Derotational distal femoral osteotomy corrects excessive femoral anteversion in patients with patellofemoral instability: A systematic review.

PURPOSE: Patellofemoral instability (PFI) is a common condition that can be caused from multiple factors, including lower limb rotational malalignments. Determining precise criteria for performing corrective torsional osteotomy can be a daunting task due to the lack of consensus on normal and excessive values and the limited evidence-based data in the postoperative results. The purpose was to assess the clinical, functional and imaging outcomes following derotational distal femoral osteotomy (DDFO) in patients with PFI and/or anterior knee pain (AKP) associated with lower limb rotational malalignments. METHODS: Searches were conducted on PubMed, EMBASE and Web of Science databases up to October 2023. Studies reporting outcomes after DDFO in patients with PFI and/or AKP were eligible for the systematic review. The primary outcome was imaging metrics, especially femoral anteversion. Secondary outcomes included the patient-reported outcome measures (PROMs) (clinical and functional). Quantitative synthesis involved the use of weighted averages to calculate pre- to postoperative mean differences (MD) and compare them against the minimal clinically important difference (MCID). RESULTS: Ten studies (309 knees) were included with a mean follow-up of 36.1 ± 11.7 months. Imaging outcomes consistently indicated the correction of femoral anteversion (MD = -19.4 degrees, 95% confidence interval: -20.1 to -18.7) following DDFO. PROMs showed significant improvements in most studies, exceeding the MCID. Patient satisfaction with the DDFO was high (93.3%). CONCLUSIONS: The DDFO was an effective treatment option for correcting excessive femoral anteversion in patients with PFI associated with clinically relevant functional and clinical improvement and a high satisfaction rate. LEVEL OF EVIDENCE: Level IV, systematic review of level II-IV studies.

Adrenal Gland Incidentaloma: A Rare Case of Extranodal B-cell Lymphoma.

The prevalence of adrenal incidentalomas (i.e., incidental findings) has grown in recent years with the evolution of imaging methods. Adrenal masses can be benign or malignant. Malignant ones are less frequent, but the detection of primary adrenal neoplasms is even less frequent, especially in the case of a diffuse large B-cell lymphoma (DLBCL). This case concerns a 68-year-old man who presented to the emergency department due to fatigue and anorexia. Given his blood test results on admission, he underwent a computed tomography (CT) with angiography that identified a mass in the left adrenal gland with displacement of the ipsilateral kidney. Left tumorectomy, adrenalectomy, and nephrectomy were performed, and the mass corresponded to a nongerminal center-type DLBCL. This case highlights the importance of prompt diagnosis and surgical and pharmacologic treatment of DLBCL.

Cultural Translation and Validation of the Bariatric Quality of Life Index to European Portuguese.

INTRODUCTION: Obesity is a chronic noncommunicable disease, defined by a body mass index over 30 kg/m2. Its impact is not restricted to its association with higher risks of mortality and morbidity from other noncommunicable diseases, but also with a decrease in quality of life (QoL). There are several tools to assess QoL, from generic health-related tools to obesity-related specific ones. However, to assess QoL in patients undergoing bariatric surgery, only the Bariatric Analysis and Reporting Outcome System was available, which presented some significant problems. Therefore, the Bariatric Quality of Life (BQL) Index was developed. The aim of this study was the validation and cultural adaptation of the BQL Index for European Portuguese. METHODS: A cross-sectional study was conducted, with the presentation of two questionnaires to the participants: BQL Index and EQ-5D-3L (European Quality of Life 5 Dimensions and 3 Level) Index. Direct translation followed reviewing, back-translation, comparison, and pilot testing were performed. Retest was done six months after the baseline. The following psychometric properties were assessed: convergent validity using the Spearman r correlation coefficient between BQL Index and EQ-5D-3L Index; internal consistency based on Cronbach alpha coefficient; and reproducibility between test and retest through Spearman r correlation coefficient and intraclass correlation coefficient (ICC). RESULTS: A total of 260 participants were included, the mean age was 45 ± 10 years old, the mean body mass index was 44 ± 6.5 kg/m2 and 78% were females. The most frequent obesity-related comorbidities were osteoarticular disease (69%), anxiety/depression (60%), and hypertension (54%). The most common eating patterns were volume eater (67%) and sweet eater (62%). Quality of Life scores were 41.3 ± 9.3 for the BQL Index, 0.35 ± 0.19 for the EQ-5D-3L Index and 55.7 ± 19.8 for the EQ-5D-3L VAS. The translation yielded good convergent validity (r = 0.62), good internal consistency (alpha = 0.94), and good reproducibility (r = 0.62 and ICC = 0.79). CONCLUSION: Our translation exhibited good parametric properties, with validity within the original BQL values, higher internal consistency, and good reproducibility.

Forced Handling Decreases Emotionality but Does Not Improve Young Horses' Responses toward Humans and their Adaptability to Stress.

Horses are often still exposed to stressful or inadequate conditions and difficult relationships with humans, despite growing concerns about animal welfare. In the present study, we investigated the impact of different approaches of short-term handling sessions on young Lusitanian horses raised on a high-breed farm, specifically on their later adaptability to humans and stressful environments. Thirty-one foals (3 months old ± 15 days), from both sexes, were separated into three groups, one submitted to 3 consecutive days of handling sessions (Int-H), another to one handling session each month for 3 months (Month-H), and one left undisturbed (control). At 8 months old ± 15 days, all foals were evaluated during behavioral tests (restraint in a stock and forced-person test). Evaluations were based on behavioral observations and physiological assessments. The handled foals (Int-H and Month-H) reacted less to being isolated and restrained and better tolerated human contact and veterinary procedures than the control ones. The handled foals displayed less evasive and negative behaviors toward human approach, but also sought less human contact and did not interact, regardless of the handling timeframe. All animals displayed signs of stress when restrained in the stock, with increased neutrophil counts and CHCM levels in the blood, and no differences in metabolic (CK and LDH) and other hematological parameters. The neutrophil-lymphocyte ratio was significantly higher (p < 0.05) in handled foals than in control ones, suggesting low standards of welfare. Our data suggest that early forced handling decreases fearfulness in new environments; however, it does not improve the horses' relationship with humans, and it decreases welfare.

