Theoretical-methodological essay on gender identity information validity in epidemiological surveillance of violence.

The inclusion of the "gender identity" field in the Brazilian violence surveillance system, although representing a step forward, still has limitations that may compromise epidemiological data validity. Existing response options for victims' identities do not adequately cover the diversity of this analysis category, resulting in classification biases. Additionally, the absence of options for cisgender identities reflects an approach that naturalizes these identities, while trans identities are considered deviant and subject to surveillance. To overcome these limitations, it is imperative to adopt a broader understanding of gender as a social and performative construction. This requires a reassessment of social structures and data collection instruments. In this context of discussion, this theoretical-methodological essay aims to reflect on gender identity measurement in the Reporting Diseases System interpersonal and self-inflicted violence surveillance system, taking as frameworks the theoretical conceptions about gender as a performative act and the foundations of validity in epidemiological investigations.

Influence of type of household on prognosis at one year in patients ≥65 years attending hospital emergency departments in Spain. The EDEN-6 study.

OBJECTIVE: To investigate whether the type of household is associated with prognosis at one year in patients ≥65 years of age discharged after medical consultation requiring emergency department care. METHODS: Data from the Emergency Department and Elder Needs (EDEN) cohort were used. This retrospective cohort included all patients ≥65 years of age seen in 52 Spanish emergency departments over one week (April 1-7, 2019) in whom the type of household was recorded and categorized as living at home alone, with relatives, with professional caregivers, or in a nursing home. Patient demographic and other baseline characteristics and management during the index emergency department episode were recorded and used to adjust the following 1-year outcomes: all-cause mortality, hospitalization and emergency department revisit. Associations between type of household and outcomes are expressed as adjusted hazard ratios with 95% confidence intervals using living alone as the reference category. RESULTS: 13,442 patients with a median age of 79 years (interquartile range 72-86) were included; 56% were women, 12.2% of patients lived alone, 74.9% with relatives, 3.9% with a professional caregiver, and 9.1% in a nursing home. During the year following discharge, the mortality rate was 14.0%, the hospitalization rate 29.7%, and the emergency department revisit rate 59.3%. In the fully adjusted model, the risk of death was associated only with living in a nursing home (hazard ratio 1.366 (1.101-1.695)). On the other hand, the risk of hospitalization was lower in individuals living in nursing homes (hazard ratio 0.783 [0.676-0.907]) and at home with relatives (hazard ratio 0.897 [0.810-0.992]), while the risk of emergency department revisit was lower in individuals living in nursing homes (hazard ratio 0.826 [0.742-0.920]) or at home with caregivers (hazard ratio 0.856 [0.750-0.976]). CONCLUSION: The type of household was modestly associated with the one-year prognosis of patients ≥65 years of age discharged after attendance at an emergency department. Living in a nursing home is associated with an increased risk of death but a decreased risk of rehospitalization or emergency department revisit, while living at home with relatives or professional caregivers is associated only with a decreased risk of hospitalization and emergency department revisit, respectively.

3D-Printed Cardiac Models for Fetal Counseling: A Pilot Study and Novel Approach to Improve Communication.

A fetal cardiology consultation involves using two-dimensional drawings to explain the cardiac anatomy which can result in inherent variation in how the congenital heart disease (CHD) is conveyed. In this pilot study, we incorporated three-dimensional printed (3DP) models into fetal counseling to demonstrate feasibility and evaluate the impact on parental knowledge, understanding, and anxiety. Parents with a prenatal diagnosis of a muscular ventricular septal defect (VSD) and/or coarctation of aorta were enrolled. Providers were randomized into a Model or Drawing Group and crossed after six months. Parents completed a survey after the consultation which evaluated knowledge of the CHD lesion, expectant surgical management, self-rated understanding, attitude towards the visualization tool, and anxiety. Twenty-nine patients enrolled over a 12 month period. Twelve consultations were done for coarctation of aorta, 13 for VSD, and four for coarctation with a VSD. Both Model and Drawing groups scored similarly in self-reported understanding and confidence, helpfulness of and improvement in communication with the visualization tool. The Model group had higher scores on questions related to the CHD anatomy and surgical intervention [5 [4-5] versus 4 [3.5-5]], p = 0.23 although this didn't reach statistical significance. For the majority (83%) of consultations, the cardiologist agreed that the 3D model improved communication. In this pilot study, we demonstrate the use of 3DP cardiac models during prenatal CHD counseling is feasible and produces results related to parental understanding and knowledge that are equal to and possibly better than the current standard of care.

Effect of Flu Vaccination on Severity and Outcome of Heart Failure Decompensations.

