considered a cost-effective alternative and should be included as an intervention strategy in the care of patients with CCC.

Barreiras no acesso aos serviços de saúde por residentes de comunidades rurais: Revisão integrativa / Barreras en el acceso a los servicios de salud por parte de los residentes de comunidades rurales: Revisión integrativa / Barriers in access to health services by residents of rural communities: Integrative review

Objetivo: compreender as barreiras no acesso aos serviços de saúde por residentes de comunidades rurais. Método: Trata-se de uma revisão integrativa da literatura, realizada no período de agosto a novembro de 2021, nas bases de dados Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online e ScienceDirect. Resultados: A busca nas bases de dados resultou em um total de 44 artigos selecionados. Aplicados os critérios de inclusão e exclusão, foi elencado para análise, o total de 21 artigos os quais foram lidos na íntegra. Destes, 3 foram excluídos, pois não contemplaram o objeto abordado e 18 artigos foram selecionados para integrar este estudo. Conclusão: Foi possível compreender a estrutura de acesso aos serviços de saúde primários pela população residente de comunidades rurais, identificando as barreiras e dificuldades enfrentadas, permite prover e pensar em estratégias que minimizem os impactos sobre a saúde desta população(AU)

Objective: to understand the barriers in accessing health services by residents of rural communities. Method: This is an integrative literature review, carried out from August to November 2021, in the Scientific Electronic Library Online, Medical Literature Analysis and Retrieval System Online and ScienceDirect databases. Results: The search in the databases resulted in a total of 44 selected articles. After applying the inclusion and exclusion criteria, a total of 21 articles were listed for analysis, which were read in full. Of these, 3 were excluded, as they did not contemplate the object addressed and 18 articles were selected to integrate this study. Conclusion: It was possible to understand the structure of access to primary health services by the population residing in rural communities, identifying the barriers and difficulties faced, allowing to provide and think of strategies that minimize the impacts on the health of this population(AU)

Objetivo: comprender las barreras en el acceso a los servicios de salud por parte de los habitantes de las comunidades rurales. Método: Se trata de una revisión integrativa de la literatura, realizada de agosto a noviembre de 2021, en las bases de datos Scientific Electronic Library Online, Medical Literature Analysis and Retrieval System Online y ScienceDirect. Resultados: La búsqueda en las bases de datos arrojó un total de 44 artículos seleccionados. Después de aplicar los criterios de inclusión y exclusión, se listaron para su análisis un total de 21 artículos, los cuales fueron leídos en su totalidad. De estos, 3 fueron excluidos, por no contemplar el objeto abordado y 18 artículos fueron seleccionados para integrar este estudio. Conclusión: Fue posible comprender la estructura de acceso a los servicios primarios de salud por parte de la población residente en las comunidades rurales, identificando las barreras y dificultades enfrentadas, permitiendo brindar y pensar estrategias que minimicen los impactos en la salud de esta población(AU)

Thiazolidine derivatives: In vitro toxicity assessment against promastigote and amastigote forms of Leishmania infantum and ultrastructural study.

Neglected diseases, such as Leishmaniasis, constitute a group of communicable diseases that occur mainly in tropical countries. Considered a public health problem with limited treatment. Therefore, there is a need for new therapies. In this sense, our proposal was to evaluate in vitro two series of thiazolidine compounds (7a-7e and 8a-8e) against Leishmania infantum. We performed in vitro evaluations through macrophage cytotoxicity assays (J774) and nitric oxide production, activity against promastigotes and amastigotes, as well as ultrastructural analyzes in promastigotes. In the evaluation of cytotoxicity, the thiazolidine compounds presented CC50 values between 8.52 and 126.83 µM. Regarding the evaluation against the promastigote forms, the IC50 values ranged between 0.42 and 142.43 µM. Compound 7a was the most promising, as it had the lowest IC50. The parasites treated with compound 7a showed several changes, such as cell body shrinkage, shortening and loss of the flagellum, intense mitochondrial edema and cytoplasmic vacuolization, leading the parasite to cell inviability. In assays against the amastigote forms, the compound showed a low IC50 (0.65 µM). These results indicate that compound 7a was efficient for both evolutionary forms of the parasite. In silico studies suggest that the compound has good oral bioavailability. These results show that compound 7a is a potential drug candidate for the treatment of Leishmaniasis.

