Crise global da atenção primária à saúde / Global crisis in primary health care / Crisis global de la atención primaria

Enquanto no Norte Global se discute uma crise na Atenção Primária à Saúde, a maioria dos países nunca chegou a constituir sistemas de saúde baseados propriamente numa atenção primária robusta. Nesse cenário, o Brasil apresenta uma tendência mais favorável, com conquistas importantes para a atenção primária e a medicina de família e comunidade nos últimos dez anos. Restam desafios a serem superados para que o Sistema Único de Saúde alcance níveis satisfatórios de acesso a seus serviços, com profissionais adequadamente formados e valorizados pela população.

While the Global North is discussing a crisis in primary health care, the majority of countries have never managed to establish health systems based on robust primary care. Brazil presents a more favorable trend, with important achievements for primary care and family practice over the last ten years. There are still challenges to be overcome so that the Unified Health System achieves satisfactory levels of access to its services, with professionals who are properly trained and valued by the public.

Mientras que en el Norte Global se habla de una crisis de la atención primaria, la mayoría de los países nunca han creado realmente sistemas sanitarios basados en una atención primaria robusta. Brasil, muestra una tendencia más favorable, con importantes logros para la atención primaria y la medicina familiar y comunitaria en los últimos diez años. Aún quedan retos por superar para que el Sistema Único de Salud alcance niveles satisfactorios de acceso a sus servicios, con profesionales debidamente formados y valorados por la población.

Physical activity levels and junk food intake among female undergraduate students in Mandya: a cross sectional study

Background: Physical activity (PA) is defined as any bodily movement produced by skeletal muscles that requires energy expenditure. It has been proven that regular physical activity helps control and prevent noncommunicable diseases like diabetes, heart disease, stroke, and several types of cancer. This study aimed to describe the levels of physical activity among female undergraduate students in Mandya and to assess their knowledge, attitude and practice regarding junk food habits. Methods: This cross-sectional study was done in Government women’s degree college, Mandya district, South Karnataka between November 2023 to December 2023 among female undergraduate students in the institute. Global physical activity questionnaire (GPAQ) has been used to describe their physical activity levels. Descriptive statistics like frequency, proportion, mean and standard deviation has been used. Results: The study was conducted among 170 students. Based on the MET values it is found that majority of them had moderate level of PA 81 (47.6%), while 39(22.9%) had high levels and 50 (29.4%) had low PA levels. Of 170 participants, 43 (25%) had junk food intake once a week, 46 (27%) had twice a week, 81 (48%) had thrice or more per week. The association between PA level and junk food was found to be statistically significant (p<0.05). Conclusions: The findings of this study help us in understanding the importance of adopting a healthy lifestyle, including a balanced diet and regular physical activity practice.

Diseño curricular para el desarrollo sostenible y la ciudadanía global: intervención pedagógica en educación superior / Curricular design for sustainable development and global citizenship: pedagogical intervention in higher education / Projeto curricular para desenvolvimento sustentável e cidadania global: intervenção pedagógica no ensino superior

RESUMEN El artículo tuvo como objetivo plantear el diseño e implementación de una propuesta para el fortalecimiento de las competencias de desarrollo sostenible y la ciudadanía mundial. Se formula el modelo de gestión curricular que contribuye en la solución de los problemas locales y globales, dentro de los procesos pedagógicos de la Institución Universitaria Pascual Bravo en Medellín- Colombia. A través de las fases de caracterización, planificación, aplicación y evaluación, se propuso una investigación cuantitativa, con alcance descriptivo y de tipo experimental aplicada a 152 profesionales en formación de diferentes pregrados, durante el segundo el semestre académico del año 2021. Los resultados indican que el rango medio de la puntuación mediana del post test es mayor que la del pre test con un p-valor 4.553x10-9 menor del 5%. Esto se ve materializado en las capacidades de los estudiantes para ser flexibles y adaptables, tener conocimientos de la comunicación intercultural, ser autosuficiente en relación con los asuntos globales y generar un buen clima escolan De ahí se concluye que, la intervención pedagógica mejoró los resultados, de forma significativa, sobre los aprendizajes de los participantes del estudio.

ABSTRACT The objective of this article was to propose the design and implementation of a proposal to strengthen sustainable development competencies and global citizenship. The curricular management model is formulated that contributes to the solution of local and global problems, within the pedagogical processes of the Pascual Bravo University Institution in Medellín-Colombia. Through the phases of characterization, planning, application and evaluation, quantitative research was proposed, with a descriptive and experimental scope applied to 152 professionals in training from different undergraduate degrees, during the second academic semester of the year 2021. The results indicate that the average range of the median score of the post test is greater than that of the pretest with a p-value 4.553x01-9 less than 5%. This is materialized in the students' abilities to be flexible and adaptable, have knowledge of intercultural communication, be self-sufficient in relation to global issues, and generate a good school climate. From this it is concluded that the pedagogical intervention significantly improved the learning results of the study participants.

