Four years of the COVID-19 pandemic: how does Brazil deal with the impacts? A DOHaD perspective.

Over the last few years, during the pandemic, the Brazilian population has suffered several problems, ranging from health to socioeconomic impacts. When we consider Brazilian science, there has been an undeniable scientific delay generated by the pandemic, especially in areas that are not related to the coronavirus. In this context, with the aim of fostering collaboration among researchers in the field of Developmental Origins of Health and Diseases (DOHaD) and enhancing the potential for implementing public health strategies to prevent noncommunicable chronic diseases, the Brazilian Association of Developmental Origins of Health and Diseases (DOHaD Brazil) was established in 2020. In this narrative, we explore the effects of the COVID-19 pandemic in Brazil, focusing on its impacts on scientific research conducted in universities. Additionally, we underscore the significance of the DOHaD Brazil Association, particularly from the perspective of young researchers engaged in DOHaD research in Brazil.

Biosocial Technical Systems: An Emerging Approach to Analyse Responses to Novel Diseases.

The COVID-19 pandemic emerged in the context of a parallel epidemic of information, namely an infodemic. With the development of vaccines occurring in record time, a disinformation campaign ensued rendering the infodemic ever more troubling. As COVID-19 had to be curbed with vaccines opinion pools and surveys indicated that a minority, but relevant, part of the general public had weakened trust in public health policies and also on governmental responses to the pandemic in general. This dissent in public opinion on pandemic response is interpreted in this chapter as a controversy related to the efficacy and risks associated to vaccines. Such controversy gained momentum partly because traditional scientific communication has been largely unidirectional rather than bi-directional. We propose to apply a novel biosocial technical perspective to examine the COVID-19 pandemic controversy and communication, articulating social, biological and technical issues. The interaction between COVID-19 and vaccines, i.e. artefact-biological interactions, resulted in vaccine development in record time. However, the interaction between social systems and vaccine as artefacts was plagued by partial public reluctance in their acceptance. This rendered communication efforts ever more relevant, bringing lessons related to the importance of a more fluid bi-directional communication in future disease epidemics.

Technological Advances in the Diagnosis of Cardiovascular Disease: A Public Health Strategy.

This article reviews technological advances and global trends in the diagnosis, treatment, and monitoring of cardiovascular diseases. A bibliometric analysis was conducted using the SCOPUS database, following PRISMA-ScR guidelines, to identify relevant publications on technologies applied in the diagnosis and treatment of cardiovascular diseases. An increase in scientific output since 2018 was observed, reflecting a growing interest in the technologies available for the treatment of cardiovascular diseases, with terms such as "telemedicine", "artificial intelligence", "image analysis", and "cardiovascular disease" standing out as some of the most commonly used terms in reference to CVDs. Significant trends were identified, such as the use of artificial intelligence in precision medicine and machine learning algorithms to analyse data and predict cardiovascular risk, as well as advances in image analysis and 3D printing. Highlighting the role of artificial intelligence in the diagnosis and continuous monitoring of cardiovascular diseases, showing its potential to improve prognosis and reduce the incidence of acute cardiovascular events, this study presents the integration of traditional cardiology methods with digital health technologies-through a transdisciplinary approach-as a new direction in cardiovascular health, emphasising individualised care and improved clinical outcomes. These advances have great potential to impact healthcare, and as this field expands, it is crucial to understand the current research landscape and direction in order to take advantage of each technological advancement for improving the diagnosis, treatment, and quality of life of cardiovascular patients. It is concluded that the integration of these technologies into clinical practice has important implications for public health. Early detection and personalised treatment of cardiovascular diseases (CVDs) can significantly reduce the morbidity and mortality associated with these diseases. In addition, the optimisation of public health resources through telemedicine and telecare can improve access to quality care. The implementation of these technologies can be a crucial step towards reducing the global burden of cardiovascular diseases.

The use of individual tracking programs in public health: a bioethics dilemma.

