Association between functional aspects and health-related quality of life in patients with colorectal cancer: can handgrip strength be the measure of choice in clinical practice?

PURPOSE: We aimed to investigate the association between handgrip strength (HGS) and health-related quality of life (HRQoL) in patients with colorectal cancer (CRC). A cross-sectional study was conducted including CRC patients. METHODS: We performed an assessment of aspects of functional health using the criteria of frailty phenotype (defined by Fried et al., 2001), sarcopenia (defined by the European Working Group on Sarcopenia in Older People 2, 2018) and by HGS, which measures muscle strength using a manual dynamometer. HRQoL was assessed using the EORTC questionnaire QLQ-C30. Analyses of variance and multivariate linear regression were used to compare frailty, sarcopenia, and HGS with HRQoL. RESULTS: A total of 142 patients were included (age 62.7 ± 11.4 years; 56.3% women; 18.3% of patients with frailty; 9.9% with sarcopenia, and 15.5% had low HGS). After adjusting for sociodemographic, clinical, and nutritional variables, the regression analysis showed that frailty and sarcopenia were associated with worse HRQoL. Low HGS was associated with worse HRQoL in patients with CRC regardless of both frailty components (global health status: B = - 13.4, p = 0.004; physical function: B = - 10.4, p = 0.006; emotional function: B = - 18.1, p = 0.041; fatigue: B = 9.1, p = 0.027; dyspnea: B = 10.7, p = p = 0.024; appetite loss: B = 12.4, p = 0.041) and sarcopenia components (global health status: B = - 13.2, p = 0.004; physical function: B = - 15.0, p = 0.001; emotional function: B = - 25.1, p = 0.006; fatigue: B = 15.2, p = 0.007; pain: B = 18.7, p = 0.024, dyspnea: B = 11.4, p = 0.017). CONCLUSION: We concluded that HGS was positively associated with HRQoL in patients with CRC and may initially be the variable of choice in clinical practice, which is associated with HRQoL.

Nutritional status at hospital admission and prediction of clinical outcomes in children and adolescents with cancer: Results of the Brazilian survey on oncological nutrition in paediatrics.

BACKGROUND: Changes in nutritional status are recognised as predictors of unfavourable outcomes in children and adolescents with cancer, particularly in developing countries. There have been no studies on children and adolescents with cancer from every region of Brazil or on the impact of nutritional status on clinical outcomes. The aim of this study is to assess the association between the nutritional status of children and adolescents with cancer and the prediction of clinical outcomes. METHODS: This was a longitudinal, multicentre, hospital-based study. An anthropometric nutritional assessment was performed, and the Subjective Global Nutritional Assessment (SGNA) was administered within 48 h of admission. Seven hundred and twenty-three patients (aged 2-18 years) were included in the sample, undergoing cancer treatment. They were recruited in 13 reference centres in the five macro-regions of Brazil between March 2018 and August 2019. The outcomes evaluated were readmission within 30 days and death within 60 days of admission. To identify predictors of 60-day survival, Cox regression and log-rank statistics were used to compare Kaplan-Meier curves between the strata. RESULTS: About 36.2% (n = 262) of the samples were malnourished according to the SGNA. Severe malnutrition by the SGNA (relative risk [RR] = 8.44, 95% confidence interval [CI]: 3.35-21.3, P = 0.001) and living in the North region (RR = 11.9, 95% CI: 3.34-42.7, P = 0.001) were associated with the poorest survival. The North (RR = 5.77, 95% CI: 1.29-25.8, P = 0.021), Northeast (RR = 1.46, 95% CI: 1.01-2.11, P = 0.041), Midwest (RR = 0.43, 95% CI: 0.20-0.095, P = 0.036), age group 10-18 years (RR = 0.65, 95% CI: 0.45- 0.94, P = 0.022) and haematologic malignancy (RR = 1.52, 95% CI: 1.10-2.10, P = 0.011) were predictors of readmission within 30 days. CONCLUSIONS: The prevalence of malnutrition was high and related to death. These results highlight the need to use the SGNA in clinical practice alongside classic anthropometric methods for the diagnosis of malnutrition, and the need to standardise care across all Brazilian regions, which should include nutritional care for children and adolescents with cancer.

Prevented cases of neural tube defects and cost savings after folic acid fortification of flour in Brazil.

