Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles' compliance.

Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles' adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool-Kamishibai board (K-board)-during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles' compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles' compliance was addressed in the K-board. Audit data were recorded in 'SimpleQI'. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.

Enhanced production of prodigiosin by Serratia marcescens UCP 1549 using agrosubstrates in solid-state fermentation.

This work aimed to investigate the production of prodigiosin by S. marcescens UCP 1549 in solid-state fermentation (SSF), as a sustainable alternative for reducing the production costs and environmental impact. Thus, different agro-industrial substrates were used in the formulation of the prodigiosin production medium, obtaining the maximum yield of pigment (119.8 g/kg dry substrate) in medium consisting of 5 g wheat bran, 5% waste soybean oil and saline solution. The pigment was confirmed as prodigiosin by the maximum absorbance peak at 535 nm, Rf 0.9 in TLC, and the functional groups by infrared spectrum (FTIR). Prodigiosin demonstrated stability at different values of temperature, pH and NaCl concentrations and antimicrobial properties, as well as not show any toxicity. These results confirm the applicability of SSF as a sustainable and promising technology and wheat bran as potential agrosubstrate to produce prodigiosin, making the bioprocess economic and competitive for industrial purposes.

Hypervolemic hyponatremia and transplant-free survival in children with cirrhosis due to biliary atresia.

BACKGROUND: Biliary atresia is the number one cause of cirrhosis and liver transplantation in children. Hyponatremia is the most important electrolytic disturbance observed in decompensated cirrhosis. Studies of hyponatremia in cirrhotic children are scarce and those that exist have defined hyponatremia as serum sodium < 130 mEq/L lasting for at least 7 days. METHODS: We evaluated transplant-free survival (Kaplan-Meier) of children with cirrhosis due to biliary atresia and serum sodium < 130 mEq/L persisting for 1, 2-6, and ≥7 days. This was a single-center, historical cohort that included all patients aged ≤ 18 years on a liver transplantation waiting list. RESULTS: We studied 128 patients. The overall frequency of hyponatremia was 30.5% (39/128). Thirteen patients (10.2%) had hyponatremia when put on the list, and 20.3% developed it during follow-up. The Kaplan-Meier overall transplant-free survival rate was 83.3%. Patients with persistent hyponatremia for at least two days had the lowest transplant-free survival. Glomerular filtration rate (P = .00, RR = 0.96, IC 95% = 0.94-0.99), BMI/age Z-score (P = .02, RR = 0.59, IC 95% = 0.39-0.91), INR (P = .00, RR = 1.43, IC 95% = 1.17-1.74), and serum sodium (P = .04, RR = 0.91, IC 95% = 0.84-0.99) were independently associated with transplant-free survival. We did not observe any difference in mortality prediction after adding sodium to the original PELD score. CONCLUSIONS: We conclude that persistent hyponatremia lasting at least two days may herald poor prognosis for children with cirrhosis due to biliary atresia.

Collagen XVIII and LOXL-4 polymorphisms in women with and without advanced pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: We verified the presence of single nucleotide polymorphisms (SNP) rs2236479 of the collagen 18 (COL18A1) and rs2862296 of the lysyl oxidase-like 4 (LOXL-4) genes and the association with pelvic organ prolapse (POP) in Brazilian women and determined risk factors for POP development. METHODS: We assessed 532 postmenopausal women divided into POP (stages III and IV) and control (stages 0 and I) groups by examination and peripheral blood sample collection. DNA sequences of interest were analyzed by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). We used logistic regression models for the analyses, with p < 0.005 for significance. RESULTS: The frequency of homozygous polymorphic alleles (AA) in COL18A1 and (GG) in LOXL-4 were similar in both groups (17.5% and 15.4% for COL18A1 and 18.9% and 20.6% for LOXL-4, respectively). There were no associations between those polymorphisms or other genotypes and POP. Multiple logistic regression analysis identified age [odds ratio (OR) = 1.10, confidence interval (CI) 95% = 1.07; 1.14), number of vaginal births (OR = 1.66, CI 95% = 1.36; 2.03), and family history (OR = 2.55 CI 95% = 1.43; 4.55) as independent risk factors for POP. CONCLUSION: Our study suggests lack of association between DNA polymorphisms rs2236479 of COL18A1 and rs2862296 of LOXL-4 with advanced POP in this population.

