Self-Perception of Mental Health and Exacerbated Social Inequalities Among Vulnerable Older Adults During the COVID-19 Pandemic in Brazil (2021-2023).

This study analyzes the self-perception of mental health of socially vulnerable elderly people during the COVID-19 crisis in Brazil. Conducted across all state capitals from February 2021 to October 2023, it included 366 participants living in various conditions such as camps, street situations, slums, and communities. The average age was 66.7 years, with a majority being male (59.0%), of Black or Brown race/color (62.3%), and earning below one minimum wage (36.6%). Findings revealed that older adults in street situations, experiencing psychological manifestations like sleep disturbances due to the pandemic, tended to assess their mental health more negatively. In contrast, older men of white race/color without such manifestations, and those practicing strategies like physical activity or relaxation, were less likely to perceive their mental health as poor. Addressing housing, implementing health strategies, and recognizing sample and regional complexities are crucial interventions for older adults in street situations.

The COVID-19 pandemic in Brazil: space-time approach of cases, deaths, and vaccination coverage (February 2020 - April 2024).

OBJECTIVE: To assess the evolution of the COVID-19 pandemic in Brazil and its macro-regions, considering disease incidence and mortality rates, as well as identifying territories with still rising disease indices and evaluating vaccine coverage and population adherence to COVID-19 immunization. METHODS: An ecological study conducted in Brazil with COVID-19 cases and deaths reported between February 2020 and April 2024, obtained through the Coronavirus Panel. Historical series were constructed from incidence and mortality rates to assess the pandemic's evolution, and temporal trends were estimated using the Seasonal Trend Decomposition using Loess (STL) method. The Spatial Variation in Temporal Trends (SVTT) technique was employed to identify clusters with significant variations in temporal trends. Vaccination was analyzed considering the percentage of vaccinated and unvaccinated population in each municipality of the country. RESULTS: Brazil recorded a total of 38,795,966 cases and 712,038 deaths from COVID-19 during the study period. Incidence and mortality rates showed three waves of the disease, with a fourth wave of smaller amplitude. Four clusters with significant case growth and two with increased deaths were identified. Vaccine coverage varied among municipalities, with some regions showing low vaccination rates and others with high immunization adherence. CONCLUSION: The study provided a comprehensive overview of coronavirus behavior in Brazil, and its results highlight the ongoing importance of vaccination and the need to direct efforts and resources to areas of higher risk.

Barriers That Interfere with Access to Tuberculosis Diagnosis and Treatment across Countries Globally: A Systematic Review.

This study evaluated the barriers that interfere with access to diagnosis and treatment of tuberculosis (TB) from the perspective of the patient and health professionals globally. Using the PICo acronym, the question we asked was "What are the barriers that interfere with access to tuberculosis diagnosis and treatment (I) from the perspective of patients and/or health professionals (P) across countries globally (Co)?". We searched the following databases: EMBASE, Scopus, MEDLINE, Latin American and Caribbean Literature in Health Sciences (LILACS), and Web of Science. On Rayyan, duplicates were removed and extraction was done afterward by two authors independently, followed by a tiebreaker. Using a Critical Appraisal Tool proposed by the Joanna Briggs Institute, the methodological quality of the article was assessed. From 36 published articles, the barriers to tuberculosis diagnosis as obtained from our study include information scarcity/low TB knowledge, exorbitant cost of transport, sample collection challenges, long distance to health facility, gender limitations, lack of decentralized diagnostic services, payment for diagnosis and testing, medication side effects, multiple visits during therapy, delayed diagnosis, poor human resources, low knowledge of medical practitioners, concerns regarding the efficacy of treatment, poor facility coordination, poor socioeconomic factors, fear and stigmatization of TB, and wrong initial diagnosis. The review of studies on TB diagnosis and treatment barriers evidences the diverse barriers to the eradication of tuberculosis. Eliminating these barriers is an onus that lies on policy makers, citizens, and health workers alike, with the joint aim of reducing the global TB burden.

Glucans: A Therapeutic Alternative for Sepsis Treatment.

Sepsis treatment is a challenging condition due to its complexity, which involves host inflammatory responses to a severe and potentially fatal infection, associated with organ dysfunction. The aim of this study was to analyze the scientific literature on the immunomodulatory effects of glucans in a murine model of systemic infection induced by cecal ligation and puncture. This study comprises an integrative literature review based on systematic steps, with searches carried out in the PubMed, ScienceDirect, Scopus, Web of Science, and Embase databases. In most studies, the main type of glucan investigated was ß-glucan, at 50 mg/kg, and a reduction of inflammatory responses was identified, minimizing the occurrence of tissue damage leading to increased animal survival. Based on the data obtained and discussed in this review, glucans represent a promising biotechnological alternative to modulate the immune response and could potentially be used in the clinical management of septic individuals.

