Diagnostic evaluation of institutions as a basis for designing the Brazilian maturity model of telehealth services.

BACKGROUND: The number and specificities of telehealth service units that expanded their services and diversified with the COVID-19 pandemic in Brazil need to be discovered. The objective of this manuscript is to present a methodology for the diagnostic evaluation of 19 telehealth units from different regions of the country for federal governmental decision-making. METHODS: A cross-sectional quantitative and qualitative study was carried out in the form of a census based on administrative records with an online survey and in-depth interviews with local telehealth managers. RESULTS: Despite the discontinuity of regular funding, the results point to a diversity of initiatives and advances. Citizenship, sustainability, security, and budget management are recurring themes in the maturity analysis of telehealth services after the advent of the pandemic. CONCLUSION: It is necessary for Brazil to build a resilient model of the maturity of telehealth services that contemplates the different regional scenarios.

Niobium oxyhydroxide as a bioactive agent and reinforcement to a high-viscosity bulk-fill resin composite.

OBJECTIVE: The present in vitro study incorporated niobium oxyhydroxide fillers into an experimental high-viscosity bulk-fill resin composite to improve its mechanical performance and provide it a bioactive potential. METHODOLOGY: Scanning electron microscopy synthesized and characterized 0.5% niobium oxyhydroxide fillers, demonstrating a homogeneous morphology that represented a reinforcement for the feature. Fillers were weighed, gradually added to the experimental resin composite, and homogenized for one minute, forming three groups: BF (experimental high-viscosity bulk-fill resin composite; control), BF0.5 (experimental high-viscosity bulk-fill resin composite modified with 0.5% niobium oxyhydroxide fillers), and BFC (commercial bulk-fill resin composite Beautifil Bulk U, Shofu; positive control). In total, 10 specimens/groups (8 × 2 × 2 mm) underwent flexural strength (FS) tests in a universal testing machine (Instron) (500N). Resin composites were also assessed for Knoop hardness (KH), depth of cure (DoC), degree of conversion (DC), elastic modulus (E), and degree of color change (ΔE). The bioactive potential of the developed resin composite was evaluated after immersing the specimens into a simulated body fluid in vitro solution and assessing them using a Fourier-transformed infrared spectroscope with an attenuated total reflectance accessory. One-way ANOVA, followed by the Tukey's test (p<0.05), determined FS, DC, KH, and ΔE. For DoC, ANOVA was performed, which demonstrated no significant difference between groups (p<0.05). CONCLUSIONS: The high-viscosity bulk-fill resin composite with 0.5% niobium oxyhydroxide fillers showed promising outcomes as reinforcement agents and performed well for bioactive potential, although less predictable than the commercial resin composite with Giomer technology.

Percepção dos enfermeiros sobre condições de trabalho na atenção primária durante a pandemia de sars-cov-2 / Nurses perception of working conditions in primary care during the sars cov-2 pandemic / Percepción de las enfermeras sobre las condiciones de trabajo en atención primaria durante la pandemia por sars-cov-2

Objetivo: Analisar a percepção do enfermeiro acerca das condições de trabalho no contexto da Atenção Primária à Saúde (APS) durante a pandemia de SARS-CoV-2. Métodos: Trata-se de um estudo descritivo, transversal, de abordagem qualitativa, recorte de um estudo multicêntrico e de abrangência nacional. Os dados apresentados neste estudo correspondem aos obtidos no estado do Rio Grande do Norte, onde foram entrevistados 45 enfermeiros da APS no período de dezembro de 2020 a abril de 2021. Após as entrevistas, as narrativas gravadas foram transcritas e analisadas através da Análise de Conteúdo de Bardin. Resultados: A partir da fala dos enfermeiros, evidenciou-se que a utilização de Equipamentos de Proteção Individual, a organização e desenvolvimento de novos protocolos e fluxos assistenciais trouxeram sofrimento psíquico aos profissionais, tanto pelas condições de trabalho inadequadas, quanto pela proximidade com o sofrimento de pacientes e o medo de contágio. Conclusão: Mesmo com tantas dificuldades, os enfermeiros lotados na atenção primária à saúde tiveram que reconstruir suas práticas na perspectiva de garantir, dentro dos limites impostos pela situação adversa, a melhor assistência possível, mostrando a força e resiliência das equipes da APS nos mais diversos contextos. (AU)

