Situational analysis of hypertension management at primary health care level in São Paulo, Brazil: population, healthcare professional and health system perspectives.

BACKGROUND: Government-led, population-wide initiatives are crucial for advancing the management of hypertension - a leading cause of cardiovascular disease (CVD) morbidity and mortality. An urban population health initiative was conducted against this backdrop, focussing on hypertension in the primary health system in São Paulo, Brazil. Within the frame of the initiative and under the supervision and leadership of the municipal health authorities, a situational analysis was conducted on the needs in hypertension management, marking the first phase of a Design Thinking process. This article describes the situational analysis process and presents the identified elements to be strengthened considering hypertension diagnosis, treatment and control. METHODS: First, a mixed-methods approach was used, starting with a literature review of municipal hypertension data followed by meetings (N = 20) with the local public health administration to assess health system level components. To investigate activities on hypertension diagnosis, treatment and control, nine primary healthcare units were selected from two districts of São Paulo city- Itaquera and Penha- which received an online form addressed to managers, participated in conversation circles of staff and patients, and underwent shadowing of community health agents. RESULTS: Data gave rise to two main outputs: (i) a patient care journey map; and (ii) a matrix summarizing the identified needs at patient, healthcare professional and health system level for diagnosis, treatment and control of hypertension. Patient awareness and knowledge of hypertension was found to be insufficient and its management needs to be improved. For health professionals, disease awareness, technical training, more time dedicated to patients, and simplified guidelines and clinical decision-making tools for hypertension management were identified as principal needs. The situational analysis found that the healthcare systems efficiency might be improved by establishing defined treatment and care delivery goals with a focus on outcomes and implemented through action plans. CONCLUSIONS: This situational analysis identified several needs related to hypertension control in São Paulo that are in line with global challenges to improve the control of CVD risk factors. Findings were also confirmed locally in an expansion phase of this situational analysis to additional primary care facilities. As a consequence, solutions were designed, promptly taken up and implemented by the municipal health secretariat.

Circadian misalignment proxies, BMI, and chronic conditions: the role for weekday to weekend sleep differences.

OBJECTIVE: To evaluate whether social jet lag (SJL) and weekend catch-up sleep (CUS), proxies of circadian misalignment, were associated with BMI and chronic conditions. METHODS: Participants (n = 2,050,18-65y) were part of a virtual cross-sectional and population-based research. We examined CUS and SJL as continuous and categorical (< 1 h,1-2 h, > 2 h). Linear regression analyses were performed to assess the differences in BMI (outcome) associated with CUS and SJL. Restricted cubic splines were performed to explore the shape of the relationship between weekday-to-weekend variability in sleep duration, midpoint, wake time, and bedtime. Logistic regression models were used to estimate ORs(95%CIs) for chronic conditions and overweight related to CUS and SJL. Analyses were adjusted for sleep duration, biological and behavior-related variables. RESULTS: We found a positive association of SJL and CUS with BMI. The effects remained even after adjustment for weekly sleep duration and demonstrated a proportional increase with the magnitude of sleep variability. Among participants with SJL > 2 h, BMI increased by 2.29 kg/m2 (95%CI:0.84;3.74,p:0.002). They also had 129% higher odds of chronic conditions (95%CI:1.16;4.52, p:0.01) and 119% higher odds of overweight (95%CI: 1.20;3.98,p:0.01). Individuals with CUS > 2 h presented 78% higher odds of overweight (95%CI:1.27;2.50,p:0.001) and an increase of 1.61 kg/m2 in BMI (95%CI: 0.81; 2.40,p < 0.001). CONCLUSIONS: Our findings, which demonstrate that even a slight weekend sleep extension and variability of just 1 h is associated with higher values of BMI, suggest incorporating measures for sleep consistency and regularity into clinical protocols and public health guidelines to prevent and treat obesity and related diseases.

Association of largest meal timing and eating frequency with body mass index and obesity.

BACKGROUND AND AIMS: The circadian pattern of eating behaviors has garnered increasing interest as a strategy for obesity prevention and weight loss. It is believed that the benefits stem from aligning food intake with the body's natural daily rhythms. However, the existing body of evidence is limited in scale and scope and there has been insufficient evaluation of temporal eating behaviors, such as the specific time of day in which the highest calorie consumption occurs, meal frequency, and distribution. This research aims to explore the association between the timing of the largest meal of the day and eating frequency with Body Mass Index (BMI) and obesity. METHODS: Participants (n = 2050, 18-65y) were part of an exploratory cross-sectional and population-based research, with data collection in a virtual environment. Linear regression analyses and restricted cubic splines evaluated differences in BMI associated with independent eating variables [timing of the largest meal, number of meals/day (as continuous and categorical: ≤3 or >3/day), and each largest meal of the day (breakfast/lunch/dinner)]. Logistic regression models were fitted to assess Odds Ratios (OR) and 95 % Confidence Intervals (CI) of obesity associated with the same independent variables. RESULTS: Our main findings were that the timing of the largest meal and reporting dinner as the largest meal were associated with higher values of BMI (respectively, 0.07 kg/m2 and 0.85 kg/m2) and increased odds of obesity [respectively OR(95%CI):1.04(1.01,1.08), and OR(95%CI):1.67(1.18,2.38)]. Those who realized more than 3 meals/day presented lower values of BMI (-0.14 kg/m2) and 32 % lower odds of having obesity [OR(95%CI):0.68(0.52,0.89)]. Reporting lunch as the largest meal also protected against obesity [OR(95%CI):0.71(0.54,0.93)]. These associations were statistically significant and independent of sex, age, marital status, education level, diet quality, sleep duration, and weekly frequency of physical exercise. CONCLUSION: Having the largest meal earlier in the day, concentrating the majority of caloric intake during lunch, and consuming more than three meals a day, may present a promising intervention for preventing and treating obesity/overweight.

