Comparison of Cytological Adequacy between 23- and 25-Gauge in Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules: A Single-Center Prospective Study.

INTRODUCTION: Approximately 15% of fine-needle aspiration (FNA) of thyroid nodules are considered nondiagnostic. Several factors are potentially involved, including clinical and nodule features but also the gauge (G) of the needle used. However, few studies have compared the cytological adequacy obtained with different gauge needles and the data are controversial. We aimed to evaluate cytological adequacy results using 23- or 25-G needles. METHODS: This study is an observational and prospective study of thyroid nodules submitted to ultrasound-guided FNA. The procedure was performed randomly using 23- or 25-G needles. The samples were reported by different cytopathologists who were blinded to the information of the gauge of the needle used. Statistical analysis was performed to compare cytological adequacy of FNA between the two groups. RESULTS: A total of 177 thyroid nodules were included - 98 (55.4%) using 23-G and 79 (44.6%) using 25-G needles. The 23-G group presented a higher rate of cytological adequacy (69.4% [68/98] vs. 46.8% [37/79], p = 0.002). No differences were found between the two groups regarding patient or nodule characteristics. On logistic regression, 23-G needles correlated with better cytological adequacy (unadjusted OR 2.57 [95% CI: 1.39-4.77]), even after adjusting for nodule dimension, location, and type of cytology (slides +/- additional liquid-based cytology) (adjusted OR 2.44 [95% CI: 1.23-4.84]). CONCLUSION: The gauge of the needle used was found to be an independent predictor of cytological adequacy, with 23-G needles providing more adequate samples. Further investigation is needed to confirm our results in order to stablish the optimal diagnosis technique.

Performing publics of science in the COVID-19 pandemic: A qualitative study in Austria, Bolivia, Germany, Italy, Mexico, and Portugal.

Research about science and publics in the COVID-19 pandemic often focuses on public trust and on identifying and correcting public attitudes. Drawing on qualitative interviews with 209 residents in six countries-Austria, Bolivia, Germany, Italy, Mexico, and Portugal-this article uses the concept of performativity to explore how participants understand, and relate to science, in the COVID-19 context. By performativity, we mean the ways by which participants understand themselves as particular sorts of publics through identification with, and differentiation from, various other actors in matters that are perceived as controversies surrounding science: COVID-19 vaccination, media communication of science, and the interactions between governments and scientists. The criteria used to construct the similarities and differences among publics were heterogeneous and fluid, showing how epistemic beliefs about the nature of, and trust in, scientific knowledge are intermingled with social and cultural memberships embedded in specific contexts and across disparate places.

Leg dystrophic calcification as a consequence of chronic diabetic foot infection: a case report.

Foot ulceration and infection is associated with a substantial increase in morbidity and mortality in patients with diabetes. We present a clinical case of recurrent diabetic foot infection with an atypical clinical evolution. A 58-year-old male patient with type 1 diabetes and a history of bilateral Charcot foot neuroarthropathy was followed at our Diabetic Foot Clinic for an unhealed plantar foot ulcer for >1.5 years with recurrent episodes of infection. He was admitted to hospital due to foot ulcer reinfection with sepsis and ipsilateral lower limb cellulitis. The foot infection was found to be associated with an underlying abscess in the anterior compartment of the leg, with a cutaneous fistulous course with extensive alterations of an inflammatory nature. Exudate from the lesion was drained and tissue biopsied, revealing Serratia marcescens and Klebsiella oxytoca with dystrophic calcification (DC). Surgical excision of dystrophic tissue with debridement of the fistulous tracts was performed. The excised material corroborated the presence of fibroadipose connective tissue with marked DC, as well as areas of mixed inflammation compatible with a chronic infectious aetiology. Targeted long-term antibiotic therapy was implemented, for a total of six weeks, with a favourable clinical evolution and complete closure of the lesion at the final follow-up. DC results from calcium deposition in degenerated tissues without evidence of systemic mineral imbalance and is a potential cause of non-healing ulcers. Few cases of DC have been reported in diabetic foot patients and its treatment remains challenging and controversial. A longer follow-up period is necessary to verify the effectiveness of our approach.

Nationwide consensus on quality indicators to assess glaucoma care: A modified Delphi approach.

