Mindful eating questionnaire: Validation and reliability in Brazilian adults with type 2 diabetes mellitus.

OBJECTIVE: The objective was to evaluate the psychometric properties of the Mindful Eating Questionnaire (MEQ) in Brazilian subjects with type 2 diabetes mellitus (T2DM) and validate a Brazilian version of the MEQ for adults with T2DM (MEQ-DM). METHODOLOGY: Baseline data from the multicentre Nutritional Strategy for Glycaemic Control in Patients with Type 2 Diabetes Mellitus (NUGLIC) trial were used. Construct validity was assessed using exploratory factor analysis (EFA). The root mean square error of approximation (RMSEA), comparative fit index (CFI) and Tucker‒Lewis index (TLI) fit indices indicated the adequacy of the model. The reliability of the questionnaire was evaluated considering the different factor loadings. Criterion validity was tested by correlating the MEQ-DM with sociodemographic variables, body mass index (BMI) and physical activity levels. RESULTS: A total of 370 participants were included, who were mostly female (60.8 %) and had a median age of 61 (54-67) years. The EFA results supported the two-factor structure of the 25-item MEQ-DM: disinhibition and awareness. The results of the fit indices (RMSEA = 0.04; CFI = 0.95 and TLI = 0.94) and composite reliability (disinhibition = 0.84 and awareness = 0.81) were consistent. The criterion validity analysis indicated a significant association between MEQ-DM scores and age, sex, civil status, education level, BMI and physical activity (p < 0.05). CONCLUSION: When explored with Brazilian adults with T2DM, the MEQ-DM presented a factorial model with two dimensions: disinhibition and awareness. This model must be confirmed in future studies with Brazilians with T2DM.

Movement Disorders in PURA Syndrome: A Video Case Series.

Background: PURA syndrome is a rare genetic disorder characterized by neonatal hypotonia, neurodevelopmental delay, facial dysmorphism, epileptic seizures, complex movement disorders, among other features. Although many pathogenic variants have been reported, there is currently no clear genotype-phenotype association identified. Cases: Four patients diagnosed with PURA syndrome, despite carrying different pathogenic variants, presented a similar mixed hyperkinetic movement disorder. The phenomenology presented a complex set of symptoms, including chorea, interspersed with dystonic and uncoordinated movements. All patients presented also hypotonia, nystagmus, feeding difficulties, craniofacial dysmorphisms. Hypersomnolence and breathing problems were common and observed in three patients, while seizures were found in three patients. Conclusions: PURA syndrome may be considered in the differential diagnosis of infants with severe hypotonia, feeding difficulties and severe developmental delay with epileptic seizures, that start to develop a mixed hyperkinetic movement disorder. These complex movements may be an important clue for the diagnosis of this rare disorder.

Oligosymptomatic long-term carriers of SARS-CoV-2 display impaired innate resistance but increased high-affinity anti-spike antibodies.

The vast spectrum of clinical features of COVID-19 keeps challenging scientists and clinicians. Low resistance to infection might result in long-term viral persistence, but the underlying mechanisms remain unclear. Here, we studied the immune response of immunocompetent COVID-19 patients with prolonged SARS-CoV-2 infection by immunophenotyping, cytokine and serological analysis. Despite viral loads and symptoms comparable to regular mildly symptomatic patients, long-term carriers displayed weaker systemic IFN-I responses and fewer circulating pDCs and NK cells at disease onset. Type 1 cytokines remained low, while type-3 cytokines were in turn enhanced. Of interest, we observed no defects in antigen-specific cytotoxic T cell responses, and circulating antibodies displayed higher affinity against different variants of SARS-CoV-2 Spike protein in these patients. The identification of distinct immune responses in long-term carriers adds up to our understanding of essential host protective mechanisms to ensure tissue damage control despite prolonged viral infection.

ORAL CARE TO REDUCE COSTS AND INCREASE CLINICAL EFFECTIVENESS IN PREVENTING NOSOCOMIAL PNEUMONIA: A SYSTEMATIC REVIEW.

