Food Neophobia in Children: A Case Study in Federal District/Brazil.

A reluctance to eat and/or avoidance of novel foods is characterized as food neophobia (FN). FN restricts the diet to familiar foods when, in fact, it should be much more varied. FN can be a barrier to healthy foods, affecting the quality of diet, and impairing children's growth and development. Therefore, according to their caregivers' perceptions, this study aimed to evaluate FN in children from Federal District/Brazil. The Brazilian Children's Food Neophobia Questionnaire (BCFNeo), a specific instrument developed and validated in Brazil, was answered by caregivers of children aged 4 to 11 y/o. Sampling occurred through snowball recruitment, being convenient and non-probabilistic. The Health Sciences Ethics Committee approved the study. The analysis evaluated FN in total (BCFNeoTot) and in the following domains: general (FNgen), for fruits (FNfru), and for vegetables (FNveg). FN scores were compared between sex and child's age and categorized according to three ordinal levels. FN levels were compared using the Mann-Whitney U test. The Friedman test, followed by the Wilcoxon test with Bonferroni correction, was performed to analyze differences in FN according to the environment. Of the caregivers' answers for their children, 595 answers were included, because 19 were out of age. The prevalence of high FN was 42.9%. The domain with the highest prevalence of high FN was vegetables (48.6%). Children aged 8 to 11 y/o had a higher mean FN in two domains (FNgen p = 0.047 and FNveg p = 0.038) when compared to children aged 4 to 7 y/o. Boys were more neophobic in all domains (FNgen p = 0.017; FNfru p = 0.010; FNveg p = 0.013; BCFNeoTot p = 0.008), and FN tends not to decrease with age. The results showed that the children of the FD are more neophobic than Brazilian children in general, highlighting the importance of additional studies in FN determinants in this population and nutritional education interventions to reduce FN among FD children.

Modeling of the biomechanical behavior and growth of the human uterus during pregnancy.

Premature birth poses a challenge to public health, with one in ten babies being born prematurely worldwide. The pathological distension of the uterus can create tension in the uterine wall, triggering contractions that may lead to birth, including premature birth. While there has been an increase in the use of computational models to study pregnancy in recent years, ethical challenges have limited research on the mechanical properties of the uterus during gestation. This study proposes a biomechanical model based on a stretch-driven growth mechanism to describe uterine evolution during the second half of the gestational period. The constitutive model employed is anisotropic, reflecting the presence of fibers in uterine tissue, and it is also considered incompressible. The geometric model representing the uterine body was derived from truncated ellipsoids, subject to intrauterine pressure as loading. Simulation results indicate that the proposed model is effective in reproducing growth patterns documented in the literature, such as simultaneous increases in intrauterine volume and uterine tissue volume, accompanied by a reduction in uterine wall thickness within limits reported in experimental data.

Impacto psicológico na equipe do SAMU 192 durante pandemia COVID-19 / Pandemic's Effect on SAMU 192 Workers' Mental Health / Impacto de la pandemia en la salud mental de los trabajadores de SAMU 192

Resumo Introdução: O Serviço de Atendimento Móvel de Urgência - SAMU 192 é o componente pré-hospitalar móvel instituído pelo Ministério da Saúde no Brasil. Com a pandemia COVID-19, o serviço passou a atender os pacientes acometidos pela doença. Esse cenário trouxe grande tensão para os profissionais, o que tornou relevante compreender as alterações psicológicas vivenciadas pela equipe, a fim de proporcionar uma assistência psicológica adequada e o bem-estar aos mesmos. Objetivo: Analisar os níveis de depressão, ansiedade e estresse na equipe do SAMU 192. Metodologia: Estudo transversal, exploratório-descritivo, com abordagem quantitativa. Aplicou-se a versão reduzida da escala Depression, Anxiety and Stress Scale‐21 (DASS-21) na equipe do SAMU 192, uma escala tipo Likert de quatro pontos que avalia os níveis de depressão, ansiedade e estresse. Resultados: Participaram da pesquisa 54 profissionais do SAMU 192, 78,8% da equipe total. A média de idade foi de 37,41 anos, sendo a maioria do sexo feminino. A maioria dos profissionais apresentaram níveis normais de depressão, ansiedade e estresse, entretanto, os casos de alterações representaram 27,77%, 24,08% e 18,51% respectivamente. Houve maior risco de estresse entre os profissionais que realizam plantão noturno, maior risco de ansiedade em técnicos de enfermagem e em profissionais que trabalham no período diurno ou folguistas e depressão em técnicos de enfermagem. Conclusão: Os níveis de estresse, ansiedade e depressão encontrados no estudo foram baixos, o que difere do esperado e pode estar relacionado a fatores protetores como a satisfação e identificação com o trabalho. Se houver secções dentro do resumo devem estar a negrito e iniciar-se numa nova linha

Abstract Introduction: The Mobile Emergency Care Service - SAMU 192 is the pre-hospital mobile component instituted by the Ministry of Health in Brazil. With the COVID-19 pandemic, the service started to assist patients affected by the disease. This scenario brought great tension to the professionals, making it relevant to understand the psychological changes experienced by the team to provide adequate psychological assistance and well-being to them. Objective: To analyze levels of depression, anxiety, and stress in the SAMU 192 team. Methodology: Cross-sectional, exploratory-descriptive study with a quantitative approach. The shortened version of the Depression, Anxiety, and Stress Scale-21 (DASS-21) was applied to the SAMU 192 team, a four-point Likert scale that assesses levels of depression, anxiety, and stress. Results: Fifty-four SAMU 192 professionals participated in the research, accounting for 78.8% of the total team. The average age was 37.41 years, with the majority being female. Most professionals exhibited normal levels of depression, anxiety, and stress, however, cases of alterations represented 27.77%, 24.08%, and 18.51%, respectively. There was a higher risk of stress among professionals working night shifts, a higher risk of anxiety among nursing technicians and professionals working during the day or on rotating shifts, and depression among nursing technicians. Conclusion: The levels of stress, anxiety, and depression found in the study were low, which differs from expectations and may be related to protective factors such as job satisfaction and identification with work.