[Shared development of prostate cancer education materialElaboración compartida de material educativo sobre el cáncer de próstata]. / Construção compartilhada de material educativo sobre câncer de próstata.

OBJECTIVE: To describe the process of shared development of a prostate cancer education booklet. METHODS: A participant observation study was performed with a convenience sample which initially included a group of 16 co-workers (15 men and one woman) to gather information for the development of educational material. The first draft was assessed by eight specialists (five specialists in early cancer detection, one specialist in urology, and two communication specialists) and by a different group of 21 co-workers from the same company (18 men and three women). The booklet addressed the risks and benefits of prostate cancer screening. RESULTS: The participants were not aware of the Brazilian Health Ministry recommendation against prostate cancer screening. The group discussed their doubts and perceptions regarding the theme. The final booklet, which became a publication by the José Alencar Gomes da Silva National Cancer Institute (INCA), was evaluated by participants and specialists. CONCLUSIONS: The participation of men in the development and assessment of the material confirmed the pressing need to disseminate information regarding the risks and potential damage associated with prostate cancer screening. Educational materials should not be treated as independent items, but rather as complementary resources to be used as part of shared, critical, and creative educational initiatives.

OBJETIVO: Describir el proceso de elaborar material educativo sobre el cáncer de próstata de manera compartida. MÉTODOS: Se realizó una investigación participativa con una muestra de conveniencia constituida, inicialmente, por un grupo de 15 hombres y una mujer (con una media de edad de 52 años), todos trabajadores de la misma empresa, con el fin de contribuir a la elaboración de material educativo. La evaluación de la primera versión estuvo a cargo de ocho especialistas (cinco en detección temprana del cáncer, uno en urología y dos en comunicación social) y de otro grupo de 21 participantes (18 hombres y tres mujeres con una media de edad de 41 años). En el material elaborado se abordaron los riesgos y beneficios del tamizaje del cáncer de próstata. RESULTADOS: Los participantes desconocían la recomendación dada por el Ministerio de Salud del Brasil contra el tamizaje del cáncer de próstata y hubo debate sobre dudas y percepciones relativas al tema. Los participantes y los especialistas evaluaron el producto final, que se convirtió en una publicación del Instituto Nacional del Cáncer José Alencar Gomes da Silva. CONCLUSIONES: La participación de los hombres en la elaboración y evaluación del material confirmó la imperiosa necesidad de difundir información sobre los riesgos y posibles perjuicios relacionados con el tamizaje de ese tipo de cáncer. El material educativo no debe verse como una obra aislada, sino como un recurso complementario para actividades educativas en salud de carácter participativo, crítico y creativo.

A diagnostic model for impending death in cancer patients: Preliminary report.

BACKGROUND: Several highly specific bedside physical signs associated with impending death within 3 days for patients with advanced cancer were recently identified. A diagnostic model for impending death based on these physical signs was developed and assessed. METHODS: Sixty-two physical signs were systematically documented every 12 hours from admission to death or discharge for 357 patients with advanced cancer who were admitted to acute palliative care units (APCUs) at 2 tertiary care cancer centers. Recursive partitioning analysis was used to develop a prediction model for impending death within 3 days with admission data. The model was validated with 5 iterations of 10-fold cross-validation, and the model was also applied to APCU days 2 to 6. RESULTS: For the 322 of 357 patients (90%) with complete data for all signs, the 3-day mortality rate was 24% on admission. The final model was based on 2 variables (Palliative Performance Scale [PPS] and drooping of nasolabial folds) and had 4 terminal leaves: PPS score ≤ 20% and drooping of nasolabial folds present, PPS score ≤ 20% and drooping of nasolabial folds absent, PPS score of 30% to 60%, and PPS score ≥ 70%. The 3-day mortality rates were 94%, 42%, 16%, and 3%, respectively. The diagnostic accuracy was 81% for the original tree, 80% for cross-validation, and 79% to 84% for subsequent APCU days. CONCLUSIONS: Based on 2 objective bedside physical signs, a diagnostic model was developed for impending death within 3 days. This model was applicable to both APCU admission and subsequent days. Upon further external validation, this model may help clinicians to formulate the diagnosis of impending death.