BACKGROUND: Nosocomial pneumonia ranks among the top 5 diseases that lead to additional financial costs due to hospitalization. This study aimed to evaluate the cost of oral care and its clinical effectiveness in preventing pneumonia in a systematic review. METHODS: The search was conducted in the following databases: PubMed, Cochrane Library, Web of Sciences, Scopus, CINAHL, LILACS, complemented by gray literature and manual search, between January/2021 and August/2022. Two independent reviewers extracted data from the selected articles, individually analyzing each study's quality using the BMJ Drummond checklist. The data were tabulated by clinical or economic type. RESULTS: A total of 3,130 articles were identified; the eligibility criteria were verified, and 12 articles were selected for qualitative analysis. Only 2 achieved satisfactory quality assessment for economic analysis studies. There was heterogeneity between clinical and economic data. Eleven of the 12 studies reported a decrease in the incidence of nosocomial pneumonia following the application of oral care practices. Most authors reported a reduction in the estimate of individual costs, followed by a decrease in the need for antibiotic therapy. The costs of oral care were very low compared to other costs. CONCLUSIONS: Despite the low level of evidence in the literature, heterogeneity and poor quality of the selected studies, most studies concluded that oral care seemed to lead to reduced costs in hospital expenses for treating pneumonia.

COVID-19 and Breast Cancer in Brazil.

Objectives: This study aimed to evaluate COVID-19 effects on breast cancer screening and clinical stage at diagnosis in patients of 50-69 years of age receiving care within the public healthcare network (SUS) in 2013-2021 in Brazil and its macro-regions. Methods: This ecological study used Poisson regression to analyze trends in screening and staging. A secondary database was formed using SUS sources: outpatient data system of the SUS network and Oncology-Brazil Panel. Results: There was a reduction in screening, with an annual percent change of -5.9 (p < 0.022). The number of notified cases fell by 31.5% in 2020-2021 compared to 2018-2019. There was a 10.7% increase in the proportion of stage III/IV cases (p < 0.001) in 2020-2021 compared to 2013-2019, now surpassing the number of cases of early stage breast cancer. Conclusion: COVID-19 led to a reduction in breast cancer screening and an expressive increase in advanced tumors in users of the public healthcare network. Urgent interventions in public policies are required as the negative effects of the pandemic on the diagnosis/treatment of breast cancer are becoming apparent even earlier than expected.

High mobility group box 1, ATP, lipid mediators, and tissue factor are elevated in COVID-19 patients: HMGB1 as a biomarker of worst prognosis.

The severe acute respiratory syndrome coronavirus 2, the agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic, has spread worldwide since it was first identified in November 2019 in Wuhan, China. Since then, progress in pathogenesis linked severity of this systemic disease to the hyperactivation of network of cytokine-driven pro-inflammatory cascades. Here, we aimed to identify molecular biomarkers of disease severity by measuring the serum levels of inflammatory mediators in a Brazilian cohort of patients with COVID-19 and healthy controls (HCs). Critically ill patients in the intensive care unit were defined as such by dependence on oxygen supplementation (93% intubated and 7% face mask), and computed tomography profiles showing ground-glass opacity pneumonia associated to and high levels of D-dimer. Our panel of mediators included HMGB1, ATP, tissue factor, PGE2 , LTB4 , and cys-LTs. Follow-up studies showed increased serum levels of every inflammatory mediator in patients with COVID-19 as compared to HCs. Originally acting as a transcription factor, HMGB1 acquires pro-inflammatory functions following secretion by activated leukocytes or necrotic tissues. Serum levels of HMGB1 were positively correlated with cys-LTs, D-dimer, aspartate aminotransferase, and alanine aminotransferase. Notably, the levels of the classical alarmin HMGB1 were higher in deceased patients, allowing their discrimination from patients that had been discharged at the early pulmonary and hyperinflammatory phase of COVID-19. In particular, we verified that HMGB1 levels above 125.4 ng/ml is the cutoff that distinguishes patients that are at higher risk of death. In conclusion, we propose the use of serum levels of HMGB1 as a biomarker of severe prognosis of COVID-19.

