[The history of teaching at the Fernandes Figueira Institute: an interview with Susana Wuillaume]. / A história do ensino no Instituto Fernandes Figueira: entrevista com Susana Wuillaume.

This interview was conducted with Susana Maciel Wuillaume, a pediatrician with broad experience in education and in the management of the Fernandes Figueira Institute. Various topics in the institution's history and Wuillaume's individual trajectory were covered, such as the organization of the graduate course and the medical residency programs and the structure of the institution itself. This interview is part of a project to document and investigate the history of the Fernandes Figueira Institute, which celebrates its one hundredth anniversary in 2024.

Entrevista realizada com Susana Maciel Wuillaume, médica pediatra com larga experiência na docência e na gestão do Instituto Fernandes Figueira. São abordados diferentes temas da história institucional e da trajetória individual da entrevistada, como a organização da pós-graduação e dos programas de residências médica e a estruturação do próprio instituto. A entrevista faz parte de um projeto que documenta e investiga a história do Instituto Fernandes Figueira, que completa seu centenário em 2024.

Detection of sexually transmitted infections among transvestites and transsexual women in prison in the metropolitan region of Rio de Janeiro, Brazil.

OBJECTIVE: To evaluate the seropositivity rate of rapid tests for HIV, syphilis and hepatitis B and C among transvestites and transgender women (transfeminine persons) inmates in the metropolitan region of Rio de Janeiro, analyzing the results based on sociodemographic, prison profile and access to health technologies to prevent sexually transmitted infections (STIs). METHODS: Cross-sectional census-type study carried out with transfeminine in eleven male prisons in Rio de Janeiro, between the months of April and June 2021. RESULTS: The detection rates found were 34.4% for HIV, and 48.9% for syphilis, and 0.8% for type B and C hepatitis. Seropositivity for more than one infection was verified in 25.4% of participants, and HIV/syphilis was the most prevalent. An increase in the level of education (p=0.037) and having a steady partner in prison (p=0.041) were considered protective factors for STIs in this population. Difficulties were identified in accessing STI prevention technologies, such as male condoms, lubricating gel, rapid tests, and prophylactic antiretroviral therapies for HIV. CONCLUSION: HIV and syphilis seropositivity rates were high, but within the profile found in this population in other studies inside or outside prisons. The data found indicates the need to incorporate effective strategies for access to health technologies for the prevention of STIs. The scarcity of scientific publications containing epidemiological data on STIs in the transfeminine prison population limited deeper comparisons of the results obtained in this study.

[Online survey on the reasons for vaccine hesitancy against COVID-19 in children and adolescents in Brazil]. / Inquérito online sobre os motivos para hesitação vacinal contra a COVID-19 em crianças e adolescentes do Brasil.

The objective is to unveil the reasons for vaccine hesitancy among parents and/or guardians of children and adolescents toward the prevention of COVID-19. This is a descriptive study, with a qualitative approach that seeks to analyze the answers to the open question "Why will you not vaccinate or have not vaccinated or are in doubt about vaccinating the children and adolescents under your responsibility, for the prevention of COVID-19?". The research included adult individuals, Brazilians, living in the country, responsible for children and adolescents under 18 years of age. Data collection took place electronically in November and December 2021. The answers were organized and processed with the support of the software Iramuteq. The textual corpus of this research was composed of the response of 1,896 participants, consisting of 87% who were hesitant (1,650) and 13% (246) of parents who intend to vaccinate but who outlined some doubts and considerations about the vaccination of children and adolescents. These are reasons why parents and/or guardians have not vaccinated or are in doubt about vaccinating the children and adolescents under their responsibility for the prevention of COVID-19: fears about vaccination regarding the conception that the vaccine is in the experimental phase, fear of adverse reactions and long-term effects. The reasons for the lack of intention to vaccinate stem from the understanding of the participants that COVID-19 in children is not serious, the risks of vaccination are greater than the benefits, and the right of choice not to vaccinate.

Objetiva-se desvelar os motivos para hesitação vacinal de pais e/ou responsáveis de crianças e adolescentes para prevenção da COVID-19. Trata-se de um estudo descritivo, de abordagem qualitativa, que busca analisar as respostas da pergunta aberta "por que você não vai vacinar, não vacinou ou está na dúvida em vacinar as crianças e os adolescentes sob sua responsabilidade para prevenção da COVID-19?". A pesquisa incluiu indivíduos adultos, brasileiros, residentes no país, responsáveis por crianças e adolescentes menores de 18 anos. A coleta de dados aconteceu de forma eletrônica entre os meses de novembro e dezembro de 2021. As respostas foram organizadas e processadas com suporte do software Iramuteq. O corpus textual desta pesquisa foi composto pela resposta de 1.896 participantes, constituído por 87% de hesitantes (1.650) e 13% (246) de pais que têm intenção de vacinar, mas que esboçaram algumas dúvidas e considerações a respeito da vacinação de crianças e adolescentes. São motivos pelos quais pais e/ou responsáveis não vacinaram ou estão na dúvida em vacinar as crianças e os adolescentes sob sua responsabilidade para prevenção da COVID-19: receio em razão de a vacina estar em fase experimental e medo das reações adversas e dos efeitos a longo prazo. Já os motivos para ausência de intenção de vacinar decorrem dos entendimentos dos participantes de que a COVID-19 em crianças não é grave, os riscos da vacinação são maiores do que os benefícios e o direito de escolha em não vacinar.

El objetivo es revelar los motivos de la indecisión a las vacunas de padres y/o responsables de niños y adolescentes para la prevención de COVID-19. Se trata de un estudio descriptivo con enfoque cualitativo, que busca analizar las respuestas a la pregunta abierta "¿Por qué no va a vacunar o no vacunó o tiene dudas en vacunar a los niños y los adolescentes bajo su responsabilidad para la prevención del COVID-19?". La investigación incluyó individuos adultos, brasileños, residentes en el país, responsables de niños y adolescentes menores de 18 años. La recolección de datos se realizó de forma electrónica entre los meses de noviembre y diciembre de 2021. Las respuestas se organizaron y procesaron con ayuda del software Iramuteq. El corpus textual de esta investigación fue compuesto por la respuesta de 1.896 participantes, siendo constituido por el 87% de indecisos (1.650) y el 13% (246) de padres que tienen la intención de vacunar, pero que esbozaron algunas dudas y consideraciones respecto a la vacunación de niños y adolescentes. Son motivos por los cuales los padres y/o responsables no vacunaron o están en duda en vacunar a los niños y adolescentes bajo su responsabilidad para prevención del COVID-19: temores con la vacunación en cuanto a la concepción de que la vacuna está en fase experimental, miedo a las reacciones adversas y los efectos a largo plazo. Los motivos de la ausencia de intención en vacunar se deben a que los participantes entienden que el COVID-19 en niños no es grave, que los riesgos de la vacunación son mayores que los beneficios y que tienen derecho a decidir no vacunarse.

