Full Financial Education Programmes for People with Disabilities: a Scoping Review / Programas Integrais de Educação Financeira para Pessoas com Incapacidade: uma Revisão de Literatura

ABSTRACT: Financial literacy has been recognised worldwide as a way to confront social inequalities in work access, own financial control and education, particularly among vulnerable groups. People with disabilities, especially those with intellectual and developmental disabilities, experience additional challenges accessing opportunities to learn financial-related competencies. There is an extensive bibliography on this subject that stretches for decades, but this does not translate into an extensive availability of science-based programmes. To our knowledge, no comprehensive search to find the gaps in this evidence has been conducted. We conducted a scoping review that sought to identify the core goals, contents, approaches, gaps and limitations of full financial education programmes for youths and adults with disabilities. Seven publications met the inclusion criteria, which included implementation of programmes that embrace a multidimensional set of skills. Selection and categorisation of the programmes' contents were conducted independently by three researchers. Findings suggest that money and transactions is the content most consistently addressed in the programmes designed for persons with disabilities. A stronger focus on self-determination skills is needed to support financial-related decision-making and self-advocacy. The results indicate that the use of approaches based on Universal Design for Learning, problem-based learning and the combined use of simulated and community-based instruction are critical strategies to support access to financial competencies. Gaps and future orientations include the need to broaden the number of studies that implement and evaluate programmes considering the multidimensional nature of the financial competencies and its critical role for social inclusion of people with disabilities.

RESUMO: A literacia financeira tem sido reconhecida mundialmente como uma forma de responder a desigualdades sociais no acesso ao trabalho, controlo financeiro e educação, principalmente em grupos vulneráveis. As pessoas com incapacidade, principalmente intelectual e desenvolvimental, enfrentam barreiras adicionais no acesso a oportunidades para a aprendizagem de competências financeiras. A bibliografia é extensa e estende-se por décadas, mas não resulta na mesma proporção em programas completos, baseados na evidência, e que estejam disponíveis. No nosso conhecimento, não existe uma revisão detalhada direcionada para as lacunas desta evidência. Realizamos uma revisão do tipo Scoping Review para identificar os objectivos, conteúdos, abordagens, lacunas e limitações de programas integrais para a Educação Financeira dirigidos a jovens e adultos com Incapacidade. Foram selecionadas sete publicações que cumpriam os critérios de inclusão, designadamente a implementação de programas que englobassem um espectro multidimensional de competências. A selecção e a categorização dos conteúdos dos programas foram conduzidos independentemente por três investigadores. Os resultados sugerem que o uso de dinheiro e as transacções constituem os conteúdos mais abordados nos programas. Parece ser necessário um maior enfoque nas competências de autodeterminação para apoiar tomadas de decisão e autoadvocacia na vida financeira. As abordagens baseadas no Desenho Universal para a Aprendizagem, a Aprendizagem Baseada em Problemas e o uso combinado de aprendizagem em contexto simulado e real foram identificadas como estratégias fundamentais. As lacunas e as orientações para o futuro incluem a necessidade de ampliar o número de estudos que implementem e avaliem programas assentes na natureza multidimensional das competências financeiras e no seu papel crítico na inclusão social de pessoas com incapacidade.

The role of pacas of captivity as a potential reservoir of zoonotic fungi in Acre, Western Amazon, Brazil / O papel de pacas de cativeiro como potencial reservatório de fungos zoonóticos no Acre, Amazônia Ocidental, Brasil

Wild animals can be natural reservoirs of different microorganisms, essential for monitoring these pathogens for the generation of knowledge and creation of tools aimed at programs for the prevention and control of infectious diseases, including zoonoses. The objective was to report the fungal diversity in the skin of pacas in captivity in Acre, Western Amazon, Brazil. Twenty-six animals were evaluated, from which skin samples were collected by superficial scraping, hair avulsion, and sterile plastic brush. The samples were seeded on Mycosel agar, and the phenotypic characteristics of the colonies were analyzed. In 80.8% of the samples, different fungi were isolated, from the genera Candida, Microsporum,and Trichophyton, among others. This is the first description of the identification of fungi in the skin of pacas and suggests that these animals can be considered essential reservoirs of saprophytic or pathogenic microorganisms with zoonotic potential in the Western Amazon.(AU)

Animais silvestres podem ser reservatórios naturais de diferentes microrganismos, sendo fundamental o monitoramento destes patógenos para a geração de conhecimento e criação de ferramentas direcionadas a programas de prevenção e controle de enfermidades infecciosas, incluindo as zoonoses. Assim, objetivou-se relatar a diversidade fúngica da pele de pacas criadas em cativeiro no Acre, Amazônia Ocidental, Brasil. Foram avaliados 26 animais, dos quais amostras cutâneas foram colhidas por raspagem superficial, avulsão pilosa e escova plástica estéril. As amostras foram semeadas em ágar Mycosel e as características fenotípicas das colônias foram analisadas. Em 80,8% das amostras houve isolamento de diferentes fungos, dos gêneros Candida, Microsporum e Trichophyton, dentre outros. Esta é a primeira descrição da identificação de fungos na pele de pacas e sugere que estes animais podem ser considerados importantes reservatórios de microrganismos saprófitas ou patogênicos, de potencial zoonótico, na Amazônia Ocidental.(AU)

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary Sjögren syndrome: results of an epidemiologic systematic review/ meta-analysis and a consensus guideline from the Brazilian society of rheumatology (hepatic, gastrointestinal and pancreatic)

Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, some systemic manifestations, mainly liver, gastrointestinal, and pancreatic are not routinely evaluated. To address these manifestations, the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology conducted a broad systematic review of the literature on studies investigating prevalence and diagnosis of these symptoms in Sjogren´s patients and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. This is the second part of this guideline, providing 6 recommendations for liver, gastrointestinal, and pancreatic care of SS patients.

Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force

Abstract Objective: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle-Ottawa Scale to assess the quality of nonrandomized studies. Results: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.

Factors associated with hospitalizations for Covid-19 in patients with rheumatoid arthritis: data from the Reumacov Brazil registry

Abstract Background: Patients using immunosuppressive drugs may have unfavorable results after infections. However, there is a lack of information regarding COVID 19 in these patients, especially in patients with rheumatoid arthritis (RA). Therefore, the aim of this study was to evaluate the risk factors associated with COVID 19 hospitalizations in patients with RA. Methods: This multicenter, prospective cohort study is within the ReumaCoV Brazil registry and included 489 patients with RA. In this context, 269 patients who tested positive for COVID 19 were compared to 220 patients who tested negative for COVID 19 (control group). All patient data were collected from the Research Electronic Data Capture database. Results: The participants were predominantly female (90.6%) with a mean age of 53 ±12 years. Of the patients with COVID 19, 54 (20.1%) required hospitalization. After multiple adjustments, the final regression model showed that heart disease (OR =4.61, 95% CI 1.06-20.02. P < 0.001) and current use of glucocorticoids (OR =20.66, 95% CI 3.09-138. P < 0.002) were the risk factors associated with hospitalization. In addition, anosmia was associated with a lower chance of hospitalization (OR =0.26; 95% CI 0.10-0.67, P < 0.005). Conclusion: Our results demonstrated that heart disease and the use of glucocorticoids were associated with a higher number of hospital admissions for COVID 19 in patients with RA. Trial registration: Brazilian Registry of Clinical Trials RBR 33YTQC.

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary sjogren syndrome: results of an epidemiologic systematic review/ meta-analysis and a consensus guideline from the Brazilian Society of Rheumatology (articular, pulmonary and renal)

Abstract Sjogren's Syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, these systemic manifestations are not routinely evaluated and there is no homogenous approach to their diagnosis or evaluation. To close this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of these manifestations and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. The first part of this guideline summarizes the most important topics, and 11 recommendations are provided for the articular, pulmonary, and renal care of SS patients.

Chronic use of hydroxychloroquine did not protect against COVID-19 in a large cohort of patients with rheumatic diseases in Brazil

Abstract Background: There is a lack of information on the role of chronic use of hydroxychloroquine during the SARS-CoV-2 outbreak. Our aim was to compare the occurrence of COVID-19 between rheumatic disease patients on hydroxychloroquine with individuals from the same household not taking the drug during the first 8 weeks of community viral transmission in Brazil. Methods: This baseline cross-sectional analysis is part of a 24-week observational multi-center study involving 22 Brazilian academic outpatient centers. All information regarding COVID-19 symptoms, epidemiological, clinical, and demographic data were recorded on a specific web-based platform using telephone calls from physicians and medical students. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. Mann-Whitney, Chi-square and Exact Fisher tests were used for statistical analysis and two binary Final Logistic Regression Model by Wald test were developed using a backward-stepwise method for the presence of COVID-19. Results: From March 29th to May 17st, 2020, a total of 10,443 participants were enrolled, including 5166 (53.9%) rheumatic disease patients, of whom 82.5% had systemic erythematosus lupus, 7.8% rheumatoid arthritis, 3.7% Sjögren's syndrome and 0.8% systemic sclerosis. In total, 1822 (19.1%) participants reported flu symptoms within the 30 days prior to enrollment, of which 3.1% fulfilled the BMH criteria, but with no significant difference between rheumatic disease patients (4.03%) and controls (3.25%). After adjustments for multiple confounders, the main risk factor significantly associated with a COVID-19 diagnosis was lung disease (OR 1.63; 95% CI 1.03-2.58); and for rheumatic disease patients were diagnosis of systemic sclerosis (OR 2.8; 95% CI 1.19-6.63) and glucocorticoids above 10 mg/ day (OR 2.05; 95% CI 1.31-3.19). In addition, a recent influenza vaccination had a protective effect (OR 0.674; 95% CI 0.46-0.98). Conclusion: Patients with rheumatic disease on hydroxychloroquine presented a similar occurrence of COVID-19 to household cohabitants, suggesting a lack of any protective role against SARS-CoV-2 infection. Trial registration Brazilian Registry of Clinical Trials (ReBEC; RBR - 9KTWX6).

