A way forward in pulmonary aspiration incidence reduction: ultrasound, mathematics, and worldwide data collection

Abstract Aspiration of gastric contents during induction of general anesthesia remains a significant cause of mortality and morbidity in anesthesia. Recent data show that pulmonary aspiration still accounts for many cases with implications on mortality despite technical and technological evolution. Practical, ethical, and methodological issues prevent high-quality research in the setting of aspiration and rapid sequence induction/intubation, and significant controversy is ongoing. Patients' position, drugs choice, dosing and timing, use of cricoid force, and a reliable risk assessment are widely debated with significant questions still unanswered. We focus our discussion on three approaches to promote a better understanding of rapid sequence induction/intubation and airway management decision-making. Firstly, we review how we can use qualitative and quantitative assessment of fasting status and gastric content with the point-of-care ultrasound as an integral part of preoperative evaluation and planning. Secondly, we propose using imaging-based mathematical models to study different patient positions and aspiration mechanisms, including identifying aspiration triggers. Thirdly, we promote the development of a global data collection system aiming to obtain precise epidemiological data. Therefore, we fill the gap between evidence-based medicine and experts' opinion through easily accessible and diffused computer-based databases. A better understanding of aspiration epidemiology obtained through focused global data gathering systems, the widespread use of ultrasound-based prandial status evaluation, and development of advanced mathematical models might potentially guide safer airway management decision making in the 21st century.

Articular mobilization promotes improvement in functional and inflammatory parameters in a gouty arthritis model

ABSTRACT Objective Gouty arthritis is characterized by painful inflammation due to the deposition of monosodium urate crystals in joint tissues. Despite available treatments, many patients experience ineffective management and adverse effects. This study evaluated a manual therapy protocol involving passive joint mobilization at the peak of inflammation in a gouty arthritis model using functional and inflammatory parameters. Methods Twenty male Wistar rats, 12 weeks old, were divided into two groups (n=10 each): Gouty Arthritis and Control Groups, which were further subdivided into treated and untreated groups (n=5 each). The Gouty Arthritis Group received intraarticular knee injection of 50µL of monosodium urate crystals, while the Control Group received 50µL of phosphate buffered saline. The treatment involved a 9-minutes session of grade III joint mobilization (according to Maitland). Nociception, grip strength, and edema were evaluated before induction (EV0), 7 hours after assessment (EV1), immediately after treatment (EV2), and 1 hour after treatment (EV3). The animals were euthanized, and synovial fluid was collected to analyze leukocyte migration. Results The model mimicked the signs of the Gouty Arthritis Group, with a decrease in the threshold of nociception and strength and an increase in edema and leukocyte count. The mobilization protocol significantly increased the nociceptive threshold and grip strength and reduced edema; however, it did not reverse the increase in leukocyte count. Conclusion Our results suggest that mobilization promotes analgesia and may modulate the inflammatory process owing to reduced edema and subtle attenuation of cell migration, which contributes to strength gain.

L-glutamine supplementation reduced morphological damage in the renal glomerulus of rats with Walker-256 tumor

ABSTRACT Purpose: To evaluate the effects of the experimental subcutaneous Walker-256 tumor and L-glutamine supplementation, an antioxidant, on the glomerular morphology of rats. Methods: Twenty Wistar rats were distributed into four groups (n = 5): control (C); control treated with 2% L-glutamine (CG); rats with Walker-256 tumor (WT); and rats with Walker-256 tumor treated with 2% L-glutamine (WTG). Renal histological samples were submitted to periodic acid-Schiff and Masson's Trichrome staining to analyze glomerular density, morphometry of glomerular components and glomerulosclerosis; and to immunohistochemistry for fibroblast growth factor-2 (FGF-2). Results: WT showed 50% reduction in body mass gain and cachexia index > 10%, while WTG demonstrated reduction in cachexia (p < 0.05). WT revealed reduction of glomerular density, increase in the glomerular tuft area, mesangial area, matrix in the glomerular tuft, decrease in the urinary space and synechia, and consequently higher glomerulosclerosis (p < 0.05). L-glutamine supplementation in the WTG improved glomerular density, and reduced glomerular tuft area, urinary space, mesangial area, and glomerulosclerosis compared to WT(p < 0.05). WT showed higher collagen area and FGF-2 expression compared to C (p < 0.05). WTG presented lower collagen fibers and FGF-2 expression compared to WT (p < 0.05). Conclusions: L-glutamine supplementation reduced cachexia and was beneficial for glomerular morphology of the rats, as well as it reduced kidney damage and improved the remaining glomeruli morphology.

Aplicabilidade do Three Delays Model no contexto da mortalidade materna: revisão integrativa / Applicability of the Three Delays Model in the context of maternal mortality: integrative review

RESUMO O objetivo desta revisão é sumarizar evidências disponíveis na literatura científica provenientes da aplicabilidade do Three Delays Model no contexto da mortalidade materna quanto aos fatores causais e às medidas interventivas. Trata-se de revisão integrativa da literatura, realizada sem recorte temporal, em sete bases de dados, com os descritores Maternal Mortality, Pregnancy Complications, Maternal Death e a palavra-chave Three Delays Model. 15 estudos foram selecionados para análise. O primeiro atraso destacou-se como determinante para as mortes maternas, sendo a recusa em buscar assistência obstétrica na instituição de saúde uma iniciativa da mulher ou de familiares. No segundo atraso, fatores geográficos e infraestrutura precária das estradas dificultaram o acesso aos serviços de saúde. No terceiro atraso, as condições assistenciais nas instituições de saúde implicaram reduzida qualidade dos cuidados. A aplicabilidade do modelo possibilita demonstrar as barreiras enfrentadas pelas mulheres na busca de cuidados obstétricos e visualizar contextos que necessitam de ações interventivas para enfrentar a problemática.

