Healthcare outcomes assessed with observational study designs compared with those assessed in randomized trials: a meta-epidemiological study.

BACKGROUND: Researchers and decision-makers often use evidence from randomised controlled trials (RCTs) to determine the efficacy or effectiveness of a treatment or intervention. Studies with observational designs are often used to measure the effectiveness of an intervention in 'real world' scenarios. Numerous study designs and their modifications (including both randomised and observational designs) are used for comparative effectiveness research in an attempt to give an unbiased estimate of whether one treatment is more effective or safer than another for a particular population. An up-to-date systematic analysis is needed to identify differences in effect estimates from RCTs and observational studies. This updated review summarises the results of methodological reviews that compared the effect estimates of observational studies with RCTs from evidence syntheses that addressed the same health research question. OBJECTIVES: To assess and compare synthesised effect estimates by study type, contrasting RCTs with observational studies. To explore factors that might explain differences in synthesised effect estimates from RCTs versus observational studies (e.g. heterogeneity, type of observational study design, type of intervention, and use of propensity score adjustment). To identify gaps in the existing research comparing effect estimates across different study types. SEARCH METHODS: We searched MEDLINE, the Cochrane Database of Systematic Reviews, Web of Science databases, and Epistemonikos to May 2022. We checked references, conducted citation searches, and contacted review authors to identify additional reviews. SELECTION CRITERIA: We included systematic methodological reviews that compared quantitative effect estimates measuring the efficacy or effectiveness of interventions tested in RCTs versus in observational studies. The included reviews compared RCTs to observational studies (including retrospective and prospective cohort, case-control and cross-sectional designs). Reviews were not eligible if they compared RCTs with studies that had used some form of concurrent allocation. DATA COLLECTION AND ANALYSIS: Using results from observational studies as the reference group, we examined the relative summary effect estimates (risk ratios (RRs), odds ratios (ORs), hazard ratios (HRs), mean differences (MDs), and standardised mean differences (SMDs)) to evaluate whether there was a relatively larger or smaller effect in the ratio of odds ratios (ROR) or ratio of risk ratios (RRR), ratio of hazard ratios (RHR), and difference in (standardised) mean differences (D(S)MD). If an included review did not provide an estimate comparing results from RCTs with observational studies, we generated one by pooling the estimates for observational studies and RCTs, respectively. Across all reviews, we synthesised these ratios to produce a pooled ratio of ratios comparing effect estimates from RCTs with those from observational studies. In overviews of reviews, we estimated the ROR or RRR for each overview using observational studies as the reference category. We appraised the risk of bias in the included reviews (using nine criteria in total). To receive an overall low risk of bias rating, an included review needed: explicit criteria for study selection, a complete sample of studies, and to have controlled for study methodological differences and study heterogeneity. We assessed reviews/overviews not meeting these four criteria as having an overall high risk of bias. We assessed the certainty of the evidence, consisting of multiple evidence syntheses, with the GRADE approach. MAIN RESULTS: We included 39 systematic reviews and eight overviews of reviews, for a total of 47. Thirty-four of these contributed data to our primary analysis. Based on the available data, we found that the reviews/overviews included 2869 RCTs involving 3,882,115 participants, and 3924 observational studies with 19,499,970 participants. We rated 11 reviews/overviews as having an overall low risk of bias, and 36 as having an unclear or high risk of bias. Our main concerns with the included reviews/overviews were that some did not assess the quality of their included studies, and some failed to account appropriately for differences between study designs - for example, they conducted aggregate analyses of all observational studies rather than separate analyses of cohort and case-control studies. When pooling RORs and RRRs, the ratio of ratios indicated no difference or a very small difference between the effect estimates from RCTs versus from observational studies (ratio of ratios 1.08, 95% confidence interval (CI) 1.01 to 1.15). We rated the certainty of the evidence as low. Twenty-three of 34 reviews reported effect estimates of RCTs and observational studies that were on average in agreement. In a number of subgroup analyses, small differences in the effect estimates were detected: - pharmaceutical interventions only (ratio of ratios 1.12, 95% CI 1.04 to 1.21); - RCTs and observational studies with substantial or high heterogeneity; that is, I2 ≥ 50% (ratio of ratios 1.11, 95% CI 1.04 to 1.18); - no use (ratio of ratios 1.07, 95% CI 1.03 to 1.11) or unclear use (ratio of ratios 1.13, 95% CI 1.03 to 1.25) of propensity score adjustment in observational studies; and - observational studies without further specification of the study design (ratio of ratios 1.06, 95% CI 0.96 to 1.18). We detected no clear difference in other subgroup analyses. AUTHORS' CONCLUSIONS: We found no difference or a very small difference between effect estimates from RCTs and observational studies. These findings are largely consistent with findings from recently published research. Factors other than study design need to be considered when exploring reasons for a lack of agreement between results of RCTs and observational studies, such as differences in the population, intervention, comparator, and outcomes investigated in the respective studies. Our results underscore that it is important for review authors to consider not only study design, but the level of heterogeneity in meta-analyses of RCTs or observational studies. A better understanding is needed of how these factors might yield estimates reflective of true effectiveness.

O impacto da pandemia da Covid-19 na saúde mental de estudantes universitários / The impact of the Covid-19 pandemic on the mental health of university students / El impacto de la pandemia de Covid-19 en la salud mental de los estudiantes universitarios

A pandemia pelo SARS-CoV-2 é um dos maiores desafios sanitários em escala global. Devido estado de emergência, uma série de medidas de controle e prevenção foram adotadas, como distanciamento social e redução das reuniões públicas. Nesse cenário, buscou-se avaliar a saúde mental de estudantes de uma instituição privada de Ensino Superior diante da pandemia. Esta pesquisa trata-se de um estudo transversal descritivo desenvolvido na Faculdade do Vale do Jaguaribe, localizada em Aracati-CE. A coleta de dados ocorreu de dezembro de 2020 a fevereiro de 2021, utilizando formulário eletrônico contendo variáveis sociodemográficas, epidemiológicas e relativas aos diferentes aspectos da saúde mental do estudante frente a pandemia da COVID-19. A análise foi baseada no cálculo de frequências absolutas e relativas das variáveis além de medidas de tendência central e dispersão. Dos 333 discentes que participaram do estudo, a média de idade foi 25, com variação entre 18 e 56 anos, sendo maioria do sexo feminino (72,7%), autodenominação de cor/etnia parda (72,7%) e não estarem trabalhando (53,8%). A taxa de positividade entre os graduandos para COVID-19 foi de 9% (30). Ao serem questionados sobre como a pandemia alterou seus níveis de estresse ou saúde mental, 75,5% responderam que houve piora. Dentre os sintomas mais relatados no período da quarentena, estavam medo e ansiedade (ambos com 74,2%), seguidos por insegurança (69,7%). Baseados nos achados deste estudo, recomenda-se a incorporação de ações multiprofissionais na atenção aos estudantes dentro da academia. Sugere-se a implantação de um serviço qualificado buscando desenvolver um olhar holístico para os discentes.