Derotational high tibial osteotomy in cases of anterior knee pain and/or patellofemoral instability: a systematic review.

IMPORTANCE: Derotational high tibial osteotomy (HTO) is a surgical intervention for correcting rotational malalignments in the lower limb, which may contribute to anterior knee pain (AKP) and/or patellofemoral instability (PFI). This surgical technique is not yet widely implemented and requires a systematic evaluation of its outcomes. AIM: To assess the effectiveness of derotational HTO in correcting rotational malalignments of the lower limb in patients with AKP and/or PFI through radiological, clinical, and patient-reported outcome measures. EVIDENCE REVIEW: Searches were conducted in the PubMed, Embase, and Web of Science databases up to March 3, 2023, to identify studies utilizing derotational HTO in patients with AKP and/or PFI. The primary outcome measures of interest were measurements of lower limb angular correction. Other radiological, clinical, and patient-reported outcome measures were also analyzed. The risk of bias was judged with the RoBANS tool. FINDINGS: A total of 8 studies were included, comprising 215 patients (27.0 â€‹± â€‹3.9 years) and 245 knees. The most reported angle was tibial torsion (k â€‹= â€‹6 studies, n â€‹= â€‹173 knees), with a mean difference between postoperative and preoperative values (postsurgical correction) ranging from -37.8° to -10.8°. Patient-reported outcome measures showed significant improvements in the postoperative moment, exceeding the minimal clinically important difference in almost all cases, and with high patient satisfaction (93.6%). CONCLUSIONS AND RELEVANCE: Derotational HTO allows the correction of rotational malalignments of the lower limb (tibial torsion) and promotes patient satisfaction. LEVEL OF EVIDENCE: Level IV.

Age-Related Macular Degeneration and Extramacular Drusen: Genetic Associations in the Coimbra Eye Study.

Purpose: To explore the association between the genetics of age-related macular degeneration (AMD) and extramacular drusen (EMD) in patients with and without AMD. Methods: We included 1753 eyes (912 subjects) with phenotypic characterization regarding AMD and EMD. Genetic sequencing and the genetic risk score (GRS) for AMD were performed according to the EYE-RISK consortium methodology. To test for differences in the GRS from EMD cases, AMD cases, and controls, a clustered Wilcoxon rank-sum test was used. The association of AMD, EMD, and the GRS was evaluated using logistic regression models adjusted for age and sex. Individual associations of common risk variants for AMD with EMD were explored. Results: EMD were found in 755 eyes: 252 (14.4%) with AMD and 503 (28.7%) without. In total, 122 eyes (7.0%) had only AMD, and 876 (50.0%) were controls. EMD were strongly associated with AMD (odds ratio [OR], 3.333; 95% confidence interval [CI], 2.356-4.623; P < 0.001). The GRS was associated with an increased risk of AMD (OR, 1.416; 95% CI, 1.218-1.646; P < 0.001) but not with EMD. Individually, the common risk variants ARMS2 rs10490924 (P = 0.042), C3 rs2230199 (P = 0.042), and CETP rs5817082 (P = 0.042) were associated with EMD, after adjustment for AMD, sex, and age. Conclusions: We found a strong association between EMD and AMD, suggesting a common pathogenesis. The GRS for AMD was not associated with EMD, but a partially overlapping genetic basis was suggested when assessing individual risk variants. We propose that EMD per se do not represent an increase in the global genetic risk for AMD.

CB307: A Dual Targeting Costimulatory Humabody VH Therapeutic for Treating PSMA-Positive Tumors.

PURPOSE: CD137 is a T- and NK-cell costimulatory receptor involved in consolidating immunologic responses. The potent CD137 agonist urelumab has shown clinical promise as a cancer immunotherapeutic but development has been hampered by on-target off-tumor toxicities. A CD137 agonist targeted to the prostate-specific membrane antigen (PSMA), frequently and highly expressed on castration-resistant metastatic prostate cancer (mCRPC) tumor cells, could bring effective immunotherapy to this immunologically challenging to address disease. EXPERIMENTAL DESIGN: We designed and manufactured CB307, a novel half-life extended bispecific costimulatory Humabody VH therapeutic to elicit CD137 agonism exclusively in a PSMA-high tumor microenvironment (TME). The functional activity of CB307 was assessed in cell-based assays and in syngeneic mouse antitumor pharmacology studies. Nonclinical toxicology and toxicokinetic properties of CB307 were assessed in a good laboratory practice (GLP) compliant study in cynomolgus macaques. RESULTS: CB307 provides effective CD137 agonism in a PSMA-dependent manner, with antitumor activity both in vitro and in vivo, and additional activity when combined with checkpoint inhibitors. A validated novel PSMA/CD137 IHC assay demonstrated a higher prevalence of CD137-positive cells in the PSMA-expressing human mCRPC TME with respect to primary lesions. CB307 did not show substantial toxicity in nonhuman primates and exhibited a plasma half-life supporting weekly clinical administration. CONCLUSIONS: CB307 is a first-in-class immunotherapeutic that triggers potent PSMA-dependent T-cell activation, thereby alleviating toxicologic concerns against unrestricted CD137 agonism.

RNASEH2B loss and PARP inhibition in advanced prostate cancer.