ABSTRACT The objective of this review is to summarize evidence available in the scientific literature from the applicability of the Three Delays Model in the context of maternal mortality in terms of causal factors and interventional measures. It is an integrative literature review, carried out with no time frame, in seven databases, with the descriptors Maternal Mortality, Pregnancy Complications, Maternal Death and the keyword Three Delays Model. 15 studies were selected for analysis. The first delay stood out as a determinant of maternal deaths, with the refusal to seek obstetric care in the health institution an initiative of the woman or family members. In the second delay, geographic factors and poor road infrastructure made access to health services difficult. In the third delay, the care conditions in the health institutions implied a reduced quality of care. The applicability of the model makes it possible to demonstrate the barriers faced by women in the search for obstetric care and to visualize contexts that need interventional actions to face the problem.

Modelo de enfermería: Resignificación / Nursing Model: Resignification

El individuo, en la actualidad, representa una gran responsabilidad para el profesional de enfermería, dada la atención integral y transpersonal que requiere, entendiendo los códigos de creencia que lo limitan para llegar a la autorrealización; pretendiendo establecer en el individuo estándares de salud y de autocuidado, no aplicando para todos los grupos de desarrollo del individuo, ya que cada uno cuenta con una percepción diferente del universo llamada cosmovisión. Estas interpretaciones gestan diferentes arquetipos colectivos que se adquieren en el proceso de enculturación. Para el modelo de resignificación, la relación del individuo, cultura y arquetipos colectivos, son de suma importancia para establecer la autogestión del cuidado, donde el individuo desarrolla sus propias habilidades, destrezas y herramientas para establecer un equilibrio en el medio interno (pensamientos) y el medio externo (conductas), considerando cuatro áreas de desarrollo: biológica, psicológica, social y la que se busca desarrollar, la parte espiritual, llevándolo a la autorrealización.

The individual, nowadays, represents a great responsibility for the nursing professional, given the comprehensive and transpersonal care that he requires, understanding the codes of belief that limit him to reach self-realization; pretending to establish standards of health and self-care in the individual, not applying to all groups of development of the individual, since each one has a different perception of the universe called Worldview. These interpretations generate different collective archetypes that are acquired in the process of enculturation. For the model of resignification, the relationship of the individual, culture and collective archetypes, are of the utmost importance to establish the care self-management, where the individual develops their own abilities, skills and tools to establish a balance in the internal environment (thoughts) and the external environment (behaviors), considering four areas of development: biological, psychological, social and the one that is sought develop, the spiritual part, leading to self-realization.

Construction and validation of predictive model for post-stroke delirium in patients with acute ischemic stroke / 国际脑血管病杂志

Objective:To construct a predictive model of post-stroke delirium (PSD) in patients with acute ischemic stroke (AIS), and to verify its predictive value.Methods:Patients with AIS admitted to the Department of Neurology, Lianyungang Hospital Affiliated to Xuzhou Medical University from February to May 2022 were enrolled prospectively. They were divided into modeling group and validation group according to the order of enrollment. Depending on whether the patients had delirium or not, the patients in the modeling group were divided into delirium group and non-delirium group. The independent risk factors for PSD were determined by multivariable logistic regression analysis, and the prediction model of PSD was constructed accordingly. The predictive value of the model was verified by the receiver operating characteristic curve. Results:Three hundred and fifty patients with AIS were included in the modeling group, of which 71 (20.28%) had PSD. The validation group included 150 patients with AIS, and 36 of them (24.00%) had PSD. Multivariate logistic regression analysis showed that age (odds ratio [ OR] 1.036, 95% confidence interval [ CI] 1.000-1.074; P=0.050], National Institutes of Health Stroke Scale (NIHSS) score ( OR 1.607, 95% CI 1.438-1.797; P<0.001), neutrophil/lymphocyte ratio (NLR) ( OR 1.135, 95% CI 1.016-1.267; P=0.025), and atrial fibrillation ( OR 5.528, 95% CI 1.315-23.245; P=0.020) were the independent risk factors for PSD. The predictive model was Z=0.036×age+0.475×NIHSS score+0.127×NLR+1.710×assignment of atrial fibrillation - 10.160. The area under the curve of the model was 0.935, and the sensitivity and specificity were 97.2% and 82.5% respectively. Conclusion:This model can effectively predict the PSD risk of patients with AIS, with higher sensitivity and specificity, and can provide a basis for PSD screening of patients with AIS.

Theoretical model of sexual and reproductive health care: subsidies for evaluative research / Modelo teórico de la atención a la salud sexual y reproductiva: subsidios para investigaciones evaluativas / Modelo teórico da atenção à saúde sexual e reprodutiva: subsídios para pesquisas avaliativas

ABSTRACT Objective: To elaborate a Theoretical Model of Sexual and Reproductive Health care offered in Primary Health Care. Method: Documentary research, with a qualitative approach. Government documents and evaluative studies constituted the data sources, collected between August 2018 and June 2019, and analyzed based on the health evaluation literature. Results: Promotion of Sexual and Reproductive Health and Clinical Care were two structural components of the theoretical model of sexual and reproductive health care in Primary Care. The model includes disease prevention activities, health promotion, treatments, and diagnoses related to sexual and reproductive health. Conclusion: The theoretical model developed in this study presents the theory that supports the operationalization of sexual and reproductive health care in primary care according to government regulations in Brazilian scenario and may be useful in future evaluative research on the subject.