Anencephaly, encephalocele, and spina bifida are congenital neural tube defects and are the main causes of neonatal morbidity and mortality and impose a heavy economic burden on health systems. This study to estimates the direct costs of neural tube defects from the perspective of the Brazilian Ministry of Health, and the prevented cases and cost savings during the period in which mandatory folic acid fortification was in effect in the country (2010-2019). It is a top-down cost-of-illness oriented study based on the prevalence of the disorders in Brazil. Data were collected from the Brazilian Ministry of Health's outpatient and hospital information system databases. The direct cost was estimated from the total patient-years, allocated by age and type of disorder. Prevented cases and cost savings were determined by the difference in the prevalence of the disorders in the pre- and post-fortification periods based on the total number of births and the sum of outpatient and hospital costs during the period. The total cost of outpatient and hospital services for these disorders totaled R$ 92,530,810.63 (Int$ 40,565,896.81) in 10 years; spina bifida accounted for 84.92% of the total cost. Hospital costs were expressive of all three disorders in the first year of the patient's life. Between 2010 and 2019, mandatory folic acid fortification prevented 3,499 live births with neural tube defects and resulted in R$ 20,381,586.40 (Int$ 8,935,373.25) in hospital and outpatient cost savings. Flour fortification has proved to be a valuable strategy in preventing pregnancies with neural tube defects. Since its implementation, there has been a 30% decrease in the prevalence of neural tube defects and a 22.81% decrease associated in hospital and outpatient costs.

Predictive validity of GLIM malnutrition diagnosis in patients with colorectal cancer.

BACKGROUND: Considering that the validation of the Global Leadership Initiative on Malnutrition (GLIM) remains unclear in patients with colorectal cancer, the present study aimed to assess the agreement, accuracy, sensitivity, specificity, and prognostic effect of the GLIM on survival when compared with the Patient-Generated Subjective Global Assessment (PG-SGA). METHODS: Patients with colorectal cancer who were scheduled to undergo a routine abdominal computed tomography (CT) scan were recruited. Using the GLIM two-step approach, the patients were first screened for malnutrition by using the PG-SGA Short Form (score ≥3). The malnutrition diagnosis was based on the etiologic (disease burden [cancer] or reduced food intake) and phenotypic GLIM criteria, including weight loss, body mass index, and skeletal muscle index at the third lumbar vertebra when using the CT scans. The food intake was assessed by the PG-SGA. RESULTS: This study included 191 patients (age, 60.5 ± 11.3 years; 57% men), and 23% and 32% were malnourished according to the GLIM and the PG-SGA, respectively. The GLIM revealed fair sensitivity (64%), good agreement (kappa = 0.65), specificity (96%), and diagnostic accuracy for detecting malnutrition (area under the receiver operating characteristic curve = 0.80; 95% CI, 0.72-0.88) when compared with the PG-SGA. The malnutrition value according to the GLIM and the PG-SGA was associated with short-term survival. However, only the PG-SGA was associated with long-term survival. CONCLUSIONS: Although showing fair sensitivity, the GLIM had good agreement, specificity, and diagnostic accuracy for malnutrition detection and was an independent predictor of short-term survival in patients with colorectal cancer.

Respiratory and Sound Pressures, Maximum Phonation Time, Cervical Disability and Voice-Related Quality of Life of Teachers.

INTRODUCTION: Many teachers report discomfort and a decrease in the quality of aerodynamic, respiratory, and cervical vocal aspects as well as of vocal self-assessment. OBJECTIVE: Characterize and correlate measurements of Sound Pressure Levels, Maximum Phonation Time of /a/, Maximum Respiratory Pressures, Voice-Related Quality of Life and cervical pain in teachers with vocal and musculoskeletal complaints and no organic vocal fold lesions, and compare with normative values. METHODS: Retrospective study with 56 teachers. Anamnesis, video laryngoscopy, hearing screening, measurements of sound pressure and maximum phonation time, and manovacuometry were performed. Self-assessment protocols for Voice-Related Quality of Life and Neck Disability Index were completed. RESULTS: there was significant higher Sound Pressure Levels; significant lower Maximum Phonation Time of /a/, Maximum Expiratory Pressure, and total and physical scores of Voice-Related Quality of Life; most participants had mild cervical disability; there was a negative correlation between Maximum Expiratory Pressure and Neck Disability Index, between Maximum Inspiratory Pressure and Maximum Sound Pressure Level, and between Neck Disability Index and Voice-Related Quality of Life. CONCLUSION: The results showed that there are damages and inadequacies in teachers' vocal production which affect their quality of life. Therefore, it is necessary to pay attention to the conditions of use of the voice by professionals, and to their health education.

