Burden and Regional Disparities in the Firearm Mortality Profiles in Brazil: A Systematic Analysis of Findings From the Global Burden of Disease 2019.

Introduction: Owing to legislative changes and regional disparities, knowledge of firearm death profile in Brazil is limited, creating a complex situation that requires data to improve the strategies to reduce the burden of this health problem. The aim of this study was to describe the burden of firearm injuries and regional disparities in Brazil, including the characterization of mortality profiles specifically in the year 2019. Method: The researchers extracted secondary data from the Institute of Health Metrics and Evaluation, from Global Burden of Disease study, including information on new cases and deaths caused by firearms. They also examined metrics such as incidence, mortality, years of life lost owing to disability, years of life living with disability, and years of life lost owing to premature death. Descriptive statistics (number of deaths and proportion) were performed. Results: The findings reveal that nearly 50,000 firearm-related deaths occurred in Brazil in 2019, corresponding to a rate of 21.6 deaths per 100,000 inhabitants. These deaths collectively contributed to around 3 million years of life lost when adjusted for disability. Notably, there are significant regional disparities, with the Northeast region of Brazil bearing a higher burden of firearm injuries. The study further differentiates mortality profiles on the basis of the type of firearm-related death. Young individuals and young adults experience a higher mortality rate due to homicides. On the other hand, individuals aged ≥70 years are more prone to firearm-related suicides. Conclusions: Firearm injuries in Brazil have distinct mortality profiles. Acknowledging these different profiles is crucial when devising effective public policies to address this issue.

Night eating syndrome among university students: are aspects of academic life associated with eating disorders? / Síndrome do comer noturno entre estudantes universitários: aspectos da vida acadêmica estariam associados ao distúrbio alimentar?

Introduction: the critical period in the lives of college adults implies lifestyle changes such as reducing physical activity and adopting unhealthy eating habits that can result in increased body fat. Thus, college students may represent a population at increased risk for Night Eating Syndrome. Objective: to analyze aspects of university students' academic life, work and housing that could be associated with Night Eating Syndrome. Methods: cross-sectional study carried out with 900 students from Architecture, Engineering, Medicine and Psychology courses at a higher education institution located in Cajazeiras, Paraíba, Brazil. Self-administered questionnaires were used for data collection: the Night Eating instrument Questionnaire (NEQ) to quantify Night Eating Syndrome (NCS) behaviors and a form for variables on demographic, health, academic life, work and housing aspects. Results: the prevalence of NES determined by the NEQ≥25 score was 16.8%. In the Engineering course, the prevalence of SCN was higher in women than in men, and in the Psychology course, it was higher in men than in women. Among students with a job and who lived at home, the prevalence of the syndrome was higher for those who worked in the afternoon and lower for those who worked at night. Conclusion: the prevalence of NES found among Brazilian university students was high (16.8%), particularly in two situations: (1) being enrolled in an undergraduate course with a predominance of students of the other sex; and (2) live with parents and work in the afternoon. These observations may be helpful in identifying subpopulations of students at increased risk for eating disorders.

Introdução: o período crítico da vida de adultos universitários implica mudanças do estilo de vida como a diminuição da atividade física e a adoção de hábitos alimentares pouco saudáveis que podem resultar em aumento da gordura corporal. Assim, estudantes universitários podem representar uma população com risco aumentado para a Síndrome do Comer Noturno. Objetivo: analisar aspectos da vida acadêmica, do trabalho e da moradia de estudantes universitários que poderiam se associar à Síndrome do Comer Noturno. Método: estudo transversal realizado com 900 estudantes dos cursos de Arquitetura, Engenharia, Medicina e Psicologia de uma instituição de ensino superior localizada em Cajazeiras, Paraíba, Brasil. Para a coleta de dados foram usados questionários autoaplicados: o instrumento Night Eating Questionnaire (NEQ) para quantificar comportamentos da Síndrome do Comer Noturno (SCN) e um formulário para variáveis sobre aspectos demográficos, de saúde, vida acadêmica, trabalho e moradia. Resultados: a prevalência da SCN determinada pelo escore NEQ≥25 foi 16,8%. No curso de Engenharia a prevalência da SCN foi maior nas mulheres em relação aos homens, e no curso de Psicologia, foi maior nos homens em relação as mulheres. Entre os estudantes com emprego e que moravam na casa dos pais, a prevalência da síndrome foi maior para aqueles que trabalham no período da tarde e menor para aqueles que trabalham à noite. Conclusão: a prevalência da SCN encontrada entre os estudantes universitários brasileiros foi alta (16,8%), particularmente em duas situações: (1) estar matriculado um curso de graduação com predominância de estudantes do outro sexo; e (2) morar com os pais e trabalhar no período da tarde. Estas observações podem ser úteis na identificação de subpopulações de estudantes com risco aumentado de distúrbios de alimentação