Álbum seriado acolher educando sobre classificação de risco / Serial album host educating on risk classification / Anfitrión de álbumes en serie que educa sobre la clasificación de riesgos

Objetivo: relatar a produção de uma tecnologia educacional sobre classificação de risco para sistematizar o processo de trabalho educativo de equipes de saúde que atuam em unidades de urgência e emergência. Métodos: trata-se de um estudo descritivo, do tipo relato de experiência referente a produção de uma tecnologia educacional, desenvolvida entre dezembro de 2019 a novembro de 2020. Resultados: A experiência foi descrita a partir de duas trajetórias: revisão narrativa da literatura e produção da tecnologia educacional. Utilizou-se como estratégia metodológica a produção de tecnologia baseada em evidências. Da revisão narrativa da literatura emergiram sete temas geradores; da produção, materializou-se uma tecnologia educacional, do tipo álbum seriado, com onze páginas, organizado em vinte tópicos, para ser utilizado em unidades de urgência e emergência, com vistas a sensibilizar os usuários sobre a classificação de risco. Conclusão: a produção baseada em evidências de tecnologias educacionais é uma estratégia a ser ampliada na enfermagem, com vistas a sistematizar a assistência de enfermagem de forma segura e com qualidade. (AU)

Objective: to report the production of an educational technology on risk classification to systematize the educational work process of health teams working in urgency and emergency units. Methods: this is a descriptive study, of the experience report type, referring to the production of an educational technology, developed from December 2019 to November 2020. Results: The experience was described from two trajectories: narrative literature review and production of educational technology. The production of evidence-based technology was used as a methodological strategy. From the narrative review of the literature, seven generative themes emerged; After the production, an educational technology was materialized, of the serial album type, with eleven pages, organized in twenty topics, to be used in urgency and emergency units, with a view to sensitizing users about risk classification. Conclusion: evidence-based production of educational technologies is a strategy to be expanded in nursing, with a view to systematizing nursing care safely and with quality. (AU)

Objetivo: informar sobre la producción de una tecnología educativa en clasificación de riesgos para sistematizar el proceso de trabajo educativo de los equipos de salud que trabajan en las unidades de urgencia y emergencia. Metodos: se trata de un estudio descriptivo, del tipo relato de experiencia, referido a la producción de una tecnología educativa, desarrollado de diciembre de 2019 a noviembre de 2020. Resultados: La experiencia se describió a partir de dos trayectorias: revisión de literatura narrativa y producción de tecnología educativa. La producción de tecnología basada en evidencia se utilizó como estrategia metodológica. De la revisión narrativa de la literatura surgieron siete temas generativos; Luego de la producción, se materializó una tecnología educativa, tipo álbum serial, de once páginas, organizadas en veinte temas, para ser utilizadas en unidades de urgencia y emergencia, con miras a sensibilizar a los usuarios sobre la clasificación de riesgo. Conclusión: la producción basada en evidencia de tecnologías educativas es una estrategia a expandir en enfermería, con miras a sistematizar la atención de enfermería de manera segura y con calidad. (AU)

Percepção de risco e comportamento de estudantes universitários relacionados às infecções sexualmente transmissíveis / Perception of risk and behavior of university students related to sexually transmitted infections / Percepción de riesgo y comportamiento de estudiantes universitarios relacionados con infecciones de transmisión sexual

Objetivo: Verificar associação entre a percepção de risco para infecções sexualmente transmissíveis e variáveis sociocomportamentais de universitários. Métodos: Estudo transversal, realizado com 655 estudantes de ensino superior. A amostragem foi probabilística por conglomerados. Utilizou-se um questionário estruturado para coleta de dados. A análise estatística foi realizada no Statistical Package for Social Sciences. Resultados: Maioria do sexo feminino, com média de 23 anos de idade, cor não branca, solteira/separada e de religião católica. Houve associação significativa entre percepção de risco e a idade, religião, orientação sexual, idade da sexarca, realização do teste do Vírus da Imunodeficiência Humana, número de parcerias e uso de preservativo com parceiro fixo. Conclusão: Foi possível confirmar que a percepção de risco é realmente uma variável importante, e que, a sua ausência pode ser um fator determinante para adoção de comportamentos considerados arriscados para aquisição de infecções sexualmente transmissíveis, como maior número de parcerias sexuais e baixa adesão ao preservativo. (AU)