Objective: To analyze the perception of nurses about working conditions in the context of PHC during the COVID-19 pandemic. Methods: This is a descriptive, cross-sectional study with a qualitative approach, part of a multicenter study with a national scope. The data presented in this study correspond to those obtained in the state of Rio Grande do Norte, in which 45 nurses from primary health care were interviewed from December 2020 to April 2021. After the interviews, the recorded narratives were transcribed and analyzed through the Bardin's Content Analysis. Results: The collective discourse showed that the use of Personal Protective Equipment, the organization and development of new protocols and care flows brought psychic suffering to professionals, both due to inadequate working conditions and the proximity to the suffering of patients and the fear of Contagion. Conclusion: Even with so many difficulties, nurses working in primary health care had to rebuild their practices in order to guarantee, within the limits imposed by the adverse situation, the best possible assistance, showing the strength and resilience of PHC teams in the most diverse contexts. (AU)

Objetivo: Analizar la percepción de los enfermeros sobre las condiciones de trabajo en el contexto de la APS durante la pandemia de COVID-19. Métodos: Se trata de un estudio descriptivo transversal con enfoque cualitativo, parte de un estudio multicéntrico de alcance nacional. Los datos presentados en este estudio corresponden a los obtenidos en el estado de Rio Grande do Norte, en el que fueron entrevistados 45 enfermeros de atención primaria de salud entre diciembre de 2020 y abril de 2021. Después de las entrevistas, las narraciones grabadas fueron transcritas y analizadas a través de la escala de Bardin. Análisis de contenido. Resultados: El discurso colectivo mostró que el uso de Equipos de Protección Individual, la organización y desarrollo de nuevos protocolos y flujos de atención trajeron sufrimiento psíquico a los profesionales, tanto por las inadecuadas condiciones de trabajo como por la proximidad al sufrimiento de los pacientes y el miedo al Contagio. Conclusión: Incluso con tantas dificultades, los enfermeros que actúan en la atención primaria de salud tuvieron que reconstruir sus prácticas para garantizar, dentro de los límites impuestos por la situación adversa, la mejor asistencia posible, mostrando la fortaleza y resiliencia de los equipos de APS en los más diversos contextos. (AU)

Diagnosis of Congenital Toxoplasmosis: Challenges and Management Outcomes.

Introduction Congenital toxoplasmosis (CT), despite being mostly subclinical at birth, can cause disabling disease in the fetus and lead to long-term sequelae. It is an important cause of chorioretinitis in infants and adolescents. Data on postnatal treatment are controversial, and there is a lack of universal guidelines. Methods A cross-sectional study of newborns with suspected CT was conducted between January 2007 and December 2021. Results Seventy-one patients with suspected CT were included. During pregnancy, 64 (90.1%) of the mothers underwent therapy, of which 59 (83.1%) with spiramycin. Amniocentesis identified one positive polymerase chain reaction assay. Most newborns were asymptomatic with normal laboratory, ophthalmological, and hearing screening. There was one case of hyperproteinorrachia. Fifty-seven patients (80.3%) started treatment: 42 (73.7%) with spiramycin, seven (12.3%) with pyrimethamine, sulfadiazine, and folinic acid (P+S+FA), and eight (14%) with P+S+FA intercalated with spiramycin. Adverse effects were found in 11 (19.3%) cases, mainly neutropenia. After investigation, we found three confirmed CT cases corresponding to 4.2% of suspected cases and an incidence of 0.4 per 10,000 births. All had normal clinical and laboratory exams in the neonatal period and started P+S+FA, fulfilling 12 months of therapy. During the follow-up, all presented normal psychomotor development without any long-term sequelae. Conclusion The lower incidence in our study, compared to the incidence in Europe, may be related to the decline in the prevalence of toxoplasmosis as well as the effectiveness of measures to prevent primary infection and a well-established program of antenatal screening, followed by the early initiation of treatment during pregnancy to prevent vertical transmission.

Modeling 1-D aqueous film forming foam transport through the vadose zone under realistic site and release conditions.