Association between sleep duration and latency, nocturnal awakenings, and body mass index among infants / Associação entre duração e latência do sono, despertares noturnos e índice de massa corporal de lactentes

ABSTRACT Objective: To investigate the association between sleep duration, nocturnal awakenings, and sleep latency with body mass index (BMI) at six and 12 months of age. Methods: 179 children from a birth cohort were enrolled. At six and 12 months of age, anthropometric data were obtained using standardized techniques and infants' mothers answered the Brief Infant Sleep Questionnaire for sleep data. The association of BMI with the independent variables (sleep duration, latency, and nocturnal awakenings) was assessed by linear regression models. Analyses were adjusted for potential confounders and a p-value<0.05 was adopted to define statistical significance. Results: For each additional hour of sleep duration, BMI was reduced by 0.15 kg/m² (95% confidence interval [CI] -0.28; -0.01; p=0.03) and each additional minute of sleep latency increased BMI by 0.01 kg/m² (95%CI -0.00; 0.03; p=0.02). These associations were independent of gestational age, child sex, birth weight, duration of exclusive breastfeeding, smoking during pregnancy, and mother's BMI, education, and marital status. Nocturnal awakenings showed no association with the outcome. Conclusions: Our findings suggest that sleep duration and sleep latency time are associated with BMI in the first year of life. Insights into the influence of sleep early in life on weight status may be helpful to complement future nutritional recommendations and prevent and treat obesity.

RESUMO Objetivo: Investigar a associação entre duração do sono, despertares noturnos e latência do sono com o índice de massa corporal (IMC) aos seis e 12 meses de idade. Métodos: foram incluídas 179 crianças de uma coorte de nascimentos. Aos seis e 12 meses de idade, dados antropométricos foram obtidos por meio de técnicas padronizadas e as mães dos lactentes responderam ao Brief Infant Sleep Questionnaire para dados do sono. A associação do IMC com as variáveis independentes (duração do sono, latência e despertares noturnos) foi avaliada por modelos de regressão linear. As análises foram ajustadas para potenciais fatores de confusão e o p-valor<0,05 foi adotado para definir a significância estatística. Resultados: Para cada hora adicional de duração do sono, o IMC foi reduzido em 0,15 kg/m² (intervalo de confiança [IC]95% -0,28; -0,01; p=0,03) e cada minuto adicional no tempo de latência resultou em aumento de 0,01 kg/m² (IC95% -0,00; 0,03; p=0,02) no IMC. Essas associações foram independentes da idade gestacional, sexo da criança, peso ao nascer, duração do aleitamento materno exclusivo, tabagismo durante a gravidez e IMC, escolaridade e estado civil da mãe. Os despertares noturnos não apresentaram associação com o desfecho. Conclusões: Nossos achados sugerem que a duração e a latência do sono estão associadas ao IMC no primeiro ano de vida. Informações sobre a influência do sono no início da vida sobre o status do peso podem ser úteis para complementar futuras recomendações nutricionais e prevenir e tratar a obesidade.

Association between iron deficiency anemia and sleep duration in the first year of life / Associação entre anemia ferropriva e duração do sono no primeiro ano de vida

Abstract Objective: The aim of this study was to investigate the association between iron deficiency anemia and sleep duration in the first year of life. Methods: A total of 123 infants were investigated, with sleep being evaluated at 3, 6, and 12 months of age and anemia at birth and 6 months. The cutoff points for anemia and short sleep duration were hemoglobin <11 g/dL (at birth and/or 6 months) and <10 h (at 3, 6, and 12 months), respectively. The comparison of the average sleep time between infants with and without anemia was performed using the Student's t-test, and logistic regression models were also used to verify differences in the sleep duration (short/not short) between the groups. Linear regression analyses were conducted to determine the association between sleep duration and hemoglobin values. The analyses were adjusted for potential confounders. Results: Children with anemia were more likely to be short sleepers [odds ratio (95% confidence interval (CI)): 4.02 (1.02-15.76); p≤0.05], and for each unit increase in hemoglobin values, the sleep duration increased by 16.2 min [β (95%CI): 0.27 (0.00-0.55); p≤0.05), regardless of family income, maternal schooling, gender, and body mass index at birth. Conclusions: Our results suggest that iron deficiency anemia is associated with short sleep duration in the first year of life and indicate the need for longitudinal investigations, with longer follow-up, to verify the impact of anemia on sleep duration at subsequent ages.

RESUMO Objetivo: Investigar a associação entre a anemia por deficiência de ferro e a duração do sono no primeiro ano de vida. Métodos: Foram avaliadas 123 crianças, sendo o sono investigado aos três, seis e 12 meses de idade e a anemia ao nascimento e aos seis meses. Utilizaram-se como pontos de corte para anemia e curta duração de sono, respectivamente, hemoglobina<11 g/dL (nascimento e/ou seis meses) e tempo total <10 h (3, 6 e/ou 12 meses). A comparação do tempo médio de sono entre as crianças com e sem anemia foi realizada pelo teste t de Student e modelos de regressão logística foram usados para verificar diferenças na duração do sono (curta/não curta) entre os grupos. Análises de regressão linear foram conduzidas para determinar a associação entre a duração do sono e valores de hemoglobina. As análises foram ajustadas para potenciais confundidores. Resultados: As crianças com anemia tiveram maior chance de apresentar curta duração do sono [odds ratio — OR (intervalo de confiança — IC95%): 4,02 (1,02-15,76); p≤0,05]. Para cada unidade de aumento nos valores da hemoglobina, o tempo de sono aumentou em 16,2 min [β (IC95%): 0,27 (0,00-0,55); p≤0,05), independentemente de renda familiar, escolaridade materna, sexo e índice de massa corporal ao nascimento. Conclusões: Nossos resultados sugerem que a anemia ferropriva está associada à curta duração do sono no primeiro ano de vida e indicam a necessidade de investigações longitudinais, com maior tempo de seguimento, para verificar o impacto da anemia na duração do sono em idades subsequentes.

Looking for related posts on GitHub discussions.