Performance of subjective global nutritional assessment in predicting clinical outcomes: Data from the Brazilian survey of pediatric oncology nutrition.

BACKGROUND: Methods for assessing nutritional status in children and adolescents with cancer is a difficult in clinical practice. The study aimed to evaluate the performance of Subjective Global Nutritional Assessment (SGNA) in predicting clinical outcomes in children and adolescents with cancer in Brazil. METHODS: This was a prospective cohort multicenter study. It was included 723 children and adolescents with cancer aged 2-18 years between March 2018 and August 2019. Nutritional assessment was performed according to World Health Organization recommendations and using SGNA within 48h of hospitalization. Unplanned readmission, length of hospital stay, and post-discharge death were analyzed. Cohen's kappa coefficient was used to ascertain the agreement between body mass index for age (BMI/A) and SGNA. The sensitivity, specificity, positive and negative predictive values, and accuracy of SGNA were estimated. Odds ratios (ORs) with 95% confidence intervals (CIs) were evaluated using multiple logistic regression. RESULTS: The mean patient age was 9.4 ± 4.9 years. SGNA showed that 29.7% (n = 215) and 6.5% (n = 47) patients had moderate and severe malnutrition, respectively. Considering the concurrent validity criterion, SGNA had an OR (95% CI) of 6.8 (3.1-14.9) for predicting low and very low weight for age at admission, with a sensitivity and specificity of 72.4% (59%-82.1%) and 72% (64.2%-78.9%), respectively. SGNA could predict death in children with severe/moderate malnutrition, with an accuracy of 63.8% (63%-65.1%). Logistic multivariate analysis showed that the adjusted effect of death; hematological tumor; living in the northeast, southeast, and midwest regions of Brazil; and older age was associated with malnutrition according to SGNA. CONCLUSION: Based on concurrent validity between SGNA and anthropometry, SGNA performed well and had a good ability to predict death in Brazilian children with cancer.

Impact of Nutritional Status on Survival in Head and Neck Cancer Patients After Total Laryngectomy.

Malnutrition is an important prognostic indicator of laryngeal squamous cell carcinoma. Retrospective study with head and neck cancer patients who underwent total laryngectomy. 243 patients of both sex were evaluated. The univariate analyses demonstrated an increased risk of death for the patients with greater weight loss, hypoalbuminemia, radiotherapy as an initial treatment, salvage surgery, and radical neck dissection. In a Multivariate Cox regression, older age (p = 0.03, 95% confidence interval [CI] 1.003-1.06, hazard ratio [HR] 1.029), Nutritional Risk Index ≤100 (p = 0.008, 95% CI 1.18-3.12, HR 1.921) and adjuvant radiotherapy (p = 0.029, 95% CI 0.31-3.12, HR 0.544) demonstrated prognostic significance in survival. Nutritional status is a modifiable variable and these findings highlight the need to adoption of simple nutritional assessment methods routinely during the treatment of head and neck cancer patients, in order to help improve prognosis after surgery.

Cost-effectiveness of mandatory folic acid fortification of flours in prevention of neural tube defects: A systematic review.

BACKGROUND: Neural tube defects (NTDs) constitute the most frequent group among congenital malformations and are the main cause of neonatal morbimortality. Folic acid (FA) can reduce the risk of pregnancies affected by NTDs. OBJECTIVE: We aimed to investigate whether mandatory folic acid (FA) fortification of flours is cost-effective as compared to non-mandatory fortification, and to verify whether FA dosage, cost composition, and the quality of economic studies influence the cost-effectiveness of outcomes. METHODS: We conducted a systematic review. The protocol was registered on PROSPERO (CRD 42018115682). A search was conducted using the electronic databases MEDLINE/PubMed, Web of Science, Embase, Scopus, and EBSCO/CINAHL between January 2019 and October 2020 and updated in February 2021. Eligible studies comprised original economic analyses of mandatory FA fortification of wheat and corn flours (maize flours) compared to strategies of non-mandatory fortification in flours and/or use of FA supplements for NTD prevention. The Drummond verification list was used for quality analysis. RESULTS: A total of 7,859 studies were identified, of which 13 were selected. Most (77%; n = 10) studies originated from high-income countries, while three (23%) were from upper-middle-income countries. Results of a cost-effectiveness analysis showed that fortification is cost-effective for NTD prevention, except for in one study in New Zealand. The cost-benefit analysis yielded a median ratio of 17.5:1 (0.98:1 to 417.1:1), meaning that for each monetary unit spent in the program, there would be a return of 17.5 monetary units. Even in the most unfavorable case of mandatory fortification, the investment in the program would virtually payoff at a ratio of 1:0.98. All FA dosages were cost-effective and offered positive health gains, except in one study. The outcomes of two studies showed that FA dosages above 300 µg/100 g have a higher CBA ratio. The studies with the inclusion of "loss of consumer choice" in the analysis may alter the fortification cost-efficacy ratio. CONCLUSION: We expect the findings to be useful for public agencies in different countries in decision-making on the implementation and/or continuity of FA fortification as a public policy in NTD prevention.

