Community-Based Pediatric Palliative Care: How Services Support Children's and Families' Quality of Life.

Background: The Massachusetts Department of Public Health's Pediatric Palliative Care Network (PPCN) provides Community-Based Pediatric Palliative Care (CBPPC) to children with life-limiting conditions and their families. CBPPC services aim to improve children and families' quality of life (QOL). Objectives: To identify perceived domains of QOL important for children and families and to understand whether and how CBPPC supports QOL. Design: A community-based participatory research framework was used to develop recruitment and data collection materials for eight focus groups and seven interviews. Collected data were transcribed and analyzed with an inductive approach. Setting/Subjects: A convenience sample of 33 PPCN caregivers, 20 providers, and seven key informants, including policymakers, community organizations, and hospital-based clinicians, were interviewed virtually in the United States. Measurements: Perceived QOL domains for children and families, respectively, and perceived impact of CBPPC services on QOL. Results: Reported QOL domains described as important for children were socialization/community integration and accessibility; expression/play; and physical wellness. Control or autonomy, psycho-emotional wellness, and self-care were identified as important for families. Clinical services were described as "integral to mental health" through offered spiritual support; advocacy in the community; and education. PPCN's integrative services were noted as distractions from pain and helped improve communication and bonding. Sibling support and bereavement care were also mentioned as impactful on QOL. Conclusions: Family-centered CBPPC was described as supportive of children's and families' QOL. Future studies should consider using population-based QOL measures, leveraging the QOL domains identified through this analysis and other outcome measures in a cost-effectiveness analysis.

Registros, monitoramento e avaliação no e-SUS APS por cirurgiões-dentistas em um distrito sanitário de Recife/PE

Objetivo: A presente pesquisa teve por objetivo analisar a percepção dos cirurgiões-dentistas de um Distrito Sanitário da cidade do Recife-PE sobre registros, monitoramentos e avaliações realizadas no e-SUS APS. Métodos: Trata-se de um estudo com abordagem qualitativa. Os dados foram coletados através de entrevista individual com roteiro semiestruturado, entre os meses de julho e agosto de 2022, com oito cirurgiões-dentistas de equipes de saúde bucal do Distrito Sanitário I do município de Recife, Pernambuco. Em seguida, realizou-se a análise das informações produzidas através da técnica de análise de conteúdo. Resultados: O e-SUS APS facilitou o processo de trabalho dos pesquisados ao simplificar o registro e a consulta das informações dos usuários, proporcionando o acompanhamento da situação de saúde. No entanto, este vem sendo subutilizado. Já no que se refere às fragilidades, os entrevistados destacaram barreiras relacionadas à estrutura das unidades de saúde, como situações técnicas de conectividade da internet, assim como necessidade de capacitações eficazes e periódicas. Conclusões: O estudo revelou que um dos problemas que permeiam a operacionalização do e-SUS APS diz respeito a sua subutilização. Existe a necessidade de capacitação dos cirurgiões-dentistas para o uso do e-SUS APS e há investimento na infraestrutura das unidades básicas de saúde, pois a informatização ainda é precária.

Biomechanics in Keratoconus Diagnosis.

Purpose: To prospectively review the importance of biomechanical assessment in the screening, diagnosis, prognosis, individualized planning, and clinical follow-up for ectatic corneal diseases.Methods: We demonstrate two commercially available devices to assess the corneal biomechanics in vivo, the Ocular Response Analyzer (ORA, Reichester, NY, USA) and the Corvis ST (Oculus, Wetzlar, Germany). Novel devices have been demonstrated to provide in vivo biomechanical measurements, including Brillouin optical microscopy and OCT elastography. Conclusion: The integration of biomechanical data and other data from multimodal refractive imaging using artificial intelligence demonstrated the ability to enhance accuracy in diagnosing ectatic corneal diseases.

Chronic back pain among Brazilian adults: data from the 2019 National Health Survey. / Dor crônica na coluna entre adultos brasileiros: dados da Pesquisa Nacional de Saúde 2019.

OBJECTIVE: To estimate the prevalence of chronic back pain (CBP) and its associated factors. METHODS: This cross-sectional study analyzed the 2019 National Health Survey, with 88,531 adults, using logistic regression to identify associated factors. RESULTS: CBP was reported by 21.6% of adults and was more likely to occur among women (odds ratio - OR=1.27; 95% confidence interval - 95%CI 1.19-1.35), increased with age: 25-34 years (OR=1.30; 95%CI 1.11-1.51), 35-44 (OR=1.78; 95%CI 1.54-2.07), 45-54 years (OR=2.23; 95%CI 1.91-2.59), 55-64 years (OR=2.47; 95%CI 2.12-2.88), and 65 years or older (OR=2.17; 95%CI 1.85-2.54); among smokers (OR=1.24; 95%CI 1.13-1.35); ex-smokers (OR=1.30; 95%CI 1.21-1.39); those who mentioned heavy housework (OR=1.41; 95%CI 1.31-1.53); obesity (OR=1.12; 95%CI 1.03-1.21); hypertension (OR=1.21; 95%CI 1.11-1.32); high cholesterol (OR=1.53; 95%CI 1.42-1.65); with self-rated health - with a very good reference - in the gradients: good (OR=1.38; 95%CI 1.23-1.55), regular (OR=2.64; 95%CI 2.34-2.98), poor (OR=4.24; 95%CI 3.64-4.94), and very poor (OR=5.24; 95%CI 4.13-6.65); its likelihood was lower in adults with complete elementary school/incomplete high school (OR=0.82; 95%CI 0.75-0.90) and complete high school/incomplete higher education (OR=0.87; 95%CI 0.81-0.95). CONCLUSION: Back pain has a high prevalence and shows associations with demographic and socioeconomic factors, lifestyle, chronic diseases, and self-rated health.

