Child undernutrition in Brazil: the wound that never healed

Abstract Objective To describe the scenario of child undernutrition in Brazil and its determinants. Data source Narrative review of the literature with inclusion of data from population surveys, surveillance and monitoring systems, and active search in favelas and underserved communities carried out by CREN. Data synthesis Household surveys carried out from 1974 to 2019 indicate that undernutrition (<5 years) decreased until 2006. Underweight (W/A ≤-2 Z) and stunting (H/A ≤-2 Z) showed a decrease of 17% to 3% and 37% to 7%, respectively. After 2006, there was an increase in underweight of 53% and 76% for wasting (BMI/A ≤-2 Z), with the prevalence of stunting being stagnant at around 7%. Active search data in favelas and underserved communities show that the prevalence of stunting is 11% in those <5 years. In 2021, 30% of the population lived in poverty, 73% of which were black or brown. Stunting in black and brown children <5 years old is, respectively, 9% and 12% higher when compared to white children. Poverty decreased between 2012 and 2015 (27 to 25%), but increased again (2016=26% to 2021=30%), in parallel with food insecurity, which decreased between 2004 and 2013 (12% to 6%), but reached its worst level in the historical series (2022:15%). Conclusion Despite advances, Brazil's social protection system was not able to reduce inequalities and the reversal of the trend towards decreasing child undernutrition could be observed from 2006 onwards.

Qualidade das informações sobre lipoaspiração para o público leigo: Uma revisão de escopo / Quality of information about liposuction for the lay public: A scoping review

Introdução: Esta revisão de escopo tem por objetivo analisar a qualidade das informações sobre lipoaspiração para o público leigo. Método: Foi realizada busca na literatura no período de 18 de novembro a 12 de dezembro de 2021 nas seguintes plataformas de base de dados: Medline, Cochrane, LILACS, Embase e BVS. A estratégia de busca envolveu a combinação de vários descritores. Três investigadores independentes leram o resumo dos estudos que foram obtidos usando a estratégia de busca para avaliar aqueles que preenchiam os critérios de elegibilidade. Resultados: Inicialmente, foram levantados 33 artigos utilizando a estratégia de busca. Dentre esses, 23 estudos foram excluídos após a leitura dos resumos e avaliação dos critérios de elegibilidade, por não possuírem desfechos de interesse ao tema proposto. Assim, dez estudos preenchiam os critérios de inclusão, sendo nove estudos transversais e uma revisão de literatura. Dentre os dez artigos incluídos, nove relatam que as informações sobre lipoaspiração são precárias e imprecisas. Conclusão: O conteúdo sobre lipoaspiração disponibilizado ao público leigo por meio da Internet é, na sua maioria, insatisfatório.

Introduction: This scoping review aims to analyze the quality of information about liposuction for the lay public. Method: A literature search was carried out from November 18 to December 12, 2021, on the following database platforms: Medline, Cochrane, LILACS, Embase, and VHL. The search strategy involved the combination of several descriptors. Three independent investigators read the abstract of studies obtained using the search strategy to evaluate those that met the eligibility criteria. Results: Initially, 33 articles were collected using the search strategy. Among these, 23 studies were excluded after reading the abstracts and evaluating the eligibility criteria, as they did not have outcomes of interest to the proposed topic. Thus, ten studies met the inclusion criteria, nine of which were cross-sectional and one literature review. Among the ten articles included, nine report that information about liposuction is poor and inaccurate. Conclusion: The content on liposuction made available to the lay public via the Internet is, for the most part, unsatisfactory.

Modelo alternativo para o treinamento de técnicas de microssuturas em "patch" de pericárdio bovino / Alternative model for training microsuture techniques in bovine pericardium patches

Introdução: As técnicas microcirúrgicas caracterizam-se pela aplicação de manobras e suturas em estruturas milimétricas com o auxílio de lentes de aumento. São técnicas complexas, utilizadas em diversas especialidades médicas, que demandam grande habilidade e treinamento antes da aplicação em humanos. O objetivo é desenvolver um modelo de baixo custo e alta fidelidade, para o treinamento de técnicas de microcirurgia, utilizando um fragmento de patch de pericárdio bovino. Método: São utilizados para a confecção deste modelo segmentos remanescentes de uma placa de pericárdio bovino, previamente utilizado em reparos vasculares. O material é recortado em duas partes simétricas e suas extremidades fixadas aos campos cirúrgicos, com auxílio de clamps. A borda superior de cada uma das partes é, então, suturada à borda inferior com fio de Prolene 8-0, de maneira que cada uma forme uma estrutura tubular. Posteriormente, as extremidades tubulares livres passam pela dissecção da camada adventícia e são suturadas entre si, mimetizando uma anastomose vascular término-terminal. Resultados: Com o modelo, simulam-se os mesmos inconvenientes/ dificuldades presentes nas suturas vasculares humanas, como a delaminação de camadas, excesso da camada adventícia e risco de sutura inadvertida da parede posterior, provando sua utilidade na aquisição de habilidades microcirúrgicas básicas, sem necessidade de manipulação de tecidos humanos ou animais. A prática neste modelo pode ocorrer dentro do próprio centro cirúrgico e emprega materiais que seriam descartados. Conclusão: A utilização do pericárdio bovino para confecção de suturas milimétricas mimetiza o tecido vascular humano e é um procedimento de baixo custo, que possibilita o treinamento de habilidades microcirúrgicas.