Phase angle as a marker for muscle abnormalities and function in patients with colorectal cancer.

BACKGROUND AND AIMS: Considering the applicability of phase angle (PhA) as a marker of muscle mass and function, we aimed to investigate whether PhA is a predictor of muscle abnormalities and function in patients with cancer. METHODS: In a sample of patients with colorectal cancer (CRC), PhA was obtained from measurements of resistance and reactance from bioelectrical impedance analysis. Computerized tomography imaging at the third lumbar vertebra was used to evaluate muscle abnormalities by quantifying skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD). Muscle function was assessed by handgrip strength (HGS) and gait speed (GS). RESULTS: This cross-sectional study included 190 participants (X±SD), mean age 60.5 ± 11.3 years; 57% men; 78% had cancer stages III to IV. PhA was highly correlated with SMI (r = 0.70) and moderately correlated with HGS (r = 0.54). PhA explained 48% of the SMI variability (R2 = 0.485), 21% of the SMD variability (R2 = 0.214), 26% of HGS (R2 = 0.261) and 9.8% of GS (R2 = 0.098). In the multivariate model adjusted for age, sex, body mass index, performance status, comorbidities and cancer stage, 1-degree decrease in PhA was associated with low SMI (Odds Ratio (OR) = 6.56, 95% CI: 2.90-14.86) and with low SMI and HGS combined (OR = 11.10, 95% CI: 2.61-47.25). In addition, Receiving Operating Characteristics curve analysis showed that PhA had a good diagnostic accuracy for detecting low SMI, low SMI and SMD combined, low SMD and HGS and low SMI and HGS combined (AUC = 0.81, 95% CI: 0.74-0.88; AUC = 0.88, 95% CI: 0.81-0.95; AUC = 0.80, 95% CI: 0.70-0.91; AUC = 0.82, 95% CI: 0.74-0.89; respectively). CONCLUSIONS: PhA was a predictor of muscle abnormalities and function and had a good diagnostic accuracy for detecting low muscle mass, low muscle mass and radiodensity, low muscle radiodensity and strength, and low muscle mass and strength in patients with CRC.

Programa Computadorizado e Alfabetização e Abordagem Fonovisuoarticulatória para Pessoas com Deficiência Intelectual / Computer Literacy Program of Phonovisuoarticulatory Approach for Children with Intellectual Disabilities

RESUMO: Pesquisas envolvendo o processo de escolarização da pessoa com Deficiência Intelectual (DI) são necessárias, visto que, em média, 45,6% das pessoas com DI são analfabetas no Brasil. Diante desse cenário, torna-se fundamental pensar no processo de alfabetização desses estudantes, especificamente em possibilidades que auxiliem práticas pedagógicas eficazes. Este artigo objetivou analisar a eficácia do Programa Computadorizado de Alfabetização de abordagem Fonovisuoarticulatória em três estudantes com DI, de 12 e 13 anos de idade, não alfabetizados que frequentavam uma escola especial. Para tanto, o estudo foi dividido em quatro etapas: I- Aplicação da avaliação de leitura e escrita; II- Aplicação do procedimento experimental, após avaliações e testes, utilizando o delineamento de Linha de Base Múltipla - a intervenção foi realizada individualmente em sessões de aproximadamente 50 minutos, três vezes por semana, durante quatro meses, e as informações foram anotadas na Folha de Registro; III- Reaplicação da avaliação de leitura e escrita; IV- Aplicação do Questionário de Validade Social. Os dados foram analisados considerando aspectos como o desempenho dos participantes, o monitoramento do processo de leitura e escrita e o número de acertos nas etapas de intervenção. Os resultados mostraram que os participantes aumentaram as respostas corretas após a introdução da intervenção com o programa quando foram apresentadas as atividades das vogais e das consoantes, uma vez que estiveram todas as sessões de intervenção acima da linha de base. O Questionário de Validade Social demonstrou a percepção da professora e da coordenadora pedagógica sobre a intervenção, relatando que puderam observar avanços dos participantes quanto ao processo de alfabetização.

