Weight-Gain Velocity in Newborn Infants Managed with the Kangaroo Method and Associated Variables.

Objectives The Kangaroo method helps promote maternal breastfeeding and adequate growth of low birthweight preterm infants. The objective of this study was to analyze the association between weight-gain velocity during use of the Kangaroo method and maternal and infant variables. Methods A nested cross-sectional study in a cohort of newborn infants managed using the Kangaroo method was carried out at a reference center for the method in Brazil. Data on low birthweight and preterm infants managed using the Kangaroo Method (n = 78) and on their respective mothers (n = 70) was collected between January and July 2014. Maternal and infant variables were associated and correlated with weight-gain velocity (g/kg/day) at each phase of the method (p < 0.05). Results Mean weight-gain velocity increased from 0.12 ± 11.11 g/kg/day in the first phase to 13.47 ± 4.84 g/kg/day in the third phase (p < 0.001), and percentage of adequate weight increased at phase 3 (p < 0.001). Birthweight was inversely correlated with weight-gain velocity at phases 1 and 2 of the Kangaroo method. Birthweight of under 1500 g was associated with a lower likelihood of inadequate weight-gain velocity of the newborn at phase 1 (OR = 0.1; 95 % CI 0.01-0.78; p = 0.012). In phase 3, maternal age was directly correlated with weight-gain velocity. Conclusions Weight-gain velocity was associated with maternal (age) and infant (gestational age at birth, birthweight, weight for gestational age at birth, length of hospital stay and five-minute Apgar score) variables. Knowledge of the factors influencing weight-gain velocity and its behavior at each phase of the method can help guide conduct toward potentializing factors that promote adequate weight-gain.

A Brazilian case of IFAP syndrome with severe congenital ichthyosis and limb malformations caused by a rare variant in MBTPS2.

OBJECTIVE: The classic triad, which defines IFAP syndrome, is ichthyosis follicularis, alopecia, and photophobia. It is a rare X-linked genetic disorder characterized by multiple congenital anomalies with variable severity, caused by pathogenic variants in the MBTPS2 gene, which encodes a zinc metalloprotease that is essential for normal development. This study aimed to report a case of a Brazilian patient with IFAP syndrome presenting skeletal anomalies, which is a rare finding among patients from different families. CASE DESCRIPTION: We describe a male proband with IFAP syndrome showing severe ichthyosis congenita, cryptorchidism, limb malformation, and comprising the BRESHECK syndrome features. Using whole-exome sequencing, we identified a rare missense variant in hemizygosity in the MBTPS2 gene, which had not been identified in other family members. COMMENTS: This is the first diagnosis of IFAP syndrome in Brazil with a molecular investigation. The present case study thus expands our knowledge on the mutational spectrum of MBPTS2 associated with IFAP syndrome.

Epidemiology and control of trachoma in the state of Ceará, Northeast Brazil, 2007-2021.

BACKGROUND: To analyze the epidemiology, surveillance, and control strategies for trachoma in the state of Ceará, northeast Brazil, from 2007 to 2021. METHODS: This ecological study was based on secondary data from the Information System on Notifiable Diseases of the Secretary of Health of the state of Ceará. Data from school and home surveys for trachoma detection obtained during the study period were analyzed, the percentage of positivity was estimated, and sociodemographic and clinico-epidemiological factors were investigated. RESULTS: The coverage of trachoma surveillance and control actions in Ceará municipalities increased from 12.5% in 2007 to 55.9% in 2019, but with an average restriction of 8.0% during the COVID-19 pandemic. The estimated trachoma positivity (mean overall positivity) was less than 5.0% (2.76%, 95% CI 1.2-5.2), with a higher proportion of cases in the 5-9-year age group (45.0%, 95% CI 44.6-45.4), in females (53.2%, 95% CI 52.8-53.6), and rural areas (52.6%, 95% CI 52.2-53.0). Positivity above 10.0% was observed in the Litoral Leste/Jaguaribe and Sertão Central regions, with a higher occurrence of the follicular inflammatory clinical form (98.1%, 95% CI 98.0-98.2). CONCLUSIONS: Trachoma remains in the state of Ceará and is likely underreported. Despite recent advances, the fragility of health surveillance activities compromises the recognition of the actual magnitude and distribution of trachoma in the state. Accurate information is fundamental for planning, monitoring, and evaluating surveillance and disease control.