Introduction: Microsurgical techniques are characterized by the application of maneuvers and sutures to millimetric structures with the aid of magnifying lenses. These are complex techniques, used in various medical specialties, which require great skill and training before applying them to humans. The objective is to develop a lowcost and high-fidelity model for training microsurgery techniques using a fragment of bovine pericardium patch. Method: Remaining segments of a bovine pericardium plate, previously used in vascular repairs, are used to create this model. The material is cut into two symmetrical parts, and its ends are fixed to the surgical drapes with the aid of clamps. The upper edge of each part is then sutured to the lower edge with 8-0 Prolene thread so that each one forms a tubular structure. Subsequently, the free tubular ends undergo dissection of the adventitial layer and are sutured together, mimicking an end-to-end vascular anastomosis. Results: With the model, the same inconveniences/ difficulties present in human vascular sutures are simulated, such as delamination of layers, excess of the adventitial layer, and risk of inadvertent suturing of the posterior wall, proving its usefulness in the acquisition of basic microsurgical skills, without need to manipulate human or animal tissues. Practice in this model can take place within the surgical center itself and uses materials that would otherwise be discarded. Conclusion: The use of bovine pericardium to create millimetric sutures mimics human vascular tissue and is a low-cost procedure that allows the training of microsurgical skills.

Pandemia de COVID-19 e a saúde dos estudantes: análise da correlação entre psicopatologias e a síndrome de Burnout / COVID-19 Pandemic and student health: analysis of the correlation between psychopathologies and Burnout syndrome

Analisar a correlação entre estresse, ansiedade e depressão com a síndrome de Burnout em estudantes de graduação de uma universidade pública federal. Trata-se de um estudo exploratório-descritivo, com abordagem quantitativa, que utilizou um questionário on-line para coleta de dados, que ocorreu entre dezembro de 2021 e março de 2022, disponibilizado por e-mail. Participaram 169 discentes, e a correlação entre as variáveis sociodemográficas e as dimensões estresse, ansiedade e depressão evidenciou que os brasileiros, principalmente as mulheres e praticantes de alguma religião, mostraram escores mais elevados. Quanto à síndrome de Burnout, notaram-se valores altos para as dimensões exaustão emocional e eficácia profissional, mas escores baixos para a dimensão descrença. Ao verificar-se a correlação entre a escala de ansiedade, depressão e estresse e a síndrome de Burnout, percebeu-se uma relação negativa entre seus domínios e a eficácia estudantil. Revelou-se também uma correlação entre a depressão e a exaustão emocional.

To analyze the correlation between stress, anxiety, and depression with the Burnout syndrome in undergraduate students at a federal public university. This is an exploratory descriptive study, with a quantitative approach, which used an online questionnaire for data collection, which took place from December 2021 to March 2022, available by email. 169 students participated in the study, in which the correlation between sociodemographic variables and the dimensions stress, anxiety and depression showed that Brazilians, especially women and practitioners of some religion, showed higher scores. As for the Burnout syndrome, high values were observed for the emotional exhaustion and professional efficacy dimensions, but low scores for the disbelief dimension. When verifying the correlation between the anxiety, depression and stress scale and the Burnout syndrome, a negative relationship between its domains and student effectiveness was noticed. A correlation was also revealed between depression and emotional exhaustion.

A promising alternative for mature skin: the effects of phytoestrogens on human skin and its topical use / Alternativa promissora para peles maduras: os efeitos dos fitoestrógenos na pele humana e seu uso tópico

Skin quality deteriorates with age for various reasons, including hormone deficiencies. In women, the decline in estrogen levels during menopause plays an important role in skin degeneration, with consequent atrophy, collagen reduction, loss of elasticity, and impaired wound healing. Research has demonstrated the beneficial effects of topical phytoestrogen in preventing and repairing skin aging, with localized action and without side effects. The objective of this study was to review the relevant literature, demonstrating that this can be a safe and effective alternative for treating the skin of perimenopausal women.

A qualidade da pele deteriora-se com a idade por vários motivos, incluindo as deficiências hormonais. Nas mulheres, o declínio dos níveis de estrógeno, durante a menopausa, tem papel importante na degeneração cutânea, com consequente atrofia, redução do colágeno, perda de elasticidade e deficiência da cicatrização de feridas. Pesquisas têm demonstrado efeitos benéficos do fitoestrogênio tópico na prevenção e reparação do envelhecimento cutâneo, com ação localizada e sem efeitos colaterais. O objetivo deste estudo foi revisar a literatura pertinente ao assunto, demonstrando que esta pode ser uma alternativa segura e eficaz para o tratamento da pele de mulheres na perimenopausa.

Milky secretion after late breast reconstruction with latissimus dorsi musculocutaneous flap with implant / Produção de secreção leitosa após reconstrução mamária tardia com retalho musculocutâneo de latíssimo do dorso com implante

We present a rare case of a 28-year-old patient with invasive ductal carcinoma who underwent neoadjuvant chemotherapy, modified radical mastectomy, radiotherapy, and late breast reconstruction with latissimus dorsi flap associated with the implant. One year later, she underwent reconstruction of the nipple-areola complex over the cutaneous island of the latissimus dorsi flap with a total skin graft from the thigh and graft from the caudal portion of the contralateral papilla. She became pregnant six months after the reconstruction of the nipple-areola complex and, unexpectedly, presented milk production by the reconstructed breast.

