Efficacy of antibiotic prophylaxis to preventing brucellosis in accidental exposure: A systematic review.

BACKGROUND: Antibiotic prophylaxis to prevent brucellosis after accidental exposure to Brucella is an important topic in public health. This study aimed to systematically review the efficacy of antibiotic prophylaxis following accidental exposure to Brucella in preventing human brucellosis disease. METHODS: The study protocol was registered in PROSPERO (CRD42023456812). The outcomes included the incidence of brucellosis disease, adverse events rate, and antibiotic prophylaxis adherence. A comprehensive literature search, conducted until 20 November, 2023, involved Medline, Embase, Cochrane Library, and LILACS databases. Descriptive analysis and meta-analysis using R software were performed, risk of bias was assessed using JBI Critical appraisal tools, and certainty of evidence was assessed using the GRADE tool. RESULTS: Among 3102 initially identified records, eight studies involving 97 individuals accidentally exposed, all focused on high-risk accidental exposure to Brucella in laboratory settings, were included in the review. All studies reported the prophylactic treatment comprising doxycycline at a dosage of 100 mg twice daily, combined with rifampicin at 600 mg, both administered over 21 days. Prophylaxis adherence was reported in 86% of cases, and incidence of brucellosis post-treatment was 0.01. Adverse events, mainly gastrointestinal, occurred in 26% of cases. Critical appraisal revealed limitations in reporting demographics and clinical information. The certainty of evidence was rated as 'very low,' emphasising the need for caution in interpreting the observed outcomes due to study design constraints and the absence of comparative groups. CONCLUSIONS: PEP is an alternative practice reported in the literature, used in accidents with high-risk exposure to Brucella. The currently available evidence of the efficacy of antibiotic prophylaxis is insufficient to support a recommendation for or against the widespread use of antibiotic prophylaxis, so caution is needed in interpreting results due to the very low certainty of evidence, primarily stemming from case series and lack of comparative groups.

Arterial Spin Labeling: Techniques, Clinical Applications, and Interpretation.

Arterial spin labeling (ASL) is an emerging noninvasive MRI technique for assessing cerebral perfusion. An important advantage of ASL perfusion is the lack of a requirement for an exogenous tracer. ASL uses magnetically labeled water protons from arterial blood as an endogenous diffusible tracer. For this reason, ASL is an attractive perfusion imaging modality for children and for patients with contraindications or adverse reactions to gadolinium, patients with renal failure, and those who need repeated follow-up imaging. Another advantage of ASL is the possibility of quantifying cerebral blood flow, which provides an opportunity for comparative analysis among multiple longitudinal studies, unlike other MR perfusion techniques, which are semiquantitative and yield relative perfusion parameters. Advances in MRI technology and pulse sequence design have translated ASL beyond the research arena to successful clinical implementation. However, ASL is still underused in routine clinical practice. Some disadvantages of ASL include a lower signal-to-noise ratio and a longer acquisition time than those with dynamic susceptibility contrast-enhanced MRI. Additional factors limiting the use of ASL include variations in existing techniques and pulse sequence design, the complexity of implementation and postprocessing, insufficient experience with and/or knowledge of the potential clinical applications, and the absence of interpretation guidelines. The authors review the technical and physiologic basis of ASL perfusion, as well as artifacts, pitfalls, and its current clinical applications. A practical approach for interpreting ASL findings is also suggested.

Integration of Automatic Text Mining and Genomic and Proteomic Analysis to Unravel Prostate Cancer Biomarkers.

Prostate cancer (PCa) is the most prevalent noncutaneous cancer among men. The limited accuracy and/or invasive nature of the current diagnostic tools have driven the demand for new and noninvasive biomarkers. Urine as a noninvasive sample that contains prostatic secretions is a promising source of PCa markers. The automatic text-mining functionality of VOSviewer was used to retrieve and create co-occurrence networks of terms associated with PCa. These results were complemented with DisGENET data, a repository of PCa associations, and with a recent bioinformatic analysis integrating all differentially expressed proteins identified in tumor tissue and urine from PCa patients to address the limited term selection of VOSviewer. Afterward, the results were integrated with gene expression data from the Gene Expression Omnibus database to correlate gene and protein levels. This study suggests AXIN2, GSTM2, KLK3, LGALS3, MSMB, PRTFDC1, and SH3RF1 as important entities in PCa context. KLK, LGALS3, and MSMB proteins are common to a previous bioinformatic analysis, and a concordance was found between the levels of gene and protein expression. The applicability of the pipeline presented here was validated by showing altered urinary levels of galectin-3 protein in PCa patients compared to noncancer subjects.