ABSTRACT: Research involving the schooling process of the person with Intellectual Disability (ID) is necessary, since, on average, 45.6% of people with ID are illiterate in Brazil. Before this scenario, it is essential to think about the literacy process of these students, specifically possibilities that help effective pedagogical practices. This paper aimed to analyze the effectiveness of the Computerized Literacy Program with a Phonovisuoarticulatory approach in three students with ID, 12 and 13 years old, illiterate who attended a special school. Therefore, the study was divided into four stages: I- Application of reading and writing assessment; II- Application of the experimental procedure, after assessment and tests, using the Multiple Baseline design - the intervention was performed individually in sessions of approximately 50 minutes, three times a week for four months, and the information was registered on the Record Sheet; III- Reapplication of the reading and writing assessment; IV- Application of the Social Validity Questionnaire. The data were analyzed considering aspects such as the performance of the participants, monitoring of the reading and writing process and the number of correct answers in the intervention stages. The results showed that all participants increased the correct responses after the introduction of the intervention with the program when the activities of vowels and consonants were presented, with all intervention sessions being above the baseline. The Social Validity Questionnaire demonstrated the perception of the teacher and the pedagogical coordinator about the intervention, reporting that they were able to observe the participants' progress regarding the literacy process.

Dados do Inquérito Brasileiro de Nutrição Oncológica em Pediatria: Estudo Multicêntrico e de Base Hospitalar / Data from the Brazilian Survey of Pediatric Oncology Nutrition: Multicenter, Hospital-Based Study / Datos de Encuesta Brasileña de Nutrición en Oncología Pediátrica: Estudio Multicéntrico Hospitalario

Introdução: A desnutrição é observada em crianças com câncer e está associada a desfechos clínicos negativos. Objetivo: Descrever a prevalência de inadequação do estado nutricional de crianças e adolescentes com neoplasia maligna na admissão hospitalar em Centros de Referência do câncer infantil no Brasil. Método: Estudo transversal aninhado a um estudo de coorte, multicêntrico, de base hospitalar. A amostra probabilística foi feita em dois estágios em cada estrato por Macrorregião pelo método de probabilidade proporcional ao tamanho com um ano de coleta em cada instituição. Foram coletados em 13 instituições de referência dados clínicos, antropométricos, de composição corporal e sobre o questionário de Avaliação Nutricional Subjetiva Global Pediátrica (ANSGP), em até 48 horas da admissão hospitalar, entre março de 2018 e agosto de 2019. Resultados: O estudo totalizou 723 pacientes nas cinco regiões do Brasil. A prevalência de desnutrição moderada e grave foi de 25,9% na faixa etária de 2 a 5 anos, 40,1% de 5 a 10 anos e 39,7% de 10 a 19 anos, de acordo com ANSGP. Segundo o Índice de Massa Corporal/Idade (IMC/I), magreza e magreza acentuada totalizaram 13%, risco de sobrepeso, sobrepeso e obesidade apresentaram uma prevalência de 26,7% de 2 a 5 anos; 24,9% de 5 a 10 anos; e 25,7% de 10 a 19 anos. Conclusão: Evidenciou-se alta prevalência de inadequação nutricional pela ANSGP, sugerindo que a desnutrição pode ser subdiagnosticada quando utilizado somente o IMC/I, fortalecendo a necessidade de utilização de métodos complementares na avaliação nutricional de crianças com câncer

Introduction: Malnutrition is found in children with cancer and is associated with negative clinical outcomes. Objective: To describe the prevalence of inadequate nutritional status of children and adolescents with malignant neoplasm at hospital admission in childhood cancer reference centers in Brazil. Method: Cross-sectional study nested in a multicenter, hospital-based cohort study. The probabilistic sample was carried out in two stages in each stratum by macro-region using the probability method proportional to the size with one year of collection in each institution. Clinical, anthropometric, body composition data and the Pediatric Subjective Global Nutritional Assessment (SGNA) questionnaire were collected from 13 reference institutions within 48 hours of hospital admission, from March 2018 to August 2019. Results: The study totaled 723 patients in the 5 regions of Brazil. The prevalence of moderate and severe malnutrition was 25.9% in the age group of 2 to 5 years, 40.1% in 5 to 10 years and 39.7% in 10 to 19 years, according to the SGNA. According to the Body Mass/Age Index (BMI/I), thinness and marked thinness totaled 13%, risk of overweight, overweight and obesity showed a prevalence of 26.7% from 2 to 5 years, 24.9% from 5 to 10 years and 25.7% from 10 to 19 years. Conclusion: There was a high prevalence of nutritional inadequacy by the SGNA, suggesting that malnutrition can be underdiagnosed when using only the BMI/I, strengthening the need to use complementary methods in the nutritional assessment of children with cancer