Bedside clinical signs associated with impending death in patients with advanced cancer: preliminary findings of a prospective, longitudinal cohort study.

BACKGROUND: Five highly specific physical signs associated with death within 3 days among cancer patients were recently reported that may aid in the diagnosis of impending death. In this study, the frequency and onset of another 52 bedside physical signs and their diagnostic performance for impending death were examined. METHODS: Three hundred fifty-seven consecutive patients with advanced cancer who had been admitted to acute palliative care units at 2 tertiary care cancer centers were enrolled. Fifty-two physical signs were systematically documented every 12 hours from admission to death or discharge. The frequency and median time of onset of each sign from death backwards were examined, and the likelihood ratios (LRs) associated with death within 3 days were calculated. RESULTS: Two hundred three of the 357 patients (57%) died at the end of the admission. Eight physical signs that were highly diagnostic of impending death were identified. These signs occurred in 5% to 78% of the patients within the last 3 days of life, had a late onset, and had a high specificity (>95%) and a high positive LR for death within 3 days. They included nonreactive pupils (positive LR, 16.7; 95% confidence interval [CI], 14.9-18.6), a decreased response to verbal stimuli (positive LR, 8.3; 95% CI, 7.7-9), a decreased response to visual stimuli (positive LR, 6.7; 95% CI, 6.3-7.1), an inability to close eyelids (positive LR, 13.6; 95% CI, 11.7-15.5), drooping of the nasolabial fold (positive LR, 8.3; 95% CI, 7.7-8.9), hyperextension of the neck (positive LR, 7.3; 95% CI, 6.7-8), grunting of vocal cords (positive LR, 11.8; 95% CI, 10.3-13.4), and upper gastrointestinal bleeding (positive LR, 10.3; 95% CI, 9.5-11.1). CONCLUSIONS: Eight highly specific physical signs associated with death within 3 days among cancer patients were identified. These signs may inform the diagnosis of impending death.

Acute symptomatic complications among patients with advanced cancer admitted to acute palliative care units: A prospective observational study.

BACKGROUND: Limited information is available on the symptomatic complications that occur in the last days of life. AIM: We documented the frequency, clinical course, and survival for 25 symptomatic complications among patients admitted to acute palliative care units. DESIGN: Prospective longitudinal observational study. MEASUREMENTS: Their attending physician completed a daily structured assessment of symptomatic complications from admission to discharge or death. SETTING/PARTICIPANTS: We enrolled consecutive advanced cancer patients admitted to acute palliative care units at MD Anderson Cancer Center, USA, and Barretos Cancer Hospital, Brazil. RESULTS: A total of 352 patients were enrolled (MD Anderson Cancer Center = 151, Barretos Cancer Hospital = 201). Delirium, pneumonia, and bowel obstruction were the most common complications, occurring in 43%, 20%, and 16% of patients on admission, and 70%, 46%, and 35% during the entire acute palliative care unit stay, respectively. Symptomatic improvement for delirium (36/246, 15%), pneumonia (52/161, 32%), and bowel obstruction (41/124, 33%) was low. Survival analysis revealed that delirium (p < 0.001), pneumonia (p = 0.003), peritonitis (p = 0.03), metabolic acidosis (p < 0.001), and upper gastrointestinal bleed (p = 0.03) were associated with worse survival. Greater number of symptomatic complications on admission was also associated with poorer survival (p < 0.001). CONCLUSION: Symptomatic complications were common in cancer patients admitted to acute palliative care units, often do not resolve completely, and were associated with a poor prognosis despite active medical management.

Clinical signs of impending death in cancer patients.

