Risk factors for osteoporotic hip fracture among community-dwelling older adults: a real-world evidence study

Abstract Background Hip fractures in the older adults lead to increased morbidity and mortality. Although a low bone mineral density is considered the leading risk factor, it is essential to recognize other factors that could affect the risk of hip fractures. This study aims to evaluate the contribution of clinical characteristics, patient-reported outcomes, and muscle and aerobic capacity for hip fractures in community-dwelling older adults. Methods This is a retrospective cohort study with real world-data from subjects ≥ 60 years old attending an outpatient clinic in Minas Gerais, Brazil, from May 1, 2019, to August 22, 2022. Data about clinical characteristics (multimorbidity, medications of long-term use, sedative and or tricyclic medications, number of falls), patient-reported outcomes (self-perception of health, self-report of difficulty walking, self-report of vision problems, and self-report of falls) and muscle and aerobic capacity (calf circumference, body mass index, and gait speed) were retrieved from an electronic health record. The association of each potential risk factor and hip fracture was investigated by a multivariable logistic regression analysis adjusted for age and sex. Results A total of 7,836 older adults were included with a median age of 80 years (IQR 72-86) and 5,702 (72.7%) were female. Hip fractures occurred in 121 (1.54%) patients. Multimorbidity was associated with an increased risk of hip fracture (OR = 1.12, 95%CI 1.06-1.18) and each episode of fall increased the chance of hip fracture by 1.7-fold (OR = 1.69, 95%CI 1.52-1.80). Patient-reported outcomes associated with increased fracture risk were regular or poor self-perception of health (OR = 1.59, 95%CI 1.06-2.37), self-report of walking difficulty (OR = 3.06, 95%CI 1.93-4.84), and self-report of falls (OR = 2.23, 95%CI 1.47-3.40). Body mass index and calf circumference were inversely associated with hip fractures (OR = 0.91, 95%CI 0.87-0.96 and OR = 0.93, 95%CI 0.88-0.97, respectively), while slow gait speed increased the chance of hip fractures by almost two-fold (OR = 1.80, 95%CI 1.22-2.66). Conclusion Our study reinforces the importance of identified risk factors for hip fracture in community-dwelling older adults beyond bone mineral density and available fracture risk assessment tools. Data obtained in primary care can help physicians, other health professionals, and public health policies to identify patients at increased risk of hip fractures.

Avaliação da eficiência dos diferentes métodos de ensino de ressuscitação cardiopulmonar para crianças e adolescentes: revisão integrativa / Evaluation of the efficiency of the different methods of teaching cardiopulmonary resuscitation to children and adolescents: integrative review

Objetivo: Avaliar a eficiência dos diferentes métodos de ensino de Suporte Básico de Vida (SBV) para estudantes leigos a partir dos 12 anos de idade. Métodos: Realizou-se busca por artigos nas plataformas MEDLINE/PubMed e Lilacs/BVS, entre dezembro de 2021 e janeiro de 2022, para responder à questão norteadora "Qual a efetividade dos diferentes métodos de ensino de ressuscitação cardiopulmonar para crianças e adolescentes?". Incluíram-se artigos publicados nos últimos cinco anos, nos idiomas inglês e português. Resultados: Sete artigos abordaram os métodos de ensino: aprendizagem autorregulada, treinamento dos professores seguido dos estudantes, educação em pares; ensino online associado ao autotreinamento prático, ensino à distância, treinamento digital somado à prática, e uso de aplicativo por meio de um tabletcom posterior avaliação. Em todos os estudos houve comparação da intervenção com o treinamento convencional. De forma geral, todos os métodos de ensino contribuíram para desenvolver a habilidade de agir em situações de trauma, mas as estratégias que envolviam a presença de instrutores nos treinamentos mostraram melhores resultados, a curto e longo prazo. Conclusão: O presente estudo verificou os achados na literatura a respeito da eficácia de diferentes métodos de ensino de SBV para crianças e adolescentes. Dentre todas as abordagens observou-se melhor desempenho nos métodos que contaram com a presença de instrutores, os quais ofertaram feedback aos alunos e diminuíram as distrações. Porém, o ensino digital, o autorregulado e o aos pares também se mostraram viáveis. Logo, a escolha do método deve se pautar na realidade do público-alvo

Objective: To evaluate the efficiency of different teaching methods of Basic Life Support for lay students from 12 years of age.Methods: A search was carried out for articles on the MEDLINE/PubMed and Lilacs/BVS platforms between December 2021 and January 2022 to answer the guiding question, "How effective are the different teaching methods of cardiopulmonary resuscitation for children and adolescents?".Articles published in English and Portuguese in the last five years were included.Results: Seven articles addressed teaching methods: self-regulated learning, training of teachers followed by students, peer education, online teaching associated with practical self-training, distance learning, digital training added to practice, and application use through a tablet with subsequent evaluation.In all studies, there was a comparison between intervention and conventional training.Generally, all teaching methods contributed to developing the ability to act in trauma situations, but strategies that involved the presence of instructors in training showed better short- and long-term results.Conclusion: this study verified the findings in the literature regarding the effectiveness of different BLS teaching methods for children and adolescents.Among all approaches, better performance was observed in methods that had the presence of instructors, who offered feedback to students and reduced distractions. However, digital, self-r egulated, and peer teaching also proved viable.Therefore, the choice of method should be based on the target audience's reality

Síndrome congênita do zika e impactos para as famílias: uma revisão integrativa / Congenital zika syndrome and family impacts: an integrative review