The SARS-CoV-2 pandemic has presented itself as one of the greatest health challenges on a global scale. Given the state of public health emergency, a series of control and prevention measures have been adopted, such as social distancing and reduction of public meetings, as in universities. Faced with this scenario, we sought to evaluate the mental health of students from a private institution of Higher Education in the face of the COVID-19 pandemic. Thus, this research was a descriptive cross-sectional study developed at the Faculdade do Vale do Jaguaribe, located in the City of Aracati- CE. Data collection occurred from December 2020 to February 2021, using an electronic form containing sociodemographic and epidemiological variables, as well as variables related to the repercussions in different aspects of the student's mental health when facing the pandemic of COVID-19. The analysis was based on the calculation of absolute and relative frequencies of the variables, as well as measures of central tendency and dispersion. Of the 333 students who participated in the study, the mean age was 25 years, with ages ranging from 18 to 56 years, the majority being female (72.7%), self- denominated as Brown (72.7%), not working when answering the form (53.8%). The positivity rate among undergraduates for COVID-19 was 9% (30/333). When asked how the pandemic altered their stress levels or mental health, 75.5% responded that it had worsened. Among the symptoms most reported by students during the quarantine period were fear and anxiety (both 74.2%), followed by insecurity (69.7%). It is suggested the implementation of a qualified approach service seeking to develop a holistic look for the students.

La pandemia por SARS-CoV-2 es uno de los mayores desafíos sanitarios a escala global. Debido al estado de emergencia, se han adoptado una serie de medidas de control y prevención, como el distanciamiento social y la reducción de reuniones públicas. En este escenario, se buscó evaluar la salud mental de los estudiantes de una institución privada de educación superior frente a la pandemia. Esta investigación es un estudio descriptivo transversal desarrollado en la Facultad de Valle de Jaguaribe, ubicada en Aracati-CE. La recopilación de datos se llevó a cabo de diciembre de 2020 a febrero de 2021, utilizando un formulario electrónico que contiene variables sociodemográficas, epidemiológicas y relacionadas con los diferentes aspectos de la salud mental del estudiante frente a la pandemia de COVID-19. El análisis se basó en el cálculo de frecuencias absolutas y relativas de las variables, además de medidas de tendencia central y dispersión. De los 333 estudiantes que participaron en el estudio, la media de edad fue de 25 años, con variación entre 18 y 56 años, siendo la mayoría del sexo femenino (72,7%), autodenominación de la raza / etnia morena (72,7%) y no trabajando (53,8%). La tasa de positividad entre los estudiantes de pregrado para COVID-19 fue del 9% (30). Cuando se les preguntó cómo la pandemia había alterado su nivel de estrés o salud mental, el 75,5% respondió que había empeorado. Entre los síntomas más comunes durante el período de cuarentena, se encontraban el miedo y la ansiedad (ambos con un 74,2%), seguidos de la inseguridad (69,7%). Basados en los resultados de este estudio, se recomienda la incorporación de acciones multiprofesionales en la atención a los estudiantes dentro de la academia. Se sugiere la implementación de un servicio calificado que busque desarrollar una mirada holística hacia los estudiantes.

Eficácia da ivermectina e atazanavir no tempo de recuperação dos sintomas de covid-19: uma coorte prospectiva / Effectiveness of ivermectin and atazanavir on time to resolution from covid-19 symptoms: a prospective cohort / Eficacia de ivermectina y atazanavir en el tiempo hasta lá resolución de los síntomas de covid-19: una cohorte prospectiva

Objetivo: avaliar a eficácia da Ivermectina e do Atazanavir em comparação com placebo no tempo de resolução dos sintomas e no tempo de duração da doença por COVID-19. Método: estudo observacional, de coorte prospectivo, longitudinal, descritivo e analítico com pacientes sintomáticos ambulatoriais, acompanhados por 06 meses em duas Unidades Básicas de Saúde para atendimento de COVID-19 em Teresina- Piauí, Brasil, no período de novembro a abril de 2021 identificados por amostragem aleatória 1:1:1. Foram realizados exames Reverse transcription polymerase chain reaction (RT-PCR) para confirmação laboratorial da suspeita de infecção pelo novo coronavírus e avaliação sociodemográfica e clínica. Resultados: dos 87 pacientes randomizados, 62,1% (n=54) eram do sexo masculino, com média de idade de 35,1 anos, possuíam companheira (53,9%), baixa renda (50,6%), eutróficos (40,7%) e sem comorbidades de saúde (78,2%). Não houve diferença entre o tempo médio para resolução dos sintomas, que foi de 21 dias (IQR, 8-30) no grupo atazanavir, 30 dias (IQR, 5-90) no grupo ivermectina em comparação com 14 dias (IQR, 9-21) no grupo controle. No dia 180, houve resolução dos sintomas em 100% no grupo placebo, 93,9% no grupo atazanavir e 95% no grupo ivermectina. A duração mediana da doença foi de 08 dias em todos os braços do estudo. Conclusão: o tratamento com atazanavir (6 dias) e ivermectina (3 dias) não reduziu o tempo de resolução dos sintomas e nem o tempo de duração da doença entre os pacientes ambulatoriais com COVID-19 leve em comparação com o grupo placebo. Os resultados não suportam o uso de ivermectina e atazanavir para tratamento de COVID-19 leve a moderado.

