Practices developed by nurses in primary health care in southern Brazil.

OBJECTIVE: To understand the practices developed by nurses in primary care in southern Brazil. METHOD: Qualitative study, with data collection via online interviews, conducted between October 2020 and May 2021, and recorded. 174 nurses from 24 municipalities in southern Brazil participated. Data analysis used inductive thematic analysis. RESULTS: The activity that stood out among nurses was the nurse consultation, for all age groups and health conditions, especially when dealing with chronic disease, prenatal care, attention to women and children, mental health, home visits, and the management of the nursing team and the health unit. FINAL CONSIDERATIONS: This study demonstrated that an excess of responsibilities associated to care and management, added to a lack of balance in the activities common to the team make it difficult for nurses to develop clinical practices.

Social participation in Anvisa's regulations: hybrid, colloquial, and scientific evidence for democratic decision-making. / Participação social na regulamentação da Anvisa: evidências híbridas, coloquiais e científicas para decisão democrática.

Anvisa's public consultation (PC) is the most widely used social participation mechanism in current health regulations, which was based on antagonistic movements: the democratization of decision-making and State counter-reformation. Starting from the concept of social participation, defined as various actions from society related to public decision-making, which values diversity and the exercise of citizenship, the present article discusses the possibility of PCs configuring a democratic regulation process by considering popular beliefs and colloquial evidence, and promoting the creation of hybrid evidence in an evidence-moderated model. Despite the different interests, the PCs open the door to opportunities for democratic deliberation by society in the search of understanding, where it is expected that the State will make the best decision and justify it. In this sense, the role of evidence in clarifying complex issues is defined as a space where dissent, believed to democratize society, is important in revealing the limits of scientific evidence in an environment of information asymmetry. Finally, this article aims to refute technocracy as an instrument of power in health regulations, thereby achieving the greatest democratic potential of Anvisa's regulations.

A consulta pública (CP) da Anvisa é o mecanismo de participação social mais usado na regulamentação, consolidada com base em movimentos antagônicos: democratização da tomada de decisão e contrarreforma do Estado. Diante do conceito de participação social como várias ações relacionadas à decisão pública com valorização da diversidade e como exercício da cidadania, o artigo discute a possibilidade de as CPs configurarem um processo de regulamentação democrático ao considerar saberes populares e evidências coloquiais, além de promover a criação de evidências híbridas em um modelo moderado de evidências. Apesar dos diferentes interesses, as CPs abrem oportunidades para deliberação democrática da sociedade na busca do entendimento, onde se espera que o Estado escolha a melhor decisão e a justifique. Dessa forma, delimita-se o papel das evidências a esclarecer questões complexas em um espaço em que o dissenso, visto como caminho para a democratização da sociedade, é importante para revelar as limitações das evidências científicas em um ambiente de assimetria de informações. Por fim, espera-se refutar a tecnocracia como instrumento de poder na regulação sanitária e assim alcançar o maior potencial democrático da regulamentação da Anvisa.

Human versus Artificial Intelligence: Validation of a Deep Learning Model for Retinal Layer and Fluid Segmentation in Optical Coherence Tomography Images from Patients with Age-Related Macular Degeneration.

Artificial intelligence (AI) models have received considerable attention in recent years for their ability to identify optical coherence tomography (OCT) biomarkers with clinical diagnostic potential and predict disease progression. This study aims to externally validate a deep learning (DL) algorithm by comparing its segmentation of retinal layers and fluid with a gold-standard method for manually adjusting the automatic segmentation of the Heidelberg Spectralis HRA + OCT software Version 6.16.8.0. A total of sixty OCT images of healthy subjects and patients with intermediate and exudative age-related macular degeneration (AMD) were included. A quantitative analysis of the retinal thickness and fluid area was performed, and the discrepancy between these methods was investigated. The results showed a moderate-to-strong correlation between the metrics extracted by both software types, in all the groups, and an overall near-perfect area overlap was observed, except for in the inner segment ellipsoid (ISE) layer. The DL system detected a significant difference in the outer retinal thickness across disease stages and accurately identified fluid in exudative cases. In more diseased eyes, there was significantly more disagreement between these methods. This DL system appears to be a reliable method for accessing important OCT biomarkers in AMD. However, further accuracy testing should be conducted to confirm its validity in real-world settings to ultimately aid ophthalmologists in OCT imaging management and guide timely treatment approaches.

Chemical composition and antimicrobial activity of Cordiera myrciifolia leaves against pathogenic bacteria and fungi: Drug potentiation ability and inhibition of virulence.