Cuidados de enfermagem ao paciente com pé diabético e suas complicações: habilidades e dificuldades assistenciais / Nursing care for patients with diabetic foot and its complications: care skills and difficulties / Cuidados de enfermería a pacientes con pie diabético y sus complicaciones: habilidades y dificultades de los cuidados

Objetivo: Identificar as habilidades e dificuldades assistenciais no cuidado de enfermagem ao paciente com pé diabético e suas complicações na atenção terciária. Método: Estudo qualitativo realizado em um hospital público de Campina Grande, Paraíba, com oito enfermeiros que atuavam em clínica cirúrgica. Realizaram-se entrevistas semiestruturadas para coleta de dados, as quais foram submetidas à análise de conteúdo temática. Resultados: Os enfermeiros caracterizaram o pé diabético como uma complicação do Diabetes Mellitus, que torna o paciente mais susceptível à internação, destacando a falta de cuidados como a principal causa de comprometimento da assistência; a inexistência de um protocolo assistencial e a falta de recursos materiais e humanos induzem os profissionais a agirem de forma individualizada, resultando em lacunas na humanização e integralidade da assistência. Considerações finais: Os resultados sinalizam a necessidade de melhores condições materiais e tecnológicas e da reformulação do ambiente de trabalho, de forma que os enfermeiros tenham condições de planejar e realizar ações centradas na integralidade do cuidado, baseadas em protocolos assistenciais, considerando as suas necessidades individuais e dessa forma, aprimorar o atendimento aos pacientes diabéticos.

Objective: Identify assistance skills and difficulties in nursing care for patients with diabetic foot and its complications in tertiary care. Method: Qualitative study held at a public hospital in Campina Grande, Paraíba, with eight nursing professionals working in surgical clinic. A semi-structured interview was conducted to collect data, which were submitted to thematic content analysis. Results: The nurses characterized the diabetic foot as a complication of Diabetes Mellitus, which makes the patient more susceptible to hospitalization, highlighting the lack of care as the main cause of impairment of the diabetic foot; the lack of a care-related protocol and the lack of material and human resources induce professionals to act individually, resulting in gaps in humanization and integrality of care. Final considerations: The results indicate the need for better material and technological conditions and the reformulation of the work environment, so that nurses are able to plan and carry out actions focused on comprehensive care, based on assistences protocols, considering their needs individual and thus improve the care for diabetic patients.

Objetivo: Identificar habilidades asistenciales y dificultades en los cuidados de enfermería a pacientes con pie diabético y sus complicaciones en atención terciaria. Método: Estudio cualitativo realizado en un hospital público de Campina Grande, Paraíba, con ocho profesionales de enfermería que trabajan en clínica quirúrgica. Se realizó una entrevista semiestructurada para la recogida de datos, que fueron sometidos a análisis temático de contenido. Resultados: Las enfermeras caracterizaron el pie diabético como una complicación de la Diabetes Mellitus, que hace al paciente más susceptible a la hospitalización, destacando la falta de cuidados como la principal causa de deterioro del pie diabético; la falta de un protocolo relacionado con los cuidados y la carencia de recursos materiales y humanos inducen a los profesionales a actuar individualmente, resultando en lagunas en la humanización e integralidad de los cuidados. Consideraciones finales: Los resultados indican la necesidad de mejores condiciones materiales y tecnológicas y la reformulación del ambiente de trabajo, para que las enfermeras sean capaces de planificar y realizar acciones centradas en la atención integral, con base en protocolos asistenciales, considerando sus necesidades individuales y así mejorar la atención a los pacientes diabéticos.

From a recombinant key antigen to an accurate, affordable serological test: Lessons learnt from COVID-19 for future pandemics.