Objective: to verify the existence of an association between the perception of risk and socio-behavioral variables of university students. Methods: Cross-sectional study with 655 students of higher education. Sampling was probabilistic by clusters; A structured questionnaire was used for data collection. Statistical analysis was performed in the Statistical Package for Social Sciences. Results: The majority were female, with a mean age of 23 years, non-white, single / separated / widowed and Catholic. There was a significant association between risk perception and gender, age, religion, sexual orientation, sexarche age, Human Immunodeficiency Virus testing, number of sexual partnerships and condom use with a fixed partner. Conclusion: It was possible to confirm that risk perception is a really important variable and the lack of it can be a determining factor for the adoption of risky behaviors associated with the acquisition of sexually transmitted infections, like greater number of sexual partnerships and low adherence to condoms. (AU)

Objetivo: Verificar la existencia de asociación entre la percepción del riesgo y variables de comportamiento de la universidad colaboradora. Métodos: Estudio cuantitativo, analítico realizado con 655 estudiantes universitarios. La muestra fue probabilística por conglomerados; Se utilizó un cuestionario con 60 preguntas objetivas. Los datos fueron analizados mediante el paquete estadístico para las Ciencias Sociales. Este trabajo sigue los lineamientos de la Resolución 466/2012 del SNC. Resultados: La mayoría eran mujeres con una media de 23 años, no blanco, Individual / Separado / viuda, y católica. Se observó una asociación significativa entre la percepción del riesgo y el género, la edad, la religión, la orientación sexual, la edad sexarche, la realización de la prueba del Vírus de Inmunodeficiencia Humana, número de parejas sexuales y el uso del condón con parejas habituales. Conclusión: Se pudo constatar que la percepción de riesgo es realmente una variable importante, y que su ausencia puede ser un factor determinante para la adopción de conductas consideradas de riesgo para la adquisición de infecciones de transmisión sexual, como mayor número de parejas sexuales y baja adherencia al condón. (AU)

Diagnosis and rehabilitation of an infant with palatal mucormycosis: A clinical report and systematic literature review.

STATEMENT OF PROBLEM: Oral mucormycosis is uncommon in pediatric patients with hematolymphoid diseases. Prosthetic rehabilitation is challenging, and protocols are scarce in the literature. PURPOSE: The purpose of this clinical report and systematic literature review of case reports and case series was to describe the clinicopathologic aspects of oral mucormycosis and the interim prosthetic rehabilitation of an affected infant. MATERIAL AND METHODS: The clinical lesions were ulcerative and necrotic with underlying bone exposure that affected the hard palate. The affected area underwent surgical debridement, and histopathologic analysis was performed. A literature search in PubMed/MEDLINE, Embase, Scopus, and Web of Science up to October 2023 was performed. RESULTS: The histopathological features were consistent with mucormycosis. Topical and systemic antifungals were prescribed. Tooth eruption was insufficient, and an acetate plate without clasp retention, but still with adequate retention, was fabricated. Articulatory, masticatory, and swallowing functions were restored, preventing the passage of food and fluids into the oroantral cavities. Twenty-five articles describing 26 patients with oral mucormycosis related to hematolymphoid disorders affecting the pediatric population were identified. None of the authors of these articles provided information about oral rehabilitation. CONCLUSIONS: Early diagnosis and treatment are essential to increasing the chances of survival for infants affected by oral mucormycosis. Custom-made rehabilitation should be provided to restore oral function and improve the patient's general health.

International Migration, Refugees, and Spread of Tuberculosis in Brazil: Analysis of Clusters, Trends, and Associated Factors (2010-2021).

BACKGROUND: International migration is a global phenomenon with significant implications on the health-disease process due to exposures along transit routes and local/destination epidemiological indicators. We aimed to analyze the transmission and spread of tuberculosis among international migrants and refugees from a spatiotemporal perspective and the associated factors. METHOD: This was an ecological study of cases of tuberculosis in international migrants in Brazil, between 2010 and 2021. Annual incidence rates were calculated and spatiotemporal scan techniques were used to identify municipalities at risk. Multiple logistic regression was used to identify factors associated with tuberculosis in international migrants. RESULTS: A total of 4037 cases of tuberculosis were reported in Brazil in international migrants. Municipalities at risk for this event were identified using the spatiotemporal scan technique, and a cluster was identified with ITT: +52.01% and ETT: +25.60%. A higher probability of TB infection was identified in municipalities with a TB incidence rate >14.40 cases/100 inhabitants, population >11,042 inhabitants, Gini index >0.49, and illiteracy rate >13.12%. A lower probability was found in municipalities with average per capita household income >BRL 456.43. CONCLUSIONS: It is recommended that health authorities implement monitoring and rigorous follow-up in affected areas to ensure proper diagnosis and treatment completion for international migrants, preventing disease spread to other communities.

Reference intervals for bone marrow cells in juvenile and young adult cats bone marrow cytology.

