Early maladaptive schemas mediate the relationship between severe childhood trauma and eating disorder symptoms: evidence from an exploratory study.

BACKGROUND: Childhood trauma history has frequently been linked to eating disorders (EDs); nevertheless, the scientific literature calls for extending knowledge regarding mediators between EDs and childhood trauma. This study explored whether ED symptoms and early maladaptive schemas were more severe in ED patients with severe childhood trauma than in ED patients with no/mild childhood trauma and whether early maladaptive schemas mediated the relationship between childhood trauma and ED symptom severity. METHODS: Data were extracted from the Regional Centre for Eating Disorders registry at the University Hospital of Verona. The extracted data included self-reported data, including the Eating Disorder Inventory-3 score, Young Schema Questionnaire score, Childhood Experience and Experience of Care and Abuse Questionnaire score, and sociodemographic and clinical information on the ED outpatients seeking care. A mediation analysis using the structural equation modeling procedure was conducted. RESULTS: Forty-two outpatients, 31% of whom exhibited severe childhood trauma, satisfied the criteria for registry data extraction. The severity of ED symptoms, as well as the early maladaptive schemas' scores for emotional deprivation, defectiveness, failure, vulnerability, insufficient self-control, and negativity, were greater in ED outpatients with severe childhood trauma. Furthermore, early maladaptive schemas related to defectiveness, failure, and negativity had a mediating role in the relationship between severe childhood trauma and ED symptom severity. CONCLUSIONS: This exploratory study provides preliminary evidence about the importance of early maladaptive schemas in the relationship between trauma history and ED psychopathology. In addition, ED symptoms may represent a dysfunctional attempt to avoid unpleasant emotions associated with schema activation. The results support the need to consider early maladaptive schemas in the treatment of traumatized patients with ED symptoms. Study limitations, research and clinical implications are discussed.

Eating disorder psychopathology was found to be related to a history of trauma. Nonetheless, our understanding of the mediators of the relationship between childhood trauma and eating disorders remains to be improved. The current study revealed that certain early maladaptive schemas (i.e., defectiveness, failure, and negativity) mediated the relationship between childhood trauma and eating disorder symptoms and that outpatients who experienced severe childhood trauma reported more severe eating disorder symptoms and greater severity of certain early maladaptive schemas, such as emotional deprivation, defectiveness, failure, vulnerability, insufficient self-control, and negativity. Our findings support the need to consider early maladaptive schemas in the treatment of traumatized patients with eating disorders.

The impact of an online course on agreement rates of the certainty of evidence assessment using Grading of Recommendations, Assessment, Development, and Evaluation Approach: a before-and-after study.

BACKGROUND AND OBJECTIVE: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach is a systematic method for assessing the certainty of evidence (CoE) and strength of recommendations in health care. We aimed to verify the effects of an online-based GRADE course on multirater consistency in the evaluation of the CoE in systematic reviews (SRs) analysis. STUDY DESIGN AND SETTINGS: Sixty-five Brazilian methodologists and researchers participated in an online course over 8 weeks. Asynchronous lessons and weekly synchronous meetings addressed the GRADE system in the context of CoE assessment. We asked participants to evaluate the CoE of random SRs (two before and another two after the course). Analyzes focused on the multirater agreement with a standard response, in the interrater agreement, and before-after changes in the proportion of participants that rated down the domains. RESULTS: 48 individuals completed the course. Participants presented improvements in the raters' assessment of the CoE using the GRADE approach after the course. The multirater consistency of indirectness, imprecision, and the overall CoE increased after the course, as well as the agreement between raters and the standard response. Furthermore, interrater reliability increased for risk of bias, inconsistency, indirectness, publication bias, and overall CoE, indicating progress in between-raters consistency. After the course, approximately 78% of individuals rated down the overall CoE to a low/very low degree, and participants presented more explanations for the judgment of each domain. CONCLUSION: An online GRADE course improved the consistency and agreement of the CoE assessment by Brazilian researchers. Online training courses have the potential to improve skills in guideline methodology development.

Empowerment of genetic information by women at-risk of being carriers of Duchenne and Becker muscular dystrophies.

The emergence of therapies acting on specific molecular targets for Duchenne and Becker muscular dystrophies (DBMD) led to expanded access of diagnostic DMD analysis. However, it is unclear how much of these advances have also improved healthcare and access to genetic testing for women at-risk of being carriers. This study evaluates the process of genetic counseling and empowerment of genetic information by women from DBMD families. We carried out a cross-sectional study between February and June 2022 in Brazil. The online survey with items regarding sociodemographic data; family history; access to health services; reproductive decisions; and the Genomic Outcome Scale was answered by 123 women recruited from a rare diseases reference service and a nationwide patient advocacy group. Genetic counseling was reported by 77/123 (62.6%) of women and 53.7% reported having performed genetic analysis of DMD. Although the majority knew about the risks for carriers of developing heart disease and muscle weakness, only 35% of potential carriers have had cardiac studies performed at least once in their lives. Country region, type of kinship, number of affected males in the family, age, notion of genetic risk, education level, and participation in advocacy groups were the main factors associated with adequate healthcare access to women and empowerment of genetic information. Education to health professionals and policies to expand access to carrier genetic testing, whether public policies or regulation of pharmaceutical companies' diagnostic programs, is paramount to improve the care of families with DBMD in Brazil.