PURPOSE: Performance assessments are essential to tracking and improving quality in health care systems. Key aspects of the care process that act as indicators must be measured in order to gain an in-depth understanding of a care unit's operation. Without standardized quality indicators (QIs), it is difficult to characterize and compare the abilities of institutions to achieve excellence. The aim of this study is to reach a consensus among glaucoma specialists concerning the development of a set of QIs to assess the performance of glaucoma care units. METHODS: A two-round Delphi technique was performed among glaucoma specialists in Portugal, using a 7-point Likert scale. Fifty-three initial statements (comprising process, structure, and outcome indicators) were evaluated and participants had to agree on which ones would be part of the final set of QIs. RESULTS: By the end of both rounds, 28 glaucoma specialists reached consensus on 30/53 (57%) statements, including 19 (63%) process indicators (mainly relating to the proper implementation of complementary exams and the setting of follow-up intervals), 6 (20%) structure indicators, and 5 (17%) outcome indicators. Of the indicators that were part of the final list, functional and structural aspects of glaucoma progression and the availability of surgical/laser procedures were the most prevalent. CONCLUSIONS: A set of 30 QIs for measuring the performance of glaucoma units was developed using a consensus methodology involving experts in the field. Their use as measurement standards would provide important information about unit operations and allow further implementation of quality improvements.

O cuidar do adolescente com obesidade na atenção primária à saúde: perspectivas de gestores e profissionais / The care of obese adolescents in primary health care: perspectives of managers and professionals / Atención a adolescentes con obesidad en atención primaria de salud: perspectivas de gestores y profesionales

RESUMO Objetivo: Descrever e explorar, sob a perspectiva de gestores e profissionais de saúde, o cuidado ofertado ao adolescente com obesidade no âmbito da Atenção Primária à Saúde. Método: Estudo de caso, realizado em município do estado do Ceará-Brasil. A coleta de dados ocorreu em 2022, por meio de entrevistas semiestruturadas. Os dados foram examinados através da Análise de conteúdo de Bardin. Resultados: O cuidado ao adolescente com obesidade é fragmentado, cada profissional atua conforme decisão própria, pois o município não utiliza protocolos que subsidiem a prática assistencial. Foram elencadas potencialidades para o cuidado, sendo a principal a equipe multiprofissional. Quanto às dificuldades, destacou-se a procura do serviço de saúde pelo adolescente. Conclusão: Faz-se necessária uma (re)organização do modelo de atenção ao adolescente com obesidade no município. Além disso, o estudo ressalta a necessidade de maior atenção a obesidade na adolescência e provoca reflexões acerca do cuidado dispensado a este adolescente.

ABSTRACT Objective: Describe and explore, from the perspective of managers and health professionals, the care offered to adolescents with obesity in the context of Primary Health Care. Method: A case study conducted in a municipality in the state of Ceará-Brazil. Data collection took place in 2022 through semi-structured interviews. The data were examined using Bardin Content Analysis. Results: The care of obese adolescents is fragmented, and each professional acts according to their own decision, as the municipality does not use protocols that subsidize the practice of care. Potentials for care were listed, the main one being the multidisciplinary team. Regarding the difficulties, the adolescent's demand for health services was highlighted. Conclusion: It is necessary to (re) organize the care model for obese adolescents in the municipality. In addition, the study highlights the need for greater attention to adolescent obesity and causes reflections on the care provided to this adolescent.

RESUMEN Objetivo: Describir y explorar, desde la perspectiva de los gestores y profesionales sanitarios, la atención ofrecida a los adolescentes con obesidad en el ámbito de la Atención Primaria de Salud. Método: Estudio de caso, realizado en un municipio del estado de Ceará-Brasil. Los datos se recogieron en 2022 mediante entrevistas semiestructuradas. Los datos se analizaron mediante el análisis de contenido de Bardin. Resultados: La atención a los adolescentes con obesidad está fragmentada, y cada profesional actúa según su propia decisión, ya que el municipio no utiliza protocolos para subvencionar la práctica asistencial. Se enumeraron las potencialidades asistenciales, siendo la principal el equipo multiprofesional. En cuanto a las dificultades, se destaca la búsqueda del servicio sanitario por parte del adolescente. Conclusión: Es necesario (re)organizar el modelo de atención a los adolescentes con obesidad en el municipio. Además, el estudio pone de manifiesto la necesidad de prestar más atención a la obesidad en la adolescencia y suscita reflexiones sobre la atención prestada a este adolescente.