L-carnitine added to post-thawed semen acts as an antioxidant and a stimulator of equine sperm metabolism.

The objective of this study was to enhance the in vitro sperm quality and in vivo fertility of frozen-thawed equine semen by the addition of l-carnitine (LC) to post-thawed semen. Different concentrations of LC were added to thawed samples to obtain four treatments control and 0.5, 1 and 2 mM LC. In the in vitro experiments, sperm motility and kinematics, membrane integrity and intracellular calcium ion concentration ([Ca2+ ]i ) were investigated, and the antioxidant bioactivity of LC was assessed by measuring hydrogen peroxide and nitrite concentrations (NO2 - ). The fertility rate was assessed via the artificial insemination of mares. The treatment with 1 mM LC increased sperm [Ca2+ ]i (60.6 ± 0.05 AU), reduced nitrite concentration (39.1 ± 14.9 µM/µg protein), increased the sperm straightness percentage (STR: 78.3 ± 5.3%) and increased the pregnancy rate (75%) as compared to the control ([Ca2+ ]i 48.4 ± 0.05 AU, NO2 - concentration 63.1 ± 14.4 µM/µg protein, STR 67.5 ± 7.9%, 12.5% pregnancy rate, p < 0.05). These results suggest that 1 mM LC acts as an antioxidant and stimulator of sperm metabolism in post-thawed equine semen, increasing the fertility rate. Thus, addition of LC might be an alternative to improve the fertility of poor quality post-thawed equine semen.

Addition of caffeine to equine thawed sperm increases motility and decreases nitrite concentration.

The aim of this study was to improve the quality of frozen-thawed equine sperm by the addition of caffeine to it. Semen from nine stallions was frozen and different concentrations of caffeine (3, 5 and 7.5 mM) were added to frozen-thawed semen. The sperm kinetic parameters, membrane functionality and integrity, and acrosome integrity and spontaneous acrosome reacted sperm were evaluated with a computer-assisted sperm analysis, a hypoosmotic swelling test and epifluorescent microscopy, respectively. Nitrite and hydroperoxide concentrations of frozen-thawed semen were measured using spectrophotometry. Sperm fertility was evaluated by artificial insemination (AI) of 16 mares with thawed ejaculates (control and 5 mM caffeine-treated groups). Compared to that in the control, the addition of 5 mM caffeine induced an increase in sperm motility (38.9 ± 2.8 versus 32.6 ± 3.4%), and a decrease in nitrite concentration (11.4 ± 2.1 versus 12.8 ± 2.9 µM/µg protein, p < .05). Moreover, the pregnancy rate from AI in the caffeine group was significantly higher (62.5%) than that in the control group (12.5%). These data suggest that caffeine reduced the nitrite concentration and enhanced sperm motility in thawed equine sperm, thus increasing the fertility rate in mares inseminated with caffeine-treated equine semen.

Essential oil from Brazilian Red Propolis exhibits anthelmintic activity against larvae of Toxocara cati.

Toxocara spp. are responsible for causing toxocariasis, a zoonotic disease of global importance, which is difficult to treat as the available drugs have moderate efficacy in the clinical resolution of the disease. A promising alternative to the existing drugs is Propolis, which is known for having biological and pharmacological properties such as antiparasitic, antioxidant, and antitumor activities. In this study, we report the in vitro anthelmintic activity of essential oil from Brazilian Red Propolis (EOP) against larvae of Toxocara cati. Approximately 100 larvae per well were cultivated in microplates containing RPMI-1640 medium and incubated in the presence of EOP (18.75, 37.5, 75, 150, 300 and 600 µg/mL) to determine the Minimum Inhibitory Concentration (MIC) and IC50 (concentration required to inhibit 50% of the population) values. Then, T. cati larvae treated with the MIC of EOP were inoculated in mice to evaluate their progression in vivo. A concentration of 600 µg/mL of EOP showed 100% larvicidal activity after exposure for 48 h, while 300 µg/mL represented the IC50 and CC50. The anthelmintic activity of EOP was confirmed by the inability of the treated T. cati larvae to infect the mice. Our findings demonstrate the potential of EOP as an anthelmintic.