Objective: to evaluate the effectiveness of Ivermectin and Atazanavir compared to placebo in the time to resolution of symptoms and duration of illness due to COVID-19. Method: observational, prospective, longitudinal, descriptive and analytical cohort study with symptomatic outpatients, followed for 06 months in two Basic Health Units for COVID-19 care in Teresina-Piauí, Brazil, from November to April 2021 identified by 1:1:1 random sampling. Reverse transcription polymerase chain reaction (RT-PCR) tests were performed for laboratory confirmation of suspected infection with the new coronavirus and sociodemographic and clinical evaluation. Results: of the 87 randomized patients, 62.1% (n=54) were male, with a mean age of 35.1 years, had a partner (53.9%), low income (50.6%), eutrophic (40.7%) and without health comorbidities (78.2%). There was no difference between the median time to resolution of symptoms, which was 21 days (IQR, 8-30) in the atazanavir group, 30 days (IQR, 5- 90) in the ivermectin group compared with 14 days (IQR, 9- 21) in the control group. At day 180, there was resolution of symptoms in 100% in the placebo group, 93.9% in the atazanavir group, and 95% in the ivermectin group. The median duration of illness was 8 days in all study arms. Conclusion: Treatment with atazanavir (6 days) and ivermectin (3 days) did not reduce the time to symptom resolution or the duration of illness among outpatients with mild COVID-19 compared to the placebo group. The results do not support the use of ivermectin and atazanavir for the treatment of mild to moderate COVID-19.

Objetivo: evaluar la efectividad de Ivermectina y Atazanavir en comparación con placebo en el tiempo de resolución de los síntomas y duración de la enfermedad por COVID-19. Método: estudio de cohorte observacional, prospectivo, longitudinal, descriptivo y analítico con pacientes ambulatorios sintomáticos, seguidos durante 06 meses en dos Unidades Básicas de Salud para atención de COVID-19 en Teresina-Piauí, Brasil, de noviembre a abril de 2021 identificados por 1:1:1 muestreo aleatorio. Se realizaron pruebas de reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) para confirmación de laboratorio de sospecha de infección por el nuevo coronavirus y evaluación sociodemográfica y clínica. Resultados: de los 87 pacientes aleatorizados, 62,1% (n=54) eran del sexo masculino, con una edad media de 35,1 años, tenían pareja (53,9%), bajos ingresos (50,6%), eutróficos (40,7%) y sin comorbilidades de salud (78,2%). No hubo diferencia entre la mediana de tiempo hasta la resolución de los síntomas, que fue de 21 días (RIC, 8-30) en el grupo de atazanavir, 30 días (RIC, 5- 90) en el grupo de ivermectina en comparación con 14 días (RIC, 9 - 21) en el grupo control. En el día 180, hubo una resolución de los síntomas del 100 % en el grupo de placebo, del 93,9 % en el grupo de atazanavir y del 95 % en el grupo de ivermectina. La mediana de duración de la enfermedad fue de 8 días en todos los brazos del estudio. Conclusión: El tratamiento con atazanavir (6 días) e ivermectina (3 días) no redujo el tiempo de resolución de los síntomas ni la duración de la enfermedad entre los pacientes ambulatorios con COVID-19 leve en comparación con el grupo placebo. Los resultados no respaldan el uso de ivermectina y atazanavir para el tratamiento de la COVID-19 de leve a moderada.

Perfil de serviços públicos que realizam avaliação do frênulo lingual em neonatos no Rio Grande do Norte / Profile of health services that assessthelingual frenulum of newborns in public and maternity hospitals of Rio Grande do Norte state / Perfil de servicios que realizanevaluación del frenillo lingual en neonatos en hospitales públicos y maternidades del estado de Rio Grande do Norte

Introdução:A anquiloglossia é caracterizada pela alteração do frênulo lingual resultando na restrição dos movimentos da língua. A avaliação do frênulo lingual em neonatos é importante para diagnosticar precocemente essa alteração. Objetivo:Traçar perfil de serviços que realizam avaliação do frênulo lingual em neonatos nos hospitais e maternidades públicas do estado do Rio Grande do Norte. Metodologia:Trata-se de um estudo observacional, descritivo e transversal, com abordagem quantitativa. Foram incluídos na pesquisa as maternidades públicas e filantrópicas do estadoque realizam procedimentos obstétricos e assistência materno-infantil. As informações acerca da avaliação do frênulo lingual em neonatos e caracterização desses serviços foram coletadas por meio de um questionário eletrônico. Os dados foram armazenados em planilhas no Excel e analisados através do programa estatístico SPSS versão 23.0, em queforam conduzidas análises das variáveis investigadas.Resultados:Participaram do estudo 23 hospitais e maternidades públicas do estado, econstatou-se que apenas 7 (30,44%) ofertam a avaliação do frênulo lingual em neonatos no próprio estabelecimento, enquantoas demais encaminham para outros serviços. O exame foi implantado nas maternidades entre os anos de 2014 e 2018. A quantidade de profissionais que realizam esta avaliação variou entre 1 e 9 por instituição, e os profissionais envolvidos foram os fonoaudiólogos e cirurgiões-dentistas. A prevalência da anquiloglossia variou de 3,7% a 14,5%. A maioria das maternidades realizam a frenotomia e o profissional que executa é o médico ou cirurgião-dentista.Conclusões:Constatou-se uma baixa oferta da avaliação do frênulo lingual em neonatos no próprio estabelecimento de nascimento. Além disso, essa oferta ainda não acontece de forma universal, principalmente no interior do estado (AU).