RESUMO O objetivo do artigo foi propor a elaboração e a implementação de uma proposta para fortalecer as competências de desenvolvimento sustentável e a cidadania global. Ele formula o modelo de gestão curricular que contribui para a solução de problemas locais e globais, dentro dos processos pedagógicos da Instituição Universitária Pascual Bravo em Medellín-Colômbia. Por meio das fases de caracterização, planejamento, aplicação e avaliação, foi proposta uma pesquisa quantitativa, com escopo descritivo e tipo experimental, aplicada a 152 profissionais em formação de diferentes cursos de graduação, durante o segundo semestre acadêmico do ano de 2021. Os resultados indicam que a faixa média da pontuação mediana do pós-teste é maior do que a do pré-teste, com um p-valor de 4,553x01-9 inferior a 5%. Isso se materializa nas habilidades dos alunos de serem flexíveis e adaptáveis, de terem conhecimento de comunicação intercultural, de serem autoconfiantes em relação a questões globais e de gerarem um bom clima escolar Portanto, conclui-se que a intervenção pedagógica melhorou significativamente os resultados de aprendizagem dos participantes do estudo.

Novo Modelo Incremental para Predição de Mortalidade na Hipertensão Pulmonar Pré-Capilar / New Incremental Model for Predicting Mortality in Pre-Capillary Pulmonary Hypertension

Resumo Fundamento: Na hipertensão pulmonar (HP), é necessária a identificação de marcadores prognósticos de fácil obtenção associados com disfunção do ventrículo direito (VD) e sobrevida. Objetivo: Avaliar a associação do índice de anisocitose eritrocitária (RDW, do inglês red cell distribution width) com parâmetros ecocardiográficos e sobrevida em pacientes com HP pré-capilar, com o desenvolvimento de um modelo de predição de mortalidade. Métodos: Estudo observacional, longitudinal, prospectivo, conduzido entre maio de 2019 e dezembro de 2022. Trinta e quatro pacientes com HP pré-capilar submeteram-se à realização de ecocardiograma bidimensional e hemograma. Um ponto de corte de 14,5% foi adotado para definir o RDW como alterado (≥14,5%) ou normal (<14,5%). Valores de p<0,05 foram considerados significativos. Resultados: O RDW médio foi 14,4%. Houve uma diferença significativa na saturação periférica de oxigênio (SpO2) (p=0,028), strain do VD (p=0,047) e derrame pericárdico (p=0,002) entre os grupos com RDW normal e elevado. Durante um período mediano de 15 meses, 20,6% dos pacientes foram a óbito. Os pacientes com RDW aumentado tiveram uma sobrevida global mais curta (44,7%, log-rank p=0,019), sendo um preditor de mortalidade na regressão univariada de Cox. A adição do strain do VD < 16% e da SpO2 ≤93% ao modelo incluindo somente RDW mostrou valor incremental na predição de mortalidade (χ2=8,2, p=0,049; χ2=12,4, p=0,041), com área sob a curva ROC (do inglês, Receiver Operating Characteristic) aumentada (0,729 vs. 0,837 vs. 0,909) e probabilidade de sobrevida diminuída (44.7% vs. 35.6% vs. 25%, log-rank p=0,019). Conclusões: O RDW fornece informações sobre a gravidade da HP pré-capilar pela sua correlação com parâmetros ecocardiográficos de disfunção do VD e mortalidade, a qual é melhor predita por um modelo incluindo RDW, strain do VD e SpO2.

Abstract Background: In pulmonary hypertension (PH), the identification of easily obtainable prognostic markers associated with right ventricular (RV) dysfunction and survival is needed. Objective: To evaluate the association of red cell distribution width (RDW) with clinical, echocardiographic parameters and survival in patients with pre-capillary PH, with the development of a mortality prediction model. Methods: Observational, longitudinal, and prospective study conducted from May 2019 to December 2022. Thirty-four patients with pre-capillary PH underwent two-dimensional echocardiography and complete blood count. A cutoff point of 14.5% was considered to define RDW as altered (≥14.5%) or normal (<14.5%). P values <0.05 were considered significant. Results: The median RDW was 14.4%. There was a significant difference in peripheral arterial oxygen saturation (SpO2) (p=0.028), RV strain (p=0.047), and pericardial effusion (p=0.002) between the normal and elevated RDW groups. During a median follow-up of 15 months, 20.6% died. Patients with increased RDW had a shorter overall survival (44.7%, log-rank p=0.019), which was a predictor of mortality in univariate Cox regression (HR 8.55, p=0.048). The addition of RV strain <16% and SpO2 ≤93% to the model including RDW alone showed incremental value in predicting mortality (χ2=8.2, p=0.049; χ2=12.4, p=0.041), with increased area under the receiver operating characteristic curve (0.729 vs. 0.837 vs. 0.909) and decreased probability of survival (44.7% vs. 35.6% vs. 25%, log-rank p=0.019). Conclusions: RDW provides information on the severity of pre-capillary PH by correlating with echocardiographic parameters of RV dysfunction and mortality, which is best predicted by a model including RDW, RV strain and SpO2.