Software teams increasingly adopt different tools and communication channels to aid the software collaborative development model and coordinate tasks. Among such resources, software development forums have become widely used by developers. Such environments enable developers to get and share technical information quickly. In line with this trend, GitHub announced GitHub Discussions-a native forum to facilitate collaborative discussions between users and members of communities hosted on the platform. Since GitHub Discussions is a software development forum, it faces challenges similar to those faced by systems used for asynchronous communication, including the problems caused by related posts (duplicated and near-duplicated posts). These related posts can add noise to the platform and compromise project knowledge sharing. Hence, this article addresses the problem of detecting related posts on GitHub Discussions. To achieve this, we propose an approach based on a Sentence-BERT pre-trained general-purpose model: the RD-Detector. We evaluated RD-Detector using data from three communities hosted in GitHub. Our dataset comprises 16,048 discussion posts. Three maintainers and three Software Engineering (SE) researchers manually evaluated the RD-Detector results, achieving 77-100% of precision and 66% of recall. In addition, maintainers pointed out practical applications of the approach, such as providing knowledge to support merging the discussion posts and converting the posts to comments on other related posts. Maintainers can benefit from RD-Detector to address the labor-intensive task of manually detecting related posts.

Association between sleep duration and latency, nocturnal awakenings, and body mass index among infants.

OBJECTIVE: To investigate the association between sleep duration, nocturnal awakenings, and sleep latency with body mass index (BMI) at six and 12 months of age. METHODS: 179 children from a birth cohort were enrolled. At six and 12 months of age, anthropometric data were obtained using standardized techniques and infants' mothers answered the Brief Infant Sleep Questionnaire for sleep data. The association of BMI with the independent variables (sleep duration, latency, and nocturnal awakenings) was assessed by linear regression models. Analyses were adjusted for potential confounders and a p-value<0.05 was adopted to define statistical significance. RESULTS: For each additional hour of sleep duration, BMI was reduced by 0.15 kg/m² (95% confidence interval [CI] -0.28; -0.01; p=0.03) and each additional minute of sleep latency increased BMI by 0.01 kg/m² (95%CI -0.00; 0.03; p=0.02). These associations were independent of gestational age, child sex, birth weight, duration of exclusive breastfeeding, smoking during pregnancy, and mother's BMI, education, and marital status. Nocturnal awakenings showed no association with the outcome. CONCLUSIONS: Our findings suggest that sleep duration and sleep latency time are associated with BMI in the first year of life. Insights into the influence of sleep early in life on weight status may be helpful to complement future nutritional recommendations and prevent and treat obesity.

Association between iron deficiency anemia and sleep duration in the first year of life.

OBJECTIVE: The aim of this study was to investigate the association between iron deficiency anemia and sleep duration in the first year of life. METHODS: A total of 123 infants were investigated, with sleep being evaluated at 3, 6, and 12 months of age and anemia at birth and 6 months. The cutoff points for anemia and short sleep duration were hemoglobin <11 g/dL (at birth and/or 6 months) and <10 h (at 3, 6, and 12 months), respectively. The comparison of the average sleep time between infants with and without anemia was performed using the Student's t-test, and logistic regression models were also used to verify differences in the sleep duration (short/not short) between the groups. Linear regression analyses were conducted to determine the association between sleep duration and hemoglobin values. The analyses were adjusted for potential confounders. RESULTS: Children with anemia were more likely to be short sleepers [odds ratio (95% confidence interval (CI)): 4.02 (1.02-15.76); p≤0.05], and for each unit increase in hemoglobin values, the sleep duration increased by 16.2 min [ß (95%CI): 0.27 (0.00-0.55); p≤0.05), regardless of family income, maternal schooling, gender, and body mass index at birth. CONCLUSIONS: Our results suggest that iron deficiency anemia is associated with short sleep duration in the first year of life and indicate the need for longitudinal investigations, with longer follow-up, to verify the impact of anemia on sleep duration at subsequent ages.

Seroprevalence of SARS-CoV-2 antibodies in schoolchildren in the city of São Paulo, 2020.

OBJECTIVE: To estimate seroprevalence of SARS-CoV-2 antibodies in schoolchildren aged 4 to 14 years living in the city of São Paulo, according to clinical, demographic, epidemiological, and social variables, during the school closure period as a measure against covid-19 spread. METHODS: A serological survey was made in September 2020 with a random sample stratified by school system (municipal public, state public and private) type. A venous blood sample was collected using the Wondfo SARS-CoV-2 Antibody Test (lateral flow method) for detection of total SARS-CoV-2 virus antibodies. Semi-structured questionnaires were applied to collect clinical, demographic, social, and epidemiological data. RESULTS: Seroprevalence of SARS-CoV-2 antibodies in schoolchildren was of 16.6% (95%CI 15.4-17.8). The study found higher seroprevalence in the municipal (18.5%; 95%CI 16.6-20.6) and state (16.2%; 95%CI 14.4-18.2) public school systems compared to the private school system (11.7; 95%CI 10.0-13.7), among black and brown students (18.4%; 95%CI 16.8-20.2) and in the most vulnerable social stratum (18.5 %;95%CI 16.9-20.2). Lower seroprevalence was identified in schoolchildren who reported following the recommended protective measures against covid-19. CONCLUSION: Seroprevalence of SARS-CoV-2 antibodies is found mainly in the most socially vulnerable schoolchildren. This study can contribute to support public policies that reinforce the importance of suspending face-to-face classes and developing strategies aimed at protective measures and monitoring of the serological status of those who have not yet been included in the vaccination schedule.