OBJECTIVE: to understand the bioethical perspectives on mobile tracking device use. METHODS: theoretical study based on action research, carried out with eight graduate students from a public university. A focus group was used, with a thematic content analysis methodology with a codebook structure, approved by the Research Ethics Committee. RESULTS: from the analysis, there was a concern about using devices after the pandemic ended. Using or not the device, rights inherent to humans, legislation and effectiveness of methods deepen interpretations, moving participants from a personalistic conception of the topic to a vision focused on professional implications about the methods. FINAL CONSIDERATIONS: the debate on the impact of using technological devices on health, especially those that imply restriction of rights that refer to individuals' private life, involves a discussion of a professional nature, in addition to requirement for clear rules on the topic.

Quality improvement collaborative for improving patient care delivery in Argentine public health sector intensive care units.

BACKGROUND: The demand for healthcare services during the COVID-19 pandemic was excessive for less-resourced settings, with intensive care units (ICUs) taking the heaviest toll. OBJECTIVE: The aim was to achieve adequate personal protective equipment (PPE) use in 90% of patient encounters, to reach 90% compliance with objectives of patient flow (OPF) and to provide emotional support tools to 90% of healthcare workers (HCWs). METHODS: We conducted a quasi-experimental study with an interrupted time-series design in 14 ICUs in Argentina. We randomly selected adult critically ill patients admitted from July 2020 to July 2021 and active HCWs in the same period. We implemented a quality improvement collaborative (QIC) with a baseline phase (BP) and an intervention phase (IP). The QIC included learning sessions, periods of action and improvement cycles (plan-do-study-act) virtually coached by experts via platform web-based activities. The main study outcomes encompassed the following elements: proper utilisation of PPE, compliance with nine specific OPF using daily goal sheets through direct observations and utilisation of a web-based tool for tracking emotional well-being among HCWs. RESULTS: We collected 7341 observations of PPE use (977 in BP and 6364 in IP) with an improvement in adequate use from 58.4% to 71.9% (RR 1.2, 95% CI 1.17 to 1.29, p<0.001). We observed 7428 patient encounters to evaluate compliance with 9 OPF (879 in BP and 6549 in IP) with an improvement in compliance from 53.9% to 67% (RR 1.24, 95% CI 1.17 to 1.32, p<0.001). The results showed that HCWs did not use the support tool for self-mental health evaluation as much as expected. CONCLUSION: A QIC was effective in improving healthcare processes and adequate PPE use, even in the context of a pandemic, indicating the possibility of expanding QIC networks nationwide to improve overall healthcare delivery. The limited reception of emotional support tools requires further analyses.

Novedades en el calendario de vacunas de Argentina. Primera parte: virus sincicial respiratorio / News in Argentina's vaccine schedule. Part one: respiratory syncytial virus

A fines de 2023 la autoridad sanitaria de Argentina realizó modificaciones en el Calendario Nacional obligatorio, que serán implementadas en forma progresiva durante 2024. Este artículo está enfocado en la introducción de la vacuna contra el virus sincicial respiratorio en las personas embarazadas que cursan las semanas 32 a 36 de gestación durante la temporada de circulación del virus. (AU)

At the end of 2023, the Argentine health authority modified the mandatory National Calendar, which will be implemented progressively during 2024. This article focuses on the introduction of the vaccine against respiratory syncytial virus in pregnant women in the 32nd to 36th weeks of gestation during the season of the virus's circulation. (AU)

Novedades en el calendario de vacunas de Argentina. Segunda parte: virus del papiloma humano / News in Argentina's vaccine schedule. Second part: human papillomavirus

A fines de 2023 la autoridad sanitaria de Argentina realizó modificaciones en el Calendario Nacional obligatorio, que serán implementadas en forma progresiva durante 2024. Este artículo está enfocado en la reducción del esquema contra el virus del papiloma humano. (AU)