2021 recommendations of the Brazilian Society of Rheumatology for the gynecological and obstetric care of patients with Sjogren's syndrome

Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs. Women with SS often experience gynecological symptoms due to the disease and need extra care regarding their sexual activity, reproductive health and during pregnancy, conditions that are not properly conducted in the clinical practice. To cover this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of symptoms, diagnosis, monitoring, prognosis, and treatment of these manifestations. A Focus Group meeting was held and included experts in the field and methodologists, based on a previously developed script, with themes related to the objective of the study. The most important topics were summarized and 11 recommendations were provided.

Saúde mental e trabalho na saúde da família: relato de experiência / Mental health and work in a family health: an experience report / Salud mental y trabajo en la salud de la familia: relato de experiencia

Este é um relato sobre uma experiência em saúde mental e trabalho no contexto de uma unidade da Saúde da Família, principal política para viabilizar a atenção básica no Sistema Único de Saúde. Foi desenvolvida durante um estágio de Psicologia. O objetivo foi relatar uma experiência numa unidade de Saúde da Família, com base em um diagnóstico organizacional com ênfase no trabalho do agente comunitário de saúde. O método foi a observação participante, seguida de dois encontros os quais possibilitaram reflexão sobre as dificuldades da equipe bem como a ampliação da discussão no âmbito da gestão. Os resultados mais relevantes foram proporcionados pelas reflexões sobre a potência da escuta qualificada nos atendimentos e no trabalho em equipe, possibilidades de apoio por meio do matriciamento e a importância da comunicação na relação com a gestão. A intervenção foi considerada positiva, pois abriu possibilidades favoráveis no trabalho, mesmo que de forma preliminar, com solicitações de continuidade do trabalho.

This is a report about an experience engaging both mental health and work in the context of a Family Health Unit, which is the main policy to enable basic health care in the Unified Health System. It was developed during a psychology internship. The objective was to report an experience in a Family Health unit, based on an organizational diagnosis with emphasis on the work of the community health agent. The method used was the participant observation, followed by two meetings, which allowed the reflection on the difficulties of the team, as well as the expansion of the discussion within the scope of management. The reflections on the power of qualified listening in the attendance and teamwork, along with the possibilities of support through the Matrix Support, and the importance of communication in relation to management provided the most relevant results. The intervention was considered positive, since it opened favorable possibilities at work, even preliminarily, with requests for the continuity of the work.

Este es un relato sobre una experiencia en salud mental y trabajo en el contexto de una unidad de Salud de la Familia, principal política para viabilizar la atención básica en el Sistema Único de Salud. Fue desarrollada durante una pasantía en psicología. El objetivo fue relatar una experiencia en una unidad de Salud de la Familia, a partir de un diagnóstico organizacional con énfasis en el trabajo del agente comunitario de salud. El método fue la observación participante, seguida de dos encuentros, que posibilitaron una reflexión sobre las dificultades del equipo, así como la ampliación de la discusión en el ámbito de la gestión. Los resultados más relevantes fueron proporcionados por las reflexiones sobre la potencia de la escucha calificada en las atenciones y en el trabajo en equipo, posibilidades de apoyo por medio del matriciamiento y la importancia de la comunicación en la relación con la gestión. La intervención fue considerada positiva, pues abrió posibilidades favorables en el trabajo, aunque de forma preliminar, con solicitudes de continuidad del trabajo.

Versão em português do questionário SNAQ: tradução e adaptação cultural / Portuguese version of the snaq questionnaire: translation and cultural adaptation

ABSTRACT BACKGROUND: Poor appetite is common through the aging process and increases the risk of weight loss, protein-energy malnutrition, immunossupression, sarcopenia and frailty. The Simplified Nutritional Appetite Questionnaire (SNAQ) has the aim to monitor appetite and identify older adults at risk of weight loss. OBJECTIVE: To describe the process of translation and cultural adaptation to Brazilian Portuguese of the SNAQ. METHODS: The translation and cultural adaptation was developed in five steps: translation (by three of the authors of the manuscript and assembled by consensus), backtranslation (by an English native speaker), semantic evaluation (by one verontologist and one nutritionist), comprehension of content (by nutrition specialists and by a group of older persons), pre-test and the SNAQ final version development. RESULTS: The SNAQ Portuguese version maintained the original version meaning and referral. To achieve this feature, the process required some modifications to improve the understanding of older persons, such as inclusion of other options to the answers of some questions, rewritten of one question and inclusion of a meal definition. CONCLUSION: SNAQ questionnaire has been successfully translated and adapted to Portuguese. As our next step, we are validating this tool in different clinical settings in Brazil.