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

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

Scientometric analysis of research on trachoma in Brazil, 2000-2020.

OBJECTIVE: To analyze the scientometric profile of research on trachoma in Brazil. METHODS: Bibliographic research of publications on trachoma in Brazil indexed by the Scopus database from 2000 to 2020, based on specific criteria. Data on authorship, country of origin, institutions, and keywords were collected and analyzed with analysis of time trends. Bibliographic networks were constructed via a scientometric visualization software-VOSviewer® 1.6.16. RESULTS: We analyzed 42 publications on trachoma in Brazil. The annual average was two articles, with an increase of about 50% during the period. The average number of authors was three per document and school surveys were the most common subject category. Most published articles came from Brazilian institutions (95.2%), mainly those based in Southeast and North Brazil. Of the most productive authors, 10 were mentioned as first author in 26.2% of publications (11/42) and the predominant institutions are based in the state of São Paulo. The term "trachoma" (n = 18) was the most recurrent keyword. CONCLUSION: This first scientometric analysis of research on trachoma in Brazil showed a limited number of studies on this disease. The scientific production slightly increased, although the origin of many studies is geographical areas with lower endemicity of this disease. Greater investments are needed for a better understanding and control of this neglected tropical disease. The analysis of bibliographic production on this topic is important to strengthen the development of research and strategic planning of programs for the control of trachoma and neglected tropical diseases in general.

Frequent Infection of Cats With SARS-CoV-2 Irrespective of Pre-Existing Enzootic Coronavirus Immunity, Brazil 2020.

Carnivores such as cats and minks are highly susceptible to SARS-CoV-2. Brazil is a global COVID-19 hot spot and several cases of human-to-cat transmission have been documented. We investigated the spread of SARS-CoV-2 by testing 547 domestic cats sampled between July-November 2020 from seven states in southern, southeastern, and northeastern Brazil. Moreover, we investigated whether immune responses elicited by enzootic coronaviruses affect SARS-CoV-2 infection in cats. We found infection with significantly higher neutralizing antibody titers against the Gamma variant of concern, endemic in Brazil during 2020, than against an early SARS-CoV-2 B.1 isolate (p<0.0001), validating the use of Gamma for further testing. The overall SARS-CoV-2 seroprevalence in Brazilian cats during late 2020 validated by plaque reduction neutralization test (PRNT90) was 7.3% (95% CI, 5.3-9.8). There was no significant difference in SARS-CoV-2 seroprevalence in cats between Brazilian states, suggesting homogeneous infection levels ranging from 4.6% (95% CI, 2.2-8.4) to 11.4% (95% CI, 6.7-17.4; p=0.4438). Seroprevalence of the prototypic cat coronavirus Feline coronavirus (FCoV) in a PRNT90 was high at 33.3% (95% CI, 24.9-42.5) and seroprevalence of Bovine coronavirus (BCoV) was low at 1.7% (95% CI, 0.2-5.9) in a PRNT90. Neutralizing antibody titers were significantly lower for FCoV than for SARS-CoV-2 (p=0.0001), consistent with relatively more recent infection of cats with SARS-CoV-2. Neither the magnitude of SARS-CoV-2 antibody titers (p=0.6390), nor SARS-CoV-2 infection status were affected by FCoV serostatus (p=0.8863). Our data suggest that pre-existing immunity against enzootic coronaviruses neither prevents, nor enhances SARS-CoV-2 infection in cats. High SARS-CoV-2 seroprevalence already during the first year of the pandemic substantiates frequent infection of domestic cats and raises concerns on potential SARS-CoV-2 mutations escaping human immunity upon spillback.

Feline Leishmaniasis Caused by Leishmania infantum: Parasite Sequencing, Seropositivity, and Clinical Characterization in an Endemic Area From Brazil.