Resumen Introducción: El Servicio de Atención Móvil de Urgencia - SAMU 192 es el componente prehospitalario móvil instituido por el Ministerio de Salud en Brasil. Con la pandemia COVID-19, el servicio comenzó a atender a pacientes afectados por la enfermedad. Este escenario generó una gran tensión en los profesionales, lo que hizo relevante comprender las alteraciones psicológicas experimentadas por el equipo, con el fin de proporcionar una asistencia psicológica adecuada y garantizar su bienestar. Objetivo: Analizar los niveles de depresión, ansiedad y estrés en el equipo del SAMU 192. Metodología: Estudio transversal, exploratorio-descriptivo, con enfoque cuantitativo. Se aplicó la versión reducida de la escala de Depresión, Ansiedad y Estrés (DASS-21) en el equipo del SAMU 192, una escala tipo Likert de cuatro puntos que evalúa los niveles de depresión, ansiedad y estrés. Resultados: Participaron en la investigación 54 profesionales del SAMU 192, que representaron el 78,8% del equipo total. La edad promedio fue de 37,41 años, siendo la mayoría del sexo femenino. La mayoría de los profesionales presentaron niveles normales de depresión, ansiedad y estrés, sin embargo, los casos de alteraciones representaron el 27,77%, 24,08% y 18,51% respectivamente. Hubo un mayor riesgo de estrés entre los profesionales que trabajan en turnos nocturnos, un mayor riesgo de ansiedad en técnicos de enfermería y en profesionales que trabajan en el turno diurno o en días libres, y depresión en técnicos de enfermería. Conclusión: Los niveles de estrés, ansiedad y depresión encontrados en el estudio fueron bajos, lo que difiere de lo esperado y puede estar relacionado con factores protectores como la satisfacción e identificación con el trabajo.

Effects of Pilates exercises on health-related quality of life in postmenopausal women: a systematic review and meta-analysis.

OBJECTIVE: To verify the effects of Pilates exercises on health-related quality of life (HRQoL) in postmenopausal women. METHODS: A systematic search was conducted in the following databases: PubMed, Embase, CENTRAL, CINAHL, Web of Science, LILACS, SportDiscus, Scielo, and PEDro. Randomized clinical trials (RCTs) that intervened with Pilates and had HRQoL as an outcome were eligible. The methodological quality of each RCT was assessed using the PEDro scale and the certainty of the evidence using the GRADE system. Meta-analyses were conducted by standardized mean difference (SMD). RESULTS: Initially, 760 records were located. After screening, 11 RCTs were included in the systematic review. Five studies presented low risk of bias (PEDro score ≥ 6). Evidence of very low to moderate certainty demonstrated significant effects in favor of Pilates exercises vs control groups for five of the nine HRQoL domains analyzed: bodily pain (SMD = 0.96), physical functioning (SMD = 0.85), social functioning (SMD = 0.45), role physical (SMD = 0.79), and role emotional (SMD = 0.61). Subgroup analyzes demonstrated that Pilates had a positive impact on more domains whens administered for ≥ 48 sessions (eight domains) vs < 48 sessions (three domains); and when administered on equipment (seven domains) vs mat (three domains). CONCLUSION: Pilates exercises, in general, allowed significant effects to improve HRQoL in postmenopausal women, especially when performed on equipment and when administered for at least 48 sessions. However, no analysis showed high certainty of evidence, and more RCTs of high methodological quality are needed to confirm these findings.

Regional modulation of toll-like receptor signaling pathway genes in acute epididymitis in mice.

BACKGROUND: Region-specific immune environments in the epididymis influence the immune responses to uropathogenic Escherichia coli (UPEC) infection, a relevant cause of epididymitis in men. Toll-like receptors (TLRs) are essential to orchestrate immune responses against bacterial infections. The epididymis displays region-specific inflammatory responses to bacterial-derived TLR agonists, such as lipopolysaccharide (LPS; TLR4 agonist) and lipoteichoic acid (LTA; TLR2/TLR6 agonist), suggesting that TLR-associated signaling pathways could influence the magnitude of inflammatory responses in epididymitis. OBJECTIVES: To investigate the expression and regulation of key genes associated with TLR4 and TLR2/TLR6 signaling pathways during epididymitis induced by UPEC, LPS, and LTA in mice. MATERIAL AND METHODS: Epididymitis was induced in mice using UPEC, ultrapure LPS, or LTA, injected into the interstitial space of the initial segment or the lumen of the vas deferens close to the cauda epididymidis. Samples were harvested after 1, 5, and 10 days for UPEC-treated animals and 6 and 24 h for LPS-/LTA-treated animals. Ex vivo epididymitis was induced by incubating epididymal regions from naive mice with LPS or LTA. RT-qPCR and Western blot assays were conducted. RESULTS: UPEC infection up-regulated Tlr2, Tlr4, and Tlr6 transcripts and their associated signaling molecules Cd14, Ticam1, and Traf6 in the cauda epididymidis but not in the initial segment. In these epididymal regions, LPS and LTA differentially modulated Tlr2, Tlr4, Tlr6, Cd14, Myd88, Ticam1, Traf3, and Traf6 expression levels. NFKB and AP1 activation was required for LPS- and LTA-induced up-regulation of TLR-associated signaling transcripts in the cauda epididymidis and initial segment, respectively. CONCLUSION: The dynamic modulation of TLR4 and TLR2/TLR6 signaling pathways gene expression during epididymitis indicates bacterial-derived antigens elicit an increased tissue sensitivity to combat microbial infection in a spatial manner in the epididymis. Differential activation of TLR-associated signaling pathways may contribute to fine-tuning inflammatory responses along the epididymis.