Acceso a la cirugía cardíaca en Colombia: un análisis situacional / Access to cardiac surgery in Colombia: a situational analysis

Resumen Introducción: Aproximadamente el 33% de los pacientes con enfermedades cardiovasculares requerirán cirugía cardíaca al menos una vez en la vida; sin embargo, menos de una cuarta parte de la población mundial tiene acceso a la atención quirúrgica cardíaca cuando la necesita. A pesar del progreso que ha tenido Colombia en cuanto a la prestación de atención quirúrgica cardíaca en las últimas décadas, se sabe poco sobre el acceso a la atención cardíaca en todo el país. Por lo tanto, la cirugía global busca estudiar y construir sobre la situación actual en áreas de acceso limitado a la atención médica quirúrgica y fortalecer los sistemas de salud. Objetivo: Describir la situación actual en Colombia en términos de personal quirúrgico y de infraestructura disponible, para entender mejor las brechas existentes en el acceso a la atención quirúrgica cardíaca para las poblaciones necesitadas. Materiales y método: Los datos sobre la fuerza laboral de la cirugía cardiaca se obtuvieron a partir de una encuesta a cirujanos registrados en el directorio de cirugía cardíaca y la Red de Cirugía Cardiotorácica de Colombia, en tanto que los de procedimientos del 2018 al 2019, se obtuvieron de los datos del gobierno nacional. Resultados: En Colombia había 110 cirujanos cardíacos o 1.8 cirujanos cardíacos por millón de habitantes, de los cuales el 85% eran hombres. Las densidades en cada uno de los 32 departamentos de Colombia variaron desde 4.6 cirujanos por millón de habitantes (Bogotá), a ningún cirujano en 14 departamentos. Se registraron 52 instituciones, con una mediana de 250 camas (rango intercuartílico 130-350). Uno de cada cinco departamentos de cirugía cardíaca ofreció un programa de subespecialidad en cirugía cardíaca. La revascularización miocárdica fue el procedimiento realizado con mayor frecuencia. Conclusiones: Este estudio identificó datos sobre la situación actual de la cirugía cardíaca en Colombia. A pesar de la disponibilidad relativamente favorable de mano de obra quirúrgica cardíaca en Colombia, la variación geográfica y los factores sociales y económicos apuntan a una necesidad urgente de evaluar las políticas de calidad de atención relacionadas con la atención quirúrgica cardíaca en poblaciones desatendidas.

Abstract Introduction: Approximately 33% of patients with cardiovascular diseases will require heart surgery at least once in their lifetime; yet, less than a quarter of the world’s population has access to cardiac surgical care when needed. Despite Colombia’s progress in cardiac surgical care delivery in recent decades, little is known regarding access to cardiac care across the country. Therefore, global surgery seeks to study and build upon the current situation in areas of limited access to surgical healthcare and to strengthen health systems. Objetive: Describe the current situation in Colombia in terms of surgical personnel and available infrastructure, to better understand the existing gaps in access to cardiac surgical care for populations in need. Materials and method: Data on the cardiac surgical workforce were obtained from a survey of surgeons registered in the cardiac surgery directory and the Cardiothoracic Surgery Network in Colombia. Procedural data from 2018-2019 were obtained from national government data. Results: There were 110 cardiac surgeons or 1.8 cardiac surgeons per million inhabitants in Colombia, of which 85.0% were male. Densities in each of the 32 departments of Colombia varied from 4.6 surgeons per million inhabitants (Bogotá) to no surgeons in 14 departments. There were 52 institutions registered, with a median of 250 beds (interquartile range 130-350). One in five cardiac surgery departments offered a certified cardiac surgery fellowship program. Coronary artery bypass grafting was the most frequently performed procedure. Conclusions: This study identified data regarding the current situation of cardiac surgery in Colombia. Despite relatively favorable cardiac surgical workforce availability in Colombia, geographical variation and social and economic factors point to an urgent need to evaluate the quality-of-care policies related to cardiac surgical care in underserved populations.

A cross-sectional study to evaluate uploader-based quality and reliability of content on YouTube about endometriosis

Background: Endometriosis is characterized by the development and presence of endometrial glands and stroma outside of the uterine cavity. Reflux of endometrial tissue fragments, cells, and protein-rich fluid into the pelvis during menstruation is considered the most important mechanism for the development of endometriosis, which is termed reflux menstruation. This study aims to assess quality and reliability of information on YouTube related to endometriosis.Methods: A cross-sectional observational study of YouTube videos was conducted in April 2023. Videos related to endometriosis were searched by six authors, easy using one search term. Relevant videos in English or Hindi language of duration 1-20 minutes were included in the study. These were evaluated for type of uploader, popularity, type of content and lastly quality and reliability using global quality score (GQS) and DISCERN scores respectively.Results: The 67 relevant videos conveying Endometriosis related information had 21,620,808 views, 120,830 likes and 11,655 comments. Around 31 (46.3%) of videos uploaded were by doctors and health care organizations, outnumbering those uploaded by news channels 14 (20.9%), patients 5 (7.5%), and others 17 (25.4%). 59 (88.06%) of these videos described symptoms of endometriosis, and 67.1% presented the cause or etiology. A total of 47 (70.1%) of videos discussed information regarding treatment options.Conclusions: YouTube videos have a wide reach among audience. In this study it was found that there was no significant difference in the quality, reliability or video power index (VPI) of videos uploaded by different types of uploaders. It is important to ensure that content with high quality and reliability is available from qualified medical professionals and organizations; for viewers to understand their disease and take treatment decisions.

Superbugs Unleashed: Is Time Running Out to Stop the Global Infection Crisis?