Zoonotic leishmaniasis caused by Leishmania infantum is a disease of One Health concern since human and animal cases and environmental damage are interconnected. L. infantum has a complex epidemiological cycle with multiple hosts, including mammals-humans, domestic, and wild animals-and arthropod vectors. Knowledge on mammal infections in endemic areas is crucial for developing control strategies. This work aimed to detect and characterize L. infantum infection in domestic cats from areas where human and canine leishmaniasis cases occur. No cases of feline leishmaniasis (FeL) had been previously reported in those areas. Five municipalities from Bahia state were chosen, comprising 2,480.8 km2 with 1,103,866 inhabitants. Ninety domiciliated and/or sheltered cats underwent clinical examination and serology by a rapid reference test recommended by the Brazilian government. Cytology, PCR, and parasite DNA sequencing were performed in bone marrow samples. Rapid tests detected antibodies in 5.6% (5/90) of the cats. Leishmania infantum infection was confirmed in 7.8% (7/90) of the cats by PCR, sequencing, and parasite isolation. Three out of the five municipalities (60%) had infected cats, and PCR positivity varied from 6.9 to 29%. One cat was categorized as harboring active L. infantum infection with amastigote forms in bone marrow smears. No clinical signs were detected at the first clinical exam, but 1 month later the cat developed severe FeL. The cat isolate was grown in culture, typed and its DNA sequence was homologous to the L. infantum reference strain (PP75). In conclusion, cats are potential hosts and may acquire L. infantum in endemic areas where canine and human cases occur. For cats, the need for surveillance, differential diagnosis and clinical care is highly recommended since a fast clinical progression of FeL developed in a subclinical animal. An accurate standardized immunodiagnostic assay for FeL is warranted.

Factors associated with trachoma treatment and control treatment in schools of municipality of the Northeast Region, Brazil. / Fatores associados ao tratamento e ao controle do tratamento do tracoma em escolares de município da Região Nordeste, Brasil.

INTRODUCTION: Trachoma maintains itself as a public health problem and an important cause of morbidity, visual impairment and preventable blindness in Brazil. OBJECTIVE: To analyze factors associated with treatment and control of trachoma treatment in schoolchildren diagnosed during the national campaign in 2014, in the town of Russas, Ceará. METHODOLOGY: A cross-sectional study was brought out from January to April 2016. Social, demographic, economic and follow-up data were collected for 390 schoolchildren aged five to 14 years old, diagnosed with trachoma in the campaign in 2014. They were defined dependent variables: trachoma treatment and control of trachoma disease, categorized as adequate and inadequate, and multivariate analyzes were performed. RESULTS: Treatment was considered adequate in 56.7% of schoolchildren and in only 5.9% treatment control was classified as adequate. In the multivariate analysis, they have got an association with the trachoma treatment result: rural residence zone and waste destination in a non-public space. The last control of the treatment of trachoma remained associated to the variables: rural residence zone; family income less than a minimum wage and school not examined by the physician. CONCLUSION: Inadequate treatment and control of trachoma treatment showed an association with socioeconomic variables and follow-up of primary care. Health education activities were not accessible to the entire community, indicating the need for more involvement by primary care professionals.

INTRODUÇÃO: O tracoma mantém-se como problema de saúde pública e importante causa de morbidade, deficiência visual e cegueira evitável no Brasil. OBJETIVO: Analisar fatores associados ao tratamento e ao controle do tratamento do tracoma em escolares diagnosticados durante Campanha Nacional de Hanseníase, Verminoses, Tracoma e Esquistossomose, em 2014, no município de Russas, Ceará. METODOLOGIA: Estudo transversal desenvolvido de janeiro a abril de 2016. Foram coletados dados sociais, demográficos, econômicos e de acompanhamento pela atenção básica de 390 escolares de 5 a 14 anos de idade diagnosticados com tracoma, na campanha em 2014. Definiram-se as variáveis dependentes: tratamento do tracoma e controle do tratamento do tracoma, categorizadas em adequado e inadequado, realizando-se análises bi e multivariada. RESULTADOS: O tratamento foi considerado adequado em 56,7% dos escolares, e em apenas 5,9% o controle do tratamento foi classificado como adequado. Na análise multivariada, mantiveram associação com o desfecho tratamento do tracoma as variáveis zona de residência rural e destino dos dejetos em rede não pública. O desfecho controle do tratamento do tracoma permaneceu associado às variáveis: zona de residência rural, renda familiar menor que um salário mínimo e escolar não examinado pelo médico. CONCLUSÃO: O tratamento e controle do tratamento inadequados do tracoma mostraram associação com variáveis socioeconômicas e de acompanhamento pela atenção básica. As atividades de educação em saúde não foram acessíveis a toda a comunidade, indicando a necessidade de maior envolvimento dos profissionais da atenção básica.