Determining the effects of Candida utilis-fermented pea starch vs. unfermented pea starch, alone or in whole diets, on palatability and glycemic response in dogs and cats.

Current research suggests yeast fermentation has the potential to improve palatability of pea-based diets for both cats and dogs. However, to be useful, fermentation should not compromise other healthy attributes of peas such as a low glycemic response. Fermentation of uncooked pea starch with Candida utilis (ATCC 9950) appeared to increase crude protein, crude fiber content, inorganic compounds (phosphorus and iron) and phenols. Whole diets were designed with fermented and unfermented pea starch to assess palatability, food intake, and glycemic responses in unacclimated, mixed sex Beagle dogs and mixed breed cats (n = 8 and n = 7, respectively). For palatability testing, a control diet was formulated with 30% corn starch as well as test diets with 30% inclusion of fermented or unfermented pea starch (all lab-made), then compared to a commercial diet containing pea starch (Legacy/Horizon). Fermentation had little effect on rapidly digestible starch either in uncooked starch form or when incorporated into whole diets, but did decrease resistant starch by 15% and increase slowly digestible starch by 20%. Palatability tests using either two choices or four choices at a time revealed a significant preference for the fermented pea starch diet (p < 0.01) in both species. For the glycemic responses, a total of four different pea products were included: unfermented pea starch, fermented pea starch, and 30% inclusion of unfermented and fermented pea starch in whole formulated diets. There were no significant changes in glycemic responses with the fermented pea diet compared to the unfermented diet, demonstrating that healthful low glycemic properties of pea starch were retained after C. utilis fermentation. Overall, C. utilis-fermentation technique was successfully adapted to pea starch where it resulted in increased palatability and food intake in dogs and cats, with potential to positively contribute to overall health benefits for both species.

Instruments to Evaluate Food Neophobia in Children: An Integrative Review with a Systematic Approach.

Food neophobia (FN), a frequent disorder in childhood, profoundly impacts the quality of a diet, restricting the intake of nutrients to maintain proper nutrition. Therefore, using the appropriate tools to assess FN in children to promote healthy eating habits is essential. The study aimed to develop an integrative review with a systematic approach to identify the instruments to measure FN in children and analyze their differences. The included studies (n = 17) were more concentrated in Europe, demonstrating the possible lack of dissemination of the topic at a global level. Among the 18 tools, 6 were represented by adaptations of the Food Neophobia Scale (FNS) and the Children's Food Neophobia Scale (CFNS), and one was the CFNS itself, demonstrating the relevance of these pioneering tools. The need to meet mainly cultural and cognitive criteria led to the creation of other instruments (n = 11). A diversity of approaches concerning the respondents, age range, items, scales, and validation methods was revealed. Modifications to the tools in some nations highlighted their adaptability and effectiveness in addressing regional variations. The instruments can contribute to additional research to help us better understand the prevalence of FN in children, resulting in their health and well-being.

Eventos gerenciais e assistenciais como interferências na carga de trabalho / Managerial and assistance events such as workload interference / Eventos gerenciales y de asistencia como interferencia en la carga de trabajo

Objetivo: Analisar eventos no processo de trabalho gerencial e assistencial da enfermagem, como interferências na carga de trabalho de enfermagem em Unidade de Terapia Intensiva. Métodos: Estudo epidemiológico, transversal, de série histórica na análise da carga de trabalho. Foram realizadas aferições do Nursing Activities Score entre 2007 a 2014. Os eventos foram divididos em ações gerenciais e assistenciais. Resultados: O Nursing Activities Score foi aplicado 35262 vezes em 4731 pacientes. Entre as intervenções gerenciais, a carga de trabalho foi maior na vigência da Resolução da Diretoria Colegiada nº. 26 da Agência Nacional de Vigilância Sanitária concomitante ao aumento da proporção de pacientes por enfermeiro (p<0,001), na implantação dos sítios assistenciais (p<0,001) e na expansão da unidade (p<0,001). Entre as intervenções assistenciais, houve aumento da carga de trabalho no período de incorporação tecnológica (p<0,001), credenciamento de transplante hepático (p<0,001) e implantação de bundle de controle de infecção (p<0,001). Conclusão: Os eventos no processo de trabalho gerencial e assistencial da enfermagem que tiveram como objetivo melhorar a qualidade da assistência, constituem fatores que interferem na carga de trabalho da enfermagem em UTI, uma vez que esta tem aumentado ao longo dos anos. (AU)

Objective: To analyze events in the managerial and care work process, such as interferences in the nursing workload in the Intensive Care Unit. Methods: Epidemiological, cross-sectional, historical series study on workload analysis. Measurements of the Nursing Activities Score were carried out between 2007 and 2014. The events were divided into managerial and assistance actions. Results: The Nursing Activities Score was applied 35262 times to 4731 patients. Among management interventions, the workload was greater under the Directors' Collegiate Resolution no. 26 of the National Health Surveillance Agency concomitant to the increase in the proportion of patients per nurse (p<0.001), in the implantation of assistance sites (p<0.001) and in the expansion of the unit (p<0.001). Among assistance interventions, there was an increase in the workload in the period of technological incorporation (p<0.001), accreditation of liver transplantation (p<0.001) and implantation of an infection control bundle (p<0.001). Conclusion: Interventions that aimed to improve the quality of care are factors that interfere with the nursing workload in the ICU, whereas it has increased over the years. (AU)