Look, you are (not) alone: circulating gift and the mental health of healthcare professionals during the COVID-19 pandemic. / Olha, você (não) está sozinho: a circulação da dádiva e a saúde mental de profissionais de saúde durante a pandemia de COVID-19.

The mental health of health professionals who worked directly in services during the COVID-19 pandemic to care for patients affected by the disease became a fundamental issue to be considered, given the several consequences of this activity for these professionals. This article aimed to understand the challenges and demands of health professionals concerning support to address the emotional and physical exhaustion of working on the so-called frontline during the COVID-19 pandemic. The qualitative methodological approach was based on semi-structured interviews conducted online with these professionals after the first months of the pandemic. The hero's place in which they were set, even if only in media discourses, soon gave way to their weaknesses and fragile work relationships to emerge: stress, fear, and the listening and reception desire. Marcel Mauss' gift theory was brought up considering that new ways of reading and interpreting health work relationships contribute to necessary and urgent reformulations of their current context, targeting mental health and, more broadly, the comprehensive health of healthcare professionals.

Durante a pandemia de COVID-19, a saúde mental dos profissionais de saúde, que trabalharam diretamente nos serviços voltados para o cuidado dos pacientes afetados pela doença, tornou-se questão fundamental a ser considerada, dado os diversos desdobramentos que essa atuação gerou para esses profissionais. O objetivo deste artigo foi compreender desafios e demandas dos profissionais de saúde em termos de suporte para lidar com o desgaste emocional e físico com a atuação na chamada linha de frente durante a pandemia de COVID-19. A abordagem metodológica qualitativa se deu a partir de entrevistas semiestruturadas realizadas em ambiente online com esses profissionais, passados os primeiros meses de pandemia. O lugar de herói em que eles foram colocados, ainda que apenas nos discursos midiáticos, logo deu espaço para que as fragilidades destes e das relações de trabalho aparecessem: estresse, medo e o desejo de escuta e acolhimento. A teoria da dádiva de Marcel Mauss foi trazida considerando que novas formas de leitura e interpretação das relações de trabalho em saúde contribuem para reformulações necessárias e urgentes do contexto em que se encontram hoje, visando a saúde mental e, mais amplamente, a saúde integral dos profissionais da área de saúde.

Olha, você (não) está sozinho: a circulação da dádiva e a saúde mental de profissionais de saúde durante a pandemia de COVID-19 / Look, you are (not) alone: circulating gift and the mental health of healthcare professionals during the COVID-19 pandemic

Resumo Durante a pandemia de COVID-19, a saúde mental dos profissionais de saúde, que trabalharam diretamente nos serviços voltados para o cuidado dos pacientes afetados pela doença, tornou-se questão fundamental a ser considerada, dado os diversos desdobramentos que essa atuação gerou para esses profissionais. O objetivo deste artigo foi compreender desafios e demandas dos profissionais de saúde em termos de suporte para lidar com o desgaste emocional e físico com a atuação na chamada linha de frente durante a pandemia de COVID-19. A abordagem metodológica qualitativa se deu a partir de entrevistas semiestruturadas realizadas em ambiente online com esses profissionais, passados os primeiros meses de pandemia. O lugar de herói em que eles foram colocados, ainda que apenas nos discursos midiáticos, logo deu espaço para que as fragilidades destes e das relações de trabalho aparecessem: estresse, medo e o desejo de escuta e acolhimento. A teoria da dádiva de Marcel Mauss foi trazida considerando que novas formas de leitura e interpretação das relações de trabalho em saúde contribuem para reformulações necessárias e urgentes do contexto em que se encontram hoje, visando a saúde mental e, mais amplamente, a saúde integral dos profissionais da área de saúde.

Abstract The mental health of health professionals who worked directly in services during the COVID-19 pandemic to care for patients affected by the disease became a fundamental issue to be considered, given the several consequences of this activity for these professionals. This article aimed to understand the challenges and demands of health professionals concerning support to address the emotional and physical exhaustion of working on the so-called frontline during the COVID-19 pandemic. The qualitative methodological approach was based on semi-structured interviews conducted online with these professionals after the first months of the pandemic. The hero's place in which they were set, even if only in media discourses, soon gave way to their weaknesses and fragile work relationships to emerge: stress, fear, and the listening and reception desire. Marcel Mauss' gift theory was brought up considering that new ways of reading and interpreting health work relationships contribute to necessary and urgent reformulations of their current context, targeting mental health and, more broadly, the comprehensive health of healthcare professionals.

Social Representations of Hesitant Brazilians about Vaccination against COVID-19.

BACKGROUND: The control of the COVID-19 pandemic has been a great challenge. Understanding the thoughts and beliefs underlying vaccine hesitancy can help in the formulation of public policies. The present study aimed to analyze the social representations of hesitant Brazilians about vaccination against COVID-19. METHODS: Qualitative research guided by the Theory of Social Representations, carried out through an online survey among Brazilian adults living in Brazil. The data were analyzed using the IRaMuTeQ software. RESULTS: Of the 173,178 respondents, 10,928 were hesitant and declared reasons for vaccination hesitation. The analysis generated three classes: mistrust of the vaccine and underestimation of the severity of the pandemic; (dis)information and distrust of political involvement; and fear of adverse reactions to COVID-19 vaccines. CONCLUSIONS: Social knowledge, presented by the representations apprehended in this study, demonstrates difficulty in discerning the reliability of information and a social imagination full of doubts and uncertainties. Understanding the internal dynamics of these groups, with their representations of the world, is important to propose policies and actions that echo and cause changes in the understanding of the role of immunization. It is essential to shed light on the sociological imagination so that gaps filled with false information can be dismantled and confronted with scientific knowledge accessible to the population.