OBJETIVO: Estimar a prevalência da dor crônica na coluna (DCC) e os fatores associados à sua ocorrência. MÉTODOS: Estudo transversal analisando a Pesquisa Nacional de Saúde 2019, com 88.531 adultos, usando regressão logística para identificar fatores associados. RESULTADOS: A DCC foi apontada por 21,6% dos adultos, mostrou maior chance em mulheres (odds ratio ­ OR=1,27; intervalo de confiança de 95% ­ IC95% 1,19­1,35), aumentou com a idade de 25­34 anos (OR=1,30; IC95% 1,11­1,51), 35­44 (OR=1,78; IC95% 1,54­2,07), 45­54 anos (OR=2,23; IC95% 1,91­2,59), 55­64 anos (OR=2,47; IC95% 2,12­2,88) e 65 anos ou mais (OR=2,17; IC95% 1,85­2,54); fumantes (OR=1,24; IC95% 1,13­1,35); ex-fumantes (OR=1,30; IC95% 1,21­1,39); que citaram atividade física doméstica pesada (OR=1,41; IC95% 1,31­1,53); obesidade (OR=1,12; IC95% 1,03­1,21); hipertensos (OR=1,21; IC95% 1,11­1,32); colesterol aumentado (OR=1,53; IC95% 1,42­1,65); autoavaliação, cuja referência era muito boa, mostrou gradiente boa (OR=1,38; IC95% 1,23­1,55); regular (OR=2,64; IC95% 2,34­2,98), ruim (OR=4,24; IC95% 3,64­4,94), e muito ruim (OR=5,24; IC95% 4,13­6,65); e menor chance em adultos com ensino fundamental completo/ensino médio incompleto (OR=0,82; IC95% 0,75­0,90) e médio completo/superior incompleto (OR=0,87; IC95% 0,81­0,95). CONCLUSÃO: A dor na coluna tem elevada prevalência e mostra associação com fatores demográficos, socioeconômicos, estilo de vida, doenças crônicas e autoavaliação de saúde.

Corneal biomechanics for corneal ectasia: Update.

Knowledge of biomechanical principles has been applied in several clinical conditions, including correcting intraocular pressure measurements, planning and following corneal treatments, and even allowing an enhanced ectasia risk evaluation in refractive procedures. The investigation of corneal biomechanics in keratoconus (KC) and other ectatic diseases takes place in several steps, including screening ectasia susceptibility, the diagnostic confirmation and staging of the disease, and also clinical characterization. More recently, investigators have found that the integration of biomechanical and tomographic data through artificial intelligence algorithms helps to elucidate the etiology of KC and ectatic corneal diseases, which may open the door for individualized or personalized medical treatments in the near future. The aim of this article is to provide an update on corneal biomechanics in the screening, diagnosis, staging, prognosis, and treatment of KC.

Live births of immigrant mothers in Brazil: A population-based study.

Introduction: Migration has become a major challenge for many countries, and women constitute half of the migrants in the world. Few studies have been conducted on migrant mothers in Brazil. We aim to identify differences in the pregnancies, childbirths, and live birth (LB) indicators of immigrant women, compared with those of Brazilian women living in the municipality of São Paulo (MSP), Brazil. Methods: The LB characteristics of immigrant mothers from Bolivia (15,886), China (3861), Paraguay (1370), and Peru (1039) were compared with those of Brazilian mothers (967,921) living in the MSP between 2012 and 2017. Pearson's chi-square test was used to compare proportions with a significance level of 5%. Results: Teenage pregnancy and low education were more frequent among Bolivian (13.1 and 31.7%, respectively) and Paraguayan mothers (13.1 and 36.2%). Bolivian women exhibited a high percentage of late-onset prenatal care (8.7%), few prenatal visits (14.3%), vaginal birth (77.0%), home delivery (1.6%), and postterm (3.6%). Bolivian (13.6%), Peruvian (10.6%), and Paraguayan (7.9%) women exhibited a higher prevalence of macrosomia than Chinese (4.3%) and Brazilian (4.0%) women. There was a high prevalence of preterm and low birth weights among Paraguayan (12.5 and 7.7%, respectively) and Brazilian mothers (11.0 and 9.7%) and a high rate of cesarean sections among Chinese (42.1%) and Brazilian (53.5%). Conclusion: Differences were observed in the sociodemographic profiles for the pregnancies, childbirths, and LBs of immigrant mothers, in view of their increase and diversity in the MSP. There was greater vulnerability among immigrant mothers, compared with Brazilian mothers, particularly regarding access to prenatal care.

Incontinência Urinária Em Mulheres Jovens E Nulíparas: Fatores Associados E Prevalência / Urinary Incontinence in Young and Nulliparous Women: Associated Factors and Prevalence / Incontinencia Urinaria en Mujeres Jóvenes Nulíparas: Factores Asociados Y Prevalencia

Objetivo:Verificar a prevalência e os fatores de risco associados à incontinência urinária em mulheres jovens nulíparas. Método: Revisão integrativa da literatura, realizada através de busca nas bases de dados: Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências de Saúde (LILACS), Índice Bibliográfico Espanhol em Ciências da Saúde (IBECS) e na Base de Dados de Enfermagem (BDENF), no período de março a junho de 2021, utilizando os descritores: "incontinência urinária", "prevalência", "mulheres", "estudantes" e "adulto jovem" combinados através do operador booleano "AND". Resultados: A busca inicial resultou em 234 artigos e, após aplicação dos critérios de elegibilidade, obteve-se uma amostra final de 5 artigos. Após as análises, evidenciou-se prevalência de incontinência urinária em mulheres jovens nulíparas de 48%. Os fatores de risco foram: atividade física de alto impacto, duração da atividade física, sintomas intestinais e urinários concomitantes. Conclusão: Observou-se que a ocorrência de incontinência urinária em mulheres jovens nulíparas é uma condição comum, os fatores de risco associados demonstram a necessidade de orientação em saúde a essas mulheres para evitar a cronificação do agravo.