RESUMEN Objetivo: Construir el Modelo Teórico de atención en Salud Sexual y Reproductiva ofrecida en la Atención Primaria de Salud como una de las etapas iniciales del proceso de evaluación de implantación. Método: Investigación documental, con enfoque cualitativo. Los documentos gubernamentales y los estudios evaluativos constituyeron las fuentes de datos, recopilados entre agosto de 2018 y junio de 2019 y analizados con base en la literatura de evaluación de la salud. Resultados: La Promoción de la Salud Sexual y Reproductiva y la Atención Clínica fueron los dos componentes estructurantes del modelo teórico de atención de la salud sexual y reproductiva en Atención Primaria. Incluye actividades de prevención de enfermedades, promoción de la salud, tratamientos y diagnósticos relacionados con la salud sexual y reproductiva. Conclusión: El modelo teórico desarrollado en este estudio presenta la teoría que apoya la operacionalización de la atención de la salud sexual y reproductiva en la atención primaria de acuerdo con las normativas gubernamentales en escenario brasileño, y puede ser útil en futuras investigaciones evaluativas sobre el tema.

RESUMO Objetivo: Construir um Modelo Teórico da atenção à saúde sexual e reprodutiva ofertada na Atenção Primária à Saúde. Métodos: Pesquisa documental, com abordagem qualitativa. Documentos governamentais e estudos avaliativos constituíram as fontes de dados, coletadas entre agosto de 2018 e junho de 2019 e analisadas com base na literatura de avaliação em saúde. Resultados: A Promoção da Saúde Sexual e Reprodutiva e a Assistência Clínica foram os dois componentes estruturantes do modelo teórico da atenção à saúde sexual e reprodutiva na Atenção Primária. O modelo contempla atividades de prevenção de doenças, promoção da saúde, tratamentos e diagnósticos relacionados à saúde sexual e reprodutiva. Conclusão: O modelo teórico elaborado apresenta a teoria que subsidia a operacionalização da atenção à saúde sexual e reprodutiva na atenção primária, segundo as normativas governamentais no cenário brasileiro, e poderá ser útil em pesquisas avaliativas futuras sobre o tema.

Cooking autonomy: a multilevel conceptual model on healthy home cooking / Autonomía culinaria: un modelo multinivel conceptual sobre cocinar sano en el hogar / Autonomia culinária: um modelo conceitual multinível de culinária doméstica saudável

The empowerment of home cooking has been recently approached in the literature as pertaining to cooking skills and the capacity to overcome social, physical, and economic obstacles. However, thus far no studies have related the State's role in this important health-promoting home practice, namely healthy cooking. We aim to elaborate on the concept and develop a multilevel conceptual model of cooking autonomy (CMCA) in order to relate the State's role in healthy home cooking. This is a theoretical-conceptual study consisting of three phases: conceptual elaboration, expert panel consultation, and content validity of the CMCA developed in this study. A comprehensive literature review worked as the theoretical and conceptual basis, featuring Amartya Sen's human capability approach. A total of 28 experts issued their opinions in listening workshops and interviews. Cooking autonomy was defined as the capacity to think, to decide, and to act to prepare meals from scratch, influenced by interpersonal relations, environment, cultural values, access to opportunities, and guarantee of rights. The CMCA has six levels, differing according to the degree of participation of an individual. We also present two charts with examples of the agent's practices and actions that can be developed by the State in the public policy sphere. As a pioneering model in the international literature, the CMCA provides the conceptual basis for the development of studies and interventions on cooking autonomy, focusing not only on individual skills, but also on the role of public policies for healthy home cooking.

El empoderamiento de cocinar en el hogar se ha tratado recientemente en la literatura como una cuestión dentro del ámbito de las habilidades para cocinar y la capacidad para superar obstáculos sociales, físicos, y económicos. No obstante, hasta ahora ningún estudio ha relacionado el papel del Estado para esta importante práctica de promoción de la salud en el hogar, denominada cocina sana. Nuestro objetivo ha sido elaborar el concepto y desarrollar un modelo conceptual multinivel de autonomía culinaria (MCAC), con el fin de relacionar el papel del estado para la cocina sana en el hogar. Se trata de un estudio teórico-conceptual consistente en tres fases: elaboración conceptual, consulta de panel de expertos, y validez del contenido del MCAC desarrollado en este ejercicio. La revisión general de la literatura sirvió como base teórica y conceptual, destacando el enfoque basado en las capacidades de Amartya Sen. Un total de 28 expertos proporcionaron sus opiniones escuchando talleres y entrevistas. La autonomía culinaria se definió como la capacidad para pensar, decidir, y actuar para preparar comidas desde cero, influenciada por las relaciones interpersonales, el ambiente, valores culturales, acceso a oportunidades, y garantía de derechos. El MCAC cuenta con seis niveles, diferenciados según el grado de participación individual del agente. También presentamos dos tablas con ejemplos de las prácticas y acciones de los agentes que se pueden desarrollar por parte del Estado en la esfera de políticas públicas. Como modelo pionero en la literatura mundial, el MCAC proporciona la base conceptual para el desarrollo de estudios e intervenciones en la autonomía culinaria, centrándose no solo en las habilidades individuales, sino también en el papel de las políticas públicas para la cocina sana en el hogar.

O empoderamento na culinária doméstica tem sido tratado recentemente, na literatura específica sobre o tema, como uma questão de domínio de habilidades culinárias e de capacidade em superar obstáculos sociais, físicos e econômicos. Ainda não há, contudo, estudos que relacionem o papel do Estado a essa importante prática promotora de saúde em casa, que é o cozinhar saudável. Desse modo, este trabalho adotou como objetivos elaborar o conceito e desenvolver o modelo conceitual multinível de autonomia culinária (MCAC), a fim de relacionar o papel do Estado à prática da culinária saudável em casa. Trata-se de um estudo teórico-conceitual dividido em três fases: elaboração conceitual, consulta a painel de especialistas e validação de conteúdo do MCAC desenvolvido neste trabalho. Ampla revisão bibliográfica serviu de base teórica e conceitual, com destaque para a abordagem das capacidades humanas de Amartya Sen. No total, 28 especialistas opinaram em oficinas de escuta e em entrevistas. A autonomia culinária foi definida como a capacidade de pensar, decidir e agir para preparar refeições em casa, usando majoritariamente alimentos in natura ou minimamente processados, sob a influência das relações interpessoais, do meio ambiente, dos valores culturais, do acesso a oportunidades e da garantia de direitos. O MCAC possui seis níveis, que diferem entre si quanto ao grau de participação do agente. Além do MCAC, são apresentados dois quadros que fornecem exemplos de práticas do agente e de ações que podem ser desenvolvidas no âmbito de políticas públicas pelo Estado. Pioneiro na literatura mundial, o MCAC apresentado fornece as bases conceituais para o desenvolvimento de pesquisas e intervenções sobre o assunto, não apenas focando nas habilidades individuais, mas também no papel das políticas públicas.