Objetivo: Analizar eventos en el proceso de trabajo gerencial y asistencial, como interferencias en la carga de trabajo de enfermería en la Unidad de Cuidados Intensivos. Métodos: Estudio epidemiológico, transversal, de serie histórica sobre análisis de carga de trabajo. Las mediciones del Puntaje de Actividades de Enfermería se realizaron entre 2007 y 2014. Los eventos se dividieron en acciones gerenciales y asistenciales. Resultados: El puntaje de actividades de enfermería se aplicó 35262 veces a 4731 pacientes. Entre las intervenciones de gestión, la carga de trabajo fue mayor bajo la Resolución del Consejo Colegiado no. 26 de la Agencia Nacional de Vigilancia Sanitaria concomitante al aumento de la proporción de pacientes por enfermera (p <0,001), en la implantación de sitios asistenciales (p <0,001) y en la ampliación de la unidad (p <0,001). Entre las intervenciones asistenciales, hubo un aumento de la carga de trabajo en el período de incorporación tecnológica (p <0,001), acreditación de trasplante hepático (p <0,001) e implantación de un paquete de control de infecciones (p <0,001). Conclusion: Las intervenciones dirigidas a mejorar la calidad de la atención son factores que interfieren con la carga de trabajo de enfermería en la UCI, mientras que se ha incrementado con los años. (AU)

Association between the General Movement Optimality Score and clinical features in newborns during hospitalization: A cross-sectional study.

AIMS: To describe the General Movements (GMs) of hospitalized newborns to verify if their global and detailed GMA are related and if their GMs are associated with clinical features. METHODS: Cross-sectional study. Thirty-eight preterm and full-term newborns, who were hospitalized in the neonatal intermediate care unit of a reference hospital, were included. Prechtl's General Movement Assessment (GMA), including the General Movement Optimality Score (GMOS) list, was used as an assessment tool. Clinical variables, such as preterm birth, birthweight, length of hospitalization, Apgar scores, pregnancy problems, admission at neonatal intensive care unit, use of invasive mechanical ventilation, and brain imaging findings were also collected. Newborns were videoed at a single time for 3 min before discharge. RESULTS: Most newborns presented GMs with normal or poor repertoire quality. GMOS ranged from 17 to 42 points. Scores were lower in abnormal GMs. Abnormal GMs were associated with preterm birth, length of hospital stay >30 days and birthweight <2500 g. Accordingly, lower GMOSs were also associated with preterm birth, a birthweight <2500 g and a hospital stay >30 days but also with the invasive mechanical ventilation application. CONCLUSION: Preterm and full-term newborns presented normal or abnormal GMs during hospitalization. Preterm birth, low birthweight, longer hospital stay and a time period of invasive ventilation were associated with worse GM behaviors.

Salmonella and other Enterobacteriaceae in conventional and organic vegetables grown in Brazilian farms.

This study aimed to assess the microbiological profile of conventional and organic vegetables grown in Brazilian farms through the detection of Salmonella and other Enterobacteriaceae. A total of 200 samples (100 conventional and 100 organic), including leafy greens, spices/herbs, and other unusual vegetables, were submitted to the enumeration of Enterobacteriaceae by plating on VRBG agar. Moreover, colonies of Enterobacteriaceae were randomly selected and submitted to identification by MALDI-TOF MS. Samples were also tested for Salmonella, using culture-based and PCR-based enrichment methods. The mean counts of Enterobacteriaceae in conventional and organic vegetables were 5.1 ± 1.5 and 5.4 ± 1.4 log CFU/g, respectively (P > 0.05). A total of 18 genera (including 38 species) of Enterobacteriaceae were identified, and the most frequent ones found in samples from both farming systems were Enterobacter (76%) and Pantoea (68%). Salmonella was identified in 17 samples (8.5%): nine (4.5%) in conventional and eight (4.0%) in organic vegetables. These results indicate that the farming system had no impact on the Enterobacteriaceae populations and rates of Salmonella and revealed unsatisfactory microbiological safety of some samples, mainly due to the presence of Salmonella. These findings highlight the need for control measures during vegetable production, regardless of the farming system, to reduce microbial contamination and the risks of foodborne illnesses.

Food Neophobia in Children with Autistic Spectrum Disorder (ASD): A Nationwide Study in Brazil.

Food neophobia (FN) is common among children with autistic spectrum disorder (ASD), potentially impairing their health and diet quality. This study aimed to investigate and classify the prevalence of FN among 4-to-11-year-old Brazilian children with ASD. This descriptive cross-sectional study was performed by applying online a validated instrument to identify FN in Brazilian children with ASD through their caregivers' responses for a national prevalence of FN in this group. The final sample included 593 children with ASD, 80.1% of boys, with a mean age of 6.72 ± 2.31 years, and 83% having only ASD. Almost 75% (n = 436) of the children with ASD had high food neophobia scores. The fruit neophobia domain had the lowest prevalence of high neophobia (63.7%). No significant difference in FN (total, fruit, and vegetable domains) was found, considering gender and age. There was no statistical difference in FN (all domains) by the number of residents in the same household, income, or the caregivers' educational level. FN did not decrease in older children with ASD. FN is a more complex problem, requiring a multidisciplinary trained team to face the problem.