Decoupling of Temperature and Strain Effects on Optical Fiber-Based Measurements of Thermomechanical Loaded Printed Circuit Board Assemblies.

This study investigated the use of distributed optical fiber sensing to measure temperature and strain during thermomechanical processes in printed circuit board (PCB) manufacturing. An optical fiber (OF) was bonded to a PCB for simultaneous measurement of temperature and strain. Optical frequency-domain reflectometry was used to interrogate the fiber optic sensor. As the optical fiber is sensitive to both temperature and strain, a demodulation technique is required to separate both effects. Several demodulation techniques were compared to find the best one, highlighting their main limitations. The importance of good estimations of the temperature sensitivity coefficient of the OF and the coefficient of thermal expansion of the PCB was highlighted for accurate results. Furthermore, the temperature sensitivity of the bonded OF should not be neglected for accurate estimations of strains. The two-sensor combination model provided the best results, with a 2.3% error of temperature values and expected strain values. Based on this decoupling model, a methodology for measuring strain and temperature variations in PCB thermomechanical processes using a single and simple OF was developed and tested, and then applied to a trial in an industrial environment using a dynamic oven with similar characteristics to those of a reflow oven. This approach allows the measurement of the temperature profile on the PCB during oven travel and its strain state (warpage).

Guia das Redes entre Educação e Saúde ­ Guia Redes / Guide to Networks between Education and Health ­ Guide Networks

O Guia Redes participa do desafio de ver e exercer redes que aumentem e que proporcionem a confiança em si e a lucidez de fazer amizades todo o tempo. Confiança e amizade são as sementes da autonomia (que sempre pode ser apoiada, não individualizada) e do pertencimento ao coletivo (que sempre é original porque se faz e refaz a cada momento, sem estagnação em qualquer patamar). Em tempos corridos, cheios de trabalho solitário e de net sem gente, o Guia Redes ajuda a criar mundos compartilhados. E compartilhar é decisão necessária e corajosa quando precisamos expandir a garantia de direitos. Retomamos o que está destacado na capa do Guia Redes: "Guia para o Cuidado COMPARTILHADO das Redes de Educação e Saúde". O destaque proposital na palavra compartilhado é parte do início dessa conversa: a importância de conceber o Guia Redes como instrumento de partilha, de troca, de gestão compartilhada de REDE(S), ou seja, o uso do Guia, tanto por professores quanto pelos profissionais da saúde junto às crianças, tem como princípio a produção coletiva, a produção EM rede.

Immunomodulatory role of oral microbiota in inflammatory diseases and allergic conditions.

In recent years, the interplay between oral microbiota and systemic disease has gained attention as poor oral health is associated with several pathologies. The oral microbiota plays a role in the maintenance of overall health, and its dysbiosis influences chronic inflammation and the pathogenesis of gum diseases. Periodontitis has also been associated with other diseases and health complications such as cancer, neurogenerative and autoimmune disorders, chronic kidney disease, cardiovascular diseases, rheumatic arthritis, respiratory health, and adverse pregnancy outcomes. The host microbiota can influence immune cell development and immune responses, and recent evidence suggests that changes in oral microbiota composition may also contribute to sensitization and the development of allergic reactions, including asthma and peanut allergies. Conversely, there is also evidence that allergic reactions within the gut may contribute to alterations in oral microbiota composition. Here we review the current evidence of the role of the oral microbiota in inflammatory diseases and health complications, as well as its future relevance in improving health and ameliorating allergic disease.

Survey on selenium clinical supplementation in autoimmune thyroid disease.

Objective: Previous trials show that selenium could be a very useful tool in the control and treatment of autoimmune thyroid diseases. In this cross-sectional study, through a survey, we aim to evaluate Portuguese endocrinologists' perception and pattern of prescription of selenium supplements in these diseases and verify its agreement with current guidelines. Methods: The endocrinologists registered in the Portuguese Medical Association were sent an email with a web-based questionnaire, regarding their knowledge and use of selenium supplements in thyroid autoimmune pathology. Results: A total of 105 physicians (33% of the total) submitted the survey. The selenium serum concentration in the general population was unknown to 80% of respondents. Over a third of respondents have never prescribed selenium for autoimmune thyroid disease. However, 89% are not afraid of recommending it, and 61% indicate Graves' orbitopathy as the pathology they would supplement. In Hashimoto's thyroiditis, 36% of respondents use selenium occasionally or frequently, and this percentage rises to 60% in Graves' disease. Conclusions: Although recommendations only encompass mild Graves' orbitopathy, selenium is prescribed across the spectrum of autoimmune thyroid diseases, probably due to recent studies that consistently show improvement of biochemical hallmarks in these patients. Further investigation is required on the impact of selenium supplements on primarily clinical outcomes and to identify disorders and/or patients who will benefit the most. Also, there is still insufficient knowledge of this field in the medical community, and evidence-based practice should continue to be promoted by endocrinology societies.