A Randomized, Open-Label, Non-inferiority Clinical Trial Assessing 7 Versus 14 Days of Antimicrobial Therapy for Severe Multidrug-Resistant Gram-Negative Bacterial Infections: The OPTIMISE Trial Protocol.

INTRODUCTION: Shorter courses of antimicrobials have been shown to be non-inferior to longer, "traditional" duration of therapies, including for some severe healthcare-associated infections, with a few exceptions. However, evidence is lacking regarding shorter regimes against severe infections by multidrug-resistant Gram-negative bacteria (MDR-GNB), which are often caused by distinct strains and commonly treated with second-line antimicrobials. In the duratiOn of theraPy in severe infecTIons by MultIdrug-reSistant gram-nEgative bacteria (OPTIMISE) trial, we aim to assess the non-inferiority of 7-day versus 14-day antimicrobial therapy in critically ill patients with severe infections caused by MDR-GNB. METHODS: This is a randomized, multicenter, open-label, parallel controlled trial to assess the non-inferiority of 7-day versus 14-day of adequate antimicrobial therapy for intensive care unit (ICU)-acquired severe infections by MDR-GNB. Adult patients with severe infections by MDR-GNB initiated after 48 h of ICU admission are screened for eligibility. Patients are eligible if they proved to be hemodynamically stable and without fever for at least 48 h on the 7th day of adequate antimicrobial therapy. After consenting, patients are 1:1 randomized to discontinue antimicrobial therapy on the 7th (± 1) day or to continue for a total of 14th (± 1) days. PLANNED OUTCOMES: The primary outcome is treatment failure, defined as death or relapse of infection within 28 days after randomization. Non-inferiority will be achieved if the upper edge of the two-tailed 95% confidence interval of the difference between the clinical failure rate in the 7-day and the 14-day group is not higher than 10%. CONCLUSION: The OPTIMISE trial is the first randomized controlled trial specifically designed to assess the duration of antimicrobial therapy in patients with severe infections by MDR-GNB. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05210387. Registered on 27 January 2022. Seven Versus 14 Days of Antibiotic Therapy for Multidrug-resistant Gram-negative Bacilli Infections (OPTIMISE).

Back Pain and Body Posture Evaluation Instrument for Adults (BackPEI-A): Updating and an online application.

INTRODUCTION: Back Pain and Body Posture Evaluation Instrument for Adults (BackPEI-A) lags the most recent literature, as it does not assess issues related to activity increasingly present in the daily lives of people of all ages. PURPOSE: (1) to update the BackPEI-A by including four new questions regarding the use of mobile devices; (2) to present a new graphic design of the issues related to back and neck pain to facilitate understanding of the location of these pains; (3) to test the content validity and the reliability of the new questions; and (4) to identify whether the BackPEI-A version in online form has adequate reliability. METHODS: The content validation by evaluation of eight experts, and the reliability of the new questions and of the online version were assessed. The new questions were translated to English. Content validation was assessed by the content validity index (CVI). Reliability was assessed using the agreement percentage (%C), the kappa statistic (k), and the intraclass correlation coefficient (ICC). k > 0.4 and %C > 0.5 were assumed to include new questions. RESULTS: The new questions showed good agreement among the experts, k > 0.4 and %C > 0.5. Both forms applied presented an average kappa of total sample ranging from moderate to good, and moderate ICC values, showing an adequate reliability. CONCLUSION: The updated BackPEI-A is valid and reliable and allows the identification of aspects related to back and neck pain, as well as possible risk factors.

Radiographic Measures for the Assessment of Frontal and Sagittal Knee Alignments and the Associated Normality Values: A Meta-Analysis.

Objective: The purpose of this literature review was to identify knee alignment assessment methods using radiography in the sagittal and frontal planes and to identify normality values for classifying knee alignment using these methods. Methods: A systematic review with a meta-analysis was conducted. The eligibility criterion was studies that performed radiographic examinations to assess the knee alignment of adults without a history of hip or knee prosthesis surgery. The methodological qualities of the included studies were assessed using the QUADAS-2 tool. A meta-analysis was performed to measure the normality values of knee alignment in the frontal plane. Results: The hip-knee-ankle (HKA) angle was the measure most frequently used to assess knee alignment. Only a meta-analysis of HKA normality values was possible. Thereby, we found normality values of the HKA angle for the overall population, men, and women. The normality values of knee alignment for healthy adults that were found in this study were as follows: overall sample (male and female patients) HKA angle = -0.2° (-2.8° to 2.41°), male patient HKA angle = 0.77° (-2.91° to 7.94°), and female patient HKA angle = -0.67° (-5.32° to 3.98°). Conclusion: This review identified the most common methods and expected values for knee alignment assessment methods using radiography in the sagittal and frontal planes. We suggest HKA angles ranging from -3° to 3° as the cutoff for classifying knee alignment in the frontal plane, in accordance with the normality limits found in the meta-analysis.