Physical structure and supplies for hand hygiene in the CCU of a public hospital / Estrutura física e insumos destinados à higienização das mãos no CTI de um hospital público / Estructura física e insumos destinados a la higienización de manos en la UCI de un hospital público

Background and Objectives: healthcare-associated infections (HAIs) are a serious public health problem worldwide. They occur mainly in Critical Care Units (CCUs), where physical structure and supplies do not favor hand hygiene (HH) compliance among health professionals. Thus, the present study aimed to describe and assess the physical structure and supplies for HH practice in a CCU of a public cancer hospital in the North region, Pará, Brazil. Methods: this is a descriptive, observational and cross-sectional study with a quantitative approach. Data were collected through a questionnaire based on the Guide to the Implementation of the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. Results: the study identified that there were 17 functioning beds and 6 interdicted, in addition to 11 sinks on site, but only 5 had liquid soap and paper towels, all with water. Ten alcohol dispensers were identified, but only 7 were functioning and replenished. None of the professionals found had a pocket alcoholic bottle. Conclusion: the study concluded that the physical structure and supplies found in the investigated CCU are partially adequate for carrying out hand disinfection. However, improvements in these structures must be implemented as well as periodic audits and permanent health education activities, aiming to remind professionals about HH practice correctly.(AU)

Justificativas e objetivos: as infecções relacionadas à assistência a saúde (IRAS) são um grave problema de saúde pública mundial. Ocorrem principalmente nos Centros de Terapia Intensiva (CTI), onde a estrutura física e insumos não favorecem a adesão da higienização das mãos (HM) entre os profissionais de saúde. Dessa forma, o presente estudo teve como objetivo descrever e avaliar a estrutura física e de insumos destinados à prática de HM em um CTI de um hospital público oncológico da região Norte, Pará, Brasil. Métodos: trata-se de um estudo descritivo, observacional e transversal com abordagem quantitativa. Os dados foram coletados através de um questionário baseado no Guia para a Implementação da Estratégia Multimodal da Organização Mundial da Saúde (OMS) para a Melhoria da Higiene das Mãos. Resultados: o estudo identificou que existiam 17 leitos funcionantes e 6 interditados, além de 11 pias no local, porém apenas 5 possuíam sabão líquido e papel toalha, todas com água. Foram identificados 10 dispensadores de álcool, porém apenas 7 estavam funcionantes e reabastecidos. Nenhum dos profissionais encontrados possuíam frasco alcoólico de bolso. Conclusão: o estudo concluiu que a estrutura física e os insumos encontrados no CTI investigado estão parcialmente adequados para a realização da prática de desinfecção das mãos. Contudo, devem ser implementadas melhorias nessas estruturas, bem como auditorias periódicas e atividades de educação permanente em saúde, visando relembrar os profissionais sobre a prática de HM de forma correta.(AU)

Justificación y objetivos: las infecciones asociadas a la atención de la salud (IAAS) son un grave problema de salud pública a nivel mundial. Ocurren principalmente en Unidades de Cuidados Intensivos (UCI), donde la estructura física y los suministros no favorecen la adherencia a la higiene de manos (HM) entre los profesionales de la salud. Así, el presente estudio tuvo como objetivo describir y evaluar la estructura física y los insumos para la práctica de la HM en una UCI de un hospital oncológico público de la región Norte de Pará, Brasil. Métodos: se trata de un estudio descriptivo, observacional, transversal con enfoque cuantitativo. Los datos fueron recolectados a través de un cuestionario basado en la Guía para la Implementación de la Estrategia Multimodal para la Mejora de la Higiene de Manos de la Organización Mundial de la Salud (OMS). Resultados: el estudio identificó que había 17 camas en funcionamiento y 6 intervenidas, además de 11 lavabos en el lugar, pero solo 5 tenían jabón líquido y toallas de papel, todas con agua. Se identificaron 10 dispensadores de alcohol, pero solo 7 funcionaban y se reponían. Ninguno de los profesionales encontrados tenía una botella de alcohol de bolsillo. Conclusión: el estudio concluyó que la estructura física y los insumos encontrados en la UCI investigada son parcialmente adecuados para la realización de la práctica de desinfección de manos. Sin embargo, se deben implementar mejoras en estas estructuras, así como auditorías periódicas y actividades de educación continua en salud, con el objetivo de recordar a los profesionales sobre la práctica correcta de HM.(AU)

Unraveiling the correlation among neurodevelopmental and inflammatory biomarkers in patients with chronic schizophrenia.

INTRODUCTION: Nuclear distribution element like-1 (Ndel1) is a cytosolic oligopeptidase, which was suggested as a potential biomarker of aberrant neurodevelopment and early stage of schizophrenia (SCZ). The involvement of Ndel1 in neurite outgrowth, neuronal migration and neurodevelopment was demonstrated. Moreover, Ndel1 cleaves neuropeptides, including the endogenous antipsychotic peptide neurotensin, and lower Ndel1 activity was reported in SCZ patients compared with healthy controls (HCs). Changes in brain-derived neurotrophic factor (BDNF) and inflammatory cytokines levels were also implicated in SCZ. OBJECTIVE: This preliminary study aimed to investigate the interactions between these immune and neurodevelopmental/neurotrophic biomarkers, namely BDNF and the recently identified SCZ biomarker Ndel1. RESULTS: We observed lower Ndel1 activity and IL-4 levels, and higher BDNF levels, in plasma of SCZ (N = 23) compared with HCs (N = 29). Interestingly, significant correlation between Ndel1 activity and IL-4 levels was observed in SCZ, while no correlation with any other evaluated interleukins (namely IL-2, IL-8, IL-10 and IL-17A) or BDNF levels was noticed. CONCLUSION: Although this hypothesis needs to be further explored for a better understanding of the mechanisms by which these altered pathways are associated to each other in SCZ, we suggest that Ndel1 and the inflammatory marker IL-4 are directly correlated.