OBJECTIVE: To investigate the relationship of seasonal flu vaccination with the severity of decompensation and long-term outcomes of patients with heart failure (HF). METHODS: We analyzed 6147 consecutively enrolled patients with decompensated HF who presented to 33 Spanish emergency departments (EDs) during January and February of 2018 and 2019, grouped according to seasonal flu vaccination status. The severity of HF decompensation was assessed by the Multiple Estimation of Risk Based on the Emergency Department Spanish Score in Patients With Acute Heart Failure (MEESSI-AHF) + MEESSI scale, need of hospitalization and in-hospital all-cause mortality. The long-term outcomes analyzed were 90-day postdischarge adverse events and 90-day all-cause death. Associations between vaccination, HF decompensation severity and long-term outcomes were explored by unadjusted and adjusted logistic and Cox regressions by using 14 covariables that could act as potential confounders. RESULTS: Overall median (IQR) age was 84 (IQR = 77-89) years, and 56% were women. Vaccinated patients (n = 1139; 19%) were older, had more comorbidities and had worse baseline status, as assessed by New York Heart Association class and Barthel index, than did unvaccinated patients (n = 5008; 81%). Infection triggering decompensation was more common in vaccinated patients (50% vs 41%; P < 0.001). In vaccinated and unvaccinated patients, high or very-high risk decompensation was seen in 21.9% and 21.1%; hospitalization occurred in 72.5% and 73.7%; in-hospital mortality was 7.4% and 7.0%; 90-day postdischarge adverse events were 57.4% and 53.2%; and the 90-day mortality rate was 15.8% and 16.6%, respectively, with no significant differences between cohorts. After adjusting, vaccinated decompensated patients with HF had decreased odds for hospitalization (OR = 0.823, 95%CI = 0.709-0.955). CONCLUSION: In patients with HF, seasonal flu vaccination is associated with less severe decompensations.

[Revisit after discharge from the emergency department in a cohort of patients with COVID-19 pneumonia and analysis based on the healthcare resource used for follow-up. RESALSEVID study]. / Análisis de la evolucion tras el alta de urgencias en pacientes con neumonía por COVID-19 en función del recurso sanitario utilizado para el seguimiento: estudio RESALSEVID.

INTRODUCTION: COVID-19 pneumonia is a manifestation of SARS-CoV-2 infection and in most cases involves hospital admission. There are recommendations according to which these patients can be discharged without hospital admission, but there is no evidence regarding the revisit and the most appropriate type of follow-up. The objective of the RESALSEVID study was to investigate the variables associated with the 30-day revisit (Rev30d) in a group of patients discharged directly from 4 emergency departments (ED) with COVID-19 pneumonia, and analyze whether there were differences based on 4 different tracking devices. METHOD: Analysis of a prospective cohort of patients discharged directly from the ED with COVID-19 pneumonia in 4 hospital with different models of follow-up at discharge (primary care, hospitalization at home [HaH] phone and in person, HaH phone, hospital phone). RESULTS: Five hundred twenty patients were included, with a mean age of 50.1 years and 51% men. Rev30d was 18.3% and was related only to immunosuppression, odds ratio 4.49 (95% confidence interval 1.10-18.24); p=0.022. There was no difference in Rev30d based on the follow-up model used at discharge from the ED. CONCLUSIONS: There are some recommendations that allow the safe discharge of patients with COVID-19 pneumonia, with no differences in Rev30d depending on the type of follow-up.

Theoretical-methodological essay on gender identity information validity in epidemiological surveillance of violence / Ensayo teórico-metodológico sobre la validez de la información de identidad de género en el seguimiento epidemiológico de la violencia / Ensaio teórico-metodológico sobre validade da informação da identidade de gênero no monitoramento epidemiológico da violência

ABSTRACT The inclusion of the "gender identity" field in the Brazilian violence surveillance system, although representing a step forward, still has limitations that may compromise epidemiological data validity. Existing response options for victims' identities do not adequately cover the diversity of this analysis category, resulting in classification biases. Additionally, the absence of options for cisgender identities reflects an approach that naturalizes these identities, while trans identities are considered deviant and subject to surveillance. To overcome these limitations, it is imperative to adopt a broader understanding of gender as a social and performative construction. This requires a reassessment of social structures and data collection instruments. In this context of discussion, this theoretical-methodological essay aims to reflect on gender identity measurement in the Reporting Diseases System interpersonal and self-inflicted violence surveillance system, taking as frameworks the theoretical conceptions about gender as a performative act and the foundations of validity in epidemiological investigations.