Aqueous film forming foams (AFFFs) have been used to extinguish fires since the 1960s, leading to widespread subsurface contamination by per- and polyfluoroalkyl substances (PFAS), an essential component of AFFF. This study presents 1-D simulations of PFAS migration in the vadose zone resulting from AFFF releases. Simulation scenarios used soil profiles from three US Air Force (USAF) installations, encompassing a range of climatic conditions and hydrogeologic environments. A three-component mixture, representative of major constituents of AFFF, facilitated the exploration of competitive and synergistic effects of co-constituents on PFAS migration. To accurately capture unsaturated transport of PFAS in porous media, the model considers (1) surfactant-induced flow, (2) non-linear sorption to the solid phase, (3) competitive accumulation at the air-water interface, and (4) the moisture-dependence of the air-water interfacial area. Defined PFAS releases were consistent with fire training exercises, emergency responses, and accidental spills of record. Simulation results illustrate the importance of hydrogeologic, climatic, geochemical, and AFFF release conditions on PFAS transport and retention. Comparison of field observations and model simulations for Ellsworth AFB indicate that much of the PFOA and PFOS mass is associated with the air-water interface and the solid phase, which limits their migration potential in the vadose zone. Results also show that rates of migration in the aqueous phase are largely controlled by hydrogeologic properties, including recharge rates and hydraulic conductivity. AFFF spill scenarios varying in volume, concentration, and frequency reveal the importance of release characteristics in determining rates of PFAS migration and concentration peaks. Variability is attributed to non-linear sorption processes, where, contrary to simple linear partitioning formulations, transport is strongly affected by the concentration of PFAS species. Simulations also demonstrate the importance of modeling the AFFF as a mixture since competitive interfacial accumulation effects are shown to enhance the mobility of less surface-active PFAS compounds.

[Eating Habits of People with Type 2 Diabetes Mellitus in Portugal: A Cross-Sectional Study]. / Hábitos Alimentares das Pessoas com Diabetes Mellitus Tipo 2 em Portugal: Um Estudo Transversal.

INTRODUCTION: Nutrition is a cornerstone of diabetes mellitus prevention and management; therefore, it is essential to enable patients to adopt healthy eating habits. Previous studies have not yet documented the main errors in the eating habits of Portuguese people with type 2 diabetes mellitus. This study aims to identify the main errors in the eating habits of people living with type 2 diabetes mellitus in Portugal and to evaluate its associations with sociodemographic variables. METHODS: Cross-sectional multicentric study in a convenience sample of people with type 2 diabetes mellitus in Primary Health Care Units. The UK Diabetes and Diet Questionnaire (UKDDQ) - translated and adapted, was applied from July to October 2022. Descriptive and inferential statistical analyses were conducted. RESULTS: Of the 550 participants, 52.2% were female, 68.3% were 65 years or over, 55.8 % had an education level up to the fourth grade, 24.7% had economic deprivation, and the mean time since diagnosis was 10.60 ± 8.13 years. Only 36.2% of the sample had a healthy UKDDQ score. Less than 50% of the sample had healthy scores for the items "high-fiber rice or pasta", "high-fiber bread", "butter, margarine and vegetable oils" and "vegetables and pulses". Only 8.9% of the sample had a healthy consumption of fiber. About 70.4% reported healthy scores for the consumption of "high-added-sugar foods" and 54.7% for "high-saturated fat". A statistically significant weak positive correlation was found between the UKDDQ score and age (ρ = 0.201, p < 0.001) with a more frequent choice of healthy foods with increasing age. Female respondents reported healthier habits, particularly in the consumption of "high-saturated fat" and "high-fiber foods". CONCLUSION: The majority of our sample did not take advantage of the potential benefits of healthy eating habits. The main food groups whose consumption should be emphasized or discouraged were individualized, particularly the need to encourage the consumption of high-fiber foods. Targeted educational actions must focus especially on younger and/or male patients.