Resumo Em 2015, um espectro de anomalias congênitas, incluindo microcefalia, acometeu recém-nascidos como resultado da transmissão vertical pelo vírus zika, posteriormente denominada síndrome congênita do zika (SCZ). Desde então, cerca de 4 mil crianças foram afetadas em 27 países, sendo o Brasil o mais atingido. Cuidadores familiares também têm sido impactados. Esse estudo analisa publicações científicas que investigam as maneiras como a doença afetou as dinâmicas de vida de cuidadores familiares de crianças com SCZ. Realizou-se uma revisão integrativa de literatura consultando as bases de dados PubMed, Biblioteca Virtual em Saúde e Embase. Após as etapas de triagem, foram identificados 31 artigos. Os principais resultados foram agrupados em quatro categorias: a) impactos sociais que evidenciaram mudanças nas relações familiares, nos projetos de vida e no convívio social; b) impactos subjetivos - sentimentos de resiliência, solidão, luto, sobrecarga, medo, incerteza e relação com a espiritualidade; c) impactos econômicos e materiais - perda de renda, aumento de despesas, mudança de moradia e desemprego e d) impactos na saúde - despreparo dos serviços, renúncia do cuidado de si, modificações dos padrões nutricionais e de sono, repercussão para a saúde mental e níveis de estresse, ansiedade e depressão.

Abstract In 2015, a range of congenital anomalies resulting from mother-to-child transmission of the zika virus emerged. Later called congenital zika syndrome (CZS), the condition includes microcephaly. Since then, around 4,000 children have been affected in 27 countries, with Brazil accounting for the largest proportion of cases. Family caregivers have also been affected. This study analyzes the literature on caregivers of children with CZS and how the disease has affected their everyday lives. We conducted an integrative review using the PubMed, Virtual Health Library, and Embase databases. Thirty-one articles were identified for analysis after screening. The findings were grouped into four categories: a) social impacts - changes in family relationships, life projects, and social life; b) subjective impacts - feelings of resilience, loneliness, grief, overburdening, fear, uncertainty, and spirituality and religion; c) economic and material impacts - loss of income, increased household expenses, change of residence, and unemployment; and d) health impacts - service unpreparedness, selflessness, self-care, changes in nutritional and sleep patterns, and mental health problems, including stress, anxiety and depression.

Depression Screening in a population-based study: Brazilian National Health Survey 2019 / Rastreamento de sintomas depressivos em um estudo de base populacional: Pesquisa Nacional de Saúde 2019

Abstract This study evaluated the prevalence of positive screening for depression in Brazil and its associated factors. We used data from National Health Survey 2019 (Pesquisa Nacional de Saúde - PNS), a population-based survey with 88,531 adults. The Patient Health Questionnaire (PHQ-9) was used with two scoring methods, the algorithm and the cutoff point≥10. The variables included sociodemographic characteristics. The prevalence ratios and 95% confidence intervals (95%CI) were estimated using Poisson regression. The positive screening for depression was 10.8% (95%CI: 10.4-11.0), at the cutoff point ≥10 and 5.7% (95%CI: 5.4-6.0) for algorithm. Significant differences were found in prevalence in some Brazilian states. Multivariable analyses showed that being female, black, under 70 years of age, having little education, being single, and living in an urban area were independently associated with a depressive symptoms. The highest association was found in the states of Sergipe, Goiás, Piauí, Espírito Santo, São Paulo, Alagoas and lowest in Pará, Mato Grosso and Maranhão. The prevalence of positive screening for depression in Brazil has increased in recent years. More investment in mental health resources is necessary and surveys such as the PNS should be continued.

Resumo Este estudo avaliou a prevalência de triagem positiva para depressão no Brasil e seus fatores associados. Utilizou-se dados da Pesquisa Nacional de Saúde 2019 (PNS), um inquérito de base populacional com 88.531 adultos. Para avaliar os sintomas depressivos utilizou-se o Patient Health Questionnaire (PHQ-9) com dois métodos de pontuação: o algoritmo e o ponto de corte ≥10. As variáveis incluíram características sociodemográficas. Utilizou-se a regressão de Poisson para obter razões de prevalência, com intervalo de confiança de 95% (IC95%). A triagem positiva para depressão foi de 10,8% (IC95%: 10,4-11,0), no ponto de corte ≥10 e 5,7% (IC95%: 5,4-6,0) para o algoritmo. Houve diferenças significativas na prevalência entre alguns estados brasileiros. Análises multivariadas mostraram que ser do sexo feminino, negro, ter menos de 70 anos, ter baixa escolaridade, ser solteiro e residir em área urbana estiveram independentemente associados a sintomas depressivos. A maior associação foi encontrada nos estados de Sergipe, Goiás, Piauí, Espírito Santo, São Paulo, Alagoas e a menor no Pará, Mato Grosso e Maranhão. A prevalência de triagem positiva para depressão no Brasil tem aumentado nos últimos anos. É necessário mais investimento em saúde mental e pesquisas como a PNS devem ser feitas continuamente.

Diagnósticos de enfermagem baseados na repercussão do câncer mamário e mastectomia / Nursing diagnoses based on breast cancer repercussion and mastectomy / Diagnósticos de enfermería basados en repercusión y mastectomía del cáncer de mama