RESUMEN La inclusión del campo de la "identidad de género" en el sistema brasileño de vigilancia de la violencia, aunque representa un paso adelante, todavía tiene limitaciones que pueden comprometer la validez de los datos epidemiológicos. Las opciones de respuesta existentes para las identidades de las víctimas no cubren adecuadamente la diversidad de esta categoría de análisis, lo que genera sesgos de clasificación. Además, la ausencia de opciones para las identidades cisgénero refleja un enfoque que naturaliza estas identidades, mientras que las identidades trans se consideran desviadas y sujetas a seguimiento. Para superar estas limitaciones, es imperativo adoptar una comprensión más amplia del género como una construcción social y performativa. Esto requiere una reevaluación de las estructuras sociales y de los instrumentos de recolección de datos. En este contexto de discusión, este ensayo teórico-metodológico tiene como objetivo reflexionar sobre la medición de la identidad de género en el sistema de vigilancia de la violencia interpersonal y autoinfligida del Sistema de Enfermedades de Declaración Obligatoria, tomando como referentes las concepciones teóricas sobre el género como acto performativo y los fundamentos de validez en las investigaciones epidemiológicas.

RESUMO A inclusão do campo "identidade de gênero" no sistema de vigilância de violências brasileiro, embora tenha representando um avanço, ainda apresenta limitações que podem comprometer a validade dos dados epidemiológicos. As opções de resposta existentes para as identidades das vítimas não abrangem adequadamente a diversidade dessa categoria de análise, resultando em vieses de classificação. Adicionalmente, a ausência de opções para as identidades cisgênero reflete uma abordagem que naturaliza essas identidades, enquanto as identidades trans são consideradas desviantes e passíveis de monitoramento. Para superar essas limitações, é imprescindível adotar uma compreensão mais ampla do gênero como uma construção social e performativa. Isso requer uma reavaliação das estruturas sociais e dos instrumentos de coleta de dados. Nesse contexto de discussão, este ensaio teórico-metodológico tem como objetivo refletir sobre a aferição da identidade de gênero no sistema de vigilância de violências interpessoais e autoprovocadas do Sistema de Agravos de Notificação, tomando como referenciais as concepções teóricas sobre gênero como ato performativo e os fundamentos da validade em investigações epidemiológicas.

Interseccionalidade e transexualidade no processo discriminatório: uma revisão integrativa / Intersectionality and transsexuality in the process of discrimination: an integrative review / Interseccionalidad y transexualidad en el proceso discriminatorio: una revisión integradora

Objetivo: identificar na literatura acadêmica as principais discriminações interseccionais vividas por mulheres trans e discutir o seu processo de estabelecimento nesse grupo populacional. Método: estudo de revisão integrativa de literatura conduzida em duas bases e três bibliotecas virtuais durante o ano de 2021 e revisada em 2022. Foi realizada análise lexicográfica por meio do software IRAMUTEC. Resultados: foram identificados 486 manuscritos, selecionando-se 15 para análise. Emergiram três categorias analíticas: (1) Interseccionalidade como multiplicador de opressões, (2) Dificuldade de acesso ao cuidado e a precarização da saúde e (3) Necessidade de Políticas Públicas Específicas e o enfrentamento da InJustiça. Conclusão: as condições estruturais do racismo, sexismo, etnofobia e violências correlatas se sobrepõem, e na base da pirâmide discriminatória se encontram as mulheres transexuais negras. Pesquisas adicionais são necessárias para levar a melhores intervenções a esta população em risco de violência.

Objective: to identify, in the academic literature, the main intersecting discriminations experienced by trans women and to discuss process by which it is established related to this population group. Method: this integrative literature review study was conducted in two databases and three virtual libraries during 2021 and then revised in 2022. Lexicographic analysis was performed using the IRAMUTEC software. Results: 486 manuscripts were identified and 15 were selected for analysis. Three analytical categories emerged: (1) Intersectionality as a multiplier of oppression; (2) Difficulty in accessing care and increasingly precarious health; and (3) Need for specific public policies and addressing injustice. Conclusion: the structural conditions of racism, sexism, ethnophobia, and related violence overlap, and black transsexual women are at the base of the pyramid of discrimination. Additional research is needed to lead to better interventions for this population at risk of violence.

Objetivo: identificar en la literatura académica las principales discriminaciones interseccionales experimentadas por mujeres trans, así como discutir su proceso de implantación en este grupo poblacional. Método: estudio de revisión integradora de literatura realizado en dos bases de datos y tres bibliotecas virtuales durante el año 2021 y revisado en 2022. El análisis lexicográfico se realizó mediante el software IRAMUTEC. Resultados: se identificaron 486 manuscritos y se seleccionaron 15 para su análisis. Surgieron tres categorías de análisis: (1) Interseccionalidad como multiplicador de la opresión, (2) Dificultad de acceso a la atención y precarización de la salud, y (3) Necesidad de Políticas Públicas Específicas y el enfrentamiento a la InJusticia. Conclusión: las condiciones estructurales del racismo, el sexismo, la etnofobia y las violencias relacionadas se superponen, y en la base de la pirámide de discriminación se encuentran las mujeres negras transgénero. Se necesita investigaciones adicionales para conducir a mejores intervenciones para esta población en riesgo de violencia.