Why do some patients with acute ischemic stroke fail to improve after intravenous thrombolytic therapy? A case-control study / Por que alguns pacientes com acidente vascular cerebral isquêmico agudo após terapia trombolítica endovenosa não melhoram? Um estudo caso-controle

Introdução: a terapia trombolítica é a principal medida salvadora adotada em vítimas de acidente vascular cerebral isquêmico (AVCI), adequada para a maioria delas. Entretanto, alguns pacientes não apresentam evolução clínica, piorando o prognóstico, o que constitui uma lacuna científica essencial. Objetivo: analisar os determinantes da não melhora clínica em pacientes com AVC em uso de trombolíticos rt-PA.Método: estudo observacional retrospectivo caso-controle, realizado de 2014 a 2017 por meio de busca ativa de prontuários de pacientes com AVC submetidos à terapia trombolítica em um hospital de referência no Ceará. A falência clínica foi caracterizada como ausência de redução no National Institutes of Health Stroke Scale-Score (NIHSS).Resultados: um total de 139 pacientes incluídos no estudo em uma única unidade de AVC. A média de idade foi de 66,14 anos (variando de 34 a 95). O seguimento de 24 horas foi completado em 100% dos pacientes. Resultado favorável 24 horas pós-trombólise foi observado em 113 pacientes (81,29%), e não houve melhora clínica em 26 (18,7%). A transformação hemorrágica pós-trombólise foi um forte preditor de não melhora (p=0,004), e diabetes foi o principal fator de risco modificável encontrado (p=0,040).Conclusão: diabetes e transformação hemorrágica após trombólise foram identificados como fatores de risco para não melhora clínica em pacientes com AVC agudo submetidos à terapia trombolítica.

Introduction: thrombolytic therapy is the primary saving measure adopted in ischemic cerebrovascular accident (ICVA) victims, adequate for most of them. However, some patients do not show clinical progress, worsening the prognosis, which constitutes an essential scientific gap.Objective: to analyze the determinants of clinical non-improvement in stroke patients who used rt-PA thrombolytic agentes.Methods: retrospective observational case-control study, carried out from 2014 to 2017 through an active search of medical records of CVA patients undergoing thrombolytic therapy in a reference hospital in Ceará. Clinical failure was characterized as no reduction in the National Institutes of Health Stroke Scale-Score (NIHSS).Results: a total of 139 patients enrolled in the study in a single CVA unit. The mean age was 66.14 years (range 34 to 95). The 24-hour follow-up was completed in 100% of patients. A favorable result 24 hours post-thrombolysis was observed in 113 patients (81.29%), and there was no clinical improvement in 26 (18.7%). Post-thrombolysis hemorrhagic transformation was a strong predictor of no improvement (p=0.004), and diabetes was the main modifiable risk factor found (p=0.040).Conclusion: diabetes and hemorrhagic transformation after thrombolysis were identified as risk factors for clinical non-improvement in patients with acute stroke undergoing thrombolytic therapy.

Epidemiological study on the lip and oral cavity cancer in Brazil: connecting science and clinical applicability.