Objetivo: Descrever diagnósticos de Enfermagem baseados nos discursos de mulheres sobre a repercussão do câncer mamário e mastectomia. Métodos: Trata-se de pesquisa descritiva, com abordagem qualitativa, realizada em uma Organização Não Governamental (ONG) no município de João Pessoa, Paraíba, Brasil. O universo amostral foi composto por todas as 15 mulheres mastectomizadas durante os meses de setembro e outubro de 2017. Essas mulheres responderam um roteiro de entrevista semiestruturada. A análise dos dados qualitativos foi norteada pela Técnica de Análise de Conteúdo proposta por Bardin. Após a delimitação das categorias, foram construídos diagnósticos de Enfermagem por meio da Classificação Internacional da Prática de Enfermagem (CIPE)®. Resultados: Foram identificadas três categorias temáticas: Sentimentos experenciados após diagnóstico de câncer e realização da mastectomia; Modificações biológicas e psicológicas após a mastectomia; Resiliência diante do sofrimento. Os diagnósticos de Enfermagem elencados foram: angústia, bem-estar prejudicado, bem-estar espiritual prejudicado, autoestima alterada, autoimagem alterada, capacidade de autocuidado prejudicada, dificuldades diárias, distúrbio da identidade pessoal, insatisfação com a vida e o corpo. Conclusão: é necessário enfatizar o cuidado no momento de verbalizar o diagnóstico, a escuta diante do outro e a percepção das mulheres diante do processo de adoecimento. (AU)

Objective: To describe nursing diagnoses based on women's discourse on the repercussions of breast cancer and mastectomy. Methods: This is a descriptive research, with a qualitative approach, carried out in a Non-Governmental Organization (NGO) in the city of João Pessoa, Paraíba, Brazil. The sample universe was composed of all 15 women undergoing mastectomy during the months of September and October 2017. These women answered a semi-structured interview script. The analysis of qualitative data was guided by the Content Analysis Technique proposed by Bardin. After delimiting the categories, Nursing diagnoses were constructed using the International Classification of Nursing Practice (ICNP) ®. Results: Three thematic categories were identified: Feelings experienced after cancer diagnosis and mastectomy; Biological and psychological changes after mastectomy; Resilience in the face of suffering. The nursing diagnoses listed were anguish, impaired well-being, impaired spiritual well-being, impaired self-esteem, impaired self-image, impaired self-care capacity, daily difficulties, personal identity disorder, dissatisfaction with life and body. Conclusion: it is necessary to emphasize care when verbalizing the diagnosis, listening to the other and the women's perception of the illness process. (AU)

Objetivo: Describir los diagnósticos de enfermería basados en el discurso de las mujeres sobre las repercusiones del cáncer de mama y la mastectomía. Métodos: Se trata de una investigación descriptiva, con enfoque cualitativo, realizada en una Organización No Gubernamental (ONG) en la ciudad de João Pessoa, Paraíba, Brasil. El universo muestral estuvo compuesto por las 15 mujeres sometidas a mastectomía durante los meses de septiembre y octubre de 2017. Estas mujeres respondieron un guión de entrevista semiestructurado. El análisis de datos cualitativos fue guiado por la Técnica de Análisis de Contenido propuesta por Bardin. Después de delimitar las categorías, los diagnósticos de enfermería se construyeron utilizando la Clasificación Internacional de la Práctica de Enfermería (CIPE) ®. Resultados: Se identificaron tres categorías temáticas: sentimientos experimentados después del diagnóstico de cáncer y mastectomía; Cambios biológicos y psicológicos después de la mastectomía; Resiliencia ante el sufrimiento. Los diagnósticos de enfermería enumerados fueron angustia, deterioro del bienestar, deterioro del bienestar espiritual, deterioro de la autoestima, deterioro de la autoimagen, deterioro de la capacidad de autocuidado, dificultades diarias, trastorno de la identidad personal, insatisfacción con la vida y el cuerpo. Conclusion: es necesario enfatizar el cuidado al verbalizar el diagnóstico, escuchar al otro y la percepción de la mujer sobre el proceso de la enfermedad. (AU)

Correlação entre autocuidado e apoio social em pessoas com insuficiência cardíaca / Correlation between self-care and social support in people with heart failure / Correlación entre autocuidado y apoyo social en personas con insuficiencia cardíaca

Objetivo: correlacionar o apoio social com o autocuidado de pessoas com insuficiência cardíaca. Método: estudo exploratório, descritivo e transversal, com abordagem quantitativa, realizado com 63 pessoas com insuficiência cardíaca atendidas no ambulatório de cardiologia de um hospital universitário. Os dados foram coletados mediante um instrumento estruturado para obtenção dos dados sociodemográficos e de condições de saúde; a European Heart Failure Self Care Behaviour Scale foi usada para avaliação do autocuidado, cujo escore final tem pontuação invertida, indicando que quanto menor a pontuação, melhor o autocuidado; e a Escala de Apoio Social Medical Outcomes Study, a qual indica, por meio de cinco dimensões (emocional, material, afetivo, informação e interação social), que quanto maior a pontuação, melhor o apoio social. Resultados: quanto à amostra, observou-se uma maior frequência do sexo masculino (57,14%), faixa etária de 60 ou mais (60,31%), casados ou em união estável (65,07%), com cinco a oito anos de estudo (28,57%), sem ocupação (82,5%) e aposentados (57,14%). Quanto ao autocuidado e ao apoio social, obtiveram-se médias satisfatórias de 27,01 (±6,66) e 80,27 (±16,48), respectivamente. Na investigação da correlação entre o apoio social e o autocuidado, identificou-se correlação negativa (r = -0,252), com significância estatística (p ≤ 0,05) entre a dimensão informação e o autocuidado. Conclusão: infere-se que a dimensão informação do apoio social relaciona-se significativamente com o autocuidado de pessoas com insuficiência cardíaca, apontando que o autocuidado se eleva à medida que a dimensão informação aumenta.(AU)