Introdução: A nutrição é uma área de intervenção na prevenção e gestão da diabetes mellitus; por isso, é fulcral promover a capacitação da população para a adoção de hábitos alimentares saudáveis. Ainda que existam alguns estudos nesta área, não se conhecem os principais erros nos hábitos alimentares das pessoas com diabetes em Portugal. Os objetivos deste estudo foram identificar os principais erros nos hábitos alimentares das pessoas com diabetes mellitus tipo 2 em Portugal e avaliar a sua relação com variáveis sociodemográficas. Métodos: Estudo transversal multicêntrico, em amostra de conveniência de pessoas com diabetes mellitus tipo 2 seguidas em Unidades de Cuidados de Saúde Primários. Aplicação do UK Diabetes and Diet Questionnaire (UKDDQ) ­ traduzido e adaptado, de julho a outubro de 2022. Análise estatística descritiva e inferencial. Resultados: Amostra de 550 participantes, 52,2% do sexo feminino, 68,3% com 65 anos ou mais, 55,8% com nível de escolaridade igual ou inferior ao 1.º ciclo do ensino básico, 24,7% com insuficiência económica e tempo desde o diagnóstico médio de 10,60 ± 8,13 anos. Apenas 36,2% da amostra obteve um score UKDDQ considerado saudável. Menos de 50% obteve scores saudáveis para os itens "arroz ou massa ricos em fibras", "pão integral", "manteiga, margarina e óleos vegetais" e "vegetais e leguminosas". Somente 8,9% da amostra obteve score saudável para o consumo de fibras. Cerca de 70,4% obteve score saudável para o consumo de açúcares livres e 54,7% para o consumo de ácidos gordos saturados. Verificou-se a existência de uma correlação com significado estatístico positiva fraca entre o score UKDDQ e a idade (ρ = 0,201, p < 0,001), com escolha mais frequente de alimentos saudáveis com o aumentar da idade. As pessoas do sexo feminino reportaram hábitos alimentares mais saudáveis, particularmente no consumo de fibras e ácidos gordos saturados. Conclusão: A maior parte da nossa amostra não usufruiu do potencial efeito positivo de uma alimentação saudável. Individualizam-se grupos de alimentos cujos consumos devem ser enfatizados ou desencorajados, particularmente, a necessidade de incentivar o consumo de alimentos ricos em fibra. Ações educacionais dirigidas devem ter especial foco em pessoas mais jovens e/ou do sexo masculino.

Niobium oxyhydroxide as a bioactive agent and reinforcement to a high-viscosity bulk-fill resin composite

Abstract Objective The present in vitro study incorporated niobium oxyhydroxide fillers into an experimental high-viscosity bulk-fill resin composite to improve its mechanical performance and provide it a bioactive potential. Methodology Scanning electron microscopy synthesized and characterized 0.5% niobium oxyhydroxide fillers, demonstrating a homogeneous morphology that represented a reinforcement for the feature. Fillers were weighed, gradually added to the experimental resin composite, and homogenized for one minute, forming three groups: BF (experimental high-viscosity bulk-fill resin composite; control), BF0.5 (experimental high-viscosity bulk-fill resin composite modified with 0.5% niobium oxyhydroxide fillers), and BFC (commercial bulk-fill resin composite Beautifil Bulk U, Shofu; positive control). In total, 10 specimens/groups (8 × 2 × 2 mm) underwent flexural strength (FS) tests in a universal testing machine (Instron) (500N). Resin composites were also assessed for Knoop hardness (KH), depth of cure (DoC), degree of conversion (DC), elastic modulus (E), and degree of color change (ΔE). The bioactive potential of the developed resin composite was evaluated after immersing the specimens into a simulated body fluid in vitro solution and assessing them using a Fourier-transformed infrared spectroscope with an attenuated total reflectance accessory. One-way ANOVA, followed by the Tukey's test (p<0.05), determined FS, DC, KH, and ΔE. For DoC, ANOVA was performed, which demonstrated no significant difference between groups (p<0.05). Conclusions The high-viscosity bulk-fill resin composite with 0.5% niobium oxyhydroxide fillers showed promising outcomes as reinforcement agents and performed well for bioactive potential, although less predictable than the commercial resin composite with Giomer technology.

Práticas educacionais colaborativas em saúde mediadas pelas tecnologias da informação e comunicação: uma revisão de literatura / Collaborative educational practices in health mediated by information and communication technologies: a literature review / Prácticas educativas colaborativas en salud mediadas por las tecnologías de la información y comunicación: una revisión de literatura

O objetivo do presente estudo foi identificar elementos estruturantes do processo de trabalho das redes educacionais colaborativas em saúde mediadas por tecnologias de informação e comunicação, assinalando suas características-chave e sua dinâmica de funcionamento. Trata-se de uma revisão de escopo, realiza-da nas bases de dados: Medline, Lilacs e no portal Oasisbr. Foram encontrados 1.499 estudos, dos quais, oito atenderam aos critérios de inclusão. Os resultados da investigação apontam as práticas educacionais colaborativas em saúde mediados por essas tecnologias como processos amplos e complexos, envolvendo a associação de diversos fatores. Destacam-se a dimensão técnico-pedagógica, a gestão estratégica, o gerenciamento do fluxo de informações, os aspectos relacionais, as competências de cada membro e a mediação do processo colaborativo. A integração dos diferentes aspectos da rede traduz um conjunto de desafios para a estruturação dos processos colaborativos que não se limita à pura acumulação cognitiva, mas vincula-se a processos de aprendizagem e desenvolvimento dos sujeitos