The global infection crisis poses a significant threat to public health, with the emergence and spread of antibiotic-resistant bacteria or "superbugs" becoming a major concern.The crisis has been fueled by various factors, including the overuse of antibiotics, inadequate infection prevention and control measures,and the lack of investment in research and development of new treatments.Addressing this issue requires a comprehensive approach that involves improving surveillance and monitoring systems, promoting individual responsibility, and investing in research and development.Collaboration between stakeholders, including governments, healthcare providers, researchers, and the public, is crucial in overcoming the challenges posed by the global infection crisis. Despite promising advances in emerging technologies, sustained investment in research and development is necessary to ensure continued progress in addressing the issue.Failure to take action risks a future where superbugs run rampant and existing treatments become ineffective. It is time to act decisively to halt the spread of superbugs and prevent a global health crisis.

Haydée Guanais Dourado: formação profissional e financiamento da Fundação Rockefeller (1941-1956) / Haydée Guanais Dourado: professional training and financing from the Rockefeller Foundation (1941-1956) / Haydée Guanais Dourado: formación profesional y financiación de la Fundación Rockefeller (1941-1956)

Objetivo: descrever e analisar a trajetória formativa e profissional da enfermeira Haydée Guanais Dourado (HGD) entre 1941 e 1956. A ênfase está em dois períodos de estudos e treinamento realizados por ela nos Estados Unidos da América do Norte e no Canadá com o financiamento da Fundação Rockefeller (FR). Métodos: a pesquisa utilizou fontes documentais coletadas em arquivos do Museu da Escola de Enfermagem da Universidade Federal da Bahia, do Centro de Documentação da Escola Anna Nery, na Hemeroteca Digital da Biblioteca Nacional e entre familiares de HGD [duas entrevistas, cinco cartões de bolsistas, um dossiê da FR, notícias de jornais e imagens] que registraram a sua experiência enquanto bolsista. A análise dos documentos foi baseada nos métodos onomástico e indiciário, conforme a proposta de Carlo Ginzburg, que destaca a importância do nome para a coleta e análise documental. Resultados: as múltiplas experiências de aprendizagem e de observação de Haydée no exterior prepararam-na para atuar como líder na área da educação em enfermagem em um momento em que a prioridade era a criação de novas Escolas de Enfermagem. Considerações finais: embora a política de concessão de bolsas patrocinada pela FR tivesse objetivos institucionais e políticos bem definidos, as escolhas de HGD foram decisivas na definição de seu trajeto profissional.

Objective: to describe and analyze nurse Haydée Guanais Dourado's (HGD) educational and professional trajectory between 1941 and 1956. The emphasis is on two periods of studies and training carried out by her in the United States of North America and in Canada with funding from the Rockefeller Foundation. Methods: the research used documentary sources collected in archives at the Museum of the Nursing School of the Universidade Federal da Bahia, the Escola Anna Nery Documentation Center, the National Library Hemeroteca Digital and among family members of HGD [two interviews, five scholarship holder cards, a dossier from the Rockefeller Foundation (RF), newspaper reports and images] that recorded her experience as a scholarship recipient. Document analysis was based on onomastic and indexical methods, as proposed by Carlo Ginzburg, which highlights the importance of the name for document collection and analysis. Results: Haydée's multiple learning and observation experiences abroad prepared her to act as a leader in the field of nursing education at a time when the priority was the creation of new Nursing Schools. Final considerations: although the scholarship granting policy sponsored by RF had well-defined institutional and political objectives, HGD's choices were decisive in defining her professional path.

Objetivo: describir y analizar la trayectoria educativa y profesional de la enfermera Haydée Guanais Dourado (HGD) entre 1941 y 1956. El énfasis está en dos períodos de estudios y formación realizados por ella en los Estados Unidos de Norteamérica y en Canadá con financiación. de la Fundación Rockefeller (FR). Métodos: la investigación utilizó fuentes documentales recopiladas en archivos del Museo de la Escuela de Enfermería de la Universidade Federal da Bahia, del Centro de Documentación de la Escola Anna Nery, de la Hemeroteca Digital de la Biblioteca Nacional y de familiares de HGD [dos entrevistas, cinco tarjetas de becario, un dossier de la FR, reportajes periodísticos e imágenes] que registraron su experiencia como becario. El análisis de los documentos se basó en métodos onomásticos e indexicales, propuestos por Carlo Ginzburg, lo que resalta la importancia del nombre para la recopilación y análisis de documentos. Resultados: las múltiples experiencias de aprendizaje y observación de Haydée en el extranjero la prepararon para actuar como líder en el campo de la educación en enfermería en un momento en que la prioridad era la creación de nuevas Escuelas de Enfermería. Consideraciones finales: si bien la política de concesión de becas patrocinada por FR tenía objetivos institucionales y políticos bien definidos, las elecciones de HGD fueron decisivas para definir su trayectoria profesional.