Non-syndromic Oculocutaneous Albinism: Novel Genetic Variants and Clinical Follow Up of a Brazilian Pediatric Cohort.

Oculocutaneous albinism (OCA) is a genetic disorder characterized by skin, hair, and eye hypopigmentation due to a reduction or absence of melanin. Clinical manifestations include vision problems and a high susceptibility to skin cancer. In its non-syndromic form, OCA is associated with six genes and one chromosomal region. Because OCA subtypes are not always clinically distinguishable, molecular analysis has become an important tool for classifying types of OCA, which facilitates genetic counseling and can guide the development of new therapies. We studied eight Brazilian individuals aged 1.5-18 years old with clinical diagnosis of OCA. Assessment of ophthalmologic characteristics showed results consistent with albinism, including reduced visual acuity, nystagmus, and loss of stereoscopic vision. We also observed the appearance of the strabismus and changes in static refraction over a 2-year period. Dermatologic evaluation showed that no participants had preneoplastic skin lesions, despite half of the participants reporting insufficient knowledge about skin care in albinism. Whole-exome and Sanger sequencing revealed eight different mutations: six in the TYR gene and two in the SLC45A2 gene, of which one was novel and two were described in a population study but were not previously associated with the OCA phenotype. We performed two ophthalmological evaluations, 2 years apart; and one dermatological evaluation. To the best of our knowledge, this is the first study to perform clinical follow-up and genetic analysis of a Brazilian cohort with albinism. Here, we report three new OCA causing mutations.

A Brazilian case of IFAP syndrome with severe congenital ichthyosis and limb malformations caused by a rare variant in MBTPS2 / Um caso brasileiro de síndrome IFAP com ictiose congênita grave e malformações de membros causadas por uma variante rara em MBTPS2

Abstract Objective: The classic triad, which defines IFAP syndrome, is ichthyosis follicularis, alopecia, and photophobia. It is a rare X-linked genetic disorder characterized by multiple congenital anomalies with variable severity, caused by pathogenic variants in the MBTPS2 gene, which encodes a zinc metalloprotease that is essential for normal development. This study aimed to report a case of a Brazilian patient with IFAP syndrome presenting skeletal anomalies, which is a rare finding among patients from different families. Case description: We describe a male proband with IFAP syndrome showing severe ichthyosis congenita, cryptorchidism, limb malformation, and comprising the BRESHECK syndrome features. Using whole-exome sequencing, we identified a rare missense variant in hemizygosity in the MBTPS2 gene, which had not been identified in other family members. Comments: This is the first diagnosis of IFAP syndrome in Brazil with a molecular investigation. The present case study thus expands our knowledge on the mutational spectrum of MBPTS2 associated with IFAP syndrome.

RESUMO Objetivo: A clássica tríade de ictiose folicular, alopecia e fotofobia dá nome a uma síndrome rara de origem genética com herança ligada ao cromossomo X (síndrome IFAP, do inglês Ichthyosis Follicularis, Alopecia, and Photophobia). Esta é uma síndrome caracterizada por múltiplas anomalias congênitas de expressividade variável, causada por variantes patogênicas no gene MBTPS2, que codifica uma zinco-metaloprotease essencial para o desenvolvimento normal humano. O objetivo deste estudo é apresentar o relato de caso de um paciente brasileiro com síndrome IFAP que apresentou anomalias esqueléticas, um achado raro entre os pacientes de diferentes famílias. Descrição do caso: Apresentamos um probando do sexo masculino com síndrome IFAP, com ictiose congênita grave, criptorquidia, malformação de membros e as características da síndrome de BRESHECK. Por meio do sequenciamento do exoma completo, identificamos uma variante rara do tipo missense, em hemizigose, no gene MBTPS2, não identificada em outros membros da família. Comentários: Este é o primeiro diagnóstico de síndrome IFAP no Brasil com investigação molecular. A análise molecular e a descrição de uma variante rara no gene MBPTS2 expandem nosso conhecimento sobre o espectro mutacional desse gene associado à síndrome IFAP.

