Social determinants and access to health services in patients with COVID-19: a cross-sectional study.

OBJECTIVE: To verify the association between social determinants of health and access to health services for COVID-19 patients. METHOD: Analytical, cross-sectional study, carried out in three states in the Northeast of Brazil (Ceará, Maranhão and Pernambuco), with 968 patients, using questionnaires with sociodemographic data, determinants and the Primary Care Assessment Tool, adapted to the reality of COVID-19, with 58 items, classified as high (score ≥ 6.6) and low (score < 6.6), whose high value reveals better standards of access to health services. The Chi-square test was used for comparative analysis. RESULTS: There was a significant difference (p < 0.05) between the domains of the instrument and the following determinants: age, skin color, body mass index, origin, schooling, employment, services close to home, first service, income and means of transport. CONCLUSION: Access to health services for people with COVID-19 was associated with various determinants, including individual, behavioural and social ones, correlated with the structural and organizational aspects of the health services offered by the three states of Northeastern Brazil.

Quality of Life and Hormonal Impairment in Pediatric Patients With Craniopharyngiomas.

INTRODUCTION: Craniopharyngiomas (CP) are tumors in the sellar region that, despite a high survival rate, are associated with significant morbidity, including hypothalamic, hormonal, and visual dysfunction. This study aimed to assess the quality of life (QoL) in pediatric patients with CP and to evaluate its relationship with various factors, with a focus on the impact of endocrine dysfunction. METHODS: In this observational cross-sectional study, patients with CP aged between 0 and 18 years, currently followed up in a tertiary hospital by a multidisciplinary team, were included. QoL was assessed using the validated PEDS-QL4.0 questionnaire, which was administered to parents. This tool estimates Global QoL (QoL-G), further divided into Physical (QoL-P) and Psychosocial (QoL-PS) dimensions, including Emotional (QoL-Em), Social (QoL-S), and School (QoL-Sc) aspects. In Portugal, the estimated average QoL-G is 79.8, QoL-P is 83.5, and QoL-PS is 78.2. Variables studied included gender, current and diagnostic age, follow-up time, presence of hydrocephalus, hypothalamic involvement, type of resection (total or subtotal), radiotherapy, visual impairment, hormonal deficits, and therapy. RESULTS: The study included 11 patients with a median age of 15.2 years (interquartile ratio (IQR), 9.7-17.9 years) and a mean age at diagnosis of 9.3±4.1 years. Of these patients, 54.5% were male, and 36.4% were obese. Subtotal resection was performed in 72.7% of cases. Hydrocephalus was present in 54.5% of the patients, hypothalamic involvement in 63.7%, radiotherapy was received by 81.8%, and visual impairment was noted in 54.5%. All patients presented with at least one hormonal deficit. The average QoL-G was 69.9±22.5, with QoL-P at 66.9±30.0 and QoL-PS at 70.9±21.4. A worse QoL-S was associated with female gender (p=0.030) and subtotal resection (p=0.048). Worse QoL-G, QoL-P, QoL-Em, and QoL-PS were linked to hypothalamic involvement (p values 0.008, 0.025, 0.015, and 0.009, respectively). Irradiated patients had worse QoL-G (p=0.006). Treatment with sexual hormones enhanced QoL-Global (p=0.035) and QoL-Emotional (p=0.020), while treatment for adrenal insufficiency and diabetes insipidus improved QoL-Emotional (p=0.021 and p=0.013). No significant associations with visual deficit or obesity were found. CONCLUSIONS: Pediatric patients with CP appear to have poorer QoL-G, QoL-P, and QoL-PS compared to the healthy Portuguese population. However, the small sample size limits statistically significant associations with many of these variables. Predictors of worse QoL include female gender, hypothalamic involvement, subtotal resection, and radiotherapy. The results may be biased due to the small sample size, questionnaire administration to parents, and possible inadequacy of the questionnaire for the studied population. There is a need for a more suitable tool to enable a more precise assessment of QoL in these patients.

Efficacy of three benznidazole dosing strategies for adults living with chronic Chagas disease (MULTIBENZ): an international, randomised, double-blind, phase 2b trial.