Trustworthiness of information sources on vaccines for COVID-19 prevention among Brazilians.

OBJECTIVE: This study aims to assess the trustworthiness of information sources, perception of clear information about the vaccine, and strategies to increase adherence to vaccination to provide managers with information that helps establish effective communication with the population about vaccination. METHOD: This is an online survey conducted between January 22 and 29, 2021, preceded by an Informed Consent, that aims to assess vaccine hesitancy, which corresponded to the first week of vaccination initiation to prevent COVID-19 in Brazil. Data were obtained from a questionnaire made available through a free platform and stored in Google Forms and later exported to the SPSS statistical package for analysis. The sample consisted of all questionnaires from participants who self-declared as age 18 or older, Brazilian, and residing in Brazil at the time of the survey. Incomplete records with more than 50% of blank items and duplicates were excluded. All categorical variables were analyzed from their absolute and relative frequencies. Multivariate logistic regression was performed to verify the relationship between dependent variables and independent variables. RESULTS: The results show that trust in information sources diverges between hesitant and non-hesitant. They also showed that some participants show an overall distrust that seems to have deeper foundations than issues related only to the source of information. The high rejection of television and the WHO as sources of information among hesitant suggests that integrated actions with research institutes, public figures vaccinating, and religious leaders can help to combat vaccine hesitation. Two actors become particularly important in this dynamic, both for good and bad, and their anti-vaxxer behavior must be observed: the doctor and the Ministry of Health. CONCLUSION: This study contributes to gathering valuable information to help understand the behavior and thinking relevant to the adherence to vaccination recommendations.

Inquérito online sobre os motivos para hesitação vacinal contra a COVID-19 em crianças e adolescentes do Brasil / Online survey on the reasons for vaccine hesitancy against COVID-19 in children and adolescents in Brazil / Encuesta en línea sobre los motivos de la indecisión a las vacunas contra COVID-19 en niños y adolescentes de Brasil

Resumo: Objetiva-se desvelar os motivos para hesitação vacinal de pais e/ou responsáveis de crianças e adolescentes para prevenção da COVID-19. Trata-se de um estudo descritivo, de abordagem qualitativa, que busca analisar as respostas da pergunta aberta "por que você não vai vacinar, não vacinou ou está na dúvida em vacinar as crianças e os adolescentes sob sua responsabilidade para prevenção da COVID-19?". A pesquisa incluiu indivíduos adultos, brasileiros, residentes no país, responsáveis por crianças e adolescentes menores de 18 anos. A coleta de dados aconteceu de forma eletrônica entre os meses de novembro e dezembro de 2021. As respostas foram organizadas e processadas com suporte do software Iramuteq. O corpus textual desta pesquisa foi composto pela resposta de 1.896 participantes, constituído por 87% de hesitantes (1.650) e 13% (246) de pais que têm intenção de vacinar, mas que esboçaram algumas dúvidas e considerações a respeito da vacinação de crianças e adolescentes. São motivos pelos quais pais e/ou responsáveis não vacinaram ou estão na dúvida em vacinar as crianças e os adolescentes sob sua responsabilidade para prevenção da COVID-19: receio em razão de a vacina estar em fase experimental e medo das reações adversas e dos efeitos a longo prazo. Já os motivos para ausência de intenção de vacinar decorrem dos entendimentos dos participantes de que a COVID-19 em crianças não é grave, os riscos da vacinação são maiores do que os benefícios e o direito de escolha em não vacinar.

Abstract: The objective is to unveil the reasons for vaccine hesitancy among parents and/or guardians of children and adolescents toward the prevention of COVID-19. This is a descriptive study, with a qualitative approach that seeks to analyze the answers to the open question "Why will you not vaccinate or have not vaccinated or are in doubt about vaccinating the children and adolescents under your responsibility, for the prevention of COVID-19?". The research included adult individuals, Brazilians, living in the country, responsible for children and adolescents under 18 years of age. Data collection took place electronically in November and December 2021. The answers were organized and processed with the support of the software Iramuteq. The textual corpus of this research was composed of the response of 1,896 participants, consisting of 87% who were hesitant (1,650) and 13% (246) of parents who intend to vaccinate but who outlined some doubts and considerations about the vaccination of children and adolescents. These are reasons why parents and/or guardians have not vaccinated or are in doubt about vaccinating the children and adolescents under their responsibility for the prevention of COVID-19: fears about vaccination regarding the conception that the vaccine is in the experimental phase, fear of adverse reactions and long-term effects. The reasons for the lack of intention to vaccinate stem from the understanding of the participants that COVID-19 in children is not serious, the risks of vaccination are greater than the benefits, and the right of choice not to vaccinate.

Resumen: El objetivo es revelar los motivos de la indecisión a las vacunas de padres y/o responsables de niños y adolescentes para la prevención de COVID-19. Se trata de un estudio descriptivo con enfoque cualitativo, que busca analizar las respuestas a la pregunta abierta "¿Por qué no va a vacunar o no vacunó o tiene dudas en vacunar a los niños y los adolescentes bajo su responsabilidad para la prevención del COVID-19?". La investigación incluyó individuos adultos, brasileños, residentes en el país, responsables de niños y adolescentes menores de 18 años. La recolección de datos se realizó de forma electrónica entre los meses de noviembre y diciembre de 2021. Las respuestas se organizaron y procesaron con ayuda del software Iramuteq. El corpus textual de esta investigación fue compuesto por la respuesta de 1.896 participantes, siendo constituido por el 87% de indecisos (1.650) y el 13% (246) de padres que tienen la intención de vacunar, pero que esbozaron algunas dudas y consideraciones respecto a la vacunación de niños y adolescentes. Son motivos por los cuales los padres y/o responsables no vacunaron o están en duda en vacunar a los niños y adolescentes bajo su responsabilidad para prevención del COVID-19: temores con la vacunación en cuanto a la concepción de que la vacuna está en fase experimental, miedo a las reacciones adversas y los efectos a largo plazo. Los motivos de la ausencia de intención en vacunar se deben a que los participantes entienden que el COVID-19 en niños no es grave, que los riesgos de la vacunación son mayores que los beneficios y que tienen derecho a decidir no vacunarse.