Apresentamos um caso raro de uma paciente de 28 anos com carcinoma ductal invasivo submetida a quimioterapia neoadjuvante, mastectomia radical modificada, radioterapia e reconstrução mamária tardia com retalho de latíssimo do dorso associado a implante. Um ano depois, foi submetida a reconstrução do complexo areolopapilar sobre a ilha cutânea do retalho do grande dorsal com enxerto de pele total da coxa e enxerto da porção caudal da papila contralateral. Ela engravidou seis meses após a reconstrução do complexo areolopapilar e, inesperadamente, apresentou produção de leite pela mama reconstruída.

Brazilian Portuguese version of the Patient Scar Assessment Questionnaire / Validação da versão em português do Patient Scar Assessment Questionnaire

Introduction: Scars and their associated signs and symptoms have the potential to impact many aspects of health. Given the growing number of individuals with new scars, it is essential to have reliable, sensitive, and specific assessment tools that analyze the influence that scars can have on the quality of life. The objective is translate the Patient Scar Assessment Questionnaire (PSAQ) into Portuguese, adapt it to the Brazilian cultural context, and test its reproducibility, reliability, and validity. Methods: The questionnaire was applied to 121 individuals with post-surgical scars consecutively selected at a plastic surgery clinic from January 2015 to June 2016. The PSAQ consists of 39 questions divided into five subscales: appearance, symptoms, perception, satisfaction with appearance, and symptoms. Then its reproducibility, face, content, and construct validity were analyzed. Internal consistency was tested using Cronbach's alpha coefficient, and construct validation was performed by correlating the translated instrument with the QualiFibro and Patient and Observer Scar Assessment Scale (POSAS) questionnaires. Results: Analysis of the internal consistency of the PSAQ subscales obtained values >0.70 in all domains, showing good internal consistency. Reproducibility was demonstrated using Pearson's correlation and the Bland-Altman method, and the outcomes showed good reproducibility. In construct validation, a significant correlation was observed in all PSAQ domains with POSAS and QualiFibro. Conclusion: The PSAQ was translated into Portuguese and adapted to Brazilian culture, reproducible and presenting face, content, and construct validity.

Introdução: Cicatrizes e seus sinais e sintomas associados têm potencial para impactar vários aspectos da saúde. Dado o número crescente de indivíduos que adquirem novas cicatrizes, é importante ter ferramentas de avaliação confiáveis, sensíveis e específicas que analisem a influência que as cicatrizes podem exercer sobre a qualidade de vida. O objetivo é traduzir o Patient Scar Assessment Questionnaire (PSAQ) para a língua portuguesa, adaptá-lo ao contexto cultural brasileiro e testar sua reprodutibilidade, confiabilidade e validade. Método: O questionário foi aplicado em 121 indivíduos portadores de cicatrizes pós-cirúrgicas selecionados consecutivamente em ambulatório de cirurgia plástica no período de janeiro de 2015 a junho de 2016. O PSAQ é constituído por 39 questões divididas em cinco subescalas: aparência, sintomas, percepção, satisfação com a aparência e com os sintomas. Foram analisados a reprodutibilidade, validade de face, conteúdo e construto. A consistência interna foi testada pelo alfa de Cronbach e a validação de construto foi realizada correlacionando o instrumento traduzido com os questionários QualiFibro e Patient and Observer Scar Assessment Scale (POSAS). Resultados: A análise da consistência interna das subescalas do PSAQ obteve valores maiores que 0,70 em todos os domínios, evidenciando uma boa consistência interna. A reprodutibilidade foi demonstrada através da correlação de Pearson e método de Bland-Altman, sendo observada boa reprodutibilidade. Na validação de construto observou-se correlação significativa entre todos os domínios do PSAQ com a POSAS e QualiFibro. Conclusão: O PSAQ foi traduzido para o português e adaptado à cultura brasileira, mostrando-se reprodutível e apresentando validade de face, conteúdo e construto.

Frailty syndrome, feelings of impotence and functional capacity in elderly patients with venous ulcers / Síndrome de fragilidade, sentimento de impotência e capacidade funcional em idosos portadores de úlcera venosa

Introduction: Chronic venous ulcers have a negative impact on the physical, psychic, and social domains, affecting the quality of life of patients, especially the elderly. This study aimed to assess frailty, functional capacity, and feelings of helplessness in older people with venous ulcers. Method: 112 older people were divided into two groups according to the presence or absence of venous ulcers. All patients were interviewed using the Edmonton Frail Scale (EFS), Health Assessment Questionnaire-20 (HAQ20), and the Impotence Feelings Measurement Instrument (IMSI) from May 2017 to August 2018. Results: Regarding the EFS score, 76.8% of patients with venous ulcers were classified as vulnerable and frail, compared to 28.6% of patients in the group without ulcers. Scores on the HAQ-20 showed statistically significant differences between groups in all categories of the instrument, indicating that older people with venous ulcers had reduced general functional capacity compared to older people without ulcers. The mean IMSI score was 41.2 for the group with venous ulcers and 33.4 for the group without ulcers. Conclusion: Venous ulcers had a negative impact on functional capacity and increased frailty and feelings of powerlessness in the elderly.