Cordiera myrciifolia is an abundant species in Northeast Brazil that presents metabolites of biological/therapeutic interest. From this perspective, the present study aimed to investigate the chemical constituents and evaluate the in vitro antimicrobial activity of hexane (HECM) and ethanolic (EECM) extracts of C. myrciifolia leaves. The extracts were analyzed by chromatographic techniques (GC and UPLC) coupled with mass spectrometry. The antimicrobial activity of the extracts and the extracts combined with conventional drugs was evaluated by microdilution. The in vitro effect of the treatments on Candida's morphological transition was verified through cultivation in humid chambers. In HECM, 11 constituents including fatty acids, and triterpenes, including phytosterols, alkanes, tocols, and primary alcohols were identified. Triterpenes represented >40% of the identified constituents, with Lupeol being the most representative. In EECM, 13 constituents were identified, of which eight belonged to the class of flavonoids. High antibacterial activity of HECM was detected against Escherichia coli and Staphylococcus aureus, with Minimum Inhibitory Concentrations of 8 and 16 µg/mL, respectively. The combined activity was more effective when combined with Norfloxacin and Imipenem. In anti-Candida activity, the IC50 of the extracts ranged from 36.6 to 129.1 µg/mL. There was potentiating effect when associated with Fluconazole. Both extracts inhibited the filamentous growth of C. tropicalis at a concentration of 512 µg/mL. C. myrciifolia extracts prove to be candidates for the development of new therapeutic formulations to treat bacterial and fungal infections.

Deposition of collagen III and alterations in basement membrane integrity as candidate prognostic markers in prostate cancer.

The extracellular matrix surrounding the tumor undergoes changes in its organization during the metastasis process. The present study aims to quantify total collagen, collagen I (Col I) and collagen III (Col III), analyze the alignment of collagen fibers and assess the basement membrane integrity in samples from patients with metastatic and non-metastatic prostate cancer. Tissue samples from 60 patients were classified into groups based on prognostic parameters: better prognosis (n = 20), worse prognosis without metastasis (n = 23) and metastatic (n = 17). Picrosirius red with further analysis under polarizing microscope was used to quantify (with validation using immunohistochemistry) and analyze collagen alignment, and Periodic Acid Schiff staining was used to analyze the basement membrane integrity. The Col I/Col III ratio was found to be higher in the metastatic group than in the groups with better prognosis (p = 0.012) and worse prognosis without metastasis (p = 0.018). Basement membrane integrity constitution in malignant tumor tissue differed from that of adjacent non-tumor tissue (p < 0.001). Moreover, the worsening in the tumor tissue integrity was positively correlated with worse prognostic parameters. All in all, absence of Col III and basement membrane integrity might be indicators of poor prognosis in prostate cancer.

Mortalidade por violência autoprovocada em mulheres em idade fértil no Rio Grande do Norte / Mortalidad por violencia autoprovocada en mujeres en edad fértil en Rio Grande do Norte / Mortality by self-inflicted injury in fertile women of Rio Grande to Norte state

Introdução:A violência autoprovocada é um importante problema de saúde pública. Esse agravo produz impactos no campo da saúde do indivíduo, da família eda coletividade com desdobramentos sociais e econômicos. Objetivo:Analisar a mortalidade por violência autoprovocada em mulheres em idade fértil no estado do Rio Grande do Norte, Brasil, entre os anos de 2012 e 2021. Metodologia:Trata-se de um estudo ecológico com abordagem quantitativa e utiliza-se como base o estado do Rio Grande do Norte. Os dados foram coletados do Departamento de Informática do Sistema Único de Saúde, por meio das Informações em Saúde,nas seções de estatísticas vitais e população residente com a seleção sexo feminino e faixa etária de 10 a 49 anos.Resultados:Entre os anos de 2012 a 2021, no estado do Rio Grande do Norte,foram registrados 213 óbitos de mulheres em idade fértil por lesões autoprovocadas. Considerando o início e o final desse período, é possível destacar que a faixa etária de maior ocorrência de suicídio foi de 30 a 39 anos em 2012 e de 40 a 49 anos em 2021. Observou-se, nos anos avaliados, que as mulheres eram em sua maioria solteiras, de raça parda/preta e que a própria residência da vítima foi o local predominante para o desfecho da lesão autoprovocada. No que se refere à escolaridade e à relação do óbito com período de gravidez ou puerpério é preciso ressaltar o alto índice de "Não informada" e "Ignorada" nos registros.A taxa média de mortalidade por lesões autoprovocadas em mulheres em idade fértil entre 2012 e 2021 foi de 2,0 óbitos por cada 100.000 habitantes. Conclusões:Assim, conclui-se que o cenário da mortalidade por violência autoprovocada em mulheres em idade fértil no Rio Grande do Norte necessita de estratégias para prevenção do suicídio nessa faixa etária (AU).