Objective:To verify the prevalence and risk factors associated with urinary incontinence in nulliparous young women. Methods: Integrative literature review, performed by searching the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS), Spanish Bibliographic Index in Health Sciences (IBECS) and in the Nursing Database (BDENF), from March to June 2021, using the descriptors: "urinary incontinence", "prevalence", "women", "students" and "young adult" combined with the Boolean operator "AND". Results: The initial search resulted in 234 articles and, after applying the eligibility criteria, a final sample of 5 articles was obtained. After the analyses, a prevalence of urinary incontinence in young nulliparous women of 48% was evidenced. Risk factors were: high-impact physical activity, duration of physical activity, concomitant bowel and urinary symptoms. Conclusion: It was observed that the occurrence of urinary incontinence in nulliparous young women is a common condition. The associated risk factors demonstrate the need for health guidance to these women to avoid the chronification of the disease.

Objetivo:Verificar la prevalencia y los factores de riesgo asociados a incontinencia urinaria en mujeres jóvenes nulíparas. Método: Revisión integral de literatura realizada a través de búsqueda en las bases de datos: Medical Literature Analysis and Retrieval System Online (MEDILINE) Literatura Latinoamericana y del Caribe en Ciencias De Salud (LILACS), Índice bibliográfico español en ciencias de salud (IBECS) y en la Base de Datos de Enfermería (BDENF), en el periodo de marzo a junio del 2021 utilizando los descriptores "incontinencia urinaria", "prevalencia", "mujeres", "estudiantes" y "adulto joven" combinados a través del operador booleano "AND". Resultados: Después del análisis se evidenció una prevalencia de incontinencia urinaria en mujeres jóvenes nulíparas de 48%. Los factores de riesgo fueron: actividad física de alto impacto, duración de actividad física, síntomas intestinales y urinarios concomitantes. Conclusión: Se observó que la ocurrencia de incontinencia urinaria en mujeres jóvenes nulíparas es una condición común. Los factores de riesgo asociados demuestran la necesidad de orientación en salud a esas mujeres para evitar la cronificación de la gravedad.

Dor crônica na coluna entre adultos brasileiros: dados da Pesquisa Nacional de Saúde 2019 / Chronic back pain among Brazilian adults: data from the 2019 National Health Survey

RESUMO Objetivo: Estimar a prevalência da dor crônica na coluna (DCC) e os fatores associados à sua ocorrência. Métodos: Estudo transversal analisando a Pesquisa Nacional de Saúde 2019, com 88.531 adultos, usando regressão logística para identificar fatores associados. Resultados: A DCC foi apontada por 21,6% dos adultos, mostrou maior chance em mulheres (odds ratio — OR=1,27; intervalo de confiança de 95% — IC95% 1,19-1,35), aumentou com a idade de 25-34 anos (OR=1,30; IC95% 1,11-1,51), 35-44 (OR=1,78; IC95% 1,54-2,07), 45-54 anos (OR=2,23; IC95% 1,91-2,59), 55-64 anos (OR=2,47; IC95% 2,12-2,88) e 65 anos ou mais (OR=2,17; IC95% 1,85-2,54); fumantes (OR=1,24; IC95% 1,13-1,35); ex-fumantes (OR=1,30; IC95% 1,21-1,39); que citaram atividade física doméstica pesada (OR=1,41; IC95% 1,31-1,53); obesidade (OR=1,12; IC95% 1,03-1,21); hipertensos (OR=1,21; IC95% 1,11-1,32); colesterol aumentado (OR=1,53; IC95% 1,42-1,65); autoavaliação, cuja referência era muito boa, mostrou gradiente boa (OR=1,38; IC95% 1,23-1,55); regular (OR=2,64; IC95% 2,34-2,98), ruim (OR=4,24; IC95% 3,64-4,94), e muito ruim (OR=5,24; IC95% 4,13-6,65); e menor chance em adultos com ensino fundamental completo/ensino médio incompleto (OR=0,82; IC95% 0,75-0,90) e médio completo/superior incompleto (OR=0,87; IC95% 0,81-0,95). Conclusão: A dor na coluna tem elevada prevalência e mostra associação com fatores demográficos, socioeconômicos, estilo de vida, doenças crônicas e autoavaliação de saúde.

ABSTRACT Objective: To estimate the prevalence of chronic back pain (CBP) and its associated factors. Methods: This cross-sectional study analyzed the 2019 National Health Survey, with 88,531 adults, using logistic regression to identify associated factors. Results: CBP was reported by 21.6% of adults and was more likely to occur among women (odds ratio — OR=1.27; 95% confidence interval — 95%CI 1.19-1.35), increased with age: 25-34 years (OR=1.30; 95%CI 1.11-1.51), 35-44 (OR=1.78; 95%CI 1.54-2.07), 45-54 years (OR=2.23; 95%CI 1.91-2.59), 55-64 years (OR=2.47; 95%CI 2.12-2.88), and 65 years or older (OR=2.17; 95%CI 1.85-2.54); among smokers (OR=1.24; 95%CI 1.13-1.35); ex-smokers (OR=1.30; 95%CI 1.21-1.39); those who mentioned heavy housework (OR=1.41; 95%CI 1.31-1.53); obesity (OR=1.12; 95%CI 1.03-1.21); hypertension (OR=1.21; 95%CI 1.11-1.32); high cholesterol (OR=1.53; 95%CI 1.42-1.65); with self-rated health — with a very good reference — in the gradients: good (OR=1.38; 95%CI 1.23-1.55), regular (OR=2.64; 95%CI 2.34-2.98), poor (OR=4.24; 95%CI 3.64-4.94), and very poor (OR=5.24; 95%CI 4.13-6.65); its likelihood was lower in adults with complete elementary school/incomplete high school (OR=0.82; 95%CI 0.75-0.90) and complete high school/incomplete higher education (OR=0.87; 95%CI 0.81-0.95). Conclusion: Back pain has a high prevalence and shows associations with demographic and socioeconomic factors, lifestyle, chronic diseases, and self-rated health.

PMA treatment fosters rat retinal ganglion cell survival via TNF signaling.