The aim of the present study was to identify structural elements of the work process of collaborative educational networks in health, mediated by information and communication technologies, by pointing out its key characteristics and its operating dynamics. This is a scope review, accomplished in the following databases Medline and Lilacs and in the Oasisbr portal. A total of 1.499 studies were found, and eight of them met the inclusion criteria. The search results indicate the collaborative educational practices in health mediated by these technologies as broad and complex processes, involving the association of several factors. The technical-pedagogical dimension, the strategic management, the management of the information flow, the relational aspects, the competencies of each member, and the mediation of the collaborative process are highlighted. The integration of the different aspects of the network translates a set of challenges for the structuring of collaborative processes, which is not limited to pure cognitive accumulation, but is bound to learning processes and to the subjects' development.

El objetivo del presente estudio es identificar elementos estructurantes del proceso de trabajo de las redes educativas colaborativas en salud mediadas por tecnologías de la información y comunicación, señalando sus características claves y su dinámica de funcionamiento. El trabajo presenta una revisión de escopo, realizada en las bases de datos: Medline, Lilacs y en el portal Oasisbr. Fueron encontrados 1.499 estudios, de los cuales ocho cumplieron los criterios de inclusión. Los resultados de la investigación apuntan a las prácticas educativas colaborativas en salud mediadas por estas tecnologías como procesos amplios y com-plejos, que abarcan la asociación de diversos factores. Se destacan la dimensión técnico-pedagógica, la gestión estratégica, el gerenciamiento del flujo de información, los aspectos relacionales, las competencias de cada miembro y la mediación del proceso colaborativo. La integración de los diferentes aspectos de la red traduce un conjunto de desafíos para la estructuración de los procesos colaborativos, que no se limitan a la acumulación cognitiva, sino que se vinculan a los procesos de aprendizaje y desarrollo de los sujetos

Implementação da Prática Avançada de Enfermagem no enfrentamento do atraso vacinal: um relato de experiência / Implementation of Advanced Practice Nursing in coping with vaccine delay: an experience report

OBJETIVO: Descrever a implementação de práticas avançadas de enfermagem para abordar o atraso na imunização em crianças menores de dois anos de idade. MÉTODO: Trata-se de um relato de experiência que monitorou a situação vacinal de crianças menores de dois anos e descreveu práticas avançadas de enfermagem para melhorar a adesão à vacinação. RESULTADOS: Foi monitorado o estado vacinal das crianças e realizadas ações e intervenções individuais e coletivas, como consultas individuais, buscas ativas, ligações telefônicas e mensagens via aplicativo de celular, educação continuada e produção de materiais educativos para conscientização entre a comunidade, pais/responsáveis e profissionais de saúde sobre a importância de manter o calendário vacinal atualizado, conforme proposto pelo Programa Nacional de Imunizações. CONCLUSÃO: As intervenções neste relatório demonstraram implicações importantes para a saúde pública e podem sugerir que as práticas avançadas de enfermagem têm um impacto positivo na melhoria da cobertura vacinal.

OBJECTIVE: To describe the implementation of advanced practice nursing to address delayed immunization in children under two years of age. METHOD: This experience report monitored the immunization status of children under two years of age and described advanced practice nursing to improve immunization compliance. RESULTS: The immunization status of children was monitored, and individual and collective actions and interventions were carried out, such as individual consultations, active searches, telephone calls and messages via a mobile phone application, ongoing education, and the production of educational materials to raise awareness among the community, parents/guardians and health professionals about the importance of keeping the immunization schedule up to date, as proposed by the Brazilian National Immunization Program. CONCLUSION: The interventions in this report have demonstrated important public health implications and may suggest that advanced nursing practices positively impact improving immunization coverage.

Ambiguous Genitalia: An Unexpected Diagnosis in a Newborn.

Alterations in gonad formation or function can lead to congenital conditions in which chromosomal, gonadal, or anatomical sex is atypical. These conditions are referred to as disorders of sex development (DSD) and have a heterogeneous etiology. The assessment of these children by a multidisciplinary team is crucial for an accurate diagnosis and should be initiated promptly due to the potentially life-threatening nature of congenital adrenal hyperplasia, a common cause of DSD. We present a neonate born at 39 weeks with a weak cry, slight hypotonia, poor suction reflex, peculiar facies, and ambiguous genitalia. From the study carried out, the abdominopelvic ultrasound revealed a nodular structure compatible with the left gonad. Aneuploidy screening confirmed the presence of the Y chromosome. Additionally, normal endocrinological studies and the karyotype showed a genotype compatible with cri-du-chat syndrome with partial trisomy of chromosome 3. Children with cri-du-chat syndrome characteristically exhibit a cat-like cry and distinctive facial features, along with developmental delay and intellectual disability. Duplication of 3p is a rare genetic disorder, usually associated with other chromosomal anomalies and congenital malformations, namely, of the genitals.