Epidemiology and control of trachoma in the state of Ceará, Northeast Brazil, 2007-2021

ABSTRACT Background: To analyze the epidemiology, surveillance, and control strategies for trachoma in the state of Ceará, northeast Brazil, from 2007 to 2021. Methods: This ecological study was based on secondary data from the Information System on Notifiable Diseases of the Secretary of Health of the state of Ceará. Data from school and home surveys for trachoma detection obtained during the study period were analyzed, the percentage of positivity was estimated, and sociodemographic and clinico-epidemiological factors were investigated. Results: The coverage of trachoma surveillance and control actions in Ceará municipalities increased from 12.5% in 2007 to 55.9% in 2019, but with an average restriction of 8.0% during the COVID-19 pandemic. The estimated trachoma positivity (mean overall positivity) was less than 5.0% (2.76%, 95% CI 1.2-5.2), with a higher proportion of cases in the 5-9-year age group (45.0%, 95% CI 44.6-45.4), in females (53.2%, 95% CI 52.8-53.6), and rural areas (52.6%, 95% CI 52.2-53.0). Positivity above 10.0% was observed in the Litoral Leste/Jaguaribe and Sertão Central regions, with a higher occurrence of the follicular inflammatory clinical form (98.1%, 95% CI 98.0-98.2). Conclusions: Trachoma remains in the state of Ceará and is likely underreported. Despite recent advances, the fragility of health surveillance activities compromises the recognition of the actual magnitude and distribution of trachoma in the state. Accurate information is fundamental for planning, monitoring, and evaluating surveillance and disease control.

The visual system in infants with microcephaly related to presumed congenital Zika syndrome.

PURPOSE: To describe and analyze ocular features in infants with microcephaly due to presumed congenital Zika syndrome. METHODS: Ophthalmologic evaluation, including indirect ophthalmoscopy and eye fundus imaging, visual acuity testing with Teller Acuity Cards, and strabismus assessment were performed in infants with microcephaly at a nongovernmental organization clinic for visually disabled children. RESULTS: A total of 70 infants with microcephaly were referred to the clinic. Of these, 25 (mean age, 3 months; 14 males) had ophthalmologic changes: 18 (26%) had intraocular abnormalities, including macular chorioretinal atrophy, mottled retinal pigment epithelium and optic nerve pallor; 7 patients (10%) had strabismus or nystagmus without intraocular abnormalities. Visual acuity was below normal range in all 11 infants tested. CONCLUSIONS: Ophthalmologic abnormalities occurred in 36% of the patients. Macular circumscribed chorioretinal atrophy, focal mottled retinal pigment epithelium, optic nerve pallor, early-onset strabismus, nystagmus and low visual acuity were common ophthalmological features in infants with microcephaly due to presumed congenital Zika syndrome.

Scientometric analysis of research on trachoma in Brazil, 2000-2020 / Análise cienciométrica da pesquisa sobre tracoma no Brasil, 2000-2020

ABSTRACT OBJECTIVE To analyze the scientometric profile of research on trachoma in Brazil. METHODS Bibliographic research of publications on trachoma in Brazil indexed by the Scopus database from 2000 to 2020, based on specific criteria. Data on authorship, country of origin, institutions, and keywords were collected and analyzed with analysis of time trends. Bibliographic networks were constructed via a scientometric visualization software—VOSviewer® 1.6.16. RESULTS We analyzed 42 publications on trachoma in Brazil. The annual average was two articles, with an increase of about 50% during the period. The average number of authors was three per document and school surveys were the most common subject category. Most published articles came from Brazilian institutions (95.2%), mainly those based in Southeast and North Brazil. Of the most productive authors, 10 were mentioned as first author in 26.2% of publications (11/42) and the predominant institutions are based in the state of São Paulo. The term "trachoma" (n = 18) was the most recurrent keyword. CONCLUSION This first scientometric analysis of research on trachoma in Brazil showed a limited number of studies on this disease. The scientific production slightly increased, although the origin of many studies is geographical areas with lower endemicity of this disease. Greater investments are needed for a better understanding and control of this neglected tropical disease. The analysis of bibliographic production on this topic is important to strengthen the development of research and strategic planning of programs for the control of trachoma and neglected tropical diseases in general.