Introduction:Ankyloglossia is characterized by alterations in the lingual frenulum resulting in restricted tongue movements. Assessing the lingual frenulum in newborns is important for early diagnosis of this disorder. Objective:Describe the profile of health servicesthat assess the lingual frenulum of newborns in public and maternity hospitals of Rio Grande do Norte state. Methodology:This is a cross-sectional descriptive study using a quantitative approach. Included in the research were public and philanthropic maternity hospitals in statethat perform obstetric procedures and provide maternal and child care. The information about lingual frenulum assessment in newborns and characterization of these health services was collected via an electronic questionnaire. The data were stored in Excel spreadsheets and analyzed using the SPSS version 23.0 program, where analyses of the variables investigated were carried out. Results:A total of 23 public and maternity hospitalsparticipated, only 7 of which (30.44%) assessed the lingual frenulum of newborns on site, while the others referred them to other medical facilities. The examination was implemented in maternity hospitals between 2014 and 2018. The number of professionals who performed this assessment varied between 1 and 9 per institution, and included speech therapists, and dentists. The prevalence of ankyloglossia ranged from 3.7 to 14.5%. Most of the maternity hospitals performed frenotomy, where the procedure was conducted by a doctor or dentist. Conclusions:On-site lingual frenulum assessment of newborns was low in the institutions, and does not occur universally, mainly in the rural areas of the state (AU).

Introducción: La anquiloglosia se caracteriza por la alteración del frenillo lingual que resulta en la restricción de los movimientos de la lengua. La evaluación del frenillo lingual en neonatos es importante para un diagnóstico precoz de este trastorno.Objetivo: Delinear un perfil de servicios que realizanevaluación del frenillo lingual en neonatos en hospitales públicos y maternidades del estado de Rio Grande do Norte.Metodología: Se trata de un estudio observacional y transversal con enfoque cuantitativo. Se incluyeron en la investigación las maternidades públicas y filantrópicas del estadoque realizan procedimientos obstétricos y de atención materno-infantil. La información sobre la evaluación del frenillo lingual en neonatos y la caracterización de estos servicios fui recogido por medio de un cuestionario electrónico. Los datos fueron almacenados en hojas Excel y analizados utilizando el programa estadístico SPSSversión 23.0, donde se realizaron análisis de las variables investigadas. Resultados: Un total de 23 hospitales públicos y maternidades participaron del estudio, en el que se constató que solo 7 (30,44%) evalúan el frenillo lingual en neonatos en establecimiento propio, mientras los demás refieren a otros servicios. El examen se implementó en las maternidades entre 2014 y 2018. El número de profesionales que realizan esta evaluación varió entre 1 y 9 por institución, y los profesionales involucrados fueron terapeutas del habla y odontólogos. La prevalencia de anquiloglosia varió entre 3,7 y 14,5 %. La mayoría de las maternidades realizan la frenotomía y el profesional que la realiza es el médico u odontólogo. Conclusiones: Hubo una baja oferta de avaluación del frenillo lingual en neonatos en el propio establecimiento. Además, esta oferta aún no es universal, especialmente en el interior del estado (AU).

Características demográficas, socioeconômicas e da procura dos usuários em um serviço de reabilitação física de referência estadual, Mato Grosso, 2021 / Demographic, socioeconomic and service demand features of users in a state reference physical rehabilitation service, Mato Grosso, 2021 / Características demográficas, socioeconómicas y de la demanda de los usuarios en un servicio de rehabilitación física de referencia estatal, Mato Grosso, 2021

Introdução: O estudo dos fatores sociodemográficos e socioeconômicos de usuários doSistema Único de Saúde éimportante para o planejamento e a avaliação das ações dos serviços de saúde procurados por esta população. Objetivo:Descrever as características demográficas, socioeconômicas e da procura dos usuários adultos com demanda dereabilitação física ortopédica e neurológica emum Centro Especializado em Reabilitação de referência no Estado de Mato Grosso. Metodologia:Estudo observacional descritivo baseado nos prontuários dosetor de acolhimento de um Centro Especializado em Reabilitação de Mato Grosso,de fevereiro a maio de 2021. Foram analisados dados demográficos e socioeconômicos de usuários adultos de ambos os sexos. Utilizou-se o teste de qui-quadrado de Pearson para as associações entre as variáveis segundo eixo de reabilitação (ortopédica e neurológica). Resultados:Dos196 prontuários analisados,94% dos usuários eram procedentes de Cuiabá, comidade média de 50,3 anos, sendo 52,55% do sexo feminino. Aprocura pelo serviçofoi de 69%pela reabilitação ortopédica (69%) e de 31%reabilitação neurológica. Observaram-se diferenças estatisticamente significantes entre as frequências nos dois eixos dereabilitação física estudados nas variáveis idade (p=0,0005), escolaridade (p=0,0031), principal atividade de trabalho (p=0,0045), doenças concomitantes (p=0,0016), tratamento em outro estabelecimento de saúde (p=0,0041) e motivo da procura pela reabilitação (p<0,0001). Conclusões:Osresultados mostraram que os casos neurológicos possuem maior idade, baixo nível de escolaridadeepequeno percentual de trabalho remuneradoem relação aos casos ortopédicos. Tais resultados sugerem que as necessidades de saúde e de reabilitação dependem da singularidade dos casos e podem subsidiara efetivação depolíticas públicas que favoreçam a reorganização dos serviços e a articulação intersetorial entre saúde, educação emercado de trabalho (AU).

Introduction: Assessing sociodemographic and socioeconomic factors related to Unified Health System's users is essential to plan and evaluate the actions by the health services sought by them.Aim: Describing the demographic and socioeconomic features of adult users, and their search for having their orthopedic and neurological-physical rehabilitation demands fulfilled by a Specialized Center in Orthopedic and Neurological Rehabilitation in Mato Grosso State.Methodology: Observational descriptive study based on medical records collected between February and March 2021, provided by the welcoming sector of a Specialized Center in Rehabilitation in Mato Grosso State. Demographic and socioeconomic records of adult users belonging to both sexes were analyzed. Person's chi-square test was adopted to associate the variables based on the orthopedic and neurological rehabilitation axes.Results: In total, 94% of the 196 analyzed medical records regard patients from Cuiabá, in the mean age group 50.3 years; 52.55% of them belonged to the female sex. The search for orthopedic rehabilitation reached 69% and that for neurological rehabilitation recorded 31%. There were significant statistical differences between frequencies on the two assessed physical rehabilitation axes based on variables such as age (p=0.0005), schooling (p=0.0031), main labor activity (p=0.0045), concomitant diseases (p=0.0016), treatment provided in another health establishment (p=0.0041) and reason for seeking rehabilitation (p<0.0001). Conclusions: Results have shown that neurological cases are linked to older age, low schooling and low rate of paid work in comparison to orthopedic cases. These results have suggested that health and rehabilitation needs depend on cases' particularities; moreover, they can subsidize the process to make public policies to reinforce services'organization, as well as inter-sectoral articulation among health, education and labor market, effective (AU).