Introducción: La desnutrición se observa en niños con cáncer y se asocia con resultados clínicos negativos. Objetivo: Describir la prevalencia del estado nutricional inadecuado de niños y adolescentes con neoplasia maligna al ingreso hospitalario en centros de referencia de cáncer infantil en Brasil. Método: Estudio transversal anidado en un estudio de cohorte hospitalario multicéntrico. La muestra probabilística se realizó en dos etapas en cada estrato por macrorregión utilizando el método de probabilidad proporcional al tamaño con un año de recolección en cada institución. Se recopilaron datos clínicos, antropométricos, de composición corporal y el cuestionario Global Pediatric Subjective Nutritional Assessment (ANSGP) de 13 instituciones de referencia dentro de las 48 horas posteriores al ingreso hospitalario, desde marzo de 2018 hasta agosto de 2019. Resultados: El estudio totalizó 723 pacientes en las 5 regiones de Brasil. La prevalencia de desnutrición moderada y severa fue de 25,9% en el grupo de edad de 2 a 5 años, 40,1% de 5 a 10 años y 39,7% de 10 a 19 años, según la ANSGP. Según el Índice de Masa Corporal/ Edad (IMC/I), la delgadez y la delgadez marcada totalizaron 13%, el riesgo de sobrepeso, sobrepeso y obesidad mostró una prevalencia de 26,7% de 2 a 5 años, 24,9% de 5 a 10 años y 25,7% de 10 a 19 años. Conclusión: Hubo una alta prevalencia de insuficiencia nutricional por parte de la ANSGP, lo que sugiere que la desnutrición puede ser infradiagnosticada cuando se utiliza solo el IMC/I, fortaleciendo la necesidad de utilizar métodos complementarios en la evaluación nutricional de los niños con cáncer

Implementação do Pecs Associado ao Point-Of-View Video Modeling na Educação Infantil para Crianças com Autismo / Implementation of PECS Associated with Point-Of-View Video Modeling in Early Childhood Education for Children with Autism

RESUMO Este estudo teve por objetivo analisar os efeitos do Picture Exchange Communication System (PECS) associado ao Point-of-view Video Modeling (POVM) nas habilidades comunicativas de três crianças diagnosticadas com Transtorno do Espectro Autista (TEA) e Necessidades Complexas de Comunicação. Empregou-se o delineamento experimental de múltiplas sondagens combinado ao delineamento de tratamentos alternados, sendo o PECS associado ao POVM a variável independente e as habilidades de comunicação a variável dependente. Os dados foram analisados considerando aspectos como: a porcentagem de non-overlapping, a porcentagem de respostas corretas quanto ao desempenho dos participantes e os dados da escala Likert quanto à validade social. Os resultados mostraram que a partir do início da intervenção, os níveis e as tendências de seus dados mudaram, todos os participantes obtiveram o critério, atingindo o non-overlapping de 100%. Em todas as fases do PECS associado ao POVM, os participantes obtiveram porcentagem média acima de 90%. O estudo foi considerado pelos responsáveis, pelas estagiárias e pelas professoras como socialmente válido. Conclui-se que os participantes com TEA indicaram uma mudança após a intervenção, ao comparar a condição de linha de base com a intervenção e follow-up, demonstrando uma possibilidade em Comunicação Suplementar e/ou Alternativa para as crianças com TEA.

ABSTRACT This study aimed to analyze the effects of the Picture Exchange Communication System (PECS) associated to Point-of-view Video Modeling (POVM) in communicative skills of three children diagnosed with Autistic Spectrum Disorder (ASD) and Complex Communication Needs. The experimental design of multiple probe combined with the design the alternate treatments was used, being PECS associated to POVM the independent variable and the communication skills were the dependent variables. Data were analyzed considering aspects such as: the percentage of non-overlapping, participants' performance percentage of correct responses and Likert scale data on social validity. The results showed that from the beginning of the intervention, the data levels and trends changed, all the participants obtained the criterion, reaching 100% non-overlapping. In all phases of PECS associated to POVM the participants had an average percentage above 90%. The study was considered by those responsible for the child, the trainees and the teachers. It was concluded that the participants with ASD indicated a change after the intervention, when comparing baseline condition with intervention and follow-up, demonstrating a possibility in Augmentative and Alternative Communication for children with ASD.