RESUMO CONTEXTO: A perda de apetite é comum durante o envelhecimento e aumenta o risco de perda de peso, desnutrição energético-proteica, imunossupressão, sarcopenia e fragilidade. O Simplified Nutritional Appetie Questionnaire (SNAQ) tem como objetivo monitorar o apetite e identificar idosos sob risco de perda de peso. OBJETIVO: Descrever o processo de tradução e adaptação cultural para o português do Brasil o questionário SNAQ. MÉTODOS: A tradução e adaptação cultural foram realizadas em etapas: tradução (por três autores do manuscrito e grupo para consenso), retrotradução para versão original (por inglês nativo), avaliação semântica (gerontólogo e nutricionista), compreensão de conteúdo (por nutricionistas especialistas e por um grupo de idosos), pré teste e desenvolvimento da versão final. RESULTADOS: A versão em português do SNAQ manteve o significado da versão original. Para alcançar este resultado foram necessárias algumas modificações durante o processo para aperfeiçoar a compreensão dos idosos, como a inclusão de outras opções para respostas de algumas questões, revisão de escrita de uma das questões e inclusão de uma definição para o que é refeição. CONCLUSÃO: A tradução e adaptação cultural do questionário SNAQ foram bem sucedidas. A próxima etapa será a validação desta ferramenta em diferentes contextos clínicos no Brasil.

Efeitos da suplementação com simbióticos sobre a função intestinal e a inflamação sistêmica de idosos inseridos na comunidade - análises secundárias de um estudo clínico-randomizado / Effects of synbiotic supplementation on gut functioning and systemic inflammation of community-dwelling elders - secondary analyses from a randomized clinical trial

ABSTRACT BACKGROUND: Aging is a complex process marked by alterations on gut functioning and physiology, accompanied by an increase on the inflammatory status, leading to a scenario called "inflammaging". OBJECTIVE: To evaluate the effects of a synbiotic substance on systemic inflammation, gut functioning of community-dwelling elders. METHODS: This is a secondary analysis from a randomized clinical trial, lasting 24 weeks, including 49 elders, distributed into two groups: SYN (n=25), which received a synbiotic substance (Frutooligossacaride 6g, Lactobacillus paracasei LPC-31 109 to 108 UFC, Lactobacillus rhamnosus HN001 109 to 108 UFC, Lactobacillus acidophilus NCFM 109 to 108 UFC e Bifidobacterium lactis HN019 109 to 108 UFC), or PLA (n=24), receiving placebo. The evaluations consisted of serum IL-10 e TNF-α (after overnight fasting), evaluation of chronic constipation (by Rome III Criteria) and faeces types (by Bristol Stool Form Scale). Data were compared before and after the supplementation time, and between groups. RESULTS: No significant differences were found between baseline and final values of serum inflammatory markers. Some subtle beneficial changes were observed in SYN, concerning both gut functioning and faeces types. CONCLUSION: From our data, synbiotic supplementation showed a subtle benefit in gut functioning in apparently healthy community-dwelling elders. Our findings can suggest that the benefits in healthy individuals were less expressive than the ones presented in studies with individuals previously diagnosed as dysbiosis. Future studies, comparing elders with and without gut dysbiosis can confirm our findings.

RESUMO CONTEXTO: O envelhecimento é um processo complexo marcado por alterações no funcionamento e fisiologia intestinais, acompanhado de alterações no estado inflamatório, o que leva ao quadro denominado inflammaging. OBJETIVO: Avaliar os efeitos de uma substância simbiótica sobre o funcionamento intestinal e a inflamação sistêmica de idosos inseridos na comunidade. MÉTODOS: Trata-se de uma análise secundária de um estudo clínico randomizado, com 24 meses de duração, que incluiu 49 idosos, distribuídos em dois grupos: SIM (n=25), que receberam uma substância simbiótica (Frutooligossacaride 6g, Lactobacillus paracasei LPC-31 109 to 108 UFC, Lactobacillus rhamnosus HN001 109 to 108 UFC, Lactobacillus acidophilus NCFM 109 to 108 UFC e Bifidobacterium lactis HN019 109 to 108 UFC), ou PLA (n=24), que receberam placebo. As avaliações foram realizadas antes e após o período de suplementação, e incluíram: concentrações de IL-10 e TNF-α no soro (após uma noite de jejum); investigação de constipação crônica (pelo Critério de Roma III) e dos tipos de fezes (pela Escala de Bristol). Os dados foram comparados entre antes e após a suplementação, e entre os grupos. RESULTADOS: Não foram encontradas diferenças significativas entre valores iniciais e finais nos marcadores de inflamação; alguns benefícios sutis foram observados no grupo SIM, no funcionamento intestinal e nos tipos de fezes. CONCLUSÃO: A suplementação com simbióticos mostrou um benefício sutil nessa população. Nossos resultados apontam que idosos aparentemente saudáveis não se beneficiam tanto da suplementação de simbióticos quanto pessoas previamente identificadas com disbiose. Estudos futuros, comparando idosos com e sem disbiose poderão confirmar esses achados.