Introdução: Úlceras venosas crônicas exercem impacto negativo nos domínios físico, psíquico e social, afetando a qualidade de vida de pacientes, especialmente os idosos. O objetivo deste estudo foi avaliar o nível de fragilidade, capacidade funcional e sentimento de impotência em idosos com úlcera venosa. Método: Um total de 112 idosos foram distribuídos em dois grupos de acordo com a presença ou ausência úlcera venosa. Todos os pacientes foram entrevistados utilizando-se os questionários Edmonton Frail Scale (EFS), Health Assessment Questionnaire-20 (HAQ-20) e o Instrumento de Medida de Sentimento de Impotência (IMSI) no período de maio de 2017 a agosto de 2018. Resultados: Em relação à pontuação na EFS, 76,8% dos pacientes com úlcera venosa foram classificados como vulneráveis e frágeis, em comparação a 28,6% dos pacientes do grupo sem úlcera. Pontuações no HAQ-20 mostraram diferenças estatisticamente significantes entre os grupos em todas as categorias do instrumento, indicando que idosos com úlcera venosa apresentavam redução da capacidade funcional geral em comparação aos idosos sem úlcera. A pontuação média para o IMSI foi de 41,2 para o grupo com úlcera venosa e 33,4 para o grupo sem úlcera. Conclusão: Úlceras venosas causaram impacto negativo na capacidade funcional e aumento de fragilidade e sentimento de impotência nos idosos.

Augmentation mammoplasty and autologous fat transplantation: an alternative for the treatment of hypomastia and mild pectus excavatum - Case report / Mamoplastia de aumento e transplante de gordura autóloga: uma alternativa para o tratamento da hipomastia e pectus excavatum leve - Relato de caso

Pectus excavatum(PE) is a congenital chest deformity characterized by deep depression in the sternum. Autologous fat transplantation has been used for aesthetic purposes, mainly on the face, and has recently gained relevance in thoracic and breast surgeries. The present study aims to present a case of mild PE associated with hypomastia. A 24-year-old female patient attended the consultation for breast augmentation due to hypomastia, but the clinical examination also revealed an associated mild PE that the patient did not notice. Surgical planning included breast augmentation and autologous fat transfer. A 260ml silicone breast implant was used, and 250ml of fat was injected in the sternal region and the lower medial contour of the breasts. There were no complications during the 12-month follow-up period. The combination of augmentation mammoplasty and fat transplantation in treating PE deformity proved to be a minimally invasive, good, safe option with high patient satisfaction.

Pectus excavatum (PE) é uma deformidade torácica congênita, caracterizada como uma depressão profunda no esterno. O transplante autólogo de gordura tem sido utilizado para fins estéticos, principalmente na face, e recentemente ganhou relevância nas cirurgias torácica e das mamas. O objetivo do presente estudo é apresentar um caso de PE leve associado a hipomastia. Uma paciente de 24 anos compareceu à consulta para mamoplastia de aumento por hipomastia, mas o exame clínico também revelou um PE leve associado que não foi percebido pela paciente. O planejamento cirúrgico incluiu a mamoplastia de aumento e a transferência de gordura autóloga. Foi utilizado um implante mamário de silicone de 260ml, e uma quantidade total de 250ml de gordura foi injetada na região esternal e no contorno medial inferior das mamas. Não houve complicações durante o período de acompanhamento de 12 meses. A associação de mamoplastia de aumento e transplante de gordura no tratamento da deformidade de PE revelou-se uma opção minimamente invasiva, boa, segura e com alta satisfação da paciente.

Proposal for Educational Intervention in People Living with Type 2 Diabetes Mellitus and in their Family Caregiver

Objective: Design a proposal of educational intervention for both, people who live with Diabetes Mellitus type 2 and their family caregiver. Methodology: Methodology. A case series study was conducted with the participation of 12 people living with type 2 diabetes mellitus and attending a Mutual Help Group in Pachuquilla, Hidalgo. Sociodemographic data, somatometric measurements (weight, height, BMI, waist circumference), blood pressure, and capillary blood samples for glycosylated hemoglobin were collected. Results: The mean age was 64 and range of 39-79 years, O.D. of 12; 67% women; 25% finished secondary school, 50% worked at home, 17% in commerce, 33% unemployed; 58% married, 25% widowed, and 17% divorced and in common law; 33.% with less than 5 years diagnosed, 67% have been diagnosed for more than 5 years; 75% depend economically; 67% have complications, 75% with family support, in diabetes knowledge 33% obtained intermediate score and 67% inadequate score; the weight average was of 77 kg and range of 57-116.5 kg, and O.D. 17 kg; in waist circumference, 100% exceed the recommended limit, in BMI, 50% is classified as overweight and 50% as obese; in blood pressure 50% > 130/80 mmHg and in glycosylated hemoglobin 75% > 7% mg/dl. Conclusion: The currently implemented strategy does not reflect good knowledge and control of the disease. This study invites us to continue with research where an educational intervention is implemented in which family caregivers are included and active participation is encouraged, in addition to implementing the IEP as a theoretical basis for the intervention.

A novel method for testing accuracy of bite registration using intraoral scanners / 대한치과교정학회지

Objective@#The evidence on the accuracy of bite registration using intraoral scanners is sparse. This study aimed to develop a new method for evaluating bite registration accuracy using intraoral scanners. @*Methods@#Two different types of models were used; 10 stone models and 10 with acrylic resin teeth. A triangular frame with cylindrical posts at each apex (one anterior and two posteriors) was digitally designed and manufactured using three-dimensional (3D) printing. Such a structure was fitted in the lingual space of each maxillary and mandibular model so that, in occlusion, the posts would contact their opposing counterparts, enforcing a small interocclusal gap between the two arches. This ensured no tooth interference and full contact between opposing posts. Bite registration accuracy was evaluated by measuring the distance between opposing posts, with small values indicating high-accuracy. Three intraoral scanners were used: Medit i500, Primescan, and Trios 4. Viewbox software was used to measure the distance between opposing posts and compute roll and pitch. @*Results@#The average maximum error in interocclusal registration exceeded 50 μm. Roll and pitch orientation errors ranged above 0.1 degrees, implying an additional interocclusal error of around 40 μm or more. The models with acrylic teeth exhibited higher errors. @*Conclusions@#A method that avoids the need for reference hardware and the imprecision of locating reference points on tooth surfaces, and offers simplicity in the assessment of bite registration with an intraoral scanner, was developed. These results suggest that intraoral scanners may exhibit clinically significant errors in reproducing the interocclusal relationships.