Objective: to correlate social support with self-care for people with heart failure. Method: an exploratory, descriptive and cross-sectional study with a quantitative approach, carried out with 63 individuals with heart failure treated at a university hospital's Cardiology outpatient clinic. The data were collected using a structured instrument to obtain sociodemographic data and health conditions; the European Heart Failure Self Care Behavior Scale was used to assess self-care, whose final score has an inverted value, indicating that the lower the score, the better the self-care; and the Medical Outcomes Study Social Support Scale, which, through five dimensions (Emotional, Material, Affective, Information and Social Interaction), indicates that the higher the score, the better the social support. Results: in relation to the sample, there was a higher frequency of males (57.14%), aged 60 or over (60.31%), married or in a stable union (65.07%), with five to eight study years (28.57%), unemployed (82.5%) and retired (57.14%). In relation to self-care and social support, satisfactory mean values of 27.01 (±6.66) and 80.27 (±16.48) were obtained, respectively. When investigating the correlation between social support and self-care, a negative correlation (r = -0.252) was identified, with statistical significance (p ≤ 0.05) between the Information dimension and self-care. Conclusion: it is inferred that the social support Information dimension is significantly related to the self-care of people with heart failure, indicating that self-care increases as the Information dimension increases.(AU)

Objetivo: correlacionar el apoyo social con el autocuidado en personas con insuficiencia cardíaca. Método: estudio exploratorio, descriptivo y transversal, con enfoque cuantitativo, realizado con 63 personas con insuficiencia cardíaca atendidas en el ambulatorio de cardiología de un hospital universitario. Los datos se recogieron mediante un instrumento estructurado para obtener datos sociodemográficos y condiciones de salud; se utilizó la European Heart Failure Self Care Behaviour Scale para evaluar el autocuidado, cuya puntuación final es inversa, indicando que cuanto menor sea la puntuación, mejor será el autocuidado; y la Escala de Apoyo Social Medical Outcomes Study, que indica, a través de cinco dimensiones (emocional, material, afectivo, información e interacción social), que cuanto mayor sea la puntuación, mejor será el apoyo social. Resultados: en cuanto a la muestra, se observó una mayor frecuencia del sexo masculino (57,14%), un rango de edad de 60 años o más (60,31%), casados o en unión estable (65,07%), con entre cinco y ocho años de estudio (28,57%), sin ocupación (82,5%) y jubilados (57,14%). En relación con el autocuidado y el apoyo social, se obtuvieron medias satisfactorias de 27,01 (±6,66) y 80,27 (±16,48), respectivamente. En la investigación de la correlación entre el apoyo social y el autocuidado, se identificó una correlación negativa (r = -0,252), con significancia estadística (p ≤ 0,05) entre la dimensión información y el autocuidado. Conclusión: se infiere que la dimensión información del apoyo social se relaciona significativamente con el autocuidado de personas con insuficiencia cardíaca, señalando que el autocuidado mejora a medida que la dimensión información aumenta.Primaria y Secundaria; Educación en Salud.(AU)

Expressão da espiritualidade nos cuidados paliativos: revisão narrativa / Expressing spirituality in palliative care: a narrative review / Expresión de la espiritualidad en los cuidados paliativos: una revisión narrativa

Resumo A terminalidade da vida requer uma abordagem ampla, com o alívio das dores física, emocional, familiar e social. Ademais, questões espirituais devem ser abordadas como forma de garantir ao paciente todas as fontes de conforto. Em vista disso, esta revisão narrativa da literatura tem o intuito de discutir os efeitos da espiritualidade/religiosidade nos cuidados paliativos. A partir de uma busca manual de trabalhos nas bases PubMed e Biblioteca Virtual em Saúde, foram selecionados 11 trabalhos para a revisão. As discussões foram divididas em três eixos: espiritualidade dos pacientes terminais, espiritualidade dos profissionais da saúde e espiritualidade dos familiares. Conclui-se que as práticas espirituais durante o fim da vida e no enfrentamento das angústias são cruciais tanto para pacientes e familiares quanto para os profissionais.

Abstract End of life requires a comprehensive approach to relief physical, emotional, family and social pain, addressing spiritual issues as a way to ensure patients all sources of comfort. Given this scenario, this narrative literature review discusses the effects of spirituality/religiosity in palliative care. Based on a manual search for papers in the PubMed and Virtual Health Library databases, 11 articles were selected for the review. The discussions were divided into three axes: spirituality of terminally ill patients, spirituality of health professionals and spirituality of family members. In conclusion, spiritual practices during the end of life and in coping with anguish are crucial both for patients and their families and for professionals.

Resumen El final de la vida requiere un enfoque amplio, con alivio del dolor físico, emocional, familiar y social. Además, las cuestiones espirituales deben abordarse como forma de ofrecer confort al paciente. En este contexto, esta revisión narrativa de la literatura tiene como objetivo discutir los efectos de la espiritualidad/religiosidad en los cuidados paliativos. A partir de una búsqueda de artículos en PubMed y en la Biblioteca Virtual de Salud, se seleccionaron 11 artículos para la revisión. Los debates se dividieron en tres ejes: espiritualidad de los pacientes terminales, espiritualidad de los profesionales sanitarios y espiritualidad de los familiares. Se concluye que las prácticas espirituales durante el final de la vida y en el afrontamiento de la angustia son cruciales tanto para los pacientes y sus familias como para los profesionales de la salud.

Brazilian society of rheumatology methodological guide for the development of evidence-based clinical guidelines in rheumatology

Abstract Clinical practice guidelines (CPG) are developed to align standards of health care around the world, aiming to reduce the incidence of misconducts and enabling more effective use of health resources. Considering the complexity, cost, and time involved in formulating CPG, strategies should be used to facilitate and guide authors through each step of this process. The main objective of this document is to present a methodological guide prepared by the Epidemiology Committee of the Brazilian Society of Rheumatology for the elaboration of CPG in rheumatology. Through an extensive review of the literature, this study compiles the main practical recommendations regarding the following steps of CPG drafting: distribution of working groups, development of the research question, search, identification and selection of relevant studies, evidence synthesis and quality assessment of the body of evidence, the Delphi methodology for consensus achievement, presentation and dissemination ofthe recommendations, CPG quality assessment and updating. This methodological guide serves as an important tool for rheumatologists to develop reliable and high-quality CPG, standardizing clinical practices worldwide.