BACKGROUND: Clinical trials have suggested antitumor activity from PARP inhibition beyond homologous recombination deficiency (HRD). RNASEH2B loss is unrelated to HRD and preclinically sensitizes to PARP inhibition. The current study reports on RNASEH2B protein loss in advanced prostate cancer and its association with RB1 protein loss, clinical outcome and clonal dynamics during treatment with PARP inhibition in a prospective clinical trial. METHODS: Whole tumor biopsies from multiple cohorts of patients with advanced prostate cancer were interrogated using whole-exome sequencing (WES), RNA sequencing (bulk and single nucleus) and immunohistochemistry (IHC) for RNASEH2B and RB1. Biopsies from patients treated with olaparib in the TOPARP-A and TOPARP-B clinical trials were used to evaluate RNASEH2B clonal selection during olaparib treatment. RESULTS: Shallow co-deletion of RNASEH2B and adjacent RB1, co-located at chromosome 13q14, was common, deep co-deletion infrequent, and gene loss associated with lower mRNA expression. In castration-resistant PC (CRPC) biopsies, RNASEH2B and RB1 mRNA expression correlated, but single nucleus RNA sequencing indicated discordant loss of expression. IHC studies showed that loss of the two proteins often occurred independently, arguably due to stochastic second allele loss. Pre- and post-treatment metastatic CRPC (mCRPC) biopsy studies from BRCA1/2 wildtype tumors, treated on the TOPARP phase II trial, indicated that olaparib eradicates RNASEH2B-loss tumor subclones. CONCLUSION: PARP inhibition may benefit men suffering from mCRPC by eradicating tumor subclones with RNASEH2B loss. CLINICALTRIALS: gov NCT01682772FUNDING. AstraZeneca; Cancer Research UK; Medical Research Council; Cancer Research UK; Prostate Cancer UK; Movember Foundation; Prostate Cancer Foundation.

Capivasertib in combination with enzalutamide for metastatic castration resistant prostate cancer after docetaxel and abiraterone: Results from the randomized phase II RE-AKT trial.

BACKGROUND: PTEN loss and aberrations in PI3K/AKT signaling kinases associate with poorer response to abiraterone acetate (AA) in metastatic castration-resistant prostate cancer (mCRPC). In this study, we assessed antitumor activity of the AKT inhibitor capivasertib combined with enzalutamide in mCRPC with prior progression on AA and docetaxel. METHODS: This double-blind, placebo-controlled, randomized phase 2 trial, recruited men ≥ 18 years with progressing mCRPC and performance status 0-2 from 15 UK centers. Randomized participants (1:1) received enzalutamide (160 mg orally, once daily) with capivasertib (400 mg)/ placebo orally, twice daily on an intermittent (4 days on, 3 days off) schedule. Primary endpoint was composite response rate (RR): RECIST 1.1 objective response, ≥ 50 % PSA decrease from baseline, or circulating tumor cell count conversion (from ≥ 5 at baseline to < 5 cells/7.5 mL). Subgroup analyses by PTENIHC status were pre-planned. RESULTS: Overall, 100 participants were randomized (50:50); 95 were evaluable for primary endpoint (47:48); median follow-up was 43 months. RR were 9/47 (19.1 %) enzalutamide/capivasertib and 9/48 (18.8 %) enzalutamide/placebo (absolute difference 0.4 % 90 %CI -12.8 to 13.6, p = 0.58), with similar results in the PTENIHC loss subgroup. Irrespective of treatment, OS was significantly worse for PTENIHC loss (10.1 months [95 %CI: 4.6-13.9] vs 14.8 months [95 %CI: 10.8-18]; p = 0.02). Most common treatment-emergent grade ≥ 3 adverse events for the combination were diarrhea (13 % vs 2 %) and fatigue (10 % vs 6 %). CONCLUSIONS: Combined capivasertib/enzalutamide was well tolerated but didn't significantly improve outcomes from abiraterone pre-treated mCRPC.

Thio-2 Inhibits Key Signaling Pathways Required for the Development and Progression of Castration-resistant Prostate Cancer.

Therapies that abrogate persistent androgen receptor (AR) signaling in castration-resistant prostate cancer (CRPC) remain an unmet clinical need. The N-terminal domain of the AR that drives transcriptional activity in CRPC remains a challenging therapeutic target. Herein we demonstrate that BCL-2-associated athanogene-1 (BAG-1) mRNA is highly expressed and associates with signaling pathways, including AR signaling, that are implicated in the development and progression of CRPC. In addition, interrogation of geometric and physiochemical properties of the BAG domain of BAG-1 isoforms identifies it to be a tractable but challenging drug target. Furthermore, through BAG-1 isoform mouse knockout studies, we confirm that BAG-1 isoforms regulate hormone physiology and that therapies targeting the BAG domain will be associated with limited "on-target" toxicity. Importantly, the postulated inhibitor of BAG-1 isoforms, Thio-2, suppressed AR signaling and other important pathways implicated in the development and progression of CRPC to reduce the growth of treatment-resistant prostate cancer cell lines and patient-derived models. However, the mechanism by which Thio-2 elicits the observed phenotype needs further elucidation as the genomic abrogation of BAG-1 isoforms was unable to recapitulate the Thio-2-mediated phenotype. Overall, these data support the interrogation of related compounds with improved drug-like properties as a novel therapeutic approach in CRPC, and further highlight the clinical potential of treatments that block persistent AR signaling which are currently undergoing clinical evaluation in CRPC.

Multiparametric bone MRI targeting aides lesion selection for CT-guided sclerotic bone biopsies in metastatic castrate resistant prostate cancer.