Mathematical and statistical models for the control of mosquito-borne diseases: the experience of Costa Rica / Modelos matemáticos y estadísticos para el control de enfermedades transmitidas por mosquitos: la experiencia de Costa Rica / Modelos matemáticos e estatísticos para o controle de doenças transmitidas por mosquitos: a experiência da Costa Rica

ABSTRACT Objective. To summarize the results of research conducted in Costa Rica in which mathematical and statistical methods were implemented to study the transmission dynamics of mosquito-borne diseases. Methods. Three articles with mathematical and statistical analysis on vector-borne diseases in Costa Rica were selected and reviewed. These papers show the value and relevance of using different quantitative methods to understand disease dynamics and support decision-making. Results. The results of these investigations: 1) show the impact on dengue case reports when a second pathogen emerges, such as chikungunya; 2) recover key parameters in Zika dynamics using Bayesian inference; and 3) show the use of machine learning algorithms and climatic variables to forecast the dengue relative risk in five different locations. Conclusions. Mathematical and statistical modeling enables the description of mosquito-borne disease transmission dynamics, providing quantitative information to support prevention/control methods and resource allocation planning.

RESUMEN Objetivo. Resumir los resultados de las investigaciones realizadas en Costa Rica en las que se aplicaron métodos matemáticos y estadísticos para estudiar la dinámica de transmisión de las enfermedades transmitidas por mosquitos. Métodos. Se seleccionaron y analizaron tres artículos con análisis matemáticos y estadísticos sobre enfermedades transmitidas por vectores en Costa Rica. En estos artículos se muestra el valor y la pertinencia de emplear diferentes métodos cuantitativos para comprender la dinámica de la enfermedad y brindar apoyo a la toma de decisiones. Resultados. Los resultados de estas investigaciones: 1) muestran la repercusión en los informes de casos de dengue cuando surge un segundo agente patógeno, como el chikunguña; 2) recuperan parámetros clave en la dinámica del Zika mediante la inferencia bayesiana; y 3) muestran el uso de los algoritmos de aprendizaje automático y las variables climáticas para pronosticar el riesgo relativo de dengue en cinco lugares diferentes. Conclusiones. Los modelos matemáticos y estadísticos permiten describir la dinámica de transmisión de las enfermedades transmitidas por mosquitos, mediante la provisión de información cuantitativa para brindar apoyo a los métodos de prevención y control y a la planificación de la asignación de recursos.

RESUMO Objetivo. Resumir os resultados de estudos realizados na Costa Rica em que foram aplicados métodos matemáticos e estatísticos para estudar a dinâmica de transmissão de doenças transmitidas por mosquitos. Métodos. Foram selecionados e revisados três artigos com análises matemáticas e estatísticas sobre doenças transmitidas por vetores na Costa Rica. Esses artigos mostram o valor e a pertinência do uso de diferentes métodos quantitativos para compreender a dinâmica das doenças e apoiar a tomada de decisões. Resultados. Os resultados dessas investigações: 1) mostram o impacto nas notificações de casos de dengue quando surge um segundo patógeno, como o chikungunya; 2) recuperam parâmetros-chave na dinâmica do zika, usando a inferência bayesiana; e 3) mostram o uso de algoritmos de aprendizagem por máquina e variáveis climáticas para prever o risco relativo da dengue em cinco locais diferentes. Conclusões. A modelagem matemática e estatística permite a descrição da dinâmica de transmissão de doenças transmitidas por mosquitos ao oferecer informações quantitativas para apoiar métodos de prevenção e/ou controle e o planejamento da alocação de recursos.

Research advances in / 临床肝胆病杂志

The incidence rate of nonalcoholic fatty liver disease (NAFLD) is increasing year by year, with limited treatment methods, and its pathogenesis is a research hotspot at present. In order to better clarify its pathogenesis, it is urgent to develop advanced, safe, and effective in vitro or in vivo models to understand and develop treatment strategies for this disease. This article reviews the in vitro models commonly used in the preclinical study of NAFLD and discusses their advantages and disadvantages, so as to provide a theoretical basis for the pathogenesis and treatment of NAFLD.

Development of a new model for predicting recurrence after liver transplantation for hepatocellular carcinoma beyond Milan criteria / 临床肝胆病杂志

Objective To develop a new model for predicting recurrence after liver transplantation for hepatocellular carcinoma (HCC) beyond Milan criteria based on related preoperative and postoperative indicators. Methods A retrospective analysis was performed for the clinical data of the patients with HCC beyond Milan criteria who underwent orthotopic liver transplantation for the first time in Tianjin First Central Hospital from August 2014 to July 2018, and according to the presence or absence of recurrence during follow-up, the patients were divided into recurrence group and no-recurrence group. The t -test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison of survival curves. Univariate and multivariate Cox proportional hazards regression analyses were used to identify the risk factors for recurrence-free survival after surgery. A new model was developed for recurrence after liver transplantation in the patients with HCC beyond Milan criteria based on the risk factors identified. The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive performance, and the Hosmer-Lemeshow test was used to assess the goodness of fit of the model. Results A total of 117 patients with HCC beyond Milan criteria were enrolled in this study, with a median follow-up time of 24 (1-74) months. A total of 53 patients (45.3%) experienced recurrence after surgery, among whom 52 (98.1%) had recurrence within 3 years after surgery, with a median time to recurrence of 6 (1-52) months. The Cox proportional hazards regression analysis showed that preoperative serum alpha-fetoprotein (AFP) >769 ng/mL, neutrophil-lymphocyte ratio (NLR) >3.75, and ki67 index >0.25 were independent risk factors for recurrence-free survival after liver transplantation. The model established based on these three risk factors had an AUC of 0.843, with good sensitivity (88.7%) and specificity (70.3%). The optimal cut-off value was selected according to the maximization of Youden index, and then the patients were divided into low-risk group (0-1 point) and high-risk group (1.5-4 points). The log-rank test showed that the low-risk group had significantly higher 3-and 5-year recurrence-free survival rates than the high-risk group (84.1%/72.0% vs 10.9%/10.9%, χ 2 =29.425, P < 0.001). Conclusion Liver transplantation for HCC beyond Milan criteria should be performed with caution, and the predictive model established based on preoperative AFP, NLR, and ki67 index can accurately assess the indication for liver transplantation in such patients.

