Monitoring risk factors for dementia in middle-aged and older adults: a longitudinal study.

Given the importance of dementia syndrome and its impacts on the population, interest in studying modifiable risk factors for dementia is growing. Objective: To compare the prevalence of risk factors for dementia in middle-aged and older adults over a two-year period and to identify what variables in baseline were predictive of cognitive decline in the follow-up. Methods: Longitudinal and quantitative study, with follow-up evaluation after two years, conducted with 200 participants aged 45 years or more, registered in Primary Care Units. In the baseline (2018/2019) and follow-up (2021) assessments, sociodemographic data were collected, and cognitive performance and risk factors for dementia were evaluated (education, hearing loss, head trauma, high blood pressure, alcohol use, obesity, smoking, depressive symptoms, social isolation, physical inactivity, and diabetes mellitus). Data were compared using the McNemar's test. Individual multinomial logistic regression models were performed to identify the factors associated with cognitive decline after two years. Results: The percentages of low education, traumatic brain injury, and smoking remained the same in both assessments. There was a significant increase in the prevalence of high blood pressure (from 55.0 to 62.0%) and physical inactivity (from 58.5 to 74.5%) and a significant reduction in social isolation (from 25.0 to 18.0%). Participants with depressive symptoms in baseline had a higher risk of cognitive decline in follow-up. Conclusion: There was an increase in the prevalence of high blood pressure and physical inactivity and a reduction in social isolation after two years. Depressive symptoms predict cognitive decline.

Dada a importância da síndrome demencial e de seus impactos na população, cresce o interesse em estudar os fatores de risco modificáveis para a demência. Objetivo: Comparar a prevalência de fatores de risco para demência em adultos de meia-idade e pessoas idosas, em um período de dois anos, e identificar quais fatores de risco na avaliação de base predizem o declínio cognitivo na avaliação de acompanhamento. Métodos: Estudo longitudinal e quantitativo, com avaliação de acompanhamento após dois anos, realizado com 200 participantes com 45 anos ou mais, cadastrados na Atenção Básica. Nas avaliações de base (2018/2019) e de acompanhamento (2021) foram coletados dados sociodemográficos, foram feitas avaliação cognitiva e avaliação dos fatores de risco para demência (escolaridade, perda auditiva, traumatismo craniano, hipertensão arterial, uso de álcool, obesidade, tabagismo, sintomas depressivos, isolamento social, inatividade física, diabetes mellitus). Os dados foram comparados pelo teste de McNemar. Modelos de regressão logística multinominal individuais foram conduzidos para identificar quais fatores estavam associados ao declínio cognitivo após dois anos. Resultados: Os percentuais de baixa escolaridade, traumatismo craniano e tabagismo mantiveram-se os mesmos nas duas avaliações. Houve aumento significativo da prevalência de hipertensão arterial (de 55,0 para 62,0%) e inatividade física (de 58,5 para 74,5%), e redução significativa do isolamento social (de 25,5 para 18,0%). Participantes com sintomas depressivos na avaliação de base apresentaram maior risco de declínio cognitivo no acompanhamento. Conclusão: Houve aumento das prevalências de hipertensão arterial e inatividade física; e redução do isolamento social. Sintomas depressivos predizem declínio cognitivo.

Factors associated with poor health literacy in older adults: A systematic review.

OBJECTIVES: To identify factors associated with poor health literacy in older adults. METHODS: A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy". PROSPERO - CRD: 42022350140. RESULTS: Out of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others). CONCLUSIONS: The factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.

Factors Associated with Symptoms of Posttraumatic Stress in Mothers During the COVID-19 Pandemic.

OBJECTIVES: The objective of the study was to evaluate the factors associated with symptoms of posttraumatic stress in mothers during the COVID-19 pandemic. METHODS: Cross-sectional study conducted with mothers of children and adolescents living in Brazil, who answered an online questionnaire containing sociodemographic variables and the Impact of Events Scale-Revised. The Poisson regression model with robust variance was used to identify the factors associated with posttraumatic stress. RESULTS: A percentage of 83.82% of mothers reported an overload in caring for their children during the pandemic. The prevalence of posttraumatic stress symptoms was 39.05%, and this condition was associated with younger age, living in the northern region of the country, using medications, presenting neuropsychiatric comorbidities and being little/more or less satisfied with life. CONCLUSIONS FOR PRACTICE: The mental health situation of mothers during and after the pandemic must be monitored, in order to guarantee public policies capable of optimizing the coping with the situation.

IgE-mediated cow's milk allergy in Brazilian children: Outcomes of oral food challenge.

Background: Oral food challenge (OFC) is useful for diagnosing food allergies and assessing tolerance, but severe reactions may occur during the procedure. Objective: To characterize the frequency and severity of reactions during cow's milk (CM) OFCs. Methods: A cross-sectional study was conducted to analyze the outcome of cow's milk oral food challenges (CMOFCs) performed to confirm IgE-mediated CM allergy or to assess food tolerance. CM was given first as baked milk (BM), followed by whole CM if there was no prior reaction to BM. An OFC was considered positive if IgE-mediated symptoms developed up to 2 h after ingestion. Symptoms were described and variables including age at OFC, prior anaphylaxis, other atopic diseases, and skin test results were compared according to the OFC outcomes. Results: A total of 266 CMOFCs were performed, including 159 patients with a median age of 6.3 years old. One hundred thirty-six tests were positive and 62 resulted in anaphylaxis. Thirty-nine anaphylactic reactions were observed up to 30 min after the first dose. Severe anaphylaxis (cardiovascular and/or neurological involvement) was reported in 5 tests. A second dose of epinephrine was required in 3 tests, and 1 presented a biphasic response. Younger patients had a higher risk of anaphylaxis during baked milk oral food challenge (BMOFC) (p = 0.009). The frequency of anaphylaxis was higher in patients submitted to BM (p = 0.009). Conclusions: Anaphylaxis is a known complication of CMOFCs even when there is no prior anaphylaxis or when conducted with baked products. This study reinforces the importance of conducting OFC in appropriate settings with a well-trained team.