OBJECTIVE: The aim of this study was to describe and discuss the epidemiological indicators of lip and oral cavity cancer in Brazil, in 2017, according to data from the Global Burden of Disease data. METHODS: This is a descriptive study reported according to STROBE guidelines. We identified epidemiological indicators using the Global Burden of Disease results tool. Mortality/incidence rates were described per 100,000 population. Global Burden of Disease 2017 reviews were completed using Python version 2.7, Stata version 13.1, and R version 3.3. RESULTS: In 2017, there were 5,237 deaths from the lip or oral cavity cancer in Brazil, most of them were males aged between 50 and 69 years (2,730 cases, which was equivalent to 52% of the universe of deaths resulting from this cause). Regarding the burden of lip and oral cavity cancer, per 100,000 Brazilians, we observed an incidence of 3.99, prevalence of 15.46, and mortality of 2.29 (with higher indicators in the South and Southeast regions of the country). CONCLUSIONS: Epidemiological indicators of lip and oral cavity cancer were higher in men, with higher mortality indicators in individuals aged 50-69 years, and higher rates (incidence, prevalence, and mortality) in the South and Southeast regions of Brazil. From 2002-2015, there was a reduction in mortality; however, in the period from 2015-2017, there was a resumption in the growth of this indicator.

Epidemiological study on the lip and oral cavity cancer in Brazil: connecting science and clinical applicability

SUMMARY OBJECTIVE: The aim of this study was to describe and discuss the epidemiological indicators of lip and oral cavity cancer in Brazil, in 2017, according to data from the Global Burden of Disease data. METHODS: This is a descriptive study reported according to STROBE guidelines. We identified epidemiological indicators using the Global Burden of Disease results tool. Mortality/incidence rates were described per 100,000 population. Global Burden of Disease 2017 reviews were completed using Python version 2.7, Stata version 13.1, and R version 3.3. RESULTS: In 2017, there were 5,237 deaths from the lip or oral cavity cancer in Brazil, most of them were males aged between 50 and 69 years (2,730 cases, which was equivalent to 52% of the universe of deaths resulting from this cause). Regarding the burden of lip and oral cavity cancer, per 100,000 Brazilians, we observed an incidence of 3.99, prevalence of 15.46, and mortality of 2.29 (with higher indicators in the South and Southeast regions of the country). CONCLUSIONS: Epidemiological indicators of lip and oral cavity cancer were higher in men, with higher mortality indicators in individuals aged 50-69 years, and higher rates (incidence, prevalence, and mortality) in the South and Southeast regions of Brazil. From 2002-2015, there was a reduction in mortality; however, in the period from 2015-2017, there was a resumption in the growth of this indicator.

Physical inactivity level and lipid profile in traditional communities in the Legal Amazon: a cross-sectional study : Physical inactivity level in the Legal Amazon.

BACKGROUND: The practice of regular physical activity can alter the lipid profile in populations according to diverse demographic characteristics. OBJECTIVE: To evaluate the association of physical inactivity with the lipid profile among vulnerable populations. METHODS: A cross-sectional study was conducted among 349 vulnerable individuals from Tocantins state, northern Brazil. The International Physical Activity Questionnaire 7 Day short form was used to measure self-reported physical activity levels. Venous blood samples were drawn to evaluate lipid profile. Logistic regression adjusted by the socioeconomic variables was used to analyse the effects of physical inactivity on the lipidic profile. The level of significance was 5% and Stata® (StataCorp, LC) version 11 was used. RESULTS: We observe an inverse relationship between physical inactivity and HDL-C-that is, those who were sedentary or below the WHO Recommendations for physical activity were at 2.6 greater odds (IC95% 1.21, 5.67; p = 0.015) of having a lower HDL compared with those meeting or exceeding WHO physical activity recommendations. CONCLUSION: On the vulnerable populations studied, the insufficiently active or sedentary individuals (called the physical inactivity individuals) have more risk of the altered HDL-C.

Autonomic cardiac modulation in postmenopausal women with dry eye syndrome: a cross-sectional analytical study.

OBJECTIVE: The aim of this study was to assess cardiac autonomic modulation in postmenopausal women with and without dry eye syndrome (DES) and to identify associations between clinical and socioeconomic factors. METHODS: A cross-sectional study was carried out at the Institute of Ocular Surgery of the Northeast (ICONE), Brazil. Convenience sample of postmenopausal women, over 40 years old, who were divided into two groups: with and without DES. Clinical, sociodemographic, and ophthalmological characteristics of these women were assessed. Capture of RR intervals was performed using a cardio frequency meter. Differences between the groups were analyzed using the Chi-square test, the Student's t test, and the Mann-Whitney test. RESULTS: Women with DES were present in 60.4% (n=58), highest median age (63.5 years, 95%CI 62.0-67.9; p<0.001), median length of time menopause (19 years old, 95%CI 10.4-24.0; p<0.001). There was a difference in the standard deviation of all normal-to-normal index between the groups. However, when the differences were adjusted to the clinical model, no association was found between DES and heart rate variability (HRV). CONCLUSIONS: The analysis of cardiac autonomic modulation in postmenopausal women is similar in the presence or absence of DES. Clinical factors, time of menopause, and intensity of symptoms were not associated with HRV indices.