Association between iron deficiency anemia and sleep duration in the first year of life / Associação entre anemia ferropriva e duração do sono no primeiro ano de vida

Abstract Objective: The aim of this study was to investigate the association between iron deficiency anemia and sleep duration in the first year of life. Methods: A total of 123 infants were investigated, with sleep being evaluated at 3, 6, and 12 months of age and anemia at birth and 6 months. The cutoff points for anemia and short sleep duration were hemoglobin <11 g/dL (at birth and/or 6 months) and <10 h (at 3, 6, and 12 months), respectively. The comparison of the average sleep time between infants with and without anemia was performed using the Student's t-test, and logistic regression models were also used to verify differences in the sleep duration (short/not short) between the groups. Linear regression analyses were conducted to determine the association between sleep duration and hemoglobin values. The analyses were adjusted for potential confounders. Results: Children with anemia were more likely to be short sleepers [odds ratio (95% confidence interval (CI)): 4.02 (1.02-15.76); p≤0.05], and for each unit increase in hemoglobin values, the sleep duration increased by 16.2 min [β (95%CI): 0.27 (0.00-0.55); p≤0.05), regardless of family income, maternal schooling, gender, and body mass index at birth. Conclusions: Our results suggest that iron deficiency anemia is associated with short sleep duration in the first year of life and indicate the need for longitudinal investigations, with longer follow-up, to verify the impact of anemia on sleep duration at subsequent ages.

RESUMO Objetivo: Investigar a associação entre a anemia por deficiência de ferro e a duração do sono no primeiro ano de vida. Métodos: Foram avaliadas 123 crianças, sendo o sono investigado aos três, seis e 12 meses de idade e a anemia ao nascimento e aos seis meses. Utilizaram-se como pontos de corte para anemia e curta duração de sono, respectivamente, hemoglobina<11 g/dL (nascimento e/ou seis meses) e tempo total <10 h (3, 6 e/ou 12 meses). A comparação do tempo médio de sono entre as crianças com e sem anemia foi realizada pelo teste t de Student e modelos de regressão logística foram usados para verificar diferenças na duração do sono (curta/não curta) entre os grupos. Análises de regressão linear foram conduzidas para determinar a associação entre a duração do sono e valores de hemoglobina. As análises foram ajustadas para potenciais confundidores. Resultados: As crianças com anemia tiveram maior chance de apresentar curta duração do sono [odds ratio — OR (intervalo de confiança — IC95%): 4,02 (1,02-15,76); p≤0,05]. Para cada unidade de aumento nos valores da hemoglobina, o tempo de sono aumentou em 16,2 min [β (IC95%): 0,27 (0,00-0,55); p≤0,05), independentemente de renda familiar, escolaridade materna, sexo e índice de massa corporal ao nascimento. Conclusões: Nossos resultados sugerem que a anemia ferropriva está associada à curta duração do sono no primeiro ano de vida e indicam a necessidade de investigações longitudinais, com maior tempo de seguimento, para verificar o impacto da anemia na duração do sono em idades subsequentes.

Sleep and circadian hygiene practices association with sleep quality among Brazilian adults.

Objective: To investigate the association of sleep and circadian hygiene practices (sleep-promoting and sleep-disturbing behaviors) with sleep quality indicators. Methods: Participants (n = 2050; 18-65 y) were part of virtual population-based research. Logistic regression models were fitted to assess differences in the OR (95% CI) of poor quality with sleep-promoting/disturbing practices (time-of-day of exercise, pre-bedtime routine, naps, electronic devices with illuminated screens, caffeine and alcohol consumption, and smoking). Linear regression analyses evaluated differences in sleep duration, latency, and awakenings associated with the same variables. Restricted cubic splines were used to study the shape of the association of screen time before bed with sleep duration, latency, and awakenings. Analyses were adjusted for age, sex, region, marital status, educational level, evening diet quality, and BMI. Results: Evening use of electronic devices with illuminated screens showed a negative effect on all sleep parameters. Reporting dinner as the largest meal and evening caffeine consumption was associated with shorter sleep duration and longer sleep latency. Smokers had higher odds of longer latency. A protective effect of morning exercises was demonstrated on sleep quality, latency, and awakenings. Alcohol consumers presented lower odds of poor quality and lower frequency of awakenings. Pre-bedtime practices showed no or negative effect on sleep outcomes. Conclusions: Recommendations to promote sleep quality and prevent sleep-related problems, with corresponding circadian health benefits, should include engaging in regular exercise, preferably in the morning, and avoiding naps, heavy meals close to bedtime, caffeine, smoking, and evening screen exposure.

Seroprevalence of SARS-CoV-2 antibodies in schoolchildren in the city of São Paulo, 2020 / Soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares no município de São Paulo, 2020

ABSTRACT OBJECTIVE To estimate seroprevalence of SARS-CoV-2 antibodies in schoolchildren aged 4 to 14 years living in the city of São Paulo, according to clinical, demographic, epidemiological, and social variables, during the school closure period as a measure against covid-19 spread. METHODS A serological survey was made in September 2020 with a random sample stratified by school system (municipal public, state public and private) type. A venous blood sample was collected using the Wondfo SARS-CoV-2 Antibody Test (lateral flow method) for detection of total SARS-CoV-2 virus antibodies. Semi-structured questionnaires were applied to collect clinical, demographic, social, and epidemiological data. RESULTS Seroprevalence of SARS-CoV-2 antibodies in schoolchildren was of 16.6% (95%CI 15.4-17.8). The study found higher seroprevalence in the municipal (18.5%; 95%CI 16.6-20.6) and state (16.2%; 95%CI 14.4-18.2) public school systems compared to the private school system (11.7; 95%CI 10.0-13.7), among black and brown students (18.4%; 95%CI 16.8-20.2) and in the most vulnerable social stratum (18.5 %;95%CI 16.9-20.2). Lower seroprevalence was identified in schoolchildren who reported following the recommended protective measures against covid-19. CONCLUSION Seroprevalence of SARS-CoV-2 antibodies is found mainly in the most socially vulnerable schoolchildren. This study can contribute to support public policies that reinforce the importance of suspending face-to-face classes and developing strategies aimed at protective measures and monitoring of the serological status of those who have not yet been included in the vaccination schedule.