At the end of 2023, the Argentine health authority modified the mandatory National Calendar, which will be implemented progressively during 2024. This article focuses on the reduction in the human papillomavirus scheme. (AU)

Novedades en el calendario de vacunas de Argentina. Tercera parte: neumococo / News in Argentina's vaccine schedule. Third part: pneumococcus

A fines de 2023 la autoridad sanitaria de Argentina realizó modificaciones en el Calendario Nacional obligatorio, que serán implementadas en forma progresiva durante 2024. Este artículo está enfocado en el reemplazo progresivo de las vacunas antineumocóccicas conjugada de 13 serotipos y polisacárida no conjugada de 23 serotipos por la vacuna conjugada de 20 serotipos. (AU)

At the end of 2023, the Argentine health authority modified the mandatory National Calendar, which will be implemented progressively during 2024. This article focuses on the progressive replacement of the 13-serotype pneumococcal conjugate and the 23-serotype polysaccharide vaccines by the 20-serotype conjugate vaccine. (AU)

Guia de planejamento da gestão do trabalho e da educação na saúde no âmbito estadual e municipal do sistema único de saúde (SUS) / Work management and health education planning guide at the state and municipal levels of the unified health system health (SUS)

O planejamento no SUS é um requisito legal e essencial para garantir a direção da gestão e organização das ações e serviços de saúde, bem como a alocação de recursos necessários para enfrentar os problemas do sistema de saúde e melhorar sua capacidade de resposta às demandas da população. A Secretaria de Gestão do Trabalho e da Educação na Saúde (SGTES) do Ministério da Saúde busca apoiar gestores, técnicos e conselheiros de saúde na elaboração do Plano Estadual de Gestão do Trabalho e da Educação na Saúde (PEGTES). O plano proposto será desenvolvido pelas equipes estaduais vinculadas ao setor, com oficinas regionais e encontros mensais, visando à identificação, classificação, priorização e análise dos problemas e necessidades da área de Gestão do Trabalho e da Educação na Saúde. O objetivo é alcançar metas e ações estratégicas para o período 2024-2027, fortalecendo a gestão descentralizada e participativa do SUS e melhorando as condições de trabalho e a qualidade da atenção prestada à população. A metodologia proposta inclui a elaboração de matrizes de análise e planejamento para subsidiar o processo de construção do plano estadual. O resultado esperado é que até o final do ano, cada estado tenha seu PEGTES legitimado nas instâncias de gestão e controle social do SUS.

Planning within the Unified Health System (SUS) is not only a legal requirement but also a relevant mechanism to ensure the direction of management and organization of actions and services, as well as the identification and allocation of resources needed to address and overcome health system issues, thereby improving its responsiveness to the population's health demands and needs. Through this publication, the Ministry of Health's Secretariat for Health Workforce and Education (SGTES) aims to support health managers, technicians, and health councilors in developing the State Plan for Health Workforce and Education (PEGTES). The plan will be developed by state teams linked to the Health Workforce and Education Management sector (GTES) in the 26 State Health Departments (SES), with technical support from the SGTES team, from June to November 2023. It presents a proposal for organizing the planning process, as well as the theoretical and methodological content that will underpin the development of PEGTES, including concepts, methods, and tools for identifying, classifying, prioritizing, and analyzing GTES-related problems and needs. These form the basis for setting objectives and goals to be achieved during the 2024-2027 period, through the implementation of corresponding strategic actions within each specific objective of the "operational modules" of PEGTES, along with their respective responsible parties, necessary resources, and indicators for monitoring and periodic evaluation. The PEGTES development process, based on the proposed methodology, will begin with regional workshops in June 2023, followed by monthly meetings of state teams with the national coordination, where partial products (chapters of the Plan) will be presented, simultaneously shared with the respective sectors responsible for developing the State Health Plan in each SES. Thus, it is expected that by the end of the current year, each SES will have its PEGTES, legitimized in the SUS management and social control instances of each state, i.e., in the Bipartite Intermanager Commission (CIB) and the State Health Council (CES). With this initiative, they believe in strengthening the decentralized and participatory management of SUS, with a special focus on constructing policies, plans, and projects that contribute to addressing GTES-related issues, aiming at rationalizing and improving the working conditions and adapting the professional profiles of SUS workers to the system's needs, and enhancing the quality of care provided to the population.