Detection of sexually transmitted infections among transvestites and transsexual women in prison in the metropolitan region of Rio de Janeiro, Brazil / Testagem rápida de infecções sexualmente transmissíveis entre travestis e mulheres transexuais em situação de prisão na Região Metropolitana do Rio de Janeiro, Brasil

ABSTRACT Objective: To evaluate the seropositivity rate of rapid tests for HIV, syphilis and hepatitis B and C among transvestites and transgender women (transfeminine persons) inmates in the metropolitan region of Rio de Janeiro, analyzing the results based on sociodemographic, prison profile and access to health technologies to prevent sexually transmitted infections (STIs). Methods: Cross-sectional census-type study carried out with transfeminine in eleven male prisons in Rio de Janeiro, between the months of April and June 2021. Results: The detection rates found were 34.4% for HIV, and 48.9% for syphilis, and 0.8% for type B and C hepatitis. Seropositivity for more than one infection was verified in 25.4% of participants, and HIV/syphilis was the most prevalent. An increase in the level of education (p=0.037) and having a steady partner in prison (p=0.041) were considered protective factors for STIs in this population. Difficulties were identified in accessing STI prevention technologies, such as male condoms, lubricating gel, rapid tests, and prophylactic antiretroviral therapies for HIV. Conclusion: HIV and syphilis seropositivity rates were high, but within the profile found in this population in other studies inside or outside prisons. The data found indicates the need to incorporate effective strategies for access to health technologies for the prevention of STIs. The scarcity of scientific publications containing epidemiological data on STIs in the transfeminine prison population limited deeper comparisons of the results obtained in this study.

RESUMO Objetivo: Avaliar a taxa de soropositividade dos testes rápidos para HIV, sífilis e hepatite B e C entre travestis e mulheres transexuais (transfemininas) privadas de liberdade na Região Metropolitana do Rio de Janeiro, analisando os resultados diante do perfil sociodemográfico, prisional e acesso às tecnologias de saúde para prevenir infecções sexualmente transmissíveis (IST). Métodos: Estudo transversal do tipo censitário realizado com transfemininas em 11 prisões do Rio de Janeiro, entre os meses de abril e junho de 2021. Resultados: As taxas de soropositividade encontradas foram de 34,4% para o HIV, 48,9% para sífilis e 0,8% para as hepatites do tipo B e C. A soropositividade para mais de uma infecção foi verificada em 25,4% das participantes, e HIV/sífilis foi a mais prevalente. O aumento no nível de escolarização (p=0,037), e possuir parceiro fixo na prisão (p=0,041) foram considerados fatores de proteção para as IST nessa população. Foram identificadas dificuldades no acesso às tecnologias de prevenção contra IST, como preservativo masculino, gel lubrificante, testes rápidos e terapias antirretrovirais profiláticas para o HIV. Conclusão: As taxas de soropositividade para o HIV e sífilis foram elevadas, mas no perfil encontrado nessa população em outros estudos dentro e fora das prisões. Os dados encontrados indicam a necessidade de incorporar estratégias efetivas para o acesso às tecnologias em saúde para a prevenção das IST. A escassez de publicações científicas contendo dados epidemiológicos sobre IST na população transfeminina em situação de prisão limitou a realização de comparações mais profundas dos resultados obtidos neste estudo.

Acquired Hip Dysplasia in Children with Congenital Zika Virus Infection in the First Four Years of Life.

Acquired hip dysplasia has been described in children with cerebral palsy (CP); periodic surveillance is recommended in this population to prevent hip displacement and dislocation. Children with congenital zika syndrome (CZS) may present a spectrum of neurological impairments with changes in tonus, posture, and movement similar to children with CP. However, the relationship between CZS and hip dysplasia has not been characterized. In this prospective cohort study, we aimed to describe the occurrence of hip dysplasia in patients with CZS. Sixty-four children with CZS from 6 to 48 months of age were included and followed at a tertiary referral center in Rio de Janeiro, Brazil, with periodic radiologic and clinical hip assessments. Twenty-six (41%) patients were diagnosed with hip dysplasia during follow-up; mean age at diagnosis was 23 months. According to the Gross Motor Function Classification System (GMFCS), 58 (91%) patients had severe impairment (GMFCS IV and V) at the first evaluation. All patients with progression to hip dysplasia had microcephaly and were classified as GMFCS IV or V. Pain and functional limitation were reported by 22 (84%) caregivers of children with hip dysplasia. All patients were referred to specialized orthopedic care; eight (31%) underwent surgical treatment during follow-up. Our findings highlight the importance of implementing a hip surveillance program and improving access to orthopedic treatment for children with CZS in order to decrease the chances of dysplasia-related complications and improve quality of life.

Anthropometric Parameters of Children with Congenital Zika Virus Exposure in the First Three Years of Life.

Little is known about the impact of congenital Zika virus (ZIKV) exposure on growth in the first years of life. In this prospective cohort study,201 ZIKV antenatally-exposed children were followed at a tertiary referral center in Rio de Janeiro, Brazil. Eighty-seven were classified as congenital Zika syndrome (CZS) patients and 114 as not congenital Zika syndrome (NCZS); growth parameters were described and compared between groups and with WHO standard growth curves. Thirty-four (39%) newborns with CZS and seven (6%) NCZS were small for gestational age (p < 0.001). NCZS mean weight measures ranged from −0.45 ± 0.1 to 0.27 ± 0.2 standard deviations (SD) from the WHO growth curve median during follow-up, versus −1.84 ± 0.2 to −2.15 ± 0.2 SD for the CZS group (p < 0.001). Length mean z-scores varied from −0.3 ± 0.1 at 1 month to 0.17 ± 0.2 SD between 31 and 36 months in the NCZS group, versus −2.3 ± 0.3 to −2.0 ± 0.17 SD in the CZS group (p < 0.001). Weight/height (W/H) and BMI z-scores reached -1.45 ± 0.2 SD in CZS patients between 31 and 36 months, versus 0.23 ± 0.2 SD in the NCZS group (p < 0.01). Between 25 and 36 months of age, more than 50% of the 70 evaluated CZS children were below weight and height limits; 36 (37.1%) were below the W/H cut-off. Gastrostomy was performed in 23 (26%) children with CZS. During the first three years of life, CZS patients had severe and early growth deficits, while growth of NCZS children was normal by WHO standards.