Hábitos alimentares e fatores de risco para hipertensão arterial sistêmica em escolares / Food habits and risk factors for systemic arterial hypertension in schools

Introdução: Atualmente, observa-se níveis de pressão arterial elevados cada vez mais cedo entre adolescentes, configurando-se como um fator de risco cardiovascular importante. Objetivo: avaliar os hábitos alimentares e a frequência dos seguintes fatores de risco para hipertensão arterial em escolares: obesidade, sobrepeso, obesidade abdominal, inatividade física, antecedentes familiares e níveis pressóricos elevados. Casuística e Métodos: trata-se de um estudo exploratório descritivo, realizado em uma escola pública de ensino médio de um município do sudoeste goiano, Brasil, escolhida por conveniência, com 76 escolares. Para a coleta de dados foram utilizados os questionários "saúde na boa" e de "atividade física habitual", ambos validados para uso na população brasileira. Os fatores de inclusão foram: indivíduos devidamente matriculados na escola; de ambos os sexos; com idades compreendidas entre 14 e 18 anos; não gestantes; isentos de qualquer tipo de medicação; sem nenhuma habilidade física reduzida. As variáveis apresentaram distribuição normal. As frequências dos fatores de risco foram avaliadas pelo teste Qui-quadrado. A comparação entre os sexos foi efetuada pelo teste t para amostras independentes e as análises de associação entre os fatores de risco e a pressão arterial foram realizadas por análise de regressão linear bivariada e multivariada. O valor de significância estabelecido foi de p < 0,05. Resultados: 82,9% dos escolares possuíam dois ou mais fatores de risco para a hipertensão, sendo os mais prevalentes a inatividade física, a obesidade abdominal e antecedentes familiares. Foram observadas associações positivas entre pressão arterial sistólica e diastólica com índice de massa corporal e circunferência abdominal. Além disso, as menores médias de atividade física foram observadas em indivíduos do sexo feminino. Em relação aos hábitos alimentares, observou-se baixo consumo de frutas e alto consumo de doces e refrigerantes. Conclusão: Esses dados deixam evidente a exposição de escolares a múltiplos fatores de risco para doenças crônicas e podem nortear ações intersetoriais de comunidades acadêmicas, autoridades educacionais e de saúde.

Introduction: Currently, there are increasingly early high blood pressure levels among adolescents, which is an important cardiovascular risk factor. Objective: To evaluate the food habits and the frequency of the following risk factors for hypertension in students: obesity, overweight, abdominal obesity, physical inactivity, family background and high blood pressure levels. Patients and Methods:This is a descriptive exploratory study, carried out at a public high school in a city in Southwest of Goiás State in a non-probabilistic convenience sampling of 76 students. We used two questionnaires: "Saúde na Boa" and Habitual Physical Activity, both validated for use in the Brazilian population. Inclusion criteria were individuals regularly enrolled in school of both sexes; age ranging from 14 to 18 years old; Those who were not pregnant; free from any type of medication, and without any reduced physical ability. Variables presented normal distribution. Frequencies of the risk factors were assessed by the Chi-squared test. Comparison between genders was performed by the t test for independent samples. The analyzes of association between risk factors and blood pressure were performed by bivariate and multivariate linear regression analysis. The established significance level was p < 0,05. Results: Of the students, 82,9% had two or more risk factors for hypertension. The most prevalent ones were physical inactivity, abdominal obesity, and family background. There were positive associations between systolic and diastolic blood pressure with body mass index and waist circumference. In addition, the lowest averages of physical activity were observed in female participants. In relation to food habits, it was observed low consumption of fruits and high consumption of sweets and soft drinks. Conclusion: These data make evident to the exposure of students to multiple risk factors for chronic diseases and can guide intersectoral actions of academic communities, educational, and health authorities.

Correlation of enthesitis indices with disease activity and function in axial and peripheral spondyloarthritis: a crosssectional study comparing MASES, SPARCC and LEI

Abstract Background: The presence of enthesitis is associated with higher disease activity, more disability and incapacity to work and a poorer quality of life in spondyloarthritis (SpA). There is currently no consensus on which clinical score should be used to assess enthesitis in SpA. The objective of the present work was to compare the correlation of three enthesitis indices (MASES, SPARCC and LEI) with measures of disease activity and function in a heterogeneous population of patients with axial and peripheral SpA. Methods: A cross-sectional study was conducted in three Brazilian public university hospitals; patients fulfilling ASAS classification criteria for peripheral or axial SpA were recruited and measures of disease activity and function were collected and correlated to three enthesitis indices: MASES, SPARCC and LEI using Spearman's Correlation index. ROC curves were used to determine if the the enthesitis indices were useful to discriminate patients with active disease from those with inactive disease. Results: Two hundred four patients were included, 71.1% (N = 145) fulfilled ASAS criteria for axial SpA and 28.9% (N = 59) for peripheral SpA. In axial SpA, MASES performed better than LEI (p = 0.018) and equal to SPARCC (p = 0.212) regarding correlation with disease activity (BASDAI) and function (BASFI). In peripheral SpA, only MASES had a weak but statistical significant correlation with DAS28-ESR (rs 0.310 p = 0.05) and MASES had better correlation with functional measures (HAQ) than SPARCC (p = 0.034). Conclusion: In this sample composed of SpA patients with high coexistence of axial and peripheral features, MASES showed statistical significant correlation with measures of disease activity and function in both axial and peripheral SpA.(AU)

Epidemiological, clinical and immune factors that influence the persistence of antiphospholipid antibodies in leprosy