Introducción: El estudio de los factores sociodemográficos y socioeconómicos de los usuarios del Sistema Único de Salud es importante para planificar y evaluar las acciones de los servicios de salud buscados por esta población.Objetivo: Describir las características demográficas, socioeconómicas y de demanda de usuarios adultos con demanda de rehabilitación física ortopédica y neurológica en un Centro Especializado de Rehabilitación de Referencia en el Estado de Mato Grosso.Metodología: Estudio observacional descriptivo basado en las historias clínicas del sector de acogimiento de un Centro Especializado de Rehabilitación en Mato Grosso, de febrero a mayo de 2021. Se analizaron datos demográficos y socioeconómicos de usuarios adultos de ambos sexos. Se utilizóla prueba de chi-cuadrado de Pearson para las asociaciones entre las variables según el eje de rehabilitación (ortopédico y neurológico).Resultados: De las 196 historias clínicas analizadas, 94% de los usuarios provenían de Cuiabá, con una edad promedio de 50,3 años, de los cuales 52,55% eran de sexo femenino. La demanda del servicio fue del 69% para la rehabilitación ortopédica (69%) y del 31% para la rehabilitación neurológica. Se observaron diferencias estadísticamente significativas entre las frecuencias en los dos ejes de rehabilitación física estudiados en las variables edad (p=0,0005), escolaridad (p=0,0031), actividad laboral principal (p=0,0045), enfermedades concomitantes (p=0,0016), tratamiento en otro establecimiento de salud (p=0,0041) y motivo de búsqueda de rehabilitación (p <0,0001). Conclusiones:Los resultados mostraron que los casos neurológicos tienen mayor edad, bajo nivel de educación y un pequeño porcentaje de trabajo remunerado en relación con los casos ortopédicos. Estos resultados sugieren que las necesidades de salud y rehabilitación dependen de la singularidad de los casos y pueden apoyar la implementación de políticas públicas que favorezcan la reorganización de los servicios y la articulación intersectorial entre salud, educación y mercado laboral (AU).

Potencialidades e limitações do Prontuário Eletrônico do Cidadão (PEC) enquanto ferramenta de gestão de cuidado e planejamento: avaliação a nível nacional e local / Potentials and limitations of the Electronic Citizen Record (PEC) as a care management and planning tool: assessment at national and local level

O objetivo desse estudo foi analisar as potencialidade e limitações do Prontuário Eletrônico do Cidadão (PEC) e comparar com os indicadores assistenciais de saúde bucal da Atenção Básica a nível nacional e de um município no interior do estado da Paraíba. A coleta de dados foi dividida em dois momentos: primeiro foram coletadas informações dos relatórios do e-SUS PEC presentes no site eletrônico e-Gestor do Departamento da Atenção Básica do Ministério da Saúde, referentes às equipes de saúde bucal das USF e em seguida a aplicação de um questionário estruturado para avaliar a aceitação, a facilidade e o uso do Prontuário Eletrônico do Cidadão (PEC) pelos cirurgiões dentistas cadastrados no município. Nos resultados, as regiões do Norte e Nordeste apresentaram os menores coeficientes de resolutividade (46,6 e 50,6) e com maior cobertura de primeira consulta odontológica (9,5 e 9,3), entretanto com maiores valores para exodontias (14,2 e 13,1); quanto à proporção de procedimentos preventivos observados, nota-se que o grau de priorização de cuidados de prevenção é alto em todas as regiões. Em nível local foram observadas variações significativas entre as USF; quanto ao uso do PEC 73,1% concordam que encontram mais rápido o prontuário no formato eletrônico e 61,5% concordam que o PEC otimiza seu processo de trabalho, já em relação ao manuseio do sistema 76,9% concordaram ser fácil. Portanto, existe uma disparidade de primeira consulta odontológica com a conclusão dos tratamentos e apesar de ser alta a cobertura de primeiro atendimento, mesmo assim, não é suficiente para evitar agravos dos problemas de saúde bucal, bem como o PEC é uma importante ferramenta que proporciona melhor assistência ao paciente, auxilia no atendimento, ajuda no planejamento de cuidados em saúde, facilita o acesso de dados (AU).

The objective of this study was to analyze and compare the potentialities and limitations of the Citizen's Electronic Record (PEC) with the oral health care indicators of Primary Care at national level and of a municipality in the interior of the state of Paraíba. Data collection will take place in two stages: first, information will be collected from the e-SUS PEC reports present on the e-Gestor website of the Department of Primary Care of the Ministry of Health, referring to the USF oral health teams, and then to application of a specific and objective questionnaire to assess acceptance, ease and use of the Citizen's Electronic Record (PEC) by dentists registered in the municipality. The results show that the Northeast and North have the lowest resolubility coefficients (46.6 and 50.6) and the highest coverage of the first dental appointment (9.5 and 9.3), however with higher values for extractions (14.2 and 13.1); as for the proportion of preventive procedures observed, it is noted that the degree of prioritization of preventive care is high in all regions and at the local level, significant variations were observed between USF; regarding the use of the PEC, 76.9% did not receive qualification or training, 23.1% always experience difficulties when handling it and 46.2% are sometimes able to operate all the functions of the system. Therefore, there is a disparity between the first dental visit and the completion of treatments and, despite the high coverage of the first visit, even so, it is not enough to avoid worsening oral health problems, as well as the PEC is an important tool that provides better patient care, assist with care, help with health care planning, facilitate data access (AU).

