Práticas coletivas e individuais associadas à dificuldade dos enfermeiros da atenção primária à saúde / Collective and individual practices associated with the difficulty of primary health care nurses / Prácticas coletivas e individuais asociadas a la dificultad de las enfermeras de atención primaria de salud

Objetivo: analisar as práticas individuais e coletivas que estão associadas as dificuldades dos enfermeiros que atuam na Atenção Primária à Saúde da região Norte. Métodos: observacional de prevalência e analítico. Foram incluídos enfermeiros da atenção básica. A coleta ocorreu entre novembro de 2019 a agosto de 2021, nos sete estados do Norte, através de um formulário eletrônico, analisados pelos testes binomial, quiquadrado e G no programa Bioestat. Resultados: Entre os 626 enfermeiros do estudo, 15,7% (98/626) afirmaram ter dificuldade no exercício de suas práticas, quanto à autonomia das suas responsabilidades normativas legais. O Amapá teve menor proporção (8,3%; 9/108) de enfermeiros com dificuldade em relação a região. As práticas associadas a dificuldade foram: a não participação do enfermeiro no gerenciamento dos insumos (p=0,03), realizar consulta eventualmente (p=0,03) e nunca prescrever medicamentos (p=0,02); resolutividade insuficiente na consulta pré-natal (p=0,000), acompanhamento de crescimento e desenvolvimento infantil (p=0,001); planejamento familiar (p=0,000); hanseníase (p=0,005); tuberculose (p=0,031); hipertensão arterial (p<0,0001); diabetes (p<0,0001). Conclusão: As dificuldades quanto à autonomia das responsabilidades normativas legais estão associadas a práticas individuais e coletivas que são privativas do enfermeiro e estão regulamentadas nos programas de saúde pública. (AU)

Objective: to analyze the individual and collective practices that are associated with the difficulties of nurses who work in Primary Health Care in the North region. Methods: observational of prevalence and analytical. Primary care nurses were included. The collection took place between November 2019 and August 2021, in the seven states of the North, through an electronic form, analyzed by the binomial, chi-square and G tests in the Bioestat program. Results: Among the 626 nurses in the study, 15.7% (98/626) stated that they had difficulty in exercising their practices, regarding the autonomy of their legal normative responsibilities. Amapá had a lower proportion (8.3%; 9/108) of nurses with difficulties in relation to the region. The practices associated with the difficulty were: the non-participation of nurses in the management of supplies (p=0.03), occasional consultations (p=0.03) and never prescribing medication (p=0.02); insufficient resolution in the prenatal consultation (p=0.000), monitoring of child growth and development (p=0.001); family planning (p=0.000); leprosy (p=0.005); tuberculosis (p=0.031); arterial hypertension (p<0.0001); diabetes (p<0.0001). Conclusion: Difficulties regarding the autonomy of legal normative responsibilities are associated with individual and collective practices that are exclusive to nurses and are regulated in public health programs. (AU)

Objetivo: analizar las prácticas individuales y colectivas que están asociadas a las dificultades de los enfermeros que actúan en la Atención Primaria de Salud de la región Norte. Métodos: observacional de prevalencia y analítico. Se incluyeron enfermeras de atención primaria. La colecta se realizó entre noviembre de 2019 y agosto de 2021, en los siete estados del Norte, a través de un formulario electrónico, analizado por las pruebas binomial, chi-cuadrado y G en el programa Bioestat. Resultados: Entre los 626 enfermeros del estudio, 15,7% (98/626) afirmaron tener dificultad en el ejercicio de sus prácticas, en cuanto a la autonomía de sus responsabilidades normativas legales. Amapá tuvo menor proporción (8,3%; 9/108) de enfermeros con dificultades en relación a la región. Las prácticas asociadas a la dificultad fueron: la no participación de los enfermeros en la gestión de los insumos (p=0,03), consultas ocasionales (p=0,03) y nunca recetar medicamentos (p=0,02); resolución insuficiente en la consulta prenatal (p=0,000), seguimiento del crecimiento y desarrollo infantil (p=0,001); planificación familiar (p=0,000); lepra (p=0,005); tuberculosis (p=0,031); hipertensión arterial (p<0,0001); diabetes (p<0,0001). Conclusión: Las dificultades en cuanto a la autonomía de las responsabilidades normativas legales están asociadas a las prácticas individuales y colectivas, exclusivas de los enfermeros y reguladas em los programas de salud pública. (AU)