BACKGROUND: Treatment with benznidazole for chronic Chagas disease is associated with low cure rates and substantial toxicity. We aimed to compare the parasitological efficacy and safety of 3 different benznidazole regimens in adult patients with chronic Chagas disease. METHODS: The MULTIBENZ trial was an international, randomised, double-blind, phase 2b trial performed in Argentina, Brazil, Colombia, and Spain. We included participants aged 18 years and older diagnosed with Chagas disease with two different serological tests and detectable T cruzi DNA by qPCR in blood. Previously treated people, pregnant women, and people with severe cardiac forms were excluded. Participants were randomly assigned 1:1:1, using a balanced block randomisation scheme stratified by country, to receive benznidazole at three different doses: 300 mg/day for 60 days (control group), 150 mg/day for 60 days (low dose group), or 400 mg/day for 15 days (short treatment group). The primary outcome was the proportion of patients with a sustained parasitological negativity by qPCR during a follow-up period of 12 months. The primary safety outcome was the proportion of people who permanently discontinued the treatment. Both primary efficacy analysis and primary safety analysis were done in the intention-to-treat population. The trial is registered with EudraCT, 2016-003789-21, and ClinicalTrials.gov, NCT03191162, and is completed. FINDINGS: From April 20, 2017, to Sept 20, 2020, 245 people were enrolled, and 234 were randomly assigned: 78 to the control group, 77 to the low dose group, and 79 to the short treatment group. Sustained parasitological negativity was observed in 42 (54%) of 78 participants in the control group, 47 (61%) of 77 in the low dose group, and 46 (58%) of 79 in the short treatment group. Odds ratios were 1·41 (95% CI 0·69-2·88; p=0·34) when comparing the low dose and control groups and 1·23 (0·61-2·50; p=0·55) when comparing short treatment and control groups. 177 participants (76%) had an adverse event: 62 (79%) in the control group, 56 (73%) in the low dose group, and 59 (77%) in the short treatment group. However, discontinuations were less frequent in the short treatment group compared with the control group (2 [2%] vs 11 [14%]; OR 0·20, 95% CI 0·04-0·95; p=0·044). INTERPRETATION: Participants had a similar parasitological responses. However, reducing the usual treatment from 8 weeks to 2 weeks might maintain the same response while facilitating adherence and increasing treatment coverage. These findings should be confirmed in a phase 3 clinical trial. FUNDING: European Community's 7th Framework Programme.

Simultaneous determination of carbonyl compounds related to thermal treatment and oxidative stability of infant formulas by gas-diffusion microextraction and high-performance liquid chromatography with ultraviolet detection.

Infant formulae are the only possible alternative to breastfeeding during the first year of life, so it is crucial to assure their innocuousness. Infant formula undergoes heat treatments to ensure safety and shelf life. However, such processes impact health as they lead to the formation of malondialdehyde, acrolein, and α-dicarbonyl compounds, related to Maillard reaction. Thus, there is a need for improved analytical methods to ensure the safety, quality, and nutritional value of infant formulae, and also exploring the potential of specific compounds as indicators for quality control and monitoring purposes. We developed and validated a novel, efficient, and cost-effective method using gas-diffusion microextraction for the simultaneous quantification of carbonyl compounds in infant formula. Malondialdehyde, acrolein, glyoxal, methylglyoxal, and diacetyl were detected as o-phenylenediamine derivatives using HPLC with UV detection. Parameters influencing extraction efficiency were studied using an asymmetric screening design. The validated method has shown excellent linearity, sensitivity, accuracy, and precision. It was applied to analyze 26 infant formula samples, including starter, follow-up, and special formulated powdered infant formula. Methylglyoxal was found in all samples (0.201-3.153 µg mL-1), while malondialdehyde was present only in certain starter formulas (1.033-1.802 µg mL-1). Acrolein (0.510-3.246 µg mL-1), glyoxal (0.109-1.253 µg mL-1), and diacetyl (0.119-2.001 µg mL-1) were detected in various sample types. Principal components and hierarchical cluster analyses have showcased distinct sample clustering based on analyte contents. This study presents a novel methodology for the analysis of markers of thermal treatment and oxidative stability in infant formula. It contributes to the characterization of the products' composition and quality control of infant formulae, thereby enhancing their safety and nutritional adequacy. This study also presents the first reported quantification of acrolein in infant formula and introduces the application of the acrolein-o-phenylenediamine derivative for food analysis.

Use of a Paclitaxel Drug-Eluting Stent for the Treatment of Hemodialysis Access Outflow Stenosis.