El planeamiento en el Sistema Único de Salud (SUS), además de ser un requisito legal, es también uno de los mecanismos relevantes para asegurar la dirección de la gestión y organización de acciones y servicios, así como la identificación y asignación de recursos necesarios para enfrentar y superar los problemas del sistema de salud, mejorando su capacidad de respuesta a las demandas y necesidades de salud de la población. A través de esta publicación, la Secretaría de Gestión del Trabajo y la Educación en Salud (SGTES) del Ministerio de Salud (MS) pretende apoyar a gestores, técnicos y consejeros de salud en la elaboración del Plan Estatal de Gestión del Trabajo y la Educación en Salud (PEGTES). El plan será desarrollado por equipos estatales vinculados al sector de Gestión del Trabajo y la Educación en Salud (GTES) en las 26 Secretarías Estatales de Salud (SES), con apoyo técnico del equipo de SGTES, de junio a noviembre de 2023. Se presenta una propuesta para la organización del proceso de planificación, así como el contenido teórico-metodológico que respaldará el desarrollo de PEGTES, incluyendo conceptos, métodos e instrumentos para la identificación, clasificación, priorización y análisis de los problemas y necesidades del área de GTES, que constituyen la base para establecer objetivos y metas a ser alcanzados durante el período 2024-2027, mediante la ejecución de acciones estratégicas correspondientes a cada objetivo específico de los "módulos operativos" del PEGTES, con sus respectivos responsables, recursos necesarios e indicadores para el seguimiento y evaluación periódica. El proceso de desarrollo de PEGTES, basado en la metodología propuesta, comenzará con talleres regionales en junio de 2023, seguidos de reuniones mensuales de los equipos estatales con la coordinación nacional del proceso, donde se presentarán productos parciales (capítulos del Plan) y se compartirán con los respectivos sectores responsables de desarrollar el Plan Estatal de Salud en cada SES. Se espera que, al finalizar el presente año, cada SES cuente con su PEGTES, legitimado en las instancias de gestión y control social del SUS en cada estado, es decir, en la Comisión Intergestores Bipartita (CIB) y el Consejo Estatal de Salud (CES). Con esto, se busca fortalecer la gestión descentralizada y participativa del SUS, con énfasis especial en la construcción de políticas, planes y proyectos que contribuyan a abordar los problemas del área de GTES, con el objetivo de racionalizar y mejorar las condiciones de trabajo y adaptar los perfiles profesionales del personal de salud del SUS a las necesidades del sistema y mejorar la calidad de la atención prestada a la población.

Consultorio de Salud Ambiental en un Hospital Privado de Comunidad de la Ciudad de Buenos Aires / Environmental Health consulting office in a Private Community Hospital of the Buenos Aires City

En los últimos años surge el concepto de Una Sola Salud que reconoce la interdependencia sistémica al observar que los cambios en la salud humana se expresan de manera sincrónica e indivisible de la salud del ambiente. Nuevas enfermedades y daños crónicos inespecíficos ocurren a la par de la pérdida de biodiversidad y vitalidad. En las últimas décadas venimos observando el surgimiento de "adaptaciones sistémicas" que requieren un abordaje desde la clínica y la toxicología a nivel individual y desde la epidemiología de la complejidad a nivel poblacional. Luego de un largo recorrido de investigaciones, el Hospital Italiano formalizó el consultorio de Salud Ambiental con la intención de brindar respuesta a la demanda de pacientes que atribuyen síntomas y signos a la polución ambiental. (AU)