Repercussions of the COVID-19 pandemic on health professionals in the state of Rio de Janeiro / Brazil.

Brazil has been severely affected by the COVID-19 pandemic. The high numbers of confirmed cases and deaths have continued unabated since the first reported case, with no flattening or downward turn in the curve. In this context, healthcare workers have been exposed uninterruptedly to stress factors throughout a year of the pandemic. The study´s aim was to identify and analyze healthcare workers´ perceptions of their feelings and concerns that have surfaced in responding to the pandemic. METHOD: This was a cross-sectional online qualitative survey study of 554 healthcare personnel working in the state of Rio de Janeiro during the COVID-19 pandemic. Recruitment occurred from July 20 to September 30, 2020, using an online survey, preceded byfree informed consent term. Data were analyzed with the Iramuteq software. RESULTS: Through a dendrogram, the words with the highest chi-square were highlighted and grouped into four classes: healthcare workers´ fear of falling ill to COVID-19 and infecting their family members; work/labor issues; feelings of powerlessness and need for public policies for government action; and fatigue and burnout in the pandemic. Each word class was also illustrated by a similarity tree. CONCLUSION: The study revealed healthcare workers´ exacerbated fear of infection and transmission of COVID-19 to their family members, besides financial losses and feelings of powerlessness and abandonment.

Acupuntura-láser para controlar la glucosa en sangre en la diabetes tipo II: un ensayo clínico aleatorizado / Laser-acupuncture to control blood glucose in Type II Diabetes: a randomized clinical trial / Laser-acupuntura no controle da glicemia na Diabetes tipo II: ensaio clínico randomizado

OBJETIVO: Evaluar la efectividad de la acupuntura-laser aplicada al cuidado de enfermería de personas con diabetes mellitus tipo II. MÉTODOS: Ensayo clínico aleatorizado, triple ciego, con 42 participantes diabéticos tipo II, ambos sexos, con edades comprendidas entre 30 y 75 años, con hipoglucemiantes orales y dificultades para mantener la glucemia posprandial ≤ 180mg/ dl. Los participantes fueron asignados aleatoriamente a dos grupos diferentes y sometidos a láser-acupuntura estándar, brazo experimental o brazo de control simulado. Se utilizaron análisis descriptivos y de asociación entre variables, con un nivel de significancia del 5% (p <0,05). Para comparar los resultados de glucosa en sangre, se utilizó la prueba t de Student para muestras pareadas y Anova para mediciones repetidas. RESULTADOS: Se observó una disminución significativa de la glucemia capilar en los participantes del brazo experimental, fenómeno no verificado en los del brazo control. CONCLUSIONES: Se infiere la plausibilidad de utilizar la técnica como tecnología para el cuidado de enfermería de personas con diabetes mellitus tipo II. Registro Brasileño de Ensayos Clínicos. UTN: U1111-1181-1675. Ensayos clínicos NCT02605889

OBJECTIVE: To evaluate the effectiveness of laser-acupuncture applied to nursing care for people with type II diabetes mellitus. METHODS: Randomized, triple-blinded clinical trial, with 42 type II diabetic participants, both genders, aged between 30 and 75 years, using oral hypoglycemic agents and difficulties in maintaining postprandial glycaemia ≤ 180mg/dl. Participants were randomly assigned to two different groups and submitted to standard laser-acupuncture, experimental arm, or simulated, control arm. Descriptive and association analyses between variables were used, with a significance level of 5% (p <0,05). To compare blood glucose results, Student's t test was used for paired samples and Anova for repeated measurements. RESULTS: A significant decrease in capillary glycaemia was observed in the participants in the experimental arm, a phenomenon not verified in those in the control arm. CONCLUSIONS: the plausibility of using the technique as a technology for nursing care for people with type II diabetes mellitus is inferred. Brazilian Registry of Clinical Trials. UTN: U1111-1181-1675. Clinical Trials NCT02605889

OBJETIVO: Avaliar a eficácia da laser-acupuntura aplicada ao cuidado de enfermagem à pessoas com diabetes mellitus tipo II. MÉTODOS: Ensaio clínico randomizado, triplo cego, com 42 participantes diabéticos do tipo II, ambos os sexos, idades entre 30 a 75 anos, em uso de hipoglicemiantes orais e dificuldades para manter a glicemia pós prandial ≤ 180mg/dl. Os participantes foram distribuídos aleatoriamente em dois grupos distintos e submetidos a laser-acupuntura padrão, braço experimental, ou simulada, braço controle. Empregaram-se análises descritivas e de associação entre variáveis, com nível de significância de 5% (p < 0,05). Para comparação entre os resultados da glicemia empregou-se teste t de Student para amostras pareadas e Anova para medidas repetidas. RESULTADOS: Observou-se diminuição significativa na glicemia capilar dos participantes do braço experimental, fenômeno não verificado naqueles do braço controle. CONCLUSÕES: Infere-se a plausibilidade da utilização da técnica como tecnologia para o cuidado de enfermagem às pessoas com diabetes mellitus do tipo II. Registro Brasileiro de Ensaios Clínicos. UTN: U1111-1181-1675. Clinical Trials NCT02605889

Aplicativos móveis desenvolvidos para crianças e adolescentes que vivem com doenças crônicas: uma revisão integrativa / Aplicaciones móviles desarrolladas para niños y adolescentes en condición crónica de salud: una revisión integradora / Mobile applications developed for children and adolescents experiencing chronic health conditions: an integrative review

Este artigo apresenta os resultados de uma revisão integrativa de literatura sobre os métodos de desenvolvimento de aplicativos móveis para crianças e adolescentes que vivem com doenças crônicas. Foi analisada a literatura disponível no Medline/PubMed, Web of Science, SciELO, Lilacs e Embase, no período de 2010 a 2020. De 87 artigos identificados nas bases de dados, oito atenderam aos critérios de inclusão e qualidade. Observou-se que o uso do humor, da gamificação e da linguagem simples e visual atraente despertou o interesse e facilita a utilização do aplicativo. A análise da literatura evidenciou que o desenvolvimento de aplicativos para crianças e adolescentes deve reconhecer as necessidades do usuário e incluí-lo em sua criação. Os aplicativos móveis de saúde favoreceram a adesão e o autocuidado e foram importantes aliados no cuidado de crianças e adolescentes adoecidos cronicamente. (AU)