A Community-Based Participatory Framework to Co-Develop Patient Education Materials (PEMs) for Rare Diseases: A Model Transferable across Diseases.

At least 50% of chronic disease patients don't follow their care plans, leading to lower health outcomes and higher medical costs. Providing Patient Education Materials (PEMs) to individuals living with a disease can help to overcome these problems. PEMs are especially beneficial for people suffering from multisystemic and underrecognized diseases, such as rare diseases. Congenital disorders of glycosylation (CDG) are ultra-rare diseases, where a need was identified for PEMs in plain language that can clearly explain complex information. Community involvement in the design of PEMs is extremely important for diseases whose needs are underserved, such as rare diseases; however, attempts to involve lay and professional stakeholders are lacking. This paper presents a community-based participatory framework to co-create PEMs for CDG, that is transferable to other diseases. A literature review and questionnaire were performed, and only four articles describing the development of PEMS for rare diseases have been found, which demonstrates a lack of standardized approaches. The framework and PEMs were co-developed with CDG families and will be crucial in increasing health literacy and empowering families. We will close a gap in the creation of PEMs for CDG by delivering these resources in lay language in several languages.

Donor-centred care: the facilitating and constraining factors experienced by gamete donors in a public bank.

The provision of care that is responsive to the preferences, needs and values of gamete donors is key to improving their recruitment and ensuring the functioning of gamete banks. This qualitative study aimed to explore gamete donors' experiences about the facilitating and constraining human and system factors to donor-centred healthcare delivery in gamete banks. It is based on 20 semi-structured interviews with oocyte and sperm donors, recruited at the Portuguese Public Bank of Gametes, conducted from November 2017 to February 2019. Deductive content analysis was performed using the software NVivo12, following the patient-centred infertility care model. Interviewees identified facilitating factors mostly related with the human dimension of care (i.e. careful and available attitude and behaviours of health professionals, as well as their good communication skills and emotional support). Constraining factors were predominantly identified at the system level (i.e. insufficient information provision, poor coordination, and integration). Lack of privacy emerged simultaneously as a human and a system constraining factor (i.e. physical discomfort during medical-technical acts or gamete collection). There is room for improving clinical practice and the organisation of healthcare services within a context where the competence and attitude of, and relationship with, the staff are highly valued.

Assistência às pessoas com transtornos mentais em conflito com a lei: perspectiva de gestores e profissionais de saúde Abstract / Care for people with mental disorders in conflict with the law: the perspective of health managers and professionals

Resumo O estudo teve como objetivo analisar a assistência às pessoas com transtornos mentais em conflito com a lei na perspectiva de gestores e profissionais de saúde. Trata-se de um estudo de caso, de abordagem qualitativa, realizado em janeiro de 2020, com 10 profissionais que atuavam no Hospital de Custódia e Tratamento Psiquiátrico do Estado do Rio Grande do Norte. Para coleta de dados, utilizou-se um questionário sociodemográfico e entrevista semiestruturada. O conteúdo textual decorrente das entrevistas foi submetido à análise textual lexicográfica, com auxílio do software IRAMUTEQ, e a análise dos dados foi realizada a partir de literatura pertinente. Emergiram três categorias: As mudanças nas relações de trabalho e o impacto na assistência; A organização da Rede de Cuidado; e A assistência intramuros e os entraves para desinstitucionalização. Conclui-se que a assistência às pessoas com transtornos mentais em conflito com a lei é influenciada pelas relações de trabalho; tem dificuldades relacionadas à estrutura física e à dinâmica das instituições; enfrenta entraves para garantir a desinstitucionalização, ao passo que fragmenta os vínculos e não implementa o Projeto Terapêutico Singular. Todavia, esforços têm sido empreendidos para articular a rede de cuidado de base territorial.