Introduction: Self-inflicted injury is a major public health problem that impacts the health, social, and economic areas of individuals, their families, and society. Aim: To analyze mortality by self-inflicted injury in fertile women from the Rio Grande do Norte state between 2012 and 2021.Methodology: This ecologic and quantitative study collected vital statistics of women aged between 10 and 49 years. Data were obtained from the Health Information Systems of the Brazilian Health Informatics Department.Results: A total of 213 deaths of fertile women by self-inflicted injury were registered between 2012 and 2021. Considering the age groups, most deaths occurred between 30 and 39 years in 2012 and between 40 and 49 years in 2021. In addition, women were mostly single andwith brown or black skin color, and most of the self-inflicted injuries happened at their houses. Regarding education level and the relationship of death with pregnancy or postpartum, most registries presented a high incidence of "Not informed" or "Ignored" answers. Last, the mean mortality by self-inflicted injury in this population was 2.0 per 100,000 inhabitants between 2012 and 2021.Conclusions: Strategies must be implemented to reduce the mortality by self-inflicted injury of fertile women from the Rio Grande do Norte state (AU).

Introducción: La violencia autoinfligida es un importante problema de salud pública. Este problema tiene impactos en la salud del individuo, la familia y la comunidad con consecuencias sociales y económicas.Objetivo: Analizar la mortalidad por violencia autoinfligida en mujeres en edad fértil en el estado de Rio Grande do Norte, Brasil, entre los años 2012 y 2021.Metodología: Se trata de un estudio ecológico con enfoque cuantitativo y utiliza como base el estado de Rio Grande do Norte. Los datos fueron recolectados del Departamento de Tecnologías de la Información del Sistema Único de Salud, a través de Información en Salud, en las secciones de estadísticas vitales y población residente con la selección del género femenino y rango de edad de 10 a 49 años. Resultados: Entre los años 2012 y 2021, en el estado de Rio Grande do Norte, se registraron 213 muertes de mujeres en edad fértil por lesiones autoinfligidas. Considerando el inicio y final de este periodo, es posible resaltar que el grupo etario con mayor incidencia de suicidio fue el de 30 a 39 años en 2012 y el de 40 a 49 años en 2021. Se observó, en los años evaluados, que las mujeres eran en su mayoría solteras, de raza mestiza/negra y la propia residencia de la víctima era el lugar predominante para la autolesión. En lo que respecta a la educación y la relación entre muerte y embarazo o puerperio, es necesario resaltar el alto índice de "No informados" e "Ignorados" en los registros. La tasa media de mortalidad por autolesiones en mujeres en edad fértil entre 2012 y 2021 fue de 2,0 muertes por 100.000 habitantes. Conclusiones: Así, se concluye que el escenario de mortalidad por violencia autoinfligida en mujeres en edad fértil en Rio Grande do Norte requiere estrategias para prevenir el suicidio en este rango de edad (AU).

Atenção hospitalar em saúde mental no Rio Grande do Norte: contribuições do planejamento e avaliação em saúde / Atención hospitalaria en salud mental en Rio Grande do Norte: aportes de la planificación y evaluación en salud / Hospital mental health care in Rio Grande do Norte: contributions of health planning and evaluation

Introdução: O componente hospitalar da Rede de Atenção Psicossocial preconiza o fechamento progressivo de hospitais psiquiátricos e a implementação de leitos de saúde mental em hospital geral, capazes de fornecer atendimento para os casos agudos que necessitem de internação de forma articulada com os demais pontos de atenção da rede. Objetivo: Diante disso, o objetivo do presente artigo foi analisar a distribuição do número de leitos de atenção hospitalar em saúde mental no Rio Grande do Norte entre 2012 e 2022 e apresentar uma proposta de planejamento e avaliação para fortalecer a Rede de Atenção Psicossocial do estado. Metodologia: Trata-se de um estudo ecológico realizado no estado do Rio Grande do Norte, Brasil, no período de 2012 a 2022, usando dados secundários sobre as internações, seguido de um estudo propositivo com base em referências de planejamento e avaliação em saúde. Resultados: Observa-se uma redução do número de leitos psiquiátricos ao longo do tempo, mas que não se mostra suficiente e não se traduz em um crescimento satisfatório de leitos de saúde mental em hospital geral. Foram propostas cinco ações com o intuito de fortalecer a Rede de Atenção Psicossocial através da implantação e qualificação de leitos de saúde mental em hospitais gerais. Conclusão: Conclui-se que o movimento de constituição do componente hospitalar da Rede de Atenção Psicossocial do Rio Grande do Norte tem se apresentado em movimento irregular e o número de leitos de saúde mental em hospital geral é insuficiente. Espera-se que as intervenções e avaliações sugeridas possam contribuir para subsidiar importantes encaminhamentos no âmbito das políticas públicas de saúde mental do Rio Grande do Norte, Brasil (AU).