BACKGROUND: Bone biopsies in metastatic castrate-resistant prostate cancer (mCRPC) patients can be challenging. This study's objective was to prospectively validate a multiparametric bone MRI (mpBMRI) algorithm to facilitate target lesion selection in mCRPC patients with sclerotic bone disease for subsequent CT-guided bone biopsies. METHODS: 20 CT-guided bone biopsies were prospectively performed between 02/2021 and 11/2021 in 17 mCRPC patients with only sclerotic bone disease. Biopsy targets were selected based on MRI, including diffusion-weighted (DWI) and T1-weighted VIBE Dixon MR images, allowing for calculation of the apparent diffusion coefficient (ADC) and the relative fat-fraction (rFF), respectively. Bone marrow with high DWI signal, ADC < 1100 µm2/s and rFF < 20% was the preferred biopsy target. Tumor content and NGS-feasibility was assessed by a pathologist. Prognostic routine laboratory blood parameters, target lesion size, biopsy tract length, visual CT density, means of HU, ADC and rFF were compared between successful and unsuccessful biopsies (p < 0.05 = significant). RESULTS: Overall, 17/20 (85%) biopsies were tumor-positive and next-generation genomic sequencing (NGS) was feasible in 13/18 (72%) evaluated samples. Neither laboratory parameters, diameter, tract length nor visual CT density grading showed significant differences between a positive versus negative or NGS feasible versus non-feasible biopsy results (each p > 0.137). Lesion mean HU was 387 ± 187 HU in NGS feasible and 493 ± 218 HU in non-feasible biopsies (p = 0.521). For targets fulfilling all MRI selection algorithm criteria, 13/14 (93%) biopsies were tumor-positive and 10/12 (83%) provided NGS adequate tissue. CONCLUSIONS: Multiparametric bone MRI can facilitate target lesion selection for subsequent CT-guided bone biopsy in mCPRC patients with sclerotic metastases. TRIAL REGISTRATION: Committee for Clinical Research of the Royal Marsden Hospital registration number SE1220.

Autogestão do diabetes na adolescência: experiência de jovens adultos e pais portugueses / Autogestión de la diabetes en la adolescencia: experiencias de jóvenes adultos y padres portugueses / Self-management of diabetes in adolescence: experience of Portuguese young adults and their parents

Resumo Objetivo Identificar os fatores que facilitam ou dificultam a construção da autonomia na adolescência através da experiência de jovens adultos com diabetes tipo 1 e seus pais. Métodos Estudo de natureza qualitativa, descritiva e exploratória. Foram realizadas duas entrevistas de grupo focal, uma com nove jovens adultos peritos na gestão de sua doença e outra com sete pais. Para análise dos dados, foram usados análise de conteúdo temática e categorial, com particularidades de entrevista de grupo focal, e recurso ao software NVIVO 12. Resultados Emergiram duas grandes categorias e dez subcategorias relativas aos fatores que facilitaram (sistemas de suporte, conhecimentos, alimentação, bomba de insulina, responsabilização precoce pela gestão da terapêutica, características dos jovens), e dificultaram (regime terapêutico, estigma, atitude dos profissionais de saúde, características dos jovens, conhecimento) o desenvolvimento da autonomia na gestão da doença. Conclusão A autonomia na gestão do diabetes envolve vários desafios aos adolescentes, o que requer adequação de atitudes e intervenções de profissionais. Além da gestão tradicional da condição de saúde, é essencial abordar temas relacionados com a socialização dos adolescentes, procurando estratégias inovadoras que promovam o coping e a qualidade de vida. Os resultados deste estudo possibilitam refletir sobre a relação terapêutica com os adolescentes, salientando a importância de individualizar cuidados e respostas inovadoras às suas necessidades específicas.

Resumen Objetivo Identificar los factores que facilitan o dificultan la construcción de la autonomía en la adolescencia a través de la experiencia de jóvenes adultos con diabetes tipo 1 y sus padres. Métodos: Estudio de naturaleza cualitativa, descriptiva y exploratoria. Se realizaron dos entrevistas de grupo focal, una con nueve jóvenes adultos expertos en la gestión de su enfermedad y otra con siete padres. Para el análisis de datos se utilizó el análisis de contenido temático y categorial, con particularidades de entrevista de grupo focal y recurso del software NVIVO 12. Resultados Surgieron dos grandes categorías y diez subcategorías relativas a los factores que facilitaron el desarrollo de la autonomía en la gestión de la enfermedad (sistemas de apoyo, conocimientos, alimentación, bomba de insulina, responsabilización temprana de la gestión de la terapéutica, características de los jóvenes) y los que la dificultaron (régimen terapéutico, estigma, actitudes de los profesionales de la salud, características de los jóvenes, conocimientos). Conclusión La autonomía en la gestión de la diabetes incluye muchos desafíos para los adolescentes, lo que requiere adaptación de actitudes e intervenciones de profesionales. Además de la gestión tradicional del estado de salud, es esencial abordar temas relacionados con la socialización de los adolescentes y buscar estrategias innovadoras que promuevan el coping y la calidad de vida. Los resultados de este estudio permiten reflexionar sobre la relación terapéutica con los adolescentes y destacar la importancia de individualizar los cuidados y las respuestas innovadoras para sus necesidades específicas.

Abstract Objective To identify the factors that facilitate or hinder the construction of autonomy in adolescence through the experience of young adults with type-1 diabetes and their parents. Methods This was a qualitative, descriptive, and exploratory study. Two focus group interviews were conducted: one with nine young adults who were experts in managing their illness and the other with seven parents. Thematic and categorical content analysis was used for data analysis, with particularities of a focus group interview and the use of the NVIVO 12 software. Results Two major categories and ten subcategories related to factors that facilitated (support systems, knowledge, diet, insulin pump, early responsibility for managing therapy, and characteristics of young people) and hindered (therapeutic regimen, stigma, attitude of health professionals, characteristics of young people, and knowledge) the development of autonomy in disease management emerged. Conclusion Autonomy in the management of diabetes involves several challenges for adolescents, which requires adaptation of attitudes and interventions by professionals. In addition to the traditional management of the health condition, addressing issues related to the socialization of adolescents is essential, looking for innovative strategies that promote coping and quality of life. The results of this study make it possible to reflect on the therapeutic relationship with adolescents, emphasizing the importance of individualizing care and innovative responses to their specific needs.