Abstract The study aimed to analyze the care of people with mental disorders in conflict with the law from the perspective of managers and health professionals. This is a qualitative case study conducted in January 2020 with 10 professionals working at the Psychiatric Custody and Treatment Hospital of the State of Rio Grande do Norte, Brazil. For data collection, a sociodemographic questionnaire and semi-structured interview were used. The textual content resulting from the interviews was submitted to lexicographic textual analysis, with the help of the IRAMUTEQ software and data analysis was performed based on pertinent literature. Three categories emerged: Changes in work relationships and impact on care; The organization of the Care Network; and Intra-wall care and barriers to deinstitutionalisation. It is concluded that the care for people with mental disorders in conflict with the law is influenced by work relationships; has difficulties related to the physical structure and dynamics of institutions; it faces obstacles to ensure deinstitutionalization while fragmenting ties and not implementing the Singular Therapeutic Project. However, efforts have been made to articulate the territorial-based care network.

Um diálogo com andrea canevaro / A conversation with andrea canevaro

RESUMO Esta entrevista tem como objetivo compartilhar as reflexões de Andrea Canevaro, um estudioso considerado o principal acadêmico que se dedicou à Educação Especial e à inclusão escolar na Itália, nos últimos 40 anos, com trabalho que se desdobra em muitos outros países, o qual contempla atividades de formação de profissionais, coordenação de projetos e assessoria a órgãos públicos no campo educacional. Por meio de um diálogo, procurou-se dar destaque às dimensões históricas e aos desafios atuais concernentes às políticas de inclusão escolar, às mudanças na organização dos serviços e ao avanço de novas perspectivas na compreensão de fenômenos como a deficiência. A análise procura colocar em evidência dinâmicas que favoreceram as transformações na organização dos serviços e a criação de novas alternativas no campo pedagógico.

ABSTRACT This interview aims to share Andrea Canevaro's reflections, a scholar considered the main academic who has dedicated himself to Special Education and school inclusion in Italy, in the last 40 years, with work that unfolds in many other countries, which includes training activities for professionals, project coordination and consulting services for public institutions in the educational field. Through a dialog, it was sought to shed light on the historical dimensions and current challenges related to school inclusion policies, changes in the organization of services and the promotion of new perspectives in the understanding of phenomena such as disability. This analysis aims to highlight dynamics that have favored changes in the organization of services and the creation of new alternatives in the pedagogical field.

Dispensação de medicamentos no sistema prisional: garantia de assistência farmacêutica? / Medicine dispensation in the prison system: Is pharmaceutical care assured?

Resumo Este artigo objetiva analisar o processo de dispensação de medicamentos em unidades prisionais. Foi realizado um estudo qualitativo, em sete penitenciárias do estado da Paraíba, sendo entrevistados 13 profissionais de saúde e 43 pessoas privadas de liberdade em uso de medicamentos essenciais/estratégicos, no período compreendido entre os meses de fevereiro a agosto de 2016. Os resultados foram categorizados na perspectiva da análise de conteúdo de Bardin e três categorias emergiram: armazenamento de medicamentos no sistema penitenciário, processo de dispensação de medicamentos no sistema penitenciário e responsabilidades sanitárias para garantir a assistência farmacêutica. Conclui-se que a inexistência de farmácias, o não cumprimento legal no que se refere a presença do profissional com habilidade e competência técnica para realizar a dispensação primando pelos padrões de qualidade/segurança e pela relevância das orientações relacionadas ao uso e armazenamento, associado a falta de clareza na definição das responsabilidades sanitárias dos gestores a partir da instância de governo, são fatores que comprometem a política uma vez que incrementam o investimento, mas não garantem a assistência farmacêutica no sistema prisional.

Abstract This paper aims to analyze the process of medicine dispensation in prisons. A qualitative study was conducted in seven penitentiaries in Paraíba with 13 health professionals and 43 people deprived of liberty using essential/strategic medicines from February to August 2016. The results were categorized from the perspective of Bardin's content analysis. Three categories emerged: medicine storage location in the prison system, delivery process in the prison system, and health-related responsibilities with pharmaceutical care. We can conclude that the lack of pharmacies, the legal non-compliance regarding the availability of skilled professionals with technical competencies to perform the dispensation, focusing on the quality/safety standards and relevance of the use and storage guidelines associated with the lack of clarity in the definition of health responsibilities of managers from a government authority, are factors that compromise the policy since they increase the investment, but do not ensure pharmaceutical care in the prison system.