BACKGROUND: The current bone marrow (BM) reference intervals (RI) are based on a limited number of cats. Age-related changes in BM variables might be important,possibly affecting the interpretation of the results. OBJECTIVES: Establish BM cytologic reference intervals (RIs) and association of age and sex on these findings, in healthy juvenile and young adult cats. METHODS: BM aspirates of cats deemed healthy based on history and clinical, CBC, serum chemistry findings, and negative retrovirus serology were obtained and examined cytologically. The examination included a 1000-nucleated differential cell count and cell morphologic assessment. RIs were calculated using parametric, robust, and nonparametric methods. The cytologic findings were examined for associations with sex and age. RESULTS: The study included 40 cats (females, 22 [55%]; males, 18 [45%]) with a median age of 1.5 years (range 0.5-5). Most calculated RIs were similar to those previously reported. BM plasma cell and monocyte counts were weakly and positively correlated with age (rs, .312 and .373, respectively; P < .05). Metarubricytes were higher infemales (mean, 25.1%; SD, 6.0%) than males (mean, 21.2%; SD, 6.0%; P < .05). CONCLUSIONS: The BM differential cell counts determined in this study can serve as RIs for cats aged 0.5-5 years.

Cardiovascular risk in women with nonclassical congenital adrenal hyperplasia.

CONTEXT: The outcomes related to cardiovascular risk (CVR) in patients with nonclassical form of congenital adrenal hyperplasia (NCAH) are unknown, especially those related to therapeutic options, including low doses of glucocorticoids (GCs) or oral contraceptive pills. OBJECTIVES: to analyze CVR by markers of atherosclerosis in females with nonclassical form according to therapeutic options. DESIGN AND SETTING: a cross-sectional study at a tertiary center. PATIENTS AND METHODS: Forty-seven females with NCAH (33.4 ± 10 years) were subdivided into: G1 (n = 28) treated with dexamethasone (0.14 ± 0.05 mg/m2/day); G2 (n = 19) with oral contraceptive pills; and G3 (30 matched controls). CVR was analyzed through serum lipids, HOMA-IR, inflammatory cytokines levels and quantitative image evaluations (pulse wave velocity-PWV, endothelial function by flow mediated dilatation-FMD, carotid intima media thickness-CIMT and visceral fat-VAT by abdominal tomography. RESULTS: There were no statistically significant differences in BMI, HOMA-IR, HDL-cholesterol, or triglyceride levels among groups (p > 0.05). Serum interleukin-6 levels ​​were higher in G1 than in G2 (p = 0.048), and interleukin-8 levels were higher in G1 than in G2/3 (p = 0.008). There were no statistically significant differences in VAT, PWV, FMD or CIMT among groups (p > 0.05). In multivariable regression analysis, there was no statistically significant association between glucocorticoid dose and evaluated outcomes. CONCLUSION: Adult females with NCAH did not show increased CVR using methodologies for detection of precocious atherosclerosis. Although patients receiving dexamethasone therapy had increased IL-6 and 8 levels, these data were not associated with radiological markers of atherosclerosis. Our cohort was composed of young adults and should be reevaluated in a long-term follow-up.

Investigation of anti-Leptospira spp. antibodies and leptospiruria in cats attended to a veterinary teaching hospital in southern Brazil.

Leptospirosis is a bacterial zoonosis that affects both humans and animals worldwide. Currently, it is known that cats may be susceptible to infection. This study aims to investigate the presence of anti-Leptospira spp. antibodies and leptospiruria in cats, using Microscopic Agglutination Test (MAT) and Real-time Polymerase Chain Reaction (PCR) techniques, respectively. A total of 76 cats, undergoing comprehensive anamnesis, general physical examination, and complementary exams were included in the investigation. Among the 76 cats tested, 9.2% (7/76) exhibited the presence of anti-Leptospira spp. antibodies, while Leptospira spp. DNA was detected in at 1.3% (1/76) of the evaluated urine samples. No significant associations were observed between the serological and molecular diagnostic results and the assessed variables, including clinical data and laboratory results of cats testing positive. This study provides insight into the occurrence of Leptospira spp. infection and leptospiruria in cats treated at a veterinary teaching hospital in southern Brazil.

Data Base similarity (DBsimilarity) of natural products to aid compound identification on MS and NMR pipelines, similarity networking, and more.