PURPOSE: To evaluate the outcomes and durability of drug-eluting stents (DESs) for the treatment of hemodialysis access outflow stenosis. MATERIAL AND METHODS: A single-center retrospective analysis was conducted of all patients with hemodialysis vascular access outflow stenosis treated with a paclitaxel-coated DES (Eluvia; Boston Scientific, Marlborough, Massachusetts) between January 2020 and July 2022. A total of 34 DESs were implanted to treat outflow stenosis in 32 patients. Primary target lesion patency after stent deployment was the main outcome. Comparison between the time interval free from target lesion reintervention (TLR) after previous plain balloon angioplasty (PBA) and that after stent deployment for the same target lesion was considered a secondary outcome. RESULTS: The primary patency at 6, 12, and 18 months was 63.1%, 47.6%, and 41.7%, respectively. The secondary patency rate was 100% at 18 months. The median time interval free from TLR increased from 4.1 to 11.9 months (P < .001). No adverse events were observed during the median follow-up period of 387 days. CONCLUSIONS: The patency rates after use of DES for hemodialysis access outflow stenosis were comparable with results for drug-coated balloons and stent grafts, addressing recoil and minimizing the risk of jailing by a covered stent.

Publicações científicas sobre direção veicular por pessoas idosas: revisão de escopo / Scientific publications on driving by older adults: scope review

Resumo Objetivo Mapear evidências científicas nacionais e internacionais sobre a condução veicular por pessoas idosas. Método Revisão de escopo baseada no manual proposto pelo Joanna Briggs Institute. Para as buscas foram acessadas as bases MEDLINE, Web of Science, Scopus, SciELO e a literatura cinzenta, por meio do Google Scholar. Resultados Dos 1.194 estudos encontrados, selecionaram-se 189 artigos submetidos aos critérios de elegibilidade. Os países precursores nas publicações foram Austrália e Estados Unidos, e o ápice das pesquisas ocorreu entre 2013 e 2014. Os participantes dos estudos eram pessoas idosas saudáveis, 63,49% (120); seguidos de 17,46% (33) com doença de Alzheimer; 11,11% (21) com Transtorno Neurocognitivo Leve; 6,88% (13) com doença de Parkinson; e 19,58% (37) com outras comorbidades. Diferentes tipos de intervenções foram identificadas nos estudos, destas, 94,02% (178) avaliaram a eficácia de instrumentos que mensuram a aptidão do motorista idoso. Conclusão Houve predominância de estudos na busca de instrumentos de avaliação que mensurassem a funcionalidade do condutor idoso. Esse fato ratifica a importância de avaliação padronizada, validada e economicamente viável que colabore na identificação do motorista em risco. Evidenciou-se a necessidade de intervenções para a prática da geriatria e gerontologia, por meio de ações para formação de equipe multidisciplinar especializada em condução veicular, de modo a adequar as diretrizes de licenciamento a fim de atender às especificidades dos condutores idosos, considerando os aspectos sociais, econômicos, políticos e educacionais, especialmente nos departamentos de trânsito brasileiro.

Abstract Objective To map national and international scientific evidence regarding driving by older adults. Method Scope review based on the manual proposed by the Joanna Briggs Institute. Searches were conducted in the MEDLINE, Web of Science, Scopus, SciELO databases, and grey literature through Google Scholar. Results Out of 1,194 studies identified, 189 papers meeting eligibility criteria were selected. Pioneering countries in publications were Australia and the United States, with the peak of research occurring between 2013 and 2014. Study participants included healthy older adults (63.49%, 120), followed by those with Alzheimer's disease (17.46%, 33), Mild Neurocognitive Disorder (11.11%, 21), Parkinson's disease (6.88%, 13), and other comorbidities (19.58%, 37). Various interventions were identified, with 94.02% (178) assessing the effectiveness of instruments measuring the fitness of older drivers. Conclusion There was a prevalence of studies aimed at identifying assessment tools to measure the functionality of older drivers. This underscores the importance of standardized, validated, and economically viable assessments that contribute to identifying at-risk drivers. The need for interventions in geriatrics and gerontology was evident, emphasizing the necessity for actions to establish a specialized multidisciplinary team in vehicular driving. This approach seeks to align licensing guidelines with the specific needs of older drivers, taking into account social, economic, political, and educational aspects, particularly within the Brazilian traffic departments.

Social determinants and access to health services in patients with COVID-19: a cross-sectional study / Determinantes sociales y acceso a los servicios sanitarios en pacientes con COVID-19: un estudio transversal / Determinantes sociais e acesso aos serviços de saúde em pacientes com COVID-19: estudo seccional

ABSTRACT Objective: To verify the association between social determinants of health and access to health services for COVID-19 patients. Method: Analytical, cross-sectional study, carried out in three states in the Northeast of Brazil (Ceará, Maranhão and Pernambuco), with 968 patients, using questionnaires with sociodemographic data, determinants and the Primary Care Assessment Tool, adapted to the reality of COVID-19, with 58 items, classified as high (score ≥ 6.6) and low (score < 6.6), whose high value reveals better standards of access to health services. The Chi-square test was used for comparative analysis. Results: There was a significant difference (p < 0.05) between the domains of the instrument and the following determinants: age, skin color, body mass index, origin, schooling, employment, services close to home, first service, income and means of transport. Conclusion: Access to health services for people with COVID-19 was associated with various determinants, including individual, behavioural and social ones, correlated with the structural and organizational aspects of the health services offered by the three states of Northeastern Brazil.