BACKGROUND: The physical signs of impending death have not been well characterized in cancer patients. A better understanding of these signs may improve the ability of clinicians to diagnose impending death. We examined the frequency and onset of 10 bedside physical signs and their diagnostic performance for impending death. METHODS: We systematically documented 10 physical signs every 12 hours from admission to death or discharge in 357 consecutive patients with advanced cancer admitted to two acute palliative care units. We examined the frequency and median onset of each sign from death backward and calculated their likelihood ratios (LRs) associated with death within 3 days. RESULTS: In total, 203 of 357 patients (52 of 151 in the U.S., 151 of 206 in Brazil) died. Decreased level of consciousness, Palliative Performance Scale ≤20%, and dysphagia of liquids appeared at high frequency and >3 days before death and had low specificity (<90%) and positive LR (<5) for impending death. In contrast, apnea periods, Cheyne-Stokes breathing, death rattle, peripheral cyanosis, pulselessness of radial artery, respiration with mandibular movement, and decreased urine output occurred mostly in the last 3 days of life and at lower frequency. Five of these signs had high specificity (>95%) and positive LRs for death within 3 days, including pulselessness of radial artery (positive LR: 15.6; 95% confidence interval [CI]: 13.7-17.4), respiration with mandibular movement (positive LR: 10; 95% CI: 9.1-10.9), decreased urine output (positive LR: 15.2; 95% CI: 13.4-17.1), Cheyne-Stokes breathing (positive LR: 12.4; 95% CI: 10.8-13.9), and death rattle (positive LR: 9; 95% CI: 8.1-9.8). CONCLUSION: We identified highly specific physical signs associated with death within 3 days among cancer patients.

Estimation of economic losses due to leptospirosis in dairy cattle.

There are few studies that effectively quantify the economic losses resulting from problems caused by leptospirosis in naturally infected dairy cattle. Given this gap, the objective of this study was to propose and apply a method to quantify the economic losses resulting from productive and reproductive problems in a commercial dairy herd naturally infected by Leptospira spp. For this study, the zootechnical and economic indicators at a property with Jersey cattle were analyzed during the period from 2014 to 2017. The leptospirosis outbreak occurred in 2014, and the therapeutic approach was carried out between 2015 and 2017, with the latter considered the year of control of the outbreak. The adopted integrated control strategy consisted of dividing the herd according to the serological results obtained through the microscopic agglutination test, the treatment of reagents with streptomycin, and vaccination against leptospirosis of non-reagent heifers and cows. The method used to evaluate the economic indicators of the property was the calculation of the gross margin by taking into account the implicit and explicit cost parameters associated with the manifestation of leptospirosis. The prevalence rate of leptospirosis decreased from 49.4 % in 2015 to 21.6 % in 2017. There was a reduction in the abortion rate (from 40.00 % in 2014 to 9.00 % in 2017), in the stillborn rate (from 2.63 % in 2014 to 1.69 % in 2017) and an increase in the calving rate (from 65.00 % in 2014 to 86.00 % in 2017). In addition, there were increases in the number of lactating cows (from 38 in 2014-57 in 2017) and the mean times of lactation duration, which increased from 275 days in 2014-295 days in 2017. As a result, the average annual production of milk increased from 164,655 liters in 2014-248,521 liters in 2017. In 2014, when treatment hadn't yet started, the gross margin per liter of milk sold, considering implicit and explicit costs, was US$0.00. In 2015 and 2016, US$0.27 and US$0.30 were obtained, respectively, for this variable. In 2017, with the disease under control on the property, the gross margin per liter of milk reached US$0.36. The gross margin per liter of milk sold was higher in the period when the disease was controlled, showing losses of up to 84 % of the gross margin during the outbreak. Immediate treatment of positive cows and preventive measures had a significant impact on improving the productive and economic efficiency of the property.

Factors Associated With Elder Abuse According to the Levels of Social Determinants in Brazil.