Kikuchi-Fujimoto Disease: The Unexpected Diagnosis of a Cervical Adenopathy.

Many cases of adenopathies, whose differential diagnosis includes a wide spectrum of pathologies (including some malignant conditions like lymphoproliferative diseases, e.g., lymphomas), resort to primary healthcare. Kikuchi-Fujimoto disease is a rare, benign, self-limiting entity characterized by adenopathies, mainly in the cervical region, which may be associated with constitutional symptoms. This specific pathology is very rare in primary care and is often overlooked. That is why it is essential to promote medical literacy and provide support in managing these cases, which we want to emphasize through this case presentation. This case report presents a 24-year-old female patient who sought a consultation at the Family Health Unit due to a painful swelling in the right cervical region that lasted two weeks. She denied a history of recent infections or constitutional symptoms. A painful and hard right submaxillary mass, measuring 2 cm in diameter, was identified upon palpation. An analytical study and ultrasound of the soft tissues of the cervical region were initially required. Analytically, there were no relevant changes; however, the ultrasound revealed "hypoechoic ganglion formations in the right laterocervical chains, from the retroauricular region to the lower region of the neck, the largest measuring 19x7mm". The patient was reassessed one month later, due to an increase in the number of adenopathies, and a new ultrasound was performed that revealed "supraclavicular adenopathy". After that, she was referred to Secondary Healthcare (Central Hospital), where a lymph node biopsy was performed, with histological results of Kikuchi-Fujimoto disease. The patient maintains a follow-up in a hemato-oncology consultation, with painless adenopathies that, according to her, get worse with anxiety symptoms. Currently, the patient is being treated symptomatically, with stabilization of adenopathies and anxious manifestations. These patients need long-term follow-up due to the possibility of disease recurrence or the development of autoimmune processes. Although it is a diagnosis of exclusion, this disease must always be considered, since it can be mistaken with other serious pathologies that require aggressive treatments. Regarding the relationship between anxiety disorder and the worsening of adenopathies, although no conclusive evidence was found in the literature, there are some studies that have established a connection between inflammation and the deterioration of certain depressive symptoms.

Telehealth service maturity model for the Brazilian scenario (TMSMM.br) / Modelo de madurez de servicios de telemedicina para el escenario brasileño (TMSMM.br) / Modelo de maturidade de serviços de telessaúde para o cenário brasileiro (TMSMM.br)

This article describes a proposed framework called Telehealth Service Maturity Model (TMSMM.br) for evaluating the current stage of telehealth centers in the Brazilian context. The steps included literature review, compilation and interpretation, data collection instrument, survey with center coordinators, model development, and evaluation process. The review resulted in 857 quality aspects for telehealth services, grouped into 12 themes with 34 topics. TMSMM.br consists of defining 3 foundational dimensions (themes, services, stages) and provides a standardized set of 200 requirements ordered across 5 thematic domains (structure, organization, user, operation and community) for 8 services (consultation, consultation, diagnosis, treatment and referral, education and training, social control and communication, healthcare network, and research, development, and innovation). TMSMM.br enables telehealth centers to identify and compare essential characteristics and their maturity stages.

Este artículo describe una propuesta de marco de referencia llamado Modelo de Madurez de Servicios de Telemedicina (TMSMM.br) para evaluar la etapa actual de los centros de telemedicina en el contexto brasileño. Las etapas incluyeron revisión de literatura, compilación e interpretación, instrumento de recolección, encuesta a coordinadores de centros, desarrollo del modelo y proceso de evaluación. La revisión resultó en 857 aspectos de calidad para servicios de telemedicina, agrupados en 12 temas con 34 tópicos. TMSMM.br consiste en la definición de 3 dimensiones estructurales (temas, servicios, etapas) y proporciona un conjunto estandarizado de 200 requisitos ordenados en 5 dominios temáticos (estructura, organización, usuario, operación y comunidad) para 8 servicios (consulta, asesoría, diagnóstico, tratamiento y remisión, educación y capacitación, control social y comunicación, red de atención de salud e investigación, desarrollo e innovación). TMSMM.br ayuda a los centros de telemedicina a identificar y comparar características esenciales y sus etapas de madurez