Musculoskeletal disorders and work ability of workers at a university campus in southern Brazil.

Background: When performed in unfavorable conditions, work can lead to the development of musculoskeletal disorders and decrease in work ability. Objectives: To identify the differences between three groups of workers (professors, technicians and outsourced workers) as for the sociodemographic profile, work ability, prevalence of musculoskeletal disorders, activity restrictions, and the correlation between the presence of musculoskeletal disorders and activity restrictions with each domain of the Work Ability Index. Methods: The sample consisted of 67 university workers assessed by a Sociodemographic Data Questionnaire, the Nordic Musculoskeletal Symptoms Questionnaire and the Work Ability Index. Descriptive statistics and Kendall's Tau correlation coefficient were used. Results: Professors presented more favorable sociodemographic and lifestyle aspects and higher work ability, while outsourced workers had less favorable sociodemographic and lifestyle aspects and lower work ability. The correlation between activity restrictions and work ability was found in only one domain of Work Ability Index among professors. Among outsourced workers were found correlations on presence of musculoskeletal disorders and activity restrictions with six domains of Work Ability Index. Technicians did not show significant correlation. Conclusions: Outsourced workers presented worse work ability and less favorable sociodemographic and lifestyle aspects among the workers in the study, requiring the maintenance and improvement of work ability in this population.

Introdução: O trabalho, quando realizado em condições desfavoráveis, pode levar ao desenvolvimento de distúrbios musculoesqueléticos e à diminuição da capacidade para o trabalho. Objetivos: Identificar diferenças entre três grupos de trabalhadores (professores, técnicos e terceirizados) em relação a perfil sociodemográfico, capacidade para o trabalho, presença de distúrbios musculoesqueléticos e restrição para atividades e correlacionar a presença de distúrbios musculoesqueléticos e a restrição para atividades com cada domínio do índice de Capacidade para o Trabalho. Métodos: A amostra foi composta por 67 trabalhadores de uma universidade, os quais preencheram um questionário de dados sociodemográficos, o Questionário Nórdico de Sintomas Osteomusculares e o índice de Capacidade para o Trabalho. Foram utilizados estatística descritiva e o teste tau de Kendall para identificar possíveis correlações. Resultados: Os professores apresentaram aspectos sociodemográficos e de estilo de vida mais favoráveis e maior capacidade para o trabalho, enquanto os terceirizados apresentaram aspectos sociodemográficos e de estilo de vida menos favoráveis, além de menor capacidade para o trabalho. Foi encontrada correlação entre restrição para atividades em apenas um dos domínios do Índice de Capacidade para o Trabalho entre professores. Entre os terceirizados, foram encontradas correlações entre a presença de distúrbios musculoesqueléticos e a restrição para atividades em seis domínios do índice de Capacidade para o Trabalho. Os técnicos administrativos não apresentaram correlações significativas. Conclusões: Os trabalhadores terceirizados apresentaram pior capacidade para trabalho e aspectos sociodemográficos e de estilo de vida menos favoráveis entre os trabalhadores do estudo, sendo necessárias a manutenção e a melhora da capacidade para o trabalho desta população.

Risk Factors for Back Pain among Southern Brazilian School Children: A 6-Year Prospective Cohort Study.

Risk factors associated with back pain vary in different countries. Given the lack of studies in Latin America, our study aimed to assess back pain and its associated factors for six years in Southern Brazilian school children. All children attending the fifth grade of Teutônia, Brazil, were invited to participate in the study. Only schoolchildren who did not report back pain were included in the first assessment. The schoolchildren completed the Back Pain and Body Posture Evaluation Instrument (BackPEI) during three assessments (2011, 2014, and 2017). BackPEI assesses the presence of back pain and possible associated risk factors (postural, behavioral, and sociodemographic). Generalized estimated equations (GEE) were used to perform a Poisson regression model with robust variance for longitudinal analysis. After six years of follow-up, 75 schoolchildren completed all the assessments. The risk factors associated with back pain were spending more than six hours daily watching television, lifting objects from the ground adopting an inadequate posture, using another backpack type different from those with two straps, and carrying a backpack in an asymmetric way. These results are important in guiding the planning of public policies to minimize this public health problem.