RESUMO OBJETIVO Estimar a soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares de quatro a 14 anos de idade residentes no município de São Paulo, segundo variáveis clínicas, demográficas, epidemiológicas e sociais, durante o período de fechamento das escolas como medida de controle da covid-19. MÉTODOS Realizou-se um inquérito sorológico em setembro de 2020 com amostra aleatória estratificada por tipo de rede de ensino (pública municipal, pública estadual e privada). Foi coletada amostra de sangue venoso utilizando-se o teste de imunoensaio de fluxo lateral da fabricante Wondfo para detecção de anticorpos totais contra o vírus SARS-CoV-2. Aplicaram-se questionários semiestruturados para o levantamento de dados clínicos, demográficos, sociais e epidemiológicos. RESULTADOS A soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares foi de 16,6% (IC95% 15,4-17,8). O estudo encontrou soroprevalências mais elevadas na rede pública municipal (18,5%; IC95% 16,6-20,6) e estadual (16,2%; IC95% 14,4-18,2) em relação à rede privada (11,7; IC95% 10,0-13,7) e entre escolares da raça/cor preta e parda (18,4%; IC95% 16,8-20,2) e no estrato social mais vulnerável (18,5%; IC95% 16,9-20,2). A pesquisa identificou menores soroprevalências nos escolares que relataram seguir as medidas recomendadas de proteção contra a covid-19. CONCLUSÃO A soroprevalência de anticorpos contra o vírus SARS-CoV-2 atinge principalmente os escolares socialmente mais vulneráveis. Este estudo pode contribuir para embasar políticas públicas que reforcem a importância da suspensão das aulas presenciais e da necessidade de estratégias de medidas de proteção e acompanhamento do status sorológico daqueles que ainda não foram contemplados no calendário vacinal.

Trajetórias juvenis e a construção de intelectuais orgânicos/as , / Young people's trajectories and the construction of organic intellectuals ,

Resumo A partir do acompanhamento de uma trajetória de vida juvenil, buscou-se apreender de que forma e quais experiências colaboram para constituir jovens mais ativos socialmente - em uma perspectiva gramsciniana: intelectuais orgânicos/as. Questiona-se, portanto: quais seriam as experiências que incidem/incidiram sobre as vidas juvenis que contribuem/contribuíram para a construção de processos na direção da emancipação social? Assim, utilizou-se do acompanhamento singular e territorial — tecnologia social descrita e elaborada pela terapia ocupacional social — resultando nas descrições e análises de situações para que uma jovem engendrasse movimentos de catarse, destacando sua participação em ações de extensão universitária, ambientes virtuais, grêmio estudantil e atividades vinculadas ao programa de iniciação científica do ensino médio (PIBIC-EM). Projeta-se que este estudo ofereça referências para estratégias de fortalecimento das redes de jovens e fomento a criação e ampliação de diferentes espaços coletivos por onde os jovens transitam, sejam eles presenciais ou virtuais, de tal modo que possam enfrentar as diferentes vulnerabilidades que cercam seus cotidianos.

Abstract Based on the follow-up of a young woman, we sought to understand how and what experiences contribute to the formation of more socially active young people - from a Gramscian perspective, organic intellectuals. The question is, therefore, which experiences have or have had an influence on the lives of young people that contribute or have contributed to constructing processes towards social emancipation? To this end, an individual territorial follow-up—a social technology developed by social occupational therapy—was used, resulting in descriptions and analyses of situations so that this young woman could engender movements of catharsis, highlighting her participation and protagonism in university extension actions, virtual environments, student guild events, and activities linked to a high school research program. It is expected that this study will provide references for strategies to strengthen youth networks and foster the creation and expansion of different collective spaces where young people move about, whether in person or virtually so that they can cope with the vulnerabilities that surround their everyday life.

Health-Related Quality of Life Reported by Patients With Chagas Disease: A Systematic Review of Qualitative Evidence With GRADE Recommendations.

Patients with Chagas disease have reduced health-related quality of life (HRQoL). Hence, we aimed to identify the factors that mostly affected their HRQoL. This was a systematic review of qualitative studies. The Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Web of Science, and SciVerse Scopus databases were searched for relevant studies without language or date restrictions. The search and data analysis were performed by independent reviewers; all qualitative studies that reported the factors that had an impact on the HRQoL of patients with Chagas disease were included. The risk of bias was assessed using the Critical Appraisal Skills Program Qualitative Study Checklist; confidence in the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative approach. Five studies were included in this review: four in Brazil and one in California, United States, with immigrants from Central and South America. The sample consisted of 207 patients with chronic Chagas disease. Stigma, physical limitations, work absenteeism, emotional or mental aspects, fear of treatment, and fear of the future had the strongest impact on the HRQoL. All items showed moderate confidence except for fear of treatment (low confidence). The physical, emotional, mental, and cultural aspects affected the HRQoL of patients with chronic Chagas disease. Identification of these factors is important in the development of strategies aimed at improving the HRQoL of this population.

Impacto dos aplicativos móveis na adesão ao tratamento da tuberculose: uma revisão sistemática / Impact of mobile apps on tuberculosis treatment adherence: a systematic review / Impacto de las aplicaciones móviles en la adherencia al tratamiento de la tuberculosis: una revisión sistemática