Relatório de recomendação final para adoção de um protocolo estadual no estado de Santa Catarina complementar ao protocolo clínico e diretrizes terapêuticas do ministério da saúde para tratamento farmacológico da hipertensão pulmonar no âmbito do SUS / Final recommendation report for the adoption of a state protocol in the state of Santa Catarina complementary to the clinical protocol and therapeutic guidelines of the Ministry of Health for pharmacological treatment of pulmonary hypertension within the scope of the SUS

Este relatório refere-se à análise crítica do documento "Diagnóstico e Tratamento de Hipertensão Pulmonar'', elaborado pela ACAPTI e enviado como proposta para elaboração de Protocolo Estadual de Hipertensão Pulmonar, contemplando o tratamento farmacológico de HP grupo 1 (HAP) e grupo 4 (HPTEC). No documento encaminhado pelo demandante consta uma breve introdução e contextualização da patologia, diagnóstico clínico e exames complementares, critérios de inclusão e exclusão, especialidades médicas, estratificação de risco e seguimento, tratamento medicamentoso, algoritmo de tratamento medicamentoso, acessos aos medicamentos e centros de referência. Os itens relacionados ao diagnóstico foram mantidos neste relatório, conforme o documento enviado pelo demandante. Este relatório visa avaliar e emitir um parecer técnico embasado em evidências científicas sobre a disponibilização do medicamento Selexipague, a disponibilização da terapia combinada (Ambrisentana, Bosentana, Sildenafila, Ilopros a e Selexipague) para o tratamento da HP grupo 1 (HAP), a disponibilização do medicamento Riociguate para tratamento de HP grupo 4 (HPTEC), algoritmo de tratamento medicamentoso e fluxo de acesso aos medicamentos, para posterior elaboração de um Protocolo Estadual para a patologia solicitada. O Protocolo Estadual será elaborado complementarmente ao protocolo do Ministério da Saúde, assim, caso os medicamentos englobados nele sejam incorporados para a patologia em questão pela CONITEC, o fornecimento dos mesmos passa a ser por meio do CEAF.

Impacto da radioterapia adjuvante na sobrevida global e sobrevida livre de doença em pacientes do INCA / Impact of adjuvant radiotherapy on global survival and disease-free survival on INCA patients

Introdução: O câncer de mama é considerado o câncer com maior incidência e prevalência no sexo feminino e a sobrevida em países latino-americanos em geral encontra-se, em média, 20% abaixo daquela em países europeus e nos EUA. E dentre algumas das opções terapêuticas se encontra a radioterapia adjuvante com o objetivo de erradicar quaisquer depósitos tumorais remanescentes após a cirurgia para pacientes tratados por cirurgia conservadora da mama ou mastectomia. Alguns ensaios clínicos randomizados indicam um possível "efeito abscopal" em que a adição de radioterapia a cirurgia também pode reduzir o risco de recorrências distantes, diminuindo assim a mortalidade específica do câncer de mama. Objetivo: Analisar a incidência de recidiva, metástase e óbito, além de estimativa de sobrevida livre de doença e sobrevida global de acordo com a realização ou não de radioterapia adjuvante Método: Estudo do tipo coorte retrospectiva em mulheres com diagnóstico de câncer de mama no HCIII / INCA, no período de 2006 a 2010, do estádio I ao III e que foram submetidas a radioterapia adjuvante sendo realizado coleta de dados no Cadastro de Registro Hospitalar de Câncer do HCIII/INCA, complementadas por busca ativa nos prontuários físicos e eletrônicos, além de um instrumento de coleta de dados que foi elaborado exclusivamente para este estudo. Características sócio demográficas (idade do diagnostico, sexo, raça, escolaridade e estado civil), variáveis relacionadas ao tumor primário (data do diagnóstico, tipo histológico, estadiamento, status axilar, grau histológico, imunohistoquímica e terapia aplicadas) e evolução da doença (metástases, óbito e sobrevida global) foram avaliadas. Resultados: A população do estudo compreendeu 1771 mulheres. Nos estadiamentos iniciais (I a IIA) foram encontradas 964 mulheres (54,4%) e 807 (45,6%), em estadiamentos avançados (IIB ­ III). O tipo histológico mais prevalente foi carcinoma ductal infiltrante, em 81,3% das pacientes avaliadas e o subtipo molecular mais frequente foi luminal A, correspondendo a 65,3% das pacientes e o segundo mais frequente foi o triplo negativo com 12,9%. O grau histológico mais frequente foi grau 3, com 668 das pacientes (50,4%). Sobre os tratamentos concomitantes, no grupo que foi submetido a radioterapia, 35,5% foram submetidas também a quimioterapia neoadjuvante, 44% a quimioterapia adjuvante e 73,6% a hormonioterapia adjuvante. 27,4% não realizaram qualquer tipo de quimioterapia. Quanto ao tratamento cirúrgico da mama nas pacientes que realizaram radioterapia adjuvante, 65,5% foram submetidas à mastectomia e 34,5% a segmentectomia e em relação a abordagem axilar, 25,1% foram submetidas a biópsia do linfonodo sentinela e 60,4% fizeram linfadenectomia axilar. Considerando recidiva ou metástase, foi encontrado 29% nas que realizaram radioterapia adjuvante, e 22,9 % nas que não realizaram o procedimento. Em relação aos óbitos, relacionado ou não a evolução do câncer, foi encontrada taxa de 29,3% tanto nas que fizeram, como nas que não foram submetidas a radioterapia adjuvante. Para as pacientes que realizaram radioterapia adjuvante a média de sobrevida livre doença foi de cerca de 94 meses e sobrevida global de cerca de 100 meses, já em pacientes que não foram submetidas ao mesmo procedimento, a média de sobrevida livre de doença foi de cerca de 98 meses e sobrevida global em cerca de 100 meses. Conclusão: A radioterapia adjuvante já é tratamento bem estabelecido no cenário do câncer de mama, e a possibilidade de um efeito "abscopal" interferir positivamente na história natural da doença melhorando sobrevida livre de doença e sobrevida global não foi encontrada na avaliação dos nossos dados, bem como, não houve diferença na comparação dos dados em relação a presença de recidivas ou metástases em pacientes que realizaram ou não o procedimento.