Care of People with Post-COVID-19 Sequelae in the Scope of Primary Health Care: Scoping Review Protocol.

The sequelae of COVID-19 disease significantly impact the quality of life of people, requiring long-term longitudinal care for recovery and rehabilitation. Primary health care is fundamental in the reception, monitoring, and multi-professional follow-up of post-COVID-19 symptoms and complications. This study proposes a scoping review protocol to identify and map the care process of monitoring and multi-professional follow-up of post-COVID-19 sequelae within the scope of primary health care worldwide. This protocol was based on the Joanna Briggs Institute Manual and guided by PRISMA-ScR. Articles, theses, dissertations, and official documents searched in several databases (MEDLINE/PubMed, Scopus, LILACS, Web of Science, Embase, and gray literature) will be included. Two independent reviewers will organize and select studies according to inclusion and exclusion criteria using the Rayyan software. The selected publications will be organized and summarized using a checklist proposed by the PRISMA-ScR. Simple descriptive statistics will analyze the quantitative data, while thematic analysis will be used for the qualitative data. The final scoping review will present the main findings, challenges, limitations, and potential research gaps related to the care of people with post-COVID-19 sequelae.

Levothyroxine malabsorption or pseudomalabsorption? A question in the management of refractory hypothyroidism.

Purpose: The levothyroxine absorption test (LT4AT) is an important tool for distinguishing hypothyroidism due to malabsorption from 'pseudomalabsorption' conditions. Our aim was to review our institution's LT4AT results and assess its role in the management of patients with refractory hypothyroidism. Methods: We performed a retrospective study of all patients evaluated for refractory hypothyroidism who underwent LT4AT in our tertiary center between 2014 and 2020. Its results and the impact on thyroid function management during follow-up were assessed. Results: Ten female patients were included with a mean age of 40 years (min-max: 26-62). Mean weight was 72 kg (min-max: 43-88) and baseline LT4 dosage ranged from 2.5 to 5.3 µg/kg/day. The most common causes of hypothyroidism were postsurgical in 50% (n = 5) and autoimmune in 20% (n = 2). During LT4AT, normal LT4 absorption was found in all but one individual (mean FT4 increase of 231%, min-max: 85-668). The only patient with objective LT4 absorption impairment (maximal increase of 48% by hour 5) presented also Helicobacter pylori gastritis and prior history of 'intestinal surgery' during childhood. No adverse events were reported during any of the LT4ATs. During follow-up (median 11.5 months (IQR 23)), three patients obtained euthyroidism and six had improved their hypothyroidism state. Conclusions: The LT4AT is an effective and safe way to assess refractory hypothyroidism and provides valuable information to distinguish LT4 malabsorption from 'pseudomalabsorption'. Our data suggest that most patients with suspicious LT4 malabsorption perform normally during LT4AT. This test provides relevant information for better management of patients with refractory hypothyroidism.

Medicine dispensation in the prison system: Is pharmaceutical care assured? / Dispensação de medicamentos no sistema prisional: garantia de assistência farmacêutica?

This paper aims to analyze the process of medicine dispensation in prisons. A qualitative study was conducted in seven penitentiaries in Paraíba with 13 health professionals and 43 people deprived of liberty using essential/strategic medicines from February to August 2016. The results were categorized from the perspective of Bardin's content analysis. Three categories emerged: medicine storage location in the prison system, delivery process in the prison system, and health-related responsibilities with pharmaceutical care. We can conclude that the lack of pharmacies, the legal non-compliance regarding the availability of skilled professionals with technical competencies to perform the dispensation, focusing on the quality/safety standards and relevance of the use and storage guidelines associated with the lack of clarity in the definition of health responsibilities of managers from a government authority, are factors that compromise the policy since they increase the investment, but do not ensure pharmaceutical care in the prison system.