Characterization of lesions in the temporal muscle and the male reproductive system (epididymis and testicle) of dogs experimentally infected with Leishmania infantum with different clinical stages.

Leishmaniosis is a zoonotic disease with a very complex pathogenesis modulated by the interaction between the parasite, the vector and the host. Although the pathological characteristics have been extensively studied in the typically affected organs, some locations such as muscles and reproductive organs have been less studied. The objective of this study was to evaluate the presence of lesions in the temporal muscle and the male reproductive organs (testicle and epididymis) and correlate their characteristics with the presence of the parasite and with the clinical status of the dogs. The temporal muscle was studied in 25 infected beagle dogs (nine females and 16 males) and five uninfected control dogs (two females and three males) and the testicle and epididymis in the 19 males. Dogs were euthanized one year after infection and clinical signs, anti-Leishmania serum antibodies, and lymph node parasite load were assessed. Muscular and reproductive lesions were characterized by H&E and immunohistochemistry (IHC). The presence of the parasite in the lesions was evaluated using IHC and molecular techniques. Myositis was observed in 72% (18/25) of the dogs and was characterized by lymphoplasmacytic or histiocytic lesions. Mild and severe lesions were detected, the latter being statistically associated with the presence of the parasite and with the clinical status of the dogs. Orchitis was observed in 50% (8/16) of the dogs and was mainly mild and lymphoplasmacytic. No statistical relationship was found between testicular lesions and the presence of the parasite or the clinical status. Epididymitis was observed in 87.5% (14/16) of the dogs, and the lesions were often infiltrated by numerous histiocytes and neutrophils. Epididymal lesions were statistically associated with the clinical status of the dogs and with the presence of the parasite in the lesions. IgG and IgM immunoglobulins were found in all lesions, suggesting a local immune response with reactivation of the infection. Leishmania was more frequently detected in severe and histiocytic lesions, although some lesions had no detectable parasites. These results have shown that lesions in the temporal muscle, epididymis, and testicles are common in dogs infected by Leishmania infantum and that dogs may show a different response to infection. This response is characterized by varying degrees of cellular and immune responses associated with a variable presence of the parasite.

Comparative Study of Real-Time PCR (TaqMan Probe and Sybr Green), Serological Techniques (ELISA, IFA and DAT) and Clinical Signs Evaluation, for the Diagnosis of Canine Leishmaniasis in Experimentally Infected Dogs.

Canine leishmaniasis (CanL) diagnosis is not fully resolved. Currently, two specific methodologies are in continuous development, the detection of the parasite DNA or RNA in target organs and the detection of specific antibodies against Leishmania sp. For a correct diagnosis, it has been shown that the joint use of this type of test is necessary. In this work, a Sybr Green and a TaqMan Probe based on real time PCRs (qPCR) was performed for the detection of Leishmania sp. in order to correlate the results with clinicopathological and serological evaluations (IFA, ELISA and DAT) to propose an optimal biological sample to be used to detect the parasite in both early and late stages of the infection. A total of four samples were processed: conjunctival swabs, popliteal lymph node aspirates, bone marrow aspirates, and peripheral blood from experimentally infected dogs belonging to a larger study. Our results indicated that a single non-invasive sample (conjunctival swab) and the application of both types of qPCR would be reliable for determining Leishmania infection as well as the disease stage in dogs, thus avoiding bone marrow, lymph node aspirate or blood samples collection.

Neutrophil Gelatinase-Associated Lipocalin (NGAL) Is Related with the Proteinuria Degree and the Microscopic Kidney Findings in Leishmania-Infected Dogs.

Early diagnosis of renal damage in Leishmania infected dogs may allow appropriate treatments and prevent some deaths. This study investigates neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker of kidney disease in dogs experimentally infected with Leishmania infantum. Serum, urine, and kidney samples were collected from 30 infected beagle dogs and six uninfected control dogs. Based on proteinuria and azotemia values, dogs were initially classified. NGAL was measured in urine and serum samples. Then, the urinary NGAL to creatinine ratio (uNGAL/C) was calculated. Kidney samples were taken for histopathological studies, and the dogs were classified according to the severity of glomerular and tubulointerstitial lesions. In Leishmania-infected dogs, the uNGAL/C was significantly higher in proteinuric non-azotemic dogs compared with non-proteinuric non-azotemic dogs (p = 0.038). Serum NGAL (sNGAL) concentration did not differ between groups. Microscopic studies revealed several degrees of glomerulonephritis and slight focal lymphoplasmacytic interstitial nephritis in 89% and 55% of infected dogs, respectively. Urinary protein to creatinine ratio (UPC) and uNGAL/C were significantly higher in dogs with affected glomeruli compared to infected dogs without renal lesions (p = 0.045 and p = 0.043, respectively). The results show that uNGAL/C correlates with proteinuria and the presence of moderate glomerular lesions in non-azotemic dogs experimentally infected with L. infantum.