Epidemias en la actualidad: de cómo los modelos matemáticos y estadísticos permiten entenderlas, aún a profesionales "adversos" a ellos / Mathematical models to understand pandemics

Since the declaration of SARS CoV-2 pandemic, we have witnessed an accelerated increase in new cases, frequently associated with the need for intensive care and mechanical ventilation. In parallel, we have been invaded by many experts in the press and who expose their knowledge on the behavior of epidemics who use concepts that are not always well understood by the medical community. Some concepts should be knowledgeable to understand the epidemic spread. First, the epidemic spread description is not modeled with an exponential curve, but rather with a Gompertz curve. Second, a gamma curve describes the period of contagiousness. Third, the contagion magnitude or rate can be calculated and modeled. Explaining these mathematical concepts in a simple and graphic way will allow readers to understand better what is happening with the current pandemic.

Mapeamento dinâmico da probabilidade de infestação por vetores urbanos de arbovírus nos municípios do Rio Grande do Sul, 2016-2017 / Mapeo dinámico de la probabilidad de infestación por vectores urbanos de arbovirus en los municipios de Rio Grande do Sul, Brasil, 2016-2017 / Dynamic mapping of the probability of infestation by urban arbovirus vectors in the municipalities of Rio Grande do Sul state, Brazil, 2016-2017

Objetivo: Comparar o mapeamento oficial com um mapeamento probabilístico da infestação por Aedes spp. nos municípios do Rio Grande do Sul, Brasil. Métodos: Estudo ecológico com dados de amostras de criadouros em 2016-2017; obteve-se a classificação oficial em boletins epidemiológicos e estimou-se a probabilidade de infestação por município e semana, ajustando-se um modelo dinâmico de ocupação de sítios aos dados da vigilância epidemiológica municipal. Resultados: 187.245 amostras coletadas em 473 municípios originaram 10.648 detecções de Aedes aegypti e 8.414 de Aedes albopictus; o mapeamento oficial concorda com o probabilístico em municípios da região noroeste e oeste do RS; os mapeamentos discordam nas regiões leste, centro, nordeste e sul, revelando municípios oficialmente não infestados com alta probabilidade de infestação e notificação de arboviroses. Conclusão: A classificação oficial identificou infestação nos municípios infestados do noroeste e oeste, e não identificou infestação em municípios com possíveis falsos zeros e onde ela varia temporalmente.

Objetivo: Comparar el mapeo oficial con un mapeo probabilístico de infestación por Aedes spp. en los municipios de Rio Grande do Sul, Brasil. Métodos: Estudio ecológico analizando muestras colectadas en criaderos en 2016-2017; se obtuvo la clasificación oficial en boletines epidemiológicos, y la probabilidad de infestación por municipio y semana ajustando un modelo dinámico de ocupación de sitios a los datos de la vigilancia epidemiológica municipal. Resultados: 187.245 muestras de 473 municipios generaron 10.648 detecciones de Aedes aegypti y 8.414 detecciones de Aedes albopictus. El mapeo oficial está de acuerdo con el probabilístico en municipios del noroeste y oeste de RS; los mapeos no concuerdan en el este, centro, nordeste y sur, revelando municipios oficialmente no infestados con alta probabilidad de infestación y notificación de arbovirus. Conclusión: Mientras la clasificación oficial identifica municipios del noroeste y oeste infestados críticamente, no identifica infestación en municipios con posiblemente falsos ceros y en donde la infestación varía temporalmente.

Objective: To compare official mapping with probabilistic mapping of infestation by Aedes spp. in the municipalities of Rio Grande do Sul state, Brazil. Methods: This was an ecological study using data from samples of mosquito breeding sites collected in 2016-2017; official classification was obtained from epidemiological reports, and infestation per municipality and week was estimated by fitting a dynamic site-occupancy model to data from municipal epidemiological surveillance. Results: 187,245 samples collected in 473 municipalities returned 10,648 detections of Aedes aegypti, and 8,414 detections of Aedes albopictus; official mapping agrees with probabilistic mapping in municipalities in the northwestern and western regions of the state. The mappings are not in agreement in the eastern, central, northeastern and southern regions, revealing municipalities officially not infested but with high probability of infestation and notification of arbovirus infection. Conclusion: While official classification identified critically infested municipalities in the state's northwestern and western regions, it did not identify infestation in municipalities with possible false zero errors and where infestation varies over time.