Relação entre variáveis antropométricas e de aptidão física em crianças e adolescentes estratificados por sexo / Relationship between anthropometric and physical fitness variables in children and adolescents stratified by sex / Relación entre variables antropométricas y de aptitud física en niños y adolescentes estratificados por sexo

A aptidão física (ApF) pode estar associada à saúde, ao desempenho esportivo e refere-se a capacidade de apresentar um determinado desempenho motor quando submetido a situações que envolvam esforços físicos. O objetivo deste estudo foi relacionar as variáveis antropométricas e de aptidão física em crianças e adolescentes da cidade de Pelotas/RS, estratificados por sexo. Foram avaliados 1720 escolares da rede municipal de Pelotas/RS, sendo 896 crianças (idade = 9,91 ± 1,21 anos) e 824 adolescentes (idade = 13,11 ± 1,04 anos), através de uma bateria de avaliações das medidas antropométricas (estatura [EST], massa corporal [MC], envergadura [ENV], índice de massa corporal [IMC]) e de testes físicos (flexibilidade [FLEX], potência de membros superiores [PMS], potência de membros inferiores [PMI], velocidade com troca de direção [VTD], velocidade linear [VL], resistência muscular localizada [RML] e capacidade cardiorrespiratória [CC]). O estudo de caráter de diagnóstico com cunho observacional utilizou o teste de correlação através do r de Pearson e classificou-as como muito fraca (0-0,19), fraca (0,2-0,39), moderada (0,4-0,69), forte (0,7-0,89) e muito forte (0,9-1). Destacou-se que no sexo feminino houve correlação moderada com IMC e PMS, as variáveis antropométricas EST, ENV e MC apresentaram pelo menos uma correlação com as variáveis de ApF, enquanto que estas variáveis demonstraram correlações moderadas entre PMS, VL e VTD. Já no sexo masculino foi observada correlação moderada entre IMC e CC, além de correlações fracas e moderadas entre EST, ENV e MC com pelo menos uma das variáveis de ApF, enquanto as variáveis de ApF demonstraram correlações moderadas entre PMI, VL e VTD. Portanto, ressalta-se a importância do diagnóstico destas variáveis para controle dos fatores de risco à saúde bem como para identificar potenciais relacionados ao desempenho esportivo.

Physical fitness (PhF) can be associated with health, sports performance and refers to the ability to present a certain motor performance when submitted to situations involving physical efforts. The aim of this study was to relate anthropometric and physical fitness variables in children and adolescents from the city of Pelotas/RS, stratified by sex. A total of 1720 schoolchildren from the municipal schools of Pelotas/RS were evaluated, 896 children (age = 9.91 ± 1.21 years) and 824 adolescents (age = 13.11 ± 1.04 years), through a battery of the anthropometric measurements (height [HT], body mass [BM], wingspan [WP], body mass index [BMI]) and physical tests (flexibility [FLEX], upper limb power [ULP], lower limb power [LLP], change of direction speed [CODS], linear speed [LS], localized muscular endurance [LME] and cardiorespiratory capacity [CC]). The study of a diagnostic character with an observational nature used the correlation test through Pearson's r and classified them as very small (0-0.19), small (0.2- 0.39), moderate (0.4- 0.69), large (0.7-0.89) and very large (0.9-1). It was highlighted that in females there was moderate correlation with BMI and ULP, the anthropometric variables HT, WP and BM showed at least one correlation with the PhF variables, while these variables showed moderate correlations between ULP, LS and CODS. In males, a moderate correlation was observed between BMI and CC, in addition to small and moderate correlations between HT, WP and BM with at least one of the PhF variables, while the PhF variables showed moderate correlations between LLP, LS and CODS. Therefore, it emphasizes the importance of diagnosing these variables to control health risk factors as well as to identify potentials related to sports performance.

La aptitud física (AF) puede estar asociada a la salud, al rendimiento deportivo y se refiere a la capacidad de presentar un determinado desempeño motor cuando sometido a situaciones que impliquen esfuerzos físicos. El objetivo de este estudio fue relacionar variables antropométricas y de aptitud física en niños y adolescentes de la ciudad de Pelotas/RS, estratificados por sexo. Fueron evaluados 1720 escolares de las escuelas municipales de Pelotas/RS, 896 niños (edad = 9,91 ± 1,21 años) y 824 adolescentes (edad = 13,11 ± 1. 04 años), a través de una batería de medidas antropométricas (altura [HT], masa corporal [BM], envergadura [WP], índice de masa corporal [IMC]) y pruebas físicas (flexibilidad [FLEX], potencia de miembros superiores [ULP], potencia de miembros inferiores [LLP], velocidad de cambio de dirección [CODS], velocidad lineal [LS], resistencia muscular localizada [LME] y capacidad cardiorrespiratoria [CC]). El estudio, de carácter diagnóstico y observacional, utilizó la prueba de correlación mediante la r de Pearson y las clasificó en muy pequeñas (0-0,19), pequeñas (0,2-0,39), moderadas (0,4- 0,69), grandes (0,7-0,89) y muy grandes (0,9-1). Se destacó que en las hembras hubo una correlación moderada con el IMC y el ULP, las variables antropométricas HT, WP y BM mostraron al menos una correlación con las variables PhF, mientras que estas variables mostraron correlaciones moderadas entre ULP, LS y CODS. En los varones, se observó una correlación moderada entre IMC y CC, además de correlaciones pequeñas y moderadas entre HT, WP y BM con al menos una de las variables PhF, mientras que las variables PhF mostraron correlaciones moderadas entre LLP, LS y CODS. Por lo tanto, se destaca la importancia del diagnóstico de estas variables para controlar los factores de riesgo para la salud, así como para identificar potenciales relacionados con el rendimiento deportivo.

Composite outcomes in observational studies of ulcerative colitis: A systematic review and meta-analysis.