Este artigo objetiva analisar o processo de dispensação de medicamentos em unidades prisionais. Foi realizado um estudo qualitativo, em sete penitenciárias do estado da Paraíba, sendo entrevistados 13 profissionais de saúde e 43 pessoas privadas de liberdade em uso de medicamentos essenciais/estratégicos, no período compreendido entre os meses de fevereiro a agosto de 2016. Os resultados foram categorizados na perspectiva da análise de conteúdo de Bardin e três categorias emergiram: armazenamento de medicamentos no sistema penitenciário, processo de dispensação de medicamentos no sistema penitenciário e responsabilidades sanitárias para garantir a assistência farmacêutica. Conclui-se que a inexistência de farmácias, o não cumprimento legal no que se refere a presença do profissional com habilidade e competência técnica para realizar a dispensação primando pelos padrões de qualidade/segurança e pela relevância das orientações relacionadas ao uso e armazenamento, associado a falta de clareza na definição das responsabilidades sanitárias dos gestores a partir da instância de governo, são fatores que comprometem a política uma vez que incrementam o investimento, mas não garantem a assistência farmacêutica no sistema prisional.

Fármacos, remédios, medicamentos: o que a Educação tem com isso? Volume 2 ­ debates continuados, diálogos interdisciplinares / ​ 124 / 5.000 Resultados de tradução Resultado da tradução Drugs, medicines, medicines: what does Education have to do with this? Volume 2 ­ debates continued, interdisciplinary dialogues

Para além da necessária crítica à medicalização, patologização e farmacologização que no contemporâneo atravessa a escola e o ensino, o presente livro abre um espaço de criação e de renovamento da afirmação da vida, da diversidade e dos processos de inclusão. No livro encontramos diálogos que repropõem temáticas que são recorrentes nos debates sobre saúde mental e educação, como a transformação de dificuldades de aprendizagem em supostas patologias codificadas em quadros nosológicos ou a observação do incremento recente daquilo que, ao longo desses últimos anos, tem sido designado como uma "epidemia" de transtornos ou síndromes. Algumas dessas categorias diagnósticas, apesar de sua precária sustentação científica, se multiplicam e pouco contribuem para a efetiva busca de alteração das condições sociais e escolares dos envolvidos. No presente conjunto de textos encontramos estudos que discutem alternativas no ato de diagnosticar e de inventar rotas curriculares, assim como os efeitos de recentes alterações provocadas pela pandemia de covid-19, com o afastamento físico e suas consequências. Estamos, com o presente livro, diante de reflexões que associam de forma provocadora a pesquisa acadêmica e os desafios de pensar práticas que, esperamos, se multipliquem no fortalecimento das redes em defesa da educação, saúde e processos inclusivos. Trata-se de uma leitura indispensável para professores, clínicos e estudiosos interessados em saúde mental (na perspectiva da saúde coletiva), educação especial (na perspectiva da educação inclusiva), inclusão escolar e promoção da saúde.

Papillary thyroid carcinoma: the impact of histologic vascular invasion.

OBJECTIVE: The American Thyroid Association (ATA) recurrence risk prediction system considers vascular invasion (VI) as a relative indicator for adjuvant radioactive iodine (RAI) treatment, nevertheless VI final role in PTC management is yet to be defined. This study aims to assess the impact of histologic VI in PTC. METHODS: A retrospective study with PTC patients admitted in our Thyroid Cancer Unit, between January 1960 and December 2016 was performed. We reviewed 905 patient records with 275 having full information about VI on their pathological reports. Demographic and clinical variables were obtained, and univariate/multivariate analysis was performed in order to obtain potential predictive prognostic factors. RESULTS: Fifty-one out 275 patients presented VI (18.5%; 95% CI 14.4 - 23.6%), these individuals had larger tumors (median 19mm vs 12 mm, p < 0.001) with more frequent extraglandular invasion (54.0% vs 17.1%, p<0.001), regional lymph nodes involvement (29.8% vs 12.6%, p = 0.003)and distant metastasis (10.9% vs 1.9%, p = 0.003) at diagnosis. Vascular invasion was an independent predictor for regional lymph node and/or distant metastasis at diagnosis [OR 2.93 (IC95% 1.16 - 7.41, p = 0.008)]. After a median follow-up time was 68.5 months patients with VI presented higher rates of local recurrence and lymph node metastasis recurrence. CONCLUSIONS: In this study, the presence of VI in PTC is associated to higher rate of lymph node and distant metastasis at diagnosis. Its presence should be probably considered an adverse prognostic factor in PTC, perhaps justifying more aggressive therapeutic and follow-up approaches in such cases.