Só engravida quem quer? Práticas educativas nas ações de planejamento reprodutivo / Do you get pregnant only if you want to? Educational practices in reproductive planning actions

O estudo objetivou compreender as fragilidades e potencialidades nas ações de planejamento reprodutivo na rede de atenção à saúde, com ênfase nas práticas educativas junto às usuárias. A pesquisa é do tipo qualitativa e foi realizada em Unidades de Saúde da Atenção Primária e Secundária, localizadas em um município da Região Metropolitana, no interior do nordeste brasileiro, nos meses de fevereiro a março de 2015. O estudo contou com 20 participantes: quatro enfermeiras, 12 usuárias e quatro informantes-chaves, que são profissionais que atuam nas unidades em estudo. Utilizou-se entrevista semiestruturada e observação sistemática para coleta de dados e análise hermenêutica-dialética para sua organização. No cotidiano dos serviços, a educação em saúde se restringe às palestras e à temática preventiva da concepção. As usuárias expressaram pouca informação e compreensão sobre planejamento reprodutivo e uso dos métodos. Considera-se que a prática educativa requisita estratégias dialógicas para o reconhecimento de demandas e necessidades singulares na busca da garantia dos direitos sexuais e reprodutivos na atenção integral à saúde.

This scientific paper aimed to understand the weaknesses and potentialities in reproductive planning actions in the health care network, with an emphasis on educational practices with users. This research is qualitative and was carried out in Primary and Secondary Health Care Units, located in a city in the Metropolitan Region, in the countryside of the Brazilian Northeast, from February to March 2015. This study had 20 participants: four nurses, twelve users and four key informants, who are professionals who work in the units under study. Semi-structured interviews and systematic observation were used for data collection and hermeneutic-dialectic analysis for organization. In the daily life of services, health education is restricted to lectures and the preventive theme of conception. Users expressed little information and understanding about reproductive planning and use of methods. It is considered that educational practice requires dialogical strategies to recognize special demands and needs in the search for guaranteeing sexual and reproductive rights in comprehensive health care.

Fatores associados a quedas em idosos: inquérito domiciliar / Factors associated with falls in older adults: a household survey / Factores asociados con las caídas de mayores: encuesta domiciliaria

Objetivo: Identificar a prevalência de quedas e fatores associados em idosos no ambiente domiciliar. Métodos: Estudo transversal quantitativo, tipo inquérito domiciliar, observacional e analítico, realizado com 212 idosos atendidos em uma Unidade de Atenção Primária, em Fortaleza, Ceará, que relacionou aspectos demográficos, sociais e clínicos correspondendo ao autorrelato de quedas nos últimos 12 meses. A análise descritiva foi realizada por meio de frequências absolutas e percentuais. A análise inferencial ocorreu no modelo não ajustado para teste da associação entre o desfecho (ocorrência de quedas) e as variáveis associativas por meio do teste do qui-quadrado de Wald, considerando p<0,20 como critério de entrada, e, no modelo ajustado, utilizou-se a regressão de Poisson, considerando-se p<0,05. Resultados: A prevalência de quedas foi de 63,7%, com predomínio em pessoas na faixa etária entre 60 e 79 anos de idade (63,7%), do sexo feminino (53,8%), que usavam tapetes no domicílio (66,5%) e apresentavam duas ou mais comorbidades (41,5%). Sua ocorrência foi associada ao sexo feminino (RP=1,96; p<0,03), com histórico de duas ou mais comorbidades (RP=0,407; p<0,04) e episódios que envolveram tapetes (RP=1,975; p<0,03). Conclusão: Encontrou-se elevada prevalência de quedas nos idosos investigados. A identificação dos fatores, a prevenção de comorbidades e a remoção de acessórios escorregadios nos domicílios constituem mudanças que podem ser estimuladas pela abordagem dos profissionais de saúde.

Objective: To identify the prevalence of falls at home among older adults and associated factors. Methods: This quantitative observational and analytical cross-sectional study used a household survey of 212 older adults treated at a Primary Health Care Center in Fortaleza, Ceará, to check for relationships of demographic, social and clinical aspects with self-reported falls in the past 12 months. Descriptive analysis was performed using absolute and percentage frequencies. Inferential analysis consisted of an unadjusted model to test the association between the outcome (occurrence of falls) and the associative variables using the Wald Test with a significance threshold set at p<0.20 for inclusion in the model. Poisson Regression was used in the adjusted model considering p<0.05. Results: The prevalence rate of falls was 63.7%, with a predominance of people aged between 60 and 79 years old (63.7%), women (53.8%), people who used carpets at home (66.5%), and people who had two or more comorbidities (41.5%). The occurrence of falls was associated with female gender (PR=1.96; p<0.03), history of two or more comorbidities (PR=0.407; p<0.04), and episodes involving carpets (PR=1.975; p<0.03). Conclusion: There was a high prevalence of falls in the older adults analyzed. The identification of factors, the prevention of comorbidities and the removal of slippery accessories from the house are changes that can be encouraged by health professionals.

Objetivo: Identificar la prevalencia de caídas y sus factores asociados en mayores en el ambiente domiciliario. Métodos: Estudio transversal cuantitativo del tipo encuesta domiciliaria, observacional y analítico con 212 mayores asistidos en una Unidad de Atención Primaria de Fortaleza, Ceará, el cual ha relacionado los aspectos demográficos, sociales y clínicos de los relatos de caídas en los últimos 12 meses. El análisis descriptivo ha sido realizado a través de las frecuencias absolutas y porcentuales. El análisis inferencial se dio con el modelo no ajustado para la prueba de asociación entre el resultado (ocurrencia de caídas) y las variables asociativas a través de la prueba de chi-cuadrado de Wald, considerando p<0,20 como el criterio de entrada y, para el modelo ajustado, se utilizó la regresión de Poisson considerándose p<0,05. Resultados: La prevalencia de las caídas ha sido del 63,7% con el predominio de personas en la franja de edad entre 60 y 79 años de edad (63,7%), del sexo femenino (53,8%), que usaban alfombras en el domicilio (66,5%) y que presentaban dos o más comorbilidades (41,5%). Su ocurrencia se ha asociado con el sexo femenino (RP=1,96; p<0,03), el histórico de dos o más comorbilidades (RP=0,407; p<0,04) y los episodios con alfombras (RP=1,975; p<0,03). Conclusión: Se ha encontrado una elevada prevalencia de caídas en los mayores investigados. La identificación de los factores, la prevención de las comorbilidades y la remoción de los accesorios resbaladizos en los domicilios son cambios que se puede estimular a través del abordaje de los profesionales sanitarios.