In recent years, the concept of One Health has emerged, recognizing the systemic interdependence and the changes in human health that are expressed synchronously and indivisible from the environment. New diseases and nonspecific chronic damage are occuring in parallel with the loss of biodiversity and vitality.In recent decades we have observed the appearance of "systemic adaptations" that require a clinical and toxicological approach at the individual level, and address the population level from an epidemiological and complexity science paradigm. After many years of research, the Hospital Italiano de Buenos Aires formalized the Environmental Health consulting office and the measurement of glyphosate levels, giving answer to the demand of patients who associate their signs and symptoms to environmental pollution. (AU)

Temporal and Spatiotemporal Arboviruses Forecasting by Machine Learning: A Systematic Review.

Arboviruses are a group of diseases that are transmitted by an arthropod vector. Since they are part of the Neglected Tropical Diseases that pose several public health challenges for countries around the world. The arboviruses' dynamics are governed by a combination of climatic, environmental, and human mobility factors. Arboviruses prediction models can be a support tool for decision-making by public health agents. In this study, we propose a systematic literature review to identify arboviruses prediction models, as well as models for their transmitter vector dynamics. To carry out this review, we searched reputable scientific bases such as IEE Xplore, PubMed, Science Direct, Springer Link, and Scopus. We search for studies published between the years 2015 and 2020, using a search string. A total of 429 articles were returned, however, after filtering by exclusion and inclusion criteria, 139 were included. Through this systematic review, it was possible to identify the challenges present in the construction of arboviruses prediction models, as well as the existing gap in the construction of spatiotemporal models.

Zika Virus after the Public Health Emergency of International Concern Period, Brazil.

More than 100,000 Zika virus cases have been reported in Brazil since the Public Health Emergency of International Concern period ended in 2016. We analyzed cases in Brazil during 2017-2021 to identify transmission trends and forecast future infection hotspots. Our results can be used for targeted interventions to reduce transmission.

Novel Epidemic Metrics to Communicate Outbreak Risk at the Municipality Level: Dengue and Zika in the Dominican Republic.

Arboviruses remain a significant cause of morbidity, mortality and economic cost across the global human population. Epidemics of arboviral disease, such as Zika and dengue, also cause significant disruption to health services at local and national levels. This study examined 2014-2016 Zika and dengue epidemic data at the sub-national level to characterise transmission across the Dominican Republic. For each municipality, spatio-temporal mapping was used to characterise disease burden, while data were age and sex standardised to quantify burden distributions among the population. In separate analyses, time-ordered data were combined with the underlying disease migration interval distribution to produce a network of likely transmission chain events, displayed using transmission chain likelihood matrices. Finally, municipal-specific reproduction numbers (Rm) were established using a Wallinga-Teunis matrix. Dengue and Zika epidemics peaked during weeks 39-52 of 2015 and weeks 14-27 of 2016, respectively. At the provincial level, dengue attack rates were high in Hermanas Mirabal and San José de Ocoa (58.1 and 49.2 cases per 10,000 population, respectively), compared with the Zika burden, which was highest in Independencia and San José de Ocoa (21.2 and 13.4 cases per 10,000 population, respectively). Across municipalities, high disease burden was observed in Cotuí (622 dengue cases per 10,000 population) and Jimani (32 Zika cases per 10,000 population). Municipal infector-infectee transmission likelihood matrices identified seven 0% likelihood transmission events throughout the dengue epidemic and two 0% likelihood transmission events during the Zika epidemic. Municipality reproduction numbers (Rm) were consistently higher, and persisted for a greater duration, during the Zika epidemic (Rm = 1.0) than during the dengue epidemic (Rm < 1.0). This research highlights the importance of disease surveillance in land border municipalities as an early warning for infectious disease transmission. It also demonstrates that a high number of importation events are required to sustain transmission in endemic settings, and vice versa for newly emerged diseases. The inception of a novel epidemiological metric, Rm, reports transmission risk using standardised spatial units, and can be used to identify high transmission risk municipalities to better focus public health interventions for dengue, Zika and other infectious diseases.