Inequalities related to participation in Physical Education classes among South American adolescents: a pooled analysis with 173288 participants

O objetivo do presente estudo foi descrever a prevalência de participação em aulas de Educação Física (EF) entre adolescentes sul americanos de acordo com correlatos sociodemográficos. Foram utilizados dados de 11 países sul-americanos, compreendendo 173.288 adolescentes (>11 a 19 anos). A participação em aulas de EF foi autorrelatada (0, 1, 2 e ≥3 dias/semana). Os correlatos sociodemográficos foram gênero, faixa etária e status de segurança alimentar. Modelos de regressão de Poisson foram usados para estimar as razões de prevalência. Cerca de 16% dos adolescentes sul-americanos não participaram de aulas de EF, enquanto 27% participaram ≥3 dias/semana em aulas de EF. Meninos tiveram maior probabilidade de participar de aulas de aulas de EF ≥3 dias/semana do que meninas [1,10 (1,03; 1,19)], não havendo diferença de gênero na categoria 0 dia/semana [1,03 (0,91; 1,16)]. Adolescentes mais velhos (≥16 anos) apresentaram maior prevalência de 0 [1,50 (1,11; 2,02)] e 1 dia/semana [1,18 (1,05; 1,33)], e menor prevalência de 2 [0,70 (0,58; 0,85)] e ≥3 dias/semana de aulas de EF [0,73 (0,60; 0,89)] em comparação aos adolescentes mais jovens (12-13 anos). Adolescentes que relataram insegurança alimentar apresentaram maior prevalência de 0 [1,20 (1,06; 1,36)] e ≥3 dias/semana de aulas de EF [1,07 (1,02; 1,12)]. Assim, aproximadamente 16% dos adolescentes sul-americanos não participam de aulas de educação física, sendo observadas diferenças de gênero, entre faixas etárias e entre status de segurança alimentar.

We aimed to describe the prevalence of participation in Physical Education (PE) classes among South American adolescents according to sociodemographic correlates. We used nationally repre-sentative data from 11 South American countries, comprising 173,288 adolescents (>11 to 19y). Participation in PE classes was self-reported (0, 1, 2, and ≥3 days/week). Sociodemographic correlates were gender, age group, and food security status. Poisson Regression models were used to estimate the Prevalence Ratios. Around 16% of South American adolescents did not participate in PE classes, while 27% participated ≥3 days/week in PE classes. There were more boys in the ≥3 days/week category [1.10 (1.03; 1.19)] and no gender difference in the 0 days/week category [1.03 (0.91; 1.16)]. Older adolescents (≥16y) had a higher prevalence of 0 [1.50 (1.11; 2.02)] and 1 day/week [1.18 (1.05; 1.33)], and a lower prevalence of 2 [0.70 (0.58; 0.85)] and ≥3 days/week [0.73 (0.60; 0.89)] compared to the younger adolescents (12-13y). Adolescents who reported food insecurity had a higher prevalence of 0 [1.20 (1.06; 1.36)] and ≥3 days/week [1.07 (1.02; 1.12)]. In conclusion, approximately 16% of South American adolescents do not participate in PE classes, with differences related to gender, age, and food security status.

Can India achieve UNAIDS’ target by 2030?

The world is embarking on a fast-track strategy to end the AIDS epidemic by 2030. UNAIDS is targeted towards achieving the 95-95-95 strategy by 2025. Scaling up prevention, testing and treatment services towards HIV/AIDS is paramount in achieving these targets. To understand the status of India in achieving these targets, review of trials registered in the CTRI registry was done and found that among the 155 included trials, most (n=45, 29%) of the trials were drug trails, few were vaccine trials (n=6, 3.8%). Out of 155 studies, forty-one (20%) were in line to reach UNAIDS’ targets. The primary focus of those studies was improving CD4 counts and suppression of viral load (third target of UNAIDS’) (n=12, 7.7%), and the minimal focus was on promoting treatment adherence (second target of UNAIDS’) (n=11, 7%) and promotion of HIV testing (first target of UNAIDS’) (n=4, 2.5%). As prevention is always better than care, research should be encouraged towards prevention of HIV, which in turn facilitates achieving UNAIDS’ 2025 and 2030 targets.

Los cambios climáticos: ¿pueden afectar en epilepsia? Revisión del tema con presentación de 2 casos clínicos / Climate change: can it affect epilepsy? Review of the topic with presentation of 2 clinical cases

Muchas enfermedades neurológicas son condiciones crónicas complejas influenciadas en muchos niveles por cambios en el medio ambiente. El cambio climático (CC) se refiere a la gama más amplia de cambios locales, regionales y globales en los patrones climáticos promedio, impulsados principalmente, en los últimos 100 años, por actividades antropogénicas. Diversas variables climáticas se asocian con una mayor frecuencia de convulsiones en personas con epilepsia. Es probable que los riesgos se vean modificados por muchos factores, que van desde la variación genética individual y la función del canal dependiente de la temperatura, hasta la calidad de la vivienda y las cadenas de suministro globales. Los diferentes tipos de epilepsia parecen tener una distinta susceptibilidad a las influencias estacionales. El aumento de la temperatura corporal, ya sea en el contexto de la fiebre o no, tiene un papel crítico en el umbral convulsivo. Es probable que los vínculos entre el cambio climático y la epilepsia sean multifactoriales, complejos y, a menudo, indirectos, lo que dificulta las predicciones. Actualmente necesitamos más datos sobre los posibles riesgos en enfermedades; entre ellas la epilepsia. Se presentan 2 casos clínicos que refieren cambios en la frecuencia de sus crisis en relación a las altas temperaturas registradas.