Introduction: The hospital component of the Psychosocial Care Network (PCN) advocates the progressive closure of psychiatric hospitals and the implementation of mental health beds in general hospitals, capable of providing care for acute cases that require hospitalization in conjunction with other network attention points. Objective: In view of this, the objective of this article was to analyze the quantitative distribution of hospital mental health care beds in Rio Grande do Norte between 2012 and 2022 and present a planning and evaluation proposal to strengthen the state's PCN. Methodology: This is an ecological study carried out in the state of Rio Grande do Norte, Brazil, from 2012 to 2022 using secondary data on hospitalizations, followed by a proactive study based on health planning and evaluation references. Results:There has been a reduction in the number of psychiatric beds over time, but not sufficient andnot translated into a satisfactory growth in mental health beds in general hospitals. Five actions were proposed with the aim of strengthening the PCN through the implementation and qualification of mental health beds in general hospitals.Conclusion: It is concluded that the movement to establish the hospital component of PCN in Rio Grande do Norte has been irregular and the number of mental health beds in general hospitals is insufficient. It is expected that the suggested interventions and evaluations may contribute to supporting important developments within the scope of public mental health policies in Rio Grande do Norte, Brazil (AU).

Introducción: El componente hospitalario de la Red de Atención Psicosocial (RAPS) aboga por el cierre progresivo de los hospitales psiquiátricos y la implementación de camas de salud mental en los hospitales generales, capaces de brindar atención a casos agudos que requieran hospitalización en conjunto con otros puntos de atención de la red. Objetivo:Ante esto, el objetivo de este artículo fue analizar la distribución del número de camas hospitalarias de atención a la salud mental en Rio Grande do Norte entre 2012 y 2022 y presentar una propuesta de planificación y evaluación para fortalecer el RAPS del Estado. Metodología:Se trata de un estudio ecológico realizado en el Estado de Rio Grande do Norte, Brasil, de 2012 a 2022, utilizando datos secundarios sobre hospitalizaciones, seguido de un estudio propositivo basado en referencias de planificación y evaluación de la salud. Resultados:Hay una reducción en el número de camas psiquiátricas a lo largo del tiempo, pero esto no es suficiente y no se traduce en un crecimiento satisfactorio de camas de salud mental en los hospitales generales. Se propusieron cinco acciones con el objetivo de fortalecer el RAPS a través de la implementación y habilitación de camas de salud mental en hospitales generales. Conclusión:Se concluye que el movimiento para establecer el componente hospitalario del RAPS en Rio Grande do Norte ha sido irregular y el número de camas de salud mental en un hospital general es insuficiente. Se espera que las intervenciones y evaluaciones sugeridas puedan contribuir a apoyar derivaciones importantes dentro del alcance de las políticas públicas de salud mental en Rio Grande do Norte, Brasil (AU).

Automated image label extraction from radiology reports - A review.

Machine Learning models need large amounts of annotated data for training. In the field of medical imaging, labeled data is especially difficult to obtain because the annotations have to be performed by qualified physicians. Natural Language Processing (NLP) tools can be applied to radiology reports to extract labels for medical images automatically. Compared to manual labeling, this approach requires smaller annotation efforts and can therefore facilitate the creation of labeled medical image data sets. In this article, we summarize the literature on this topic spanning from 2013 to 2023, starting with a meta-analysis of the included articles, followed by a qualitative and quantitative systematization of the results. Overall, we found four types of studies on the extraction of labels from radiology reports: those describing systems based on symbolic NLP, statistical NLP, neural NLP, and those describing systems combining or comparing two or more of the latter. Despite the large variety of existing approaches, there is still room for further improvement. This work can contribute to the development of new techniques or the improvement of existing ones.

Responding to STI epidemics among young people: a characterization of the language employed in educational materials. / Enfrentamento de epidemias de ISTs em população jovem: caracterização da linguagem dos materiais educativos.

This article aims to characterize the language employed in educational and communications materials about STIs, HIV/AIDS and viral hepatitis produced by the Ministry of Health between 2010 and 2019, identifying elements related to health promotion and disease prevention. We conducted an exploratory descriptive study. The materials were selected by performing a systematic search of the Ministry of Health website focusing on the period 2010-2019. The materials were analyzed to determine the educational approaches adopted. The preventive, educational and personal development approaches were identified in 100% (201), 24.87% (50) and 7.96% (16) of the materials, respectively. The radical and popular education for health approaches were not observed. The almost exclusive focus on the preventive approach reveals that promoting changes in individual habits and behavior alone is not sufficient to combat and solve the problem of STIs, HIV/AIDS and viral hepatitis in Brazil.