Translation and cross-cultural adaptation of the Arizona Sexual Scale (ASEX) into Portuguese / Tradução e adaptação transcultural da Arizona Sexual Scale (ASEX) para a língua portuguesa

Abstract Introduction Sexual dysfunction is common in individuals with psychiatric disorders and under psychotropic medication such as antidepressants and antipsychotics. Several scales have been developed to assess sexual function in these patients. The Arizona Sexual Scale (ASEX) is a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. We describe the translation and cross-cultural adaptation of the ASEX into the Portuguese language, with the goal of contributing to the assessment of sexual function in Portuguese-speaking psychiatric patients under treatment with psychotropic drugs. Methods The translation and cross-cultural adaptation process thoroughly followed the steps recommended by the Task Force of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), namely: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing, finalization, proofreading, and final version. Results The process was successfully completed and no major differences were found between the translation, reconciliation and back-translation phases, with only small adjustments being made. Conclusion The translation of the ASEX was completed successfully, following international reference guidelines. The use of these guidelines is a guarantee of a Portuguese version that is qualitatively and semantically equivalent to the original scale. This availability of this new scale version will enable studies evaluating the sexual function of Portuguese-speaking psychiatric patients. Future studies may assess the validity of the scale for Portuguese-speaking populations.

Resumo Introdução A disfunção sexual é comum em indivíduos com doenças psiquiátricas e sob o uso de medicações como antidepressivos e antipsicóticos. Várias escalas foram desenvolvidas para avaliar a função sexual desses doentes. A Arizona Sexual Scale (ASEX) é uma escala de cinco itens de avaliação que quantifica desejo sexual, excitação, lubrificação vaginal/ereção peniana, capacidade para atingir o orgasmo e satisfação com o orgasmo. Este artigo descreve o processo de tradução e adaptação transcultural da escala ASEX para a língua portuguesa, com o objetivo de contribuir para a avaliação da função sexual dos doentes medicados com fármacos psicotrópicos nos vários países onde se utiliza essa língua. Métodos A tradução e a adaptação transcultural seguiram de forma detalhada os passos recomendados pelo grupo de trabalho da International Society for Pharmacoeconomics and Outcomes Research (ISPOR), nomeadamente: preparação, tradução inicial, reconciliação, retroversão, revisão da retroversão, harmonização, teste cognitivo, revisão do teste cognitivo, finalização, leitura final e versão final. Resultados O processo foi completado com sucesso, e não foram observadas diferenças grandes entre as fases de tradução, reconciliação e retroversão, tendo sido feitos apenas pequenos ajustes. Conclusão A tradução da escala ASEX foi bem-sucedida, seguindo orientações internacionais de referência. A aplicação dessas orientações é a garantia de uma versão em língua portuguesa que é qualitativa e semanticamente equivalente à versão original da escala. A existência desta nova versão da escala permitirá estudos que avaliem a função sexual dos doentes em países nos quais se fale a língua portuguesa. Estudos futuros poderão atestar a validade da escala para essas populações.

O emprego das tecnologias leves no cuidado ao hipertenso na Estratégia Saúde da Família / The use of soft technologies in the care of hypertensive patients in Family Health Strategy

Objective: To analyze the use of soft technologies in the care of hypertensive patients in the Family Health Strategy. Method: Descriptive study with qualitative approach. A total of 14 hypertensives and 2 professionals from a Family Health team in a municipality in the interior of the state of Ceará, Brazil, participated in the study in 2016. Data were collected through a checklist for non-participant systematic observation, subsidized by a field diary, being treated by the Thematic Content Analysis. Results: The categories constructed were: Relational technologies in the care of the hypertensive in the FHS and communication process between health-hypertensive professional in the FHS. In care practices permeate soft technologies, relationships; soft-hard, technical knowledge; and hard, the material resources, and verbal communication predominates in interpersonal relationships, to the detriment of nonverbal signals. Conclusion: There is a need to strengthen communication skills and soft technologies to re-signify the production of health care.

Objetivo: Analizar el empleo de las tecnologías leves en el cuidado al hipertenso en la Estrategia Salud de la Familia. Método: Estudio descriptivo con enfoque cualitativo. Participaron 14 hipertensos y dos profesionales de un equipo de Salud de la Familia en un Municipio del interior del Estado de Ceará, Brasil, 2016. Los datos fueron recolectados por checklist para observación sistemática no participante y diario de campo, tratados por el Análisis de Contenido Temático. Resultados: Emergieron las categorías: Tecnologías relacionales en el cuidado al hipertenso en la ESF y proceso de comunicación entre profesional-hipertenso en la ESF. En las prácticas del cuidado impregna las tecnologías leves, relaciones; leve-duras, conocimiento técnico; y duras, recursos materiales y la comunicación verbal predominan en las relaciones interpersonales, en detrimento del lenguaje no verbal. Conclusión: Es necesario fortalecer las habilidades de comunicación y las tecnologías leves para re-significar la producción de la atención en la salud.