Abstract Introduction: Antiphospholipid antibodies (aPL) are described in individuals with leprosy without the clinical features of antiphospholipid antibody syndrome (APS), a condition involving thromboembolic phenomena. We have described the persistence of these antibodies for over 5 years in patients with leprosy after specific treatment. Objectives: To determine whether epidemiological, clinical and immunological factors played a role in the longterm persistence of aPL antibodies in leprosy patients after multidrug therapy (MDT) had finished. Methods: The study sample consisted of 38 patients with a diagnosis of leprosy being followed up at the Dermatology and Venereology Outpatient Department at the Alfredo da Matta Foundation (FUAM) in Manaus, AM. ELISA was used to detect anticardiolipin (aCL) and anti-β2 glycoprotein I (anti-β2GPI) antibodies. Patients were reassessed on average of 5 years after specific treatment for the disease (MDT) had been completed. Results: Persistence of aPL antibodies among the 38 leprosy patients was 84% (32/38), and all had the IgM isotype. Mean age was 48.1 ± 15.9 years, and 23 (72.0%) were male. The lepromatous form (LL) of leprosy was the most common (n = 16, 50%). Reactional episodes were observed in three patients (9.4%). Eighteen (47.37%) were still taking medication (prednisone and/or thalidomide). Mean IgM levels were 64 U/mL for aCL and 62 U/mL for anti-β2GPI. In the multivariate binary logistic regression the following variables showed a significant association: age (p = 0.045, OR = 0.91 and CI 95% 0.82-0.98), LL clinical presention (p = 0.034; OR = 0.02 and CI 95% = 0.0-0.76) and bacterial index (p = 0.044; OR = 2.74 and CI 95% = 1.03-7.33). We did not find association between prednisone or thalidomide doses and positivity for aPL (p = 0.504 and p = 0.670, respectively). No differences in the variables vascular thrombosis, pregnancy morbidity, diabetes, smoking and alcoholism were found between aPL-positive and aPL-negative patients. Conclusion: Persistence of positivity for aPL antibodies was influenced by age, clinical presentation and bacterial index. However, further studies are needed to elucidate the reason for this persistence, the role played by aPL antibodies in the disease and the B cell lineages responsible for generation of these antibodies.

Challenging management of hepatitis B infection in ankylosing spondylitis patients in an endemic area during immunosuppressive therapy

Abstract Hepatitis B infection is a global health issue. When considering patients with rheumatic diseases, this is no different. By using immunosuppressant drugs, such as DMARDs and biologics, viral reactivation is possible, leading to serious consequences on the patient. We report 3 cases of association between ankylosing spondylitis and hepatitis B with the use of immunosuppressant drugs. Case 1 was a patient with previous HBV infection using DMARD. Cases 2 and 3 were patients chronically infected by HBV during immunosuppressant therapy. The management of HBV infection during immunosuppressant therapy is challenging and needs multidisciplinary support.

Recommendations from the Brazilian society of rheumatology for the diagnosis of Sjögren's syndrome (Part I): glandular manifestations (systematic review)

Abstract Background: Primary Sjögren's syndrome (pSS) is a systemic immune-mediated disease whose main characteristic is exocrine gland inflammation and, subsequent reduction in tear and saliva production. A delayed diagnosis is common due to the nonspecific clinical manifestations of disease. The aim of the present study was to develop recommendations for the diagnosis of glandular manifestations of pSS based on evidence and expert opinion. Main body of the abstract: We conducted a systematic literature review to retrieve the best evidence available on the accuracy of diagnostic tests for pSS. We also held two in-person meetings with experts (rheumatologists, pathologists, ophthalmologists and dentists) to establish their level of agreement using the Delphi method. Ultimately, we generated 18 recommendations that aim to facilitate the diagnosis of the glandular manifestations of pSS. Conclusion: The diagnosis of glandular manifestations of pSS is complex and multidisciplinary. It requires specific knowledge in the field of ophthalmology, immunology, pathology and imaging, making it compulsory for the rheumatologist to work with professionals from these different areas in order to improve accuracy and early diagnosis. Glandular dysfunction tests, ANA, RF, Anti-Ro, protein electrophoresis, urinalysis, blood count, C-Reactive protein, complement, testing for syphilis and viruses (HCV, HIV) and SGUS should be investigated when dryness or systemic manifestation are present. Minor salivary gland biopsy is recommended for all anti-Ro negative or incomplete criteria cases.

Nutritional risk in outpatients of a geriatric neuropsychiatry clinic

BACKGROUND: There are few published studies investigating the nutritional status of elderly individuals with psychiatric disorders. This study aims to describe the nutritional status of elderly patients from a neuropsychiatry outpatient clinic, investigating their nutritional status according to the type of psychiatric diagnostic, specifically Alzheimer's disease (AD), depression (DEP), and other types of dementia (OTD).METHODS: Elderly individuals from two outpatient clinics (n= 217) were evaluated for nutritional risk (using a validated tool) and for some anthropometric and biochemical measurements. RESULTS: We found a high prevalence of nutritional risk in the sample (about 60%). The major dietary problems found were low daily meal frequency and the low daily intake of water. Biochemical analyses indicated blood glucose and total cholesterol to be above the reference values, while hemoglobin and vitamin D were below the reference values. Anthropometric measurements did not differ between the groups with different psychiatric diagnostics, except for calf circumference, which showed to be lower in the OTD group (p=0.006). CONCLUSIONS: Although we found a high prevalence of nutritional risk, the differences between the diagnostic groups were very subtle. The nutritional risk is certainly associated with inadequate eating habits. It is necessary to seek strategies to improve the diet and other lifestyle factors in geriatric neuropsychiatry, in order to mitigate the negative outcomes brought about by the diseases.