Treatment of Childhood Brucellosis: A Systematic Review.

BACKGROUND: Proper treatment for brucellosis is crucial to eradicate the infection and prevent complications, but there is a notable gap in evidence for pediatric treatment. This study aims to address this gap by reviewing current literature, analyzing the efficacy and safety of brucellosis treatment in children, and identifying areas that require further investigation. METHODS: A systematic review, following preferred reporting items for systematic reviews and meta-analyses and Cochrane Handbook guidelines, assessed antimicrobial regimens' efficacy and safety for treating human brucellosis in children. Original human studies with clinical outcomes after drug therapy intervention for children up to 10 years were included. Searches were conducted in Medline, Embase, Cochrane Library and LILACS databases for studies indexed until March 6, 2023. Study selection, data extraction, and bias risk assessment were performed by pairs of reviewers. The quality assessment used Joanna Briggs Institute tools and grading of recommendations assessment, development and evaluation system. Data were analyzed using R software. RESULTS: A total of 1773 records were reviewed, yielding 11 eligible studies encompassing 1156 children. All included studies presented an observational design. The most reported treatment approaches included sulfamethoxazole-trimethoprim with rifampicin or aminoglycosides, with summarized failure rates of 2% (95% confidence interval: 0.0-0.49) and 13% (95% confidence interval: 0.06-0.29), respectively (very low certainty of evidence). Adverse events and time to defervescence were not reported. CONCLUSIONS: Sulfamethoxazole-trimethoprim + rifampicin were the most prescribed antibiotics for brucellosis for pediatrics. The study highlights the need for more research with robust designs, and emphasizes uncertainty regarding the efficacy of antimicrobial regimens, emphasizing the importance of further investigations to guide specific treatment protocols for this population.

Gestational age: comparing estimation methods and live births' profile.

OBJECTIVE: To identify factors associated with the definition of the gestational age (GA) estimation method recorded in the live birth certificate (LBC), and to compare the results obtained according to the method in the city of São Paulo (CSP), between 2012 and 2019. METHODS: Cross-sectional population-based study using the Live Birth Information System. Descriptive and comparative analysis was performed according to the GA estimation method, followed by a univariate and multivariate logistic regression model to identify the predictor variables of the method used. RESULTS: The estimation of GA by the date of the last menstrual period (LMP) (39.9%) was lower than that obtained by other methods (OM) (60.1%) - physical examination and ultrasound, between 2012-2019. LMP registration in the LBC increased with the mother's age, it was higher among women who were white, more educated and with partners, in cesarean sections and with private funding. In the logistic regression, public funding was 2.33 times more likely than private funding to use OM. The proportion of preterm infants (<37 weeks) with GA by LMP was 26.5% higher than that obtained by OM. Median birth weight was higher among preterm infants with GA estimated by LMP. CONCLUSION: Prematurity was higher with the GA estimated by LMP in the CSP, which may indicate overestimation by this method. The source of funding was the most explanatory variable for defining the GA estimator method at the LBC. The results point to the need for caution when comparing the GA obtained by different methods.

Cervical cancer screening in low- and middle-income countries: A systematic review of economic evaluation studies.