Epidemiologia espacial e a detecção de aglomerados espaciais do dengue na Paraíba: uma comparação entre os métodos Scan flexível e Scan circular / Spatial epidemiology and the detection of spatial clusters of dengue in Paraíba: a comparison between the flexible Scan and circular Scan methods

Resumo Introdução Estatísticas espaciais são usadas para auxiliar gestores de saúde na tomada de decisão, informando a taxa de ocorrência de agravos na população e destacando quando estas alcançam valores além do esperado. Objetivo Compreender o funcionamento e aplicabilidade das Estatísticas Espaciais Scan flexível e Scan circular, comparando seus resultados na detecção de aglomerados espaciais usando dados epidemiológicos reais do dengue no estado da Paraíba - Brasil. Método Descreveu-se o processo detalhado da aplicação das estatísticas Scan flexível e Scan circular para a detecção de áreas significativas de risco (aglomerados) do dengue na Paraíba, nos anos de 2009 a 20013, por meio dos software FLeXScan e SaTScan. Resultados Ambos os métodos revelaram o oeste do estado como a região com maior frequência de aglomerados detectados com alto risco, em todos os anos analisados, levando-se em consideração os mapas de risco de incidência do dengue na Paraíba, nos anos de 2009 a 2013. Conclusão As estatísticas Scan flexível e Scan circular são praticamente similares quanto à eficiência na detecção de aglomerados do dengue. Entretanto, verificaram-se problemas de superestimação no método Scan circular e subestimação no método Scan flexível na detecção dos aglomerados. Destacou-se ainda o auxílio destas estatísticas espaciais aos gestores de saúde quanto à localização das regiões de agravo da doença, tornando mais efetivo o direcionamento das ações de combate de forma politicamente correta.

Abstract Background Spatial statistics are used to help health managers make decisions, informing the rate of occurrence of diseases in the population and highlighting when they reach values beyond expectations. Objective To understand the functioning and applicability of Spatial Statistics Flexible Scan and Circular Scan by comparing their results in the detection of spatial clusters using real epidemiological data of dengue in the state of Paraíba - Brazil. Method The detailed process for applying the flexible scan and circular scan statistics for detecting significant dengue risk areas (clusters) in Paraíba, between 2009 and 20013, was described using the software FLeXScan and SaTScan. Results Both methods showed the highest frequency of clusters detected at high risk in the western region of the state, in all the years analyzed, considering the risk maps of dengue incidence in Paraíba, between 2009 and 2013. Conclusion The flexible scan and circular scan statistics are practically similar in terms of efficiency in detecting clusters of dengue. However, there were problems of overestimation in the circular Scan method and underestimation in the flexible Scan method in the detection of clusters. It is also worth highlighting that these spatial statistics help health managers locate the regions of disease aggravation, making it more effective to direct combat actions in a politically correct manner.

Dual-cured adhesive system improves adhesive properties of dentin cavities restored with a bulk-fill resin composite

Aim: To evaluate the impact of a dual-cured adhesive system on the in situ degree of conversion (DC), bond strength (BS) and failure mode (FM) of adhesive interfaces in dentin cavities restored with a bulk-fill resin composite. Methods: 4-mm-deep dentin cavities with a 3.1 C-factor were created in 68 bovine incisors (n = 17 per group). The lightcured (Scotchbond™ Universal) or the dual-cured (Adper™ Scotchbond™ Multi-purpose Plus) adhesive system was applied to the cavities, which were then restored with a bulkfill resin composite (Filtek™ Bulk Fill). In situ DC analysis was performed by means of micro Raman spectroscopy at the top and bottom interfaces. Push-out BS was measured in a universal testing machine after 24-h or 6-month water storage. FM was determined with a stereomicroscope. Data of in situ DC and BS were analyzed by two-way analysis of variance (ANOVA) and Tukey test (p<0.05), while the FM was analyzed descriptively. Results: The groups that received the dual-cured adhesive system showed statistically higher in situ DC and BS than those that received the light-cured adhesive system. Cohesive failure mode was the most frequent in all conditions. Conclusion: In situ DC and BS were influenced by the curing strategies of the adhesive systems with better performance of the dual-cured material

Impact of Covid-19 on diabetic adults: systematic review / Impacto da Covid-19 em adultos diabéticos: revisão sistemática

Aim: to identify which complications and prognosis of diabetic patients, hospitalized, who acquired COVID-19, through a systematic review. Methods: a systematic review based on the PRISMA flowchart, including cohort studies, available in Portuguese, English, Spanish, French, and Mandarin, published from 2019 to 2020, using the PICOS strategy, in the databases: PubMed, Web of Science, Scielo, Lilacs, Scopus and Science Direct, which in addition to the inclusion criteria after questionnaires to assess methodological quality and risk of bias. Results: of the 811 articles researched, 6 were included in this research. These studies showed that patients with COVID-19 and higher DM with worse prognosis, spent more time in the ICU, constantly needed indifference, greater complications when related to other comorbidities, high mortality rate, and glycemic control associated with advanced age directly affected patients. Outcomes even of non-diabetic subjects. Conclusion: this review identified the severity of the pathophysiological association is related to older age and biochemical and inflammatory factors linked to the two pathogens and that these subjects are more prone to specialized hospital care, which, however, result in high rates of hospital mortality.