Factors Associated With Influenza Vaccination During the COVID-19 Pandemic in Older Adults Residing in Brazil.

The current study aimed to assess influenza vaccination coverage and explore factors related to vaccine uptake in older adults in 2020 amid the coronavirus disease 2019 pandemic. A cross-sectional study using an online questionnaire was performed with 380 older adults (aged ≥60 years), living in Brazil, from May 26 to June 29, 2020. Data regarding sociodemographic, health, and social support variables were collected. Data were analyzed using Poisson regression with robust variance. Influenza vaccination coverage in the sample was 85.5% (95% confidence interval [81.6, 88.7]). Older adults with increased age had higher vaccination coverage, whereas those who were smokers, not wearing masks, and sometimes and never/almost never received professional support had lower vaccination rates. Data show that vaccine coverage for influenza in 2020 was below that recommended by Brazilian authorities. We reinforce the importance of information about the influenza vaccine, especially for younger older adults, smokers, and those who do not wear masks. Reliable information from health care professionals and the media is essential for vaccination during a pandemic. [Journal of Gerontological Nursing, 49(5), 31-38.].

Symptoms of depression, anxiety and stress in Brazilian mothers during the COVID-19 pandemic.

The study aimed to identify the factors associated with symptoms of depression, anxiety and stress in Brazilian mothers of children and adolescents during the COVID-19 pandemic. This is a cross-sectional study carried in 2020 with the participation of 822 mothers who answered an online questionnaire containing sociodemographic variables and the Depression, Anxiety and Stress Scale (DASS-21). The adjusted model showed a higher depression score in women who became unemployed during the pandemic, who felt a greater burden in taking care of children, who took medication on a regular basis, and who self-assessed their health as regular or poor/very poor. Having a lower family income increased their anxiety scale score. In contrast, the variables associated with a reduced anxiety scale score included greater age, not feeling overwhelmed with demands to care for children, not using medications, not having gastrointestinal diseases, and good/very good self-assessed health. These variables, together with the benefits of living in the Northeast and Midwest regions of Brazil as well as sleeping more hours per night, were also associated with reduced stress. The present study is significant as it points out elements present in the daily lives of mothers that have an impact on their mental health. The study points to the need to (re)think mental health policies taking into account the needs of the public studied.

Relationship between depressive symptoms, social isolation, visual complaints and hearing loss in middle-aged and older adults.

The prevalence of chronic diseases, especially depression, has been increasing worldwide. Health professionals have an important role in screening and early detection of the disorder, to prevent possible damage such as disability and dependence. With aging, sensory impairments can occur, such as visual and hearing losses, which can lead to isolation contributing to the development of depressive symptoms. The objective of this study was to analyze the relationship between depressive symptoms, social isolation, and self-perception of visual complaints and hearing loss in middle-aged and older adults. It was a cross-sectional quantitative study, in Três Lagoas, state of Mato Grosso do Sul, Brazil, with 300 participants of both sexes, aged 45 years and over, registered in the Primary Health Care network. Data were collected using a structured questionnaire with sociodemographic data and the questions "Do you consider yourself socially isolated?", "Do you have a vision and/or a hearing problem capable of stopping you from performing a daily life activity?" and "If yes, do you use a hearing aid and/or glasses or contact lenses?". Depressive symptoms were assessed using the Center for Epidemiological Studies - Depression (CES-D) scale with a cut-off score adapted for age. Data were analyzed with binary logistic regression, with the presence of depressive symptoms being the dependent variable. Values of p≤0.05 were considered significant. The majority of the sample were women (65.7%), with an average age of 60.9 years, 56.7% were classified with depressive symptoms, 27.0% considered themselves socially isolated, 84.7% reported visual acuity loss (70.7% used glasses) and 17.3% reported hearing loss (2.3% used hearing aids). Social isolation (OR = 6.0), visual complaints (OR = 3.85), and hearing loss (OR = 4.67) were related to the presence of depressive symptoms. Moreover, being married (OR = 0.51) was a protective factor in these participants. The results showed the importance of early diagnosis of depressive symptoms. The correction of visual and hearing deficits is highlighted, as these may be related to symptoms of depression. Health professionals in Primary Health Care should be able to monitor depressive symptoms, visual and hearing complaints, and to promote social interaction.

Agreement between fragility assessment instruments for older adults registered in primary health care.

OBJECTIVE: To assess the level of agreement between the Subjective Frailty Assessment (SFA) and Clinical Functional Vulnerability Index (CFVI-20) for the diagnosis of frailty in older adults. METHODS: A descriptive, comparative, cross-sectional study was conducted in 2018/2019 with 492 older adults at nine Family Health Strategy units in the city of Três Lagoas, state of Mato Grosso do Sul, Brazil. Frailty was assessed using the SFA and CFVI-20 in addition to a structured interview. The Wilcoxon test and Pearson's chi-squared test were used for the comparisons. RESULTS: Agreement was 35.4%, with a Kappa coefficient of 0.11. After dichotomizing the sample into frail and non-frail individuals, agreement was 70.1%, with a Kappa coefficient of 0.41 and Cronbach's alpha coefficients of 0.61 and 0.74 for IVCF-20 and SFA, respectively. The prevalence of frailty was lower using the IVCF-20 (17.1%) compared to 59.8% using the SFA. CONCLUSION: Agreement regarding the classification of frailty between the two instruments ranged from low to moderate. This finding underscores the need for a standardized instrument for measuring frailty in community-dwelling older adults.