Nivel de conocimiento sobre VPH en estudiantes de la Universidad del Pacífico

Introducción. El virus del papiloma humano (VPH) es una infección viral más habitual del aparato reproductor y causa diversos trastornos, tanto en hombres como en mujeres, y se considera como el principal agente para el desarrollo del cáncer cervicouterino. Objetivo. Determinar el nivel de conocimiento sobre el VPH de las alumnas del segundo año de las diferentes carreras de la Universidad del Pacífico Sede Asunción en el año 2023. Materiales y Métodos. Se realizó un estudio observacional, descriptivo de corte transversal en alumnas del segundo año de las diferentes carreras de la Universidad del Pacifico en el 2023, mediante una encuesta de conocimiento, influencia y métodos para evitar el contagio del VPH. Se aplicó la estadística descriptiva utilizando el programa EpiDat 4.2. Resultados. Participaron 95 alumnas, el 49,92% conoce que el VPH es una infección viral, el 87,37% que su síntoma más común son las verrugas genitales, el 91,58% sabe que la infección por VPH afecta a ambos sexos, el 90,53% que se puede transmitir por vía sexual, 71,58% sabe que puede producir cáncer de cuello uterino y el 86,32% conoce que la vacunación es la principal medida de prevención. El 48% de las estudiantes tuvieron un buen nivel de conocimiento global sobre el VPH. Conclusión. El nivel insuficiente de conocimiento sobre VHP refleja la necesidad de realizar fortalecer el programa educativo universitario y campañas educativas con respecto al VPH y el cáncer de cuello uterino.

Introduction. Human papillomavirus (HPV) is the most common viral infection of the reproductive tract, causes various disorders in both men and women, and it is considered to be the main agent for the development of cervical cancer. Objective. To determine the level of knowledge about HPV among students in the second year of the different careers of the Universidad del Pacífico, Asunción, 2023. Materials and Methods. A cross-sectional, observational, descriptive study was carried out with 2nd year students of the different careers of the Universidad del Pacifico in 2023, by means of a survey of knowledge about HPV, influence, and methods to prevent infection. Descriptive statistics using EpiDat 4.2 software were applied. Results. Of the 95 female students surveyed, 49.92% knew that HPV was a viral infection, 87.37% knew that the most common symptom was genital warts, 91.58% knew that HPV disease affects both sexes, 90.53% knew that it can be transmitted sexually, 71.58% knew that it could cause cervical cancer, and 86.32% knew that vaccination was the main prevention measure, 48% of the students have a good global knowledge about HPV. Conclusion. The insufficient level of knowledge about HPV reflects the need to strengthen the university educational program and educational campaigns regarding HPV and cervical cancer.

Diferenças entre homens e mulheres na prevalência da fragilidade e fatores associados entre adultos mais velhos: evidências do ELSI-Brasil / Differences between men and women in the prevalence of frailty and associated factors among older adults: evidence from ELSI-Brazil / Diferencias entre hombres y mujeres en cuanto a la prevalencia de fragilidad y los factores asociados entre adultos mayores: evidencia de ELSI-Brasil

Este trabalho, baseado em amostra nacional representativa da população com 50 anos ou mais, objetivou estimar a prevalência da fragilidade entre homens e mulheres, identificar fatores sociodemográficos e de saúde associados e estimar a fração atribuível populacional. Foram utilizados dados da segunda onda (2019-2021) do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). A fragilidade foi classificada pelo número de itens positivos entre perda de peso não intencional, exaustão, baixo nível de atividade física, lentidão da marcha e fraqueza. As análises principais foram baseadas na regressão logística multinomial estratificada por sexo. A prevalência da fragilidade foi menor nos homens (8,6%; IC95%: 6,9; 10,7) do que nas mulheres (11,9%; IC95%: 9,6; 14,8), sendo o item mais frequente o baixo nível de atividade física em ambos. A idade e a escolaridade foram os fatores sociodemográficos associados à pré-fragilidade e à fragilidade entre homens e mulheres. Houve diferença da fração atribuível populacional para fragilidade entre os sexos. Nos homens, a maior fração atribuível populacional foi para não ter companheiro (23,5%; IC95%: 7,7; 39,2) e escolaridade baixa (18,2%; IC95%: 6,6; 29,7). Nas mulheres, maiores frações atribuíveis populacionais foram para déficit de memória (17,1%; IC95%: 7,6; 26,6), déficit da visão (13,4%; IC95%: 5,1; 21,7) e diabetes mellitus (11,4%; IC95%: 4,6; 18,1). Observou-se fração atribuível populacional semelhante para doença cardíaca (8,9%; IC95%: 3,8; 14,1, em mulheres; e 8,8%; IC95%: 2,0; 15,6, em homens). Estratégias voltadas para a prática de atividade física têm o potencial de prevenir a fragilidade em ambos os sexos, enquanto a prevenção de condições crônicas é mais importante nas mulheres.