Objetivo: identificar quais complicações e prognósticos dos pacientes diabéticos, internados, que adquiriram COVID-19, por meio de uma revisão sistemática. Métodos: foi realizada uma revisão sistemática baseada no fluxograma PRISMA, incluindo estudos de coorte, disponíveis em português, inglês, espanhol, francês e mandarim, publicados de 2019 a 2020, utilizando a estratégia PICOS, nas bases de dados: PubMed, Web of Science, Scielo, Lilacs, Scopus e Sciece Direct. Além dos critérios de inclusão passam por questionários para avaliar a qualidade metodológica e risco de viés. Resultados: dos 811 artigos pesquisados, 6 foram incluídos nesta pesquisa. Esses estudos mostraram que pacientes com COVID-19 e DM apresentam pior prognóstico, maior permanência em UTI, necessidade constante de ventilação invasiva, maiores complicações quando relacionadas a outras comorbidades, elevado índice de mortalidade, e o controle glicêmico associado à idade avançada afetavam diretamente os desfechos inclusive de pacientes não diabéticos. Conclusão: esta revisão identificou que a gravidade da associação fisiopatológica está relacionada à idade mais avançada e aos fatores bioquímicos e inflamatórios ligados aos dois patógenos e que esses sujeitos são mais propensos ao atendimento hospitalar especializado, o que, no entanto, resulta em altas taxas de mortalidade hospitalar.

Avaliação in vitro da razão base/topo de dureza e da resistência de união push-out entre uma resina composta contendo diatomita e uma resina composta bulk-fill / In vitro evaluation of the base/top hardness ratio and push-out bond strength between a diatomite-containing composite resin and a bulk-fill composite resin

A escassez de dados científicos que validem os benefícios da diatomita para as propriedades físicas da resina composta Zirconfill® torna imperioso a realização de novos estudos, principalmente no tocante a utilização dessa resina contendo diatomita em restaurações semidiretas. Objetivo: Avaliar in vitro a polimerização e resistência de união entre uma resina composta contendo diatomita e de uma resina composta bulk-fill após 24 horas e após 06 meses de envelhecimento em água. Materiais e métodos: Foram utilizados 28 incisivos bovinos para produzir cavidades dentinárias cônicas (4,8 mm de diâmetro maior x 2,8 mm de diâmetro menor x 4 mm de espessura) e fator C de magnitude 3,1. Esses preparos cavitários (n=28) foram restaurados com as resinas compostas Filtek™ One Bulk-fill (BF) (3M ESPE) ou Zirconfill ® (ZF) (BM4), através da técnica semidireta, utilizando o sistema adesivo Single Bond Universal (3M ESPE) e o cimento resino dual Relyx™ Ultimate (3M ESPE). A análise da polimerização foi realizada através da razão base/topo (B/T) de dureza Vickers. E a resistência de união RU foi realizada através do teste de extrusão push-out em máquina de ensaio universal. As amostras foram armazenadas em água destilada a 37 ºC por 24 horas ou 06 meses, mas apenas a RU avaliou as amostras após 06 meses de envelhecimento. Os dados da B/T e da RU foram submetidos à análise de variância (ANOVA) a um e a dois critérios, respectivamente, com pós-teste de Tukey (p <0.05). Resultados: Não houve diferença estatisticamente significativa entre as resinas compostas na B/T. Para a RU, a resina composta ZF mostrou valores maiores do que a resina BF em ambos os tempos avaliados. Não houve diferença estatisticamente significativa de nenhuma resina na avaliação ao longo do tempo. Conclusão: A resina composta contendo diatomita mostrou-se promissora quando utilizada em restaurações semidiretas, visto que obteve resultados similar e até superior a resina composta bulk-fill (AU).

The scarcity of data validating scientific diatomite benefits for physical properties of Zirconfill® resin composite makes essential to develop new studies, especially regarding the use of this resin composite containing diatomite in semi-direct restorations. Aim: To evaluate in vitro the cure and bond strength between a resin composite containing diatomite and a bulk-fill resin composite after 24 hours and after 06 months of water storage. Materials and methods: Twenty-eight bovine incisors (n=28) were used to produce conical dentinal cavities (4,8 mm of larger diameter x 2,8 mm of smaller diameter x 4 mm of thickness) and C-factor of magnitude 3.1. These cavities were restored with Filtek™ One Bulk-Fill (BF) (3M ESPE) or Zirconfill® (ZF) (BM4) resin composites, through the semi-direct technique, using Scotchbond™ Universal (3M ESPE) adhesive system and Relyx™ Ultimate (3M ESPE) dual resin cement. The cure analysis was performed through bottom-to-top (B/T) ratio of vickers hardness, while bond strength (RU) was performed through the push-out test in a universal testing machine. The specimens were stored in distilled water at 37 ºC for 24 hours or 06 months, but only RU analyzed the specimens after 06 months aging. B/T and RU data were, respectively, submitted to one-way and two-way analysis of variance (ANOVA) with Tukey's post-test (p <0.05). Results: There was no statistically significant difference between the composite resins in B/T. For RU, the ZF composite resin showed higher values than the BF resin at both evaluated times. However, there was no statistically significant difference in resin composites over time. Conclusion: The resin composite containing diatomite showed promise when used in semi-direct restorations since it obtained similar or even superior results to bulk-fill resin composite (AU).