An insult can trigger a protective response or even cell death depending on different factors that include the duration and magnitude of the event and the ability of the cell to activate protective intracellular signals, including inflammatory cytokines. Our previous work showed that the treatment of Lister Hooded rat retinal cell cultures with 50 ng/mL phorbol 12-myristate 13-acetate (PMA), a protein kinase C activator, increases the survival of retinal ganglion cells (RGCs) kept in culture for 48 h after axotomy. Here we aim to analyze how PMA modulates the levels of TNF-α and IL-1ß (both key inflammatory mediators) and the impact of this modulation on RGCs survival. We hypothesize that the increase in RGCs survival mediated by PMA treatment depends upon modulation of the levels of IL-1ß and TNF-α. The effect of PMA treatment was assayed on cell viability, caspase 3 activation, TNF-α and IL-1ß release and TNF receptor type I (TNFRI) and TNF receptor type II (TNFRII) levels. PMA treatment increases IL-1ß and TNF-α levels in 15 min in culture and increases the release of both cytokines after 30 min and 24 h, respectively. Both IL-1ß and TNF-α levels decrease after 48 h of PMA treatment. PMA treatment also induces an increase in TNFRII levels while decreasing TNFRI after 24 h. PMA also inhibited caspase-3 activation, and decreased ROS production and EthD-1/calcein ratio in retinal cell cultures leading to an increase in cell viability. The neutralization of IL-1ß (anti-IL1ß 0,1ng/mL), the neutralization of TNF-α (anti-TNF-α 0,1ng/mL) and the TNF-α inhibition using a recombinant soluble TNFRII abolished PMA effect on RGCs survival. These data suggest that PMA treatment induces IL1ß and TNF-α release and modulation of TNFRI/TNFRII expression promoting RGCs survival after axotomy.

Is it just an obstructive pyelonephritis?

Pyelocaliceal obstruction is a diagnostic challenge, and it is important to identify the obstruction cause. Some patients present extra-renal compressive masses that need further imagiologic investigation and a biopsy, to establish the diagnosis.

Percepção de cuidadores familiares de pacientes idosos sobre cuidados paliativos / Perception of palliative care by family caregivers of elderly patients / Percepción de los cuidadores familiares de pacientes mayores sobre cuidado paliativo

Objetivo: compreender o entendimento dos cuidadores familiares de pacientes idosos sobre cuidados paliativos. Método: trata-se de um estudo qualitativo, descritivo, exploratório. Compôs-se a amostra por 11 cuidadores familiares de pacientes assistidos pela equipe de cuidados paliativos. Realizou-se uma entrevista semiestruturada na qual os participantes responderam a três questões norteadoras, examinadas pela Análise de Conteúdo. Resultados: detalha-se que emergiram três categorias: percepção dos cuidadores familiares sobre cuidados paliativos; motivos de o ente estar sendo cuidado pela equipe de cuidados paliativos; e 'É diferente ser cuidado pela equipe de cuidados paliativos'? Conclusão: conclui-se que o cuidador familiar tem entendimento sobre o que são cuidados paliativos, quais os motivos que levam o seu ente a ser acompanhado por uma equipe de cuidados paliativos e reconhece que há diferença entre o cuidado prestado pela equipe de cuidados paliativos e uma equipe não paliativista. Evidenciou-se uma comunicação efetiva entre equipe e cuidador familiar.(AU)

Objective: to understand the perception of palliative care by family caregivers of elderly patients. Method: it is a qualitative, descriptive, exploratory study. The sample was composed by 11 family caregivers of patients assisted by the palliative care team. A semi-structured interview was carried out in which the participants answered three guiding questions, examined through Content Analysis. Results: three categories are detailed to have emerged: perception of family caregivers about palliative care; reasons for the relative to be cared for by the palliative care team; and 'Is it different to be cared for by the palliative care team'? Conclusion: it is concluded that the family caregiver has an understanding about what palliative care is, about what the reasons are for his relative to be assisted by a palliative care team and recognizes that there is a difference between the care provided by the palliative care team and a non-palliative care team. An effective communication between the team and the family caregiver has been demonstrated.(AU)

Objetivo: comprender la comprensión de los cuidadores familiares de pacientes ancianos sobre los cuidados paliativos. Método: se trata de un estudio exploratorio, descriptivo y cualitativo. La muestra estuvo compuesta por 11 cuidadores familiares de pacientes asistidos por el equipo de cuidados paliativos. Se realizó una entrevista semiestructurada en la que los participantes respondieron a tres preguntas orientadoras, examinadas por Content Analysis. Resultados: se detalla que surgieron tres categorías: percepción de los cuidadores familiares sobre los cuidados paliativos; motivos para ser atendido por el equipo de cuidados paliativos; y "¿Es diferente ser atendido por el equipo de cuidados paliativos"? Conclusión: se concluye que el cuidador familiar tiene un entendimiento de lo que son los cuidados paliativos, cuáles son las razones que llevan a su ser querido a ser acompañado de un equipo de cuidados paliativos y reconoce que existe una diferencia entre los cuidados que brindan los cuidados paliativos equipo y un equipo no paliativo. Se evidenció una comunicación efectiva entre el equipo y el cuidador familiar.(AU)

SARS-CoV-2 Infection in Pregnant Women: Neuroimmune-Endocrine Changes at the Maternal-Fetal Interface.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) has devastating effects on the population worldwide. Given this scenario, the extent of the impact of the disease on more vulnerable individuals, such as pregnant women, is of great concern. Although pregnancy may be a risk factor in respiratory virus infections, there are no considerable differences regarding COVID-19 severity observed between pregnant and nonpregnant women. In these circumstances, an emergent concern is the possibility of neurodevelopmental and neuropsychiatric harm for the offspring of infected mothers. Currently, there is no stronger evidence indicating vertical transmission of SARS-CoV-2; however, the exacerbated inflammatory response observed in the disease could lead to several impairments in the offspring's brain. Furthermore, in the face of historical knowledge on possible long-term consequences for the progeny's brain after infection by viruses, we must consider that this might be another deleterious facet of COVID-19. In light of neuroimmune interactions at the maternal-fetal interface, we review here the possible harmful outcomes to the offspring brains of mothers infected by SARS-CoV-2.