O objetivo do artigo é caracterizar a linguagem utilizada nos materiais educativos e comunicacionais vinculados à temática das IST, do HIV/Aids e hepatites virais produzidos e veiculados pelo Ministério da Saúde no período de 2010 a 2019, identificando elementos de promoção à saúde e de prevenção de doenças. Metodologia descritiva exploratória para a caracterização da linguagem utilizada nos materiais educativos e comunicacionais sobre as IST, do HIV/Aids e hepatites virais. Para a seleção dos materiais educativos, adotou-se a estratégia de busca sistemática realizada no site do Ministério da Saúde do Brasil por um período de dez anos: de 2010 a 2019. Os materiais foram observados por meio dos enfoques educativos. O enfoque preventivo foi identificado em 100% dos materiais analisados (201). O enfoque educativo foi encontrado em 24,87% (50) dos materiais, e o enfoque de desenvolvimento pessoal foi encontrado em 7,96% (16). Os enfoques radical e da educação popular em saúde não foram observados. A atenção quase exclusiva ao enfoque preventivo revela que cuidados individuais isoladamente não são suficientes para combater e sanar o problema das IST, do HIV/Aids e das hepatites virais no Brasil.

Neuroimaging characterization of multiple sclerosis lesions in pediatric patients: an exploratory radiomics approach.

Introduction: Multiple sclerosis (MS), a chronic inflammatory immune-mediated disease of the central nervous system (CNS), is a common condition in young adults, but it can also affect children. The aim of this study was to construct radiomic models of lesions based on magnetic resonance imaging (MRI, T2-weighted-Fluid-Attenuated Inversion Recovery), to understand the correlation between extracted radiomic features, brain and lesion volumetry, demographic, clinical and laboratorial data. Methods: The neuroimaging data extracted from eleven scans of pediatric MS patients were analyzed. A total of 60 radiomic features based on MR T2-FLAIR images were extracted and used to calculate gray level co-occurrence matrix (GLCM). The principal component analysis and ROC analysis were performed to select the radiomic features, respectively. The realized classification task by the logistic regression models was performed according to these radiomic features. Results: Ten most relevant features were selected from data extracted. The logistic regression applied to T2-FLAIR radiomic features revealed significant predictor for multiple sclerosis (MS) lesion detection. Only the variable "contrast" was statistically significant, indicating that only this variable played a significant role in the model. This approach enhances the classification of lesions from normal tissue. Discussion and conclusion: Our exploratory results suggest that the radiomic models based on MR imaging (T2-FLAIR) may have a potential contribution to characterization of brain tissues and classification of lesions in pediatric MS.

Neural leprosy investigation using electroneuromyography and the ML Flow rapid test: a case report.

Neural leprosy, which is characterized by nerve involvement without visible skin lesions, presents a diagnostic challenge. This case report examined the significance of diverse diagnostic modalities in the identification of pure neural leprosy. A 28-year-old patient with symptoms of edema, pain, paresthesia, and diminished sensitivity in the lower limbs underwent various tests. A stilt skin smear yielded negative results on bacilloscopy, whereas a Fast ML Flow leprosy test and electroneuromyography supported the diagnosis. This discussion highlights the importance of accessible methods for early investigation. This study emphasizes the multidisciplinary approach and value of the Fast ML Flow leprosy test and electroneuromyography for diagnosing neural leprosy.

STERN: Attention-driven Spatial Transformer Network for abnormality detection in chest X-ray images.

Chest X-ray scans are frequently requested to detect the presence of abnormalities, due to their low-cost and non-invasive nature. The interpretation of these images can be automated to prioritize more urgent exams through deep learning models, but the presence of image artifacts, e.g. lettering, often generates a harmful bias in the classifiers and an increase of false positive results. Consequently, healthcare would benefit from a system that selects the thoracic region of interest prior to deciding whether an image is possibly pathologic. The current work tackles this binary classification exercise, in which an image is either normal or abnormal, using an attention-driven and spatially unsupervised Spatial Transformer Network (STERN), that takes advantage of a novel domain-specific loss to better frame the region of interest. Unlike the state of the art, in which this type of networks is usually employed for image alignment, this work proposes a spatial transformer module that is used specifically for attention, as an alternative to the standard object detection models that typically precede the classifier to crop out the region of interest. In sum, the proposed end-to-end architecture dynamically scales and aligns the input images to maximize the classifier's performance, by selecting the thorax with translation and non-isotropic scaling transformations, and thus eliminating artifacts. Additionally, this paper provides an extensive and objective analysis of the selected regions of interest, by proposing a set of mathematical evaluation metrics. The results indicate that the STERN achieves similar results to using YOLO-cropped images, with reduced computational cost and without the need for localization labels. More specifically, the system is able to distinguish abnormal frontal images from the CheXpert dataset, with a mean AUC of 85.67% - a 2.55% improvement vs. the 0.98% improvement achieved by the YOLO-based counterpart in comparison to a standard baseline classifier. At the same time, the STERN approach requires less than 2/3 of the training parameters, while increasing the inference time per batch in less than 2 ms. Code available via GitHub.