RESUMO OBJETIVO Analisar o perfil cienciométrico das pesquisas sobre tracoma no Brasil. MÉTODOS Pesquisa bibliográfica de publicações sobre tracoma no Brasil indexadas pela base de dados da Scopus, a partir de critérios específicos no período de 2000 a 2020. Foram extraídos e analisados dados sobre autoria, país de origem, instituições e descritores, com análises de tendências temporais. As redes bibliográficas foram construídas via software de visualização cienciométrica VOSviewer® 1.6.16. RESULTADOS Do total de 42 publicações analisadas sobre tracoma no Brasil, observou-se média anual de dois artigos, com incremento de aproximadamente 50% no período. Verificou-se média de três autores por documento e os inquéritos escolares foram a categoria de assunto mais comum. Os artigos publicados provêm majoritariamente de instituições brasileiras (95,2%), principalmente das sediadas nas regiões Sudeste e Norte. Dez autores mais produtivos estão mencionados nas primeiras autorias em 26,2% (11/42) das publicações e as instituições predominantes estão afiliadas ao estado de São Paulo. O termo Trachoma (n = 18) apresenta maior recorrência como descritor. CONCLUSÃO Esta primeira análise cienciométrica sobre tracoma no Brasil evidencia limitado número de pesquisas sobre essa doença. Há discreto incremento da produção científica, apesar da concentração da origem em áreas geográficas com menor endemicidade da doença. Maiores investimentos são necessários para o melhor entendimento e controle dessa doença tropical negligenciada. A análise da produção bibliográfica tem papel relevante para fortalecimento do desenvolvimento de pesquisas e planejamento estratégico de programas para o controle de tracoma e doenças tropicais negligenciadas em geral.

Morfea panesclerótica incapacitante / Disabling panesclerotic morphea

La morfea panesclerótica incapacitante es una forma severa y rara de esclerodermia localizada, es una enfermedad inflamatoria e inmunomediada de etiología desconocida. Evoluciona con endurecimiento generalizado de la piel por la esclerosis progresiva de la dermis y tejido celular subcutáneo y el deterioro de las articulaciones, huesos, fascia y músculos. La respuesta terapéutica es pobre y la progresión de la enfermedad genera discapacidad física, disminución de la calidad de vida y complicaciones fatales. Presentamos un caso de un paciente que inició los primeros síntomas a los 7 años de edad, siendo diagnosticado con morfea panesclerótica incapacitante conforme evolución clínica e histología, evolucionando con empeoramiento clínico progresivo independiente de las terapias instituidas (AU)

Disabling panesclerotic morphea is a rare and severe form of localized scleroderma, an inflammatory and immune-mediated disease of unknown etiology. It evolves with generalized hardening of the skin due to progressive sclerosis of the dermis and subcutaneous tissue and involvement of joints, bones, fascias and muscles. The therapeutic response is poor and the progression of the disease leads to physical disability, decreased quality of life and fatal complications. We present a case of a patient whose first symptoms started at 7 years of age and was further diagnosed with disabling panesclerotic morphea according to clinical evolution and histology, evolving with progressive clinical worsening regardless of the therapies instituted (AU)

Body position influences the maximum inspiratory and expiratory mouth pressures of young healthy subjects.