Inflammatory, synaptic, motor, and behavioral alterations induced by gestational sepsis on the offspring at different stages of life.

BACKGROUND: The term sepsis is used to designate a systemic condition of infection and inflammation associated with hemodynamic changes that result in organic dysfunction. Gestational sepsis can impair the development of the central nervous system and may promote permanent behavior alterations in the offspring. The aim of our work was to evaluate the effects of maternal sepsis on inflammatory cytokine levels and synaptic proteins in the hippocampus, neocortex, frontal cortex, and cerebellum of neonatal, young, and adult mice. Additionally, we analyzed the motor development, behavioral features, and cognitive impairments in neonatal, young and adult offspring. METHODS: Pregnant mice at the 14th embryonic day (E14) were intratracheally instilled with saline 0.9% solution (control group) or Klebsiella spp. (3 × 108 CFU) (sepsis group) and started on meropenem after 5 h. The offspring was sacrificed at postnatal day (P) 2, P8, P30, and P60 and samples of liver, lung, and brain were collected for TNF-α, IL-1ß, and IL-6 measurements by ELISA. Synaptophysin, PSD95, and ß-tubulin levels were analyzed by Western blot. Motor tests were performed at all analyzed ages and behavioral assessments were performed in offspring at P30 and P60. RESULTS: Gestational sepsis induces a systemic pro-inflammatory response in neonates at P2 and P8 characterized by an increase in cytokine levels. Maternal sepsis induced systemic downregulation of pro-inflammatory cytokines, while in the hippocampus, neocortex, frontal cortex, and cerebellum an inflammatory response was detected. These changes in the brain immunity were accompanied by a reduction of synaptophysin and PSD95 levels in the hippocampus, neocortex, frontal cortex, and cerebellum, in all ages. Behavioral tests demonstrated motor impairment in neonates, and depressive-like behavior, fear-conditioned memory, and learning impairments in animals at P30 and P60, while spatial memory abilities were affected only at P60, indicating that gestational sepsis not only induces an inflammatory response in neonatal mouse brains, but also affects neurodevelopment, and leads to a plethora of behavioral alterations and cognitive impairments in the offspring. CONCLUSION: These data suggest that maternal sepsis may be causatively related to the development of depression, learning, and memory impairments in the litter.

Testing a new active learning approach to advance motor learning knowledge and self-efficacy in physical therapy undergraduate education.

BACKGROUND: Motor learning (ML) science is foundational for physical therapy. However, multiple sources of evidence have indicated a science-practice gap. Clinicians report low self-efficacy with ML concepts and indicate that the lack of access to systematic training is a barrier for practical implementation. The general goal of this preliminary study was to describe the effects of a new educational intervention on physical therapy student's ML self-efficacy and knowledge. METHODS: Self-efficacy was assessed with the Physical Therapists' Perceptions of Motor Learning questionnaire. Data was acquired from third-semester students before their participation in the ML educational intervention. Reference self-efficacy data was also acquired from physical therapy professionals and first and last-semester students. The educational intervention for third-semester students was designed around an established framework to apply ML principles to rehabilitation. A direct experience, the "Learning by Doing" approach, in which students had to choose a motor skill to acquire over 10 weeks, provided the opportunity to apply ML theory to practice in a personally meaningful way. After the intervention self-efficacy was re-tested. ML knowledge was tested with an objective final exam. Content analysis of coursework material was used to determine how students comprehended ML theory and related it to their practical experience. The Kruskal-Wallis and Mann-Whitney U tests were used to compare self-efficacy scores between the four groups. Changes in self-efficacy after the educational intervention were analyzed with the Wilcoxon test. Spearman rank correlation analysis was used to test the association between self-efficacy and final exam grades. RESULTS: By the end of the intervention, students' self-efficacy had significantly increased (p < 0.03), was higher than that of senior students (p < 0.00) and experienced professionals (p < 0.00) and correlated with performance on an objective knowledge test (p < 0.03). Content analysis revealed that students learned to apply the elements of ML-based interventions present in the scientific literature to a real-life, structured ML program tailored to personal objectives. CONCLUSIONS: Positive improvements were observed after the intervention. These results need confirmation with a controlled study. Because self-efficacy mediates the clinical application of knowledge and skills, systematic, active training in ML may help reduce the science-practice gap.

Stress, anxiety, self-efficacy, and the meanings that physical therapy students attribute to their experience with an objective structured clinical examination.

BACKGROUND: Excessive stress and anxiety can impair learning. The objective structured clinical examination (OSCE) is a valuable tool to assess and promote the acquisition of clinical skills. However, significant OSCE-related stress and anxiety are frequently reported. The aim of this study was to investigate the relationships between physiological stress, self-reported levels of anxiety due to an OSCE, self-efficacy, and the meanings that physical therapy students attribute to their experience with the exam. DESIGN: Concurrent mixed methods study. METHODS: A total of 32 students took part in this study. All were enrolled in the third semester of a 10-semester Physical Therapy Bachelor Program. Salivary cortisol levels, self-reported anxiety (State-Trait Anxiety Inventory, STAI) were measured before the OSCE. Exam scores and self-efficacy ratings were also recorded. Correlations between variables were tested with the Pearson correlation, with ɑ at 0.05. Semi-structured interviews were used to explore the personal perspectives of students. Thematic analysis was used to investigate emergent themes. RESULTS: Trait anxiety scores were significantly higher than normative values (p < 0.001). A high proportion of students showed high (STAI> 49) state anxiety (37.5%) and trait anxiety (65.6%). Salivary cortisol was not associated anxiety (p > 0.05). Neither stress nor anxiety correlated with OSCE scores. A moderate and significant direct correlation was found for self-efficacy scores and OSCE scores (r = 0.475, p = 0.007). Students reported that confidence had a calming effect and led to better self-perceived performance. They also reported that the OSCE can provide meaningful learning experiences despite being stressful. CONCLUSIONS: A high proportion of our students reported a stable/lingering negative affect. However, neither stress nor anxiety related to OSCE scores. Students' confidence in their capabilities was correlated with their performance. Their subjective reports suggest that self-confidence may have protected them from the negative effects of stress and anxiety on academic performance.