Dados de mundo real: o impacto econômico da inclusão de antineoplásicos orais para as operadoras de saúde no Sistema de Saúde Suplementar do Brasil / Real world data: the economic impact of including oral antineoplastic agents for health care providers in the Brazilian Supplementary Health System

Objetivo: Avaliar o incremento mensal do custo por beneficiário da incorporação das terapias antineoplásicas orais se aprovado o PL nº 6.330/2019. Métodos: As características clínicas e dos medicamentos utilizados em pacientes em tratamento oncológico foram coletadas da base de dados de mundo real Auditron®, plataforma de avaliações de solicitações de pré-autorização de procedimentos médicos. Com base nas características dos pacientes, foram avaliadas as possibilidades de uso dos medicamentos antineoplásicos orais, conforme as diretrizes da NCCN e ESMO. O cálculo do custo incremental foi realizado utilizando o número total de pacientes diagnosticados com uma neoplasia específica e o número de pacientes aptos a receber antineoplásicos orais. Foi utilizada lista de preços CMED para cálculo dos custos de aquisição de medicamentos. Resultados: O custo incremental da incorporação de 34 drogas antineoplásicas orais em 2019 foi de R$ 5.362.642.580 (R$ 3.944.321.786- R$ 6.483.413.466), representando impacto mensal de R$ 9,50 por beneficiário. O custo incremental da incorporação de 21 drogas antineoplásicas orais em 2021 era de R$ 2.028.538.791 (R$ 1.485.919.710-R$ 3,016,407,794), representando impacto mensal de R$ 3,59 por beneficiário. Conclusão: A incorporação das drogas antineoplásicas orais acarretariam um baixo incremento mensal por beneficiário.

Objective: To evaluate the monthly increase in the cost per member of incorporating all oral neoplastic therapies if approved the bill 6,330/2019. Methods: The clinical characteristics and medications used by patients undergoing cancer treatment were collected from the real-world Auditron® database, a platform for evaluating requests for pre-authorization of medical procedures. Based on the characteristics of each patient, the possibility of using oral antineoplastic drugs according to the NCCN and ESMO guidelines was evaluated. The incremental cost calculation was performed using the total number of patients diagnosed with a specific neoplasm and the number of patients eligible to receive oral anticancer drugs. CMED price list was used to calculate drug acquisition costs. Results: The incremental cost of incorporating 34 neoplastic drugs in 2019 was R$ 5,362,642,580 (R$ 3,944,321,786- R$ 6,483,413,466), representing a monthly impact of R$ 9.50 per member. The incremental cost of incorporating 21 neoplastic drugs in 2021 was R$ 2,028,538,791 (R$ 1,485,919,710-R$ 3,016,407,794), representing a monthly impact of R$ 3.59 per beneficiary. Conclusion: The incorporation of oral anticancer drugs in the coverage of health plans following international and national treatment guidelines would result in a low monthly increase in the cost per beneficiary.

Analysis of postural asymmetry on sagittal plane between right and left side views using photogrammetry.

BACKGROUND: Postural asymmetry is natural and expected during postural assessment. Besides, there are conditions that exacerbate the difference between right and left side views, such as Idiopathic Scoliosis (IS). However, the photogrammetric postural assessment on sagittal plane is usually performed using only one side view. This study aimed testing if there are differences between the right and the left-side views in photogrammetric postural assessment of adults on sagittal plane. METHODS: Patients with and without scoliosis were assessed and were grouped into Control Group (CG) and Positive Adam's test Group (PAG) according to Adam's forward bending test. After screening, participants were assessed using the right and the left-side views according DIPA© protocol. Descriptive and inferential analysis were made using Paired t-Test and Independence Chi-square Test (χ2). RESULTS: Significant differences were found between right and left side views to knee angle and head position angle to overall sample. The mean difference was low, about 1° on head position and 2.6° on knee angle and did not affect the classification of body segments. CONCLUSION: We conclude that the postural assessment on sagittal plane of adults without IS can be performed using only one side view, becoming the photogrammetric postural assessment an easy-to-use tool.

Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA): Expansion, Content Validation, and Reliability.

The Back Pain and Body Posture Evaluation Instrument (BackPEI) was created in 2013 to assess back pain and its risk factors in school children. However, it does not assess neck pain or the habits of mobile device usage, which are aspects that are often part of school children's lives. Therefore, we aimed to update the BackPEI questionnaire to include new questions assessing aspects related to neck pain and the use of mobile devices and to test the content validity and reliability of the new questions. The updated questionnaire was named Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA). The content was validated by eight experts using the content validity index (CVI). To assess reliability, the BackPEI-CA questionnaire was applied at two different times in 105 school children, and Cohen's kappa (k) and intraclass correlation coefficient (ICC) were calculated. All aspects assessed regarding content validity had a CVI higher than 0.8. The new questions presented moderate and good kappa values and excellent ICC values. The updated version of BackPEI-CA can be used as a clinic tool for assessing the presence, frequency, and intensity of back and neck pain and their risk factors.