Self-perception of oral health among tertiary-care users: quanti-qualitative analysis with chronic kidney disease patients

Chronic kidney disease (CKD) has become a global public health challenge. The objective of this study was to analyze the relationship between self-perception of oral health and clinical condition among patients with CKD. This isa quanti-qualitative survey conducted in a CKD specialized service. The sample consisted of 60 patients who underwent oral examinations to have their severity of caries (DMFT) and need for dental prosthesis checked. Age, sex, time on dialysis, marital status, skin color, education and pre-existing diseases were also analyzed. Among the kidney patients who agreed to undergo the clinical examinations and showed communication skills, some were selected, and three focus groups were created, with the participation of a moderator and six to 10 kidney patients in each group. Their speeches were processed in the IRAMUTEQ software and analyzed through the similarity analysis and word cloud techniques. As for profile, the patients were aged 60.23 ± 10.87 years old; were male (73.33%); were on dialysis for 41.90 ± 56.57 months; were married (61.67%); were white (76.67%); had incomplete primary education (41.66%); had arterial hypertension (76.67%); had a DMFT index of 22.55 ± 8.39; 43.33% needed an upper complete denture; and 30.00% needed a lower complete denture. The similarity analysis revealed many doubts and uncertainties about current health services, which can be proven by the words 'no' and 'treatment'. The quanti-qualitative analysis showed a high rate of dental loss and the need for complete dentures and suggests inequities in oral health care for chronic kidney disease patients, especially in tertiary care. There was a positive representation regarding oral health, but the lexicographical analyses of the textual corpusconfirmed the self-perception of lack of dental care.

Esporotricose felina e saúde pública / Feline sporotrichosis and public health / Esporotricosis felina y salud pública

A esporotricose é uma zoonose, que factualmente tem se disseminado em forma de surtos epidêmicos em diferentes regiões do Brasil. É uma doença infecciosa presente nos gatos, que se infectam traumaticamente por arranhaduras de espinhos de plantas, solo contaminado, arranhaduras e mordeduras de gatos infectados. É causada pelo fungo dimórfico do gênero Sporothrix spp., e leva a uma série de impactos a saúde animal e humana. Tornou-se um problema de saúde pública, que atinge principalmente pessoas de classes sociais menos privilegiadas. Devido à gravidade dessa doença, a notificação passou a ser obrigatória em alguns estados. Também é uma doença de caráter ocupacional. O presente trabalho trará uma revisão sobre os principais aspectos dessa enfermidade, com o objetivo de alertar sobre os riscos, gravidade e seus impactos na saúde pública.

Sporotrichosis is a potentially zoonotic disease, which has actually spread in the form of epidemic outbreaks. It has become a public health problem, affecting mainly people from less privileged social classes. Due to the severity of this disease, notification has become mandatory in some states. It is also an occupational disease. It is an infectious disease present in cats, which become infected by plant spines, contaminated soil, scratches and bites from infected animals. It is caused by the dimorphic fungus of the genus Sporothrix sp. and leads to a series of impacts on animal and human health. Therefore, this work will bring a review on the main topics of this disease, with the objective of alerting about the risks, severity and its impacts on public health.

La esporotricosis es una enfermedad potencialmente zoonótica, que en realidad se ha propagado en forma de brotes epidémicos. Se ha convertido en un problema de salud pública que afecta principalmente a personas de clases sociales menos privilegiadas. Debido a la gravedad de esta enfermedad, la notificación se ha vuelto obligatoria en algunos estados. También es una enfermedad profesional. Es una enfermedad infecciosa presente en los gatos, que se infectan por traumatismos de espinas de plantas, suelo contaminado, arañazos y mordeduras de animales infectados. Es causada por el hongo dimórfico del género Sporothrix sp. y genera una serie de impactos en la salud humana y animal. Por tanto, este trabajo traerá una revisión sobre los principales temas de esta enfermedad, con el objetivo de alertar sobre los riesgos, la gravedad y sus impactos en la salud pública.