Perfil das mães imigrantes internacionais residentes no município de São Paulo / Profile of international immigrant mothers residing in the city of São Paulo

Introdução: A imigração tem se tornado um grande desafio, o que exige, tanto dos países de origem quanto dos países receptores, esforços constantes em responder às necessidades dessas populações. Atualmente o município de São Paulo, polo de empregos, é um grande receptor de imigrantes, com grande volume de mulheres em idade reprodutiva. Sendo essas populações mais vulneráveis devido à dificuldade do acesso à saúde, por barreiras linguísticas e culturais, faz-se necessário um maior enfoque na saúde reprodutiva dessas mulheres. Objetivos: Analisar se existem diferenças na gestação, parto e nascidos vivos (NV) de imigrantes em comparação às brasileiras, segundo naturalidade. Métodos: Foi realizado um estudo transversal sobre nascidos vivos no município de São Paulo, entre 2012 e 2017, a partir dos dados do Sistema de Informações sobre Nascidos Vivos (Sinasc). Foram comparadas as características de mães imigrantes e brasileiras; foi analisada a evolução de NV de 11 nacionalidades, e para cinco (Bolívia, China, Paraguai, Angola e Peru) foram comparadas suas características com as brasileiras. Foram utilizadas medidas de tendência central e proporções e calculado teste de qui-quadrado com nível de significância de 5% Foram utilizados os softwares Excel e SPSS 17.0. Resultados: Do total de 998.205 NV, 3% são filhos de mães imigrantes. Não houve diferenças entre a idade média das mães imigrantes e brasileiras. Foi mais frequente entre as brasileiras: mães adolescentes (13,0%), idade >=35 anos (18,4%), ensino superior completo/incompleto (28,0%), raça/cor branca (50,7%), parto cesáreo (53,5%), >=7 consultas de pré-natal (77,1%), início precoce ao pré-natal (83,3%), baixo peso ao nascer (9,7%) e pré-termo (11,0%); todas as diferenças estatisticamente significantes (P<0,001). Entre as mães imigrantes foi maior: nenhuma ou baixa escolaridade (24,4%), ter companheiro (57,2%), multíparas (65,7%), com 1 ou mais gestações anteriores (65,6%), parto vaginal (65,7%), <=3 consultas de pré-natal (11,6%), início tardio ao pré-natal (7º mês em diante, 7%). Por nacionalidade destacaram-se maiores proporções de adolescentes entre bolivianas (13,1%), paraguaias (13,1%) e brasileiras (13,0%); as mães angolanas com ensino superior completo/incompleto (37,1%), multíparas (78,2%), 1 ou mais perdas fetais/aborto (33,0%), início tardio ao pré-natal (12,0%), <=3 consultas de pré- natal (17,6%), pré-termo (16,4%) e baixo peso ao nascer (14,9%). Entre as mães bolivianas, encontraram-se maiores proporções de parto vaginal (77,0%) e domiciliar (1,6%), RN pós-termo (3,6%) e peso >4000g (13,6%). Conclusão: Foram encontradas diferenças nos perfis das mães brasileiras e imigrantes segundo características sociodemográficas, da gestação, do parto e de nascidos vivos, assim como entre as diferentes nacionalidades das mães. É recomendável pensar em políticas públicas específicas para abranger os diferentes aspectos culturais dos diferentes grupos de mães, visando ampliar o acesso e obter melhores resultados para sua saúde reprodutiva. _i pt

Introduction: Immigration has become a major challenge, requiring constant efforts by both countries of origin and receiving countries to meet the needs of these populations. Currently, the municipality of São Paulo is a large receiving of immigrants, with large numbers of women of reproductive age. As these populations are more vulnerable due to the difficulty of access to health, due to linguistic and cultural barriers, thus a greater focus on the reproductive health of these women is necessary. Objectives: To analyze if there are differences in gestation, delivery and live births (LB) of immigrants in comparison to Brazilians, according to their country origin. Methods: A cross-sectional study on live births was carried out in the city of São Paulo, between 2012 and 2017, based on data from the Live Birth Information System (Sinasc). The characteristics of immigrant and Brazilian mothers were compared; the evolution of live birth of 11 nationalities was analyzed, and for five (Bolivia, China, Paraguay, Angola and Peru) their characteristics were compared with the Brazilian ones. Measurements of central tendency and proportions were used and chi-square test with significance level of 5%; processed in Excel and SPSS 17.0. Results: Of the total of 998,205 live birth, 3% are children of immigrant mothers. There were no differences between the average age of immigrant and Brazilian mothers. It was more frequent among Brazilian women: adolescent mothers (13.0%), age >=35 years (18.4%); higher education (28.0%), race/color white (50.7%), cesarean section (53.5%), >=7 prenatal appointment (77.1%), early prenatal care (83.3%), low birth weight (LBW) (9.7%) and preterm LB (11.0%), all differences were statistically significant (p<0.001). Among the immigrant mothers, the highest proportions were: none or low schooling (24.4%), with partner (57.2%), multiparous (65.7%), 1 or more previous pregnancies (65.6%), vaginal delivery (65.7%), <=3 prenatal appointment (11.6%), late onset to prenatal care (7th month onwards, 7%). By nationality, the highest proportions of adolescents were: Bolivians (13.1%), Paraguayans (13.1%) and Brazilians (13.0%); the Angolan mothers were high education (37.1%), multiparous (78.2%), 1 or more fetal losses/abortion (33.0%), late onset to prenatal care (12.0%), <=3 prenatal appointments (17.6%), preterm birth (16.4%) and LBW (14.9%). Among the Bolivian mothers, were found higher proportions: vaginal birth (77.0%) and home birth (1.6%), post-term LB (3.6%) andweight >4000g (13.6%). Conclusion: Differences were found in profiles of Brazilian and immigrant mothers according to sociodemographic, gestation, delivery and live births characteristics, as well as the different nationalities of the mothers. It is recommended to think about specific public policies to cover the different cultural aspects of the different groups of mothers, in order to increase access and obtain better results for their reproductive health. _i em