Cuidados de enfermagem a crianças e adolescentes com necessidades especiais de saúde / Cuidados de enfermería a niños y adolescentes con necesidades especiales de salud / Nursing care for children and adolescents with special health needs

RESUMO Objetivo: investigar as demandas de cuidados, na ótica da equipe de enfermagem, a crianças e adolescentes com necessidades especiais de saúde (CRIANES) hospitalizadas. Método: pesquisa descritiva, exploratória e de abordagem qualitativa. Foram entrevistados 11 profissionais de enfermagem que atuam em Unidade de internação pediátrica de um hospital da região noroeste do Rio Grande do Sul, nos meses de novembro de 2019 a fevereiro de 2020. As enunciações foram duplamente transcritas e submetidas à análise de conteúdo. Resultados: os profissionais elucidaram sobre a presença de familiares cuidadores durante a hospitalização em unidade pediátrica. A equipe manifestou a importância do conhecimento técnico-científico, bem como as potencialidades e fragilidades no processo de trabalho com essa população específica. Considerações finais: A assistência do cuidado de enfermagem com CRIANES exige habilidades técnico-científicas, assim como a criação do vínculo equipe-paciente-família. Desse modo, enfatiza-se a necessidade da educação continuada dos profissionais, para fornecer assistência humanizada e resolutiva, diminuindo os índices de reinternações.

RESUMEN Objetivo: investigar las demandas de atención, en la óptica del equipo de enfermería, a niños y adolescentes con necesidades especiales de salud (NINEAS) hospitalizadas. Método: investigación descriptiva, exploratoria y de abordaje cualitativo. Fueron entrevistados 11 profesionales de enfermería que actúan en Unidad de internación pediátrica de un hospital de la región noroeste de Rio Grande do Sul-Brasil, en los meses de noviembre de 2019 a febrero de 2020. Los relatos fueron doblemente transcriptos y sometidos al análisis de contenido. Resultados: los profesionales aclararon sobre la presencia de familiares cuidadores durante la hospitalización en unidad pediátrica. El equipo relató la importancia del conocimiento técnico-científico, así como las potencialidades y fragilidades en el proceso de trabajo con esa población específica. Consideraciones finales: la asistencia del cuidado de enfermería a NINEAS exige habilidades técnico-científicas, así como la creación del vínculo equipo-paciente-familia. De ese modo, se enfatiza la necesidad de la educación continuada de los profesionales, para proporcionar asistencia humanizada y resolutiva, disminuyendo los índices de reinternaciones.

ABSTRACT Objective: to investigate care demands of children and adolescents with special health care needs (CSHCN) hospitalized from the perspective of the nursing team. Method: descriptive, exploratory and qualitative research. Eleven 11 nursing professionals were interviewed, who work in a pediatric hospitalization unit of a hospital in the northwest region of Rio Grande do Sul, from November 2019 to February 2020. The statements were double transcribed and submitted to content analysis. Results: the professionals elucidated about the presence of family caregivers during hospitalization in the pediatric unit. The team expressed the importance of technical and scientific knowledge, as well as the potential and weaknesses in the work process with this specific population. Final thoughts: Nursing care with CRIANES requires technical and scientific skills, as well as the creation of the team-patient-family bond. Thus, it emphasizes the need for continuing education of professionals, to provide humanized and problem-solving assistance, reducing the rates of readmissions.

Phrases in Noise Test (PINT) Brazil: influence of the inter-stimulus interval on the performance of children with hearing impairment. / Phrases in Noise Test (PINT) Brasil: influência do intervalo interestímulos no desempenho de crianças com deficiência auditiva.

PURPOSE: This study aimed to investigate, using the PINT Brasil, the influence of the interstimulus interval on the performance of children with moderate and severe hearing loss fitted with hearing aids. METHODS: Ten children with normal hearing (CG) and 20 children with hearing loss (SG) participated in the study. Both groups were assessed using the speech perception test called PINT Brasil in PAUSE and NO PAUSE situations. RESULTS: When comparing the PAUSE and NO PAUSE situations, only the SG presented a statistically significant difference, indicating that the NO PAUSE situation had the best performance. In this situation, the noise oscillations were smaller, and the noise reduction algorithm, which may cause the loss of message information, was not repeatedly activated. CONCLUSION: The interstimulus interval in the PINT Brasil influenced the performance of children with moderate and severe hearing loss fitted with hearing aids. The NO PAUSE situation presented the best results.

OBJETIVO: Investigar a influência do intervalo interestímulos no desempenho de crianças com deficiência auditiva de grau moderado e severo, adaptadas com aparelhos de amplificação sonora individuais (AASI), no teste PINT Brasil. MÉTODO: Participaram do estudo 10 crianças com audição normal (GC) e 20 crianças com deficiência auditiva (GE). O teste PINT Brasil foi aplicado nas situações SEM pausa e COM pausa para os dois grupos. RESULTADOS: Na comparação entre as situações SEM pausa e COM pausa, houve diferença significativa apenas para o GE, indicando a SEM pausa com melhor desempenho. Nesta última condição, as oscilações ruidosas foram menores e não houve o acionamento repetido do redutor de ruído, o que possibilita a perda de informações da mensagem. CONCLUSÃO: Conclui-se que o intervalo interestímulos no teste de percepção da fala PINT Brasil influenciou o desempenho das crianças com deficiência auditiva de grau moderado e severo, adaptadas com AASI. O melhor resultado foi encontrado na situação SEM PAUSA.