Autonomic cardiac modulation in postmenopausal women with dry eye syndrome: a cross-sectional analytical study

SUMMARY OBJECTIVE The aim of this study was to assess cardiac autonomic modulation in postmenopausal women with and without dry eye syndrome (DES) and to identify associations between clinical and socioeconomic factors. METHODS A cross-sectional study was carried out at the Institute of Ocular Surgery of the Northeast (ICONE), Brazil. Convenience sample of postmenopausal women, over 40 years old, who were divided into two groups: with and without DES. Clinical, sociodemographic, and ophthalmological characteristics of these women were assessed. Capture of RR intervals was performed using a cardio frequency meter. Differences between the groups were analyzed using the Chi-square test, the Student's t test, and the Mann-Whitney test. RESULTS Women with DES were present in 60.4% (n=58), highest median age (63.5 years, 95%CI 62.0-67.9; p<0.001), median length of time menopause (19 years old, 95%CI 10.4-24.0; p<0.001). There was a difference in the standard deviation of all normal-to-normal index between the groups. However, when the differences were adjusted to the clinical model, no association was found between DES and heart rate variability (HRV). CONCLUSIONS The analysis of cardiac autonomic modulation in postmenopausal women is similar in the presence or absence of DES. Clinical factors, time of menopause, and intensity of symptoms were not associated with HRV indices.

Profile of pharmaceutical care in primary health centers in São Bernardo do Campo, Southeastern Brazil

The effective insertion of the pharmacist into primary care is an important goal for health policies. The objective of this study was to describe and analyze pharmacists and Pharmaceutical Care in the primary health centers (UBS) of São Bernardo do Campo. Data were obtained through an interview applied to pharmacists. The instrument has three sections: (1) Pharmacist identification; (2) Pharmacist work; and (3) Pharmaceutical activities. Items in section 3 correspond to the guidelines of agencies that promote Pharmaceutical Care in the primary health system. All 24 pharmacists working in UBS in São Bernardo do Campo were interviewed. Every center dispensing medicines has a responsible pharmacist. These pharmacists are predominantly women and postgraduates. Activities of Pharmaceutical Care reported were: daily prescription analysis (75% of interviewees); monthly participation in patient groups (70.8%); monthly follow-up of pharmacotherapy adherence (58.3%); monthly participation in multiprofessional team meetings (54.2%); monthly home visits (12.5%); health education to the community (83.3%); and pharmacist consultation (37.5%). Frequency of prescription analysis and home visits was weakly associated with aspects of the pharmacist and the facility. This study showed that Pharmaceutical Services are structured in primary care in São Bernardo do Campo and many Pharmaceutical Care activities are offered in its UBS

Diagnosis and referral flow in the single health system for climacteric women.

OBJECTIVE: The association between gynecological diagnoses and their distribution across healthcare sectors benefits health promotion and the identification of topics for continued education of gynecological care. This study aimed to identify healthcare diagnoses and referral flow in climacteric women. METHODS: This is a cross-sectional study conducted at the Women's Health Clinic of the University Hospital, University of São Paulo, with a reference to gynecology and training for Residents of Family and Community Medicine, between 2017 and 2018. The medical records of 242 women whose sociodemographic and clinical information, gynecological diagnoses, and distribution of healthcare services (primary, secondary, and tertiary) had been processed were collected. Statistical analysis included the chi-square test and odds ratio. RESULTS: Smoking (OR = 2.27, 95% CI 1.05-4.89; p = 0.035) was associated with the referral of climacteric women to higher complexity services. Considering the distribution of non-oncological diagnoses in climacteric patients, the chance of women being referred to medium- and high-complexity health services presented a 2-fold increase in cases of breast diseases, a 2.35-fold increase in cases of noninflammatory disorders of the female genital tract, and a 3-fold increase in cases of inflammatory diseases of the pelvic organs. CONCLUSION: Climacteric women aged over 55 years, postmenopausal women, and smoking women were most frequently referred to medium- and high-complexity outpatient surgery.