Many neurological diseases are complex chronic conditions influenced on many levels by changes in the environment. Climate change refers to the widest range of local, regional, and global changes in average weather patterns, driven primarily, over the past 100 years, by anthropogenic activities. Various climatic variables are associated with an increased frequency of seizures in people with epilepsy. Risks are likely to be modified by many factors, ranging from individual genetic variation and temperature-dependent channel function, to housing quality and global supply chains. Different types of epilepsy appear to have different susceptibility to seasonal influences. Increased body temperature, whether in the context of fever or not, plays a critical role in the seizure threshold. The links between climate change and epilepsy are likely to be multifactorial, complex, and often indirect, making predictions difficult. We currently need more data on the possible risks of disease; among them epilepsy. We present 2 clinical cases that refer to changes in the frequency of their seizures in relation to the high temperatures recorded.

Práticas Avançadas de Enfermagem ­ PAE / Advanced Nursing Practices ­ ANP

Trata de nota técnica sobre Práticas Avançadas de Enfermagem (PAE) no Brasil, elaborada por comissão e submetida à aprovação do plenário do Conselho Federal de Enfermagem (Cofen). O documento aborda conceitos, ações, implementação e regulação das práticas avançadas de Enfermagem, expandindo os limites do escopo da atuação do enfermeiro e reforçando a sua prática clínica. (AU)

This is a technical note on Advanced Nursing Practices (ANP) in Brazil, prepared by a committee and submitted for approval by the plenary of the Federal Nursing Council (Cofen). The document addresses concepts, actions, implementation and regulation of advanced nursing practices, expanding the limits of the scope of nurses' work and reinforcing their clinical practice. (AU)

Esta es una nota técnica sobre las Prácticas Avanzadas de Enfermería (PAE) en Brasil, elaborada por un comité y sometida a la aprobación del plenario del Consejo Federal de Enfermería (Cofen). El documento aborda los conceptos, acciones, implementación y reglamentación de las prácticas avanzadas de enfermería, ampliando los límites del ámbito de actuación de las enfermeras y reforzando su práctica clínica. (AU)

Clinical application value of thromboelastogram combined with GRACE score in acute myocardial infarction / 国际检验医学杂志

Objective To analyze the correlation between thromboelastogram indicators(R time,K time,MA value)and global registry of acute coronary events(GRACE)score and acute myocardial infarction(AMI),and explore the risk factors for the onset of AMI.Methods A total of 108 patients with AMI who were hospitalized in Xuancheng Central Hospital for the first time from September 2020 to February 2023 were selected as the observation group,while 70 patients with stable coronary heart disease were selected as the control group.The clinical basic data,thromboelastogram indicators,GRACE score,and homocysteine(Hcy)of all study subjects were collected.The differences of clinical basic data,thromboelastogram indica-tors,GEACE score,and Hcy level between the observation group and the control group were statistically ana-lyzed.The predictive value of thromboelastogram indicators,GRACE score,and Hcy level for the occurrence of AMI was evaluated by using the receiver operating characteristic(ROC)curve.Binary Logistic regression model was used to conduct univariate and multivariate regression analyses on indicators with statistically sig-nificant differences,in order to determine the independent risk factors for AMI occurrence.Results There were significant differences of R time,K time,MA value,GRACE score,serum Hcy level,and the proportion of underlying diseases between the observation group and the control group(P＜0.05).The ROC curve re-sults showed that R time,K time,MA value,GRACE score,and Hcy had good predictive value for the occur-rence of different types of AMI,and the value of the combined application was higher.Univariate Logistic re-gression showed that MA value,GRACE score,Hcy level,and underlying disease were positively correlated with the occurrence of AMI(P＜0.05),while R time and K time were negatively correlated with the occur-rence of AMI(P＜0.05).Multivariate Logistic regression showed that high GRACE score and elevated Hcy level were independent risk factors for the occurrence of AMI(P＜0.05),while R time and K time were inde-pendent protective factors for the occurrence of AMI(P＜0.05).Conclusion Thromboelastogram,Hcy,and GRACE score could be used as dynamic monitoring indicators for clinical risk assessment of AMI in acute cor-onary syndrome population.

Comparative analysis of lung cancer incidence and mortality trends and risk factors in China and the United States based on GBD data / 国际肿瘤学杂志