Evolução do saneamento básico e a sua relação com a saúde pública / Basic sanitation evolution and its relationship with public health

O objetivo deste trabalho é apresentar uma revisão bibliográfica da evolução do saneamento básico brasileiro em 50 anos, mostrando as técnicas atuais tratamento de água e esgoto, e relacionando estes dados com a incidência de Doenças Relacionadas ao Saneamento Ambiental Inadequado (DRSAI). Busca de livros, protocolos e artigos no Google Acadêmico com a pesquisa de palavras-chave correspondentes a (1) "Saneamento Básico and 1970 a 2020", (2) "Saneamento Básico and Realidade no Brasil", (3) "Técnicas de Saneamento", (4) "Saneamento and Urbanização", (5) "Saneamento inadequado and doenças", (6) "Doenças relacionadas ao saneamento ambiental inadequado" e (7) "Saneamento and arboviroses". O saneamento é um direito assegurado por Lei, e deve ser universalizado até 2030, de acordo com os objetivos para o desenvolvimento sustentável. O saneamento básico brasileiro evoluiu em 50 anos, porém ainda não é universal, como por exemplo, cerca de 10% região Norte tem acesso ao esgoto tratado. A ausência do saneamento, ou sua prestação de observadas em locais de acesso desigual ao saneamento básico e também em locais de urbanizados, como no Estado de São Paulo, um dos locais de maior acesso de água e esgoto tratados, apresenta alta incidência de arbovirose. Apesar do prazo para universalização do saneamento básico, o Brasil ainda se encontra distante desse cenário ideal. Além disso, a urbanização também torna o ambiente insalubre, propiciando a incidência de DRSAI. Sendo assim, para melhorias na saúde pública, é imprescindível a existência de um serviço adequado de tratamento e abastecimento de água e esgoto

This work aims to present a bibliographic review about the Brazilian basic sanitation evolution in 50 years, showing water and sewage treatment techniques and relating this data to Diseases Related to Inadequate Environmental Sanitation (DRIES) incidence. Search for books, protocols and articles on Google Scholar with the search for keywords corresponding to (1) "Basic Sanitation and 1970 to 2020", (2) "Basic Sanitation and Brazil's Reality", (3) "Sanitation Techniques", (4) "Sanitation and Urbanization", (5) "Inadequate Sanitation and Diseases", (6) "Diseases Related to Inadequate Environmental Sanitation" and (7) "Sanitation and arboviruses". Sanitation is a right guaranteed by law and clean water and treated sewage shall be universalized until 2030, according to goals for sustainable development. The basic sanitation evolved in 50 years but stills not universal (i.e. about 10% of the Northern region has access to treated sewage). Sanitation absence or its ineffective service bring harm to health with DRIES. DRIES are more observed in places of unequal access to basic sanitation and also in urbanized places, as in the State of São Paulo, one of the places of greater access of treated water and sewage and also with higher incidence of arboviruses. Despite basic sanitation universalization deadline, Brazil is still far from this ideal scenario. Moreover, urbanization makes the environmental unhealthy, providing DRIES incidence. Thus, to public health improvements, proper basic sanitation service is essential

Back pain and its risk factors in Brazilian adolescents: a longitudinal study.

Owing to the lack of longitudinal studies in Latin American countries, we aimed to evaluate back pain and its risk factors in a 3-year longitudinal study of Brazilian adolescents. We analysed data of 525 adolescents (aged 11-16 years) attending primary school (fifth to eighth grade) in Brazil. The students were administered the self-reported Back Pain and Body Posture Evaluation Instrument (BackPEI) questionnaire in 2011 and at a follow-up evaluation that was conducted 3 years later (2014). Back pain was the outcome variable; the exposure variables included exercise, behavioural, hereditary and postural factors. Generalized estimating equations were used to perform a Poisson regression model with robust variance to evaluate the risk factors for back pain. The prevalence of back pain at baseline was 56% (n = 294); this increased significantly at the 3-year follow-up evaluation to 65.9% (n = 346). The frequency of experiencing back pain also significantly increased after 3 years in both boys (p = 0.002) and girls (p = 0.001). The prevalence of back pain increased significantly in adolescents up to the age of 13 years, stabilized in those aged 14 years and older and was higher among girls. A family history of back pain (in the parents), watching television for lengthy periods and carrying a backpack asymmetrically were predictors for back pain.

Phrases in noise test (PINT) Brazil: effectiveness of the test in children with hearing loss.