Calidad del sueño y experiencias afectivas durante la pandemia de COVID-19 en adultos residentes en el estado de Minas Gerais / Qualidade do sono e vivências afetivas de adultos residentes no estado de minas gerais durante a pandemia de covid-19 / Sleep quality and affective experiences of adults living in the state of minas gerais during the covid-19 pandemic

RESUMO Objetivos: verificar se a adesão à medida de distanciamento social e características sociodemográficas se associam com as alterações percebidas, durante a pandemia de COVID-19, na qualidade do sono e nas vivências afetivas de brasileiros residentes em Minas Gerais. Método: estudo transversal que analisou dados de questionário on-line aplicado a adultos e idosos residentes no estado de Minas Gerais. Foram estimadas prevalências e razões de prevalências, brutas e ajustadas, para as variáveis investigadas. Resultados: entre 35% e 55% dos respondentes referiram alterações nas vivências afetivas, como solidão, tristeza e ansiedade, e alterações do sono durante o período de isolamento social. Em geral, essas alterações foram mais frequentes entre aqueles que realizaram o isolamento de forma intensa ou total, indivíduos do sexo feminino e pessoas mais jovens. Conclusão: no presente estudo, foram observadas alterações importantes na qualidade de sono e nas vivências afetivas da população mineira, atingindo mais as pessoas do sexo feminino, pessoas mais jovens e que fizeram isolamento social intenso. É importante ofertar cuidados em saúde mental a fim de evitar os impactos negativos do distanciamento social em situações de pandemia.

RESUMEN Objetivos: verificar si la adherencia a la medida de distanciamiento social y las características sociodemográficas están asociadas a los cambios percibidos en la calidad del sueño y las experiencias afectivas de los brasileños residentes en Minas Gerais durante la pandemia de COVID-19. Método: estudio transversal que analizó datos de un cuestionario online aplicado a adultos y ancianos residentes en el estado de Minas Gerais. Se estimaron las prevalencias y las razones de prevalencia, brutas y ajustadas, de las variables investigadas. Resultados: entre el 35% y el 55% de los encuestados refieren alteraciones en las vivencias afectivas como soledad, tristeza, ansiedad, y alteraciones del sueño durante el período de aislamiento social. En general, estos cambios fueron más frecuentes entre los que estaban intensa o totalmente aislados, las mujeres y los individuos más jóvenes. Conclusión: en el presente estudio observamos alteraciones importantes en la calidad del sueño y en las vivencias afectivas de la población de Minas Gerais, afectando más al sexo femenino, a las personas más jóvenes y a las que habían estado en intenso aislamiento social. Es importante prestar atención a la salud mental para evitar los efectos negativos del distanciamiento social en situaciones de pandemia.

ABSTRACT Objectives: to verify whether adherence to the social distancing measure and sociodemographic characteristics are associated with perceived changes, during the COVID-19 pandemic, in sleep quality and affective experiences of Brazilians living in Minas Gerais. Method: a cross-sectional study that analyzed data from an online questionnaire applied to adults and older adults living in the state of Minas Gerais. Prevalence values and prevalence ratios, both adjusted and adjusted, were estimated for the variables investigated. Results: between 35% and 55% of the respondents reported changes in affective experiences, such as loneliness, sadness and anxiety, as well as changes in sleep during the social isolation period. In general, those alterations were more frequent among those who adhered to intense or total isolation, female individuals and younger people. Conclusion: in this study, important changes were observed in sleep quality and in the affective experiences of the population of Minas Gerais, affecting more females, younger people and individuals who adhered to intense social isolation. It is important to offer mental health care in order to avoid the negative impacts of social distancing in pandemic situations.

The increasing burden of pancreatic cancer in Brazil from 2000 to 2019: estimates from the Global Burden of Disease Study 2019

Abstract INTRODUCTION: Pancreatic cancer is increasing worldwide. The burden of pancreatic cancer in Brazil and its states was analyzed and compared with that from the USA and China. METHODS: This is a descriptive study of the incidence and mortality estimates from the Global Burden of Disease 2019 study, from 2000 to 2019. The Brazilian states presenting the highest and lowest socio-demographic index (SDI) were selected from each of the five regions. The SDI consists of the per capita income, education, and fertility rate of each population. RESULTS: A significant increase was found in age-standardized incidence and mortality of pancreatic cancer in all three countries, with differences in magnitude and annual increases. In Brazil, this incidence rose from 5.33 [95% Uncertainty Interval (UI): 5.06- 5.51] to 6.16 (95% UI: 5.68- 6.53) per 100,000 inhabitants. China and the Brazilian states with the lowest SDI, such as Pará and Maranhão, showed lower incidence and mortality rates, although presenting the highest annual increases. No difference was found between the sexes. A higher mortality rate was observed for those individuals of 70+ years, which was three to four times higher than those aged 50 to 69 years. CONCLUSIONS: The increasing burden of pancreatic cancer in the studied countries, and the higher estimates for the elderly in a fast-aging country such as Brazil, indicates that more resources and health policies will be necessary. The greatest increase in the states with lower SDI reflects inequalities in the access to diagnosis and registries of this cancer.

The burden of suicide in Brazil: findings from the Global Burden of Disease Study 2019

Abstract INTRODUCTION: Suicide deaths varies according to location, sex, and age. This study analyzed the Global Burden of Disease Study 2019 (GBD 2019) concerning suicide in Brazil. METHODS: This study described the mortality and years of life lost (YLL) due to premature death caused by suicide in Brazil in 1990 and 2019. The numbers, crude and age-standardized mortality rate (ASMR), and YLL were compared among Brazilian states, age groups, and sexes. RESULTS: There were 13,502 suicides in Brazil in 2019, 46.00% more than in 1990. The crude mortality rate increased 0.32%, while the ASMR declined -21.68% during the period. Crude and age-standardized YLL rates declined by -7.24% and -18.38%, respectively. In 2019, the biggest ASMRs were found in the South, whereas from 1990 to 2019, the ASMR declined in the South, Southeast, and Midwest, and increased in the Northeast. The number of suicides was higher among individuals aged 15-49 years, and suicide rates were higher among those aged over 70 years. From 1990 to 2019, an increase in the rate was found only of 10-14 years of age. Suicide was highest in men, except in the 10-14-year age group, ranking third in mortality among men of 15-34 years of age and fourth among women of 15-24 years of age. CONCLUSIONS: The ASMR and YLL for suicide declined since 1990, but suicide remains an important factor of mortality in the country. The South Region, men, elderly, and youth should be priorities in the implementation of suicide prevention strategies in Brazil.