As manifestações de segunda vítima de evento adverso: uma análise dos profissionais de enfermagem de um hospital público de Minas Gerais / The manifestations of the second victim of an adverse event: an analysis of nursing professionals from a public hospital in Minas Gerais

Introdução: A assistência à saúde pode resultar em eventos adversos (EA) que atingem diretamente a saúde do paciente e sua experiência no cuidado à saúde, podendo causar mortes, sequelas definitivas e temporárias, sofrimento psíquico aos pacientes, a seus familiares e aos profissionais de saúde, além de elevar o custo assistencial. Dentre os problemas relacionados à ocorrência dos EA estão os prejuízos sofridos pelos profissionais de saúde que se envolvem em um EA, denominados na literatura como "segunda vítima". Estes indivíduos experimentam efeitos psicológicos profundos, como raiva, culpa, inadequação, depressão e suicídio, devido a falhas reais ou percebidas. Objetivo: Compreender as manifestações dos profissionais de enfermagem de um hospital frente a ocorrência de EA e a relação com o fenômeno da segunda vítima. Método: Foi realizado um estudo transversal e explicativo, com métodos quantitativos. O instrumento utilizado foi o questionário Hospital Survey on Patient Safety Culture (HSOPSC), acrescido por questões para definição do perfil da população e para caracterização dos EA baseados no sistema de notificação de eventos adversos (Notivisa) da Agência Nacional de Vigilância Sanitária. A população foi composta por 203 profissionais de enfermagem envolvidos na assistência direta aos pacientes de um hospital geral, público, de alta relevância para o atendimento da população da região noroeste de Minas Gerais. Resultados: A amostra foi predominante feminina (85%), com idade média de 40,7 anos, sendo 74% técnicos de enfermagem, 25% enfermeiros e 1% auxiliares de enfermagem. Relataram ter se envolvido em pelo menos um EA nos últimos dois anos, 60% dos profissionais entrevistados. Destes, a maioria foi com dano leve (47%) e sem danos (24%). Informaram também que 75% dos eventos foram notificados ao Núcleo de Risco. A maior parte dos profissionais (55%) que se envolveu em um EA apresentou pelo menos um tipo de manifestação física e/ou psicológica. Ansiedade foi a manifestação mais relatada (24%). Se consideramos os casos em que o EA causou dano moderado, grave ou óbito (n = 36), apenas 22% dos profissionais se mostraram indiferentes, os demais apresentaram ansiedade (33%), irritação (25%), insônia (5%), perda de apetite (5%), dificuldade em retornar a rotina (5%) e, dentre outras (28%), preocupação, frustração, medo, indignação e maior atenção no trabalho. Três profissionais (3%) relataram ter sido necessário buscar assistência emocional especializada. Conclusões: Os resultados deste estudo, em conformidade com o que a literatura apresenta sobre esta problemática, demonstrou o quão deletéria e impactante para um profissional de saúde pode ser a experiência do fenômeno da segunda vítima. Esses efeitos podem ser agravados se na instituição de saúde predomina uma cultura da punição e repreensão pelas falhas cometidas.

Introduction: Health care can result in adverse events that directly affect patients' health and their experience in health care, and can cause deaths, permanent and temporary sequelae, psychological distress to patients, their families and health professionals, in addition to raising costs of medical assistance services. Among the ills related to the occurrence of adverse events are the losses suffered by health professionals who are involved in an adverse event, referred to in the literature as "second victim". These individuals experience profound psychological effects, such as anger, guilt, inadequacy, depression, and suicide, due to real or perceived flaws. Objective: to identify the manifestations, in the face of the occurrence of an adverse event, of nursing professionals in a hospital and their relationship with the phenomenon of the second victim. Method: a cross-sectional and explanatory study was carried out, using quantitative methods. The instrument used was the Hospital Survey on Patient Safety Culture questionnaire (HSOPSC). Questions to define the population profile and to characterize adverse events based on the Notivisa adverse event notification system of Anvisa (National Health Surveillance Agency) were added. The population consisted of 203 nursing professionals involved in direct assistance to patients at a general, public hospital, of high relevance for the care of the population of the northwest region of Minas Gerais. Results: The sample was predominantly female (85%), with an average age of 40.7 years, with 74% nursing technicians, 25% nurses and 1% nursing assistants. 60% (n. 119) of the professionals reported to have been involved in at least 1 adverse event in the last 2 years. Of these, the majority were with slight damage (47%) and without damage (24%). They also reported that 75% of the events were notified to the Risk Center. Most professionals (55%) who were involved in an adverse event presented at least one type of physical and/or psychological manifestation. Anxiety was the most reported manifestation (24%). If we consider the cases in which the adverse event caused moderate, severe or death damage (n. 36), only 22% of the professionals were indifferent; other professionals showed anxiety (33%), irritation (25%), insomnia (5%), loss of appetite (5%), difficulty in returning to routine (5%) and other experiences (28%), worry, frustration, fear, indignation and greater attention at work. Three professionals (3%) reported that they needed to seek specialized emotional assistance. Conclusions: The results of this study, in accordance with what the literature on this issue presents, demonstrate how harmful and impactful for a health professional can be the experience of the phenomenon of the second victim. These effects can be aggravated if a culture of punishment and reprimand for failures prevails in the health Institution.

Translation, cross-cultural adaptation, and validation of the Los Angeles Prehospital Stroke Screen for use in Brazil.