Occupational Lung Diseases: Spectrum of Common Imaging Manifestations

Occupational lung diseases (OLD) are a group of preventable conditions caused by noxious inhalation exposure in the workplace. Workers in various industries are at a higher risk of developing OLD. Despite regulations contributing to a decreased incidence, OLD remain among the most frequently diagnosed work-related conditions, contributing to significant morbidity and mortality. A multidisciplinary discussion (MDD) is necessary for a timely diagnosis. Imaging, particularly computed tomography, plays a central role in diagnosing OLD and excluding other inhalational lung diseases. OLD can be broadly classified into fibrotic and non-fibrotic forms. Imaging reflects variable degrees of inflammation and fibrosis involving the airways, parenchyma, and pleura. Common manifestations include classical pneumoconioses, chronic granulomatous diseases (CGD), and small and large airway diseases. Imaging is influenced by the type of inciting exposure. The findings of airway disease may be subtle or solely uncovered upon expiration. High-resolution chest CT, including expiratory-phase imaging, should be performed in all patients with suspected OLD. Radiologists should familiarize themselves with these imaging features to improve diagnostic accuracy.

Risk of Cognitive Impairment in Patients With Parkinson’s Disease With Visual Hallucinations and Subjective Cognitive Complaints

Background@#and Purpose Visual hallucinations (VH) and subjective cognitive complaints (SCC) are associated with cognitive impairment (CI) in Parkinson’s disease. Our aims were to determine the association between VH and SCC and the risk of CI development in a cohort of patients with Parkinson’s disease and normal cognition (PD-NC). @*Methods@#Patients with PD-NC (total score of >80 on the Parkinson’s Disease Cognitive Rating Scale [PD-CRS]) recruited from the Spanish COPPADIS cohort from January 2016 to November 2017 were followed up after 2 years. Subjects with a score of ≥1 on domain 5 and item 13 of the Non-Motor Symptoms Scale at baseline (V0) were considered as “with SCC” and “with VH,” respectively. CI at the 2-year follow-up (plus or minus 1 month) (V2) was defined as a PD-CRS total score of <81. @*Results@#At V0 (n=376, 58.2% males, age 61.14±8.73 years [mean±SD]), the frequencies of VH and SCC were 13.6% and 62.2%, respectively. VH were more frequent in patients with SCC than in those without: 18.8% (44/234) vs 4.9% (7/142), p<0.0001. At V2, 15.2% (57/376) of the patients had developed CI. VH presenting at V0 was associated with a higher risk of CI at V2 (odds ratio [OR]=2.68, 95% confidence interval=1.05–6.83, p=0.039) after controlling for the effects of age, disease duration, education, medication, motor and nonmotor status, mood, and PD-CRS total score at V0. Although SCC were not associated with CI at V2, presenting both VH and SCC at V0 increased the probability of having CI at V2 (OR=3.71, 95% confidence interval=1.36–10.17, p=0.011). @*Conclusions@#VH were associated with the development of SCC and CI at the 2-year follow-up in patients with PD-NC.

Fibromatosis subescapular como causa de escápula alada. Presentación de un caso y revisión bibliográfica / Subscapularis fibromatosis as a cause of winged scapula. Case report and literature review

La escápula alada suele producirse por lesiones neurológicas tanto del nervio espinal como del nervio torácico largo. La aparición a causa de un tumor ventral de la escápula dificulta su diagnóstico inicial. Presentamos el caso de una mujer joven, con limitación para la rotación externa del hombro, sin antecedentes traumáticos conocidos, evolución progresiva e imagen compatible con una lesión de partes blandas dependiente de la aponeurosis del músculo subescapular confirmada por biopsia como un tumor desmoide. Aunque se trata de un tumor benigno y autolimitado, tiene una inquietante alta tasa de recidivas después de la resección, por lo que se dispone de numerosos tratamientos y muchos grupos optan por hacer un seguimiento médico estrecho de los factores pronósticos y las limitaciones funcionales del paciente, con lo que obtienen resultados satisfactorios y, en algunas series, superiores a los del tratamiento quirúrgico. Nivel de Evidencia: IV

Winged scapula is usually caused by neurological injuries to both the spinal nerve and the long thoracic nerve. Its presence as a result of a ventral scapular tumor makes initial diagnosis difficult. We present the case of a young woman with limited external shoulder rotation, no known traumatic history, and images consistent with a soft tissue lesion dependent on subscapular muscle aponeurosis, which was confirmed by biopsy as a desmoid tumor. Although it is a benign, self-limiting tumor, it has an alarmingly high rate of relapse after resection, so many treatments are available, and many teams choose to closely monitor the patient's prognostic factors and functional limitations, obtaining satisfactory outcomes and, in some series, superior to those of surgical treatment. Level of Evidence: IV

Gestão unificada dos prontuários como ferramenta de gestão em Centro Pós-COVID / Unified management of medical records as a management tool in a post-COVID center / Gestión unificada de históriasclínicas como herramienta de gestión en un centro post-COVID