Avaliação da visita domiciliar em programas na primeira infância: contribuições para a realidade brasileira / Evaluación de la visita domiciliaria en programas de primera infancia: contribuciones a la realidad brasileña / House call assessment in early childhood programs: contributions to the brazilian reality

RESUMO Introdução: este estudo consiste numa reflexão sobre a avaliação da visita domiciliar em programas na primeira infância. Objetivo: discutir as dimensões envolvidas em um modelo de avaliação para a realidade brasileira, além da percepção dos autores a respeito do tema. Método: essa reflexão foi estruturada nos seguintes tópicos: dimensões envolvidas na avaliação da visita domiciliar e o processo avaliativo nos programas brasileiros. Considerando a centralidade e relevância da visita domiciliar nos programas brasileiros com foco na Primeira Infância e a tendência de consolidação dessa tecnologia como forma de intervenção adequada a programas dessa natureza, propõe-se organizar quatro dimensões para a avaliação das visitas domiciliares: dosagem, conteúdo, relacionamento e responsividade do participante. Resultado: avaliar a tecnologia de intervenção dos programas voltados para a primeira infância, no caso a visita domiciliar, permite investigar os processos que ocorrem durante a entrega das visitas domiciliares e abrir a "caixa preta" da intervenção, sendo possível elucidar problemas operacionais e propor recomendações para corrigi-las. Conclusão: o modelo proposto possibilita aos supervisores e tomadores de decisão acompanhar de forma sistemática e ajustar as dimensões que impactam nos resultados dos programas de visita domiciliar voltados para a Primeira Infância.

RESUMEN Introducción: este estudio consiste en una reflexión sobre la evaluación de la visita domiciliaria en programas en la primera infancia. Objetivo: discutir las dimensiones involucradas en un modelo de evaluación para la realidad brasileña, además de la percepción de los autores acerca del tema. Método: esta reflexión fue estructurada en los siguientes tópicos: dimensiones involucradas en la evaluación de la visita domiciliaria y el proceso evaluativo en los programas brasileños. Considerando la centralidad y relevancia de la visita domiciliaria en los programas brasileños con foco en la Primera Infancia y la tendencia de consolidación de esta tecnología como forma de intervención adecuada a programas de esa naturaleza, se propone organizar cuatro dimensiones para la evaluación de las visitas domiciliarias: dosificación, contenido, relación y respuesta del participante. Resultado: evaluar la tecnología de intervención de los programas dirigidos a la primera infancia, en el caso la visita domiciliaria, permite investigar los procesos que ocurren durante la entrega de las visitas domiciliarias y abrir la "caja negra" de la intervención, siendo posible aclarar problemas operativos y proponer recomendaciones para corregirlos. Conclusión: el modelo propuesto posibilita a los supervisores y tomadores de decisiones acompañar de forma sistemática y ajustar las dimensiones que impactan en los resultados de los programas de visita domiciliariadirigidos para la Primera Infancia.

ABSTRACT Introduction: This study consists of a reflection on house call assessment in early childhood programs, which aimed to discuss the dimensions involved in an assessment model for the Brazilian reality, in addition to the authors' perception of the topic. Method: This reflection was structured around the following topics: dimensions involved in house call assessment and the assessment process in Brazilian programs. Considering the centrality and relevance of house calls in Brazilian programs focused on early childhood and the tendency to consolidate this technology as an intervention strategy suitable for programs of this nature, it is proposed to organize four dimensions for house call assessment: dosage, content, relationship, and participant responsiveness. Results: Assessing the intervention technology of programs aimed at early childhood, in this case house calls, allows us to inquire into the processes that occur during house calls and to open the 'black box' of intervention, making it possible to clarify operational issues and propose recommendations to fix them. Conclusion: The model proposed allows supervisors and decision makers to systematically monitor and adjust the dimensions that impact the results of house call programs aimed at early childhood.

Modelo de vulnerabilidade em saúde: esclarecimento conceitual na perspectiva do sujeito-social / Modelo de vulnerabilidad en salud: esclarecimiento conceptual en la perspectiva del sujeto social / Health vulnerability model: conceptual clarification from social subjects' perspective

Resumo Objetivo: Esclarecer a vulnerabilidade em saúde a partir da proposição de um modelo conceitual. Método: Aplicou-se o esclarecimento de conceito segundo proposta de Meleis, subsidiado por revisão e por reflexão crítica. Selecionaram-se 101 artigos em cinco base de dados por meio da equação de busca " vulnerability " AND " health ", cujos achados foram submetidos à análise categorial e de similitude. Essa foi processada no software Iramuteq para identificação do elemento essencial, conceitos e subconceitos da vulnerabilidade em saúde - e posterior construção de um modelo. Resultados: A partir da revisão e etapas posteriores, a vulnerabilidade em saúde foi redefinida, e foi construído um modelo com base na relação de três componentes: 1) O sujeito-social, com seus conceitos e subconceitos; 2) A condição de precariedade e agenciamento; 3) Processos de potencialização ou fragilização da vulnerabilidade em saúde. O fenômeno foi descrito, identificando-se o sujeito-social como elemento essencial, e foram conhecidos os principais atributos com as definições constitutivas e operacionais, tornando possível identificar a presença da vulnerabilidade em saúde. Conclusão: O conceito foi esclarecido por meio da construção de um modelo, fornecendo subsídios à elaboração de pesquisas na área da saúde e ao futuro desenvolvimento de teorias de médio ou longo alcance do fenômeno de interesse.

Resumen Objetivo: Esclarecer la vulnerabilidad en salud a partir de la proposición de un modelo conceptual. Métodos: Se aplicó el esclarecimiento de concepto según la propuesta de Meleis, respaldado con revisión y reflexión crítica. Se seleccionaron 101 artículos en cinco bases de datos por medio de la ecuación de búsqueda " vulnerability " AND " health ", cuyos resultados fueron sometidos al análisis categorial y de similitud. Este fue procesado con el software Iramuteq para la identificación del elemento esencial, conceptos y subconceptos de la vulnerabilidad en salud y la posterior construcción de un modelo. Resultados: A partir de la revisión y etapas posteriores, la vulnerabilidad en salud fue redefinida y se construyó un modelo basado en la relación de tres componentes: 1) El sujeto social, con sus conceptos y subconceptos, 2) La condición de precariedad y gestión, 3) Procesos de potencialización o debilitamiento de la vulnerabilidad en salud. El fenómeno se describió con la identificación del sujeto social como elemento esencial y se conocieron los principales atributos con las definiciones constitutivas y operativas, lo que permitió identificar la presencia de la vulnerabilidad en salud. Conclusión: El concepto fue esclarecido mediante la construcción de un modelo y respalda la elaboración de estudios en el área de la salud y el desarrollo futuro de teorías de medio o largo alcance del fenómeno de interés.