Objetivo: Analisar o emprego das tecnologias leves no cuidado ao hipertenso na Estratégia Saúde da Família. Método: Descritivo com abordagem qualitativa. Participaram da pesquisa 14 hipertensos e dois profissionais de uma equipe de Saúde da Família em um município do interior do estado do Ceará, Brasil, em 2016. Os dados foram coletados por um checklist para observação sistemática não participante, subsidiados por um diário de campo, tratados pela Análise de Conteúdo Temática. Resultados: As categorias construídas foram: Tecnologias relacionais no cuidado ao hipertenso na ESF e processo de comunicação entre profissional de saúde-hipertenso na ESF. Nas práticas do cuidado, permeiam as tecnologias leves, as relações; leves-duras, o conhecimento técnico; e duras, os recursos materiais, e a comunicação verbal predomina nas relações interpessoais, em detrimentos dos sinais não verbais. Conclusão: Urge a necessidade de fortalecer as habilidades de comunicação e as tecnologias leves para ressignificar a produção do cuidado em saúde.

Comunicação terapêutica na interação profissional de saúde e hipertenso na estratégia saúde da família / Comunicación terapêutica na interacción profesional de saúde y hipertenso na estratégia saúde da família / Therapeutic communication in the interaction between health workers and hypertensive patients in the family health strategy

Resumo OBJETIVO Analisar a comunicação terapêutica na interação entre profissional de saúde e paciente hipertenso na Estratégia Saúde da Família. MÉTODOS Estudo descritivo com abordagem qualitativa. A amostra constituiu-se de 14 pacientes hipertensos e dois profissionais da ESF em um município do Estado do Ceará, Brasil, em 2016. Na coleta de dados, utilizou-se um checklist para observação sistemática não participante contendo as estratégias de comunicação terapêutica: expressão, clarificação, validação e um diário de campo, sendo tratados pela análise de conteúdo. RESULTADOS Verificou-se que os profissionais da ESF não utilizam de forma adequada a comunicação terapêutica, reconhecendo a necessidade de investimento nesse dispositivo, que atua como ponte de acesso aos usuários, potencializa as práticas assistenciais e abre caminhos que instrumentalizam as relações interpessoais. CONCLUSÕES Desvelou-se que as estratégias de comunicação terapêutica são pouco exploradas pelos profissionais de saúde, sendo necessário, portanto, desenvolver habilidades para empregá-las adequadamente no cuidado ao hipertenso.

Resumen OBJETIVO Analizar la comunicación terapéutica entre el profesional de la salud y pacientes hipertensos en la Estrategia de Salud de la familia. MÉTODOS Estudio descriptivo con enfoque cualitativo. La muestra estuvo constituida por 14 pacientes hipertensos y dos profesionales del Estrategia de Salud de la Familia (ESF - "Estratégia Saúde Família") de un municipio del estado de Ceará, Brasil, en 2016. En la recopilación de datos, seutilizó una lista de verificación para la observación sistemática no participante la cual contiene las estrategias de comunicación terapéutica: expresión, claridad, validación y un diario de campo que trata del análisis de contenido. RESULTADOS Se comprobó que los profesionales del ESF no utilizan de manera adecuada la comunicación terapéutica, reconociéndose la necesidad de inversión en este dispositivo que actúa como puente para el acceso a los usuarios, realza las prácticas asistenciales y abre caminos que instrumentalizan las relaciones interpersonales. CONCLUSIONES Se reveló que las estrategias de comunicación terapéutica son poco aplicadas por los profesionales de la salud que las requieren, por lo tanto, se hace necesario desarrollar destrezas para utilizarla correctamente en el cuidado de los pacientes hipertensos.

Abstract OBJECTIVE To analyze the therapeutic communication in the interaction between health professionals and hypertensive patients in the Family Health Strategy. METHODS Descriptive study with qualitative approach. The sample consisted of 14 hypertensive patients and two health professionals of the Family Health Strategy (ESF - "Estratégia Saúde Família") in a city of the state of Ceará, Brazil, in 2016. In the data collection, a checklist was used for non-participant systematic observation containing the strategies of therapeutic communication, namely: expression, clarity, validation, and a field diary, being these subjected to content analysis. RESULTS It was noted that ESF professionals do not adequately use therapeutic communication, indicating the need of investment in this device, which acts as a bridge for users, enhances care practices and opens paths that instrumentalize interpersonal relationships. CONCLUSIONS It was realized that health professionals are not fully exploring therapeutic communication strategies, therefore being necessary to develop skills to use these techniques correctly when caring for hypertensive patients.

FINDRISK: estratificação do risco para Diabetes Mellitus na saúde coletiva / FINDRISK: Diabetes Mellitus risk stratification in community health / FINDRISK: estratificación del riesgo de Diabetes Mellitus en salud colectiva

Objetivo: Analisar a importância do FINDRISK para a estratificação do risco em Diabetes Mellitus (DM) tipo 2 como estratégia preventiva na saúde coletiva. Métodos: Estudo epidemiológico, descritivo e analítico, realizado com 371 pessoas, com idade entre 30 e 69 anos, desenvolvido entre agosto 2015 e março de 2016 no Nordeste brasileiro. Aplicou-se o instrumento FINDRISK para coleta de dados por meio da análise estatística inferencial, com cálculo das razões de prevalência ao nível de significância de 5%. Resultados: Dos sujeitos, 85,7% (n=318) apresentaram nenhum/baixo/moderado risco de DM2, sendo 66,8% (n=248) do sexo feminino, 59% (n=218) com idade superior a 45 anos, 72% (n=267) com índice de massa corporal elevado, 77% (n=284) com circunferência abdominal aumentada, 54% (n=202) praticavam atividade física, 67% (n=250) não comiam verduras/frutas, 80% (n=297) não tinham glicose elevada e 52% (n=194) apresentavam familiar com DM. Conclusão: O questionário apresentou-se como um importante instrumento para estratificar o risco para DM2, além de potencialmente indutor no planejamento de ações de prevenção e da promoção da saúde conforme o nível de gravidade.