Serological tests detect antibodies generated by infection or vaccination, and are indispensable tools along different phases of a pandemic, from early monitoring of pathogen spread up to seroepidemiological studies supporting immunization policies. This work discusses the development of an accurate and affordable COVID-19 antibody test, from production of a recombinant protein antigen up to test validation and economic analysis. We first developed a cost-effective, scalable technology to produce SARS-COV-2 spike protein and then used this antigen to develop an enzyme-linked immunosorbent assay (ELISA). A receiver operator characteristic (ROC) analysis allowed optimizing the cut-off and confirmed the high accuracy of the test: 98.6% specificity and 95% sensitivity for 11+ days after symptoms onset. We further showed that dried blood spots collected by finger pricking on simple test strips could replace conventional plasma/serum samples. A cost estimate was performed and revealed a final retail price in the range of one US dollar, reflecting the low cost of the ELISA test platform and the elimination of the need for venous blood sampling and refrigerated sample handling in clinical laboratories. The presented workflow can be completed in 4 months from first antigen expression to final test validation. It can be applied to other pathogens and in future pandemics, facilitating reliable and affordable seroepidemiological surveillance also in remote areas and in low-income countries.

Plasma and memory antibody responses to Gamma SARS-CoV-2 provide limited cross-protection to other variants.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to be a global problem in part because of the emergence of variants of concern that evade neutralization by antibodies elicited by prior infection or vaccination. Here we report on human neutralizing antibody and memory responses to the Gamma variant in a cohort of hospitalized individuals. Plasma from infected individuals potently neutralized viruses pseudotyped with Gamma SARS-CoV-2 spike protein, but neutralizing activity against Wuhan-Hu-1-1, Beta, Delta, or Omicron was significantly lower. Monoclonal antibodies from memory B cells also neutralized Gamma and Beta pseudoviruses more effectively than Wuhan-Hu-1. 69% and 34% of Gamma-neutralizing antibodies failed to neutralize Delta or Wuhan-Hu-1. Although Class 1 and 2 antibodies dominate the response to Wuhan-Hu-1 or Beta, 54% of antibodies elicited by Gamma infection recognized Class 3 epitopes. The results have implications for variant-specific vaccines and infections, suggesting that exposure to variants generally provides more limited protection to other variants.

Immunogenicity of SARS-CoV-2 Trimeric Spike Protein Associated to Poly(I:C) Plus Alum.

The SARS-CoV-2 pandemic has had a social and economic impact worldwide, and vaccination is an efficient strategy for diminishing those damages. New adjuvant formulations are required for the high vaccine demands, especially adjuvant formulations that induce a Th1 phenotype. Herein we assess a vaccination strategy using a combination of Alum and polyinosinic:polycytidylic acid [Poly(I:C)] adjuvants plus the SARS-CoV-2 spike protein in a prefusion trimeric conformation by an intradermal (ID) route. We found high levels of IgG anti-spike antibodies in the serum by enzyme linked immunosorbent assay (ELISA) and high neutralizing titers against SARS-CoV-2 in vitro by neutralization assay, after two or three immunizations. By evaluating the production of IgG subtypes, as expected, we found that formulations containing Poly(I:C) induced IgG2a whereas Alum did not. The combination of these two adjuvants induced high levels of both IgG1 and IgG2a. In addition, cellular immune responses of CD4+ and CD8+ T cells producing interferon-gamma were equivalent, demonstrating that the Alum + Poly(I:C) combination supported a Th1 profile. Based on the high neutralizing titers, we evaluated B cells in the germinal centers, which are specific for receptor-binding domain (RBD) and spike, and observed that more positive B cells were induced upon the Alum + Poly(I:C) combination. Moreover, these B cells produced antibodies against both RBD and non-RBD sites. We also studied the impact of this vaccination preparation [spike protein with Alum + Poly(I:C)] in the lungs of mice challenged with inactivated SARS-CoV-2 virus. We found a production of IgG, but not IgA, and a reduction in neutrophil recruitment in the bronchoalveolar lavage fluid (BALF) of mice, suggesting that our immunization scheme reduced lung inflammation. Altogether, our data suggest that Alum and Poly(I:C) together is a possible adjuvant combination for vaccines against SARS-CoV-2 by the intradermal route.