Introduction: Breast cancer is considered the cancer with the highest incidence and prevalence in females and survival in Latin American countries is, on average, 20% lower than in European countries and the USA. And among some of the therapeutic options is adjuvant radiotherapy with the aim of eradicating any tumor deposits remaining after surgery for patients treated by breast-conserving surgery or mastectomy. Some RCTs indicate a possible "abscopal effect" in which the addition of radiotherapy to surgery may also reduce the risk of distant recurrences, thus decreasing breast cancer-specific mortality. Objective: To analyze the incidence of recurrence, metastasis and death, in addition to estimating disease-free survival and overall survival according to whether or not adjuvant radiotherapy was performed Method: Retrospective cohort study in women diagnosed with breast cancer at HCIII/ INCA, in the period from 2006 to 2010, from stages I to III and who underwent adjuvant radiotherapy, with data collection being carried out in the Hospital Registry of Cancer of the HCIII/INCA, complemented by an active search in the physical and electronic records, in addition to of a data collection instrument that was designed exclusively for this study. Sociodemographic characteristics (age at diagnosis, sex, race, education and marital status), variables related to the primary tumor (date of diagnosis, histological type, staging, axillary status, histological grade, immunohistochemistry and therapy applied), and disease evolution ( metastases, death and overall survival) were evaluated. Results: The study population comprised 1771 women. In the initial stages (I to IIA), 964 women (54.4%) were found and 807 (45.6%) were in advanced stages (IIB ­ III). The most prevalent histological type was infiltrating ductal carcinoma, in 81.3% of the patients evaluated and the most frequent molecular subtype was luminal A, corresponding to 65.3% of the patients and the second most frequent was triple negative with 12.9% . The most frequent histological grade was grade 3, with 668 of the patients (50.4%). Regarding concomitant treatments, in the group that underwent radiotherapy, 35.5% were also submitted to neoadjuvant chemotherapy, 44% to adjuvant chemotherapy and 73.6% to adjuvant hormone therapy. 27.4% did not undergo any type of chemotherapy. Regarding the surgical treatment of the breast in patients who underwent adjuvant radiotherapy, 65.5% underwent mastectomy and 34.5% segmentectomy and in relation to the axillary approach, 25.1% underwent sentinel lymph node biopsy and 60.4 % underwent axillary lymphadenectomy. Considering recurrence or metastasis, 29% were found in those who underwent adjuvant radiotherapy, and 22.9% in those who did not undergo the procedure. Regarding deaths, related or not to the evolution of cancer, a rate of 29.3% was found both in those who underwent and in those who did not undergo adjuvant radiotherapy. For patients who underwent adjuvant radiotherapy, the mean disease-free survival was about 94 months and overall survival was about 100 months, whereas in patients who did not undergo the same procedure, the mean disease-free survival was about 100 months. 98 months and overall survival of about 100 months. Conclusion: Adjuvant radiotherapy is already a well-established treatment in the breast cancer scenario, and the possibility of an "abscopal" effect positively interfering with the natural history of the disease, improving disease-free survival and overall survival was not found in the evaluation of our data, as well as, there was no difference in the comparison of data regarding the presence of recurrences or metastases in patients who underwent the procedure or not