Dilemas éticos no direito de acesso aos cuidados paliativos na pandemia da COVID-19 / Dilemes ètics sobre el dret d'accés a les cures pal·liatives durantla pandèmiade laCOVID-19 / Dilemas éticos sobre el derecho de acceso a los cuidados paliativos en la pandemiade laCOVID-19 / Ethical dilemmas on the right of access to palliative care in the COVID-19 pandemic

La revisió del tema té com a objectiu enumerar alguns dilemes ètics que involucren l'equitat, relacionats amb el dret d'accés a les cures pal·liatives(CP) en el context de la pandèmia causada per la COVID-19. Aquesta és una reflexió teòrica que pren com a referència l'enfocament de Norman Daniels a Accountability for Reasonableness. Els dilemes ètics sorgits per l'assignació d'escassos recursos als pacients de CP van involucrar el dret a l'accés: respiradors artificials, tractament de diàlisi, analgèsics, tractament psicosocial i accés a llocs per a l'exercici de l'espiritualitat. És fonamental discutir els dilemes assenyalats perquè el procés de deliberació en l'assignació dels recursos de salut es realitzi de manera equitativa, en la direcció del principi d'equitat, podent utilitzar referències bioètiques per a dotar de major transparència a les decisions i que la població pugui valorar-les com a justes i justificades.(AU)

A revisão do tema objetiva elencar alguns dilemas éticos, envolvendo à equidade, relacionados ao direito de acesso aos Cuidados Paliativos (CP) no contexto da pandemia da COVID-19. Trata-se de uma reflexão teórica, utilizando-se como referencial a abordagem de “Responsabilização pela Razoabilidade”, de Norman Daniels. Os dilemas éticos levantados na alocação de recursos escassos a pacientes em CP envolveram o direito ao acesso a: respiradores artificiais, tratamento dialítico, medicações para alívio da dor, tratamento psicossocial e acesso aos locais para o exercício da espiritualidade. É imprescindível a discussão dos dilemas apontados de modo que o processo de deliberação na alocação de recursos em saúde seja feito de maneira equitativa, como direciona o princípio da equidade, que possa se utilizar de referenciais bioéticos para dar maior transparência às decisões e que a populaçãopossa entendê-las como justas e justificadas.(AU)

The review of the topic aims to list some ethical dilemmas, involving equity, relatedto the right of access to Palliative Care (PC) in the context of the COVID-19 pandemic. This is a theoretical reflection, using the Accountability for Reasonableness approach, by Norman Daniels, as a reference. The ethical dilemmas raised in the allocation of scarce resources to PC patients involved the right to access artificial respirators, dialysis treatment, pain relief medications, psychosocial treatment and access to places for the exercise of spirituality. It is essential to discuss the dilemmas pointed out so that the deliberation process in the allocation of health resources is carried out in an equitable manner, as directed by the principle of equity, which can use bioethical references to give greater transparency to decisions and that the population can understand them as just and justified.(UA)

La revisión del tema tiene como objetivo enumerar algunos dilemas éticos, que involucran la equidad, relacionados con el derecho de acceso a los Cuidados Paliativos (CP) en el contexto de la pandemia de COVID-19. Esta es una reflexión teórica, tomando como referencia el enfoque de Accountability for Reasonableness, de Norman Daniels. Los dilemas éticos planteados en la asignación de escasos recursos a los pacientes de CP involucraron el derecho al acceso: respiradores artificiales, tratamiento de diálisis, analgésicos, tratamiento psicosocial y acceso a lugares para el ejercicio de la espiritualidad. Es fundamental discutir los dilemas señalados para que el proceso de deliberación en la asignación de los recursos de salud se realice de manera equitativa, en la dirección del principio de equidad, que puede utilizar referencias bioéticas para dar mayor transparencia a las decisiones y que la la población puede entenderlos como justos y justificados.(AU)

Factors associated with depressive and anxiety symptoms in older adults during the COVID-19 pandemic: a Brazilian study.

Objectives: Older adults are one of the most vulnerable age groups to the social distance measures imposed by the COVID-19 pandemic. This study aimed to assess factors associated with depressive and anxiety symptoms in Brazilian older adults during the pandemic.Method: This cross-sectional online study assessed 380 older adults (over 60 years of age) living in Brazil, from 26th May 2020 to 29th June 2020. A self-reported questionnaire included sociodemographic data, lifestyle, health characteristics, and the COVID-19 related variables. The Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI) were also applied. Data were analyzed via logistic regression models, using a hierarchical approach.Results: The prevalence of depressive symptoms according to GDS was 28.7% (95% CI = 24.4%, 33.4%) and the prevalence of anxiety symptoms according to GAI was 26.1% (95% CI = 21.9%, 30.7%). Physically inactive older adults, the ones who were in social isolation for more days, feel much vulnerable to contracting COVID-19, and never or almost never receive support from family/friends were more likely to have depressive symptoms. Being female, physically inactive or physically active 1-3 times/week, feel very vulnerable to contracting COVID-19 and never or almost never receive support from family/friends were associated with the anxiety symptoms.Conclusion: A high prevalence of depressive and anxious symptoms was identified in Brazilian older adults. The data can help in planning interventions aimed at older adults, also including their families, health professionals, and the whole society.

Agreement between fragility assessment instruments for older adults registered in primary health care / Acuerdo entre instrumentos de evaluación de fragilidad en mayores registrados en atención primaria de salud / Concordância entre instrumentos de avaliação da fragilidade em idosos na atenção primária à saúde

ABSTRACT Objective: To assess the level of agreement between the Subjective Frailty Assessment (SFA) and Clinical Functional Vulnerability Index (CFVI-20) for the diagnosis of frailty in older adults. Methods: A descriptive, comparative, cross-sectional study was conducted in 2018/2019 with 492 older adults at nine Family Health Strategy units in the city of Três Lagoas, state of Mato Grosso do Sul, Brazil. Frailty was assessed using the SFA and CFVI-20 in addition to a structured interview. The Wilcoxon test and Pearson's chi-squared test were used for the comparisons. Results: Agreement was 35.4%, with a Kappa coefficient of 0.11. After dichotomizing the sample into frail and non-frail individuals, agreement was 70.1%, with a Kappa coefficient of 0.41 and Cronbach's alpha coefficients of 0.61 and 0.74 for IVCF-20 and SFA, respectively. The prevalence of frailty was lower using the IVCF-20 (17.1%) compared to 59.8% using the SFA. Conclusion: Agreement regarding the classification of frailty between the two instruments ranged from low to moderate. This finding underscores the need for a standardized instrument for measuring frailty in community-dwelling older adults.