Considerações sobre a dimensão humana no curso de graduação em Enfermagem / Considerations on the human dimension in a Nursing undergraduate course / Consideraciones sobre la dimensión humana en un curso de Enfermería

O cuidado em saúde é a principal tarefa a que se destina um Curso de Graduação em Enfermagem, ampliando a saúde para além de cuidados ao corpo biológico. Dessa forma, o objetivo deste estudo foi analisar a concepção de dimensão humana segundo os professores e o Projeto Político-Pedagógico de uma instituição de ensino superior pública, localizada numa cidade no norte do Paraná. A pesquisa foi de caráter qualitativo. Os participantes da pesquisa foram 13 docentes do curso de Enfermagem da instituição pesquisa da. Como instrumentos de coleta utilizou-se uma entrevista semiestruturada e análise documental. A análise e interpretação dos dados foram realizadas a partir do referencial teórico interdisciplinar articulando conhecimentos da Saúde Coletiva, Psicologia Social e Educação, procurando explicitar a dimensão humana por meio dessas lentes, permitindo perceber a especificidade dos fenômenos estudados e suas relações com a situação educacional. Os resultados foram apresentados por meio de cinco categorias: Relação Projeto Político-Pedagógico e atividades desenvolvidas, Relações Interpessoais no processo ensino-aprendizagem, Relações interpessoais nas aproximações entre ensino e serviços, Interações entre os professores, Dimensão humana. A dimensão humana foi concebida como uma prioridade, entretanto, a falta de integração entre os professores, compreensão dissociada entre os aspectos humanos e técnicos da formação e as condições de trabalho aquém do necessário desfavoreciam a sua potencialização.

Health care is the main goal in an Undergraduate Nursing Course, extending health beyond biological body care. Thus, the objective of this study was to analyze the conception of human dimension according to the professors and the Political-Pedagogical Project of a public college, located in a city the Northern State of Paraná. The research was qualitative. The participants of the research were 13 professors of the Nursing course of the studied institution. Semi-structured interviews and documentary analysis were used as collection instruments. Analysis and interpretation of the data were performed from the interdisciplinary theoretical reference, articulating knowledge of Collective Health, Social Psychology and Education, in order to express the human dimension through these lenses, allowing to perceive the specificity of the phenomena studied and its relations with the educational situation. The results were presented in five categories: Relationship Political-Pedagogical Project and activities developed, Interpersonal Relations in the teaching-learning process, Interpersonal relations in the approaches between teaching and services, Interactions among professors, Human dimension. Human dimension was conceived as a priority; however, the lack of integration among professors, a dissociated understanding of the human and technical aspects of training, and suboptimal conditions prevented their potentialization.

El cuidado de la salud es la principal tarea que se destina un Curso de Graduación en Enfermería, ampliando de la atención de salud más allá del cuerpo biológico. Por lo tanto, el objetivo de este estudio fue analizar la concepción de la dimensión humana de acuerdo con los profesores y el Proyecto Político-Pedagógico de una institución pública de la educación superior pública, ubicada en una ciudad del norte de Paraná. La investigación fue de carácter cualitativo. Los participantes de la investigación fueron trece estudiantes del curso de Enfermería de la institución de investigación. Como instrumento de recolección se utilizaron un análisis de la entrevista semiestructurada y el análisis documental. El examen e interpretación de las informaciones se produjeron a partir del referencial teórico interdisciplinar articulando los conocimientos de la salud general, Psicología Social y Educación, el intento de clarificar la dimensión humana por medio de estas lentes, permitiendo percibirse la especificidad de los fenómenos estudiados y su relación con la situación educativa. Se presentaron los resultados por medio de cinco categorías Relación de Proyecto Político Pedagógico y las actividades desarrolladas, Relaciones interpersonales en el proceso de la enseñanza-aprendizaje, Relaciones interpersonales en las aproximaciones entre la enseñanza y servicios, Interacciones entre los profesores y Dimensión humana. La dimensión humana fue concebida como una prioridad, no obstante, la falta de integración entre los profesores, comprensión disociada entre los aspectos humanos y técnicos de la formación y las condiciones de trabajo debajo de lo necesario desfavorecerían a su potenciación.