Hemodialysis vascular access coordinator: Three-level model for access management.

Management of vascular access is a challenge for the dialysis team, particularly to keep the arteriovenous access working. The vascular access coordinator can positively contribute to increase the number of arteriovenous fistulas and reduce central venous catheters. In this article, we introduce a new approach to vascular access management centered on (the results of setting up) the role of vascular access coordinator. We described the three-level model (3Level_M) for vascular access management organized in three levels: vascular access nurse manager, vascular access coordinator, and vascular access consultant. We defined the instrumental skills and training required to be developed by each element and clarify the articulation between the model and all members of the dialysis team related to vascular access.

Evaluation of the effects of COVID-19 on semen parameters and male infertility.

The new coronavirus pandemic resulted in millions of deaths in Brazil and around the world, and presented substantial challenges to society. The shortand long-term clinical manifestations tied to COVID-19 are still poorly understood, and may involve several organs and systems, including the male genital tract, which may lead to impaired fertility. The present study aimed to analyze, through an integrative literature review of articles available in databases, the effects of COVID-19 on parameters related to human semen quality. The analyzed studies reported significant decreases in sperm motility and morphology related to COVID-19. Reductions in concentration and volume were also observed. Inflammatory response is one of the leading mechanisms that may potentially explain the observed changes, although others may also be involved. More studies are needed to better understand the effects, modes of action, as well as other aspects involved in this complex phenomenon.

Neural leprosy investigation using electroneuromyography and the ML Flow rapid test: a case report

ABSTRACT Neural leprosy, which is characterized by nerve involvement without visible skin lesions, presents a diagnostic challenge. This case report examined the significance of diverse diagnostic modalities in the identification of pure neural leprosy. A 28-year-old patient with symptoms of edema, pain, paresthesia, and diminished sensitivity in the lower limbs underwent various tests. A stilt skin smear yielded negative results on bacilloscopy, whereas a Fast ML Flow leprosy test and electroneuromyography supported the diagnosis. This discussion highlights the importance of accessible methods for early investigation. This study emphasizes the multidisciplinary approach and value of the Fast ML Flow leprosy test and electroneuromyography for diagnosing neural leprosy.

Enfrentamento de epidemias de ISTs em população jovem: caracterização da linguagem dos materiais educativos / Responding to STI epidemics among young people: a characterization of the language employed in educational materials

Resumo O objetivo do artigo é caracterizar a linguagem utilizada nos materiais educativos e comunicacionais vinculados à temática das IST, do HIV/Aids e hepatites virais produzidos e veiculados pelo Ministério da Saúde no período de 2010 a 2019, identificando elementos de promoção à saúde e de prevenção de doenças. Metodologia descritiva exploratória para a caracterização da linguagem utilizada nos materiais educativos e comunicacionais sobre as IST, do HIV/Aids e hepatites virais. Para a seleção dos materiais educativos, adotou-se a estratégia de busca sistemática realizada no site do Ministério da Saúde do Brasil por um período de dez anos: de 2010 a 2019. Os materiais foram observados por meio dos enfoques educativos. O enfoque preventivo foi identificado em 100% dos materiais analisados (201). O enfoque educativo foi encontrado em 24,87% (50) dos materiais, e o enfoque de desenvolvimento pessoal foi encontrado em 7,96% (16). Os enfoques radical e da educação popular em saúde não foram observados. A atenção quase exclusiva ao enfoque preventivo revela que cuidados individuais isoladamente não são suficientes para combater e sanar o problema das IST, do HIV/Aids e das hepatites virais no Brasil.

Abstract This article aims to characterize the language employed in educational and communications materials about STIs, HIV/AIDS and viral hepatitis produced by the Ministry of Health between 2010 and 2019, identifying elements related to health promotion and disease prevention. We conducted an exploratory descriptive study. The materials were selected by performing a systematic search of the Ministry of Health website focusing on the period 2010-2019. The materials were analyzed to determine the educational approaches adopted. The preventive, educational and personal development approaches were identified in 100% (201), 24.87% (50) and 7.96% (16) of the materials, respectively. The radical and popular education for health approaches were not observed. The almost exclusive focus on the preventive approach reveals that promoting changes in individual habits and behavior alone is not sufficient to combat and solve the problem of STIs, HIV/AIDS and viral hepatitis in Brazil.