Based on a national representative sample of the population aged 50 years or older, this study aimed to estimate the prevalence of frailty among men and women, identify associated sociodemographic and health factors, and estimate the population attributable fraction. Data from the second wave (2019-2021) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were used. Frailty was classified based on the number of positive items among unintentional weight loss, exhaustion, low level of physical activity, slow gait, and weakness. The main analyses were based on multinomial logistic regression stratified by sex. The prevalence of frailty was lower in men (8.6%; 95%CI: 6.9; 10.7) than in women (11.9%; 95%CI: 9.6; 14.8), with the most frequent item being the low level of physical activity in both. Age and schooling level were the sociodemographic factors associated with pre-frailty and fragility among men and women. The population attributable fraction was different for frailty between genders. In men, the highest population attributable fraction was due to not having a partner (23.5%; 95%CI: 7.7; 39.2) and low schooling level (18.2%; 95%CI: 6.6; 29,7). In women, higher population attributable fraction values were due to memory deficit (17.1%; 95%CI: 7.6; 26.6), vision deficit (13.4%; 95%CI: 5.1; 21.7), and diabetes mellitus (11.4%; 95%CI: 4.6; 18,1). Similar population attributable fraction levels were observed for heart disease (8.9%; 95%CI: 3.8; 14.1 in women and 8.8%; 95%CI: 2.0; 15.6 in men). Strategies aimed at physical activity have the potential to prevent frailty in both men and women, and the prevention of chronic conditions is more important in women.

Este estudio tuvo por objetivo estimar, utilizando una muestra nacional representativa de la población de 50 años o más, la prevalencia de la fragilidad entre hombres y mujeres, identificar los factores sociodemográficos y de salud asociados, y calcular la fracción atribuible a la población. Se utilizaron datos de la 2ª ola (2019-2021) del Estudio Longitudinal de Salud de los Ancianos Brasileños (ELSI-Brasil). La fragilidad se clasificó por el número de elementos positivos entre pérdida de peso no intencional, agotamiento, bajo nivel de actividad física, marcha lenta y debilidad. Los principales análisis se basaron en la regresión logística multinomial estratificada por sexo. La prevalencia de fragilidad fue menor en los hombres (8,6%; IC95%: 6,9; 10,7) que en las mujeres (11,9%; IC95%: 9,6; 14,8), y como ítem más frecuente el bajo nivel de actividad física en ambos. La edad y el nivel educativo fueron los factores sociodemográficos asociados a la pre-fragilidad y la fragilidad entre hombres y mujeres. Hubo una diferencia en fracción atribuible a la población para la fragilidad entre los sexos. Entre los hombres, la fracción atribuible a la población más elevada fue no tener pareja (23,5%; IC95%: 7,7; 39,2) y bajo nivel educativo (18,2%; IC95%: 6,6; 29,7). Entre las mujeres, las fracción atribuible a la población más elevadas fueron déficit de memoria (17,1%; IC95%: 7,6; 26,6), déficit de visión (13,4%; IC95%: 5,1; 21,7) y diabetes mellitus (11,4%; IC95%: 4,6; 18,1). Se observaron fracción atribuible a la población similares para enfermedades cardíacas (8,9%; IC95%: 3,8; 14,1 en mujeres, y 8,8%; IC95%: 2,0; 15,6 en hombres). Las estrategias dirigidas a la actividad física tienen el potencial de prevenir la fragilidad en ambos sexos, mientras que la prevención de enfermedades crónicas es más necesaria en las mujeres.

Características sociodemográficas associadas ao baixo peso e ao excesso de peso em adultos com 50 anos ou mais (ELSI-Brasil): diferenças entre sexos / Sociodemographic characteristics associated with underweight and overweight in adults aged 50 years and over (ELSI-Brasil): differences between sexes / Características sociodemográficas asociadas al bajo peso y al sobrepeso en adultos de 50 años o más (ELSI-Brasil): diferencias entre sexos