RESUMEN Objetivo: Evaluar el nivel de concordancia entre la Evaluación Subjetiva de la Fragilidad (SFA) y el Índice de Vulnerabilidad Clínico-Funcional (IVCF-20) para el rastreo de la fragilidad en los individuos. Método: Estudio descriptivo, comparativo y transversal realizado en 2018/2019 con 492 ancianos, en 09 Estrategias de Salud Familiar en el municipio de Três Lagoas-MS. La fragilidad se evaluó mediante el SFA y el IVCF-20 y una entrevista estructurada. Para las comparaciones, se utilizaron las pruebas de chi-cuadrado de Wilcoxon y Pearson. Resultados: La concordancia fue 35,4%, con un coeficiente Kappa 0,11. Al dicotomizar en frágiles y no frágiles, la concordancia fue 70,1%, con un coeficiente Kappa 0,41, un alfa de Cronbach para el IVCF-20 de 0,61 y SFA de 0,74. La prevalencia de la fragilidad fue menor en el IVCF - 20 (17,1%) y mayor en el SFA (59,8%). Conclusión: La concordancia entre los dos instrumentos fue de baja a moderada, lo que pone de manifiesto la necesidad de estandarizar el instrumento para evaluar la fragilidad en los ancianos que viven en la comunidad.

RESUMO Objetivo: Avaliar o nível de concordância entre a Avaliação Subjetiva da Fragilidade (SFA) e o Índice de Vulnerabilidade Clínico-Funcional (IVCF-20) para rastreio da fragilidade em idosos. Métodos: Estudo descritivo, comparativo e transversal realizado em 2018/2019 com 492 idosos, em 09 Estratégias Saúde da Família no município de Três Lagoas-MS. A Fragilidade foi avaliada utilizando a SFA e IVCF-20 e entrevista estruturada. Para comparações, utilizou testes de Wilcoxon e qui-quadrado de Pearson. Resultados: Concordância foi de 35,4%, com coeficiente Kappa de 0,11. Dicotomizando em idosos frágeis e não-frágeis, a concordância foi de 70,1%, com coeficiente Kappa foi 0,41 e o alfa de Cronbach para IVCF-20 foi 0.61 e SFA 0.74. A prevalência da fragilidade foi menor do IVCF - 20 (17,1%) e maior na SFA (59,8%). Conclusão: A concordância entre os dois instrumentos variou de baixa a moderada, destacando a necessidade de padronizar o instrumento para aferir a fragilidade em idosos comunitários.

A (des)coordenação federativa do Suas: tensões, rupturas e desafios / The federative (dis)coordination of Suas: tensions, ruptures and challenges

O artigo apresenta uma abordagem sobre o compartilhamento das responsabilidades dos entes federativos com as políticas públicas no Brasil, em especial, a assistência social, enquanto possibilidades de garantias de direitos de cidadania a serem efetivados pelo Estado. A pesquisa bibliográfica, embasada no método histórico-dialético, teve como objetivo percorrer a construção histórica do pacto federativo e sua importância para a implantação de um modelo de proteção social no país. A análise crítica das principais normativas do Suas aponta que a descoordenação federativa, apresentada no cenário atual, reflete duramente no que foi recém-construído pela via da assistência social para atender um significativo contingente da população brasileira. Por fim, o texto defende a descentralização político-administrativa, com vistas à construção de um efetivo projeto de luta pela universalização de acesso às políticas sociais e pela dignidade humana.

The article presents an approach on the sharing of the responsibilities of federative entities with public policies in Brazil, especially social assistance, as possibilities of guaranteeing citizenship rights to be implemented by the State. It highlights the necessary convergence relationship between the Union, states and municipalities provided for in the cooperative federalism model adopted in the Federal Constitution of 1988. It points out that the federal uncoordination, presented in the current scenario, reflects hard on what was built through social assistance to meet a significant contingent of the Brazilian population. Finally, the text defended the fulfillment of the Suas federative pact, with decentralization of financial, administrative and human resources, with a view to building an effective project to fight for universal access in social policies and human dignity.

Motivos para vacinação contra influenza em idosos em 2019 e 2020 / Motivos para la vacunación contra la influenza en adultos mayores en 2019 y 2020 / Reasons for influenza vaccination in older adults in 2019 and 2020

Resumo Objetivo Avaliar a cobertura vacinal para influenza e os motivos para vacinação ou não em idosos, nas campanhas dos anos de 2019 e 2020. Métodos Estudo quantitativo e longitudinal, realizado em Três Lagoas (MS). Participaram idosos cadastrados em serviços de saúde ou de convivência. No primeiro trimestre de 2020, foram avaliados presencialmente 172 idosos, dos quais 86 foram reentrevistados entre agosto e outubro de 2020 por meio de contato telefônico. Na primeira entrevista, questionou-se sobre a vacinação contra a gripe em 2019 e os motivos para vacinação ou não. Na segunda, as questões foram sobre a vacinação em 2020 e os motivos. As coberturas vacinais de 2019 e 2020 foram comparadas pelo teste de McNemar. Resultados Houve predomínio de mulheres, com média de 69,1 anos de idade. A cobertura vacinal em 2019 foi de 90,7%. A maioria tomou a vacina por acreditar que era importante se vacinar. Como motivos para a não vacinação, destacaram-se as reações anteriores e o fato de não ficar gripado. Em 2020, a cobertura foi de 86,0%. A maioria dos idosos se vacinou pelo fato de a vacina estar disponível no Sistema Único de Saúde. Os motivos para não vacinação foram medo de sair de casa devido à pandemia e falta de orientação profissional. Não houve diferença significativa na cobertura vacinal em 2019 e 2020 (p=0,388). Conclusão A cobertura vacinal diminuiu no ano da pandemia, sem diferença significativa. Informações confiáveis de profissionais de saúde e da mídia são essenciais para a manutenção de altas coberturas vacinais.