RESUMEN Objetivo: Verificar la asociación de los determinantes sociales de la salud con el acceso de los pacientes con COVID-19 a los servicios de salud. Método: Estudio analítico, transversal, realizado en tres estados del Nordeste de Brasil (Ceará, Maranhão y Pernambuco), con 968 pacientes, utilizando cuestionarios con datos sociodemográficos, determinantes y la Herramienta de Evaluación de la Atención Primaria (PCATool), adaptada a la realidad de la COVID-19, con 58 ítems, clasificados en alto (puntuación ≥ 6,6) y bajo (puntuación < 6,6), cuyo valor alto revela mejores estándares de acceso a los servicios de salud. Se utilizó la prueba de chi-cuadrado para analizar las comparaciones. Resultados: Hubo diferencia significativa (p < 0,05) entre los dominios del instrumento y los siguientes determinantes: edad, color de piel, índice de masa corporal, origen, escolaridad, empleo, servicios cercanos al domicilio, primer servicio, ingreso y medio de transporte. Conclusión: El acceso a los servicios de salud de las personas con COVID-19 se asoció a diversos determinantes, entre ellos individuales, comportamentales y sociales, correlacionados con los aspectos estructurales y organizativos de los servicios de salud ofrecidos por los tres estados del nordeste de Brasil.

RESUMO Objetivo: Verificar a associação dos determinantes sociais da saúde com o acesso de pacientes com COVID-19 aos serviços de saúde. Método: Estudo analítico, transversal, desenvolvido em três estados do Nordeste brasileiro (Ceará, Maranhão e Pernambuco), com 968 pacientes, utilizando-se de questionários de dados sociodemográficos, determinantes e do Primary Care Assessment Tool, adaptado para realidade da COVID-19, com 58 itens, classificado em alto (escore ≥ 6,6) e baixo (escore < 6,6), cujo valor alto revela melhores padrões de acesso aos serviços de saúde. Para análise comparativa, empregou-se o teste do Qui-quadrado. Resultados: Verificou-se diferença significativa (p < 0,05) entre os domínios do instrumento e os seguintes determinantes: idade, cor da pele, índice de massa corporal, procedência, escolaridade, vínculo empregatício, serviços próximos à residência, primeiro serviço de atendimento, renda e meios de transporte. Conclusão: O acesso aos serviços de saúde de pessoas com COVID-19 esteve associado aos diversos determinantes, sendo estes individuais, comportamentais, sociais, correlacionados aos aspectos estruturais e organizacionais dos serviços de saúde ofertados pelos três estados do Nordeste brasileiro.

Natural infection of Lutzomyia longipalpis (Lutz & Neiva, 1912) by Leishmania infantum in a municipality with a high incidence of visceral leishmaniasis in the Brazilian Midwest.

BACKGROUND: Here, Leishmania presence in sand flies from Três Lagoas, Mato Grosso do Sul, Brazil, after visceral leishmaniasis (VL) was investigated. METHODS: In April 2022, two light traps were deployed within and around the residence for two days post-VL case report. RESULTS: A total of 120 Lutzomyia longipalpis were collected. Suprapyloric flagellates were found in a female sand fly with eggs and residual blood during midgut dissection. Sequencing of ITS1 and cytb fragments confirmed Leishmania infantum DNA and identified Homo sapiens as the blood source, respectively. CONCLUSIONS: This study emphasizes the importance of monitoring sand flies in VL endemic areas.

Clinical guidelines for posterior restorations based on Coverage, Adhesion, Resistance, Esthetics, and Subgingival management. The CARES concept: Part II - full-contour resistive crowns with vertical preparation.

Restoration of posterior teeth with different extents of tissue loss has been a matter of debate in the literature. There are several recommendations and guidelines on when, how, and why to perform adhesive restorations (onlays, overlays, and endocrowns) or resistance form restorations (full-contour resistive crowns). In Part I of this three-part article series, the authors focused on adhesive partial restorations. In that article, the evidence was extensively described, and a clinically reasonable thought process was suggested for these decisions based on Coverage of susceptible cusps, Adhesion advantages and limitations, Resistance forms to be implemented, Esthetic concerns, and Subgingival management - the CARES concept. Now, in Part II, the focus is on clinical decisions for full-contour resistive crowns regarding their indications based on remaining tooth structure, materials, and different preparation designs as well as the particularities of vertical marginal preparations, perio-restorative considerations, and esthetic challenges.