Health Services, Socioeconomic Indicators, and Primary Care Coverage in Mortality by Lower Genital Tract and Breast Neoplasias in Brazilian Women during Reproductive and Non-Reproductive Periods.

Women's health assistance at the low-complexity level is focused on the most common diseases and can be affected by primary health care coverage, particularly in areas far away from large urban centers. Thus, in this work, we aim to analyze the relationship between socioeconomic status, health care indicators, and primary care coverage in mortality from neoplasms of the lower genital tract and breast in Brazilian women during reproductive and non-reproductive periods. We conducted an ecological study at the Gynecology Discipline, Medicine School, University of São Paulo. Secondary data were collected from women according to reproductive periods and mortality data from the Mortality Information System based on International Classification of Disease-10th edition regarding breast and lower genital tract neoplasms in 2017. The health service and socioeconomic indicators were obtained from the Informatics Department of the Unified Health System and Brazilian Institute of Geography and Statistics. Our results showed that primary care coverage and health service indicators were not associated with mortality from breast cancer and the female lower genital tract, both in reproductive and non-reproductive periods. Sociodemographic indicators were found to be associated with mortality from breast cancer and the female lower genital tract, with income being associated with reproductive period (ß = -0.4; 95% CI, -0.8 to -0.03) and educational level in the non-reproductive period (ß = 9.7; 95% CI, 1.5 to 18.0).

Diagnosis and referral flow in the single health system for climacteric women

SUMMARY OBJECTIVE The association between gynecological diagnoses and their distribution across healthcare sectors benefits health promotion and the identification of topics for continued education of gynecological care. This study aimed to identify healthcare diagnoses and referral flow in climacteric women. METHODS This is a cross-sectional study conducted at the Women's Health Clinic of the University Hospital, University of São Paulo, with a reference to gynecology and training for Residents of Family and Community Medicine, between 2017 and 2018. The medical records of 242 women whose sociodemographic and clinical information, gynecological diagnoses, and distribution of healthcare services (primary, secondary, and tertiary) had been processed were collected. Statistical analysis included the chi-square test and odds ratio. RESULTS Smoking (OR = 2.27, 95% CI 1.05-4.89; p = 0.035) was associated with the referral of climacteric women to higher complexity services. Considering the distribution of non-oncological diagnoses in climacteric patients, the chance of women being referred to medium- and high-complexity health services presented a 2-fold increase in cases of breast diseases, a 2.35-fold increase in cases of noninflammatory disorders of the female genital tract, and a 3-fold increase in cases of inflammatory diseases of the pelvic organs. CONCLUSION Climacteric women aged over 55 years, postmenopausal women, and smoking women were most frequently referred to medium- and high-complexity outpatient surgery.

RESUMO INTRODUÇÃO A associação entre diagnósticos ginecológicos e sua distribuição nos setores de saúde proporciona benefícios no campo da promoção de saúde e na identificação de temas para educação continuada na assistência. OBJETIVO Identificar os diagnósticos em saúde e o fluxo de encaminhamento de mulheres no climatério. MÉTODO Trata-se de estudo transversal realizado no Ambulatório de Saúde da Mulher do Hospital Universitário da Universidade de São Paulo, de referência em ginecologia e de treinamento para residentes de Medicina de Família e Comunidade, entre 2017-2018. A casuística foi realizada a partir de 274 prontuários de mulheres atendidas e foram processados informações sociodemográficas e clínicas, diagnósticos ginecológicos e distribuição dos serviços de saúde (primário, secundário e terciário). O teste qui-quadrado e razão de chance foram utilizados para estatística. RESULTADOS O tabagismo (OR=2,27, IC95% 1,05;4,89, p=0,035) foi associado ao encaminhamento de mulheres no climatério para a maior complexidade. Em relação aos tipos de diagnóstico, a chance de serem encaminhadas para a média e alta complexidade foi de 135% (OR=1,69, IC95% 0,93;3,08) nos transtornos não inflamatórios do trato genital feminino, 200% (OR=0,98, IC95% 0,23;4,02) nas doenças da mama, 300% (OR=1,51, IC95% 0,47;4,83) nos transtornos inflamatórios do trato genital feminino, sem predomínio entre os diagnósticos. CONCLUSÃO As mulheres climatéricas e na pós-menopausa acima de 50 anos e tabagistas com diagnósticos de transtornos não inflamatórios do trato genital feminino e inflamatórios, bem como doenças da mama, foram as mais direcionadas para ambulatório cirúrgico na média e alta complexidade.