INTRODUCTION: One of the main implications of hearing impairment is the difficulty in perceiving speech sounds, especially in noisy environments. Thus, the frequency-modulated system is considered an important educational tool for children with hearing impairment because it improves speech perception in acoustically-unfavorable environments, such as in the classroom. The assessment of speech perception in noise is included in the verification protocol of this device. OBJECTIVES: To verify the effectiveness of the phrases in noise test Brazil in children with hearing impairment using an frequency-modulated system. METHODS: This was a cross-sectional cohort study. The sample included 40 children, aged 4 years to 11 years and 11 months old, divided into 4 groups: (1) 10 normal hearing children; (2) 13 children with hearing aids and frequency-modulated system; (3) 12 children using cochlear implant and fitted with the frequency-modulated system; and (4) 5 children diagnosed with auditory neuropathy spectrum disorder, fitted with hearing aids and/or cochlear implant and with the frequency-modulated system. The phrases in noise test Brazil was used to evaluate speech perception in noise under the conditions with and without the frequency-modulated system. For the statistical analysis of the data, a significance level of 5% (p < 0.05) was adopted. RESULTS: There was a significant difference between the groups when they were evaluated with the frequency-modulated system. The test was also validated through concurrent and convergent validation measures. Phrases in noise test Brazil is a viable option for monitoring auditory performance in noise in different groups of children with hearing impairmen. CONCLUSION: Phrases in noise test Brazil was effective in assessing speech perception in noise and may contribute to the improvement of the indication, fitting and follow-up protocols for the frequency-modulated system use.

Efeito agudo da estimulação elétrica nervosa transcutânea (TENS) na lombalgia / Acute effect of transcutaneous nerve electric stimulation (TENS) on lombalgy

A lombalgia é um problema extremamente comum, que afeta mais pessoas do que qualquer outra afecção. Acarreta em um quadro de dor, perda de função e redução da qualidade de vida. Isto posto, o tratamento conservador é de suma importância para a reabilitação de pacientes com lombalgia. Objetivo: Avaliar o efeito agudo da estimulação elétrica transcutânea (TENS) em portadores de lombalgia. Métodos: Série de casos, no qual participaram 66 pacientes. Foi realizado uma única intervenção com TENS no modo acupuntural, frequência de 70 Hz, tempo de pulso de 150 us, com duração de 40 minutos. Foram avaliados o nível de dor, flexibilidade de isquiotibiais, força muscular e estabilização do complexo lombopélvico pré, imediatamente após e 24 horas após a intervenção. Resultados: O nível de dor, flexibilidade de isquiotibiais e força muscular dos extensores de tronco apresentaram melhora imediatamente após intervenção (p<0,05). Após 24 horas, houve aumento significativo da dor em comparação ao pós intervenção (p<0,05), porém ainda se verificou um efeito analgésico e de melhora da flexibilidade em comparação a avaliação pré. A força muscular melhorou de forma significativa pós intervenção e manteve-se 24 horas após (p<0,05). Os testes de estabilidade apresentaram maior tempo de manutenção da postura imediatamente após a aplicação da TENS, porém com redução deste feito pós 24 horas (p<0,05). Conclusão: A TENS demonstrou redução do quadro álgico, melhora da força de tronco, flexibilidade de isquiotibiais e da estabilização lombopélvica imediatamente após a intervenção. Estes efeitos se mantiveram 24 horas após, porém não com a mesma intensidade.

Low back pain is an extremely common problem that affects more people than any other condition. It causes pain, loss of function and reduced quality of life. That said, conservative treatment is of paramount importance for the rehabilitation of patients with low back pain. Objective: To evaluate the acute effect of transcutaneous electrical stimulation (TENS) in patients with low back pain. Methods: Case series, in which 66 patients participated. A single intervention with TENS was performed in acupuncture mode, frequency of 70 Hz, pulse time of 150 us, lasting 40 minutes. The level of pain, hamstring flexibility, muscle strength and stabilization of the lumbopelvic complex pre, immediately after and 24 hours after the intervention were evaluated. Results: The level of pain, hamstring flexibility and muscle strength of the trunk extensors improved immediately after intervention (p <0.05). After 24 hours, there was a significant increase in pain compared to the post-intervention period (p <0.05), but there was still an analgesic effect and improved flexibility compared to the pre evaluation. Muscle strength improved significantly after the intervention and was maintained 24 hours later (p <0.05). The stability tests showed a longer posture maintenance time immediately after the application of TENS, but with a reduction of this done after 24 hours (p <0.05). Conclusion: TENS demonstrated a reduction in pain, improvement in trunk strength, hamstring flexibility and lumbopelvic stabilization immediately after the intervention. These effects were maintained 24 hours later, but not to the same degree.