Economic assessments are relevant to support the decision to incorporate more cost-effective strategies to reduce Cervical Cancer (CC) mortality. This systematic review analyzes the economic evaluation studies of CC prevention strategies (HPV DNA-based tests and conventional cytology) in low- and middle-income countries. Medline, EMBASE, CRD, and LILACS were searched for economic evaluation studies that reported cost and effectiveness measures of HPV DNA-based tests for CC screening and conventional cytology in women, without age, language, or publication date restrictions. Selection and data extraction were carried out independently. For comparability of results, cost-effectiveness measures were converted to international dollars (2019). Report quality was assessed using the CHEERS checklist. The Dominance Matrix Ranking (DRM) was used to analyze and interpret the results. The review included 15 studies from 12 countries, with cost-effectiveness analyzes from the health system's perspective and a 3% discount rate. The strategies varied in age and frequency of screening. Most studies used the Markov analytical model, and the cost-benefit threshold was based on the per capita GDP of each country. The sensitivity analysis performed in most studies was deterministic. The completeness of the report was considered sufficient in most of the items evaluated by CHEERS. The Dominance Interpretation (DRM) varied; in 6 studies, the HPV test was dominant, 5 studies showed a weak dominance evaluating greater effectiveness of the HPV test at a higher cost, yet in 2 studies conventional cytology was dominant. Although the context-dependent nature of economic evaluations, this review points out the challenge of methodological standardization in the analytical models.

Action of swim-up and caffeine on equine frozen sperm.

Cryopreservation of equine semen is crucial to semen commercialization. However, it reduces sperm motility and longevity. Thus, sperm selection methods and addition of motility-activating substances to sperm, such as caffeine, may improve sperm quality of equine frozen semen. The objective of the current work was to evaluate the effects of caffeine on recovery and quality parameters of frozen-thawed sperm subjected to swim-up selection to be used in intracytoplasmic sperm injection (ICSI) in assisted reproductive techniques. Stallion semen were frozen and after thawing different caffeine concentrations were added to the samples performing four treatments control (no caffeine), 3, 5, and 7.5 mM caffeine. Sperm kinematic and motility were assessed by computer-assisted sperm analysis (CASA). Then, the four treated samples were submitted to the swim-up sperm selection, and the number of recovered sperm and morphology were evaluated at four times 20, 40, 60, and 80 min. The swim-up increased the recovery proportion of normal morphology sperm without (80.1±1%) or with caffeine addition (3mM: 81.2±1%, 5mM: 79.9±1% and 7.5 mM 78.9±1%) compared to the thawed semen (70±2%). However, the addition of 5 mM caffeine induced an increase in sperm motility (38.9±2.8 vs. 32.6±3.4%, P<0.05), and sperm recovery after swim-up (7.9x106 vs. 3.4x106 sperm/ml, P<0.05) compared to the control. The addition of 5 mM caffeine to frozen-thawed equine semen before swim-up selection improved sperm motility and increased the sperm recovery rate while not decreasing the percentage of morphologically normal sperm. Thus, caffeine addition to frozen-thawed equine semen before swim-up selection has potential clinical application in improving sperm quality for use in ICSI.

Acetogenin-induced fibrotic heart disease from avocado (Persea americana, Lauraceae) poisoning in horses.

Poisoning by avocado (Persea americana) has been confirmed in sheep, goats, dogs, rabbits and ostriches. The clinical signs and lesions are attributed to the acetogenin, persin. Little is known regarding the epidemiology, clinical signs, lesions and therapy caused by acetogenin-induced heart damage. During the two-year study, we investigated a horse farm with six horses that often fed themselves with P. americana leaves or mature fruit pulp and skin on the ground. Two horses died, and one underwent necropsy, histopathology, and immunohistochemistry using the anti-cardiac troponin C (cTnC). Grossly and histopathologically, there was severe cardiac fibroplasia. Immunohistochemically, there was a multifocal decrease or negative expression in the cTnC cardiomyocytes' cytoplasm. Persea americana leaves were confirmed in the alimentary tract using botanical anatomy and molecular techniques. The chemical investigation by (LC-ESI-MS) revealed the presence of the acetogenins, persin and avocadene 1-acetate from P. americana. Persin was present in leaves and fruits (seed and pulp), while avocadene 1-acetate was found in leaves and fruits (seed, peel, and pulp) with a higher concentration in the pulp. Four other horses have been examined by electrocardiogram, echocardiogram and serum Troponin 1 (cTnI). To establish a causal effect of consumption of P. Americana and heart fibroplasia in horses, long-time experiments must be carried out.

Large-volume electric field-assisted multiphase extraction of malachite green from water samples: A multisample device and method validation.