Pesticide exposure and risk of Central Nervous System tumors in children: a systematic review with meta-analysis. / Exposição a agrotóxicos e o risco de tumores do Sistema Nervoso Central em crianças: revisão sistemática com metanálise.

Central Nervous System (CNS) tumors represent more than half of all childhood malignant neoplasms. The aim of this study was to determine the relationship between environmental exposure to pesticides and the development of CNS tumors in children. We conducted a systematic review of the literature in the PubMed/MEDILINE, Embase, Web of Science, Scopus, and CINAHL databases. The inclusion criteria were cohort and case-control studies investigating the association between exposure to pesticides and CNS tumors (all histological types included in group III of the WHO Classification of Childhood Cancer) in children aged 0-14 years. The meta-analysis was performed using a random effects model and the Mantel-Haenszel method. Strength of association was measured using odds ratios (OR). The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under identification number CRD42021209354. The search identified 1,158 studies, 14 of which were included in the review. There was evidence of an association between the development of astrocytomas and exposure to all classes of pesticides (OR 1.50; 95%CI 1.15-1.96; p=0.03). The synthesis of the evidence pointed to a relationship between exposure to pesticides and some histological types of CNS tumors in childhood.

Os tumores do Sistema Nervoso Central (SNC) representam mais da metade das neoplasias infantis malignas que acometem crianças. Objetivou-se analisar o risco de exposição a agrotóxicos relacionado com o desenvolvimento de tumores do SNC em crianças. Realizou-se uma revisão sistemática da literatura nas bases de dados PubMed/MEDILINE, Embase, Web of Science, Scopus e CINAHL. Foram incluídos estudos de coorte e caso-controle sobre o desenvolvimento de tumores do SNC (todos os tipos histológicos do grupo III Classificação de Câncer Infantil) decorrentes da exposição a agrotóxicos em crianças de 0-14 anos. Na metanálise utilizou-se o modelo de efeito aleatório e o método estatístico de Mantel-Haenszel. A Razão de Chances (RC) ou Odds Ratio (OR) foi a medida de associação aplicada. A revisão foi registrada no International Prospective Register of Systematic Reviews (PROSPERO) sob o número CRD42021209354. A busca identificou 1.158 estudos, dos quais 14 compuseram a revisão. Verificou-se evidência de associação entre o desenvolvimento de astrocitomas e a exposição a todas as classes de pesticidas (OR 1,50; IC95% 1,15-1,96; p=0,03). A síntese dos resultados apontou para uma relação da exposição aos agrotóxicos com o desfecho de alguns tipos histológicos de tumores do SNC na infância.

Traffic light optimization using non-dominated sorting genetic algorithm (NSGA2).

Traffic congestion is a major concern in urban centers, as it can affect society, the environment, and the economy. There are many studies on the use of computational intelligence (CI) to improve mobility in urban centers. Some of these researches focus on developing strategies for traffic light programming, since traffic coordination is complex due to its many parameters, variables, and dynamic behavior, and also an inefficient traffic control plan can lead to increased delays and contribute to traffic congestion. Although there are many works in the literature on strategies for traffic control, there are still some contributions and gaps to be filled, especially because some studies do not consider the automatic optimization of traffic signals in real time, that is, according to the demand of vehicles on the roads, considering multiple objectives and the use of a network of intersections in their experiments. In addition, some of the proposed models are not independent of simulation to evaluate the solutions of CI algorithms, resulting in a more complex deployment in real situations. In this context, this paper presents a new method to optimize traffic light plan in a network of intersections and in real time, called Active Control of Traffic Signals (ACTS) associated with the Non-Dominated Sorting Genetic Algorithm, considering multiple objectives in the optimization process (minimizing the average delay time and the number of vehicles stops per cycle). To test the applicability of the model, a real dataset of vehicle demand collected by the Company of Transport and Traffic of Belo Horizonte (BHTrans) is loaded into the AIMSUN simulator, then the method is applied and compared with the current traffic control plan used by BHTrans. The results show that the ACTS method reduces the average vehicle delay by almost half compared to the results obtained with the current solution used by BHTrans. In real life, this means less time spent in traffic, which promotes faster traffic flow, reducing traffic congestions.

Fan Assisted Extraction of Volatile Carbonyl Compounds from Coffee Brews Based on the Full Evaporation Technique.