Este artigo descreve uma proposta de framework denominado Modelo de Maturidade de Serviços de Telessaúde (TMSMM.br) para avaliação do estágio corrente dos núcleos de telessaúde no contexto brasileiro. As etapas incluíram revisão da literatura, compilação e interpretação, instrumento de coleta, inquérito com coordenadores de núcleos, elaboração do modelo e do processo de avaliação. A revisão resultou 857 aspectos de qualidade para serviços de telessaúde, agrupados em 12 temas com 34 tópicos. TMSMM.br consiste na definição de 3 dimensões estruturantes (temas, serviços, estágios) e provê um conjunto padronizado de 200 requisitos ordenados em 5 domínios temáticos (estrutura, organização, usuário, operação e comunidade) para 8 serviços (consulta, consultoria, diagnóstico, tratamento e encaminhamento, formação e capacitação, controle social e comunicação, rede de atenção à saúde, e pesquisa, desenvolvimento e inovação). TMSMM.br colabora para que núcleos de telessaúde possam identificar e comparar características essenciais e seus estágios de maturidade.

Impact of COVID-19 on healthcare-associated infections: Antimicrobial consumption does not follow antimicrobial resistance.

BACKGROUND: This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in São Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period. METHODS: This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection ‒ CLABSI and Ventilator-Associated Pneumonia ‒ VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 ‒ December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models. RESULTS: 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (≤ 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs. CONCLUSIONS: HAI increased during COVID-19. The microorganisms' susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use.

Evolutionary history of an island endemic, the Azorean common quail.

Oceanic islands are characterized by conditions that favour diversification into endemic lineages that can be very different from their mainland counterparts. This can be the result of fast phenotypic divergence due to drift or the result of slower adaptation to local conditions. This uniqueness can obscure their evolutionary history. Here we used morphological, stable isotope, genetic and genomic data to characterize common quails (Coturnix coturnix) in the Azores archipelago and assess the divergence from neighbouring common quail populations. Historical documents suggested that these quails could have a recent origin associated with the arrival of humans in the last centuries. Our results show that Azorean quails constitute a well-differentiated lineage with small size and dark throat pigmentation that has lost the migratory ability and that diverged from mainland quail lineages more than 0.8 mya, contrary to the notion of a recent human-mediated arrival. Even though some Azorean quails carry an inversion that affects 115 Mbp of chromosome 1 and that has been associated with the loss of the migratory behaviour in other common quail populations, half of the analysed individuals do not have that inversion and still do not migrate. The long coexistence and evolution in isolation in the Azores of two chromosomal variants (with and without the inversion) is best explained by balancing selection. Thus, a unique and long evolutionary history led to the island endemic that we know today, C. c. conturbans.

Factors associated with women diagnosed with syphilis who received prenatal care in a primary healthcare unit.

OBJECTIVE: To estimate the prevalence of syphilis and its associated factors in women who were treated at public maternity hospitals and received prenatal care in a primary healthcare unit. METHODS: This cross-sectional study included 399 postpartum women. Interviews were conducted, and additional data were extracted from the pregnant woman's booklet, medical records, and printed tests. The dependent variable was a gestational syphilis diagnosis. The independent variables were grouped into socioeconomic and demographic, behavioral, reproductive, and prenatal blocks. The prevalence, prevalence ratios, and 95% confidence intervals (95%CI) were calculated. The χ 2 test was also performed (p≤0.05). Multivariate analysis was performed using Poisson regression models. RESULTS: The prevalence of gestational syphilis was 9.61% (95%CI: 7.14-12.83). We identified the following determining factors (adjusted prevalence ratios): history of sexually transmitted infections (2.3), first sexual intercourse by the age of 15 (2.42), partner having a history of syphilis (5.98), partner using crack/cocaine (6.42) and marijuana and others (3.02), not having a partner (3.07), low income (2.85), history of stillbirth (5.21), beginning prenatal care in the third trimester (3.15), and prenatal care received in a primary healthcare unit (without a Family Health Strategy team) (0.35). CONCLUSION: Individual and prenatal factors were associated with gestational syphilis. To control congenital syphilis, targeted interventions are needed to control syphilis in the adult population including expansion of access to quality prenatal care with identification of risks for syphilis and connection between prevention and treatment actions, implementation of strategies focused on early sexual education, effective establish prenatal care involving both partners, and effective implementation of the National Men's Health Policy (PNAISH - Política Nacional de Atenção Integral à Saúde dos Homens ).