Este artículo presenta los resultados de una revisión integradora de literatura sobre los métodos de desarrollo de aplicaciones móviles para niños y adolescentes en condiciones crónicas de salud. Se analizó la literatura disponible en MEDLINE/PubMed, Web of Science, SciELO, LILACS y EMBASE, en el período de 2010 a 2020. De 87 artículos identificados en las bases de datos, 8 cumplieron los criterios de inclusión y calidad. Se observó que el uso del humor, de la gamificación, lenguaje simple y visual atractivo despiertan el interés y facilitan la utilización de la aplicación. El análisis de la literatura puso en evidencia que el desarrollo de aplicaciones para niños y adolescentes debe reconocer las necesidades del usuario e incluirlo en su creación. Las aplicaciones móviles de salud favorecieron la adhesión y el autocuidado y fueron aliados importantes en el cuidado de niños y adolescentes con enfermedades crónicas. (AU)

This paper presents the results of an integrative literature review regarding the methods to develop mobile applications for children and adolescents experiencing chronic health conditions. The analyzed manuscripts were available on MEDLINE/PubMed, Web of Science, SciELO, LILACS and EMBASE, over a period from 2010 to 2020. We identified 87 manuscripts in the databases and 8 of them attended the inclusion and quality criteria. It was observed that the use of humor, gamification, simple language and attractive visuals arouse interest and facilitated the use of the application. The examined literature evidenced that the development of applications for children and adolescents must recognize the needs of users, considering them in the creation process. Mobile health applications favored adherence and self-care and were important allies in the care of chronically ill children and adolescents. (AU)

Prognostic factors of death in children during the first year of life due to congenital diaphragmatic hernia: analysis of a hospital cohort from 2005 to 2015 / Fatores prognósticos para o óbito de crianças no primeiro ano de vida por hérnia diafragmática congênita: análise de uma coorte hospitalar de 2005 a 2015

Abstract Objective: To describe and analyze the prognosis of children during the first year of life with a diagnosis of congenital diaphragmatic hernia admitted between the years 2005 and 2015 in the Neonatal Intensive Care Unit. Method: In a retrospective cohort, 129 children with a diagnosis of congenital diaphragmatic hernia were studied. The prognostic factors were analyzed, whereupon prenatal, delivery, and postnatal exposure variables were associated with death during the first year of life. The odds ratio and the confidence interval (95% CI) were calculated for all the studied variables, using the chi-squared test and Student's t-test. Results: The study included 129 children hospitalized from January of 2005 to December of 2015. Seventy-nine (61%) patients died, 50 survived, and 33 had other associated malformations. Among the prognostic factors, the following were significant and increased the chance of death: polyhydramnios (p = 0.001), gestational age of the earliest diagnosis (p = 0.004), associated congenital abnormalities (OR: 3.013, p = 0.022), pO2 of the first gasometry (p = 0.000), pCO2 of the first gasometry (p = 0.000), presence of pulmonary hypoplasia (OR: 3.074, p = 0.000), use of preoperative vasoactive drugs (OR: 2.881, p = 0.000), and use of nitric oxide (OR: 1.739, p = 0.000). The presence of only intestines in the hernia content was a protective factor (OR: 0.615, p = 0.001). Conclusion: The mortality in the first year of life in patients with congenital diaphragmatic hernia in this study was 61% in the years 2005-2015. Among the prognostic factors that demonstrated a significant effect, pulmonary hypoplasia had the greatest impact.

Resumo Objetivo: Descrever e analisar o prognóstico de crianças ao longo do primeiro ano de vida com diagnóstico de hérnia diafragmática congênita admitidas entre 2005 e 2015 na Unidade de Terapia Intensiva Neonatal. Método: Em uma coorte retrospectiva estudamos 129 crianças com diagnóstico de hérnia diafragmática congênita. Foram analisados os fatores prognósticos onde as variáveis de exposição do pré-natal, parto e pós-natais foram associadas ao óbito no primeiro ano de vida. Calculamos a odds ratio (OR) e o intervalo de confiança (IC95%) para todas as variáveis estudadas, sendo utilizados os testes de qui-quadrado e o teste T Student. Resultados: Foram incluídos no estudo 129 crianças, internados de janeiro/2005 a dezembro/2015. Foram a óbito 79 (61%) pacientes, 50 sobreviveram e 33 tinham outras malformações associadas. Entre os fatores prognósticos foram significativos e aumentaram a chance de óbito a polidrâmnia (p = 0,001), idade gestacional do diagnóstico mais precoce (p = 0,004), anomalias congênitas associadas (OR: 3,013, p = 0,022), pO2 da primeira gasometria (p = 0,000), pCO2 da primeira gasometria (p = 0,000), presença de hipoplasia pulmonar (OR: 3,074, p = 0,000), uso de drogas vasoativas pré-operatórias (OR: 2,881, p = 0,000) e o uso de oxido nítrico (OR:1,739, p = 0,000). A presença de apenas intestinos no conteúdo da hérnia foi um fator protetor (OR: 0,615, p = 0,001). Conclusão: A mortalidade no primeiro ano de vida em portadores de hérnia diafragmática congênita, neste estudo, foi de 61% de 2005 a 2015. Entre os fatores prognósticos que demonstraram um efeito significativo, a hipoplasia pulmonar foi o de maior impacto.

FACTORS ASSOCIATED TO QUALITY OF LIFE IN CHILDREN AND ADOLESCENTS WITH CYSTIC FIBROSIS.