In this work, the fan assisted extraction approach is originally exploited to determine volatile compounds in liquid samples based on the full evaporation technique. The feasibility of this strategy was firstly evaluated using model solutions containing different volatile carbonyl compounds. Different media, volumes of sample, temperatures of extraction, and times of extraction were tested. Linear regressions presenting r > 0.999, intermediate precision values < 6%, and recoveries within 76-95% were attained using a period of extraction of 10 min, a volume of sample solution of 5 µL, and a temperature of extraction of 50 °C. Analyses of brewed coffees were performed. The slopes of the calibration curves obtained using aqueous model solutions and brewed coffee samples were not significantly different. These results revealed no matrix effect under the selected experimental conditions, enabling the use of the external calibration method for quantification purposes. Twenty-four volatile carbonyl compounds were identified in brewed coffee, which elucidates the sensitivity of this approach.

COVID-19 e saúde mental: preocupações de estudantes do ensino superior do estado do Ceará

Objetivo: Objetivou-se apresentar as principais preocupações de estudantes do ensino superior do estado do Ceará, durante a pandemia da COVID-19. Metodologia: Trata-se de recorte de pesquisa maior denominada "Repercussões da pandemia do novo coronavírus na saúde mental dos estudantes de ensino superior". Estudo descritivo e exploratório que utilizou abordagem transversal. A pesquisa contou com amostra de 3.691 alunos que participaram do estudo. Devido ao contexto da pandemia, a coleta de dados foi realizada por meio remoto, via Google Forms. Foram utilizados um questionário sociodemográfico e situacional relacionado à pandemia e ao isolamento social e o Inventário de Saúde Mental (MHI-38). Resultados: O estado de Saúde Mental, de forma global, as dimensões Bem-Estar Positivo e Distresse e as dimensões primárias apresentaram tendência para diminuir com o aumento da preocupação com a continuidade do curso de forma presencial. O estudo apresentou insegurança por parte dos estudantes universitários quanto ao retorno das aulas e de como seria o "novo normal". Quanto ao medo de ser infectado e em relação à preocupação ao sair de casa, respectivamente, 76,72% e 84,85% apresentaram estado de saúde mental inferior, demonstrando, assim, como a pandemia fragilizou a saúde mental. Conclusão: Os resultados apresentaram validação estatisticamente significativas tanto para a Escala global quanto para as dimensões primárias. À vista desse panorama, constata-se o quanto a pandemia e o isolamento social repercutiram em emoções de medo e preocupação, sendo estes sentimentos que interferiram negativamente na saúde mental dos acadêmicos pesquisados.

Uso de substâncias psicoativas entre adolescentes escolares de Distritos Municipais

Objetivo: analisar o uso de substâncias psicoativas entre adolescentes escolares. Método: estudo transversal, de abordagem quantitativa, realizado em 2021, com 199 alunos de quatro escolas estaduais de Ensino Médio localizadas nos Distritos de um Município do interior do Ceará. Utilizou-se um questionário autoaplicável, DUSI (Drug Use Screening Inventory). Resultados: 92 (46,2%) alunos cursavam o primeiro ano do ensino médio, eram do sexo feminino 114 (57,3%), com idade predominante de 15 a 16 anos (N 31 65,9%). Os adolescentes relataram o uso de todas as substâncias pesquisadas, ainda que fosse somente de uma a duas vezes no último mês. Foram prevalentes: analgésicos (25,6%), álcool (15,1%), tranquilizantes (4,5%) e maconha (3,5%). Quase a totalidade dos participantes negou o uso de tabaco nos últimos 30 dias. A maioria dos participantes negou ter problemas associados ao uso dessas substâncias psicoativas. Conclusão: o estudo auxiliou a compreensão das substâncias psicoativas mais consumidas entre os alunos do Ensino Médio de Distritos Municipais, permitindo ampliar os conhecimentos sobre o uso de drogas no ambiente escolar. Esse achado demonstra a presença dessas substâncias e o uso entre os adolescentes, mesmo nos locais mais distantes dos grandes centros urbanos.