Effect of income on the cumulative incidence of COVID-19: an ecological study.

OBJECTIVE: to analyze the relationship between per capita income and the cumulative incidence of COVID-19 in the neighborhoods of the city of Rio de Janeiro, RJ, Brazil. METHOD: an ecological study using neighborhoods as units of analysis. The cumulative incidence rate per 100,000 inhabitants and the median of potential confounding variables (sex, race, and age) were calculated. Multiple analysis included quantile regression, estimating the regression coefficients of the variable income for every five percentiles from the 10th to 90th percentiles to verify the relationship between income and incidence. RESULTS: the city's rate was 36.58 new cases per 100,000 inhabitants. In general, the highest rates were observed in the wealthiest regions. Multiple analysis was consistent with this observation since the per capita income affected all percentiles analyzed, with a median regression coefficient of 0.02 (p-value <0.001; R2 32.93). That is, there is an increase of R$ 0.02 in the neighborhood's per capita income for every unit of incidence. CONCLUSION: cumulative incident rates of COVID-19 are influenced by one's neighborhood of residency, suggesting that access to testing is uneven.

Pathological findings in genital organs of bulls naturally infected with Besnoitia besnoiti.

Bulls chronically affected by bovine besnoitiosis can suffer from sterility. There is limited information about the distribution of Besnoitia cysts and their associated lesions within the male genital organs. This work describes the gross and histological abnormalities in the genital organs of 6 bulls chronically infected with Besnoitia besnoiti, including both clinically (n = 4) and subclinically (n = 2) affected cases. Parasitic cysts were observed in the genital organs of all the clinically affected bulls. The tissue cysts were most commonly found within the pampiniform plexus (4/4), where they were often seen within venous vascular walls and associated with vasculitis, followed by epididymis (3/4), tunica albuginea (2/4), and penis (1/4). In decreasing order of their frequency, observed abnormalities included seminiferous tubule degeneration, testicular fibrosis, testicular necrosis, lack of/or diminished numbers of spermatozoa, testicular atrophy, and Leydig cell hyperplasia. Only one of the subclinically infected bulls had few Besnoitia cysts within the pampinoform plexus, which was associated to small areas of necrosis and mineralization in the ipsilateral testicle. Results indicate that Besnoitia cysts and genital abnormalities are frequent in bulls chronically affected by bovine besnoitiosis, while they are mild and scarce in subclinically affected ones. Moreover, present data show that Besnotia-associated testicular lesions can occur without the presence of cysts within the testicular parenchyma. B. besnoiti cysts seem to have a tropism for the vascular structures of the spermatic chord, which may cause testicular abnormalities via vascular damage, reduced blood flow, and/or impaired thermoregulation and subsequently lead to the observed testicular lesions.

Effect of income on the cumulative incidence of COVID-19: an ecological study / Efeito da renda sobre a incidência acumulada de COVID-19: um estudo ecológico / Efecto de la renta sobre la incidencia acumulada de COVID-19: un estudio ecológico

ABSTRACT Objective to analyze the relationship between per capita income and the cumulative incidence of COVID-19 in the neighborhoods of the city of Rio de Janeiro, RJ, Brazil. Method an ecological study using neighborhoods as units of analysis. The cumulative incidence rate per 100,000 inhabitants and the median of potential confounding variables (sex, race, and age) were calculated. Multiple analysis included quantile regression, estimating the regression coefficients of the variable income for every five percentiles from the 10th to 90th percentiles to verify the relationship between income and incidence. Results the city's rate was 36.58 new cases per 100,000 inhabitants. In general, the highest rates were observed in the wealthiest regions. Multiple analysis was consistent with this observation since the per capita income affected all percentiles analyzed, with a median regression coefficient of 0.02 (p-value <0.001; R2 32.93). That is, there is an increase of R$ 0.02 in the neighborhood's per capita income for every unit of incidence. Conclusion cumulative incident rates of COVID-19 are influenced by one's neighborhood of residency, suggesting that access to testing is uneven.(AU)

180-Day functional decline among older patients attending an emergency department after a fall.