Abstract Objective: To clarify health vulnerability from the proposition of a conceptual model. Method: Concept clarification was applied according to Meleis' proposal, supported by review and critical reflection. 101 articles were selected in five databases using the search equation "vulnerability" AND "health", whose findings were submitted to category and similar analysis. This was processed in the software Iramuteq to identify the essential element, concepts and subconcepts of vulnerability in health - and later construction of a model. Results: From the review and later stages, health vulnerability was redefined and a model was constructed based on the relationship of three components: 1) The social subject, with its concepts and subconcepts; 2) The condition of precariousness and agency; 3) Processes of potentiation or weakening of vulnerability in health. The phenomenon was described, the social subject was identified as an essential element, and the main attributes were known with constitutive and operational definitions, making it possible to identify the presence of vulnerability in health. Conclusion: The concept was clarified through the construction of a model, providing support for the elaboration of research in the health area and future development of medium or long-range theories of the phenomenon of interest.

Guideline for incorporating the Delphi method in the evaluation of nursing theories / Diretriz para incorporação do método Delphi na avaliação de teorias de enfermagem / Directriz para la incorporación del método Delphi en la evaluación de las teorías de enfermería

Objective: to describe a guideline for the use of the Delphi method to evaluate nursing theories, from the perspective of internal validation. Method: a methodological study, targeted at the development of a guideline for the use of the Delphi method in the evaluation of nursing theories. Results: the Delphi method, principles of collective wisdom and levels of proficiency are used in the production of a guideline for organizing, searching, selecting and coordinating the activities of theoretical evaluators in teams. It distinguishes three phases for the theoretical evaluation process: Preparatory Phase (PP); Intermediate Phase (IP) and Theory Evaluation (TE) phase, incorporating Delphi-type selection procedures; search, selection and classification of judges/evaluators for the theory; definition of criteria for carrying out rounds and maintenance or removal of units of the theory evaluated. Conclusion: the developed guideline was able to adapt the elements of the Delphi method as a favorable strategy for the internal validation of nursing theories.

Objetivo: descrever uma diretriz de uso do método Delphi para avaliação de teorias de enfermagem, na perspectiva de validação interna. Método: estudo metodológico, dirigido ao desenvolvimento de uma diretriz para o uso do método Delphi na avaliação de teorias de enfermagem. Resultados: o método Delphi, os princípios da sabedoria coletiva e os níveis de proficiência são utilizados na produção de uma diretriz para organização, busca, seleção e coordenação de atividades de avaliadores teóricos em equipes. Distingue três fases para o processo de avaliação teórica: fase preparatória (FP); fase intermediária (FI) e fase de avaliação da teoria (AT), incorporando procedimentos de seleção do tipo de Delphi; busca, seleção e classificação de juízes/avaliadores da teoria; definição de critérios para a realização de rodadas e de manutenção ou descarte de unidades da teoria avaliada. Conclusão: a diretriz elaborada foi capaz de adequar os elementos do método Delphi como uma estratégia favorável à validação interna de teorias de enfermagem.

Objetivo: describir una directriz para el uso del método Delphi en la evaluación de teorías de enfermería, desde la perspectiva de la validación interna. Método: estudio metodológico, dirigido a la elaboración de una directriz para el uso del método Delphi en la evaluación de teorías de enfermería. Resultados: el método Delphi, los principios de sabiduría colectiva y los niveles de competencia se utilizan en la elaboración de una directriz para organización, búsqueda, selección y coordinación de las actividades de los evaluadores teóricos en equipos. Distingue tres fases para el proceso de evaluación teórica: fase preparatoria (FP); fase intermedia (FI) y fase de evaluación teórica (ET), con la incorporación de procedimientos de selección tipo Delphi; búsqueda, selección y clasificación de jueces/evaluadores de la teoría; definición de criterios para la realización de rondas y mantenimiento o disposición de unidades de la teoría evaluada. Conclusión: la directriz desarrollada logró adaptar los elementos del método Delphi como estrategia favorable para la validación interna de las teorías de enfermería.

Research in physical exercise among rural adolescents based on the theory of planned behavior in Sichuan Province / 中国学校卫生

Objective@#To verify the applicability of the theory of planned behavior(TPB) in the physical exercise behaviors of rural adolescents in Sichuan Province, and to explore the possible influencing factors of physical exercise behaviors, and to provide a theoretical basis for further effective intervention measures.@*Methods@#A total of 2 302 students were selected from grade seven and grade ten of two rural middle schools in Zizhong, Sichuan Province. The survey was conducted with a structured questionnaire. Using TPB as the research framework and basis, the structural equation model was constructed for analysis.@*Results@#Lack of physical exercise was 1 527(66.3%).Physical exercise behavior was statistically different among schools, grades(t=-7.40，-2.90，10.90,P<0.05)， and genders. Based on TPB, the structural equation model was established and corrected to obtain the revised model, and the fitting index GFI=0.93, CFI=0.94, NFI=0.94, TLI=0.93, IFI=0.94,RMSEA=0.07, indicating the model fitted good. Exercise intention directly affected exercise behaviors. The standardized effect was 0.45(95%CI=0.39-0.52). Subjective norms and perceived power were the main two mediators of the relationship between value evaluation and exercise intention. The standardized effect values were 0.66(95%CI=0.57-0.73), 0.23(95%CI=0.16-0.93)(P<0.01).@*Conclusion@#There is serious lack of physical exercise in rural adolescents in Sichuan Province. TPB has a good applicability for physical exercise in rural adolescents in Sichuan Province. Subjective norm is the most important factors to promote exercise intentions.