Resumen Objetivo Evaluar la cobertura vacunal de la influenza y los motivos para la vacunación o no de adultos mayores en las campañas de los años de 2019 y de 2020. Métodos Estudio cuantitativo y longitudinal, realizado en Três Lagoas (Mato Grosso do Sul). Participaron adultos mayores registrados en servicios de salud o de convivencia. En el primer trimestre de 2020, 172 adultos mayores fueron evaluados presencialmente de los que 86 fueron entrevistados nuevamente entre agosto y octubre de 2020 por medio de contacto telefónico. En la primera entrevista, se preguntó sobre la vacunación contra la gripe en el 2019 y los motivos para vacunarse o no vacunarse. En la segunda, las preguntas fueron sobre la vacunación en el 2020 y los motivos. Las coberturas vacunales de 2019 y de 2020 fueron comparadas por la prueba de McNemar. Resultados Hubo un predominio de mujeres, con un promedio de 69,1 años de edad. La cobertura vacunal en el 2019 fue del 90,7 %. La mayoría tomó la vacuna por considerar que era importante vacunarse. Como motivos para la no vacunación, se destacaron las reacciones anteriores y el hecho de no quedarse engripado. En el 2020, la cobertura fue del 86,0 %. La mayoría de los adultos mayores se vacunó por el hecho de que la vacuna está disponible en el Sistema Único de Salud. Los motivos para la no vacunación fueron el miedo de salir de casa en función de la pandemia y la falta de orientación profesional. No hubo diferencia significante en la cobertura vacunal en el 2019 y el 2020 (p=0,388). Conclusión La cobertura vacunal disminuyó el año de la pandemia, sin significante diferencia. Informaciones confiables de profesionales de salud y de los medios son esenciales para el mantenimiento de altas coberturas vacunales.

Abstract Objective To assess influenza vaccination coverage and reasons for vaccination or not in older adults, in the campaigns of 2019 and 2020. Methods This is a quantitative and longitudinal study, carried out in Três Lagoas (MS). Older adults registered in health care or social services participated. In the first quarter of 2020, 172 older adults were assessed in person, of whom 86 were re-interviewed between August and October 2020 through telephone contact. In the first interview, questions were asked about the flu vaccination in 2019 and the reasons for vaccination or not. In the second, the questions were about vaccination in 2020 and why. Vaccination coverage for 2019 and 2020 was compared using the McNemar test. Results There was a predominance of women, with an average age of 69.1 years. Vaccination coverage in 2019 was 90.7%. Most of them took the vaccine because they believed it was important. As reasons for non-vaccination, the previous reactions and the fact that they did not have the flu were highlighted. In 2020, coverage was 86.0%. Most older adults were vaccinated because the vaccine was available in the Unified Health System (Sistema Único de Saúde). The reasons for non-vaccination were fear of leaving home due to the pandemic and lack of professional guidance. There was no significant difference in vaccination coverage in 2019 and 2020 (p=0.388). Conclusion Vaccination coverage decreased in the year of the pandemic, with no significant difference. Reliable information from healthcare professionals and the media is essential for maintaining high vaccination coverage.

Aptidão, conhecimento e atitude de profissionais da educação infantil sobre primeiros socorros / Aptitude, knowledge and attitude of early childhood education professionals about first aid / Aptitud, conocimiento y actitud de los profesionales de la educación infantil sobre los primeros auxilios

Objetivo: analisar a aptidão, o conhecimento e a atitude de profissionais da educação infantil que participaram ou não de capacitação em primeiros socorros. Método: estudo transversal, desenvolvido com 132 profissionais da educação infantil do município de Três Lagoas, Mato Grosso do Sul, Brasil, por meio de questionário no Google Forms. Aplicaram-se os testes qui-quadrado ou Exato de Fisher. Resultados: dos 132 profissionais, 67 relataram não ter participado anteriormente de capacitação em primeiros socorros. A maioria sente-se apta a prestar atendimento nas situações de febre, ferimentos e sangramentos. Aqueles que já participaram de capacitação acertaram mais respostas referentes ao conhecimento dos conceitos de febre, convulsão, desmaio, trauma, parada cardiorrespiratória e acidente por animal peçonhento; e referente às atitudes para convulsão, desmaio, engasgo, queda/trauma e parada cardiorrespiratória. Conclusão: ter participado de capacitação proporcionou aos profissionais maior conhecimento e assertividade referente à atitude a ser tomada nas situações de emergência.

Objective: to analyze the aptitude, knowledge and attitude of early childhood education professionals who participated or not in first aid training. Method: cross-sectional study, developed with 132 professionals in early childhood education in the municipality of Três Lagoas, Mato Grosso do Sul, Brazil, using a questionnaire on Google Forms. The Chi-square or Fisher's Exact tests were applied. Results: of the 132 professionals, 67 reported that they had not previously participated in first aid training. Most feel able to provide care in situations of fever, wounds and bleeding. Those who had participated in training had more answers regarding knowledge of the concepts of fever, seizure, fainting, trauma, cardiorespiratory arrest and accidents caused by poisonous animals; and regarding attitudes towards seizure, fainting, choking, fall/trauma and cardiorespiratory arrest. Conclusion: having participated in training provided professionals with greater knowledge and assertiveness regarding the attitude to be taken in emergency situations.