OBJECTIVE: The aim of this study was to analyze the factors associated with elder abuse according to the levels of social determinants. METHODOLOGY: This is a quantitative and multicentric study, with a cross-sectional cut. It was developed in two teaching hospitals in Paraíba, Brazil, with 323 older adults, from July 2019 to February 2020. Data were collected using the Hwalek-Sengstock Elder Abuse Screening Test and Conflict Tactics Scale-1 and then analyzed using descriptive and inferential statistics. RESULTS: There was a significant association between risk for violence and female gender (p = 0.004), residing with grandchildren (p = 0.025), and having four or more comorbidities (p < 0.00). Physical violence was associated with income (p = 0.048). A positive correlation was observed between the number of comorbidities and the risk for violence score (p < 0.001), psychological violence (p = 0.004), and physical violence (p = 0.005). The probability of presenting a risk to violence increased by 2.08 times for women, 1.03 times for those who were illiterate, and 7.03 times for those with four or more comorbidities. CONCLUSION: The social determinants of health that integrate the macrosystem, such as income and number of comorbidities, correlate with situations of violence.

Treatment in vitro of retinal cells with IL-4 increases the survival of retinal ganglion cells: the involvement of BDNF.

Interleukin 4 (IL-4) is a pleiotropic cytokine involved in many functions during the development as well as in adult life. Previous work from our group demonstrated, in vitro, that this interleukin is able to prevent rat retinal ganglion cells death after axotomy. The aim of the present study was to investigate the signaling pathways involved in this trophic effect, particularly the cAMP pathway and also to demonstrate the expression of IL-4 in retinas at different stages of post natal development. Our results show that the trophic effect of IL-4 on rat retinal ganglion cells is dependent on the activation of Janus Kinase 3, Protein Kinase A, c-Jun N-terminal Kinase and Tropomyosin related Kinase receptors, on the increase in intracellular calcium levels, on polypeptide release and on the endogenous Brain Derived Neurotrophic Factor (BDNF). We also observed that treatment with IL-4 enhances c-AMP response element binding and Mitogen Activated Protein Kinase phosphorylation and increases the expression of BDNF. Concerning the IL-4 expression our data show an increase in IL-4 levels during post natal development. Taken together our results demonstrate that the trophic effect of IL-4 on retinal ganglion cells of newborn rats is mediated by cAMP pathway and BDNF release.

Importance of collection methods and stability of oral fluid samples for hepatitis B surface antigen detection.

BACKGROUND: Oral fluid (OF) sample collection and stability for HBsAg detection are not fully established. This study aims to investigate the applicability of OF collectors and sample stability for Hepatitis B virus surface antigen detection. METHODS: Paired serum and OF samples were obtained from 191 individuals, and Chembio (Chembio Diagnostic System, USA) and Salivette (Sarstedt, Germany) devices were used for OF collection. Two HBsAg enzyme immunoassays (EIAs) were used (HBsAg One kit, Radim, Rome, Italy and ETI-MAK-4, DiaSorin, Vercelli, Italy) to determine the most efficient method according OF collector. Sample volume, incubation time, and cutoff (CO) value were evaluated. The stability of OF samples was determined under different environmental conditions. RESULTS: Chembio samples analyzed using DiaSorin EIA without modification of the manufacturer's instructions, demonstrated a sensitivity of 95.24% and a specificity of 100%. Salivette samples analyzed with Radim EIA with receiver operating characteristic (ROC) curve for calculating the CO showed a sensitivity of 78.26% and a specificity of 89.88%. HBsAg was detected in Chembio and Salivette samples under different environmental conditions, but the Chembio samples were the most stable. CONCLUSIONS: Both collectors can be used for HBsAg detection in OF samples, but some modifications of commercial EIAs should be incorporated for Salivette device. OF samples were reliably stable and could be stored for up to 90 days at 2-8°C.

Tales of me: storytelling identity work, authenticity, and impression management during new CEOs' work role transitions.