A tuberculose é uma doença transmissível e um dos principais problemas de saúde pública mundial. A adesão ao tratamento e sua conclusão reduzem a mortalidade e a resistência medicamentosa e podem ser apoiadas pelo uso dos aplicativos móveis. O objetivo deste estudo foi analisar o impacto dos aplicativos móveis na adesão ao tratamento de pacientes com tuberculose, por meio de uma revisão sistemática de ensaios clínicos randomizados (ECR), conforme as diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A busca foi realizada nas bases de dados PubMed, Embase, LILACS, Scopus, ClinicalTrials.gov, Cochrane Library e em registros adicionais recuperados das referências dos ensaios selecionados. Os critérios de inclusão foram estudos envolvendo sujeitos de qualquer idade; ensaios clínicos; ensaios clínicos controlados; ensaios clínicos randomizados; pacientes que receberam uma intervenção de aplicativo móvel para promover a adesão ao tratamento da tuberculose; desfechos relacionados ao uso de aplicativos móveis; e adesão ao tratamento da tuberculose. Não houve restrição de idioma ou ano de publicação. Uma dupla de revisores independentes selecionou os artigos relevantes. Foram identificados 249 estudos, sendo analisados três ensaios, publicados entre 2016 e 2020, com 453 pacientes, nos quais as taxas de adesão foram impactadas positivamente pelos aplicativos. Contudo, não foi realizada metanálise desta revisão, e a qualidade metodológica e a força geral da evidência dos estudos encontrados foram baixas. Esta revisão sistemática apresenta dados que sugerem que os aplicativos móveis podem melhorar a adesão medicamentosa para o tratamento da tuberculose. Entretanto, são necessários ECR com maior rigor metodológico para reforçar essa eficácia.

Tuberculosis is a transmissible disease and a major public health issue worldwide. Treatment adherence and completion reduces mortality and drug resistance, which can be supported by use of mobile applications. Hence, this study sought to analyze the impact of mobile applications on treatment adherence in tuberculosis patients, by means of a systematic review of randomized clinical trials (RCTs), based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Bibliographic search was performed on the PubMed, Embase, LILACS, Scopus, ClinicalTrials.gov, and Cochrane Library databases, followed by manual search on the references of selected trials. Inclusion criteria consisted of studies with subjects of any age; clinical trials, controlled clinical trials, randomized clinical trials; patients who underwent a mobile app intervention to promote adherence to tuberculosis treatment; outcomes related to mobile application use and tuberculosis treatment adherence. No restriction regarding language or year of publication was applied. A pair of independent reviewers identified 249 relevant studies, three were selected for analysis. Published between 2016 and 2020, and with a study population of 453 patients, the papers showed that adherence rates were positively impacted by the use of applications. However, the review did not perform a meta-analysis. The methodological quality and overall strength of evidence of the studies analyzed were low. Although the reviewed data suggest that mobile apps can improve tuberculosis treatment adherence, RCTs with greater methodological rigor are needed to reinforce this effectiveness.

La tuberculosis es una enfermedad transmisible y uno de los principales problemas de salud pública en el mundo. La adherencia al tratamiento y su finalización reduce la mortalidad y la resistencia a los medicamentos, además, puede respaldarse con el uso de aplicaciones móviles. El objetivo de este estudio fue analizar el impacto de las aplicaciones móviles en la adherencia al tratamiento en pacientes con tuberculosis, por medio de una revisión sistemática de ensayos controlados aleatorizados (ECA), según la guía Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). La búsqueda se realizó en PubMed, Embase, LILACS, Scopus, clinictrials.gov, Cochrane Library y registros adicionales recuperados de las referencias de los ensayos seleccionados. Los criterios de inclusión fueron estudios con sujetos de cualquier edad; ensayos clínicos; ensayos clínicos controlados; ensayos clínicos aleatorizados; pacientes que recibieron una intervención de aplicación móvil para promover la adherencia al tratamiento de la tuberculosis; resultados relacionados con el uso de aplicaciones móviles y la adherencia al tratamiento de la tuberculosis. No hubo restricción de idioma o año de publicación. Un par de revisores independientes seleccionaron los artículos relevantes. Se identificaron 249 estudios y se analizaron 03 ensayos, publicados entre 2016 y 2020, con 453 pacientes, en los cuales las tasas de adherencia fueron impactadas positivamente por las aplicaciones. Sin embargo, no se realizó ningún metaanálisis de esta revisión y la calidad metodológica y la solidez general de las pruebas de los estudios encontrados fueron bajas. Esta revisión sistemática sugiere que las aplicaciones móviles pueden mejorar la adherencia a la medicación para el tratamiento de la tuberculosis. Sin embargo, se necesitan ECA con mayor rigor metodológico para reforzar esta efectividad.

Memória operacional e vocabulário em crianças com Transtorno do Desenvolvimento da Linguagem / Memoria operativa y vocabulario en niños con Trastorno del Desarrollo del Lenguaje / Working memory and vocabulary in children with Developmental Language Disorder

O objetivo deste estudo foi verificar se existe diferença no desempenho de crianças com Transtorno do Desenvolvimento da Linguagem (TDL) e Desenvolvimento Típico de Linguagem (DTL) em testes de memória operacional fonológica (MOF) e de memória visual de curto prazo (MVCP), e se esse desem-penho está correlacionado com o vocabulário receptivo. Selecionamos 14 crianças com TDL e 28 com DTL. Todos os sujeitos foram submetidos a dois testes de memória de curto prazo e a um teste de vocabulário receptivo. A comparação entre os grupos foi realizada por meio do Teste t de Student e a correlação entre a memória de curto prazo e o vocabulário foi obtida pela correlação de Pearson. Crian-ças com TDL tiveram pior desempenho quando comparadas ao grupo controle, tanto em MOF quanto em MVCP. A correlação positiva entre os testes de memória e vocabulário sugere que tanto a alça fo-nológica quanto a memória visual são importantes para o processamento da linguagem, mesmo que a alça fonológica possa ter maior relevância

The aim of this study was to verify if there is a difference in performance between children with Developmental Language Disorder (DLD) and typical language development (TLD) in phonological working memory (PWM) test and visual short-term memory (VSTM), and if this performance is correlated with the result of a receptive vocabulary test. We selected 14 children with DLD and 28 with TLD. All subjects underwent two short-term memory tests and a receptive vocabulary test. The comparison between the groups was performed using the Student's t-test, and the correlation between the short-term memory and the vocabulary was obtained by Pearson's correlation. Children with DLD had a worse performance when compared with the control group, both in PWM and VSTM. The positive correlation between memory and vocabulary tests suggests that both the phonological loop and visual memory are important for the processing of language, even if the phonological loop may have greater relevance.