INTRODUCTION: We developed Data Base similarity (DBsimilarity), a user-friendly tool designed to organize structure databases into similarity networks, with the goal of facilitating the visualization of information primarily for natural product chemists who may not have coding experience. METHOD: DBsimilarity, written in Jupyter Notebooks, converts Structure Data File (SDF) files into Comma-Separated Values (CSV) files, adds chemoinformatics data, constructs an MZMine custom database file and an NMRfilter candidate list of compounds for rapid dereplication of MS and 2D NMR data, calculates similarities between compounds, and constructs CSV files formatted into similarity networks for Cytoscape. RESULTS: The Lotus database was used as a source for Ginkgo biloba compounds, and DBsimilarity was used to create similarity networks including NPClassifier classification to indicate biosynthesis pathways. Subsequently, a database of validated antibiotics from natural products was combined with the G. biloba compounds to identify promising compounds. The presence of 11 compounds in both datasets points to possible antibiotic properties of G. biloba, and 122 compounds similar to these known antibiotics were highlighted. Next, DBsimilarity was used to filter the NPAtlas database (selecting only those with MIBiG reference) to identify potential antibacterial compounds using the ChEMBL database as a reference. It was possible to promptly identify five compounds found in both databases and 167 others worthy of further investigation. CONCLUSION: Chemical and biological properties are determined by molecular structures. DBsimilarity enables the creation of interactive similarity networks using Cytoscape. It is also in line with a recent review that highlights poor biological plausibility and unrealistic chromatographic behaviors as significant sources of errors in compound identification.

Clinical, immunological, and microbiological analysis of the association between periodontitis and COVID-19: a case-control study.

PURPOSE: Periodontitis and coronavirus disease (COVID-19) share risk factors and activate similar immunopathological pathways, intensifying systemic inflammation. This study investigated the clinical, immunological and microbiological parameters in individuals with COVID-19 and controls, exploring whether periodontitis-driven inflammation contributes to worsening COVID-19 endpoints. METHODS: Case (positive RT-PCR for SARS-CoV-2) and control (negative RT-PCR) individuals underwent clinical and periodontal assessments. Salivary levels of TNF-α, IL-6, IL-1ß, IL-10, OPG, RANKL, neutrophil extracellular traps, and subgingival biofilm were analyzed at two timepoints. Data on COVID-19-related outcomes and comorbidity information were evaluated from medical records. RESULTS: Ninety-nine cases of COVID-19 and 182 controls were included for analysis. Periodontitis was associated with more hospitalization (p = 0.009), more days in the intensive care unit (ICU) (p = 0.042), admission to the semi-ICU (p = 0.047), and greater need for oxygen therapy (p = 0.042). After adjustment for confounders, periodontitis resulted in a 1.13-fold increase in the chance of hospitalization. Salivary IL-6 levels (p = 0.010) were increased in individuals with COVID-19 and periodontitis. Periodontitis was associated with increased RANKL and IL-1ß after COVID-19. No significant changes were observed in the bacterial loads of the periodontopathogens Porphyromona gingivalis, Aggregatibacter actinomycetemcomitans, Tanerella forsythia, and Treponema denticola. CONCLUSIONS: Periodontitis was associated with worse COVID-19 outcomes, suggesting the relevance of periodontal care to reduce the burden of overall inflammation. Understanding the crosstalk between SARS-CoV-2 infection and chronic conditions such as periodontitis that can influence disease outcome is important to potentially prevent complications of COVID-19.

High-speed countercurrent chromatography with offline detection by electrospray mass spectrometry and nuclear magnetic resonance detection as a tool to resolve complex mixtures: A practical approach using Coffea arabica leaf extract.

INTRODUCTION: Many secondary metabolites isolated from plants have been described in the literature owing to their important biological properties and possible pharmacological applications. However, the identification of compounds present in complex plant extracts has remained a great scientific challenge, is often laborious, and requires a long research time with high financial cost. OBJECTIVES: The aim of this study was to develop a method that allows the identification of secondary metabolites in plant extracts with a high degree of confidence in a short period of time. MATERIAL AND METHODS: In this study, an ethanolic extract of Coffea arabica leaves was used to validate the proposed method. Countercurrent chromatography was chosen as the initial step for extraction fractionation using gradient elution. Resulting fractions presented a variation of compounds concentrations, allowing for statistical total correlation spectroscopy (STOCSY) calculations between liquid chromatography coupled with high-resolution tandem mass spectrometry (LC-HRMS/MS) and NMR across fractions. RESULTS: The proposed method allowed the identification of 57 compounds. Of the annotated compounds, 20 were previously described in the literature for the species and 37 were reported for the first time. Among the inedited compounds, we identified flavonoids, alkaloids, phenolic acids, coumarins, and terpenes. CONCLUSION: The proposed method presents itself as a valid alternative for the study of complex extracts in an effective, fast, and reliable way that can be reproduced in the study of other extracts.