OBJECTIVES: To determine functional changes and factors affecting 180-day functional prognosis among older patients attending a hospital emergency department (ED) after a fall. STUDY DESIGN: Retrospective analysis from a prospective cohort study (FALL-ER Registry) spanning one year that included individuals aged ≥65 years attending four Spanish EDs after a fall. We collected 9 baseline and 6 fall-related factors. MAIN OUTCOME MEASURES: Barthel Index (BI) was measured at baseline, discharge and 30, 90 and 180 days after the index fall. Absolute and relative BI changes were calculated. Absolute difference of ≥10 points between BI at baseline and at 180 days was considered a clinically significant functional decline. RESULTS: 452 patients (mean age 80 ±â€¯8 years; 70.8% women) were included. Baseline BI was 79.3 ±â€¯23.1 points. Compared with baseline, functional status was significantly lower at the 4 follow-up time points (-8.7% at discharge; and -6.9%, -7.9% and -9.5% at 30, 90 and 180 days; p < 0.001 for all comparisons in relation to baseline; p = 0.001 for change over time). One hundred and thirty-three (29.6%) patients had a clinically significant functional decline at 180 days. Age ≥85 years (OR = 2.24, 95%CI 1.23-4.08; p = 0.008), fall-related fracture (OR = 2.45, 95%CI 1.43-4.28; p = 0.001), hospitalization (OR = 1.91; 95%CI 1.11-3.29; p = 0.019) and post-fall syndrome (OR = 1.77, 95%CI 1.13-2.77; p = 0.013) were independently associated with 180-day clinically significant functional decline. CONCLUSION: Patients ≥65 years attending EDs after a fall experience a consistent and persistent negative impact on their functional status. Several factors may help identify patients at increased risk of functional impairment.

Consideraciones en el traumatismo craneoencefálico en urgencias / Considerations in traumatic brain injury in the emergency department

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Avaliação microbiológica de superfícies em terapia intensiva: reflexões sobre as estratégias preventivas de infecções nosocomiais / Microbiological evaluation of surfaces in intensive care: thinking about nosocomial infection prevention strategies / Evaluación microbiológica de superficies en cuidados intensivos: reflexiones sobre las estrategias preventivas de infecciones nosocomiales

Objetivo: determinar o perfil microbiológico de bactérias isoladas e identificadas nos leitos e bombas infusoras na unidade de terapia intensiva de um hospital universitário do Estado do Rio de Janeiro. Método: foram coletadas nove amostras de grades das camas dos pacientes e oito de teclados de bomba infusora de uma unidade de terapia intensiva, em outubro de 2014, delimitando-se uma área de 100cm² como parâmetro para ambas as coletas. As amostras foram coletadas através de swabs estéreis que foram umedecidos e transportados em Carry & Blair. Os microrganismos foram isolados, classificados e depois testados em relação à resistência antimicrobiana. Resultados: o gênero Staphylococcus coagulase negativa foi o mais prevalente. Os testes de suscetibilidade a antimicrobianos apontaram alguns destes Staphylococci como multirresistentes. Conclusão: chama-se atenção para a necessidade de ampliação do debate multiprofissional sobre questões de segurança hospitalar, apresentando a educação permanente como um possível caminho de sucesso no controle das infecções.

Objective: to determine the microbiological profile of bacteria isolated and identified from beds and infusion pumps in the intensive care unit of a university hospital in Rio de Janeiro state. Method: nine samples were collected from patients' bed side rails and eight from infusion pump keypads in an intensive care unit in October 2014. An area of 100cm² was delimited as the sampling parameter. Samples were collected using sterile swabs, which were wetted and transported with Cary-Blair. The microorganisms were isolated, classified, and then tested for antimicrobial resistance. Results: coagulase-negative Staphylococcus was the most prevalent type. Antimicrobial susceptibility testing indicated some of these Staphylococci were multi-drug resistant. Conclusion: multi-professional discussion of hospital safety issues must be expanded, and continuing professional development emerges as one possible pathway to success in nosocomial infection control.

Objetivo: determinar el perfil microbiológico de bacterias aisladas e identificadas en las camas y las bombas de infusión en la unidad de terapia intensiva de un hospital universitario de Rio de Janeiro. Método: se recolectaron nueve muestras de rejas de camas de pacientes y ocho de paneles de las bombas de infusión de una unidad de terapia intensiva, en octubre de 2014, delimitandose un área de 100 cm2 como parámetro para ambas recolecciones. Se recolectaron las muestras a través de swabs estériles que fueron humedecidos y transportados en Carry y Blair. Los microorganismos fueron aislados, clasificados y después probados repecto a la resistencia antimicrobiana. Resultados: el género Staphylococcus coagulasa negativo fue el más prevalente. Las pruebas de susceptibilidad a antimicrobianos mostraron algunos Staphylococci como resistentes a múltiples fármacos. Conclusión: se señala la necesidad de ampliación del debate entre los profesionales de la salud, sobre cuestiones de seguridad hospitalaria, presentando la educación permanente como un posible camino de éxito en el control de las infecciones.