BACKGROUND: Ulcerative colitis (UC) has been the focus of numerous observational studies over the years and a common strategy employed in their design is the use of composite and aggregate outcomes. OBJECTIVE: This systematic review and meta-analysis aims to identify composite and aggregate outcomes of observational studies in UC and to evaluate how the number and type of variables included and the length of follow-up affect the frequency of patients that achieve these outcomes. METHODS: A systematic literature search was carried out using MEDLINE [via PubMed], Scopus, and Web of Science online databases. Observational studies that included UC patients and reported composite or aggregate outcomes were identified. A set of variables considered to be representative of progressive or disabling UC was defined, the proportion of patients attaining the outcomes was determined and a random-effects meta-analysis was performed by dividing the identified studies into subgroups according to different criteria of interest. RESULTS: A total of 10,264 records were identified in the systematic search, of which 33 were retained for qualitative analysis and 20 were included in the meta-analysis. The mean frequency for composite outcomes was 0.363 [95% confidence interval (CI) 0.323-0.403]. The frequency of composite outcome for the subgroup of studies that included the variable "Biologics" was significantly higher than for those in which this variable was not reported [0.410; 95% CI 0.364-0.457 versus 0.298; 95% CI 0.232-0.364; p = 0.006]. Composite outcomes were also more frequent as the follow-up duration increased. CONCLUSION: The frequency of composite outcomes in observational studies of UC is dependent on the specific identity of the variables being reported. Moreover, longer follow-up periods are associated with higher frequencies of composite outcomes. The evidence provided here is useful for the design of future observational studies of UC that aim to maximize the frequency of patients that achieve composite outcomes.

Neurological Associations of SARS-CoV-2 Infection: A Systematic Review.

BACKGROUND: The current ongoing COVID-19 pandemic has compelled us to scrutinize major outbreaks in the past two decades, Severe Acute Respiratory Syndrome (SARS), in 2002, and Middle East Respiratory Syndrome (MERS), in 2012. We aimed to assess the associated neurological manifestations with SARS CoV-2 infection. METHODS: In this systematic review, a search was carried out by key-electronic databases, controlled vocabulary, and indexing of trials to evaluate the available pertinent studies which included both medical subject headings (MeSH) and advanced electronic databases comprising PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL). Peer-reviewed studies published in English and Spanish were considered, which reported data on the neurological associations of individuals with suspected or laboratory-confirmed SARS-CoV-2 infection. Outcomes were nervous signs or symptoms, symptom severity, and diagnoses. RESULTS: Our search identified 45 relevant studies, with 21 case reports, 3 case series, 9 observational studies, 1 retrospective study, 9 retrospective reviews, and 2 prospective reviews. This systematic review revealed that most commonly reported neuronal presentations involved headache, nausea, vomiting and muscular symptoms like fibromyalgia. Anosmia and ageusia, defects in clarity or sharpness of vision (error in visual acuity), and pain may occur in parallel. Notable afflictions in the form of anxiety, anger, confusion, post-traumatic stress symptoms, and post-intensive care syndrome were observed in individuals who were kept in quarantine and those with long-stay admissions in healthcare settings. SARS CoV-2 infection may result in cognitive impairment. Patients with more severe infection exhibited uncommon manifestations, such as acute cerebrovascular diseases (intracerebral haemorrhage, stroke), rhabdomyolysis, encephalopathy, and Guillain-Barré syndrome. CONCLUSION: SARS-CoV-2 patients experience neuronal presentations varying with the progression of the infection. Healthcare professionals should be acquainted with the divergent neurological symptoms to curb misdiagnosis and limit long-term sequelae. Health-care planners and policymakers must prepare for this eventuality, while the ongoing studies increase our knowledge base on acute and chronic neurological associations of this pathogen.

Health-Related Quality of Life of Children and Adolescents With Congenital Hyperinsulinism - A Scoping Review.

Introduction: Despite improvements in diagnosis and therapeutic advances in treatment, congenital hyperinsulinism (CHI) remains a severe disease with high patient impairment. We aimed to review the literature on Health-related Quality of Life in children and adolescents with congenital hyperinsulinism and summarize the findings. Materials and Methods: For this scoping review, a literature search was conducted in PubMed and Web of Science in May 2021. Inclusion and exclusion criteria for the selection of articles were defined a priori. Results: Two hundred and forty-five (245) articles were identified through the search and screened on the basis of title and abstract. The full texts of forty articles were then assessed. Finally, four articles (published 2012-2020) describing Health-related Quality of Life in children and adolescents with congenital hyperinsulinism were included. The study designs were heterogeneous and included cross-sectional observational studies (n=2), clinical trials (n =1), and case reports (n=1) with different sample sizes. Three studies were conducted in European countries and one in Japan. The results for Health-related Quality of Life revealed inconsistencies. Conclusion: There are only a few studies looking at Health-related Quality of Life in children and adolescents with congenital hyperinsulinism. To gain a comprehensive understanding of the impact of congenital hyperinsulinism on Health-related Quality of Life in children and adolescents, it is necessary to use both generic and condition-specific instruments to measure Health-related Quality of Life of young patients in larger samples, to collect longitudinal data, and to consider qualitative research approaches.

E-learning on medical emergencies for Dentistry students: a randomized controlled trial / E-learning em emergências médicas para estudantes de Odontologia: um ensaio clínico randomizado

This study comparedtwo teaching pedagogies to addressmedical emergencies in dental officevisitsandevaluateddental school students' knowledge about medical emergencies.This randomized controlled trial involved54senior undergraduate dental students at theFederal University of Santa Mariadivided in two groups:students who received instruction via face-to-face traditional expository class;andstudents whoreceived the same instruction via distant learning format.The students were randomly allocated to the groupsby the randomiser.orgwebsite. Data were obtained by comparing the scores students received from answering to a semi-structured questionnaire containing inquiries on ethical and legal implications, and diagnosis and management of medicalemergencies in a dental officebefore and after the instruction. Before the instruction, 96%of studentsfrom the two groupslackedknowledge about the ethical and legal implications related to the dentist obligation to deal with medical emergencies. After the instruction, both groups increasedtheir knowledge similarly as there was no significant difference in the comparison between learning about medical emergencies through lectures and thorough an e-learning format.Both teaching methods presented satisfactory results, which makes the e-learning method an option as a didactic strategy (AU).