Rastreamento da fragilidade em pessoas idosas com hipertensão arterial sistêmica por instrumentos diferentes / Tracking frailty in older adults with systemic arterial hypertension through different instruments

Resumo Objetivo Comparar o grau de concordância, a correlação e a acurácia entre os instrumentos Edmonton Frail Scale (EFS) e Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20) em pessoas idosas com hipertensão arterial sistêmica (HAS). Método Estudo transversal e domiciliar com pessoas idosas de Montes Claros, MG. Este estudo incluiu somente indivíduos com HAS cujos dados foram coletados no período de novembro de 2016 a fevereiro de 2017. Foram determinados a sensibilidade, especificidade e valores preditivos. A estatística Kappa analisou a concordância e confiabilidade, o coeficiente de Pearson avaliou a correlação entre os instrumentos. Resultados 281 eram hipertensas e foram incluídas neste estudo. Constatou-se que a prevalência de fragilidade foi 31,3% pela EFS e 22,1% pelo IVCF-20. A estatística Kappa foi 0,604 e coeficiente de correlação de Pearson foi de 0,621 (p<0,001). A acurácia foi de 84,34%. Conclusão Os instrumentos EFS e IVCF-20 demonstraram concordância e confiabilidade moderada, forte correlação positiva e boa acurácia. Os resultados ratificam a importância de padronizar o instrumento para verificar a fragilidade de pessoas idosas hipertensas. A adequada avaliação da fragilidade busca ofertar uma assistência pautada na prevenção e promoção que capazes de evitar a piora do estado de saúde e agravos da hipertensão arterial.

Abstract Objective To compare the degree of agreement, correlation, and accuracy between the Edmonton Frail Scale (EFS) and the Clinical-Functional Vulnerability Index-20 (IVCF-20) instruments in older adults with systemic arterial hypertension (SAH). Method Cross-sectional household study with older adults from Montes Claros, MG. This study included only individuals with SAH whose data were collected from November 2016 to February 2017. Sensitivity, specificity, and predictive values were determined. The Kappa statistic analyzed agreement and reliability, while the Pearson coefficient evaluated the correlation between the instruments. Results A total of 281 individuals with hypertension were included in this study. It was found that the prevalence of frailty was 31.3% according to the EFS and 22.1% according to the IVCF-20. The Kappa statistic was 0.604, and the Pearson correlation coefficient was 0.621 (p<0.001). The accuracy was 84.34%. Conclusion The EFS and IVCF-20 instruments verified moderate agreement and reliability, strong positive correlation, and good accuracy. The results confirm the importance of standardizing the instrument to assess frailty in older adults with hypertension. The appropriate assessment of frailty aims to provide care focused on prevention and promotion that can prevent worsening health status and complications of arterial hypertension.

Simplesmente mães: construção compartilhada de tecnologias sobre pré-natal de mulheres com deficiência visual / Simply mothers: shared elaboration of technologies on prenatal care of visually impaired women / Simplemente madres: creación compartida de tecnologías sobre el control prenatal para mujeres con discapacidad visual

RESUMO Objetivo: Desenvolver tecnologias educacionais sobre pré-natal com e para mulheres deficientes visuais. Método: Estudo metodológico com interface participativa e abordagem qualitativa. Realizado em uma Unidade Técnica Especializada no município de Belém, Pará, Brasil. A produção de dados ocorreu entre agosto e setembro de 2021 com seis mulheres. Utilizou-se o DOSVOX como recurso de comunicação para que as participantes respondessem quatro instrumentos com vistas ao desenvolvimento das tecnologias. A análise foi de conteúdo temático. Resultados: As mulheres com deficiência visual querem respeito à sua autonomia, inclusão e informação dos profissionais. As tecnologias produzidas apontam as demandas específicas de mulheres com deficiência visual e a importância de preservar a autonomia durante a realização do pré-natal. Conclusão: Tecnologias produzidas de forma participativa apontam perspectivas e necessidades específicas das mulheres sobre o pré-natal e poderão subsidiar tanto o agir dos enfermeiros nas consultas como favorecer mulheres com deficiência visual durante o pré-natal.

ABSTRACT Objective: To develop educational technologies on prenatal care with and for visually impaired women. Method: A methodological study with a participatory interface and qualitative approach. It was carried out at a Specialized Technical Unit in the municipality of Belém, Pará, Brazil. Data production took place between August and September 2021 with six women. DOSVOX was used as a communication resource for the participants to answer four instruments with a view to developing the technologies. The analysis was of the thematic content type. Results: Women with visual impairment want respect for their autonomy, inclusion, and information from the professionals. The technologies produced point to the specific demands of visually impaired women and to the importance of preserving autonomy during prenatal care. Conclusion: Technologies produced in a participatory way point out women's specific perspectives and needs regarding prenatal care and may support both the nurses' actions in consultations and favor women with visual impairment during prenatal care.