Perfil das mães imigrantes internacionais residentes no município de São Paulo / Profile of international immigrant mothers residing in the city of São Paulo

Introdução: A imigração tem se tornado um grande desafio, o que exige, tanto dos países de origem quanto dos países receptores, esforços constantes em responder às necessidades dessas populações. Atualmente o município de São Paulo, polo de empregos, é um grande receptor de imigrantes, com grande volume de mulheres em idade reprodutiva. Sendo essas populações mais vulneráveis devido à dificuldade do acesso à saúde, por barreiras linguísticas e culturais, faz-se necessário um maior enfoque na saúde reprodutiva dessas mulheres. Objetivos: Analisar se existem diferenças na gestação, parto e nascidos vivos (NV) de imigrantes em comparação às brasileiras, segundo naturalidade. Métodos: Foi realizado um estudo transversal sobre nascidos vivos no município de São Paulo, entre 2012 e 2017, a partir dos dados do Sistema de Informações sobre Nascidos Vivos (Sinasc). Foram comparadas as características de mães imigrantes e brasileiras; foi analisada a evolução de NV de 11 nacionalidades, e para cinco (Bolívia, China, Paraguai, Angola e Peru) foram comparadas suas características com as brasileiras. Foram utilizadas medidas de tendência central e proporções e calculado teste de qui-quadrado com nível de significância de 5% Foram utilizados os softwares Excel e SPSS 17.0. Resultados: Do total de 998.205 NV, 3% são filhos de mães imigrantes. Não houve diferenças entre a idade média das mães imigrantes e brasileiras. Foi mais frequente entre as brasileiras: mães adolescentes (13,0%), idade >=35 anos (18,4%), ensino superior completo/incompleto (28,0%), raça/cor branca (50,7%), parto cesáreo (53,5%), >=7 consultas de pré-natal (77,1%), início precoce ao pré-natal (83,3%), baixo peso ao nascer (9,7%) e pré-termo (11,0%); todas as diferenças estatisticamente significantes (P<0,001). Entre as mães imigrantes foi maior: nenhuma ou baixa escolaridade (24,4%), ter companheiro (57,2%), multíparas (65,7%), com 1 ou mais gestações anteriores (65,6%), parto vaginal (65,7%), <=3 consultas de pré-natal (11,6%), início tardio ao pré-natal (7º mês em diante, 7%). Por nacionalidade destacaram-se maiores proporções de adolescentes entre bolivianas (13,1%), paraguaias (13,1%) e brasileiras (13,0%); as mães angolanas com ensino superior completo/incompleto (37,1%), multíparas (78,2%), 1 ou mais perdas fetais/aborto (33,0%), início tardio ao pré-natal (12,0%), <=3 consultas de pré- natal (17,6%), pré-termo (16,4%) e baixo peso ao nascer (14,9%). Entre as mães bolivianas, encontraram-se maiores proporções de parto vaginal (77,0%) e domiciliar (1,6%), RN pós-termo (3,6%) e peso >4000g (13,6%). Conclusão: Foram encontradas diferenças nos perfis das mães brasileiras e imigrantes segundo características sociodemográficas, da gestação, do parto e de nascidos vivos, assim como entre as diferentes nacionalidades das mães. É recomendável pensar em políticas públicas específicas para abranger os diferentes aspectos culturais dos diferentes grupos de mães, visando ampliar o acesso e obter melhores resultados para sua saúde reprodutiva.

Introduction: Immigration has become a major challenge, requiring constant efforts by both countries of origin and receiving countries to meet the needs of these populations. Currently, the municipality of São Paulo is a large receiving of immigrants, with large numbers of women of reproductive age. As these populations are more vulnerable due to the difficulty of access to health, due to linguistic and cultural barriers, thus a greater focus on the reproductive health of these women is necessary. Objectives: To analyze if there are differences in gestation, delivery and live births (LB) of immigrants in comparison to Brazilians, according to their country origin. Methods: A cross-sectional study on live births was carried out in the city of São Paulo, between 2012 and 2017, based on data from the Live Birth Information System (Sinasc). The characteristics of immigrant and Brazilian mothers were compared; the evolution of live birth of 11 nationalities was analyzed, and for five (Bolivia, China, Paraguay, Angola and Peru) their characteristics were compared with the Brazilian ones. Measurements of central tendency and proportions were used and chi-square test with significance level of 5%; processed in Excel and SPSS 17.0. Results: Of the total of 998,205 live birth, 3% are children of immigrant mothers. There were no differences between the average age of immigrant and Brazilian mothers. It was more frequent among Brazilian women: adolescent mothers (13.0%), age >=35 years (18.4%); higher education (28.0%), race/color white (50.7%), cesarean section (53.5%), >=7 prenatal appointment (77.1%), early prenatal care (83.3%), low birth weight (LBW) (9.7%) and preterm LB (11.0%), all differences were statistically significant (p<0.001). Among the immigrant mothers, the highest proportions were: none or low schooling (24.4%), with partner (57.2%), multiparous (65.7%), 1 or more previous pregnancies (65.6%), vaginal delivery (65.7%), <=3 prenatal appointment (11.6%), late onset to prenatal care (7th month onwards, 7%). By nationality, the highest proportions of adolescents were: Bolivians (13.1%), Paraguayans (13.1%) and Brazilians (13.0%); the Angolan mothers were high education (37.1%), multiparous (78.2%), 1 or more fetal losses/abortion (33.0%), late onset to prenatal care (12.0%), <=3 prenatal appointments (17.6%), preterm birth (16.4%) and LBW (14.9%). Among the Bolivian mothers, were found higher proportions: vaginal birth (77.0%) and home birth (1.6%), post-term LB (3.6%) andweight >4000g (13.6%). Conclusion: Differences were found in profiles of Brazilian and immigrant mothers according to sociodemographic, gestation, delivery and live births characteristics, as well as the different nationalities of the mothers. It is recommended to think about specific public policies to cover the different cultural aspects of the different groups of mothers, in order to increase access and obtain better results for their reproductive health.