Objective:To conduct comparative analysis of lung cancer incidence and mortality, as well as long-term trends in incidence and mortality rates and risk factors in China and the United States from 1990 to 2019 based on data from the Global Burden of Disease Study 2019 (GBD 2019) .Methods:The GBD 2019 database was used to extract new lung cancer cases, deaths, and age-standardized rate data for the analysis of lung cancer incidence and deaths in China and the United States based on different sex and age groups from 1990 to 2019. Joinpoint software was used to calculate and analyze annual percentage change (APC) and average annual percentage change (AAPC) of age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of lung cancer in China and the United States from 1990 to 2019, and to analyze the long-term trends. Risk factors associated with lung cancer mortality in China and the United States were analyzed using the disability-adjusted life years (DALYs) .Results:New cases of lung cancer in China increased from 257 000 cases in 1990 to 832 900 cases in 2019, and ASIR increased from 30.20/100 000 in 1990 to 41.71/100 000 in 2019; deaths increased from 256 300 cases in 1990 to 757 200 cases in 2019, and ASMR increased from 31.18/100 000 in 1990 to 38.70/100 000 in 2019. ASIR and ASMR for lung cancer in the United States showed a decreasing trend from 1990 to 2019, with ASIR decreasing from 58.87/100 000 in 1990 to 45.13/100 000 in 2019, and ASMR decreasing from 49.35/100 000 in 1990 to 36.11/100 000 in 2019. In terms of gender, the disease burden of lung cancer in Chinese males was higher than that of females in 1990 and 2019, with new cases of lung cancer in males rising from 179 000 in 1990 to 576 200 in 2019, and ASIR rising from 44.29/100 000 in 1990 to 61.74/100 000 in 2019, mortality rising from 177 900 in 1990 to 523 200 in 2019, and ASMR rising from 46.33/100 000 in 1990 to 58.10/100 000 in 2019. The number of new cases of lung cancer in Chinese females rose from 78 100 in 1990 to 256 700 in 2019, and ASIR rose from 18.01/100 000 in 1990 to 24.76/100 000 in 2019; the number of deaths rose from 78 400 in 1990 to 234 000 in 2019, and ASMR rose from 18.63/100 000 in 1990 to 22.86/100 000 in 2019. In 2019, lung cancer incidence rates for males and females in China and the United States showed an increasing and then decreasing trend with age, with incidence rates of lung cancer in Chinese males and females peaking in the age group of 85-89 years old; and in the United States, incidence rates of lung cancer in males peaked in the age group of 85-89 years old, and incidence rates of females peaked in the age group of 80-84 years old. In 2019, it was shown that mortality rate of lung cancer among males in China increased and then decreased with age, reaching a peak in the age group of 85-89 years old, and mortality rate of lung cancer among females increased with age, reaching a peak in the age group of ≥95 years old. In the United States, lung cancer mortality rate for males and females showed an increasing and then decreasing trend with age, peaking in the 85-89 and 80-84 age groups, respectively. Incidence and mortality rates were higher for males than females in all age groups in China and the United States in 1990 and 2019. The analysis results of Joinpoint software showed that ASIR and ASMR of lung cancer in China showed an overall increasing trend from 1990 to 2019, with an AAPC of 1.16% (95% CI: 0.93%-1.38%, P<0.001) for ASIR and 0.78% (95% CI: 0.56%-1.01%, P<0.001) for ASMR, with the most obviously increasing trend in ASIR and ASMR from 1997 to 2004, the APC were 2.84% and 2.58%, respectively. Lung cancer ASIR and ASMR in the United States population showed a decreasing trend, with an AAPC of -1.08% (95% CI: -1.20%-0.96%, P<0.001) for ASIR and -1.05% (95% CI: -1.24%--0.87%, P<0.001) for ASMR. In 1990 and 2019, the major mortality-related risk factor for lung cancer in China and the United States was smoking, and the major mortality-related risk factor for lung cancer in Chinese females was environmental particulate matter pollution. Conclusion:ASIR and ASMR of lung cancer in China show an increasing trend from 1990 to 2019, and ASIR and ASMR of lung cancer in the United States show a decreasing trend. In 2019, incidence rate of lung cancer in males and females in China show an increasing and then decreasing trend with age, mortality rate of lung cancer for males show an increasing and then decreasing trend with age, and mortality rate of lung cancer for females show an increasing trend with age. Lung cancer incidence and mortality rates for males and females in the United States in 2019 show an increasing and then decreasing trend with age. In both 1990 and 2019, incidence rates and mortality rates are higher for males than for females in all age groups in both China and the United States. Smoking is the major mortality-related risk factor for lung cancer in China and the United States, and environmental particulate matter pollution is the major mortality-related risk factor for lung cancer in Chinese females.

Comparison of the predictive value of new simplified insulin resistance assessment indexes in identifying left ventricular subclinical dysfunction in T2DM patients / 解放军医学杂志

Objective To investigate the predictive value of new simplified insulin resistance(IR)assessment indexes in identifying subclinical left ventricular systolic function impairment in patients with type 2 diabetes mellitus(T2DM).Methods A total of 150 T2DM patients with preserved left ventricular ejection fraction(LVEF≥50%)who were admitted to Department of Endocrinology of the First Affiliated Hospital of Air Force Medical University from June 2021 to December 2021 were retrospectively analyzed.All patients underwent two-dimensional speckle tracking echocardiography to measure left ventricular global longitudinal strain(GLS).According to GLS value,the subjects were divided into the normal group(GLS≥18%group,n=80)and the impaired group(GLS<18%group,n=70).Some new simplified IR assessment indicators were calculated and compared between the two groups,including body mass index(BMI),TG/HDL-C ratio,triglyceride-glucose(TyG)index,TyG-BMI index,TyG-WHR and metabolic score for IR(METS-IR).Correlation between the GLS and the new simplified IR assessment indexes was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of different simplified IR assessment indexes,with the area under the curve(AUC)calculated.Furthermore,according to whether the subjects were complicated with hypertension,binary logistics regression analysis was performed to explore the independent correlation between the simplified IR assessment index and GLS<18%.Results Total 150 were included with aged(54.5±13.7)years with 96(64.0%)men and 54(36.0%)women.Compared with the GLS≥18%group,the TG/HDL-C ratio,TyG index,TyG-BMI,and METS-IR of subjects in the GLS<18%group were significantly increased(P<0.05).Pearson correlation analysis showed that TG/HDL-C ratio,TyG index,TyG-BMI,TyG-WHR,and METS-IR were negatively correlated with GLS(P<0.05).ROC analysis showed that TyG index had a certain predictive value for the evaluation of GLS<18%(AUC=0.678,95%CI 0.591-0.765,P<0.001).Stratification based on hypertension and further adjusting for confounding factors,TyG index remains significantly associated with GLS<18%(OR=3.249,95%CI 1.045-10.103,P=0.042).Conclusions The novel simplified insulin resistance evaluation indexes are closely associated with left ventricular subclinical systolic dysfunction in T2DM patients with preserved ejection fraction.TyG index is an effective index to identify left ventricular subclinical dysfunction in these populations.