Introduction: This study aims to understand how new CEOs construct, revise, and maintain in their narrative, repertoire stories that represent their identity as it is associated with their new occupational role. Methods: For this purpose, we conducted a qualitative study using the Grounded Theory method, involving 47 CEOs from different sectors residing in Brazil. Results: Our results allowed for the construction of a central category called Storytelling Identity Work, which refers to stories that individuals tell about themselves, and enable them to propose and redefine who they are during major life transitions. This paper seeks to explain: (a) under what conditions this phenomenon tends to occur; (b) what characterizes the success of Storytelling Identity Work and; (c) what leads to the revision or retention of stories in the self. Our results show that storytelling identity work tends to be used by new CEOs during their transition period into the role, and when their new position involves higher levels of visibility and alteration of prestige levels in comparison to their previous position. They also suggest that storytelling identity work tends to be more successful when the stories are co-constructed and validated with other significant individuals and when they enable new CEOs to feel "sufficiently authentic" and "sufficiently impressive." Finally, we theorize that such feelings, along with a sense of coherence between the story being told and other narratives consciously or unconsciously being narrated by the interviewees throughout their lives, lead to the retention of the story within the individual's self. Discussion: This article innovates by connecting the literature on personal storytelling with identity work and exploring processes that are not only useful during the process of transitioning into the role of new CEOs but also influence the constitution of the narrative repertoire and, consequently, the identity of these individuals.

ProvOER model: A provenance model for Open Educational Resources.

Open Educational Resources (OER) can be adapted and combined to create new resources that better meet the specific needs of different kinds of users and scenarios. In this sense, OER strongly contributes to generating and sharing educational knowledge. Due to the possibility of creating a new OER through the revision and remix activities, the original OER and the transformation process should be adequately identified. This way, the user of the OER has enough information about the history of the resource and, thus, can use it with confidence and security. In this context, determining data provenance, which describes the history of a data from its origin to its current state, becomes very relevant. For OER, there are examples of metadata standards and digital repositories that help to obtain the data provenance. However, the information collected is insufficient to identify the entire history of the provenance of OER. This article proposes a Provenance Model for OER called the ProvOER Model, which allows the documentation and identification of the provenance of OER. For this purpose, a minimum set of metadata was defined that reflects the OER intrinsic properties and the activities that created a new OER. The experiments showed that the ProvOER Model produced a suitable representation of the provenance of OER. In addition, the ProvOER Model allowed identifying the original OER used in a revise or remix activity and the continuous stretch used to create a new resource.

CETP Expression in Bone-Marrow-Derived Cells Reduces the Inflammatory Features of Atherosclerosis in Hypercholesterolemic Mice.

CETP activity reduces plasma HDL-cholesterol concentrations, a correlate of an increased risk of atherosclerotic events. However, our recent findings suggest that CETP expression in macrophages promotes an intracellular antioxidant state, reduces free cholesterol accumulation and phagocytosis, and attenuates pro-inflammatory gene expression. To determine whether CETP expression in macrophages affects atherosclerosis development, we transplanted bone marrow from transgenic mice expressing simian CETP or non-expressing littermates into hypercholesterolemic LDL-receptor-deficient mice. The CETP expression did not change the lipid-stained lesion areas but decreased the macrophage content (CD68), neutrophil accumulation (LY6G), and TNF-α aorta content of young male transplanted mice and decreased LY6G, TNF-α, iNOS, and nitrotyrosine (3-NT) in aged female transplanted mice. These findings suggest that CETP expression in bone-marrow-derived cells reduces the inflammatory features of atherosclerosis. These novel mechanistic observations may help to explain the failure of CETP inhibitors in reducing atherosclerotic events in humans.

Prevalence of malocclusion and related oral habits in 5- to 6-year-old children.

PURPOSE: To verify the prevalence of malocclusion and the influence of harmful oral habits on deciduous dentition in 5- and 6-year-old children enrolled in Brazilian public elementary schools during 2010. MATERIALS AND METHODS: Exams were conducted in 1385 children from 56 Brazilian elementary schools using the method recommended by the World Health Organization (WHO) for epidemiological surveys on oral health. Information about the type of arch, social and economic data and harmful oral habits of the children were collected through a structured questionnaire. RESULTS: In relation to canine occlusion, a high prevalence of Class I (74.5%), followed by Class II (19.4%), was found. Among all participants, 22% showed high overjet, 7.8% showed edge-to-edge occlusion and 2.3% showed anterior crossbite. In relation to overbite, 13.2% had short overbite, 14.3% open bite and 16.8% high overbite. The presence of posterior crossbite occurred in 14.6% of children. Maxillae predominantly exhibited the type I arch (67.9%) and mandibles predominantly exhibited type II (51.7%). In relation to harmful oral habits, 43.4% used a pacifier, 84.8% used a bottle and finger sucking was reported by 17.2%. CONCLUSION: There was a high prevalence of malocclusion associated with oral habits harmful to deciduous dentition.