Effects of TRX Suspensions Training on Functionality, Body Pain and Static Posture of an Elderly Woman: a Case Report / Efeitos do Treinamento Suspenso TRX Sobre a Funcionalidade, Dor no Corpo e a Postura Estática de uma Mulher Idosa: um Relato de Caso

Considering that suspended training (TRX® ST) refers to the idea of a full training, it is believed that its practice can bring great benefits. Thus, it was [ aimed to verify the effect of suspended training TRX® ST on the functionality, the static posture of the spine and general body pain in an elderly woman. The following were evaluated :(1) funcionality using Senior Fitness Test (SFT) protocol; (2) body pain using a validated questionnaire; and (3) spine static posture using Flexicurve before the training (1st evaluation) and after the last training session (2nd evaluation). The suspended training TRX® ST, that consists of exercises for strength and flexibility, was performed for twelve weeks, in such ways that each week consisted of two sessions, lasting 50 minutes each. The participant presented: (1) an improvement of the functionality (increasing from 12 to 19 repetitions the number of repetitions of sitting and standing up; decreasing from 5.9s to 4.5s the number of sitting and walking ; and decreasing from 6cm to 0cm the result of sitting and reaching up, in STF), except in upper limbs; (2) a reduction of pain in the dorsal, lumbar and gluteal regions; and (3) postural modifications in the lumbar spine, passing from a correction (24°) to a physiological lordosis. (41°). In contrast, the results also showed that the posture of the thoracic spine was not affected by the suspended training in twelve weeks. Since these are initial results, it is necessary to conduct further studies in order to verify the effects of training with TRX® ST on the variables pain, static posture and functionality, as well as on the dynamic posture and the quality of life of its practitioners.(AU).

Considerando que o treinamento suspenso (TRX® ST) remete à ideia de um treinamento completo, trabalhando o corpo como uma unidade, acredita-se que sua prática pode trazer grandes benefícios. Nessa perspectiva, objetivou-se identificar o efeito do treinamento suspenso TRX® ST sobre a funcionalidade, a postura estática da coluna vertebral e as dores corporais em geral em uma mulher idosa, a qual foi submetida à avaliação (1) da funcionalidade por meio do protocolo proposto pelo Senior Fitness Test (SFT); (2) das dores corporais utilizando-se o instrumento Informações sobre Dor nas Costas (IDC); e (3) da postura estática da coluna vertebral utilizando o Flexicurva antes do início do treinamento (1ª avaliação) e após a última sessão do treinamento (2ª avaliação). O treinamento suspenso (TRX® ST), composto de exercícios para força e flexibilidade, foi realizado durante 12 semanas, sendo cada semana composta de duas sessões, com duração de até 50 minutos cada. A participante apresentou: (1) melhora da funcionalidade (aumentando de 12 para 19 o número de repetições de sentar e levantar; diminuindo de 5,9s para 4,5s o tempo de sentar e caminhar; e diminuindo de 6cm para 0cm o resultado de sentar e alcançar, no STF), exceto nos membros superiores; (2) diminuição da dor nas regiões dorsal (de EVA intensidade 1 para intensidade 0), lombar (de EVA intensidade 1 para intensidade 0) e de glúteos (de EVA intensidade 2 para intensidade 1); e (3) mudança da postura da coluna lombar, passando de uma retificação (24°) para uma lordose fisiológica (41°). Em contrapartida, os resultados também demonstraram que a postura da coluna torácica não foi alterada pelo treinamento. Tendo em vista que esses são resultados iniciais, se faz necessária a condução de novos estudos a fim de verificar os efeitos do treinamento com TRX® ST sobre as variáveis dor, postura estática e funcionalidade, bem como sobre a postura dinâmica e a qualidade de vida de seus praticantes.(AU).

Anatomical reference marks, evaluation parameters and reproducibility of surface topography for evaluating the adolescent idiopathic scoliosis: a systematic review with meta-analysis.

BACKGROUND: Surface topography is a radiation-free examination that provides relevant information for the evaluation of patients with Adolescent Idiopathic Scoliosis (AIS). However, its usage is not standardized, which restricts the applicability of this instrument. RESEARCH QUESTIONS: (a) To identify the anatomical reference markers used on surface topography; (b) to identify the parameters used on surface topography; and (c) to pool correlation and reproducibility results. METHODS: Systematic searches were conducted following MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. The methodological quality was assessed according to Brink & Louw appraisal tool. RESULTS: Twenty-three studies were included for the qualitative synthesis. The most commonly used anatomical reference markers were: the prominent vertebra (C7 or T1), the posterior superior iliac spines (PSISs) and the sacrum (S1). The parameters for the evaluation of the AIS by surface topography are: spinal inclination angle (analogous to Cobb), gibbosity, thoracic kyphosis angle, lumbar lordosis angle, pelvic obliquity, spine length, apex of the curve, C7-S1 distance (frontal plane), and C7-S1 displacement (sagittal plane). Data from eleven studies were metanalyzed and evidenced the correlation of the surface topography with X-ray exams and the reproducibility of the surface topography in the sagittal and frontal planes. SIGNIFICANCE: The findings of this study recommend the use of a protocol for the application of the equipment. The analyzed studies predict the use of only four markers for anatomical reference. The evaluation of the AIS can be carried out observing nine parameters. Surface topography correlates with radiography when the spinal inclination angle (Cobb angle), thoracic kyphosis angle and lumbar lordosis angle are compared. Also, surface topography presents inter and intra-rater reproducibility in the sagittal plane and intra-rater reproducibility in the frontal plane.