Objective: To analyze the importance of FINDRISK in type 2 Diabetes Mellitus (DM) risk stratification as a preventive strategy in community health. Methods: A descriptive, analytical and epidemiological study, carried out with 371 people, aged 30-69 years, conducted between August 2015 and March 2016 in the Brazilian Northeast. The tool FINDRISK was used for data collection by means of inferential statistics analysis, with prevalence ratios calculation at the significance level of 5%. Results: Of the subjects, 85.7% (n=318) presented no/low/moderate risk of DM2, 66.8 % (n=248) were females, 59% (n=218) aged over 45 years, 72% (n=267) had high BMI, 77% (n=284) had increased waist circumference, 54% (n=202) practiced physical activity, 67% (n=250) did not eat vegetables/fruits, 80% (n=297) did not have high blood glucose, and 52% (n=194) had family history of DM. Conclusion: The questionnaire proved to be an important tool for DM2 risk stratification, and a potential inducer in the planning of health prevention and promotion actions, according to the severity level.

Objetivo: Analizar la importancia del FINDRISK para la estratificación del riesgo de Diabetes Mellitus (DM) tipo 2 como estrategia de prevención en salud colectiva. Métodos: Estudio epidemiológico, descriptivo y analítico realizado con 371 personas con edad entre los 30 y 69 años desarrollado entre agosto 2015 y marzo de 2016 en el Noreste brasileño. Se aplicó el instrumento FINDRISK para la recogida de datos a través del análisis estadístico inferencial con el cálculo de las razones de prevalencia y el nivel de significación del 5%. Resultados: Entre los sujetos, el 85,7% (n=318) presentaron ningún/bajo/moderado riesgo de DM2, siendo el 66,8% (n=248) del sexo femenino, el 59% (n=218) mayor de 45 años, el 72% (n=267) con el índice de masa corporal elevado, el 77% (n=284) con la circunferencia abdominal aumentada, el 54% (n=202) practicaban actividad física, el 67% (n=250) no comían verduras/frutas, el 80% (n=297) no tenían la glucosa elevada y el 52% (n=194) tenía algún familiar con DM. Conclusión: El cuestionario se presentó como un instrumento importante para la estratificación del riesgo de DM2 además de ser un potencial inductor para el planeamiento de las acciones de prevención y promoción de la salud según el nivel de gravedad.

Capacitação para a autogestão do adolescente com diabetes tipo 1: contributos do enfermeiro especialista em enfermagem de saúde infantil e pediatria / Training for self-management for adolescents with type 1 diabetes: contributions of the nurse specialist in child health and pediatric nursing

O presente relatório pretende traduzir as aprendizagens pessoais, profissionais e académicas vivenciadas ao longo do 3º semestre do VII Curso de Mestrado em Enfermagem na Área de Especialização de Saúde Infantil e Pediatria. Assume um caráter reflexivo e visa incorporar as competências desenvolvidas ao longo deste percurso, evidenciando um processo de aprendizagem que culmina numa prestação de cuidados de enfermagem especializados. Este relatório procura ainda espelhar o projeto de estágio desenvolvido. É sustentado na Teoria das Transições de Afaf Meleis, na Filosofia de Cuidados em Parceria e nos Cuidados Centrados na Família. As políticas de saúde a nível mundial procuram, cada vez mais, responsabilizar o indivíduo com condição crónica para o autocuidado e destacam o papel do profissional de saúde na sua capacitação para a autogestão. A prevalência da Diabetes Mellitus tipo 1 (DM1) na adolescência tem vindo a aumentar nos últimos anos, exigindo uma atenção cada vez maior dos serviços de saúde. O enfermeiro especialista encontra-se numa posição privilegiada para o desenvolvimento de uma terapêutica que promova a transição para a vida adulta e a mestria na autogestão da condição crónica de forma saudável, terminando com a assunção de um novo papel. Este percurso de aprendizagem impulsionou também o início de um processo de mudança com a integração numa equipa multidisciplinar, que pretende desenvolver o projeto "Lay LeDU DM1", uma adaptação do programa de educação para a autogestão desenvolvido por Malheiro (2015) para jovens com Spina Bífida, para adolescentes com DM1. Os benefícios associados a uma terapêutica de enfermagem de sucesso, promotora de competências de autogestão da condição crónica para o adolescente com DM1 e respetiva família, refletem-se não só ao nível da saúde do jovem, da funcionalidade familiar, financeiro (redução dos gastos em saúde) e social (redução do absentismo escolar) mas também numa transição para a vida adulta orientada para a saúde e para o bem-estar do adolescente com DM1 e sua família.

This report intends to translate the personal, professional and academical learnings developed over the third semester of the VII Master of Nursing in Infant and Paediatrics Health Specialization. It takes a reflexive stance and aims to incorporate the developed skills through this journey, demonstrating a learning process that leads to a specialized nursing care. This report also aims to present the developed project through the internship, sustained in Afaf Meleis's Transitions Theory, in the Philosophy of Partnership Care and Family Centred Care. Worldwide health policies increasingly try to hold the person with chronic condition accountable and responsible for their self-care, and highlight the health professional role in the empowerment for self-management. Diabetes Mellitus type 1 (DM1) prevalence has been increasing in the last years, demanding more attention from health services. The specialized nurse finds herself in a privileged position to develop therapeutics that promote transition to the adult life and mastery in selfmanagement of chronic condition in a healthy manner, ending with assumption of a new role. This learning journey also lead to the start of a shifting process, with the integration of a multidisciplinary team that aims to develop the project "Lay LeDU DM1", an adaptation of Malheiro's educational program (2015) with adolescents with Spina Bifida to adolescents with DM1. The associated benefits to a successful nursing therapeutic that promotes self-management skills of the chronic condition of the adolescent with DM1 are reflected not only in the health of the adolescent, family functionality, financially (reduced health spending) and social (less school absenteeism), but also in a transition to the adult life directed to the health and wellbeing of the adolescent with DM1 and family.