[Primary Health Care users' satisfaction in the Federal District: the importance of timely access and home visits]. / Satisfação do usuário da Atenção Primária no Distrito Federal: a importância do acesso oportuno e da visita domiciliar.

The aim of this cross-sectional study was to analyze user satisfaction in relation to Primary Health Care services in the Federal District and its associated factors. A total of 4,476 users of the 62 existing Family Health Strategy Teams from the Eastern Health Region were included; a pre-tested questionnaire with open and closed questions was applied. As for the "General Satisfaction Level" 54.9% of users were Satisfied and 23.0% Very Satisfied. For this outcome there was less satisfaction in cases that the user didn´t receive the care he sought for (OR 12.1 p=0.01); did not receive a home visit (OR 1.7 p=0.01); is female (OR 1.2 p=0.01) and declared to be non-white (OR 0.77 p=0.021). The "Chance to recommend the Health Unit" was: High (43.4%) and Very High (17.7%). Similarly, the lower chance to recommend was associated with no care received (OR 5.1 p=0.01) and absence of home visit (OR 1.5 p=0.01); there was no association with sociodemographic variables. Evidence showed that health services are satisfactory for most users. The study provides evidence regarding the importance of having the complete Family Health Strategy team and of expanding home visit.

High prevalence of malnutrition and nutrition impact symptoms in older patients with cancer: Results of a Brazilian multicenter study.

BACKGROUND: Malnutrition in cancer is an independent factor associated with negative clinical outcomes. The objective of this study was to evaluate the prevalence of malnutrition across different age groups in patients with cancer in Brazil and to identify associations with nutrition impact symptoms (NIS). METHODS: In this observational, cross-sectional, multicenter study, the authors evaluated 4783 patients with cancer aged ≥20 years who were admitted to 45 public hospitals in Brazil. Nutritional status, nutritional risk, and NIS were evaluated using the Patient-Generated Subjective Global Assessment. RESULTS: More than one-fourth (25.5%) of all participants were aged ≥65 years. In patients aged ≥65 years, the prevalence of moderate/suspected and severe malnutrition was 55%, it was 45.4% in those aged 51 to 64 years, and it was 36.1% in those aged ≤50 years. Among the NIS with a higher risk of occurrence in patients aged ≥65 years were no appetite (odds ratio [OR], 1.90; 95% CI, 1.62-2.22; P < .05) and dry mouth (OR, 1.40; 95% CI, 1.1-1.67; P < .05). In patients between ages 51 and 64 years, compared with those aged ≤50 years, the NIS with a higher risk of occurrence were no appetite (OR, 1.45; 95% CI, 1.23-1.69; P < .05), dry mouth (OR, 1.22; 95% CI, 1.02-1.45; P < .05), and problems with swallowing (OR, 1.56; 95% CI, 1.25-1.96; P < .05). CONCLUSIONS: The prevalence of malnutrition and the occurrence of NIS are high in hospitalized Brazilian patients aged ≥65 years who have cancer. The occurrence of NIS was higher in the population aged >50 years than in those aged ≤50 years. Nutritional screening and assessment should be performed immediately after hospitalization to enable early diagnosis and multidisciplinary or interdisciplinary intervention(s).

Frailty is associated with myosteatosis in obese patients with colorectal cancer.