Impacto da unitarização de ceftazidima + avibactam em um hospital público universitário durante a pandemia de COVID-19 / Impact of ceftazidime + avibactam unitarization in a university public hospital during the COVID-19 pandemic

Introdução: A pandemia de COVID-19 fez aumentar a demanda de medicamentos utilizados em hospitais, como a Ceftazidima + Avibactam. Nesse contexto, a Central de Misturas Intravenosas (CMIV) de um hospital público universitário passou a unitarizar as doses prescritas. O objetivo deste trabalho foi avaliar o impacto da unitarização no consumo deste antibacteriano de alto custo em um hospital público universitário. Métodos: Trata-se de uma análise farmacoeconômica de custos diretos, sobre a utilização de frascos-ampola de Ceftazidima + Avibactam no período de 01/07/2020 a 31/05/2021. Foram unitarizadas todas as doses que correspondiam a uma fração da dose total do frasco-ampola, em Cabine de Segurança Biológica classe II B2. Os frascos-ampola foram utilizados à exaustão, através do compartilhamento e organização dos horários de manipulação. Resultados: O número total de preparos realizados pela CMIV do referido hospital no período foi de 837. O consumo projetado sem a centralização dos preparos seria de 837 (um frasco por dose). Entretanto, o consumo real foi de 437 frascos. A eficiência de unitarização foi de 101%, com economia real de 400 frascos (R$ 244.832,00) para a instituição. Conclusão: A pandemia de COVID-19 sobrecarregou os sistemas de saúde do mundo todo, sendo que a atuação farmacêutica foi fundamental para garantir o acesso aos medicamentos essenciais. A CMIV assumiu a unitarização da Ceftazidima + Avibactam, antibiótico em risco de desabastecimento, gerando um consumo 47,8% menor, contribuindo para o acesso deste medicamento de forma ininterrupta durante os 11 meses avaliados na referida instituição.

Introduction: COVID-19 pandemic has increased the demand for drugs used in hospitals, such as Ceftazidime + Avibactam. In this context, the Central of Intravenous Admixtures (CMIV) of a public university hospital started to unitarize the prescribed doses. The objective of this study was to evaluate the impact of unitarization on the consumption of this high-cost antibacterial in a public university hospital. Methods: This is a pharmacoeconomic analysis of direct costs, on the Ceftazidime + Avibactam vials use, in the period from 07/01/2020 to 05/31/2021. All doses that corresponded to a fraction of the entire vial were unitarized in a Class II B2 Biological Safety Cabin. The vials were used to exhaustion, by sharing them, and organizing the manipulation schedules. Results: The total number of preparations made by the CMIV of that hospital in the period was 837 doses. The projected consumption would be 837 vials (one vial per dose). However, the actual consumption was 437 vials. The unitarization efficiency was of 101%, with real savings of 400 vials (R$ 244,832.00) for the institution. Conclusion: COVID-19 pandemic has overburdened health systems around the world, and pharmaceutical actions have been fundamental to guaranteeing access to essential medicines. CMIV took over the unitarization of Ceftazidime + Avibactam, an antibiotic at risk of shortages, leading to a 47.8% lower consumption, contributing to uninterrupted access to this drug during the 11 months evaluated at that institution.