Relatório de recomendação para adoção de um protocolo estadual para atendimento de casos suspeitos ou confirmados de síndrome de trombose com trombocitopenia (STT) associada à vacinação com as vacinas de vetor de adenovírus não replicante contra a covid-19 em Santa Catarina / Recommendation report for the adoption of a state protocol for the care of suspected or confirmed cases of thrombosis syndrome with thrombocytopenia (STT) associated with vaccination with non-replicating adenovirus vector vaccines against covid-19 in Santa Catarina

Este relatório refere-se à análise crítica dos documentos apresentados pelo CRIE/DIVE/SES/SC para a elaboração de um Protocolo Estadual de atendimento para casos de Síndrome de Trombose com Trombocitopenia (STT) associada à vacinação com vacinas de vetor de adenovírus não replicante contra a COVID-19, baseados na Nota Técnica CGPNI/DEIDT/SVS/MS nº 933/2021. Na Nota Técnica emitida pelo Ministério da Saúde consta uma breve contextualização, a investigação da STT, protocolo de investigação laboratorial, manejo clínico de casos e definição de casos para investigação de STT. O documento enviado pelo CRIE/DIVE/SES/SC intitulado "Fluxograma de Atendimento TTS" apresentou os dados da nota supracitada resumidos com a adição de um fluxograma de atendimento hospitalar. Este relatório visa avaliar e emitir um parecer técnico embasado em evidências científicas sobre a disponibilização dos medicamentos Imunoglobulina Humana intravenosa (IGHIV) e Rivaroxabana para o tratamento de STT, fluxo de aces o aos medicamentos e avaliação do impacto orçamentário, para posterior elaboração de um Protocolo Estadual para esta síndrome, destinado aos profissionais da saúde, pacientes e gestores do estado de Santa Catarina.

A nurse practitioner-led care bundle approach for primary care of patients with complex health needs.

BACKGROUND: Often developed for acute care and less frequently for primary care, care bundles are clusters of evidence-based practices for improving care delivery and patient outcomes. Care bundles usually arise when ineffective or costly outcomes are identified, are meant to make care more reliable, and require superb teamwork and communication. LOCAL PROBLEM: Patients using the highest proportion of health care services are those living with complex health conditions and challenging sociocultural lives, statistics corroborated within our primary care clinic. In our nurse practitioner (NP)-led, interprofessional, team-based primary care program serving mainly low-income patients, we noted that many patients with multiple chronic conditions had an excess of clinic encounters, emergency department visits, and hospitalizations. METHODS: To improve health status for these patients and reduce costly care inefficiencies, we developed a unique bundle of care practices for embedding within our NP-led complex care program. Our goals were to improve patient efficacy for self-management of chronic conditions and promote appropriate use of health care resources and services. INTERVENTIONS: Using AEIØOU as a mnemonic, the derived care bundle better focused our team efforts and provided us with a planning, communication, and documentation schema for quality improvement. It was particularly useful for team-based care because tasks could be documented or communicated by letter or number and easily reviewed by team members or others involved in patients' care. RESULTS: Use of the AEIØOU bundle within our program resulted in better coordination of team-based comprehensive care for our high-needs patients, seen anecdotally in fewer unnecessary contacts and missed appointments and in patient appreciation comments. Emergency department visits and hospitalization data for the six months before compared with 6 months after enrollment in the program showed significant reductions. CONCLUSIONS: To improve the primary care of complex patient populations, we recommend further use and testing of the AEIØOU bundle within other care models.