BACKGROUND: Stroke is one of the leading causes of death and neurological disability in the world. Several scales help professionals in the early recognition of the disease. However, none of these were developed in Brazil. OBJECTIVES: To translate the Los Angeles Prehospital Stroke Screen (LAPSS) into Brazilian Portuguese, and cross-culturally adapt and validate the scale in a representative sample of the Brazilian population. METHODS: This study was carried out in two phases: the first consisted in the translation and cross-cultural validation of the LAPSS, and the second in a cross-sectional study with prospectively collected data in patients with suspected stroke treated in a Brazilian prehospital and referred to a stroke center. Statistical analysis was used to assess the sensitivity, specificity, and accuracy of the scale. Cohen's Kappa coefficient (κ) was used for psychometric assessment. RESULTS: After translation and cross-cultural adaptation, the scale was applied to 86 patients. The scale presented a sensitivity of 83.8%, positive predictive value of 79.50%, specificity of 40.70%, negative predictive value of 47.80%, and accuracy of 77%. Cohen's kappa coefficient was calculated using data from 26 (30.23%) patients and the results showed excellent inter-rater reliability in the majority of the items (52.96%). CONCLUSIONS: The scale was translated and cross-culturally adapted for use in Brazil. The scale presented high sensitivity and accuracy but low specificity, and the Cohen's kappa demonstrated inter-rater reliability. The greatest difficulties occurred when the evaluation included subjective identifications. The scale excluded patients < 45 years old as stroke suspects.

Translation, cross-cultural adaptation and validation of the Cincinnati prehospital stroke scale in Brazil.

BACKGROUND: Use of internationally standardized instruments to assist healthcare professionals in accurately recognizing stroke early is recommended. The process of translation and cross-cultural adaptation is important for ensuring that scales are interpreted in the same way in different languages, thus ensuring applicability in several countries. OBJECTIVE: To translate into Brazilian Portuguese, cross-culturally adapt and validate the Cincinnati Prehospital Stroke Scale, using a representative sample of the Brazilian population. METHOD: The present study included patients with suspected stroke who were treated at a Brazilian emergency medical service and referred to a stroke center. A systematic process of translation and cross-cultural adaptation of the original scale and application of the final instrument was performed. Statistical analysis was used to assess the sensitivity, specificity and accuracy of the scale. Cohen's kappa coefficient was used to assess inter-rater reliability. RESULTS: After translation and cross-cultural adaptation, the scale was applied to 64 patients. It showed 93.0% accuracy and 92.4% sensitivity in relation to the final "gold standard" diagnosis. Cohen's kappa coefficient was calculated using data from 26 patients (40.6%) and showed excellent inter-rater reliability between items on the scale (0.8385 to 1.0000). CONCLUSION: The scale demonstrated excellent accuracy, sensitivity and inter-rater reliability. It was a useful tool for assisting healthcare professionals during initial assessments on patients with suspected stroke and significantly contributed to early recognition of stroke in a simple and quick manner.

Regulation of monoamine levels by typical and atypical antipsychotics in Caenorhabditis elegans mutant for nuclear distribution element genes.

Mammalian nuclear distribution genes encode proteins with essential roles in neuronal migration and brain formation during embryogenesis. The implication of human nuclear distribution genes, namely nudC and NDE1 (Nuclear Distribution Element 1)/NDEL1 (Nuclear Distribution Element-Like 1), in psychiatric disorders including schizophrenia and bipolar disorder, has been recently described. The partial loss of NDEL1 expression results in neuronal migration defects, while ndel1 null knockout (KO) leads to early embryonic lethality in mice. On the other hand, loss-of-function of the orthologs of nuclear distribution element genes (nud) in Caenorhabditis elegans renders viable worms and influences behavioral endophenotypes associated with dopaminergic and serotoninergic pathways. In the present work, we evaluated the role of nud genes in monoamine levels at baseline and after the treatment with typical or atypical antipsychotics. Dopamine, serotonin and octopamine levels were significantly lower in homozygous loss-of-function mutant worms KO for nud genes compared with wild-type (WT) C. elegans at baseline. While treatment with antipsychotics determined significant differences in monoamine levels in WT, the nud KO mutant worms appear to respond differently to the treatment. According to the best of our knowledge, we are the first to report the influence of nud genes in the monoamine levels changes in response to antipsychotic drugs, ultimately placing the nuclear distribution genes family at the cornerstone of pathways involved in the modulation of monoamines in response to different classes of antipsychotic drugs.

Translation, cross-cultural adaptation and validation of the Cincinnati prehospital stroke scale in Brazil / Tradução, adaptação transcultural e validação da escala de Cincinnati no Brasil

ABSTRACT Background: Use of internationally standardized instruments to assist healthcare professionals in accurately recognizing stroke early is recommended. The process of translation and cross-cultural adaptation is important for ensuring that scales are interpreted in the same way in different languages, thus ensuring applicability in several countries. Objective: To translate into Brazilian Portuguese, cross-culturally adapt and validate the Cincinnati Prehospital Stroke Scale, using a representative sample of the Brazilian population. Method: The present study included patients with suspected stroke who were treated at a Brazilian emergency medical service and referred to a stroke center. A systematic process of translation and cross-cultural adaptation of the original scale and application of the final instrument was performed. Statistical analysis was used to assess the sensitivity, specificity and accuracy of the scale. Cohen's kappa coefficient was used to assess inter-rater reliability. Results: After translation and cross-cultural adaptation, the scale was applied to 64 patients. It showed 93.0% accuracy and 92.4% sensitivity in relation to the final "gold standard" diagnosis. Cohen's kappa coefficient was calculated using data from 26 patients (40.6%) and showed excellent inter-rater reliability between items on the scale (0.8385 to 1.0000). Conclusion: The scale demonstrated excellent accuracy, sensitivity and inter-rater reliability. It was a useful tool for assisting healthcare professionals during initial assessments on patients with suspected stroke and significantly contributed to early recognition of stroke in a simple and quick manner.