In this work, a new large-volume multiphase, multi-sample electroextraction device was developed and applied to selectively extract malachite green (MG) from water samples. This device was easily constructed with ordinary materials and capable of extracting ten samples simultaneously, obtaining MG preconcentrated on a solid support, to fit into a pipette tip. A multi-well plate was applied to extract MG from aquaculture water samples, and the extracts containing the desorbed MG were analysed by LC-DAD and LC-MS/MS. The signals from both detectors were used in two independent validation procedures. Linearity, matrix effect, selectivity, precision, trueness, and limits of detection and quantification were all evaluated. For both detectors, linearity was demonstrated in the range of 0.5-5 µg L-1 (R2 > 0.98). Matrix effect was insignificant for LC-DAD only, and the average preconcentration factor was about 60 times. Recoveries ranged from 94 to 113% for LC-DAD and 95-115% for LC-MS/MS analysis. ANOVA was applied to estimate the standard deviation under repeatability (6.96-8.61% for LC-DAD and 5.98-7.41% for LC-MS/MS) and within-reproducibility (6.96-8.61% for LC-DAD and 6.56-7.41% for LC-MS/MS) conditions. The limits of detection and quantification for LC-MS/MS analysis were 4.29 and 28.74 ng L-1, respectively, while, for LC-DAD, these limits were 14.29 and 95.81 ng L-1, respectively. The results demonstrated that the developed method was suitable for determining MG in water samples, and the large-volume multiphase, multi-sample electroextraction device proved to be a powerful sample preparation technique to obtain high clean-up and large preconcentration levels, which are of paramount importance for environmental applications.

Caesarean sections, prenatal and postnatal conditions and childhood acute lymphoblastic leukaemia: A case-control study in the State of São Paulo, Brazil.

INTRODUCTION: Brazil has high rates of caesarean sections, which has been suggested as a risk factor for acute lymphoblastic leukaemia (ALL). In addition, some pre- and postnatal conditions have been identified as relevant in the etiology of ALL. OBJECTIVES: Investigate the association of caesarean sections, pre- and postnatal conditions with childhood ALL in the State of São Paulo. METHODS: Population-based case-control study including children that are below10 years old. Information on study variables was obtained through face to face interviews, through a questionnaire, and the State of São Paulo Declarations of Live Births database. The conditional and unconditional logistic regression approaches were used to calculate the odds ratio (OR) of the associations between caesarean sections, pre- and postnatal conditions with ALL, and 95 % confidence intervals (95 % CI). RESULTS: We observed a weak and non-statistically significant risk for ALL among children exposed to caesarean sections (unconditional logistic regression OR 1.08; 95 % CI 0.70-1.66; conditional logistic regression OR 1.21; 95 % CI 0.72-2.02), but among children under 3 years old and born through a caesarean sections, the risk of ALL was greater (unconditional logistic regression OR 1.70; 95 % CI 0.69-4.21). A negative association for ALL was observed among children with mothers who reported 12 years of schooling or more (unconditional logistic regression OR 0.34; 95 % CI 0.16-0.69). CONCLUSIONS: We found a tenuous suggestive association between caesarean sections and childhood ALL. The mother's high level of education showed an inverse association with ALL.

Relação entre saúde mental de idosos do Distrito Federal e exposição a informações sobre COVID-19

A fim de conhecer o tempo e a frequência com que idosos se expõem a notícias e informações sobre a COVID-19 por diferentes mídias e relacioná-los com sintomas depressivos e de ansiedade, 154 idosos (M = 69,06) do Distrito Federal responderam a um questionário online. A amostra foi composta majoritariamente por mulheres, brancas, escolarizadas e com renda proveniente de aposentadoria e/ou pensão. Constatou-se que a televisão foi o meio de comunicação mais utilizado pelos participantes, seguido pelas redes sociais. Ao considerar características demográficas, idosos mais jovens (60 a 74 anos) e com ensino superior completo apresentaram maior exposição a notícias por meio das redes sociais do que os mais velhos e com menor escolaridade. Idosos com rastreio para depressão e transtorno de ansiedade generalizada permaneceram mais horas expostos a informações sobre a COVID-19 veiculadas pela televisão que idosos não rastreados. Além disso, aqueles com rastreio para depressão relataram maior frequência de exposição a esse conteúdo pela televisão e pelas redes sociais. Os resultados deste estudo revelam a necessidade de planejamento de medidas de promoção e prevenção em saúde específicas para a população idosa a fim de lidar com as consequências da pandemia e, especialmente, infodemia de COVID-19.