Prevalence and associated factor with frailty syndrome in the brazilian elderly attended in primary care facilities: a cross-sectional study / Prevalência e fator associado à fragilidade em idosos brasileiros atendidos nas unidades básicas de saúde: um estudo transversal

INTRODUCTION: Frailty is a multidimensional syndrome that increases the vulnerability in the elderly, decreasing physiological reserves, intensifying the functional decline, being associated with numerous physical changes, determining greater risks to the elderly's health. OBJECTIVE: To analyze the association between frailty and sociodemographic conditions of the elderly met in primary care facilities in the city of Cajazeiras, northeastern Brazil. METHODS: A cross-sectional study, conducted in July 2015, with 823 elderly people through semi-structured questionnaire containing the proposed frailty criteria by Linda Fried and colleagues, and analyzed using SPSS version 21. The Chi-Square test was used to assess the association between variables, considering p<0.05 as statistically significant. The sociodemographic data were collected using an instrument created by the authors. RESULTS: The prevalence of frailty was 23.8% and is associated with older age groups (70-90 years) and older people who did not attend school (25.5%), and the main criterion of frailty found among the elderly was "slow walk" (71.7%). CONCLUSION: The frailty in elderly from Northeastern Brazil is associated with higher age and illiteracy.

INTRODUÇÃO: A fragilidade é uma síndrome multidimensional que aumenta a vulnerabilidade em idosos, causando diminuição das reservas fisiológicas, aumento do declínio funcional e está associada a inúmeras alterações físicas, determinando maiores riscos à saúde do idoso. OBJETIVO: Analisar a associação entre fragilidade e condições sociodemográficas de idosos atendidos em Unidades Básicas de Saúde da cidade de Cajazeiras, nordeste do Brasil. MÉTODOS: Estudo transversal, realizado em julho de 2015, com 823 idosos, por meio de questionário semiestruturado contendo os critérios de fragilidade propostos por Linda Fried e analisado pelo SPSS versão 21. Utilizou-se o teste qui-quadrado para verificar a associação entre as variáveis, considerando-se estatisticamente significativo p<0,05. Coletaram-se os dados sociodemográficos por meio de instrumento elaborado pelos autores. RESULTADOS: A prevalência de fragilidade foi de 23,8% e está associada a faixa etária mais velha (70-90 anos), idosos que não frequentaram a escola (25,5%), e a principal característica de fragilidade encontrada entre os idosos era "lenta" (71,7%). CONCLUSÃO: A fragilidade em idosos do Nordeste Brasileiro está associada à idade e ao analfabetismo.

Do assisted reproduction outcomes differ according to aetiology of obstructive azoospermia?

Azoospermia is defined as absence of spermatozoa and may be secondary to blocked seminal ducts, known as obstructive azoospermia. Semen quality may be impaired due to factors such as sperm cell DNA fragmentation and presence of antisperm antibodies. The objective of this article was to investigate potential differences in outcomes of in vitro fertilisation and intracytoplasmic sperm injection between groups with different obstruction aetiology, as well as between the use of different techniques and sperm cells of different origins. Retrospective, multi-centre analysis of 621 first cycles was carried out between 2008 and 2015: Group I, congenital obstruction, 45 patients and Group 2, vasectomy, 576 patients. Sperm cell retrieval was achieved in all cases. Results were similar for Group I and II fertilisation rates, 70% versus 66.85% (p = .786); pregnancy rates, 42.5% versus 41.46% (p = .896); and live birth rates, 29.73% versus 17.69% (p = .071). According to sperm cell origin (579 epididymal vs. 42 testicular), pregnancy rates, 41.47% versus 43.9% (p = .760); and live birth rates, 18.3% versus 27.78% (p = .163) had no difference. Fertilisation, pregnancy and live birth rates did not differ according to obstruction aetiology. Outcomes did not differ between groups according to sperm cell origin.