Diagnóstico de muerte encefálica en víctimas de accidentes: análisis del proceso / Diagnóstico de morte encefálica em vítimas de acidentes: análise do proceso / Brain death diagnosis in victims of traffic accidents: process analysis

Objetivo: Las víctimas de las causas externas de trauma, causadas ya sea por accidentes de tránsito o por la violencia en general, son en su mayoría jóvenes que evolucionan a muerte encefálica y posibles donantes. Teniendo en cuenta que el tiempo para determinar la muerte encefálica puede interferir en la calidad de los órganos ofrecidos, el propósito de este estudio fue analizar el período del proceso de diagnóstico de muerte encefálica. Material y métodos: Es un estudio descriptivo retrospectivo sobre el proceso de diagnóstico de muerte encefálica y su duración en pacientes víctimas mortales por causas externas de traumatismo en una ciudad del noroeste de Paraná, Brasil, desde enero a diciembre de 2012. Resultados: El promedio de tiempo para el período entre la confirmación del coma y el protocolo inicial para la determinación de la muerte encefálica en los cuatro hospitales fue de 18.90 ± 13.62 horas; el promedio de cierre del protocolo con Examen Complementario para los cuatro hospitales estudiados fue de 12 ± 8 horas, y el cierre con prueba clínica indicó 10 ± 6 horas. Conclusión: Los datos presentados describen una falla en todo el proceso de muerte encefálica, desde la detección de coma hasta el cierre del protocolo de diagnóstico de muerte encefálica, lo que aumenta considerablemente el tiempo de diagnóstico

As vítimas de causas externas por traumas, seja por acidentes de trânsito ou violência em geral, são em sua maioria jovens que evoluem para morte encefálica tornando-se potenciais doadores. Considerando que o tempo de determinação de morte encefálica pode interferir na qualidade dos órgãos ofertados, o objetivo deste estudo foi analisar o tempo do processo de determinação de morte encefálica. Trata-se de um estudo retrospectivo e descritivo sobre o processo de determinação de morte encefálica e sua duração, em pacientes vítimas fatais por causas externas ocasionadas por traumas, em um município do Noroeste do Paraná Brasil, no período de janeiro a dezembro de 2012. A média de tempo entre período compreendido entre a constatação do coma e início do protocolo de determinação de morte encefálica, nos quatro hospitais analisados foi de 18,90±13,62 horas e a média de encerramento do protocolo com Exame Complementar dos quatro hospitais estudados foi de 12±8 horas e do encerramento com prova clínica foi de 10±6 horas. Os dados apresentados descrevem uma falha em todo o processo de morte encefálica, desde a detecção do coma até a finalização do protocolo de determinação de morte encefálica, aumentando consideravelmente o período de tempo de seu diagnóstico

Objective: Victims of external causes of trauma, caused either by traffic accidents or by violence in general, are mostly youngsters who evolve to brain death and potential donors. Considering that the time to determine brain death may interfere on the quality of the offered organs, the purpose of this study was to analyze the period of brain death diagnosis process. Material and Methods: It is a retrospective, descriptive study on brain death diagnosis process and its duration in patients who are fatal victims due to external causes of trauma in a city in the Northwest of Paraná, Brazil, ranging from January to December 2012. Results: The average of time for the period between the coma confirmation and the initial protocol for brain death determination in the four hospitals consisted of 18.90±13.62 hours; the average of protocol closure with Complementary Examination for the four studied hospitals consisted of 12±8 hours, and closure with clinical proof indicated 10±6 hours. Conclusion: The data presented describe a failure in the entire brain death process, since coma detection until brain death diagnosis protocol closure, considerably increasing diagnosis time

Brazilian Amazon Traditional Medicine and the Treatment of Difficult to Heal Leishmaniasis Wounds with Copaifera.

The present study describes the use of the traditional species Copaifera for treating wounds, such as ulcers scarring and antileishmanial wounds. It also relates phytochemical studies, evaluation of the leishmanicidal activity, and toxicity. The species of Copaifera with a higher incidence in the Amazon region are Copaifera officinalis, Copaifera reticulata, Copaifera multijuga Hayne. The copaiba oil is used in the Amazon's traditional medicine, especially as anti-inflammatory ingredient, in ulcers healing, and in scarring and for leishmaniasis. Chemical studies have shown that these oils contain diterpenes and sesquiterpenes. The copaiba oil and terpenes isolated have antiparasitic activity, more promising in the amastigote form of L. amazonensis. This activity is probably related to changes in the cell membrane and mitochondria. The oil showed low cytotoxicity and genotoxicity. Furthermore, it may interfere with immune response to infection and also has a healing effect. In summary, the copaiba oil is promising as leishmanicidal agent.

Ingested microplastics (>100 µm) are translocated to organs of the tropical fiddler crab Uca rapax.

Microplastics, which are accumulating in marine sediments, are assumed to pose a risk for deposit feeding invertebrates. We tested whether the fiddler crab Uca rapax ingests and retains microplastics in its body. Furthermore, we investigated whether retention rates depend on (a) the quality of the marine environment in which the plastics were pre-weathered and on (b) their abundance. For this, polystyrene pellets were submersed at a polluted and a pristine site near Niterói, Brazil, for 2 weeks. Then specimens of U. rapax were, in laboratory experiments, exposed to fragments (180-250 µm) derived from these pellets for 2 months. After this period, microplastics were observed in the gills, stomach and hepatopancreas of the animals. However, fragment retention was not influenced by the two factors that we manipulated. The presence of microplastics in different organs of the crab supports the assumption that these particles have the potential to harm marine invertebrates.