One-day voiding diary in the evaluation of Lower Urinary Tract Symptoms in children

ABSTRACT Introduction: Voiding diary (VD) is an important tool in the evaluation of children with voiding symptoms. Voiding frequency, maximal voided volume (MVV), average voided volume (AVV) and nocturnal volume (NV) can be extracted and are valuable in diagnosing and monitoring these disorders. Recently, ICCS has reduced the period of data recording on VD from 3 to 2 days. We hypothesized that one day voiding diary would be enough for guiding treatment. Materials and Methods: Children with overactive bladder (OAB) and primary monosymptomatic enuresis (PMNE) were oriented to fulfill a 3-day VD. Data obtained from VD were evaluated for the first day (1dVD), the first two days (2dVD), and all 3 days (3dVD) and compared according to the MVV, AVV, frequency, NV and expected bladder capacity (EBC). The Friedman, Student's t test and the Fisher's exact was used. ANOVA was used for multiple comparisons. We also used Pearson correlation test. Results: Ninety-eight children were included, 59 had PMNE and 30 OAB. Frequency, AVV and VN were similar regardless how many days the voiding episodes were recorded. Only MVV was higher by a mean of only 32 mL on 3dVD compared to 1dVD. A 1dVD has a sensitivity of 93,9% and a positive likelihood ratio of 2.2. As for the correlation of MVV and EBC it was observed that in 83% of children, MVV was lower than EBC. MVV corresponds to 67% and 69% of EBC in children with PMNE and OAB, respectively. Conclusion: We believe that 1dVD is sufficient to assess these children. It has a high sensitivity and good correlation to 3dVD in evaluating these children. Bladder capacity in this population, evaluated by maximum voided volume, was close to 68% of that obtained by the EBC.

Reinfection rate in a cohort of healthcare workers over 2 years of the COVID-19 pandemic.

In this large cohort of healthcare workers, we aimed to estimate the rate of reinfections by SARS-CoV-2 over 2 years of the COVID-19 pandemic. We investigated the proportion of reinfections among all the cases of SARS-CoV-2 infection from March 10, 2020 until March 10, 2022. Reinfection was defined as the appearance of new symptoms that on medical evaluation were suggestive of COVID-19 and confirmed by a positive RT-PCR. Symptoms had to occur more than 90 days after the previous infection. These 2 years were divided into time periods based on the different variants of concern (VOC) in the city of São Paulo. There were 37,729 medical consultations due to COVID-19 at the hospital's Health Workers Services; and 25,750 RT-PCR assays were performed, of which 23% (n = 5865) were positive. Reinfection by SARS-CoV-2 was identified in 5% (n = 284) of symptomatic cases. Most cases of reinfection occurred during the Omicron period (n = 251; 88%), representing a significant increase on the SARS-CoV-2 reinfection rate before and during the Omicron variant period (0.8% vs. 4.3%; p < 0.001). The mean interval between SARS-CoV-2 infections was 429 days (ranged from 122 to 674). The Omicron variant spread faster than Gamma and Delta variant. All SARS-CoV-2 reinfections were mild cases.

Double screening for syphilis and HIV in pregnant women in a priority municipality for the elimination of vertical transmission in Brazil: incidence, risk factors and spatial analysis.

BACKGROUND: The Brazilian Ministry of Health (MoH) recommends double screening (DS) for syphilis and HIV during the first and third trimesters of antenatal care (ANC) to mitigate vertical transmission. We surveyed DS outcomes and their associated factors in a priority Brazilian municipality with >100 000 inhabitants who face challenges for both health problems. METHODS: A total of 399 women were followed up throughout pregnancy using medical records. Spatial and multinomial logistic analyses were performed. RESULTS: There was an incidence rate of 24.8%, 59.4% and 15.8% for 'full DS', 'partial DS' and 'without DS', respectively. Younger women and those with a history of both prematurity and multiparity were less likely to be in the 'full DS' category. There was an overlap of high-density clusters of 'full DS' and 'ANC in better quality basic health units', adherent to both the Family Health Strategy and the National Program for Access and Quality Improvement in Primary Care. CONCLUSIONS: The poor DS outcomes presented in 75% of the cases were mostly linked to delays in starting ANC appointments or their discontinuity. Thus, the MoH recommendations, accompanied by ongoing training, technical assistance and the periodic evaluation of their implementation, need to effectively reach providers and promote counseling and awareness about the importance of DS for pregnant women.