Perfil de los pacientes ancianos atendidos en urgencias por caídas (Registro FALL-ER): magnitud del problema y posibilidades de mejora en los servicios de urgencias hospitalarios / Profile of older patients attended in the emergency department after falls: a FALL-ER registry study of the magnitude of the problem and opportunities for improving hospital emergency care

Objetivo: Estudiar el perfil de los pacientes de 65 años o más atendidos por una caída en los servicios de urgencias (SU), las características de las caídas, y el grado y los factores asociados con la realización de recomendaciones para prevenir las caídas (RPC). Método: FALL-ER es un registro de cohortes multipropósito, prospectivo y multicéntrico, con muestreo sistemático, que incluyó todos los pacientes de 65 años o más atendidos por caída en 5 SU durante 52 días en un año. Se recogieron 68 variables independientes. Los pacientes se clasificaron en función de recibir o no RPC (cualquiera de las siguientes: ejercicio, educación sobre prevención de las caídas, derivación a especialista o modificación de fármacos relacionados con las caídas). Resultados: Se analizaron 1.507 (93,6%) del total de 1.610 pacientes. Los pacientes tenían una edad muy avanzada y alto grado de comorbilidad, polifarmacia y síndromes geriátricos previos. La caída suele suceder de día, en domicilio y en la mitad de casos sin testigo. Un 48% refirió miedo a caerse, un 22% presentó deterioro funcional agudo, un 16% ingresó y un 0,6% falleció. Se realizaron RPC en 509 (33,8%) casos. La disminución de la agudeza auditiva, deterioro cognitivo autorreferido, atención médica en el lugar de la caída, miedo a volver a caerse, deterioro funcional agudo y hospitalización se asociaron con mayor probabilidad de RPC, y la disminución de la agudeza visual con menor probabilidad. Conclusiones: Solo tres de cada diez pacientes ancianos atendidos por una caída en urgencias recibe RPC posteriores, aunque existen ciertas características relacionadas con el paciente y la caída que se asocian a una mayor probabilidad de recibirlas

Objective: To profile patients aged 65 years or older who are attended in a hospital emergency department after falls. To describe the falls, their severity, and factors relevant to recommended preventive measures. Methods: The FALL-ER is a multipurpose, multicenter prospective registry of a systematically described cohort of patients aged 65 years or older attended in 5 hospital emergency departments on 52 days of the same year. We collected data on 68 independent variables. Patients were classified according to whether they had received recommendations related to preventing falls in any of the following categories: exercise, education on fall prevention, referral to a specialist or changes in medication. Results: A total of 1507 patients or carers were interviewed (93.6% of the 1610 patients in the registry). The cohort was of advanced age and had high rates of comorbidity, polypharmacy, and history of geriatric syndromes. The majority of falls occurred during the day and in the patients home. Half the falls were not witnessed. Forty-eight percent of the patients reported fear of falling, 22% had acute functional impairment, 16% were admitted, and 0.6% died in the hospital. Recommendations directed to preventing falls were received by 509 (33.8%) cases. Loss of hearing acuity, self-reported cognitive impairment, emergency first aid at the site of the fall, fear of falling again, acute functional impairment, and hospitalization were associated with a greater likelihood of receiving recommendations for preventing falls. Loss of visual acuity was associated with a lower likelihood of receiving recommendations. Conclusions: Only a third of elderly patients attended in an emergency department after falls receive recommendations that target preventing further falls. Certain patient and fall characteristics are associated with a greater likelihood of receiving such recommendations

Profile of older patients attended in the emergency department after falls: a FALL-ER registry study of the magnitude of the problem and opportunities for improving hospital emergency care. / Perfil de los pacientes ancianos atendidos en urgencias por caídas (Registro FALL-ER): magnitud del problema y posibilidades de mejora en los servicios de urgencias hospitalarios.

OBJECTIVES: To profile patients aged 65 years or older who are attended in a hospital emergency department after falls. To describe the falls, their severity, and factors relevant to recommended preventive measures. MATERIAL AND METHODS: The FALL-ER is a multipurpose, multicenter prospective registry of a systematically described cohort of patients aged 65 years or older attended in 5 hospital emergency departments on 52 days of the same year. We collected data on 68 independent variables. Patients were classified according to whether they had received recommendations related to preventing falls in any of the following categories: exercise, education on fall prevention, referral to a specialist or changes in medication. RESULTS: . A total of 1507 patients or carers were interviewed (93.6% of the 1610 patients in the registry). The cohort was of advanced age and had high rates of comorbidity, polypharmacy, and history of geriatric syndromes. The majority of falls occurred during the day and in the patients home. Half the falls were not witnessed. Forty-eight percent of the patients reported fear of falling, 22% had acute functional impairment, 16% were admitted, and 0.6% died in the hospital. Recommendations directed to preventing falls were received by 509 (33.8%) cases. Loss of hearing acuity, self-reported cognitive impairment, emergency first aid at the site of the fall, fear of falling again, acute functional impairment, and hospitalization were associated with a greater likelihood of receiving recommendations for preventing falls. Loss of visual acuity was associated with a lower likelihood of receiving recommendations. CONCLUSION: Only a third of elderly patients attended in an emergency department after falls receive recommendations that target preventing further falls. Certain patient and fall characteristics are associated with a greater likelihood of receiving such recommendations.