BACKGROUND & AIMS: We aimed to explore the determinants of muscle fat infiltration and to investigate whether myosteatosis, assessed as muscle fat infiltration percentage (%MFI) and muscle attenuation from computed tomography (CT), is associated with frailty in a group of patients with colorectal cancer (CRC). METHODS: Cross sectional study including CRC patients. CT scan of the third lumbar vertebra was used to quantify body composition and the degree of %MFI (reported as percentage of fat within muscle area). Frailty was defined by Fried et al. (2001) as the presence of more than 3 criteria: unintentional weight loss, self-reported exhaustion, weakness (low handgrip strength), slow walking speed (gait speed) and low physical activity. Obesity was defined according to sex-and-age-specific body fat percentage (%BF) cutoff. RESULTS: A sample of 184 patients (age 60 ± 11 years; 58% men; 29% of patients with frailty) was studied. The sample was divided according to tertiles of MFI% (1st tertile 0 to 2.89%, n = 60; 2nd tertile ≥ 3.9-8.19%, n = 64; 3rd tertile ≥ 8.2-26%, n = 60). Age, females, body mass index, %BF, subcutaneous and visceral adipose tissue and the proportion of patients with frailty were significantly higher in the 3rd %MFI tertile. Phase angle and muscle attenuation were significantly lower in the 3rd %MFI tertile. The determinants of %MFI (r2 = 0.49), which was log transformed due to its normal distribution, were %BF (ß = 0.54; eß = 1.72; 95% CI: 0.032 to 0.051; P < 0.01), age (ß = 0.34; eß = 1.40; 95% CI: 0.016 to 0.032; P < 0.01) and gait speed (ß = -0.12; eß = 0.87; 95% CI: -0.84 to -0.001; P = 0.049). In addition, in obese patients (n = 74) presenting 4 or 5 frailty criteria increased the chance of having higher %MFI and lower muscle attenuation, after adjustment for sex, age and comorbidities when compared to none or 1 criteria. CONCLUSIONS: In a sample of CRC patients, %BF and gait speed were the determinants of %MFI. In addition, markers of myostetatosis were associated with frailty in the obese patients.

Comparative Analysis Between Computed Tomography and Surrogate Methods to Detect Low Muscle Mass Among Colorectal Cancer Patients.

BACKGROUND: We aimed to evaluate the agreement between computed tomography (CT) and surrogate methods applied in clinical practice for the assessment of low muscle mass. In addition, we assessed the association between different muscle-assessment methods and nutrition status, as well as the prognostic value of low muscle mass on survival in patients with colorectal cancer (CRC). METHODS: This is a cohort including 188 CRC patients with 17 months' follow-up (interquartile range: 12-23 months) for mortality. Low muscle mass was evaluated by corrected mid-upper arm muscle area (AMAc) and calf circumference, skeletal muscle mass by bioelectrical impedance analysis (BIA), muscle deficit by physical examination with the Patient-Generated Subjective Global Assessment (PG-SGA), and lumbar muscle cross-sectional area by CT (reference method). RESULTS: The prevalence of low muscle mass ranged from 9.6% to 54.3% according to the method used. The physical examination had the highest κ coefficient compared with CT. Low muscularity was associated with the presence of malnutrition, lower body fat, and low phase angle. The Cox regression models-adjusted for age, sex, and treatment 3 months before study inclusion-showed that severe muscle loss measured by BIA and CT and low muscle mass measured by PG-SGA predicted higher mortality rates. CONCLUSIONS: Compared with CT, the physical examination had the best agreement to assess low muscle mass. Low muscle mass assessed by PG-SGA, BIA, and CT showed similar prognostic values for survival.

Postoperative complication rate and survival of patients with gastric cancer undergoing immunonutrition: A retrospective study.

OBJECTIVES: This study aimed to evaluate the effect of preoperative immunonutrition on the rate of postoperative complication and survival of patients with gastric cancer. METHODS: A retrospective cohort was formed after data collection of patients hospitalized with gastric cancer. Postoperative complications classified according to the Clavien-Dindo classification system, length of hospital stay, readmissions, and rates of survival at 6 mo, 1 y, and 5 y were analyzed. A χ2 or Fisher's exact test, Student or Mann-Whitney t test, and Kaplan-Meier and Cox regressions were used in the statistical analysis. RESULTS: A total of 164 patients were included in the study, with 56 patients assigned to the immunonutrition group and 108 to the conventional group. There were no significant differences in postoperative complications between the immunonutrition and conventional groups (51.8% versus 58.3%; P = 0.423). The most frequent complications were fistula and surgical wound infection. Length of hospital stay did not differ between the groups (median of 7.0 d: P = 0.615) and the presence of readmissions did not differ either (12.5% versus 15.7%; P = 0.648). In the multivariate Cox regression, in a pooled model for group, age, sex, body mass index, Charlson comorbidity index, staging, neoadjuvant chemotherapy, and type of surgery, there was a significant difference in survival rates at 6 mo (P = 0.011), 1 y (P = 0.006), and 5 y (P < 0.001). CONCLUSIONS: Preoperative immunonutrition in patients with gastric cancer did not reduce postoperative complications or length of hospital stay. More studies are needed to confirm the benefit of immunonutriton supplementation for overall survival when associated with other protective factors.