Objetivo: Relatar a experiência dos integrantes do PET-Saúde Gestão e Assistência na implantação da gestão unificada de prontuários em Centro Tratamento Pós-Covid no interior baiano. Método:Trata-se de um relato de experiência sobre a vivência do grupo tutorial GT05 do PET-Saúde da Universidade Estadual de Feira de Santana no centro especializado no período de agosto de 2022 a julho de 2023. Resultados:As atividades de organização e unificação dos prontuários ocorreram entre maio a julho de 2023, sendo organizados 1.481 fichas de atendimentos em pastas, com codificação numérica de A01 ao Z006, correspondente às letras alfabéticas de A a Z, não sendo possível a conclusão, pelo término das atividades do programa no cenário de prática. Os recepcionistas e coordenação do serviço acompanharam as atividades de codificação numérica das fichas para darem sequência à organização, sendo disponibilizado o arquivo com banco de dados dos usuários. Conclusão:A experiência da gestão unificada dos prontuários, possibilitou aos integrantes uma reflexão sobre as ferramentas de gestão e a importância do conhecimento do serviço para a implementação de propostas resolutivas que contribuam para a organização da gestão em saúde, facilitando o trabalho da equipe multidisciplinar e possibilitando a visão ampliada dos processos de trabalho

Objective: To report the experience of the members of the PET-Saúde Gestão e Assistência in the implementation of the unified management of medical records in a Post-Covid Treatment Center in the interior of Bahia. Method:This is an experience report on the experience of the tutorial group GT05 of PET-Saúde at the State University of Feira de Santana in the specialized center from August 2022 to July 2023. Results:The organization and unification activities of the medical records took place between May and July 2023, with 1.481 attendance sheets being organized in folders, with numerical coding from A01 to Z006, corresponding to the alphabetic letters from A to Z, and it was not possible to conclude, due to the end of the program's activities in the scenario of practice. The receptionists and service coordination followed the numerical coding activities of the forms to continue the organization, and the file with the users' database was made available. Conclusion: The experience of unified management of medical records allowed the membersto reflect on the management tools and the importance of knowledge of the service for the implementation of resolution proposals that contribute to the organization of health management, facilitating the work of the multidisciplinary team and enabling a broader view of work processes.

Objetivo: Informar la experiencia de los integrantes del PET-Saúde Gestão e Assistência en la implementación de la gestión unificada de registros médicos en un Centro de Tratamiento Post-Covid en el interior de Bahia. Método: Se trata de un relato de experiencia sobre la experiencia del grupo tutorial GT05 del PET-Saúde en la Universidad Estadual de Feira de Santana en el centro especializado de agosto de 2022 a julio de 2023. Resultados:Las actividades de organización y unificación de las historias clínicas tomaron lugar entre mayo y julio de 2023, con 1.481 hojas de asistencia organizadas en carpetas, con codificación numérica de A01 a Z006, correspondientes a las letras del alfabeto de la A a la Z, y no fue posible concluir, por la finalización de las actividades del programa en el escenario de la práctica. Las recepcionistas y la coordinación del servicio siguieron las actividades de codificación numérica de los formularios para continuar con la organización, y se dispuso el archivo con la base de datos de los usuarios. Conclusión:La experiencia de gestión unificada de prontuarios permitió a los integrantes reflexionar sobre las herramientas de gestión y la importancia del conocimiento del servicio para la implementación de propuestas de resolución que contribuyan a la organización de la gestión en salud, facilitando el trabajo del equipo multidisciplinario y permitiendo una visión más amplia de los procesos de trabajo.

Pesquisa de satisfação do usuário em Centro Pós-covid: vivências de integrantes PET-Saúde "gestão e assistência / User satisfaction research in a Post-covid Center: experiences of PET-Health "management and care" members / Encuesta de satisfacción de usuarios en un Centro Postcovídico: experiencias de los miembros de PET-Saúde "gestión y asistencia

Objetivo: Relatar a experiência de implantação da pesquisa de satisfação do usuário em um Centro Pós-Covid. Método:Trata-se de um relato de experiência que descreve a vivência de integrantes do PET-Saúde Gestão e Assistência no período de agosto de 2022 a julho de 2023 a partir da análise da pesquisa de satisfação confeccionada como instrumento de gestão em saúde para avaliação e aprimoramento do atendimento público ambulatorial. Resultados:A nova proposta da pesquisa de satisfação teve sua construção baseada em três planos de respostas: primeiro, segundo e terceiro momento. A análise foi composta por 23 fichas preenchidas e analisadas. O instrumento trouxe um direcionamento com maior clareza quanto às necessidades de melhoria do serviço relatadas pelos usuários, antes não detectadas. Conclusão:a implementação do instrumento representou a possibilidade de um novo olhar da gestão referente a participação dos usuários com vistas a melhoria dos atendimentos.