Clinical quality assurance in breast cancer screening and diagnosis: a warning regarding mammographic positioning

This study aimed to evaluate the clinical image quality of mammograms performed in users of the Brazilian Unified Health System (SUS) referred to a tertiary hospital. Methods: A prospective study assessed mammograms from women referred to a specialist breast center in Goiânia, Goiás, Brazil, between May and October 2017. Scans performed in the preceding 6 months, either screening or diagnostic, were included in the study. Clinical quality was determined from 40 variables related to patient identification, technical performance, the equipment, radiological findings, reporting of results, and breast positioning. Scans performed in the public and private healthcare networks were compared regarding mammographic positioning. Results: Overall, 4,560 variables associated with the clinical quality of the images were evaluated in scans from 114 women with a mean age of 50.6 years. A total of 660 (14.47%) inadequacies were found, 443 (67.12%) of which were related to breast positioning. The most common errors were as follows: pectoral muscle could not be seen in 86.8% of scans in the craniocaudal view and inframammary angle could not be seen in 79.8% of scans in the mediolateral oblique view. Considering the breast-positioning criteria evaluated in the mediolateral oblique view, there was a greater risk of the breast not being centrally positioned with the nipple in profile (RR 4.66; 95%CI 1.05−20.62; p=0.02) and of nonvisualization of the retro-areolar area (RR 4.14; 95%CI 0.92−18.66; p=0.04) in the exams performed in the private compared to the public network.

The Holmes-Adie Syndrome in the Mona Lisa of Leonardo da Vinci (1452-1519).

The literature describes that the renowned artwork of the genius of human anatomy, Leonardo da Vinci (1452-1519), known as Mona Lisa (1503-1506), is among one of the most enigmatic artworks in the History of Art. In this context, many details inserted on the composition of this artwork, including those related to Mona Lisa physical aspects' (anatomy) are controversial. The few known descriptions that provide some thorough indications about the woman who served as the model for this work, were written by Giorgio Vasari (1511-1574) in 1550. According to Vasari, the Mona Lisa is a portrait of Lisa del Giocondo (1479-1542) and although he has given a detailed description concerning Lisa's physical characteristics, some are not fully understood so far. In this context, the unequal size of her pupils stands out, a clinical condition known as anisocoria. On this detail, this Letter presents unprecedented pieces of evidence that the anisocoria represented in Mona Lisa may be an indicator that Lisa del Giocondo had a neurological disorder known as Holmes-Adie Syndrome, which could have been caused by an endocrine disruption of the thyroid hormones. Thus, the pieces of information presented on this Letter are essential for further studies once, through them, it is possible to know more about the physical characteristics and also about the probable health condition of the renowned character of one of the most famous artworks of history.

A conjunctival papilloma in Raffaello Sanzio da Urbino (1483-1520)?

The specialized literature has described that Raffaello Sanzio da Urbino (1483-1520), universally known as Raphael, is among the greatest artists of the Renaissance. Additionally, it is also described that there are still many controversies regarding Raphael's health when he died in 1520. In this context, due to the 500th anniversary of his death, it would be timely to bring up some pieces of information that haven't been presented in the literature so far, regarding the health of this famous artist Therefore, we have decided to present in this description a self-portrait of Raphael from 1519, which, associated with previous descriptions concerning the artist's lifestyle, can provide some indication that Raphael had a clinical condition known as conjunctival papilloma.

Synthesis of Bench-Stable N-Quaternized Ketene N,O-Acetals and Preliminary Evaluation as Reagents in Organic Synthesis.

N-Quaternized ketene N,O-acetals are typically an unstable, transient class of compounds most commonly observed as reactive intermediates. In this report, we describe a general synthetic approach to a variety of bench-stable N-quaternized ketene N,O-acetals via treatment of pyridine or aniline bases with acetylenic ethers and an appropriate Brønsted or Lewis acid (triflic acid, triflimide, or scandium(III) triflate). The resulting pyridinium and anilinium salts can be used as reagents or synthetic intermediates in multiple reaction types. For example, N-(1-ethoxyvinyl)pyridinium or anilinium salts can thermally release highly reactive O-ethyl ketenium ions for use in acid catalyst-free electrophilic aromatic substitutions. N-(1-Ethoxyvinyl)-2-halopyridinium salts can be employed in peptide couplings as a derivative of Mukaiyama reagents or react with amines in nucleophilic aromatic substitutions under mild conditions. These preliminary reactions illustrate the broad potential of these currently understudied compounds in organic synthesis.