The sensitivity, specificity, and agreement of a point of care method: an assessment of the diagnostic accuracy / Sensibilidade, especificidade e concordância do método point of care: um estudo de precisão diagnóstica

Abstract The use of new technologies can improve screening in communities with difficult access to health. This article aims to evaluate the sensitivity, specificity, and agreement of a point of care test in comparison to laboratory methods for the determination of glucose (GLI), triglyceride (TG), and total cholesterol (TC) concentrations. This prospective study used data from the remaining adult population of quilombolas in Brazil. Laboratory tests using conventional methods for the analysis of venipuncture samples were used as a standard method to measure the concentrations of GLI (mg/dL), TG (mg/dL), and TC (mg/dL) and compared to the metered dose from the collection of fingertip capillary blood (point of care). Contingency tables (2x2) were used to estimate the sensitivity and specificity of the methods. Lin and Bland & Altman coefficients were used to statistically assess agreement, the level of significance was 5%. There was substantial agreement between the methods for measuring TG and poor agreement for of TC and GLI. Analysis of the Bland & Altman coefficients revealed that the fingertip method did not produce good measures. The point of care method did not offer a good ability to measure compared to that of the reference laboratory method.

Resumo O uso de novas tecnologias pode melhorar o screening em comunidades de difícil acesso à saúde. O objetivo deste artigo é avaliar a sensibilidade, especificidade e concordância do teste de point of care em comparação com método laboratorial para dosagem de Glicose (GLI), Triglicerídeo (TG) e Colesterol total (CT). Estudo prospectivo com dados de população de adultos remanescentes de quilombolas no Brasil. Exames laboratoriais convencionais para análise foram obtidos por venopunção, utilizados como método padrão para mensuração das concentrações de GLI (mg/dL), TG (mg/dL) e CT (mg/dL) e comparados a mensuração por meio de técnica de ponta de dedo (point of care). Tabelas de contingência (2x2) foram utilizadas para estimar sensibilidade e especificidade dos métodos e o coeficiente de Lin e análises de Bland & Altman foram métodos de concordância com nível de significância de 5%. Houve concordância substancial entre os métodos para mensuração de TG e fraca concordância para mensuração de CT e GLI. Os coeficientes de Bland & Altman indicam que o método de ponta de dedo não apresentou boa mensuração. O método point of care não apresentou boa capacidade de mensuração de Glicose, Triglicerídeo e Colesterol total tendo como referência o método laboratorial.

The sensitivity, specificity, and agreement of a point of care method: an assessment of the diagnostic accuracy.

The use of new technologies can improve screening in communities with difficult access to health. This article aims to evaluate the sensitivity, specificity, and agreement of a point of care test in comparison to laboratory methods for the determination of glucose (GLI), triglyceride (TG), and total cholesterol (TC) concentrations. This prospective study used data from the remaining adult population of quilombolas in Brazil. Laboratory tests using conventional methods for the analysis of venipuncture samples were used as a standard method to measure the concentrations of GLI (mg/dL), TG (mg/dL), and TC (mg/dL) and compared to the metered dose from the collection of fingertip capillary blood (point of care). Contingency tables (2x2) were used to estimate the sensitivity and specificity of the methods. Lin and Bland & Altman coefficients were used to statistically assess agreement, the level of significance was 5%. There was substantial agreement between the methods for measuring TG and poor agreement for of TC and GLI. Analysis of the Bland & Altman coefficients revealed that the fingertip method did not produce good measures. The point of care method did not offer a good ability to measure compared to that of the reference laboratory method.

Knowledge and acceptability of the human papillomavirus vaccine among health professionals in Acre state, western Amazon.