Os objetivos foram descrever a prevalência de baixo peso e excesso de peso, avaliados pelo índice de massa corporal (IMC), estratificada por sexo e faixa etária, e analisar as características sociodemográficas associadas ao IMC em mulheres e homens mais velhos. Trata-se de uma análise transversal de 8.974 participantes com ≥ 50 anos da linha de base do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil, 2015-16). O IMC foi classificado em baixo peso, eutrofia e excesso de peso de acordo com a idade do participante. Foi utilizado modelo de regressão logística multinominal, considerando-se as características sociodemográficas de mulheres e homens. Os resultados evidenciaram maior prevalência de excesso de peso nas mulheres em comparação aos homens (64,1% vs. 57,3%). Em ambos os sexos, a prevalência de baixo peso foi maior nos mais longevos, enquanto que o excesso de peso foi menor. Nas mulheres, a chance de baixo peso foi maior do que a chance de eutrofia naquelas solteiras/viúvas/divorciadas (OR = 1,95; IC95%: 1,42-2,66) e nas residentes na área rural (OR = 1,58; IC95%: 1,01-2,49), ao passo que a chance de excesso de peso foi menor do que a chance de eutrofia nas residentes na área rural (OR = 0,78; IC95%: 0,62-0,97) e em todas as macrorregiões geográficas relativas à Região Sul. Para os homens, a chance de excesso de peso foi menor do que a chance de eutrofia entre solteiros/viúvos/divorciados (OR = 0,58; IC95%: 0,48-0,69). Os mais ricos apresentaram menor chance de baixo peso (OR = 0,59; IC95%: 0,38-0,90), bem como maior chance de excesso de peso (OR = 1,52; IC95%: 1,20-1,92). Em conclusão, as características sociodemográficas associadas ao IMC diferiram entre os sexos.

The objective were to describe the prevalence of underweight and overweight, assessed by body mass index (BMI), stratified by sex and age group, and to analyze the sociodemographic characteristics associated with BMI in older women and men. This is a cross-sectional analysis of 8,974 participants aged ≥ 50 years from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brasil, 2015-2016). BMI was classified as underweight, eutrophy, and overweight according to the participant's age. A multinomial logistic regression model was used, considering the sociodemographic characteristics of women and men. The results showed a higher prevalence of overweight in women compared to men (64.1% vs. 57.3%). In both sexes, the prevalence of underweight was higher in the longest-lived individuals, while overweight was lower. In women, the chance of underweight was higher than the chance of eutrophy in those who were single/widowed/divorced (OR = 1.95; 95%CI: 1.42-2.66) and in those living in rural areas (OR = 1.58; 95%CI: 1.01-2.49), while the chance of being overweight was lower than the chance of being eutrophy in those living in rural areas (OR = 0.78; 95%CI: 0.62-0.97) and in all geographic macro-regions related to the South Region. For men, the chance of being overweight was lower than the chance of being eutrophy among single/widowed/divorced individuals (OR = 0.58; 95%CI: 0.48-0.69). The richest had a lower chance of being underweight (OR = 0.59; 95%CI: 0.38-0.90), as well as a higher chance of being overweight (OR = 1.52; 95%CI: 1.20-1.92). In conclusion, the sociodemographic characteristics associated with BMI differed between the sexes.

Los objetivos fueron describir la prevalencia de bajo peso y sobrepeso, evaluados a través del índice de masa corporal (IMC), estratificada por sexo y grupo de edad, y analizar las características sociodemográficas asociadas al IMC en mujeres y hombres mayores. Se trata de un análisis transversal de 8.974 participantes con ≥ 50 años de la línea de base del Estudio Longitudinal Brasileño sobre el Envejecimiento (ELSI-Brasil, 2015-2016). Se clasificó el IMC en bajo peso, eutrofia y sobrepeso conforme la edad del participante. Se utilizó el modelo de regresión logística multinomial, teniendo en cuenta las características sociodemográficas de mujeres y hombres. Los resultados evidenciaron una prevalencia más alta de sobrepeso en las mujeres en comparación con los hombres (64,1% vs. 57,3%). En ambos sexos, la prevalencia de bajo peso fue más alta en los grupos de mayor edad, mientras que la prevalencia del sobrepeso fue menor. La chance de bajo peso fue más alta que la chance de eutrofia en las mujeres solteras/viudas/divorciadas (OR = 1,95; IC95%: 1,42-2,66) y en las que viven en el área rural (OR = 1,58; IC95%: 1,01-2,49), mientras que la chance de sobrepeso fue menor que la chance de eutrofia en las que viven en el área rural (OR = 0,78; IC95%: 0,62-0,97) y en todas las macrorregiones geográficas relacionadas a la región Sur. La chance de sobrepeso fue menor que la chance de eutrofia entre los hombres solteros/viudos/divorciados (OR = 0,58; IC95%: 0,48-0,69). Los más ricos presentaron una chance menor de bajo peso (OR = 0,59; IC95%: 0,38-0,90), así como una chance más alta de sobrepeso (OR = 1,52; IC95%: 1,20-1,92). En conclusión, las características sociodemográficas asociadas al IMC difirieron entre los sexos.