Impacto do efeito calendário na morbimortalidade por causas externas em municípios turísticos no Estado de São Paulo, Brasil, no período de 2004 a 2014 / Impact of calendar effect on morbidity and mortality from external causes in tourist towns in the State of São Paulo, Brazil, from 2004 to 2014 / Impacto del efecto calendario en la morbimortalidad por causas externas en municipios turísticos en el Estado de São Paulo, Brasil, durante el período de 2004 a 2014

O objetivo desta pesquisa é analisar a associação de variações temporais dos agravos e das mortes por causas externas com períodos de maior fluxo de visitantes em municípios turísticos do litoral de São Paulo, Brasil, no período de 2004 a 2014. Trata-se de um estudo ecológico, de séries temporais diárias e mensais, baseado nos dados do Sistema de Informações sobre Mortalidade (SIM) e Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS) no período de 1º de janeiro de 2004 a 31 de dezembro de 2014, tendo como unidades de análise os quatro municípios do litoral norte do Estado de São Paulo. Modelos de regressão binomial negativa foram ajustados para o desfecho que representou o número de ocorrências de internações hospitalares e/ou óbitos por causas externas, tendo como preditores as variáveis de calendário (dias da semana, feriados, mês e ano de ocorrência). Os feriados de Ano Novo, Carnaval, Tiradentes e Proclamação da República destacaram-se com médias iguais ou superiores a 5 desfechos por dia. Dentre os dias da semana, a segunda-feira e o domingo apresentaram as maiores médias. Levando em consideração todos os preditores, verifica-se maior tendência de ocorrência dos desfechos na segunda-feira (OR = 1,11; IC95%: 1,05-1,18), nos feriados de Ano Novo (OR = 1,44; IC95%: 1,19-1,74) e Proclamação da República (OR = 1,49; IC95%: 1,13-1,94) e nos meses de janeiro (OR = 1,11; IC95%: 1,02-1,20) e fevereiro (OR = 1,13; IC95%: 1,04-1,23). A morbidade e a mortalidade por causas externas nos municípios estudados foram maiores no período de maior movimentação de turistas, subsidiando a estruturação do atendimento destas lesões e as ações de prevenção e de promoção de saúde direcionadas para este grupo de causas.

This study aims to analyze the association between temporal variations in injuries and deaths from external causes and periods of greater flow of visitors in tourist municipalities (counties) on the coastline of the state of São Paulo, Brazil, from 2004 to 2014. This is an ecological study of daily and monthly time series based on data from the Brazilian Mortality Information System (SIM) and Brazilian Hospital Information System of the Brazilian Unified National Health System (SIH/SUS) from January 1, 2004, to December 31, 2014, using as the analytical units the four municipalities on the northern coast of the State of São Paulo. Negative binomial regression models were adjusted for the outcome that represented the number of hospital admissions and/or deaths from external causes, with calendar variables as predictors (days of the week, holidays, month, and year of occurrence). The Brazilian holidays New Year's Day, Carnival, Tiradentes, and Proclamation of the Republic stood out with mean numbers greater than or equal to 5 outcomes per day. Among the days of the week, Monday and Sunday had the highest mean numbers. Considering all the predictors, there was a higher tendency to the occurrence of outcomes on Monday (OR = 1.11; 95%CI: 1.05-1.18), New Year's Day (OR = 1.44; 95%CI: 1.19-1.74), and Proclamation of the Republic Day (OR = 1.49; 95%CI: 1.13-1.94) and in the months of January (OR = 1.11; 95%CI: 1.02-1.20) and February (OR = 1.13; 95%CI: 1.04-1.23). Morbidity and mortality from external causes in these tourist towns were higher in the period with the greatest flow of tourists, emphasizing the need to organize care for these injuries, alongside measures for prevention and health promotion targeted to this group of causes.