OBJECTIVE: To verify the association between quality of life, functional capacity and clinical and nutritional status in children and adolescents with cystic fibrosis (CF). METHODS: Cross-sectional study, including patients from eight to 18 years old with CF. Quality of life, functional capacity, nutritional status and clinical status were evaluated with the Cystic Fibrosis Questionnaire; the 6-minute walk test (6MWT) and manual gripping force (MGF); the height percentiles for age and body mass index for age and respiratory function test, respectively. Pearson and Spearman correlation tests and logistic regression were used to analyze the data. RESULTS: A total of 45 patients, 13.4±0.5 years old, 60% female, 60% colonized by Pseudomonas aeruginosa and 57.8% with at least one F508del mutation participated in the study. When assessing the perception of quality of life, the weight domain reached the lowest values, and the digestive domain, the highest. In the pulmonary function test, the forced expiratory volume of the first second was 77.3±3.3% and the 6MWT and MGF presented values within the normal range. There was an association between quality of life and functional capacity, nutritional status and clinical status of CF patients. CONCLUSIONS: The study participants had good clinical conditions and satisfactory values of functional capacity and quality of life. The findings reinforce that the assessment of quality of life may be important for clinical practice in the management of treatment.

Mortality from gastroschisis in the state of Rio de Janeiro: a 10-year series.

OBJECTIVE: To analyze mortality and associated factors in a series of gastroschisis at birth in the state of Rio de Janeiro in a 10-year period (2005 to 2014). METHOD: A retrospective cohort study, which related the databases of the Live Births Information System and the Mortality Information System by probabilistic linkage. Final database was constructed in two stages: preparation of the two initial databases and establishment of relationships between them. RESULTS: Preterm newborns and those with low birthweight had higher risk of death, with statistical significance (p = 0.03 and p = 0.006, respectively). Regarding place of birth, although death frequency was higher in maternity units than in general hospitals (p = 0.04; OR = 0.5; 95%CI 0.3-1.0), it was observed that a unit characterized as a general hospital had a high birth frequency (61.2%). Furthermore, the comparative analysis of the risk of death between this unit and others showed a 7.5 higher risk of death in general hospitals and 3.2 higher in maternity units, with statistical significance (p < 0.001). Moreover, births in level II intensive care units had 3.9 times more risk of death compared with level III (p < 0.001). CONCLUSION: This study foments the discussion of two possible strategies in the treatment of gastroschisis in newborns. First, the centralization of care in tertiary units, enabling malformation care to be analyzed in a more detailed and standardized manner. Second, and perhaps more feasible, the elaboration of clinical guidelines to standardize immediate care for gastroschisis in babies born outside tertiary centers, as well as the standardization of their transportation until arrival at the tertiary center.

[Profile of service providers in high-risk neonatal care in the databases of the Brazilian Unified National Health System]. / Perfil dos prestadores de serviço em relação aos procedimentos de cuidado aos recém-nascidos de risco nas bases de dados do Sistema Único de Saúde.

The study aimed to analyze the profile of service providers in the Brazilian Unified National Health System (SUS) in relation to high-risk neonatal care procedures, based on data from the public-access database on Authorizations for Hospital Admissions (AIH) without identification of the neonatal patient. This cross-sectional study used data on AIH of unidentified newborns up to one day old, issued from January 2013 to December 2015, and from the National Registry of Healthcare Establishments. The TwoStep Cluster method was used to classify the establishments with similar characteristics. Regional differences were observed in the frequency of use of neonatal intensive care units and in special procedures recorded in the databases. The TwoStep Cluster method identified three groupings of providers: the first with 1,151 establishments and with low-complexity hospitalizations, the second with 84 establishments and surgical-profile hospitalizations, and the third with 393 establishments and higher complexity hospitalizations in neonatal care, including surgeries. The records on admissions jointly with multivariate analytical techniques have the potential to support decision-making by SUS administrators in the organization of neonatal care.

O objetivo foi analisar o perfil dos prestadores de serviço do Sistema Único de Saúde (SUS) em relação aos procedimentos de cuidado aos recém-nascidos de risco, valendo-se da base de dados não identificada de acesso público das Autorizações de Internação Hospitalar (AIH). Foi realizado um estudo transversal utilizando-se os dados das AIH não identificadas dos recém-nascidos com até 1 dia de vida, saídos entre janeiro de 2013 e dezembro de 2015, e do Cadastro Nacional de Estabelecimentos de Saúde. O método TwoStep Cluster foi usado para classificar os estabelecimentos com características similares. Foram observadas diferenças regionais na frequência de uso das unidades de terapia intensiva neonatal e nos procedimentos especiais registrados nas bases de dados. O método TwoStep Cluster identificou três agrupamentos de prestadores: o 1º com 1.151 estabelecimentos e com internações de baixa complexidade; o 2º com 84 estabelecimentos e internações de perfil cirúrgico; e o 3º com 393 estabelecimentos e internações de maior complexidade do cuidado neonatal, incluindo cirurgias. Os registros da internação, em conjunto com técnicas de análise multivariada, têm potencial para apoiar a tomada de decisão dos gestores do SUS na organização do cuidado neonatal.

El objetivo fue analizar el perfil de los prestadores de servicio del Sistema Único de Salud brasileño, respecto a los procedimientos de cuidados a los recién nacidos en riesgo, a partir de una base de datos no identificada de acceso público con Autorizaciones de Internamiento Hospitalario (AIH). Se trata de un estudio transversal, utilizando datos de AIH no identificadas con recién nacidos de hasta 1 día de vida, halladas entre enero de 2013 a diciembre de 2015, así como del Registro Nacional de Establecimientos de Salud. El método TwoStep Cluster se utilizó para clasificar los establecimientos con características similares. Se observaron diferencias regionales en la frecuencia de uso de las unidades de terapia intensiva neonatal y en los procedimientos especiales registrados en las bases de datos. El método TwoStep Cluster identificó tres agrupamientos de prestadores: el 1º con 1.151 establecimientos y con internamientos de baja complejidad; el 2º con 84 establecimientos e internamientos de perfil quirúrgico y el 3º con 393 establecimientos e internamientos de mayor complejidad de cuidado neonatal, incluyendo cirugías. Los registros del internamiento, junto a técnicas de análisis multivariado, tienen potencial para apoyar en la toma de decisiones por parte de los gestores del SUS en la organización del cuidado neonatal.