El objetivo de este estudio fue verificar si existe una diferencia en el desempeño de los niños con Trastorno del Desarrollo del Lenguaje (TDL) y el desarrollo del lenguaje típico (DLT) en las pruebas de memoria operativa fonológica (MOF) y memoria visual a corto plazo (MVCP), y si ese desempeño es correlacionado con el vocabulario receptivo. Seleccionamos 14 niños con TDL y 28 con DTL. Todos los sujetos se sometieron a dos pruebas de memoria a corto plazo y a una prueba de vocabulario receptivo. La comparación entre grupos se realizó mediante la prueba t de Student y la correlación entre la memoria a corto plazo y el vocabulario se obtuvo mediante la correlación de Pearson. Los niños con TDL tuvieron un peor desempeño en comparación con el grupo de control, tanto en la MOF como en la MVCP. La correlación positiva entre las pruebas de memoria y vocabulario sugiere que tanto el bucle fonológico como la memoria visual son importantes para el procesamiento del lenguaje, aunque el bucle fonológico puede tener mayor relevancia.

Consumo de alimentos açucarados e qualidade do sono no primeiro ano de vida: dados de uma coorte de nascimentos no nordeste do Brasil / Consumo de alimentos azucarados y calidad del sueño en el primer año de vida: datos de una cohorte de nacimiento en el noreste de Brasil / Consumption of sugary foods and quality of sleep in the first year of life: data from a birth cohort in northeastern Brazil

RESUMO Objetivo: investigar a duração do sono (DS), a frequência de despertares noturnos (DN) e o consumo de alimentos açucarados no primeiro ano de vida e verificar a associação entre o consumo desses alimentos e a má qualidade do sono. Métodos: a população do estudo foi composta de 179 crianças integrantes de uma coorte de nascimentos de Rio Largo-AL. As mães foram questionadas sobre a oferta regular de alimentos açucarados (açúcar/farinhas de cereais instantâneas com açúcar/bebidas açucaradas/doces) e o sono foi investigado pelo questionário traduzido e validado Brief Infant Sleep Questionnaire. Foram considerados indicadores de má qualidade do sono DS<12h e DN>2. Os testes de qui-quadrado de Pearson e exato de Fisher foram adotados para verificar associações entre o consumo de açucarados e a má qualidade do sono aos seis e 12 meses (p<0,05). Resultados: mais da metade das crianças apresentou DS<1 2h (60,3%) e cerca de » DN>2. O consumo regular de pelo menos uma das categorias de açucarados foi verificado entre 50,6, 91,1 e 100% das crianças aos três, seis e 12 meses de idade, respectivamente. Não foram encontradas associações entre o consumo desses alimentos e os indicadores de má qualidade de sono. Conclusão: o consumo de açucarados e a má qualidade de sono foram frequentes em nosso estudo, no entanto, não se identificou associação entre as variáveis. Mais investigações são necessárias para elucidar como o sono e a alimentação se inter-relacionam e se potencializam mutuamente como fatores determinantes do crescimento e desenvolvimento de lactentes.

RESUMEN Objetivo: investigar la duración del sueño (DS), la frecuencia de despertares nocturnos (DN) y el consumo de alimentos azucarados en el primer año de vida y verificar la asociación entre el consumo de estos alimentos y la mala calidad del sueño. Métodos: la población de estudio consistió en 179 niños de una cohorte de nacimiento en Rio Largo-AL. Se preguntó a las madres sobre el suministro regular de alimentos azucarados (azúcar / harinas de cereales instantáneas con azúcar / bebidas endulzadas / dulces) y se investigó el sueño mediante el cuestionario traducido y validado BriefInfantSleepQuestionnaire. Fueron considerados indicadores de mala calidad del sueño DS <12h y DN> 2. Se utilizaron las pruebas de chi-cuadrado de Pearson y exacta de Fisher para verificar las asociaciones entre el consumo de azúcar y la mala calidad del sueño a los seis y 12 meses (p <0.05). Resultados: más de la mitad de los niños tenían DS <1 2 h (60,3%) y alrededor de » DN> 2. Se verificó el consumo regular de al menos una de las categorías azucaradas entre el 50,6, el 91,1 y el 100% de los niños a los tres, seis y 12 meses de edad, respectivamente. No se encontraron asociaciones entre el consumo de estos alimentos y los indicadores de mala calidad del sueño. Conclusión: el consumo de azucarados y la mala calidad del sueño fueron frecuentes en nuestro estudio, sin embargo, no se identificó asociación entre las variables. Se necesita más investigación para dilucidar cómo el sueño y la alimentación se interrelacionan y se mejoran mutuamente como determinantes del crecimiento y desarrollo infantil.

ABSTRACT Objective: to investigate sleep duration (SD), frequency of night awakenings (NA) and consumption of sugary foods in the first year of life and to verify the association between consumption of these foods and poor sleep quality. Methods: the study population consisted of 179 children from a birth cohort in Rio Largo-AL. Mothers were asked about the regular supply of sugary foods (sugar/instant cereal flours with sugar/sweetened drinks/sweets) and sleep was investigated by the translated and validated Brief Infant Sleep Questionnaire. DS<12h and AN>2 were considered indicators of poor sleep quality. Pearson's chi-square and Fisher's exact tests were used to verify associations between sugary consumption and poor sleep quality at six and 12 months (p<0.05). Results: more than half of the children had SD<1 2h (60.3%) and about » AN>2. Regular consumption of at least one of the sugary categories was verified among 50.6, 91.1 and 100% of children at three, six and 12 months of age, respectively. No associations were found between the consumption of these foods and indicators of poor sleep quality. Conclusion: sugary consumption and poor sleep quality were frequent in our study; however, no association was identified between the variables. More investigations are needed to elucidate how sleep and feeding are interrelated and mutually potentiate as determinants of infant growth and development.