El objetivo de esta investigación es analizar la asociación de variaciones temporales en enfermedades y muertes por causas externas, durante períodos de mayor flujo de visitantes en municipios turísticos del litoral de São Paulo, Brasil, durante el período de 2004 a 2014. Se trata de un estudio ecológico, de series temporales diarias y mensuales, basado en los datos del Sistema de Información sobre Mortalidad (SIM) y Sistema de Informaciones Hospitalarias del Sistema Único de Salud (SIH/SUS), durante el período del 1º de enero de 2004 al 31 de diciembre de 2014, teniendo como unidades de análisis los cuatro municipios del litoral norte del Estado de São Paulo. Modelos de regresión binomial negativa se ajustaron al resultado que representó el número de ocurrencias de internamientos hospitalarios y/u óbitos por causas externas, teniendo como predictores variables de calendario (días de la semana, festivos, mes y año de ocurrencia). Los festivos de Año Nuevo, Carnaval, Tiradentes y Proclamación de la República se destacaron con medias iguales o superiores a 5 resultados por día. Entre los días de la semana, el lunes y el domingo presentaron las mayores medias. Teniendo en consideración todos los predictores, se verifica una mayor tendencia de ocurrencia de los resultados: los lunes (OR = 1,11; IC95%: 1,05-1,18), festivo de Año Nuevo (OR = 1,44; IC95%: 1,19-1,74) y Proclamación de la República (OR = 1,49; IC95%: 1,13-1,94) y, en los meses de enero (OR = 1,11; IC95%: 1,02-1,20) y de febrero (OR = 1,13; IC95%: 1,04-1,23). La morbilidad y mortalidad por causas externas en los municipios estudiados fueron mayores en el período de mayor movimiento de turistas, apoyando la organización de la atención a esas lesiones, así como acciones de prevención y promoción de salud dirigidas hacia este grupo de causas.

Audiological assessment of children with HIV/AIDS: a meta-analysis / Avaliação audiológica de crianças com HIV/AIDS: uma metanálise

Abstract Objective: To analyze the results of the audiological evaluation of children with HIV and AIDS. Data collection: Systematic review carried out in May 2019 in the Web of Science, PubMed, SciELO, and Scopus databases. Case reports and original articles were included, with no limitationsregarding country or year of publication. Data synthesis: 278 articles were identified; 26 were included, in which HIV/AIDS was shown to be a risk factor for hearing loss (OR = 5.364; p = 0.00). The studies used different audiological exams, with varying methodologies. There was no difference regarding the type of hearing loss (p = 0.119). Conclusion: Longitudinal studies using the same type of examination at all stages are suggested, to allow better monitoring of the effects of HIV on the child's hearing,and studies that provide more methodological details. The knowledge of the influence of HIV on the child's auditory system may lead to the promotion of measures that minimize the prevalence of hearing loss, allow an early diagnosis and timely rehabilitation, so as not to compromise child development.

Resumo Objetivo: Analisar os resultados da avaliação audiológica de crianças com HIV e AIDS. Coleta dos dados: Revisão sistemática realizada em maio de 2019 nas bases Web of Science, Pubmed, SciELO e Scopus. Relatos de caso e artigos originais foram incluídos, sem limitação quanto ao país ou ano de publicação. Síntese dos dados: Foram identificados 278 artigos, sendo que 26 foram incluídos, nos quais o HIV/AIDS foi mostrado como fator de risco para perda auditiva (OR = 5.364; p = 0.00). Os estudos utilizaram diferentes exames audiológicos, com diferentes metodologias. Não houve diferença com relação ao tipo de perda auditiva (p = 0.119). Conclusão: Sugere-se estudos longitudinais usando o mesmo tipo de exame em todas as fases para possibilitar melhor acompanhamento dos efeitos do HIV na audição da criança e estudos que tragam mais detalhes metodológicos. O conhecimento da influência do HIV no sistema auditivo infantil pode levar à promoção de medidas que minimizem a prevalência da perda auditiva, possibilitem diagnóstico precoce e permita reabilitação em tempo hábil para não comprometer o desenvolvimento infantil.

Audiological assessment of children with HIV/AIDS: a meta-analysis.

OBJECTIVE: To analyze the results of the audiological evaluation of children with HIV and AIDS. DATA COLLECTION: Systematic review carried out in May 2019 in the Web of Science, PubMed, SciELO, and Scopus databases. Case reports and original articles were included, with no limitationsregarding country or year of publication. DATA SYNTHESIS: 278 articles were identified; 26 were included, in which HIV/AIDS was shown to be a risk factor for hearing loss (OR=5.364; p=0.00). The studies used different audiological exams, with varying methodologies. There was no difference regarding the type of hearing loss (p=0.119). CONCLUSION: Longitudinal studies using the same type of examination at all stages are suggested, to allow better monitoring of the effects of HIV on the child's hearing,and studies that provide more methodological details. The knowledge of the influence of HIV on the child's auditory system may lead to the promotion of measures that minimize the prevalence of hearing loss, allow an early diagnosis and timely rehabilitation, so as not to compromise child development.