Esteestudocomparouduaspedagogiasdeensinoparalidarcomemergênciasmédicasemconsultasodontológicaseavaliouoconhecimentodealunosdocursoodontologiasobreemergênciasmédicas.Esteensaioclínicorandomizadoenvolveu54alunosdoúltimoanodocursodeodontologiadaUniversidadeFederaldeSantaMaria,divididosemdoisgrupos:alunosquereceberaminstruçãopormeiodeaulaexpositivatradicionalpresencial;ealunosquereceberamamesmainstruçãopormeiodoformatodeensinoadistância.Osalunosforamalocadosaleatoriamenteaosgrupospelositerandomiser.org.Osdadosforamobtidospormeiodacomparaçãodaspontuaçõesrecebidaspelosalunosaoresponderaumquestionáriosemiestruturadocontendoindagaçõessobreimplicaçõeséticaselegais,ediagnósticoemanejodeemergênciasmédicasemconsultórioodontológicoanteseapósainstrução.Antesdainstrução,96%dosalunosdosdoisgruposdesconheciamasimplicaçõeséticaselegaisrelacionadasàobrigaçãododentistaemlidarcomemergênciasmédicas.Apósainstrução,os dois grupos aumentaram seus conhecimentos de forma semelhante,poisnãohouvediferençasignificativanacomparaçãoentreoaprendizadosobreemergênciasmédicaspormeiodepalestrasepormeiodoformatoe-learning.Ambososmétodosdeensinoapresentaramresultadossatisfatórios,o que torna o método e-learning uma opção como estratégia didática (AU).

Reporting guidelines for human microbiome research: the STORMS checklist.

The particularly interdisciplinary nature of human microbiome research makes the organization and reporting of results spanning epidemiology, biology, bioinformatics, translational medicine and statistics a challenge. Commonly used reporting guidelines for observational or genetic epidemiology studies lack key features specific to microbiome studies. Therefore, a multidisciplinary group of microbiome epidemiology researchers adapted guidelines for observational and genetic studies to culture-independent human microbiome studies, and also developed new reporting elements for laboratory, bioinformatics and statistical analyses tailored to microbiome studies. The resulting tool, called 'Strengthening The Organization and Reporting of Microbiome Studies' (STORMS), is composed of a 17-item checklist organized into six sections that correspond to the typical sections of a scientific publication, presented as an editable table for inclusion in supplementary materials. The STORMS checklist provides guidance for concise and complete reporting of microbiome studies that will facilitate manuscript preparation, peer review, and reader comprehension of publications and comparative analysis of published results.

Adrenal Insufficiency in patients with cardiogenic shock: A meta-analysis.

BACKGROUND: Adrenal Insufficiency (AI) is rarely observed in patients with cardiogenic shock (CS). We aimed to identify the prevalence of AI in patients with CS and its effect on their clinical outcomes. AIMS: Our study aimed to determine the prevalence of AI in CS patients who underwent treatments for CS. METHODS: The articles concerning AI in CS were extracted for review from PubMed/Medline, Science Direct, World Wide Science.org, and Pro-Quest. The research articles included patients with CS, post-cardiac-arrest shock, out-of-hospital cardiac arrest, and CS after acute myocardial infarction. RStudio (version 1.0.136) was used for analyzing AI in CS patients. RESULTS: The search revealed 1463 unique publications, including 256 studies identified after screening the titles and the abstracts. Five observational cohort studies met the eligibility criteria for meta-analysis after the preliminary screening. The included studies reported a corticotropin stimulation test for AI diagnosis. The studies reportedly exhibited a low-to-fair quality. The random-effects pooled estimates indicated a 32% AI prevalence in the setting of CS [95% CI; 21%-45%; I2 = 81%]. The outcomes from the included studies were statistically significant for high heterogeneity (P = 0.001). The pooled results confirmed an 11%-51% AI prevalence in CS patients. CONCLUSIONS: This meta-analysis revealed a moderate level prevalence of AI in CS patients.

A Research Agenda for Precision Medicine in Sepsis and Acute Respiratory Distress Syndrome: An Official American Thoracic Society Research Statement.

Background: Precision medicine focuses on the identification of therapeutic strategies that are effective for a group of patients based on similar unifying characteristics. The recent success of precision medicine in non-critical care settings has resulted from the confluence of large clinical and biospecimen repositories, innovative bioinformatics, and novel trial designs. Similar advances for precision medicine in sepsis and in the acute respiratory distress syndrome (ARDS) are possible but will require further investigation and significant investment in infrastructure. Methods: This project was funded by the American Thoracic Society Board of Directors. A multidisciplinary and diverse working group reviewed the available literature, established a conceptual framework, and iteratively developed recommendations for the Precision Medicine Research Agenda for Sepsis and ARDS. Results: The following six priority recommendations were developed by the working group: 1) the creation of large richly phenotyped and harmonized knowledge networks of clinical, imaging, and multianalyte molecular data for sepsis and ARDS; 2) the implementation of novel trial designs, including adaptive designs, and embedding trial procedures in the electronic health record; 3) continued innovation in the data science and engineering methods required to identify heterogeneity of treatment effect; 4) further development of the tools necessary for the real-time application of precision medicine approaches; 5) work to ensure that precision medicine strategies are applicable and available to a broad range of patients varying across differing racial, ethnic, socioeconomic, and demographic groups; and 6) the securement and maintenance of adequate and sustainable funding for precision medicine efforts. Conclusions: Precision medicine approaches that incorporate variability in genomic, biologic, and environmental factors may provide a path forward for better individualizing the delivery of therapies and improving care for patients with sepsis and ARDS.

Oxygenation strategies during flexible bronchoscopy: a review of the literature.

During flexible fiberoptic bronchoscopy (FOB) the arterial partial pressure of oxygen can drop, increasing the risk for respiratory failure. To avoid desaturation episodes during the procedure several oxygenation strategies have been proposed, including conventional oxygen therapy (COT), high flow nasal cannula (HFNC), continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV). By a review of the current literature, we merely describe the clinical practice of oxygen therapies during FOB. We also conducted a pooled data analysis with respect to oxygenation outcomes, comparing HFNC with COT and NIV, separately. COT showed its benefits in patients undergoing FOB for broncho-alveolar lavage (BAL) or brushing for cytology, in those with peripheral arterial oxyhemoglobin saturation < 93% prior to the procedure or affected by obstructive disorder. HFNC is preferable over COT in patients with mild to moderate acute respiratory failure (ARF) undergoing FOB, by improving oxygen saturation and decreasing the episodes of desaturation. On the opposite, CPAP and NIV guarantee improved oxygenation outcomes as compared to HFNC, and they should be preferred in patients with more severe hypoxemic ARF during FOB.