Objetivo: analizar la aptitud, los conocimientos y la actitud de los profesionales de la educación infantil que participaron o no en la formación en primeros auxilios. Método: estudio transversal, desarrollado con 132 profesionales de la educación infantil del ayuntamiento de Três Lagoas, Mato Grosso do Sul, Brasil, mediante preguntas en Google Forms. Se aplicaron las pruebas de Chi-cuadrado o Exacta de Fisher. Resultados: de los 132 profesionales, 67 declararon no haber participado previamente en la formación de primeros auxilios. La mayoría de ellos se sienten capaces de brindar atención en situaciones de fiebre, heridas y hemorragias. Los que habían participado en la formación tenían más respuestas correctas en cuanto al conocimiento de los conceptos de fiebre, convulsión, desmayo, trauma, parada cardiorrespiratoria y accidentes con animales venenosos; y en cuanto a las actitudes hacia la convulsión, el desmayo, el atragantamiento, la caída/el trauma y la parada cardiorrespiratoria. Conclusión: haber participado en la capacitación proporcionó a los profesionales un mayor conocimiento y asertividad en relación con la actitud a tomar en las situaciones de emergencia.

Dificuldades vivenciadas na atenção básica pela equipe multiprofissional de saúde no atendimento ao usuário queimado / Difficulties experienced by multiprofessional health teams in providing primary care for burn victims / Dificultades vividas en la atención básica por el equipo multiprofesional de salud en la atención al usuario quemado

Objetivo: identificar as dificuldades vivenciadas nas Unidades Básicas de Saúde pela equipe multiprofissional no atendimento ao usuário queimado. Método: estudo qualitativo, descritivo, realizado com 14 profissionais atuantes em três unidades básicas de saúde no Sul do Rio Grande do Sul. A coleta de dados ocorreu em junho de 2018, por meio de entrevista semiestruturada. Os dados foram tratados por análise temática. Resultados: os multiprofissionais relataram que consideram sua formação insuficiente e que se sentem despreparados para o primeiro atendimento e manejo, repercutindo em estresse e ansiedade, quando surgem queimaduras mais específicas. Identificaram-se relato de discordâncias nas condutas adotadas e a ausência de um protocolo para o manejo apropriado. Pontuaram que a estrutura física e insumos são inadequados. Conclusão: diante das dificuldades vivenciadas para o atendimento ao queimado, é necessário capacitação profissional e um olhar mais próximo pela gestão, para investir em recursos físicos, materiais e protocolos que possibilitem esse atendimento.

Objective: to identify difficulties experienced in Basic Health Units by multiprofessional teams providing care for burn patients. Method: in this qualitative, descriptive study with 14 health personnel working in three basic health units in southern Rio Grande do Sul state, data were collected in June 2018 by semi-structured interview, and treated by thematic analysis. Results: the multiprofessionals reported that they considered their training insufficient and that they felt unprepared to provide first care and management when more specific burns presented, which was reflected in stress and anxiety. There were reports of divergences in procedures adopted and no protocol for appropriate burn management was in place. They pointed out that the physical structure and materials were unsuitable. Conclusion: the difficulties experienced in providing care to burn victims pose a need for training, and closer attention by management with a view to investing in physical resources, materials and protocols to enable this service.

Objetivo: identificar las dificultades vividas en las Unidades Básicas de Salud por el equipo multiprofesional en la atención al usuario quemado. Método: estudio cualitativo, descriptivo, realizado junto a 14 profesionales que trabajan en tres unidades básicas de salud en el sur de Rio Grande do Sul. La recolección de los datos se realizó en junio de 2018, mediante entrevista semiestructurada. Los datos fueron tratados por análisis temático. Resultados: los multiprofesionales refirieron que consideraron su formación insuficiente y que no se sentían preparados para el primer cuidado y manejo, lo que reflejaba en estrés y ansiedad, cuando surgían quemaduras más específicas. Se identificaron diferencias en las conductas adoptadas y ausencia de un protocolo para el manejo adecuados. Apuntaron que la estructura física y los insumos son inadecuados. Conclusión: ante las dificultades vividas en la atención de personas quemadas, hace falta una formación profesional y una mirada más cercana por parte de la gestión, en el sentido de invertir en recursos físicos, materiales y protocolos que hagan posible esa atención.

Dificuldades vivenciadas na atenção básica pela equipe multiprofissional de saúde no atendimento ao usuário queimado / Dificultades vividas en la atención básica por el equipo multiprofesional de salud en la atención al usuario quemado / Difficulties experienced by multiprofessional health teams in providing primary care for burn victims

RESUMO Objetivo identificar as dificuldades vivenciadas nas Unidades Básicas de Saúde pela equipe multiprofissional no atendimento ao usuário queimado. Método estudo qualitativo, descritivo, realizado com 14 profissionais atuantes em três unidades básicas de saúde no Sul do Rio Grande do Sul. A coleta de dados ocorreu em junho de 2018, por meio de entrevista semiestruturada. Os dados foram tratados por análise temática. Resultados os multiprofissionais relataram que consideram sua formação insuficiente e que se sentem despreparados para o primeiro atendimento e manejo, repercutindo em estresse e ansiedade, quando surgem queimaduras mais específicas. Identificaram-se relato de discordâncias nas condutas adotadas e a ausência de um protocolo para o manejo apropriado. Pontuaram que a estrutura física e insumos são inadequados. Conclusão diante das dificuldades vivenciadas para o atendimento ao queimado, é necessário capacitação profissional e um olhar mais próximo pela gestão, para investir em recursos físicos, materiais e protocolos que possibilitem esse atendimento.