Reseach update on determinants of child oral health based on Anderson extended model / 中国学校卫生

Abstract@#Children s oral health is related to many factors. Research on potential risk factors of children s oral health helps improve children s oral health. Based on the Anderson extended model, this review reviews the domestic and foreign literature on the factors affecting children s oral health, and finally concludes that children s oral health is related to exogenous variables, primary determinants of oral health, oral health behavior and other factors. Children s oral health can be improved by developing good oral habits, strengthening the health beliefs of parents and children, improving the oral health service system and developing oral insurance system.

Application of life course theoretical models in the relationship between exposure to early life adversity and psychopathology symptoms / 中国学校卫生

Abstract@#Early life adversity is related to multiple forms of psychopathology throughout the lifespan. However, relatively little is known about the way in which the characteristics of adversity influence subsequent mental health outcomes. The development of life course theoretical models provides a fresh perspective that aims to determine the causal association between early adversity and psychopathology. This article reviews research studies which applied one or more theoretical models, including the sensitive period, risk accumulation, risk chain, and recency models, to capture the relationship between exposure to early life adversity and psychopathology, so as to identify how early interventions can be improved.

Anti-inflammatory and antioxidant activity of essential amino acid α-ketoacid analogues against renal ischemia­reperfusion damage in Wistar rats / Actividad antiinflamatoria y antioxidante de los α-cetoanálogos de aminoácidos esenciales en un modelo de daño por isquemia-reperfusión en ratas Wistar

Introduction: Essential amino acid α-keto acid analogs are used in the treatment of chronic kidney disease to delay the symptoms of uremia. However, it is unknown whether essential amino acid α-keto acid analogs affect the oxidative stress and the inflammation in acute renal injury such as those produced by ischemia-reperfusion. Objective: To evaluate the effect of essential amino acid α-keto acid analogs on renal ischemia-reperfusion injury in Wistar rats. Materials and methods: Rats were divided into 11 groups (n=6/group): Two groups received physiological saline with or without ischemia-reperfusion injury (45 min/24 h), six groups received essential amino acid α-keto acid analogs (400, 800, or 1,200 mg/kg/24 h/7d) with or without ischemia-reperfusion injury (essential amino acid α-keto acid analogs + ischemia-reperfusion), and two groups received allopurinol (50 mg/kg/24 h/7d) with or without ischemia-reperfusion injury. Biochemical markers included creatinine and blood urea nitrogen (BUN), proinflammatory cytokines (IL-1ß, IL-6, and TNF-α), renal damage markers (cystatin C, KIM-1, and NGAL), and markers of oxidative stress such as malondialdehyde (MDA) and total antioxidant activity. Results: The essential amino acid α-keto acid analog- and allopurinol-treated groups had lower levels of creatinine, BUN, renal damage markers, proinflammatory cytokines, and MDA than their corresponding ischemia-reperfusion groups. These changes were related to the essential amino acid α-keto acid analogs dosage. Total antioxidant activity was lower in essential amino acid α-keto acid analog- and allopurinol-treated groups than in the corresponding ischemia-reperfusion groups. Conclusions: This is a new report on the nephroprotective effects of essential amino acid α-keto acid analogs against ischemia-reperfusion injury. Essential amino acid α-keto acid analogs decreased the levels of biochemical markers, kidney injury markers, proinflammatory cytokines, and MDA while minimizing total antioxidant consumption.

Introducción. Los α-cetoanálogos de aminoácidos esenciales se utilizan en el tratamiento de la enfermedad renal crónica para retrasar los síntomas de la uremia. Sin embargo, se desconoce si los α-cetoanálogos de aminoácidos esenciales afectan el estrés oxidativo y la inflamación en la lesión renal aguda tal como en la producida por la isquemia-reperfusión. Objetivo. Evaluar el efecto de las α-cetoanálogos de aminoácidos esenciales sobre la lesión renal por isquemia-reperfusión en ratas Wistar. Materiales y métodos. Se emplearon 11 grupos de ratas (n=6): dos grupos recibieron solución salina fisiológica con lesión isquemia-reperfusión o sin ella (45 min/24 h), seis grupos recibieron α-cetoanálogos de aminoácidos esenciales (400, 800 o 1.200 mg/kg/24 h/7d) con lesión isquemia-reperfusión o sin ella (α-cetoanálogos de aminoácidos esenciales + isquemia-reperfusión), y dos grupos recibieron (50 mg/kg/24 h/7d) con lesión isquemia-reperfusión o sin ella. Los marcadores bioquímicos incluyeron creatinina y nitrógeno ureico en sangre (BUN), citocinas proinflamatorias (IL-1ß, IL-6 y TNF-α), marcadores de daño renal (cistatina C, KIM-1 y NGAL) y marcadores del estrés oxidativo como el malondialdehído (MDA) y la actividad antioxidante total. Resultados. Los grupos tratados con α-cetoanálogos de aminoácidos esenciales y alopurinol tuvieron niveles inferiores de creatinina, BUN, marcadores de daño renal, citocinas proinflamatorias, actividad antioxidante total y MDA que los grupos isquemia-reperfusión correspondientes. Estos cambios se asociaron con la dosis. La actividad antioxidante total fue menor en los grupos tratados con α-cetoanálogos de aminoácidos esenciales que en los grupos isquemia-reperfusión correspondientes. Conclusiones. Este es un nuevo informe de los efectos nefroprotectores de las α-cetoanálogos de aminoácidos esenciales contra la lesión isquemia-reperfusión. Los α-cetoanálogos de aminoácidos esenciales disminuyeron los niveles de los marcadores bioquímicos, de los de lesión renal, de las citocinas proinflamatorias y el MDA, a la vez que minimizaron el consumo total de antioxidantes.