OBJECTIVE: To evaluate the knowledge and acceptability of the human papillomavirus (HPV) vaccine among health professionals from western Amazonia. METHODS: A cross-sectional study was conducted in the Sistema Assistencial è Saúde da Mulher e da Criança (Health Care System for Women and Children; SASMC) in Acre, Brazil, in 2017. The participants comprised 196 health professionals. The data collection instrument contained 31 questions about HPV, its clinical repercussions for women, and the HPV vaccine. Quantitative variables were presented as medians and 95% confidence intervals (CIs), and p<0.05 was considered statistically significant. For the analyses, chi-square tests and Mann-Whitney tests were used. The collected data were analyzed using Stata®11.0. RESULTS: Of the 196 health professionals, 39.8% (n=76) were physicians and 61.2% (n=120) were other health professionals. The interviewees were mostly female (n=143, 73%, 95% CI 66.1 to 78.9%) who worked in the medical field (n=81, 41.3%, 95% CI 34.4 to 48.6%), and the median age was 38 years (95% CI 36.0 to 39.7). Physicians had increased knowledge regarding only the statement "cervical cancer is one of the main causes of cancer in women", with a proportion ratio of 0.88 (0.80; 0.97) and p<0.001. Regarding clinical knowledge of the HPV vaccine, a low proportion of correct answers was obtained for all the questions, and no significant differences were found between the groups. CONCLUSION: Acceptability and knowledge of HPV and its vaccine were similar among health professionals, with knowledge gaps in questions about the relation between smoking and cervical cancer and specific clinical knowledge.

Neonatal mortality in Luanda, Angola: what can be done to reduce it? / Mortalidade neonatal em Luanda, Angola: o que pode ser feito para sua redução?

INTRODUCTION: One of the main health indicators is infant mortality rate, which is a metric of living conditions and population development. The goal of reducing neonatal mortality requires an adequate knowledge of the real factors at each level of health care so that maternal and human resources are efficiently channeled to the constraint. Countries that have paid special attention to improving health services for the entire pregnancy-puerperal cycle have attained the reduction of infant mortality, especially early neonatal mortality. OBJECTIVE: The present study aims to describe the profile and analyze the risk factors associated with neonatal mortality in the Angolan context at a tertiary level public maternity hospital, located in Luanda. METHODS: This is a retrospective cross-sectional study with a quantitative approach, using secondary data, of provincial base in hospital and ministerial registry instruments from January to December 2012. RESULTS: The results show that the neonatal deaths are not mere occurrences, since they indicate failures of the political powers, professionals of the health system and of the families. CONCLUSIONS: This study suggests that the major risk factor for birth mortality in Luanda is the type of delivery (c-section) and that this data is not related to the age of the mother or to premature birth. We also found that there was higher mortality between May and July, during the period of lower rainfall index in the region. However, further studies are needed that may provide a logical framework and arguments for realistic policies to mitigate neonatal mortality.

INTRODUÇÃO: Um dos principais indicadores de saúde é a taxa de mortalidade infantil, que é uma métrica de condições de vida e desenvolvimento populacional. A redução da mortalidade neonatal requer um conhecimento adequado dos fatores reais em cada nível de atenção à saúde, de modo que os recursos maternos e humanos sejam eficientemente avaliados. Os países que deram atenção especial à melhoria dos serviços de saúde para todo o ciclo gravídico-puerperal atingiram a redução da mortalidade infantil, especialmente a mortalidade neonatal precoce. OBJETIVO: O presente estudo tem como objetivo descrever o perfil e analisar os fatores de risco associados à mortalidade neonatal em uma maternidade pública de nível terciário localizada em Luanda, Angola. MÉTODO: Trata-se de um estudo retrospectivo de corte transversal com abordagem quantitativa, utilizando dados secundários de base provincial em instrumentos de registro hospitalar e ministerial de janeiro a dezembro de 2012. RESULTADOS: Os resultados mostram que os óbitos neonatais não são meras ocorrências, pois indicam falhas dos poderes políticos, de profissionais do sistema de saúde e das famílias. CONSLUSÃO: Este estudo sugere que o maior fator de risco para mortalidade ao nascimento em Luanda é o tipo de parto (c-section) e que este dado não está relacionado com a idade da mãe ou com o nascimento prematuro. Identificamos também que houve maior mortalidade entre os meses de maio a julho, durante o período de menor índice de chuvas na região. No entanto, são necessários mais estudos que possam fornecer um quadro lógico e argumentos para políticas realistas para mitigar a mortalidade neonatal.