Estratégias de resistência e empoderamento de treinadoras portuguesas / Strategies of resistance and empowerment of portuguese women coaches in sports

RESUMO Considerando que a participação das mulheres no esporte tem evidenciado desigualdade e assimetria de gênero nas várias funções e âmbitos de atuação, esta pesquisa tem como objetivo analisar como a hegemonia dos homens na função de treinador é negociada e contestada por mulheres que ocupam esta posição. Para tanto, foram entrevistadas 37 treinadoras portuguesas que atuam em esporte individuais e coletivos. Os resultados indicam que a presença no cargo de treinadora não garante uma contestação a esta hegemonia. O caráter generificado atribuído à esta ocupação promove situações discriminatórias que exigem das mulheres ações de empoderamento e agência para que possam modificar estruturas que tendem a perpetuar sua sub-representação.

ABSTRACT The participation of women in sports is the subject of analysis of several studies that continuously evidence inequality and asymmetry in relation to men in the different spheres of activity within this field. The objective of this study is to comprehend male hegemony as coaches and how it is accepted and/or contested in the sports environment by identifying attitudes that incorporate this male dominance or that contradict and resist it. The sample of this study is composed of interviews with 37 Portuguese female coaches in both individual and team sports. The results indicate that the presence of women in leadership positions in sports, such as of head coach, does not ensure in itself an objection to male hegemony. It becomes necessary that women incorporate the concept of "agency" in order to identify and implement strategies that resist and consequently change the patriarchal structures that perpetuate the underrepresentation of women in coaching sports.

The human cost of global warming: Deadly landslides and their triggers (1995-2014).

Worldwide, landslides incur catastrophic and significant economic and human losses. Previous studies have characterized the patterns in landslides' fatalities, from all kinds of triggering causes, at a continental or global scale, but they were based on data from periods of <10 years. The research herein presented hypothesizes that climate change associated with extreme rainfall and population distribution is contributing to a higher number of deadly landslides worldwide. This study maps and identified deadly landslides in 128 countries and it encompasses their role, for a 20 years' period from January/1995 to December/2014, considered representative for establishing a relationship between landslides and their meteorological triggers. A database of georeferenced landslides, their date, and casualties' information, duly validated, was implemented. A hot spot analysis for the daily record of landslide locations was performed, as well as a percentile-based approach to evaluate the trend of extreme rainfall events for each occurrence. The relationship between casualty, population distribution, and rainfall was also evaluated. For 20 years, 3876 landslides caused a total of 163,658 deaths and 11,689 injuries globally. They occurred most frequently between June and December in the Northern Hemisphere, and between December and February in the Southern Hemisphere. A significant global rise in the number of deadly landslides and hotspots across the studied period was observed. Analysis of daily rainfall confirmed that more than half of the events were in areas exposed to the risk of extreme rainfall. The relationships established between extreme rainfall, population distribution, seasonality, and landslides provide a useful basis for efforts to model the adverse impacts of extreme rainfall due to climate change and human activities and thus contribute towards a more resilient society.

Enfermeiro do trabalho: contribuições para saúde de agentes de combate às endemias / Occupational nurse: contributions to health of agents to combat endemic diseases

No âmbito do Sistema Único de Saúde (SUS), cresce a demanda pela melhoria das condições de trabalho e da qualidade de vida dos trabalhadores da saúde. Agentes de Combate à Endemias (ACE) representam uma categoria relativamente recente de trabalhadores da saúde da qual se conhece pouco acerca do perfil socioeconômico e dos agravos em saúde a que estão expostos. O objetivo deste estudo foi avaliar os fatores de riscos aos quais os ACE estão expostos e descrever as ações do enfermeiro do trabalho sobre a saúde ocupacional destes trabalhadores. Trata-se de uma revisão integrativa de literatura com artigos publicados entre 2006 a 2016, na Biblioteca Virtual em Saúde. Foram identificados riscos de natureza química, física e biológica na atuação dos ACE e situações em que o enfermeiro pode atuar na minimização ou na eliminação de tais riscos.