The burden of mental disorders attributable by cocaine use: Global Burden of Diseases Study in Brazil, 1990 and 2019

Abstract INTRODUCTION: Brazil is an important consumer market for cocaine. However, the consequences of this consumption and the pattern of distribution of the estimates are still poorly studied in the Brazilian states. The Global Burden of Disease study - 2019 (GBD-2019) has enabled us to describe and analyze indicators of mental disorders (MD) attributable by cocaine use in Brazil and its states, in 1990 and 2019. METHODS: A descriptive study of the burden of cocaine use disorders, using prevalence, age-standardized mortality rate (ASMR), years of life lost (YLL) due to premature death, years lived with disabilities (YLD), and disability adjusted life years (DALY), which accounts for YLL+YLD. RESULTS: Brazil ranks 8th as DALYs due to cocaine use disorder in the world (42.83/100.000; 95% uncertainty intervals [95% UI]: 35.28 to 61.43). Significant increases have occurred in the age-standardized rate prevalence (ASRP), ASMR, DALY, YLD, and YLL, in Brazil and its states, between 1990 and 2019. The ASRP in 2019 was 2.7-fold higher for men (278.60/100.000; 95% UI: 208.20 to 374.39) in comparison to women (104.01/100.000; 95% UI: 76.70 to 143.02). There is a predominance of YLD in the composition of DALYs; however, the YLL had the biggest increases between 1990 and 2019. CONCLUSIONS: The high rate of DALYs and the increase in mortality rates show the need to scale up effective interventions to prevent and reduce the burden of disease attributable to cocaine use disorder, which is a preventable cause of death and disability.

Suicide mortality among older adults in Brazil between 2000 and 2019 - estimates from the Global Burden of Disease Study 2019

Abstract INTRODUCTION: Older adults present a higher risk of suicide, and Brazil is experiencing a fast population aging. To understand the impact of demographic transition, we compared Brazilian suicide mortality rates (MR) among adults (50+ years) with global rates, those from one high-income country, and those from one middle-income country. Looking for regional disparities, the MR was analyzed among older adults (60+ years) by Brazilian states. METHODS: This was an ecological study based on estimates from the Global Burden of Disease Study, from 2000 to 2019. Age-standardized MR and age-specific MR per 100,000 inhabitants were described, with 95% uncertainty intervals (UI). RESULTS: During the period, the annual estimates and the declining trend in mortality were higher in the world than in the studied countries. In 2019, global age-standardized MR was 9.39 (95% UI 8.48-10.29), compared to 5.68 (95% UI 5.40-6.19), 6.01 (95% UI 5.10-7.04), and 6.63 (95% UI 6.43-6.95) in Brazil, Mexico, and England, respectively. In Brazil, despite a significant decline in national rates, stability was observed in 15 states. An increase in aging was only found for men, who presented 3-4 times higher MR than women. The states' rates presented large differences: in 2019, the rates among men aged 60-64 years varied from 7.24 (95% UI 5.31; 9.85) to 26.32 (95% UI 20.21; 34.50). CONCLUSIONS: The smaller decline in suicide mortality among older Brazilian adults, the increasing risk with aging, and the higher mortality among men indicate the need for specific prevention policies. The variation within states suggests differences in the data quality or in socio-cultural and historical aspects, which requires further investigation.

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.

Sobre gestar e parir uma criança com a Síndrome Congênita do Zika Vírus: um estudo de caso / On gestating and giving birth to a child with congenital zika virus syndrome: a case study

Resumo Este artigo busca analisar o contexto de gestação, pré-natal e parto de uma criança com Síndrome Congênita do Zika (SCZ). É um estudo exploratório qualitativo, tipo estudo de caso único, delineado a partir de entrevista em profundidade realizada com uma mãe de criança diagnosticada com SCZ em Pernambuco. A análise dos dados ocorreu mediante a categorização do conteúdo da entrevista em quatro núcleos temáticos: contexto da descoberta da gestação; condições da assistência ao pré-natal e ao parto; condições de diagnóstico e assistência à criança; e sentimentos envolvidos na descoberta da gestação e do diagnóstico da síndrome. Esse caso sinaliza falhas no planejamento reprodutivo e na assistência ao pré-natal e parto; despreparo dos profissionais de saúde; e mudanças significativas na rotina da família, que implicam escolhas difíceis num contexto de deficitária assistência pública à saúde. A epidemia da SCZ revelou problemas que vão além do controle vetorial do mosquito. O panorama atual escancara vulnerabilidades dessas famílias, intensificadas com o surgimento e as consequências da covid-19, o que tem exposto ainda mais as fragilidades da atenção integral à saúde da mulher e a necessidade de manter uma rede articulada e resolutiva na assistência e vigilância em saúde.

Abstract This study analyzes the context of pregnancy, prenatal care and birth of children with Congenital Zika Syndrome (CZS). A single case exploratory study was conducted with a mother of a child diagnosed with CZS in Pernambuco, Brazil. Data were collected by an in-depth interview and content was categorized into four themes: discovery of pregnancy; conditions of prenatal and childbirth care; conditions of diagnosis and childcare; and feelings involved in the pregnancy discovery and syndrome diagnosis. This case study highlights failures in reproductive planning and in prenatal and childbirth care; unpreparedness of health professionals; and significant changes in the family's routine, which imply difficult choices under a deficient public health care. CZS epidemic uncovered problems that go beyond mosquito vector control. The current scenario highlights the vulnerabilities of these families, intensified by the emergence and consequences of COVID-19, which has further exposed the weaknesses of women's comprehensive health care and the need to maintain an articulated and resolute network in health care and surveillance.