Para conocer el tiempo y la frecuencia con que los ancianos están expuestos a noticias e informaciones sobre el COVID-19 por diferentes medios de comunicación y relacionarlos con los síntomas depresivos y de ansiedad, 154 ancianos (m = 69,06) del Distrito Federal respondieron a un cuestionario online. La muestra estaba compuesta mayoritariamente por mujeres, de raza blanca, con estudios y con ingresos por jubilación y/o pensión. Se comprobó que la televisión era el medio de comunicación más utilizado por los participantes, seguido de las redes sociales. Teniendo en cuenta las características demográficas, los más jóvenes (60 a 74 años) y con estudios superiores completos presentan una mayor exposición a las noticias a través de las redes sociales que los más mayores y con menor escolaridad. Los ancianos con cribado de depresión y trastorno de ansiedad generalizada permanecieron más horas expuestos a la información sobre COVID-19 emitida por televisión que los ancianos no cribados. Además, los que se sometieron a pruebas de detección de la depresión informaron de una mayor frecuencia de exposición a este contenido por parte de la televisión y los medios sociales. Los resultados de este estudio revelan la necesidad de planificar medidas de promoción de la salud y de prevención específicas para la población de edad avanzada con el fin de hacer frente a las consecuencias de la pandemia y, especialmente, de la infodemia de COVID-19.

In order to know the time and frequency with which elderly are exposed to news and information about COVID-19 through different media and relate them with depressive and anxiety symptoms, 154 elderly (M = 69.06) from Distrito Federal answered an online questionnaire. The sample was composed mostly of women, white, educated, and with income from retirement and/or pension. It was found that television was the media most used by participants, followed by social networks. Considering demographic characteristics, younger elders (60 to 74 years old) and with complete college education had more exposure to news through social networks than the older ones and with less education. Elderly with screening for depression and generalized anxiety disorder remained exposed more hours to information about COVID-19 broadcast on television than unscreened elderly. In addition, those with screening for depression reported greater frequency of exposure to this content on television and social media. The results of this study reveal the need for health promotion and prevention measures planning specific to the elderly population to deal with the consequences of the pandemic and especially infodemic of COVID-19.

Gestational age: comparing estimation methods and live births' profile / Gestational age: comparing estimation methods and live births' profile

ABSTRACT Objective: To identify factors associated with the definition of the gestational age (GA) estimation method recorded in the live birth certificate (LBC), and to compare the results obtained according to the method in the city of São Paulo (CSP), between 2012 and 2019. Methods: Cross-sectional population-based study using the Live Birth Information System. Descriptive and comparative analysis was performed according to the GA estimation method, followed by a univariate and multivariate logistic regression model to identify the predictor variables of the method used. Results: The estimation of GA by the date of the last menstrual period (LMP) (39.9%) was lower than that obtained by other methods (OM) (60.1%) — physical examination and ultrasound, between 2012-2019. LMP registration in the LBC increased with the mother's age, it was higher among women who were white, more educated and with partners, in cesarean sections and with private funding. In the logistic regression, public funding was 2.33 times more likely than private funding to use OM. The proportion of preterm infants (<37 weeks) with GA by LMP was 26.5% higher than that obtained by OM. Median birth weight was higher among preterm infants with GA estimated by LMP. Conclusion: Prematurity was higher with the GA estimated by LMP in the CSP, which may indicate overestimation by this method. The source of funding was the most explanatory variable for defining the GA estimator method at the LBC. The results point to the need for caution when comparing the GA obtained by different methods.