OBJETIVO: Estudiar el perfil de los pacientes de 65 años o más atendidos por una caída en los servicios de urgencias (SU), las características de las caídas, y el grado y los factores asociados con la realización de recomendaciones para prevenir las caídas (RPC). METODO: FALL-ER es un registro de cohortes multipropósito, prospectivo y multicéntrico, con muestreo sistemático, que incluyó todos los pacientes de 65 años o más atendidos por caída en 5 SU durante 52 días en un año. Se recogieron 68 variables independientes. Los pacientes se clasificaron en función de recibir o no RPC (cualquiera de las siguientes: ejercicio, educación sobre prevención de las caídas, derivación a especialista o modificación de fármacos relacionados con las caídas). RESULTADOS: Se analizaron 1.507 (93,6%) del total de 1.610 pacientes. Los pacientes tenían una edad muy avanzada y alto grado de comorbilidad, polifarmacia y síndromes geriátricos previos. La caída suele suceder de día, en domicilio y en la mitad de casos sin testigo. Un 48% refirió miedo a caerse, un 22% presentó deterioro funcional agudo, un 16% ingresó y un 0,6% falleció. Se realizaron RPC en 509 (33,8%) casos. La disminución de la agudeza auditiva, deterioro cognitivo autorreferido, atención médica en el lugar de la caída, miedo a volver a caerse, deterioro funcional agudo y hospitalización se asociaron con mayor probabilidad de RPC, y la disminución de la agudeza visual con menor probabilidad. CONCLUSIONES: Solo tres de cada diez pacientes ancianos atendidos por una caída en urgencias recibe RPC posteriores, aunque existen ciertas características relacionadas con el paciente y la caída que se asocian a una mayor probabilidad de recibirlas.

Phlebotomine mortality effect of systemic insecticides administered to dogs.

BACKGROUND: Zoonotic visceral leishmaniasis (ZVL) caused by Leishmania (Leishmania) infantum is an important disease in humans and dogs. Different mammal species are reservoirs but dogs are considered to be the main one. Phlebotomine sand flies are the proven vector. Four systemic insecticides approved for their use in dogs were previously selected based on their potential to be used in endemic countries as part of the control programs of ZVL. These insecticides are proved to be safe and effective against the on-label insects and parasites, but there is no information about their activity against phlebotomine sand flies. METHODS: The phlebotomine mortality of four systemic insecticides in dogs was evaluated using two randomized clinical trials. For the first trial, thirty dogs were randomly allocated into five groups: four treatments and one control, of equal size. The treatments evaluated were: Guardian®SR, Elanco (moxidectin); Comfortis®, Elanco (spinosad); Bravecto®, Merck Animal Health (fluralaner); and NexGard®, Merial (afoxolaner). Blood from dogs was taken at days 2, 4, 21 and 31 post-treatment (trial 1). The compound that showed the highest efficacy was selected for a second trial (trial 2) with 20 dogs sampled at days 0, 2, 4, 7, 14, 18, 32, 39, 51 and 84 post-treatment. Membrane feeding bioassays with Phlebotomus papatasi were used to evaluate the phlebotomine mortality efficacy of the different treatments. Phlebotomine mortality was observed every 24 h following the membrane feeding during 5 days. A mixed model for a negative binomial logistic regression, and a Cox proportional hazard mixed model were used to estimate phlebotomine mortality due to different treatments. RESULTS: Fluralaner was the only compound that showed significant phlebotomine mortality. Fluralaner maintained the phlebotomine mortality between 60-80% for 30 days after treatment. In trial 1 we found that fluralaner increased the risk of death by 1.9 times (95% CI: 1.02-3.6) and 1.7 times (95% CI: 1.09-2.6) at days 2 and 4 after treatment. The Cox model resulted in an increase of 1.47 (95% CI: 1.1-1.96) times in hazard risk at day 2 and 1.89 (95% CI: 1.35-2.45) at day 4 after treatment. In trial 2 we found that fluralaner increased the risk of death by 1.64 times (95% CI: 1.16-2.54) and 1.97 times (95% CI: 1.23-3.17) at days 14 and 32. The hazard risk was also increased by 1.92 (95% CI: 1.4-2.64) times at day 14 after treatment. Phlebotomine survival including all experimental days was significantly lower in the fluralaner group in both trials. CONCLUSIONS: A single oral treatment of fluralaner in dogs induces phlebotomine mortality. Systemic insecticides in dogs should be considered as a potential preventive measure of ZVL.