Chloroquine inhibits pro-inflammatory effects of heme on macrophages and invivo.

BACKGROUND: Chloroquine has been used successfully to treat Malaria, including by chloroquine-resistant Plasmodium sp., indicating that it has effects on disease itself. Since heme has inflammatory effects and contributes to the pathogenesis of hemolytic diseases, we hypothesize that the anti-inflammatory effect of chloroquine is partially due to its inhibitory effect on heme-induced macrophage activation and on inflammatory tissue damage. METHODS: Bone marrow derived macrophages (BMDMs) were incubated with chloroquine before stimulation with heme, in different conditions, to evaluate cytokines secretion, ROS production, mitogen activated protein kinases (MAPK) or spleen tyrosine kinase (Syk) activation, alone or combined with LPS. The effects of chloroquine upon heme inflammation were also evaluated in vivo, through simultaneous i.p. injection of LPS and heme, intratracheal instillation of Poly-IC followed by heme injection, and in a rhabdomyolysis model. RESULTS: Chloroquine inhibited TNF secretion, mitochondrial ROS production, MAPK, and Syk activation induced by heme. Inhibition of TNF production could be mimicked by zinc ionophore quercetin, but not by primaquine, a chloroquine analog with low affinity for heme. IL-6 and IL-1ß secretions induced by heme in the presence of PRRs agonists were inhibited by chloroquine, but not by calcium chelator BAPTA or inhibitor of endosomal acidification concamycin B. Chloroquine also protected mice from heme inflammatory effects in vivo, inhibiting lethal synergism with PRR agonists, lung pathology caused by heme injection after intratracheal instillation of Poly-IC, and delaying death after rhabdomyolisis. CONCLUSION: Our data indicate that chloroquine might be used as a supportive therapy to control heme-induced deleterious inflammation in different hemolytic diseases.

FACTORS ASSOCIATED WITH DE-HOSPITALIZATION OF CHILDREN AND ADOLESCENTS WITH COMPLEX CHRONIC CONDITION.

OBJECTIVE: To assess the factors associated with the de-hospitalization of children and adolescents with complex chronic condition. METHODS: This cross-sectional and retrospective study investigated a sample of children and adolescents admitted to the Dehospitalization Training Unit, from January 2012 to December 2017. Data were collected by consulting medical records and patient record books, from November 2018 to June 2019. The length of stay in the unit, de-hospitalization, readmissions, frequency and cause of death, age, sex, diagnosis, place of residence, number of caregivers and kinship, and use of devices were studied. The chi-square test was used to verify the association between the dependent variable (de-hospitalization) and the independent variables (age, sex, place of residence, use of devices, and clinical diagnosis). RESULTS: A total of 93 patient records were analyzed, 37.6% aged between 7 months and 2 years old, 58.1% boys, 95.7% used tracheostomy, 92.5% gastrostomy, and 71% invasive mechanical ventilation. Hypoxic-ischemic encephalopathy was the diagnosis of 40.3% of the sample. Average hospitalization time was 288 ± 265 days; 60.2% were hospitalized between 31 days and one year, representing 50% of deaths. Of those de-hospitalized, 76.3% were discharged to the Ventilatory Assistance Homecare Program. De-hospitalization was associated with the child or adolescent's place of residence (p=0.027) and use of ventriculoperitoneal shunt (p=0.021). CONCLUSIONS: This study identified that de-hospitalization may be associated with the place of residence of the child or adolescent, with the highest number of discharges to the state capital, and non-dehospitalization when using ventricular-peritoneal shunt.

Genetic Evidence and Host Immune Response in Persons Reinfected with SARS-CoV-2, Brazil.