OBJECTIVE: The purpose of this study was to determine the effects of body position on respiratory muscle strength of young healthy subjects. PARTICIPANTS: Sixty-three (50 female, mean age 19.7±1.5 years) healthy subjects participated in the study. DESIGN: Participants were measured in the sitting position, semi-upright sitting position, and in the supine position. The order of the three conditions was randomly determined. OUTCOME MEASURES: Maximal inspiratory and expiratory mouth pressures (PImax, PEmax) and lung function. RESULTS: A significant effect of body position was observed on PEmax values, controlling for gender. PImax in the sitting position (92.8±20.05 cm H2O) was significantly higher than in the supine (84.1±15.1 cm H2O; mean difference: 8.70, 95% CI [5.95, 12.45], p<0.001) and semi-upright sitting positions (84.4±17.5 cm H2O; mean difference: 8.43, 95% CI [5.78, 11.07], p<0.001). PEmax was also significantly higher in the sitting position (125.4±34.2 cm H2O) than in the supine (115.8±29.0 cm H2O; mean difference: 9.59, 95% CI [4.86, 14.32], p<0.001) and semi-upright sitting positions (120.2±33.9 cm H2O; mean difference: 5.21, 95% CI [0.87, 9.54], p=0.013). CONCLUSIONS: Body position influences respiratory muscle strength of young healthy subjects. PImax and PEmax are higher in the sitting position than in the supine or semi-upright sitting positions.

Fatores associados ao tratamento e ao controle do tratamento do tracoma em escolares de município da Região Nordeste, Brasil / Factors associated with trachoma treatment and control treatment in schools of municipality of the Northeast Region, Brazil

RESUMO: Introdução: O tracoma mantém-se como problema de saúde pública e importante causa de morbidade, deficiência visual e cegueira evitável no Brasil. Objetivo: Analisar fatores associados ao tratamento e ao controle do tratamento do tracoma em escolares diagnosticados durante Campanha Nacional de Hanseníase, Verminoses, Tracoma e Esquistossomose, em 2014, no município de Russas, Ceará. Metodologia: Estudo transversal desenvolvido de janeiro a abril de 2016. Foram coletados dados sociais, demográficos, econômicos e de acompanhamento pela atenção básica de 390 escolares de 5 a 14 anos de idade diagnosticados com tracoma, na campanha em 2014. Definiram-se as variáveis dependentes: tratamento do tracoma e controle do tratamento do tracoma, categorizadas em adequado e inadequado, realizando-se análises bi e multivariada. Resultados: O tratamento foi considerado adequado em 56,7% dos escolares, e em apenas 5,9% o controle do tratamento foi classificado como adequado. Na análise multivariada, mantiveram associação com o desfecho tratamento do tracoma as variáveis zona de residência rural e destino dos dejetos em rede não pública. O desfecho controle do tratamento do tracoma permaneceu associado às variáveis: zona de residência rural, renda familiar menor que um salário mínimo e escolar não examinado pelo médico. Conclusão: O tratamento e controle do tratamento inadequados do tracoma mostraram associação com variáveis socioeconômicas e de acompanhamento pela atenção básica. As atividades de educação em saúde não foram acessíveis a toda a comunidade, indicando a necessidade de maior envolvimento dos profissionais da atenção básica.

ABSTRACT: Introduction: Trachoma maintains itself as a public health problem and an important cause of morbidity, visual impairment and preventable blindness in Brazil. Objective: To analyze factors associated with treatment and control of trachoma treatment in schoolchildren diagnosed during the national campaign in 2014, in the town of Russas, Ceará. Methodology: A cross-sectional study was brought out from January to April 2016. Social, demographic, economic and follow-up data were collected for 390 schoolchildren aged five to 14 years old, diagnosed with trachoma in the campaign in 2014. They were defined dependent variables: trachoma treatment and control of trachoma disease, categorized as adequate and inadequate, and multivariate analyzes were performed. Results: Treatment was considered adequate in 56.7% of schoolchildren and in only 5.9% treatment control was classified as adequate. In the multivariate analysis, they have got an association with the trachoma treatment result: rural residence zone and waste destination in a non-public space. The last control of the treatment of trachoma remained associated to the variables: rural residence zone; family income less than a minimum wage and school not examined by the physician. Conclusion: Inadequate treatment and control of trachoma treatment showed an association with socioeconomic variables and follow-up of primary care. Health education activities were not accessible to the entire community, indicating the need for more involvement by primary care professionals.