Construção e validação de cartilha para pais/cuidadores de crianças com déficit de atenção e hiperatividade / Construction and validation of a booklet for parents/caregivers of children with attention deficit and hyperactivity disorder

Introdução: Os materiais educativos, como as cartilhas, são instrumentos que ajudam no cuidar e elucidam intervenções relevantes e sensíveis ao contexto de saúde, especialmente no cuidado domiciliar a crianças desordem no neurodesenvolvimento. Objetivo: construir e validar cartilha para orientar pais e cuidadores de crianças com Transtorno de Déficit de Atenção e Hiperatividade. Materiais e Métodos: estudo metodológico para construção e validação de cartilha por juízes e pelo público-alvo. Desenvolveu-se redação, designer e layout do material com posterior validação por juízes, considerando-se o índice de validade de conteúdo para análise dos dados. Resultados: cartilha composta por 13 temas e 32 páginas. A validação contou com 21 juízes de conteúdo obtendo índice de 0,89. Sete juízes em aparência avaliaram e pontuou-se o índice de 0,91. 17 participantes do público-alvo avaliaram conteúdo geral com índice de 0,99. Após ajustes, o índice de legibilidade obteve percentual satisfatório de 54%. Discussão e Conclusão: O material construído retrata o cotidiano das famílias, apresenta ilustrações em serviços de saúde e de educação e é sensível ao público estudado. A cartilha foi considerada válida quanto ao conteúdo e aparência e apta para ser utilizada no cuidado da enfermagem à criança com o transtorno, contribuindo para orientação adequada de pais e cuidadores.

Introduction: Educational materials, such as booklets, are tools that help in caregiving and elucidate relevant and sensitive interventions to the health context, especially in home care for children with neurodevelopmental disorders. Objective: to build and validate a booklet to guide parents and caregivers of children with attention deficit hyperactivity disorder. Materials and Methods: methodological study for the construction and validation of a booklet by judges and the target audience. The material was written, designed, and laid out with subsequent validation by judges, considering the content validity index for data analysis. Results: booklet composed of 13 themes and 32 pages. The validation had 21 content judges obtaining an index of 0.89. Seven judges in appearance evaluated and scored the index of 0.91. 17 participants from the target audience evaluated general content with an index of 0.99. After adjustments, the readability index obtained a satisfactory percentage of 54%. Discussion and Conclusion: The constructed material portrays the daily life of families, presents illustrations in health and education services and is sensitive to the studied audience. The booklet was considered valid in terms of content and appearance and suitable for use in nursing care for children with the disorder, contributing to adequate guidance for parents and caregivers.

Introducción: los materiales educativos, como los cuadernillos, son herramientas que ayudan en el cuidado y dilucidan intervenciones pertinentes y sensibles al contexto sanitario, especialmente en la atención domiciliaria de niños con trastornos del neurodesarrollo. Objetivo: construir y validar un folleto para orientar a los padres y cuidadores de niños con Trastorno por Déficit de Atención e Hiperactividad. Materiales y Métodos: estudio metodológico para la construcción y validación de un cuadernillo por jueces y público objetivo. El material fue redactado, diseñado y diagramado, y posteriormente validado por jueces, considerando el índice de validez de contenido para el análisis de los datos. Resultados: folleto compuesto por 13 temas y 32 páginas. La validación contó con 21 jueces de contenido que obtuvieron un índice de 0,89. Siete jueces de apariencia evaluaron y puntuaron el índice de 0,91. 17 participantes del público destinatario evaluaron el contenido general con un índice de 0,99. Tras los ajustes, el índice de legibilidad obtuvo un porcentaje satisfactorio del 54%. Discusión y Conclusión: El material construido retrata la vida cotidiana de las familias, presenta ilustraciones en servicios de salud y educación y es sensible al público estudiado. El cuadernillo fue considerado válido en términos de contenido y apariencia y adecuado para uso en los cuidados de enfermería de niños con el trastorno, contribuyendo para la orientación adecuada de padres y cuidadores.

Exposição a agrotóxicos e o risco de tumores do Sistema Nervoso Central em crianças: revisão sistemática com metanálise / Pesticide exposure and risk of Central Nervous System tumors in children: a systematic review with meta-analysis

Resumo Os tumores do Sistema Nervoso Central (SNC) representam mais da metade das neoplasias infantis malignas que acometem crianças. Objetivou-se analisar o risco de exposição a agrotóxicos relacionado com o desenvolvimento de tumores do SNC em crianças. Realizou-se uma revisão sistemática da literatura nas bases de dados PubMed/MEDILINE, Embase, Web of Science, Scopus e CINAHL. Foram incluídos estudos de coorte e caso-controle sobre o desenvolvimento de tumores do SNC (todos os tipos histológicos do grupo III Classificação de Câncer Infantil) decorrentes da exposição a agrotóxicos em crianças de 0-14 anos. Na metanálise utilizou-se o modelo de efeito aleatório e o método estatístico de Mantel-Haenszel. A Razão de Chances (RC) ou Odds Ratio (OR) foi a medida de associação aplicada. A revisão foi registrada no International Prospective Register of Systematic Reviews (PROSPERO) sob o número CRD42021209354. A busca identificou 1.158 estudos, dos quais 14 compuseram a revisão. Verificou-se evidência de associação entre o desenvolvimento de astrocitomas e a exposição a todas as classes de pesticidas (OR 1,50; IC95% 1,15-1,96; p=0,03). A síntese dos resultados apontou para uma relação da exposição aos agrotóxicos com o desfecho de alguns tipos histológicos de tumores do SNC na infância.