Participação social na regulamentação da Anvisa: evidências híbridas, coloquiais e científicas para decisão democrática / Social participation in Anvisa's regulations: hybrid, colloquial, and scientific evidence for democratic decision-making

Resumo A consulta pública (CP) da Anvisa é o mecanismo de participação social mais usado na regulamentação, consolidada com base em movimentos antagônicos: democratização da tomada de decisão e contrarreforma do Estado. Diante do conceito de participação social como várias ações relacionadas à decisão pública com valorização da diversidade e como exercício da cidadania, o artigo discute a possibilidade de as CPs configurarem um processo de regulamentação democrático ao considerar saberes populares e evidências coloquiais, além de promover a criação de evidências híbridas em um modelo moderado de evidências. Apesar dos diferentes interesses, as CPs abrem oportunidades para deliberação democrática da sociedade na busca do entendimento, onde se espera que o Estado escolha a melhor decisão e a justifique. Dessa forma, delimita-se o papel das evidências a esclarecer questões complexas em um espaço em que o dissenso, visto como caminho para a democratização da sociedade, é importante para revelar as limitações das evidências científicas em um ambiente de assimetria de informações. Por fim, espera-se refutar a tecnocracia como instrumento de poder na regulação sanitária e assim alcançar o maior potencial democrático da regulamentação da Anvisa.

Abstract Anvisa's public consultation (PC) is the most widely used social participation mechanism in current health regulations, which was based on antagonistic movements: the democratization of decision-making and State counter-reformation. Starting from the concept of social participation, defined as various actions from society related to public decision-making, which values diversity and the exercise of citizenship, the present article discusses the possibility of PCs configuring a democratic regulation process by considering popular beliefs and colloquial evidence, and promoting the creation of hybrid evidence in an evidence-moderated model. Despite the different interests, the PCs open the door to opportunities for democratic deliberation by society in the search of understanding, where it is expected that the State will make the best decision and justify it. In this sense, the role of evidence in clarifying complex issues is defined as a space where dissent, believed to democratize society, is important in revealing the limits of scientific evidence in an environment of information asymmetry. Finally, this article aims to refute technocracy as an instrument of power in health regulations, thereby achieving the greatest democratic potential of Anvisa's regulations.

Instrumentos para avaliação de pacientes hospitalizados em cuidados paliativos: revisão integrativa / Instruments for the assessment of hospitalized patients in palliative care: integrative review / Herramientas para evaluar a los pacientes hospitalizados en cuidados paliativos: revisión integradora

RESUMO: Objetivo: identificar os instrumentos utilizados para a avaliação do paciente hospitalizado em cuidados paliativos. Método: revisão integrativa da literatura, realizada em janeiro de 2024, nas plataformas de dados on-line: National Library of Medicine e Literatura Latino-Americana e do Caribe de Informação em Ciências da Saúde e a biblioteca virtual Scientific Electronic Library Online. Foram analisados 12 artigos científicos. Resultados: foram identificados 16 instrumentos, sete genéricos, quatro específicos as para pessoas em cuidados paliativos, quatro específicos para os pacientes oncológicos e um para o diagnóstico de COVID-19. O Palliative Perfomance Scale e Edmonton Symptom Assessment foram os instrumentos mais utilizados nos estudos e os aspectos mais relevantes a serem avaliados nos pacientes em cuidados paliativos, foram: capacidade funcional, sintomas físicos e psicológicos e idade avançada. Conclusão: os instrumentos se mostraram úteis para direcionar os profissionais de saúde, na avaliação do paciente, no planejamento do cuidado e na tomada de decisões.

ABSTRACT Objective: to identify the instruments used to assess patients hospitalized in palliative care. Method: integrative literature review carried out in January 2024 on the online data platforms: National Library of Medicine and Latin America and the Caribbean Literature on Health Sciences (LILACS) and the virtual library Scientific Electronic Library Online. Twelve scientific articles were analyzed. Results: Sixteen instruments were identified, seven of them generic, four specific for people in palliative care, four specific for oncology patients and one for the diagnosis of COVID-19. The Palliative Performance Scale and Edmonton Symptom Assessment were the most used instruments in the studies and the most relevant aspects to be evaluated in patients receiving palliative care were functional capacity, physical and psychological symptoms and old age. Conclusion: The instruments were useful as they guided health professionals, assessed patients, and planned care and decision-making.