Recommendations of the Brazilian Society of Rheumatology for diagnosis and treatment of Chikungunya fever. Part 1 - Diagnosis and special situations / Recomendações da Sociedade Brasileira de Reumatologia para diagnóstico e tratamento da febre chikungunya. Parte 1 - Diagnóstico e situações especiais

Abstract Chikungunya fever has become a relevant public health problem in countries where epidemics occur. Until 2013, only imported cases occurred in the Americas, but in October of that year, the first cases were reported in Saint Marin island in the Caribbean. The first autochthonous cases were confirmed in Brazil in September 2014; until epidemiological week 37 of 2016, 236,287 probable cases of infection with Chikungunya virus had been registered, 116,523 of which had serological confirmation. Environmental changes caused by humans, disorderly urban growth and an ever-increasing number of international travelers were described as the factors responsible for the emergence of large-scale epidemics. Clinically characterized by fever and joint pain in the acute stage, approximately half of patients progress to the chronic stage (beyond 3 months), which is accompanied by persistent and disabling pain. The aim of the present study was to formulate recommendations for the diagnosis and treatment of Chikungunya fever in Brazil. A literature review was performed in the MEDLINE, SciELO and PubMed databases to ground the decisions for recommendations. The degree of concordance among experts was established through the Delphi method, involving 2 in-person meetings and several online voting rounds. In total, 25 recommendations were formulated and divided into 3 thematic groups: (1) clinical, laboratory and imaging diagnosis; (2) special situations; and (3) treatment. The first 2 themes are presented in part 1, and treatment is presented in part 2.

Resumo A febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorrem as epidemias. Até 2013, as Américas haviam registrado apenas casos importados quando, em outubro desse mesmo ano, foram notificados os primeiros casos na Ilha de Saint Martin, no Caribe. No Brasil, os primeiros relatos autóctones foram confirmados em setembro de 2014 e até a semana epidemiológica 37 de 2016 já haviam sido registrados 236.287 casos prováveis de infecção pelo chikungunya vírus (CHIKV), 116.523 confirmados sorologicamente. As mudanças ambientais causadas pelo homem, o crescimento urbano desordenado e o número cada vez maior de viagens internacionais têm sido apontados como os fatores responsáveis pela reemergência de epidemias em grande escala. Caracterizada clinicamente por febre e dor articular na fase aguda, em cerca de metade dos casos existe evolução para a fase crônica (além de três meses), com dor persistente e incapacitante. O objetivo deste trabalho foi elaborar recomendações para diagnóstico e tratamento da febre chikungunya no Brasil. Para isso, foi feita revisão da literatura nas bases de dados Medline, SciELO e PubMed, para dar apoio às decisões tomadas para definir as recomendações. Para a definição do grau de concordância foi feita uma metodologia Delphi, em duas reuniões presenciais e várias rodadas de votação on line. Foram geradas 25 recomendações, divididas em três grupos temáticos: (1) diagnóstico clínico, laboratorial e por imagem; (2) situações especiais e (3) tratamento. Na primeira parte estão os dois primeiros temas e o tratamento na segunda.

Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of chikungunya fever. Part 2 - Treatment / Recomendações da Sociedade Brasileira de Reumatologia para diagnóstico e tratamento da febre chikungunya. Parte 2 - Tratamento

Abstract Chikungunya fever has become an important public health problem in countries where epidemics occur because half of the cases progress to chronic, persistent and debilitating arthritis. Literature data on specific therapies at the various phases of arthropathy caused by chikungunya virus (CHIKV) infection are limited, lacking quality randomized trials assessing the efficacies of different therapies. There are a few studies on the treatment of musculoskeletal manifestations of chikungunya fever, but these studies have important methodological limitations. The data currently available preclude conclusions favorable or contrary to specific therapies, or an adequate comparison between the different drugs used. The objective of this study was to develop recommendations for the treatment of chikungunya fever in Brazil. A literature review was performed via evidence-based selection of articles in the databases Medline, SciELO, PubMed and Embase and conference proceedings abstracts, in addition to expert opinions to support decision-making in defining recommendations. The Delphi method was used to define the degrees of agreement in 2 face-to-face meetings and several online voting rounds. This study is part 2 of the Recommendations of the Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia - SBR) for the Diagnosis and Treatment of chikungunya fever and specifically addresses treatment.

Resumo A febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorrem as epidemias, visto que metade dos casos evolui com artrite crônica, persistente e incapacitante. Os dados na literatura sobre terapêuticas específicas nas diversas fases da artropatia ocasionada pela infecção pelo vírus chikungunya (CHIKV) são limitados, não existem estudos randomizados de qualidade que avaliem a eficácia das diferentes terapias. Há algumas poucas publicações sobre o tratamento das manifestações musculoesqueléticas da febre chikungunya, porém com importantes limitações metodológicas. Os dados atualmente disponíveis não permitem conclusões favoráveis ou contrárias a terapêuticas específicas, bem como uma adequada avaliação quanto à superioridade entre as diferentes medicações empregadas. O objetivo deste trabalho foi elaborar recomendações para o tratamento da febre chikungunya no Brasil. Foi feita uma revisão da literatura com seleção de artigos baseados em evidência, nas bases de dados Medline, SciELO, PubMed e Embase e de resumos de anais de congressos, além da opinião dos especialistas para dar apoio às decisões tomadas para definir as recomendações. Para a definição do grau de concordância foi feita uma metodologia Delphi, em duas reuniões presenciais e várias rodadas de votação on line. Este artigo refere-se à parte 2 das Recomendações da Sociedade Brasileira de Reumatologia para Diagnóstico e Tratamento da Febre Chikungunya, que trata especificamente do tratamento.