RESUMEN Objetivo: Desarrollar tecnologías educativas sobre el control prenatal con y para mujeres con discapacidad visual. Método: Estudio metodológico con interfaz participativa y enfoque cualitativo. Realizado en una Unidad Técnica Especializada de la ciudad de Belém, Pará, Brasil. La producción de datos se realizó entre agosto y septiembre de 2021 con seis mujeres. Se utilizó DOSVOX como recurso de comunicación para que las participantes respondieran a cuatro instrumentos a fin de desarrollar las tecnologías. El análisis fue de contenido temático. Resultados: Las mujeres con discapacidad visual quieren que se respete su autonomía, inclusión e información por parte de los profesionales. Las tecnologías creadas ponen de manifiesto las demandas específicas de las mujeres con discapacidad visual y la importancia de preservar la autonomía durante el control prenatal. Conclusión: Las tecnologías creadas de manera participativa señalan las perspectivas y necesidades específicas de las mujeres con respecto al cuidado prenatal y pueden ayudar a los enfermeros en las consultas y a las mujeres con discapacidad visual durante el control prenatal.

Prevalência e fatores associados à fragilidade em pessoas idosas hipertensas por meio da Escala de Fragilidade de Edmonton e Índice de Vulnerabilidade Clínico Funcional-20 / Prevalence and factors associated with frailty in older adults with hypertension using the Edmonton Frail Scale and the Clinical Functional Vulnerability Index-20

Resumo Objetivo Avaliar a prevalência de fragilidade e comparar as variáveis associadas a essa fragilidade em pessoas idosas hipertensas comunitárias brasileiras por meio da Escala de Fragilidade de Edmonton (EFE) e o Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20). Métodos Trata-se de um estudo transversal e analítico, conduzido com pessoas idosas hipertensas comunitárias com idade ≥60 anos, residentes na cidade de Montes Claros, Minas Gerais, Brasil. A seleção da amostra seguiu o modelo probabilístico por conglomerado. Os dados foram coletados entre novembro de 2016 e fevereiro de 2017 por meio de aplicação de questionário em domicílio. Foram analisadas variáveis demográficas, socioeconômicas e clínico-assistenciais. Utilizou-se a regressão de Poisson com variância robusta para obter as razões de prevalência brutas e ajustadas. Resultados Participaram 281 pessoas idosas hipertensas. A prevalência geral de fragilidade pela EFE foi de 31,3% e pelo IVCF-20 foi de 22,1%. As variáveis, que após a análise múltipla, foram estatisticamente associadas à fragilidade em idosos hipertensos, pela EFE e IVCF-20 simultaneamente, foram: idade avançada (80 anos ou mais), apresentar como comorbidade artrite reumatoide/artrose, acidente vascular encefálico, autopercepção de saúde negativa, quedas e internações nos últimos 12 meses. Apenas pela EFE, menos de 4 anos de estudo, não ter prática religiosa e não possuir renda própria foram as variáveis associadas. Enquanto pelo IVCF-20, somente a renda familiar mensal associou-se à fragilidade. Conclusão Verificou-se que a fragilidade avaliada pela EFE e pelo IVCF-20 possui similaridade, no entanto, a EFE é mais sensível. Esses resultados demonstram a necessidade dos profissionais da saúde identifiquem precocemente a fragilidade.

Abstract Objective To assess the prevalence of frailty and compare the variables associated with frailty in Brazilian community-dwelling older adults with hypertension using the Edmonton Frail Scale (EFS) and the Clinical Functional Vulnerability Index-20 (IVCF-20). Methods This is a cross-sectional analytical study conducted with community-dwelling older adults with hypertension aged ≥60 years residing in the city of Montes Claros, Minas Gerais, Brazil. Sample selection followed a probabilistic cluster sampling model. Data were collected between November 2016 and February 2017 through in-home questionnaire administration. Demographic, socioeconomic, and clinical-care variables were analyzed. Poisson regression with robust variance was used to obtain crude and adjusted prevalence ratios. Results A total of 281 older adults with hypertension participated in the study. The overall prevalence of frailty as assessed by the EFS was 31.3%, and by the IVCF-20 was 22.1%. Variables that were statistically associated with frailty in older adults with hypertension, as determined by both the EFS and IVCF-20 simultaneously, were: advanced age (80 years or older), comorbidities such as rheumatoid arthritis/osteoarthritis, stroke, negative self-perception of health, falls, and hospitalizations in the last 12 months. Only by the EFS, variables associated with frailty included less than 4 years of education, absence of religious practice, and lack of personal income. Meanwhile, according to the IVCF-20, only monthly family income was associated with frailty. Conclusion It was found that frailty assessed by EFS and IVCF-20 exhibits similarity; however, EFS is more sensitive. These findings underscore the imperative for healthcare professionals to early identify frailty.

Strengthening surveillance, disease detection, and outbreak response through Guinea-Bissau's Frontline Field Epidemiology Training Program: a cross-sectional descriptive study.