The dynamics underlying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection remain poorly understood. We identified a small cluster of patients in Brazil who experienced 2 episodes of coronavirus disease (COVID-19) in March and late May 2020. In the first episode, patients manifested an enhanced innate response compared with healthy persons, but neutralizing humoral immunity was not fully achieved. The second episode was associated with different SARS-CoV-2 strains, higher viral loads, and clinical symptoms. Our finding that persons with mild COVID-19 may have controlled SARS-CoV-2 replication without developing detectable humoral immunity suggests that reinfection is more frequent than supposed, but this hypothesis is not well documented.

Factors associated with de-hospitalization of children and adolescents with complex chronic condition / Fatores associados à desospitalização de crianças e adolescentes com condição crônica complexa

ABSTRACT Objective: To assess the factors associated with the de-hospitalization of children and adolescents with complex chronic condition. Methods: This cross-sectional and retrospective study investigated a sample of children and adolescents admitted to the Dehospitalization Training Unit, from January 2012 to December 2017. Data were collected by consulting medical records and patient record books, from November 2018 to June 2019. The length of stay in the unit, de-hospitalization, readmissions, frequency and cause of death, age, sex, diagnosis, place of residence, number of caregivers and kinship, and use of devices were studied. The chi-square test was used to verify the association between the dependent variable (de-hospitalization) and the independent variables (age, sex, place of residence, use of devices, and clinical diagnosis). Results: A total of 93 patient records were analyzed, 37.6% aged between 7 months and 2 years old, 58.1% boys, 95.7% used tracheostomy, 92.5% gastrostomy, and 71% invasive mechanical ventilation. Hypoxic-ischemic encephalopathy was the diagnosis of 40.3% of the sample. Average hospitalization time was 288 ± 265 days; 60.2% were hospitalized between 31 days and one year, representing 50% of deaths. Of those de-hospitalized, 76.3% were discharged to the Ventilatory Assistance Homecare Program. De-hospitalization was associated with the child or adolescent's place of residence (p=0.027) and use of ventriculoperitoneal shunt (p=0.021). Conclusions: This study identified that de-hospitalization may be associated with the place of residence of the child or adolescent, with the highest number of discharges to the state capital, and non-dehospitalization when using ventricular-peritoneal shunt.

RESUMO Objetivo: Avaliar os fatores associados à desospitalização de crianças e adolescentes com condição crônica complexa. Métodos: Estudo transversal e retrospectivo, que investigou a população de crianças e adolescentes internados na Unidade de Treinamento para Desospitalização (UTD), de janeiro de 2012 a dezembro de 2017. Os dados foram coletados por meio da consulta aos prontuários e livros de registros, de novembro de 2018 a junho de 2019. Foram estudados o período de internamento na UTD, a desospitalização, as reinternações, a frequência e causa dos óbitos, a idade, o sexo, o diagnóstico, o local de residência, o número de cuidadores e parentesco e o uso de dispositivos. Utilizou-se o teste do qui-quadrado para verificar a associação entre a variável dependente (desospitalização) e as variáveis independentes (idade, sexo, local de residência, uso de dispositivos e diagnóstico clínico). Resultados: O total de 93 prontuários de pacientes foi analisado, 37,6% tinham idade entre sete meses e dois anos, 58,1% eram meninos, 95,7% usavam traqueostomia, 92,5% gastrostomia e 71% ventilação mecânica invasiva. Encefalopatia hipóxico-isquêmica foi o diagnóstico de 40,3% da população. O tempo médio de hospitalização foi 288±265 dias; 60,2% ficaram internados entre 31 dias e um ano, representando 50% dos óbitos. Dos desospitalizados, 76,3% receberam alta para o Programa de Assistência Ventilatória Domiciliar (PAVD). A desospitalização foi associada ao local de procedência (p=0,027) e ao uso de derivação ventriculoperitoneal (DVP) (p=0,021). Conclusões: Identificou-se que a desospitalização esteve associada ao local de residência da criança ou adolescente e ao uso de DVP, sendo o maior número de altas para a capital do estado.