RESUMO Objetivo: Identificar fatores associados à definição do método estimador da idade gestacional (IG) registrado na declaração de nascido vivo (DNV) e comparar os resultados obtidos segundo método no município de São Paulo, entre 2012 e 2019. Métodos: Estudo transversal de base populacional utilizando o Sistema de Informações sobre Nascidos Vivos. Realizou-se análise descritiva e comparativa segundo método de estimativa da IG, seguida de modelo de regressão logística uni e multivariada para identificar as variáveis preditoras do método utilizado. Resultados: A estimativa da IG pela data da última menstruação (DUM) (39,9%) foi inferior à obtida por outros métodos (OM) (60,1%) — exame físico e ultrassonografia, entre 2012-2019. O registro da DUM na DNV aumentou com a idade da mãe, foi maior entre as brancas, mais escolarizadas e com companheiro, nas cesarianas e nos partos realizados com financiamento privado. Na regressão logística, o financiamento público apresentou chance 2,33 vezes maior que o privado para uso de OM. A proporção de prematuros (<37 semanas) com IG pela DUM foi 26,5% maior do que a obtida por OM. A mediana de peso ao nascer foi maior entre prematuros com IG estimada pela DUM. Conclusão: A prematuridade foi mais elevada com a IG estimada pela DUM no MSP, o que pode indicar superestimação por este método. A fonte de financiamento foi a variável mais explicativa para definição do método estimador da IG na DNV. Os resultados apontam a necessidade de cautela ao comparar a IG obtida por métodos diferentes.

Coverage, completeness and reliability of the data in the Information System on Live Births in public maternity wards in the municipality in São Paulo, Brazil, 2011. / Cobertura, completude e confiabilidade das informações do Sistema de Informações sobre Nascidos Vivos de maternidades da rede pública no município de São Paulo, 2011.

OBJECTIVE: to assess the coverage, completeness and reliability of data on live births in public maternity wards in São Paulo, Brazil. METHODS: data recorded in the Information System on Live Births (Sinasc) were compared with data collected in a field study (gold standard) during three months in 2011 in four maternity wards in hospital from the SUS network; kappa coefficient was calculated to assess agreement. RESULTS: 5,785 birth records were analyzed; Sinasc coverage was 99.8% and completeness was 96.2%; kappa values showed excellent and good agreement for maternal age (0.99), type of pregnancy, sex and newborn sex and birth weight (0.98), type of delivery (0.97), 1 minute (0.96) and 5th (0.95) minutes, previous live births (0.87) and education level (0.62); regular agreement for prenatal care visits (0.60) and gestational age (0.56); and weak agreement for previous stillbirths (0.09). CONCLUSION: in the assessed hospitals, Sinasc presented high coverage, completeness and reliability.

Cervical cancer screening in low- and middle-income countries: A systematic review of economic evaluation studies

Abstract Economic assessments are relevant to support the decision to incorporate more cost-effective strategies to reduce Cervical Cancer (CC) mortality. This systematic review analyzes the economic evaluation studies of CC prevention strategies (HPV DNA-based tests and conventional cytology) in low- and middle-income countries. Medline, EMBASE, CRD, and LILACS were searched for economic evaluation studies that reported cost and effectiveness measures of HPV DNA-based tests for CC screening and conventional cytology in women, without age, language, or publication date restrictions. Selection and data extraction were carried out independently. For comparability of results, cost-effectiveness measures were converted to international dollars (2019). Report quality was assessed using the CHEERS checklist. The Dominance Matrix Ranking (DRM) was used to analyze and interpret the results. The review included 15 studies from 12 countries, with cost-effectiveness analyzes from the health system's perspective and a 3% discount rate. The strategies varied in age and frequency of screening. Most studies used the Markov analytical model, and the cost-benefit threshold was based on the per capita GDP of each country. The sensitivity analysis performed in most studies was deterministic. The completeness of the report was considered sufficient in most of the items evaluated by CHEERS. The Dominance Interpretation (DRM) varied; in 6 studies, the HPV test was dominant, 5 studies showed a weak dominance evaluating greater effectiveness of the HPV test at a higher cost, yet in 2 studies conventional cytology was dominant. Although the context-dependent nature of economic evaluations, this review points out the challenge of methodological standardization in the analytical models.