RESUMEN: Objetivo: identificar los instrumentos utilizados para evaluar a los pacientes hospitalizados en cuidados paliativos. Método: revisión bibliográfica integradora, realizada en enero de 2024 en plataformas de datos en línea: National Library of Medicine, Literatura Latino-Americana y del Caribe de información en Ciencias de la Salud y Scientific Electronic Library Online. Se analizaron doce artículos científicos. Resultados: Se identificaron 16 instrumentos, siete genéricos, cuatro específicos para personas en cuidados paliativos, cuatro específicos para pacientes con cáncer y uno para el diagnóstico de covid-19. La Palliative Perfomance Scale y Edmonton Symptom Assessment fueron los instrumentos más utilizados en los estudios y los aspectos más relevantes a evaluar en los pacientes de cuidados paliativos fueron: la capacidad funcional, los síntomas físicos y psicológicos y la edad avanzada. Conclusión: Los instrumentos resultaron útiles para orientar a los profesionales sanitarios en la evaluación de los pacientes, la planificación de los cuidados y la toma de decisiones.

Practices developed by nurses in primary health care in southern Brazil / Practicas desarrolladas por los enfermeros en atención primaria de salud en el sur de Brasil / Práticas desenvolvidas pelo enfermeiro na atenção primária na região sul do Brasil

ABSTRACT Objective: To understand the practices developed by nurses in primary care in southern Brazil. Method: Qualitative study, with data collection via online interviews, conducted between October 2020 and May 2021, and recorded. 174 nurses from 24 municipalities in southern Brazil participated. Data analysis used inductive thematic analysis. Results: The activity that stood out among nurses was the nurse consultation, for all age groups and health conditions, especially when dealing with chronic disease, prenatal care, attention to women and children, mental health, home visits, and the management of the nursing team and the health unit. Final considerations: This study demonstrated that an excess of responsibilities associated to care and management, added to a lack of balance in the activities common to the team make it difficult for nurses to develop clinical practices.

RESUMEN Objetivo: Comprender las prácticas desarrolladas por las enfermeras en la atención primaria en el sur de Brasil. Método: Estudio cualitativo, con recolección de datos a través de entrevistas en línea, realizadas entre octubre de 2020 y mayo de 2021 y grabadas. Participaron 174 enfermeras de 24 municipios en el sur de Brasil. El análisis de los datos fue temático inductivo. Resultados: La consulta de enfermería se destaca como actividad de los enfermerosen todas las edades y condiciones de salud, especialmente situaciones crónicas, atención prenatal, atención a mujeres y niños, salud mental, visitas domiciliarias y gestión del equipo de enfermería y la unidad de salud. Consideraciones finales: El estudio ha demostrado que el exceso de responsabilidades asistenciales y de gestión y la falta de equilibrio entre las actividades comunes del equipo dificultan a las enfermeras el desarrollo de las prácticas clínicas.

RESUMO Objetivo: Compreender as práticas desenvolvidas pelo enfermeiro na atenção primária, na região Sul do Brasil. Método: Estudo qualitativo, cuja coleta de dados foi com entrevistas online gravadas, entre outubro de 2020 e maio de 2021. Participaram 174 enfermeiros, de 24 municípios da região sul do Brasil. Análise temática indutiva dos dados. Resultados: A consulta do enfermeiro é a atividade que se destaca, para todas as faixas etárias e condições de saúde, especialmente nas situações crônicas, pré-natal, atenção a mulher e a criança, saúde mental, visitas domiciliares, além do gerenciamento da equipe de enfermagem e da unidade de saúde. Considerações finais: Demonstrou-se que o excesso de responsabilidades assistenciais e gerenciais e a falta de equilíbrio entre as atividades comuns à equipe, dificultam o desenvolvimento de práticas clínicas do enfermeiro.

Genomic epidemiology unveils the dynamics and spatial corridor behind the Yellow Fever virus outbreak in Southern Brazil.

Despite the considerable morbidity and mortality of yellow fever virus (YFV) infections in Brazil, our understanding of disease outbreaks is hampered by limited viral genomic data. Here, through a combination of phylogenetic and epidemiological models, we reconstructed the recent transmission history of YFV within different epidemic seasons in Brazil. A suitability index based on the highly domesticated Aedes aegypti was able to capture the seasonality of reported human infections. Spatial modeling revealed spatial hotspots with both past reporting and low vaccination coverage, which coincided with many of the largest urban centers in the Southeast. Phylodynamic analysis unraveled the circulation of three distinct lineages and provided proof of the directionality of a known spatial corridor that connects the endemic North with the extra-Amazonian basin. This study illustrates that genomics linked with eco-epidemiology can provide new insights into the landscape of YFV transmission, augmenting traditional approaches to infectious disease surveillance and control.