Formação em educação física no contexto de saúde pública nos melhores cursos do Brasil / The formation of physical education in public health in the best courses in Brazil

RESUMO O objetivo do estudo foi revisar projetos pedagógicos (PP) para identificar a formação do profissional de Educação Física (PEF) (Bacharelado) no contexto de Saúde Pública nos melhores cursos do Brasil. Foram selecionados os 10 melhores cursos de graduação em EF ranqueados em dois sistemas de avaliações nacionais (Exame Nacional de Desempenho na Educação e Ranking Universitário Folha) e as 10 melhores Universidades num ranking internacional (QS World University Rankings). Mediante revisão rápida foram extraídas informações dos PPs de 18 cursos que atenderam aos critérios de inclusão. Trinta e seis disciplinas no contexto de Saúde Pública foram localizadas nas grades curriculares. Em relação a carga horária média menos de 1% da grade eletiva dos cursos era dedicada a disciplinas sobre Saúde Pública. O estudo revelou um cenário de formação de Bacharéis em EF distante do crescimento que a área demonstrou no campo da Saúde Pública nos últimos anos. É importante que os cursos de graduação em EF considerem uma formação específica no contexto da Saúde Pública, de modo a favorecer a consolidação da atuação do PEF e a qualidade do seu serviço na Atenção Primária à Saúde.

ABSTRACT The purpose of the study was to review pedagogical projects (PP) to identify the formation of the Physical Education professionals (PEF) in the context of Public Health in the best courses in Brazil. Methods: The 10 best PE undergraduate courses ranked in two national assessment systems were selected (National Education Performance Examination and Folha University Ranking) and the 10 best Universities in an international ranking (QS World University Rankings). Through a quick review, information was extracted from the PPs of 18 courses that met the inclusion criteria. Thirty-six subjects in the context of public health were located in the curricula. Regarding the average workload, less than 1% of the elective course schedule was dedicated to subjects on Public Health. The study revealed a scenario for the formation of Bachelors in PE far from the growth that the area has shown in the field of Public Health in recent years. It is important that PE undergraduate courses consider specific training in the context of Public Health, in order to favor the consolidation of the PEF's performance and the quality of its service in Primary Health Care.

Improving prostate biopsy decision making in Mexican patients: Still a major public health concern.

BACKGROUND: Prostate cancer screening has reduced its mortality in 21%. However, this has also led to an increased number of biopsies in order to establish the diagnosis, many of them unnecessary. Current screening guidelines prioritize use of prostatic magnetic resonance and new biomarkers to reduce unnecessary biopsies, however, their implementation in developing countries screening programs is mainly limited by its costs. OBJECTIVE: We aimed to evaluate Prostate Biopsy Risk Collaborative Group (PBCG) and Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) 2.0 predictions accuracy in Mexican patients in order to guide prostate biopsy decision making and reduce unnecessary biopsies. MATERIALS AND METHODS: We retrospectively analyzed patients between 55 and 90 years old who underwent prostate biopsy in a high-volume center in Mexico between January 2017 and June 2020. Clinical utility of PBCG and PCPTRC 2.0 to predict high-grade prostate cancer (HGPCa) biopsy outcomes was evaluated using decision curve analysis and compared to actual biopsy decision making. Receiver operating characteristics area under the curve (AUC) was used to measure discrimination and external validation. RESULTS: From 687 patients eligible for prostate biopsy, 433 met selections criteria. One hundred and thirty-five (31.17%) patients were diagnosed with HGPCa, 63 (14.54%) with low-grade disease and 235 (54.27%) had a negative biopsy. PCPTRC 2.0 ≥15% threshold got a standardized net benefit (sNB) of 0.70, while PBCG ≥30% and ≥35% had a sNB of 0.27 and 0.15, respectively. Use of both models for guiding prostate biopsy decision resulted in no statistical difference for HGCPa detection rates, while achieved a significant difference in reducing total and unnecessary biopsies. However, this difference was lower (better) for PCPTRC 2.0, being statistically significative when compared against PBCG thresholds. Both models were well calibrated (AUC 0.79) and achieved external validation compared with international cohorts. CONCLUSIONS: Our study is the first to effectively validate both PCPTRC 2.0 and PBCG predictions for the Mexican population, proving that their use in daily practice improves biopsy decision making by accurately predicting HGPCa and limit unnecessary biopsies without representing additional costs to screening programs.