Mortality from gastroschisis in the state of Rio de Janeiro: a 10-year series / Mortalidade por gastrosquise no estado do Rio de Janeiro: uma série de 10 anos

ABSTRACT OBJECTIVE To analyze mortality and associated factors in a series of gastroschisis at birth in the state of Rio de Janeiro in a 10-year period (2005 to 2014). METHOD A retrospective cohort study, which related the databases of the Live Births Information System and the Mortality Information System by probabilistic linkage. Final database was constructed in two stages: preparation of the two initial databases and establishment of relationships between them. RESULTS Preterm newborns and those with low birthweight had higher risk of death, with statistical significance (p = 0.03 and p = 0.006, respectively). Regarding place of birth, although death frequency was higher in maternity units than in general hospitals (p = 0.04; OR = 0.5; 95%CI 0.3-1.0), it was observed that a unit characterized as a general hospital had a high birth frequency (61.2%). Furthermore, the comparative analysis of the risk of death between this unit and others showed a 7.5 higher risk of death in general hospitals and 3.2 higher in maternity units, with statistical significance (p < 0.001). Moreover, births in level II intensive care units had 3.9 times more risk of death compared with level III (p < 0.001). CONCLUSION This study foments the discussion of two possible strategies in the treatment of gastroschisis in newborns. First, the centralization of care in tertiary units, enabling malformation care to be analyzed in a more detailed and standardized manner. Second, and perhaps more feasible, the elaboration of clinical guidelines to standardize immediate care for gastroschisis in babies born outside tertiary centers, as well as the standardization of their transportation until arrival at the tertiary center.

RESUMO OBJETIVO Analisar a mortalidade e fatores associados em uma série de nascimentos com gastrosquise no estado do Rio de Janeiro em 10 anos (2005 a 2014). MÉTODO Estudo de coorte retrospectiva, no qual foram relacionadas as bases de dados do Sistema de Informação sobre Nascidos Vivos e do Sistema de Informação sobre Mortalidade por linkage probabilístico. A base de dados final foi construída em duas etapas, que consistiram em: preparo das duas bases de dados iniciais e estabelecimento de relações entre elas. RESULTADOS Os recém-nascidos pré-termo e os com baixo peso ao nascer tiveram maior chance de óbito, com significância estatística (p = 0,03 e p = 0,006, respectivamente). Em relação ao local de nascimento, embora a frequência de óbito tenha sido maior nas maternidades do que em hospitais gerais (p = 0,04; OR = 0,5; IC95% 0,3-1,0), foi observado que uma unidade caracterizada como hospital geral apresentou uma frequência alta de nascimentos (61,2%) e, na análise comparativa da chance de óbito dessa unidade com as demais, encontrou-se uma chance de morrer 7,5 maior em hospitais gerais e 3,2 maior em maternidades, com significância estatística (p < 0,001). Além disso, nascer em unidades de terapia intensiva tipo II aumentou a chance de óbito em 3,9 vezes em comparação com as do tipo III (p < 0,001). CONCLUSÃO Este estudo dá subsídios para a discussão de duas possíveis estratégias no tratamento de recém-nascidos com gastrosquise. A primeira seria a centralização do cuidado em unidades terciárias, possibilitando que o cuidado à malformação seja analisado de forma mais minuciosa e padronizada. A segunda, e talvez mais factível, seria a elaboração de diretrizes clínicas que padronizem o cuidado imediato aos bebês com gastrosquise nascidos fora de centros terciários, bem como a padronização do transporte deles até a chegada ao centro terciário.

Factors associated to quality of life in children and adolescents with cystic fibrosis / Fatores associados à qualidade de vida em crianças e adolescentes com fibrose cística

ABSTRACT Objective: To verify the association between quality of life, functional capacity and clinical and nutritional status in children and adolescents with cystic fibrosis (CF). Methods: Cross-sectional study, including patients from eight to 18 years old with CF. Quality of life, functional capacity, nutritional status and clinical status were evaluated with the Cystic Fibrosis Questionnaire; the 6-minute walk test (6MWT) and manual gripping force (MGF); the height percentiles for age and body mass index for age and respiratory function test, respectively. Pearson and Spearman correlation tests and logistic regression were used to analyze the data. Results: A total of 45 patients, 13.4±0.5 years old, 60% female, 60% colonized by Pseudomonas aeruginosa and 57.8% with at least one F508del mutation participated in the study. When assessing the perception of quality of life, the weight domain reached the lowest values, and the digestive domain, the highest. In the pulmonary function test, the forced expiratory volume of the first second was 77.3±3.3% and the 6MWT and MGF presented values within the normal range. There was an association between quality of life and functional capacity, nutritional status and clinical status of CF patients. Conclusions: The study participants had good clinical conditions and satisfactory values of functional capacity and quality of life. The findings reinforce that the assessment of quality of life may be important for clinical practice in the management of treatment.

RESUMO Objetivo: Verificar associação entre qualidade de vida (QV), capacidade funcional e estados clínico e nutricional em crianças e adolescentes com fibrose cística (FC). Métodos: Estudo transversal incluindo pacientes de oito a 18 anos de idade com FC. A QV, a capacidade funcional, o estado nutricional e o estado clínico foram avaliados por meio do Questionário de Fibrose Cística; do teste de caminhada dos 6 minutos (TC6M) e da força de preensão manual (FPM); dos percentis de estatura para a idade e do índice de massa corporal (IMC) para a idade; e da prova de função respiratória, respectivamente. Para a análise dos dados, utilizaram-se os testes de correlação de Pearson e de Spearman e a regressão logística. Resultados: Participaram do estudo 45 pacientes com 13,4±0,5 anos, sendo 60% do sexo feminino, 60% colonizados por Pseudomonas aeruginosa e 57,8% apresentando pelo menos uma mutação F508del. Ao avaliar a percepção da QV, o domínio peso alcançou os escores mais baixos e o digestório, os mais altos. Na prova de função pulmonar, o volume expiratório forçado do primeiro segundo médio foi 77,3±3,3%, e o TC6M e a FPM apresentaram valores na faixa de normalidade. Observou-se associação da QV com a capacidade funcional, o estado nutricional e o estado clínico dos pacientes com FC. Conclusões: Os participantes do estudo apresentaram boas condições clínicas e valores satisfatórios de capacidade funcional e QV. Os achados reforçam que a avaliação da QV pode ser importante para a prática clínica, no manejo do tratamento.