Cervical cancer screening in low-and middle-income countries: a systematic review of economic evaluation studies

Economic assessments are relevant to support the decision to incorporate more cost-effective strategies to reduce Cervical Cancer (CC) mortality. This systematic review analyzes the economic evaluation studies of CC prevention strategies (HPV DNA-based tests and conventional cytology) in low- and middle-income countries. Medline, EMBASE, CRD, and LILACS were searched for economic evaluation studies that reported cost and effectiveness measures of HPV DNA-based tests for CC screening and conventional cytology in women, without age, language, or publication date restrictions. Selection and data extraction were carried out independently. For comparability of results, cost-effectiveness measures were converted to international dollars (2019). Report quality was assessed using the CHEERS checklist. The Dominance Matrix Ranking (DRM) was used to analyze and interpret the results. The review included 15 studies from 12 countries, with cost-effectiveness analyzes from the health system's perspective and a 3% discount rate. The strategies varied in age and frequency of screening. Most studies used the Markov analytical model, and the cost-benefit threshold was based on the per capita GDP of each country. The sensitivity analysis performed in most studies was deterministic. The completeness of the report was considered sufficient in most of the items evaluated by CHEERS. The Dominance Interpretation (DRM) varied; in 6 studies, the HPV test was dominant, 5 studies showed a weak dominance evaluating greater effectiveness of the HPV test at a higher cost, yet in 2 studies conventional cytology was dominant. Although the context-dependent nature of economic evaluations, this review points out the challenge of methodological standardization in the analytical models.

Brinquedo Terapêutico no ensino da insulinoterapia a crianças com diabetes: estudo de caso qualitativo / Therapeutic play in the teaching ofinsulin therapy to children with diabetes: a qualitative case study

Apresentar as manifestações de crianças com Diabetes mellitus tipo 1 participantes em uma sessão de Brinquedo Terapêutico Instrucional-BTI sobre a insulinoterapia. Estudo de Caso qualitativo, com análise temática indutiva, realizado em um acampamento de diabetes em 2014, com participação de duas crianças em idade escolar em sessão de BTI. As manifestações permitiram compreender que o domínio da insulinoterapia é um assunto complexo para a faixa etária, e demanda reforço contínuo visando a adaptação cognitiva da criança. A sessão de BTI oportunizou identificar o conhecimento prévio e as necessidades de aprendizagem sobre a conservação e técnica de injeção de insulina das crianças, com uso de linguagem adequada como o brincar. O BTI foi instrumento facilitador para identificar necessidades educacionais, além de sua ação assistencial. Seu uso reforça o potencial do lúdico na promoção do autocuidado relacionado à insulinoterapia da criança com diabete

To describe the expressions presented by children with type 1 diabetes who participated in a session on insulin therapy using the instructional therapeutic play (ITP). This is a qualitative case study in which inductive thematic analysis was conducted at a diabetes camp in 2014, and two school-aged children participated in an ITP session. The results revealed that children of the studied age group have difficulty mastering insulin therapy and need continued efforts to adapt cognitively to insulin therapy. The ITP session provided insight into the children's prior knowledge and their learning needs regarding the insulin storage and insulin injection technique using age-appropriate language such as playing. The ITP helped to identify educational needs and the involved care. The use of ITP strengthens the potential of play-based strategies to promote self-care related to insulin therapy in children with diabetes.

Aleitamento materno exclusivo: adesão e dificuldades / Exclusive breastfeeding: adhesion and difficulties

Objetivo: conhecer a taxa de adesão ao aleitamento materno exclusivo e as dificuldades que levam ao desmame precoce. Método: estudo quantitativo, observacional, com delineamento de correlação, envolvendo 102 mães de recém-nascidos internados no alojamento conjunto do SUS e convênio, no período de junho a julho de 2017. Os dados foram produzidos pelo monitoramento do aleitamento materno por 180 dias em três etapas distintas (30º; 90º e 180º dia) por meio de entrevistas com perguntas formalizadas pelo checklist efetuado por contato telefônico. Em seguida, os dados foram transcritos na íntegra e analisados por estatística descritiva e inferencial. Resultados: a taxa de adesão ao aleitamento materno nos seis primeiros meses de vida foi de 23,53%, considerada razoável segundo a Organização Mundial da Saúde (OMS). As dificuldades mais apontadas foram leite insuficiente (32,93%) e introdução da suplementação (24,39%). Conclusão: a taxa de adesão ao aleitamento materno encontrada, classificada como "razoável" pela OMS, ainda está abaixo do preconizado. As principais dificuldades referidas pelas mães ao amamentar fornecem informações para que a equipe de saúde promova ações de promoção e incentivo à prática do aleitamento materno.(AU)