Objective:To report on the experience of implementing user satisfaction research in a Post-Covid Center. Method:This is an experience report that describes the experience of members of the PET-Health Management and Care program from August 2022 to July 2023, based on the analysis of the satisfaction survey prepared as a health management tool for the evaluation and improvement of public outpatient care. Results:The new proposal of the satisfaction survey had its construction based on three response plans: first, second and third moment. The analysis consisted of 23 completed and analyzed forms. The instrument brought a clearer direction regarding the needs for service improvement reported by users, previously undetected. Conclusion:the implementation of the instrument represented the possibility of a new look of management regarding the participation of users with a view to improving care

Objetivo:Relatar la experiencia de implantación de la pesquisa de satisfacción del usuario en un Centro Pós-Covid. Método:Se trata de un relato de experiencia que describe la vivencia de los integrantes del PET-Saúde Gestão e Assistência en el período de agosto de 2022 a julio de 2023 a partir del análisis de la encuesta de satisfacción confeccionada como instrumento de gestión en salud para la evaluación y aprimoramiento de la atención pública ambulatoria. Resultados:La nueva propuesta de encuesta de satisfacción tuvo su construcción basada en tres planes de respuesta: primer, segundo y tercer momento. El análisis consistió en 23 formularios completados y analizados. El instrumento aportóuna orientación más clara en cuanto a las necesidades de mejora del servicio señaladas por los usuarios, antes no detectadas. Conclusión:la aplicación del instrumento representó la posibilidad de una nueva mirada de la gestión en cuanto a la participación de los usuarios con vistas a mejorar la atención

Quality of breast reconstruction service at a university hospital as assessed by the patients

Purpose: To evaluate the quality of breast reconstruction service at a university hospital, as assessed by the patients. Methods: This cross-sectional study enrolled adult women who underwent immediate or delayed breast reconstruction by any technique performed at a university hospital between 1 and 24 months before the assessment. The Brazilian version of the Health Service Quality Scale (HSQS) was self-applied to the participants. The HSQS produces percentage scores, which are expressed in values ranging from 0 to 10 for each domain of the scale, and into an overall percentage quality score. The management team was asked to establish a minimum satisfactory score for the breast reconstruction service. Results: Ninety patients were included. The management team considered 8.00 the minimum satisfactory score for the service. The overall percentage score was 93.3%. Only one domain, 'Support,' had an average score lower than that considered satisfactory (7.22 ± 3.0); while the others had higher scores. The domain that scored highest was 'Qualification' (9.94 ± 0.3), followed by 'Result' (9.86 ± 0.4). There was a positive correlation between 'type of oncologic surgery' and 'intentions of loyalty to the service' (ρ = 0.272; p = 0.009) and a negative correlation between 'education' and 'quality of the environment' (ρ = ­0.218; p = 0.039). The higher the patient's level of education, the higher the score attributed to 'relationship' (ρ = 0.261; p = 0.013) and the lower the score of 'aesthetics and functionality' (ρ = ­0.237; p = 0.024). Conclusion: The quality of the breast reconstruction service was considered satisfactory, but there is a demand for structural improvements, better interpersonal relationships, and a stronger support network for patients.

Formación docente en los médicos de la atención primaria de salud / Teaching training in primary health care physicians

Fundamento: el nivel académico superior en la atención primaria de salud tiene importante repercusión en la formación de los futuros profesionales, por lo que es necesario atender las necesidades de superación pedagógica con vistas a perfeccionar la competencia y desempeño en esta tarea. Objetivo: diagnosticar las necesidades de superación pedagógica en médicos de la atención primaria de salud pertenecientes al Policlínico Universitario "Juana Naranjo León" de Sancti Spíritus, Cuba. Métodos: se realizó un estudio observacional, descriptivo, de corte transversal. Su contexto fueron los escenarios docentes asistenciales del Policlínico Universitario "Juana Naranjo León" de Sancti Spíritus, en el período comprendido de 2020-2021. Para fundamentar la investigación se utilizaron métodos teóricos (análisis-síntesis e inducción-deducción) y empíricos (revisión documental y cuestionario). Se emplearon procedimientos de estadística descriptiva (frecuencia absoluta y relativa), para el análisis e interpretación de los resultados. Resultados: se evidenció limitada preparación docente e insuficiente desempeño en la formación educativa para garantizar la calidad del proceso enseñanza aprendizaje, a partir de la baja categorización y el escaso número de actividades e investigaciones de corte académico. Conclusiones: el estudio realizado permitió conocer el estado actual de los conocimientos y preparación docente-metodológica del claustro de la institución en el primer nivel de atención médica. Estos profesionales requieren atención prioritaria para el desempeño formativo, y alcanzar con ello la excelencia en el proceso docente-educativo.

Background: the higher academic level in primary health care has an important impact on the training of future professionals, so it is necessary to meet the needs of pedagogical improvement with a view to improving competence and performance in this task. Objective: to diagnose the needs for pedagogical improvement in PHC doctors belonging to the "Juana Naranjo León" University Polyclinic in Sancti Spíritus, Cuba. Methods: an observational, descriptive, cross-sectional study was carried out. Its context was the teaching assistance scenarios of the "Juana Naranjo León" University Polyclinic in Sancti Spíritus, from 2020 to 2021. Theoretical methods were used to support the research: (analysis-synthesis and induction-deduction) and empirical ones (documentary review and questionnaire). Descriptive statistical procedures (absolute and relative frequency) were used for the analysis and interpretation of the results. Results: limited teaching preparation and insufficient performance in educational training were evidenced to guarantee the quality of the teaching-learning process, taking into account the low categorization and the small number of activities and academic research. Conclusions: the study allowed us to know the current state of knowledge and teaching-methodological preparation of the teaching staff of the institution at the first level of medical care, which require priority attention for training performance, and thereby achieve excellence in the teaching-learning process.