RESUMEN Objetivo identificar las dificultades vividas en las Unidades Básicas de Salud por el equipo multiprofesional en la atención al usuario quemado. Método estudio cualitativo, descriptivo, realizado junto a 14 profesionales que trabajan en tres unidades básicas de salud en el sur de Rio Grande do Sul. La recolección de los datos se realizó en junio de 2018, mediante entrevista semiestructurada. Los datos fueron tratados por análisis temático. Resultados los multiprofesionales refirieron que consideraron su formación insuficiente y que no se sentían preparados para el primer cuidado y manejo, lo que reflejaba en estrés y ansiedad, cuando surgían quemaduras más específicas. Se identificaron diferencias en las conductas adoptadas y ausencia de un protocolo para el manejo adecuados. Apuntaron que la estructura física y los insumos son inadecuados. Conclusión ante las dificultades vividas en la atención de personas quemadas, hace falta una formación profesional y una mirada más cercana por parte de la gestión, en el sentido de invertir en recursos físicos, materiales y protocolos que hagan posible esa atención.

ABSTRACT Objective to identify difficulties experienced in Basic Health Units by multiprofessional teams providing care for burn patients. Method in this qualitative, descriptive study with 14 health personnel working in three basic health units in southern Rio Grande do Sul state, data were collected in June 2018 by semi-structured interview, and treated by thematic analysis. Results the multiprofessionals reported that they considered their training insufficient and that they felt unprepared to provide first care and management when more specific burns presented, which was reflected in stress and anxiety. There were reports of divergences in procedures adopted and no protocol for appropriate burn management was in place. They pointed out that the physical structure and materials were unsuitable. Conclusion the difficulties experienced in providing care to burn victims pose a need for training, and closer attention by management with a view to investing in physical resources, materials and protocols to enable this service.

Prevalence of risk factors for dementia in middle- and older- aged people registered in Primary Health Care.

It is important to assess the prevalence of risk factors for dementia to slow down the progression and evolution of the disease, and to support interventions and prevention programs. OBJECTIVE: We aimed to evaluate the prevalence of these factors in individuals registered in Primary Health Care in Brazil and their relationship with sex and age group. METHODS: This was a cross-sectional and quantitative study with n=300 individuals. We evaluated the prevalence of main risk factors (low education, hearing loss, high blood pressure, obesity, smoking, depression, physical inactivity, social isolation, and diabetes mellitus) and others (poor diet, alcohol use, head trauma, monolingualism, visual impairment, and sleep disorders) identified in the literature. Poisson regression was used, according to sex and age group (45-59 years/60+ years). RESULTS: The main risk factors with the highest prevalence were physical inactivity (60.3%) and depressive symptoms and hypertension (56.7% each). Among the other factors, monolingualism (98.0%), visual impairment (84.7%), and irregular consumption of fruits (60.4%), and vegetables (53.5%) prevailed. No differences were identified between sexes. The regression analysis confirmed a significant difference for education and age group, with older individuals having a higher prevalence of low schooling. CONCLUSION: The results can guide interventions, especially in developing countries. Practice of physical activity and healthy eating should be the focus of these interventions as they can indirectly help in reducing the prevalence of other factors. Early identification, screening and adequate treatment of depressive symptoms, high blood pressure and visual impairment can also contribute to reducing the prevalence of dementia.

A identificação da prevalência de fatores de risco para demência é importante para reduzir a velocidade da progressão e evolução da doença, e para subsidiar programas de prevenção e intervenção. OBJETIVO: O objetivo foi avaliar a prevalência desses fatores em indivíduos cadastrados na Atenção Primária à Saúde (APS), relacionando com sexo e faixa etária. MÉTODOS: Estudo transversal e quantitativo, com n=300 indivíduos acima de 45 anos. Avaliou-se a prevalência dos fatores de risco principais para demência (baixa escolaridade, perda auditiva, hipertensão arterial, obesidade, tabagismo, depressão, inatividade física, isolamento social e diabetes mellitus) e dos outros fatores (má alimentação, consumo de álcool, traumatismo craniano, unilinguismo, déficit visual e distúrbios do sono), identificados na literatura. Conduziu-se uma regressão de Poisson, por sexo e faixa etária (45-59 e 60+ anos). RESULTADOS: Os fatores de risco principais com maior prevalência foram a inatividade física (60,3%), a sintomatologia depressiva e a hipertensão arterial (56,7% cada). Dentre os outros fatores, prevaleceram: unilinguismo (98,0%), déficit visual (84,7%), consumo irregular de frutas (60,4%) e de verduras ou legumes (53,5%). Não foram identificadas diferenças entre os sexos. Confirmou-se diferença significativa para a escolaridade e faixa etária, com os idosos apresentando maior prevalência de baixa escolaridade. CONCLUSÃO: Os resultados podem guiar intervenções, especialmente em países em desenvolvimento. A prática de atividades físicas e a alimentação devem ser o foco dessas intervenções, auxiliando indiretamente na redução da prevalência de outros fatores. A identificação precoce, o rastreamento e o tratamento adequado de sintomas depressivos, hipertensão arterial e déficit visual também são importantes.

Which criteria can be used to predict benignity in solid renal lesions lower-equal to 2 cm?