RESUMO Introdução: O uso de instrumentos padronizados internacionalmente para auxiliar os profissionais de saúde a reconhecer precocemente o AVC é recomendado. O processo de tradução e adaptação transcultural tem sido importante para garantir que a escala seja interpretada da mesma maneira em diferentes idiomas, assegurando sua aplicabilidade em vários países. Objetivo: Traduzir para o idioma português do Brasil, adaptar transculturalmente e validar a Cincinnati Prehospital Stroke Scale na população brasileira. Método: O estudo incluiu pacientes com suspeita de acidente vascular cerebral (AVC) atendidos por um Serviço de Atendimento Móvel Urgência (SAMU) 192 e encaminhados para uma Unidade de Cuidado Integral ao AVC. Foram realizados um processo sistemático de tradução e adaptação transcultural da escala original e a aplicação do instrumento final, que possibilitou a realização dos testes de sensibilidade, especificidade e acurácia, de acordo com o estudo original, além do índice de Cohen de Kappa, para avaliar a confiabilidade interobservador. Resultados: Após a tradução e a adaptação transcultural, a escala foi aplicada em 64 pacientes, apresentando acurácia de 93,0% e sensibilidade de 92,4% em relação ao diagnóstico final, considerado padrão-ouro. Em 26 pacientes (40,6%) foi possível calcular o índice de Cohen de Kappa, evidenciando excelente confiabilidade interobservador entre os itens da escala (0,8385 a 1,0000). Conclusão: A escala apresenta ótima acurácia, sensibilidade e concordância interobservador. Trata-se de um instrumento útil para auxiliar os profissionais da saúde durante a avaliação inicial do paciente com suspeita de AVC, uma vez que contribui significativamente para o reconhecimento precoce da doença de uma maneira simples e rápida.

Salivary metabolome of children and adolescents under peritoneal dialysis.

OBJECTIVE: To study the influence of peritoneal dialysis (PD) on the salivary metabolite profile of children and adolescents with renal failure. MATERIALS AND METHODS: Healthy children/adolescents (n = 31; mean age: 12.18 ± 3.76) and children/adolescents subjected to PD (n = 12; mean age: 10.10 ± 4.25) were recruited. Oral health status assessed by the dmft/DMFT and Volpe-Manhold calculus indices. The 1H spectra were acquired in a 600-MHz Bruker nuclear magnetic resonance spectrometer and were subjected to multivariate analysis using partial least squares discriminant analysis (PLS-DA), orthogonal PLS-DA (O-PLS-DA), and univariate analysis through chi-square and t tests (SPSS 20.0, IL, USA), with a significance level of p < 0.05. RESULTS: A similar caries pattern (p = 0.57; chi-square test) was observed between the healthy (dmft = 0.72 ± 1.28 and DMFT 0.93 ± 2.30) and PD groups (dmft = 2.14 ± 3.67, DMFT 0.33 ± 0.71) and dental calculus (p > 0.05, t test). PLS-DA and O-PLS-DA were able to distinguish both groups (ACC = 0.85, R2 = 0.80, Q2 = 0.15). Salivary metabolites decrease in creatine, propionate, and sugar levels in the PD group and an increase in creatinine, butyrate, and lactate levels when compared with the healthy group. CONCLUSIONS: Children and adolescents subjected to PD have a different salivary metabolic profile from that of their healthy subjects. CLINICAL RELEVANCE: Complications of peritoneal dialysis procedures could be monitored by proper knowledge of saliva characteristics as predictors of peritonitis-related outcome. The use of metabolomics in pediatric nephrology may be an innovative methodology for the early diagnosis and monitoring of kidney diseases.

Lipopolysaccharide-induced epididymitis modifies the transcriptional profile of Wfdc genes in mice†.

Whey-acidic protein four-disulfide core domain (WFDC) genes display putative roles in innate immunity and fertility. In mice, a locus on chromosome 2 contains 5 and 11 Wfdc genes in its centromeric and telomeric subloci, respectively. Although Wfdc genes are highly expressed in the epididymis, their contributions to epididymal function remain elusive. Here, we investigated whether Wfdc genes are regulated in response to lipopolysaccharide (LPS)-induced epididymitis, an inflammatory condition that impairs male fertility. We induced epididymitis in mice via (i) interstitial LPS injection into epididymal initial segment and (ii) intravasal LPS injection into the vas deferens towards cauda epididymis. Interstitial and intravasal LPS induced a differential upregulation of inflammatory mediators (interleukin 1 beta, interleukin 6, tumor necrosis factor, interferon gamma, and interleukin 10) in the initial segment and cauda epididymis within 72 h post-treatment. These changes were accompanied by a time-dependent endotoxin clearance from the epididymis. In the initial segment, interstitial LPS upregulated all centromeric (Slpi, Wfdc5, Wfdc12, Wfdc15a, and Wfdc15b) and five telomeric (Wfdc2, Wfdc3, Wfdc6b, Wfdc10, and Wfdc13) Wfdc transcripts at 24 and 72 h. In the cauda epididymis, intravasal LPS upregulated Wfdc5 and Wfdc2 transcripts at 24 h, followed by a downregulation of Wfdc15b and three telomeric (Wfdc6a, Wfdc11, and Wfdc16) gene transcripts at 72 h. Pharmacological inhibition of nuclear factor kappa B activation prevented LPS-induced upregulation of centromeric and telomeric Wfdc genes depending on the epididymal region. We show that LPS-induced inflammation differentially regulated the Wfdc locus in the proximal and distal epididymis, indicating region-specific roles for the Wfdc family in innate immune responses during epididymitis.