Women's Childbirth Experiences During COVID-19 Pandemic in Indonesia / Experiências de parto de mulheres durante a pandemia de COVID-19 na Indonésia / Experiencias de parto de las mujeres durante la pandemia de COVID-19 en Indonesia

ABSTRACT Objective: Explore in depth the experiences of women giving birth during the COVID-19 pandemic in Indonesia. Methods: Qualitative research with a descriptive phenomenological. A total of 16 participants did not suffer from COVID-19 and gave birth during the COVID-19 pandemic in the community setting area. Results: There are five themes: 1: Feelings of anxiety and fear of giving birth in hospitals are experienced by women giving birth during the COVID-19 pandemic, 2. Screening for COVID and health protocols applied in hospitals during the COVID-19 pandemic, 3. Support from husbands, families, and health workers is needed when giving birth during the COVID-19 pandemic, 4. Lack of family visits hours is an obstacle during childbirth, particularly during the COVID-19 pandemic, and 5: Bonding attachment between mother and baby while at the hospital. Conclusion: Optimal maternity nursing care and supporting health facilities and public policies will help mothers give birth during the COVID-19 pandemic in Indonesia.

RESUMO Objetivo: Explorar em profundidade as experiências de mulheres que deram à luz durante a pandemia de COVID-19 na Indonésia. Métodos: Pesquisa qualitativa com abordagem fenomenológica descritiva. Um total de 16 participantes que não sofriam de COVID-19 deram à luz durante a pandemia de COVID-19 no ambiente comunitário. Resultados: Há cinco temas: 1: Sentimentos de ansiedade e medo de dar à luz em hospitais são vivenciados por mulheres que dão à luz durante a pandemia de COVID-19, 2. Triagem para COVID e protocolos de saúde aplicados em hospitais durante a pandemia de COVID-19, 3. O apoio de maridos, famílias e profissionais de saúde é necessário durante o parto na pandemia de COVID-19, 4. A falta de horário para visitas familiares é um obstáculo durante o parto, principalmente durante a pandemia de COVID-19, e 5: Vínculo entre mãe e bebê no hospital. Conclusão: Os cuidados ideais de enfermagem na maternidade e o apoio das unidades de saúde e políticas públicas ajudarão as mães a dar à luz durante a pandemia de COVID-19 na Indonésia.

RESUMEN Objetivo: Explorar en profundidad las experiencias de las mujeres que dieron a luz durante la pandemia de COVID-19 en Indonesia. Métodos: Investigación cualitativa con enfoque fenomenológico descriptivo. Un total de 16 participantes que no sufrieron de COVID-19 dieron a luz durante la pandemia de COVID-19 en el entorno comunitario. Resultados: Hay cinco temas: 1: Los sentimientos de ansiedad y miedo de dar a luz en los hospitales son experimentados por las mujeres que dan a luz durante la pandemia de COVID-19, 2. Detección de COVID y protocolos de salud aplicados en los hospitales durante la pandemia de COVID-19, 3. Se necesita el apoyo de esposos, familias y trabajadores de la salud cuando se da a luz durante la pandemia de COVID-19, 4. La falta de horarios de visitas familiares es un obstáculo durante el parto, particularmente durante la pandemia de COVID-19, y 5: Vínculo entre madre y bebé mientras están en el hospital. Conclusión: la atención de enfermería de maternidad óptima y el apoyo de los centros de salud y las políticas públicas ayudarán a las madres a dar a luz durante la pandemia de COVID-19 en Indonesia.

Aplicación de la Teoría del Cuidado Cultural a la investigación: prácticas de cuidado preventivas de hantavirus / Applying Cultural Care Theory to research: hantavirus preventive care practices

INTRODUCCIÓN: La investigación en enfermería surge de las necesidades y experiencias en la práctica y debe contribuir a generar, redefinir y actualizar el conocimiento de enfermería a través de comprobación o generación de nuevas teorías de enfermería. El conocimiento nuevo generado o actualizado debe retornar y mejorar la práctica del cuidado de enfermería dirigido las personas, familia y comunidad. Sin embargo en ocasiones la interrelación investigación y teoría no es clara, afectando de esta manera la relevancia de la aplicación de las teorías de enfermería en la práctica del cuidado de enfermería. OBJETIVO: La presente reflexión responde al objetivo de ejemplificar cómo se aplicó la Teoría del Cuidado Cultural Universalidad y Diversidad de Leininger al estudio del fenómeno de las prácticas de cuidado preventivas de hantavirus. DESARROLLO: Sistematización crítica de la experiencia investigativa a través de una propuesta metodológica, que describe cómo la Teoría del Cuidado Cultural Universalidad y Diversidad de Leininger guio el proceso de investigación sobre las prácticas de cuidado preventivas de hantavirus, factores personales, sociales, modos de vida y creencias culturales. CONCLUSIONES: Un elemento fundamental en toda investigación de enfermería es mostrar de manera clara y explícita cómo la teoría se interconecta con todas las fases de la investigación y en consecuencia genera conocimiento de enfermería para la práctica del cuidado.

INTRODUCTION: Nursing research arises from needs and experiences in practice and should contribute to generate, redefine and update nursing knowledge by testing or developing new nursing theories. Such new or updated knowledge should lead to improvements in the practice of nursing care applied to persons, family, and community. However, sometimes the interrelationship between research and theory is unclear, affecting the relevance of such theories to nursing care practice. OBJECTIVE: The present reflection aims to exemplify how Leininger's Theory of Cultural Care Universality and Diversity was applied to the study of hantavirus preventive care practices. DEVELOPMENT: Critical systematization of the research experience through a proposed methodology that describes how Leininger's Theory of Cultural Care Universality and Diversity guided research related to hantavirus preventive practices, personal and social factors, lifestyles, and cultural beliefs. CONCLUSIONS: A fundamental element in all nursing research is to clearly and explicitly show how theory interfaces with all phases of research and consequently generates nursing knowledge for caring practice.