PURPOSE: To evaluate magnetic resonance imaging (MRI) criteria of solid renal lesions lower-equal to 2 cm to differentiate benign and malignant tumors, using histopathology as gold standard. METHODS: Three radiologists independently evaluated objective and subjective MRI criteria of focal renal lesions. A total of 105 nodules of patients who had MRI and histopathological results in our institution were included. Subjective criteria evaluated were signal on T2-weighted imaging, presence of microscopic and macroscopic fat, hemosiderin, hemorrhage, central scar, segmented inversion enhancement and enhancement type; objective criteria were gender, ADC value, heterogeneity on T2-weighted imaging and proportion of enhancement in late post-contrast phases. Finally, the readers classified the lesions in probably benign or malignant. Interobserver agreement was evaluated by the Gwet method, and the quantitative variables by intraclass correlation coefficients. To adjust the predictive model, the logistic regression model was used considering the benignity variable as outcome. RESULTS: A total of 26 nodules (24.5%) were benign and 79 (75.2%) were malignant, with size ranging from 7 to 20 mm (median: 14 mm). The most frequent subtype was papillary renal cell carcinoma (RCC) (35.2%), followed by clear-cell RCC (24.8%) and oncocytoma (12.4%). The univariate and multivariate analysis showed, among all categories evaluated, that microscopic fat (p: 0.072), intermediate (p: 0.004) and hyper-enhancement (p: 0.031) and female sex (p: 0.0047) had the best outcome for benignity, within odds ratios of 4.29, 5.75, 4.07 and 2.86, respectively. CONCLUSION: In small solid renal lesions lower-equal to 2 cm, microscopic fat, moderate and hyper-enhancement and female sex were associated with benignity.

Intervenções de educação em saúde de primeiros socorros, no ambiente escolar: uma revisão integrativa / First aid health education interventions in the school environment: an integrative review

Resumo Objectivo: Identificar na literatura quais as intervenções de educação para a saúde em primeiros socorros são utilizadas no contexto escolar. Métodos: Este é um estudo descritivo, como revisão integrada da literatura, com uma pesquisa realizada nas plataformas LILACS, BDENF, MEDLINE e PubMed, seleccionando artigos publicados entre 2009 e 2019, em português, inglês e espanhol, disponíveis para acesso livre e completo, que caracterizaram estudos de intervenção original em escolas com o tema dos primeiros socorros. Resultado: Encontrámos 1937 artigos que, após análise dos critérios de inclusão e exclusão, resultaram em 15 artigos na amostra final. Os artigos foram divididos em duas categorias de discussão: acções de educação de primeiros socorros para professores e empregados e acções de educação de primeiros socorros para estudantes. Conclusão: Empregados, professores e estudantes não estão preparados para prestar primeiros socorros nas escolas, e que o ensino de primeiros socorros, utilizando diferentes metodologias, melhora significativamente os conhecimentos e competências das pessoas neste contexto. Estes estudos justificam a necessidade de promover a educação para a saúde nas escolas em primeiros socorros.

Abstract Objective: To identify in the literature which health education interventions in first aid are used in the school setting. Method: This is a descriptive study, as an integrated review of the literature, with a search performed in the LILACS, BDENF, MEDLINE and PubMed platforms, selecting articles published between 2009 and 2019, in Portuguese, English and Spanish, available for free and complete access, which characterized original intervention studies in schools with the theme of first aid. Result: We found 1937 articles which, after analyzing the inclusion and exclusion criteria, resulted in 15 articles in the final sample. The articles were divided into two discussion categories: first aid education actions for teachers and employees and first aid education actions for students. Conclusion: Collaborators, teachers and students are not prepared to provide first aid in schools, and that teaching first aid, using different methodologies, significantly improves people's knowledge and skills in this context. These studies justify the need to promote health education in schools about first aid.

Resumen Objetivo: Identificar en la literatura qué intervenciones de educación para la salud en primeros auxilios se utilizan en el ámbito escolar. Método: Se trata de un estudio descriptivo, a modo de revisión integradora de la literatura, con una búsqueda realizada en las plataformas LILACS, BDENF, MEDLINE y PubMed, seleccionando artículos publicados entre 2009 y 2019, en portugués, inglés y español, disponibles para acceso gratuito y completo, que caracterizó originales estudios de intervención en escuelas con el tema de primeros auxilios. Resultado: Se encontraron 1937 artículos que, tras analizar los criterios de inclusión y exclusión, dieron como resultado 15 artículos en la muestra final. Los artículos se dividieron en dos categorías de discusión: acciones de educación en primeros auxilios para docentes y empleados y acciones de educación en primeros auxilios para estudiantes. Conclusión: Colaboradores, docentes y estudiantes no están preparados para brindar primeros auxilios en las escuelas, y que la enseñanza de primeros auxilios, utilizando diferentes metodologías, mejora significativamente los conocimientos y habilidades de las personas en este contexto. Estos estudios justifican la necesidad de promover la educación sanitaria en las escuelas sobre primeros auxilios.

Information Disclosed in Patent Documents being the Source to Address Emergencies: A Strategy to Achieve Technological Developments Addressing COVID-19.

BACKGROUND: Face COVID-19 pandemic, a need for accurate information on SARS-CoV-2 virus is urgent and scientific reports have been published on a daily basis to enable effective technologies to fight the disease progression. However, at the initial occurrence of Pandemic, no information on the matter was known and technologies to fight the Pandemic were not readily available. However, searches in patent databases, if strategically designed, can offer quick responses to new pandemics. OBJECTIVE: The objective of this study is aiming to provide existing information in patent documents useful for the developmentof technologies addressing COVID-19. Considering the emergency situation the world was facing and the knowledge of COVID-19 available until April, 2020, this work presents an analysis of the main characteristics of the technological information in patent documents worldwide, related to coronaviruses and the severe acute respiratory syndrome (SARS). METHODS: Regions of concentration of such technologies, the number of available documents and their technological fields are disclosed in three approaches: 1) a wide search, retrieving technologies on SARS or coronaviruses; 2) a targeted search, retrieving documents additionally referring to Angiotensin converting enzyme (ACE2), which is used by SARS- CoV-2 to enter a cell and 3) a punctual search, which retrieved patents disclosing aspects related to SARS- CoV-2 available at that time. RESULTS: Results show the high-level technology involved in these developments and a monopoly tendency of such technologies, also evidencing that it is possible to find answers to new problems in patent documents. CONCLUSION: This work, then, aims to contribute to scientific and technological development by raising the awareness of what should be considered when searching for technologies developed for other matters that could provide solutions for a new problem.