Within the scope of Sistema Único de Saúde (SUS), the demand for improving working conditions and the quality of life of health workers is growing. Agentes de Combate à Endemias (ACE) represent a relatively recent category of health workers who are poorly informed about the socioeconomic profile and health problems they are exposed to. The objective of this study was to evaluate the risk factors to which the ACE are exposed and to describe the actions of the occupational nurse on the occupational health of these workers. It is an integrative review of literature with articles published between 2006 and 2016 in the Virtual Health Library. Chemical, physical and biological risks were identified in the performance of ACE and situations in which nurses can act in minimization or elimination of such risks.

Judicialização do acesso aos serviços de saúde: análise de caso da Secretaria de Saúde de Pernambuco / Health's Judicialization: a case study of the Health Secretariat of Pernambuco

Este artigo objetivou analisar a judicialização do acesso aos serviços de saúde na Secretaria Estadual de Saúde de Pernambuco no ano de 2016. Métodos: Tratou-se de estudo transversal, quantitativo e analítico com dados do Núcleo de Ações Judiciais da Secretaria Estadual de Saúde de Pernambuco em 2016. As variáveis foram: o produto; o estabelecimento de atendimento; CID-10; municípios da comarca; município de residência; sexo; grupo do produto e condutor da ação. Resultados: Dos 2.560 processos, os medicamentos corresponderam a 63,5% das ações. 42% das demandas concentraram-se na 1a Região de Saúde; 39,3% e 31,5% foram provenientes de unidades públicas de saúde e filantrópicas, respectivamente. Os dados corroboram com achados da literatura quanto ao item mais demandado judicialmente e à tendência de concentração em regiões metropolitanas. Difere quanto à natureza do órgão demandante por ter sido neste caso o próprio poder público e as unidades de saúde pública. Conclusões: Incorporar os objetos das demandas judiciais na oferta regular dos serviços de saúde pode contribuir para a redução de processos e aumentar o acesso dos cidadãos aos direitos legais. Em alguns casos, garantir o cumprimento das normas já editadas favorece a tendência de diminuição da judicialização, sendo necessário para esta análise os estudos longitudinais. (AU)

This article aimed to analyze the judicialization of access to health services in the State Department of Health of Pernambuco in the year 2016. Methodology: This was a cross-sectional, quantitative and analytical study with data from the Judicial Actions Center of the State Health Secretariat of Pernambuco in 2016. The variables were: the product; the establishment of care; ICD-10; municipalities of the region; municipality of residence; sex; product group and action driver. Results: Of the 2,560 cases, the medications corresponded to 63.5% of the actions. 42% of the demands were concentrated in the 1st Health Region; 39.3% and 31.5% came from public health and philanthropic units, respectively. The data corroborate with findings from the literature regarding the item most sued in court and the trend of concentration in metropolitan regions. It differs as to the nature of the complainant organ because in this case it was the public authority itself and the public health units. Conclusions: Incorporating the objects of lawsuits into the regular provision of health services can contribute to the reduction of processes and increase citizens' access to legal rights. In some cases, ensuring compliance with the standards already published favors the tendency to decrease the judicialization, being necessary for this analysis the longitudinal studies. (AU)

Objetivo: Este artículo objetivó analizar la judicialización del acceso a los servicios de salud en la Secretaría Estatal de Salud de Pernambuco en el año 2016. Metodología: Se trató de estudio transversal, cuantitativo y analítico con datos del Núcleo de Acciones Judiciales de la Secretaría Estatal de Salud de Pernambuco en 2016. Las variables fueron: el producto; el establecimiento de atención; ICD-10; municipios de la comarca; municipio de residencia; el sexo; grupo del producto y conductor de la acción. Resultados: De los 2.560 procesos, los medicamentos correspondieron al 63,5% de las acciones. El 42% de las demandas se concentró en la 1ª Región de Salud; 39,3% y 31,5% provenían de unidades públicas de salud y filantrópicas, respectivamente. Discusión: Los datos corroboran con hallazgos de la literatura en cuanto al ítem más demandado judicialmente ya la tendencia de concentración en regiones metropolitanas. Difiere en cuanto a la naturaleza del órgano demandante por haber sido en este caso el propio poder público y las unidades de salud pública. Conclusiones: Incorporar los objetos de las demandas judiciales en la oferta regular de los servicios de salud puede contribuir a la reducción de procesos y aumentar el acceso de los ciudadanos a los derechos legales. En algunos casos, garantizar el cumplimiento de las normas ya editadas favorece la tendencia de disminución de la judicialización, siendo necesario para este análisis los estudios longitudinales. (AU)