Abstract Central Nervous System (CNS) tumors represent more than half of all childhood malignant neoplasms. The aim of this study was to determine the relationship between environmental exposure to pesticides and the development of CNS tumors in children. We conducted a systematic review of the literature in the PubMed/MEDILINE, Embase, Web of Science, Scopus, and CINAHL databases. The inclusion criteria were cohort and case-control studies investigating the association between exposure to pesticides and CNS tumors (all histological types included in group III of the WHO Classification of Childhood Cancer) in children aged 0-14 years. The meta-analysis was performed using a random effects model and the Mantel-Haenszel method. Strength of association was measured using odds ratios (OR). The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under identification number CRD42021209354. The search identified 1,158 studies, 14 of which were included in the review. There was evidence of an association between the development of astrocytomas and exposure to all classes of pesticides (OR 1.50; 95%CI 1.15-1.96; p=0.03). The synthesis of the evidence pointed to a relationship between exposure to pesticides and some histological types of CNS tumors in childhood.

Alternative Postoperative Analgesia Technique for Peripheral Vascular Revascularization: A Case Report.

Peripheral arterial disease (PAD) patients often require surgical peripheral vascular revascularization (PVR), in which postoperative pain management can be challenging. This case report details a 43-year-old female patient with PAD who underwent urgent femoral popliteal bypass with an inverted ipsilateral great saphenous vein and left femoral endarterectomy. Due to contraindications for neuraxial anesthesia and the necessity for continuous anticoagulation, the procedure was performed under general anesthesia (GA) and an unconventional technique with intraoperative perineural catheter (PC) placement to guarantee adequate postoperative analgesia. The surgeon inserted the PC in the vicinity of the femoral nerve under direct visualization before surgical closure. Postoperative analgesia was successfully managed, demonstrating the effectiveness of this approach as part of a multimodal analgesia strategy. This case report suggests that such a technique, supervised by an anesthesiologist and supported by a multidisciplinary team, can provide effective postoperative pain control in PAD patients without interrupting perioperative anticoagulation. Formal protocols for similar procedures can arise, incorporating this analgesic option.

Fatal Budd-Chiari syndrome associated with Hemodialysis Reliable Outflow (HeRO) graft.

Population aging and prolonged time on dialysis pose challenges to vascular access for nephrologists and vascular surgeons. HeRO grafts are an option used for patients with central venous obstruction and without the possibility of other vascular access on upper limbs. Some long-term complications, namely access thrombosis, infection, and limb ischemia, have already been reported. There are few data on thromboembolic complications associated with this device. We report the first case in the literature of Budd-Chiari Syndrome associated with the HeRO graft.

Prevalence of trachoma in the non-indigenous Baixo Jaguaribe micro-region, Ceará State, Northeast Brazil.

BACKGROUND: The aim of the current study was to estimate the population prevalence of trachoma in non-indigenous populations in the Baixo Jaguaribe micro-region, in the state of Ceará, northeast region of Brazil, 2021-2022. METHODS: A population-based prevalence survey focusing on detecting cases of trachomatous inflammation-follicular (TF) in children aged 1-9 y and trachomatous trichiasis (TT) 'unknown to the health system' in people aged ≥15 y, was conducted in rural areas of the Baixo Jaguaribe micro-region in the state of Ceará. Indigenous populations will be further researched. RESULTS: There was no detection of cases of TF and TT. In 900 households, 2234 people were examined. In the Baixo Jaguaribe micro-region, females (54.6%; 1219/2234) and the mixed/Pardo-Brazilian ethnicity (68.1%; 1521/2234) predominated. The most commonly reported educational level was elementary and middle school (41.8%; 702/1679). In 56.2% (506/900) of households, there was a source of water within the household. The monthly income range of 50%-100% of the minimum wage predominated in the families of the Baixo Jaguaribe micro-region (43.1%; 388/900). CONCLUSIONS: Although no cases of TF and TT were detected in the Baixo Jaguaribe micro-region in the state of Ceará during the study period, considering the historical endemicity, we emphasise the need for monitoring and sustainability of surveillance actions in areas at risk for trachoma, common contexts for neglected populations.