Advances in Shared Decision Making in Brazil: The role of patient autonomy in curriculum reform, health system and clinical care.

Clinical practice in Brazil has rapidly transformed. Doctor-patient relationships are the focus of these transformations, either within health policies or in the context of medical training. The Brazilian Curriculum Guidelines have emphasized the doctor-patient relationship as part of medical skills and competences, based on patient-centered care. In this article, we present the political advances in patient-centered care. In addition, we address an overview of the Brazilian status quo of decision aids tools. Finally, we share experiences in curriculum reform for the advances of communication skills and the interfaces with narrative medicine and the arts in curricular medical training as a means to advance towards the practice of shared decision making.

In vivo and in vitro per se effect evaluation of Polycaprolactone and Eudragit® RS100-based nanoparticles.

Biodegradable polymeric nanocapsules (NC) present incredible characteristics as drug nanocarriers that optimize drug targeting. However, However, a more detailed isolated effect of polymer-based nanoparticles as drug carriers is required. This work aimed to evaluate the per se effect of blank-NC (NC-B) with different surface characteristics both in vitro and in vivo toxicity. NC1-B (Polysorbate 80 coated poly(ɛ-caprolactone) NC), NC2-B (polyethylene glycol 6000 coated poly(ɛ-caprolactone) NC), NC3-B (chitosan-coated poly(ɛ-caprolactone) NC) and NC4-B (Eudragit® RS100 NC) were prepared by nanoprecipitation method. Formulations were characterized by particle size, zeta potential, and pH. The in vitro cytotoxicity tests against tumor cell lines were performed (HepG2 and MCF-7). Antiviral activity was evaluated by MTT in Vero cells infected with HSV-1 (KOS strain). In vivo evaluation was performed in apomorphine-induced stereotypy in Wistar rats and locomotor activity distance, head movements, and rearing behavior were measured. NC1-B, NC2-B, NC3-B, and NC4-B had a diameter under 350 nm. The pH and zeta potential of formulations varied according to their coating. For in vitro evaluation of antitumor activity and antiviral activity, one-way ANOVA showed no significant differences in cell viability. In vivo tests showed low neurological effects. In conclusion, different surface characteristics of NC-B did not demonstrate toxicity against the evaluated cell lines HepG2 and MCF-7, antiviral effect against HSV-1, and the neurological effects in a stereotyping model were low and may be attributed to the per se effect of NC-B.

Gill Histopathological Biomarkers in Fish Exposed to Trace Metals in the Todos os Santos Bay, Brazil.

Histopathologies are widely recognized as biomarkers of environmental pollution. In this sense, we evaluated the putative relationship of gill histopathologies and distinct ecological impacts in two regions of Todos os Santos Bay (BTS), Brazil, the largest bay in Northeastern Brazil, South Atlantic. We compared the presence and concentration of metals (Al, As, Ba, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, V, and Zn) in water, sediments, and gills and gill histopathologies of a demersal fish (Diapterus rhombeus) and a benthic fish (Ogcocephalus vespertilio). As expected, fish and sediment samples from historically contaminated areas (Aratu) showed more remarkable traces of metals than apparently low-impact areas (Jaguaripe). Likewise, the DTC (degree of tissue change) index and the volume densities were higher in fish caught in Aratu. In addition, the Diapterus rhombeus species showed more potential than Ogcocephalus vespertilio for risk assessment as it showed more responses to the environment reflected on more histopathologies. These data support the effectiveness of incorporating functional gill morphology to monitor impacts on estuarine biota that can be used as a reference to improve the management of ecosystems and prevent harm to human health.