Envelhecer com sucesso: contributos da educação / Age successfully: education contributions / Envejecer con éxito: contribuciones de la educación

O fenómeno1 do envelhecimento tem vindo a tornar-se objeto de grande interesse no âmbito da investigação educativa, devido ao facto de ser, hoje, consensualmente aceite a ideia de que a intervenção educativa na e com a terceira idade constitui um poderoso instrumento no processo do envelhecimento bem-sucedido. O nosso trabalho apresenta os resultados de um projeto de investigação/intervenção desenvolvido com pessoas idosas em contexto institucional, cuja finalidade se centrou na promoção do envelhecimento bem-sucedido. Com base nas metodologias intrínsecas ao paradigma qualitativo interpretativo-hermenêutico, e seguindo as diretrizes do método de investigaçãoação-participativa, a nossa intervenção baseou-se na dinamização de quatro oficinas favorecedoras do processo de educação/aprendizagem dos participantes. Os resultados evidenciaram uma incontornável relação entre educação e envelhecimento bem-sucedido. Entre os resultados positivos podemos salientar como estratégias favorecedoras de um processo de envelhecimento bem-sucedido, a aquisição de novas aprendizagens e a promoção do convívio e da relação interpessoal.

Aging has become an object of great interest in educational research because it is now widely accepted that educational intervention in and with the elderly is a powerful instrument in a successful aging process. This text presents the results of an investigation/intervention project developed with elderly people. It aimed at the promotion of successful aging in a specific institutional context and, by following participatory actionresearch guidelines, was based on the dynamization of four workshops that favored the education / learning process of the participants. The data collected was analyzed according to an interpretive-hermeneutic qualitative methodology. The results showed an inescapable relationship between education and successful aging. Among other positive results, the analysis revealed the construction of new learning and the promotion of social interaction and interpersonal relationship as strategies favoring a successful aging process.

El fenómeno del envejecimiento se ha convertido en un objeto de gran interés en el ámbito de la investigación educativa, debido al hecho de que actualmente se acepta generalizadamente la idea de que la intervención educativa en y con la tercera edad representa un poderoso instrumento en el proceso de envejecimiento exitoso. Nuestro trabajo representa los resultados de un proyecto de investigación/intervención desarrollados con personas mayores en el contexto de una institución, cuya finalidad se centró en la promoción del envejecimiento exitoso. A partir de las metodologías del paradigma de investigación cualitativa hermenéutico-interpretativa, y las directrices del método de investigación-acción-participativa, nuestra intervención se basó, en la dinamización de cuatro talleres favorecedores del proceso de educación/aprendizaje de los participantes. Los resultados evidenciaron una relación inevitable entre educación y el envejecimiento exitoso. Entre los resultados positivos podemos destacar como estrategias favorecedoras del proceso de envejecimiento exitoso, la adquisición de nuevos aprendizajes, la promoción de la convivencia y de la relación interpersonal.

[Factors associated with neonatal death in high-risk infants: a multicenter study in High-Risk Neonatal Units in Northeast Brazil]. / Fatores associados ao óbito neonatal de recém-nascidos de alto risco: estudo multicêntrico em Unidades Neonatais de Alto Risco no Nordeste brasileiro.

This study aimed to identify factors associated with in-hospital mortality in High-Risk Neonatal Units (NICU) belonging to the North-Northeast Perinatal Health Network in Northeast Brazil. The explanatory variables were individual maternal characteristics, prenatal care, childbirth and neonatal care, and infant characteristics. This was a longitudinal, multicenter hospital-based study. The study population consisted of 3,623 live born infants admitted to 34 NICUs. After adjusting for the three hierarchical levels in the model for determination of death in the NICU up to the 27 th day of life, the following showed statistically significant association: type of delivery - cesarean section (OR = 0.72; 95%CI: 0.56-0.95), non-use of prenatal steroids (OR =1.51; 95%CI: 1.01-2.25), preeclampsia (OR = 0.73; 95%CI: 0.56-0.95), oligohydramnios (OR = 1.57; 95%CI: 1, 17-2.10), birth weight < 2500g (OR = 1.40; 95%CI: 1.03-1.90), 5-minute Apgar score < 7 (OR = 2.63; 95%CI: 2.21-3.14), endotracheal intubation (OR = 1.95; 95%CI: 1.31-2.91), and non-use of surfactant (OR = 0.54; 95%CI: 0.43-0.69). Death during NICU care is determined by conditions of the pregnancy, childbirth, and the newborn.