Cuidados de Familiares às Pessoas com Feridas Neoplásicas Malignas em Domicílio / Care of Family Members of People with Malignant Neoplastic Wounds at Home / Atención de Familiares de Personas con Heridas Neoplásicas Malignas en Residencia

Objetivos:Conhecer como os cuidadores de pessoas com feridas neoplásicas malignas realizam o cuidado em domicílio. Método: Estudo qualitativo que envolveu sete familiares de pessoas com feridas malignas em tratamento em uma unidade de alta complexidade em oncologia. Os dados foram produzidos por meio de entrevista semiestruturada e submetidos à análise de conteúdo temático, proposto por Bardin. Resultados: Entrevistadas sete familiares-cuidadoras, todas do sexo feminino, jovens que abandonaram o trabalho para se dedicarem à pessoa enferma. Emergiram três categorias após análise do conteúdo: familiares buscam orientações para cuidar do paciente com feridas neoplásicas malignas em domicílio; adotam estratégias no cuidado das feridas; e referem necessidade de apoio dos profissionais e instituições de saúde, porque enfrentam dificuldades no atendimento, principalmente nas unidades de atenção primária. Conclusão: Os familiares de pessoas com feridas neoplásicas malignas enfrentam dificuldades, principalmente pela escassez de conhecimento técnico e por falta de apoio das instituições e dos profissionais de saúde.

Objectives:To understand how caregivers of people with malignant neoplastic wounds perform care at home. Method: A qualitative study that involved seven relatives of people with malignant wounds undergoing treatment in a high complexity oncology unit. The data were produced through semistructured interviews and submitted to thematic content analysis, proposed by Bardin. Results: Seven family-caregivers, all female, young people who left work to dedicate themselves to the sick person were interviewed. Three categories emerged after content analysis: family members seek guidance to care for patients with malignant neoplastic wounds at home; they adopt strategies in wound care; and report the need for support from health professionals and institutions, because they face difficulties in care, especially in primary care units. Conclusion: Family members of people with malignant neoplastic wounds face difficulties, mainly due to the scarcity of technical knowledge and lack of support from health institutions and from professionals.

Objetivos:Conocer cómo los cuidadores de personas con heridas neoplásicas malignas realizan cuidados en el domicilio Método: Estudio cualitativo que involucró a siete familiares de personas con heridas malignas que estaban siendo tratados en una unidad de alta complejidad en oncología. Los datos fueron producidos por medio de entrevistas semiestructuradas y sometidos a análisis de contenido temático, propuesto por Bardin. Resultados: Se entrevistó a siete familiares-cuidadoras, todas mujeres, jóvenes que dejaron los trabajos para dedicarse al enfermo. Tres categorías surgieron después del análisis de contenido: los familiares buscan orientación para cuidar de los pacientes con heridas neoplásicas malignas en domicilio; adoptan estrategias en el cuidado de heridas e informan la necesidad de apoyo de profesionales e instituciones de salud, porque enfrentan dificultades en la asistencia, especialmente en las unidades de atención primaria. Conclusiones: Los familiares de las personas con heridas neoplásicas malignas enfrentan dificultades, principalmente debido a la escasez de conocimientos técnicos y la falta de apoyo de las instituciones y de los profesionales de la salud.

Maximal inspiratory pressure is associated with health-related quality of life and is a reliable method for evaluation of patients on hemodialysis.

OBJECTIVE: To evaluate the association between Maximal Inspiratory Pressure (MIP) and health-related quality of life (HRQoL) and to verify the reliability of the MIP in patients on hemodialysis. METHODS: In a repeated-measures design, patients on hemodialysis performed MIP and specific HRQoL questionnaire (trial 1). The MIP was repeated after 6 to 8 weeks (trial 2) and reliability was assessed using Intra-class Correlation Coefficient. Standard Error of Measurement and Minimal Detectable Change scores were calculated. RESULTS: Sixty-one individuals (68.9% men) were evaluated in trial 1. MIP was associated with specific domains "Symptoms" (r = 0.45; R2 adjusted = 0.192) and the kidney disease component summary (r = 0.38; R2 adjusted = 0.138). Regarding generic domains, the MIP was associated with "Physical Functioning" (r = 0.57; R2 adjusted = 0.375) and Physical component summary (r = 0.47; R2 adjusted = 0.258). Thirty-three patients were randomly selected to perform a second MIP test (trial 2). The Intra-class Correlation Coefficient was 0.94 (95%CI 0.88-0.97). By Bland-Altman analysis, the bias was 3.2 cmH2O, which represents a difference of 3.7%. The Standard Error of Measurement and Minimal Detectable Change for MIP were 5.9 cmH2O and 13.8 cmH2O, respectively. CONCLUSION: The MIP is a reliable test, associated with physical domains of HRQoL in patients on hemodialysis. Thus, it is a useful method for respiratory evaluation in this population.

Health-Related Quality of Life Reported by Patients With Chagas Disease: A Systematic Review of Qualitative Evidence With GRADE Recommendations

ABSTRACT Patients with Chagas disease have reduced health-related quality of life (HRQoL). Hence, we aimed to identify the factors that mostly affected their HRQoL. This was a systematic review of qualitative studies. The Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Web of Science, and SciVerse Scopus databases were searched for relevant studies without language or date restrictions. The search and data analysis were performed by independent reviewers; all qualitative studies that reported the factors that had an impact on the HRQoL of patients with Chagas disease were included. The risk of bias was assessed using the Critical Appraisal Skills Program Qualitative Study Checklist; confidence in the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative approach. Five studies were included in this review: four in Brazil and one in California, United States, with immigrants from Central and South America. The sample consisted of 207 patients with chronic Chagas disease. Stigma, physical limitations, work absenteeism, emotional or mental aspects, fear of treatment, and fear of the future had the strongest impact on the HRQoL. All items showed moderate confidence except for fear of treatment (low confidence). The physical, emotional, mental, and cultural aspects affected the HRQoL of patients with chronic Chagas disease. Identification of these factors is important in the development of strategies aimed at improving the HRQoL of this population.