Introduction: the goal of the Field Epidemiology Training Program (FETP) - Frontline is to strengthen the country's surveillance capacity at the district level to prepare and respond to health emergencies, including outbreaks, by training a skilled frontline public health workforce. We describe the FETP - Frontline program, including implementation, structure, achievements, impact, and its role in improving the epidemiological workforce capacity of Guinea-Bissau. Methods: this cross-sectional descriptive study uses 2015-2019 program data collected through record reviews and historical narratives from FETP students and graduates. We generated descriptive summary statistics using the Guinea-Bissau's FETP-Frontline program database, student assignments, and investigation reports, after reviewing the FETP standardized curriculum and program guidelines. Results: since its inception in 2016, FETP Frontline has implemented 14 cohorts and trained 198 frontline surveillance officers. Program participants improved surveillance data quality, investigated 51 outbreaks at national and regional levels, and contributed to disease research and surveillance in 227 separate field investigations. Participants frequently responded to priority health emergencies, including clusters or outbreaks of Zika, microencephalies, dengue, yellow fever, anthrax, malaria, and tuberculosis. Conclusion: Guinea-Bissau's FETP - Frontline program provides a practical example of an effective strategy to strengthen health systems through a well-prepared workforce trained to quickly detect and respond to health threats.

Health condition, income loss, food insecurity and other social inequities among migrants and refugees during the COVID-19 pandemic in Brazil.

BACKGROUND: Brazil is the destination of many international migrants and refugees and, given the circumstances of their entry into the country, many face difficulties due to the absence of targeted policies. Thus, the objective of this study was to survey the social impact of COVID-19 on international migrants and refugees regarding income loss, food insecurity and other social inequities, and to identify explanatory factors on these aspects. METHODS: This is a cross-sectional, analytical study. We used a validated instrument applied by trained interviewers. Descriptive analysis and binary logistic regression were performed to identify factors associated with income loss and food insecurity. RESULTS: A total of 360 individuals from sub-Saharan African and South American countries participated in the study. Individuals who were white, black/brown, yellow, had an occupation/employment, and earned less than one minimum wage were more likely to lose income. Those who reported no income, received less than one minimum wage, and were diagnosed with COVID-19 were more likely to be food insecure. CONCLUSIONS: The study advances knowledge by identifying factors associated with income loss, food insecurity, and individuals' difficulty in accessing health services and social support measures in Brazil.

Treatment of drug-resistant tuberculosis in children and young adolescents in Brazil.

Introduction: Drug-resistant tuberculosis (DR-TB) is a global threat and a challenge for public health authorities worldwide. In children, the diagnosis is even more challenging and DR-TB is poorly described in the literature, as are its treatment outcomes. In this study, we aimed to describe the treatment of drug-resistant TB in children and young adolescents in Brazil. Methods: A descriptive epidemiological study of treatment for DR-TB in children under 15 years of age in Brazil between 2013 and 2020. The primary data source was the Information System for Special Tuberculosis Treatments (SITE-TB). Categorical variables were analyzed using relative frequencies (%) and continuous variables by measures of central tendency to characterize the profile of the cases, namely: sociodemographic, clinical characteristics, procedures, tests performed and treatment success. In order to verify the distribution of cases, a spatial analysis was carried out based on the municipality where the cases resided. Results: Between 2013 and 2020, 19,757 tuberculosis (TB) cases occurred in children aged <15 years in Brazil, and 46 cases of treatment for DR-TB were reported during the same period (annual average of 6 cases). Of these, 73.9% were aged 10-14, 65.2% were male, 4.3% were HIV+ and 43.3% were underweight (BMI<18.5) at the start of treatment. 17.4% had previous contact with TB, 69.6% had primary resistance, 47.8% multidrug resistance. The median duration of treatment was 15 months. DOT and standardized treatment regimen were performed in 52.2% of cases. Bacilloscopy was performed for 97.8% (57.8% positive); culture for 89.1% (75.6% positive), rapid molecular test for 73.9% with proven resistance to rifampicin in 55.8%. Susceptibility testing revealed resistance mainly to isoniazid (87.8%) and rifampicin (60.6%). 73.9% of cases were successfully treated and one death was reported. Cases were treated in 26 Brazilian municipalities, with the majority in Rio de Janeiro (15) and São Paulo (4). Conclusion: DR-TB treatment was recorded in <1% of general TB cases in children and young adolescents, suggesting underreporting of drug-resistant cases in the country. Despite the low number of registered cases, the data reflect the situation of DR-TB in this population and describe important aspects of the problem, as the child needs comprehensive, individualized care, with support from different professionals. We recommend a strengthening of the country's referral services for the care of children with DR-TB so that surveillance and health care services can work together to identify and follow up cases.