Analysis of the consistency between CTA and DSA in evaluating GLASS staging of chronic limb-threatening ischemia / 介入放射学杂志

Objective To analyze the consistency between computer tomography angiography(CTA)and digital subtraction angiography(DSA)in evaluating the global limb anatomic staging system(GLASS)stage of patients with chronic limb-threatening ischemia(CLTI).Methods The clinical data of patients with CLTI,who were admitted to the First Affiliated Hospital of Xi'an Jiaotong University of China to receive treatment between January 2017 and December 2020,were retrospectively analyzed.Taking the DSA assessment as the gold standard,the consistency of CTA and DSA in evaluating the GLASS stage of patients with CLTI was analyzed.Results In the assessment of GLASS stage of CLTI,CTA showed strong agreement with DSA.The weighted Kappa coefficient of CTA and DSA for the staging of femoropopliteal segment was 0.798(95％CI=0.722-0.873,P＜0.01),and the weighted Kappa coefficient of CTA and DSA for the staging of infrapopliteal artery segment was 0.785(95％ CI=0.725-0.845,P＜0.0l).For the overall staging of GLASS,the weighted Kappa coefficient of CTA and DSA was 0.832(95％ CI=0.752-0.91 1,P＜0.01).All the above results indicated that a very strong consistency existed between CTA and DSA in evaluating the GLASS stage of patients with CLTI.Conclusion CTA examination of lower limb can accurately evaluate GLASS score and stage of CLTI patient's target lesions,which is helpful in diagnosing lower extremity arteriosclerosis occlusion disease as well as in assessing the technical difficulty degree of its revascularization operation.(J Intervent Radiol,2024,33:300-303)

Application of arterial spin labeling techniques in autism spectrum disorder with or without global developmental delay / 实用放射学杂志

Objective To measure and compare the cerebral blood flow(CBF)of children with autism spectrum disorder(ASD),global developmental delay(GDD),and ASD with GDD groups via arterial spin labeling(ASL)technique,and to evaluate the diag-nostic value of CBF values.Methods ASL images of ASD,GDD,and ASD with GDD groups of children were firstly acquired,and the CBF values of frontal lobe,temporal lobe,parietal lobe,occipital lobe,striatum and thalamus region of interest(ROI)were fur-ther measured,respectively.One-way analysis of variance or Kruskal-Wallis H test was used to compare the differences in CBF values among these three groups,and the receiver operating characteristic(ROC)curve was used to analyze the efficacy of CBF values in distinguishing ASD with GDD from without GDD.Results ASD with GDD had significantly lower CBF values in the left and right frontal lobes than those with ASD or GDD alone,and the differences were statistically significant(P<0.05).The CBF values in the left and right frontal lobes effectively distinguished ASD with GDD from without GDD[area under the curve(AUC)>0.7].Conclusion ASL technique can noninvasively assess CBF in children with or without GDD,helping to understand the pathophysiology of ASD with GDD and improving diagnostic accuracy.

Study on the detection of CT image based on multi-task network method of global attention for fine-fracture / 中国医学装备

Objective:To improve the perception of computed tomography(CT)images in detecting fine fracture through multi-task network of global attention,and to realize the detection of the target of fine fracture at case level through multi-task,and to quickly and accurately identify and locate fracture from a large number of CT images,so as to assist doctors to timely conduct treatment.Methods:A grouped Non-local network method was introduced to calculate the remote dependency relationship between each position of CT image continuous sections and channel.A single-stage detector of multi-objective detection model three dimension(3D)RetinaNet was integrated with the medical image semantic segmentation architecture(3D U-Net).A end-to-end multi-task 3D convolutional network was realized,which realized the detection of case level for fine fracture through multi-task collaboration.Select 600 CT scan images from the Rib Frac Dataset of rib fractures provided by the MICCAI 2020 Challenge,and they were divided into training set(500 cases)and test set(100 cases)as the ratio of 5:1 to test the precise performance of multi-task 3D convolutional network.Results:The precise performance of multi-task 3D convolutional network method was better than that of single-task FracNet,3D RetinaNet and 3D Retina U-Net in detection,which average precision was respectively higher 7.8%and 11.4%than 3D RetinaNet and 3D Retina U-Net.It was better than two kinds of single-task network detection method included 3D Faster R-CNN and 3D Mask R-CNN,and the average precision of that was respectively higher 6.7%and 3.1%than them.Conclusion:The integrated different modules of global attention multi-task network can improve the detection performance of fine fracture.The introduction of grouped Non-local network method can further improve the precise performance for the targets of fine fractures in detection.