Cardiovascular Risk and Lifestyle: comparison between teaching workers in Portugal and Brazil / Riesgo cardiovascular y estilo de vida: comparación entre trabajadores docentes en Portugal y Brasil / Risco Cardiovascular e Estilo de Vida: comparação entre trabalhadores do ensino de Portugal e Brasil

ABSTRACT Objective: Compare Cardiovascular Risk between workers in Brazil and Portugal who work in the teaching context and its relationship with Lifestyle and Common Mental Disorder. Methods: Cross-sectional study that compared the cardiovascular health conditions of teaching workers in Manaus (Brazil) and Coimbra (Portugal). The odds ratio between groups was estimated. Results: The differences were: Smoking and hypercholesterolemia in participants from Portugal. Hypertension, chronic disease, increased abdominal perimeter, common mental disorder, and absence from work in Brazil. The variables with the greatest effect for high cardiovascular risk were: Country-Portugal [17.273 (95%CI1.538-193.951)], sex-male [61.577 (95%CI5.398-702.469)] and smoking [593.398 (95%CI57.330-6.142.020)]. Conclusion: The differences in risk between groups showed that participants from Portugal, men, with high blood pressure and/or smokers are the most vulnerable to having a cardiovascular event. There is a need for interventions to promote cardiovascular health in the workplace in both countries.

RESUMEN Objetivo: Comparar el Riesgo Cardiovascular entre trabajadores de Brasil y Portugal que actúan em el contexto docente y su relación con el Estilo de Vida y el Trastorno Mental Común. Métodos: Estudio transversal que comparo las condiciones de salud cardiovascular de trabajadores docentes de Manaos (Brasil) y Coimbra (Portugal). Se estimó el odds ratio entre grupos. Resultados: Las diferencias fueron: Tabaquismo e hipercolesterolemia en participantes de Portugal. Hipertensión, enfermedad crónica, aumento del perímetro abdominal, trastorno mental común y ausentismo laboral en Brasil. Las variables com mayor efecto para alto riesgo cardiovascular fueron: País-Portugal [17.273 (IC95%1.538-193.951)], sexo-masculino [61.577 (IC95%5.398-702.469)] y tabaquismo [593.398(IC95%57.330- 6.142.020)]. Conclusión: Las diferencias de riesgo entre grupos mostraron que los participantes portugueses, los hombres, los hipertensos y/o fumadores son los más vulnerables a sufrir un evento cardiovascular. Es necesario realizar intervenciones para promover la salud cardiovascular en el lugar de trabajo en ambos países.

RESUMO Objetivo: Comparar o Risco Cardiovascular entre trabalhadores do Brasil e Portugal que atuam no contexto do ensino e sua relação com Estilo de Vida e Transtorno Mental Comum. Métodos: Estudo transversal que comparou as condições de saúde cardiovascular de trabalhadores do ensino de Manaus (Brasil) e Coimbra (Portugal). Foi estimada a razão de chance entre grupos. Resultados: As diferenças foram: Tabagismo e hipercolesterolemia nos participantes de Portugal. Hipertensão, doença crônica, perímetro abdominal aumentado, transtorno mental comum e afastamento do trabalho no Brasil. As variáveis com maior efeito para risco cardiovascular alto foram: País-Portugal [17.273 (IC95%1.538-193.951)], sexo-masculino [61.577 (IC95%5.398 -702.469)] e tabagismo [593.398(IC95%57.330- 6.142.020)]. Conclusão: As diferenças de risco entre grupos mostraram que os participantes de Portugal, homens, com pressão arterial aumentada e/ou tabagistas são os mais vulneráveis a ter evento cardiovascular. Há necessidades de intervenções para a promoção da saúde cardiovascular no ambiente laboral nos dois países.

Acesso aos contraceptivos e direito à saúde em Angola: experiências de mulher e de farmacêutica / Access to contraceptives and the right to health in Angola: experiences of a woman and pharmacist

RESUMO Este relato apresenta uma proposta do que a escritora Conceição Evaristo chama de 'escrevivência' - escrita da mulher negra, que se mescla com vivência, relato de memórias e memórias de seu povo, visando incomodar consciências e ecoar nossas histórias. O 'escrever, viver e se ver' da autora é reconhecido como 'escrita da alma', lugar onde cada mulher escreve considerando o mundo que vive, de uma forma integrada. Visa fazer uma breve reflexão sobre o acesso aos medicamentos, tomando o acesso aos métodos contraceptivos em Angola como recorte, tendo em conta a vivência da autora. É um estudo qualitativo e a coleta de dados foi feita por meio de pesquisa documental, estudo de campo e entrevistas. Para o tratamento de dados foi adotada a análise de conteúdo. Identificou-se que o acesso aos métodos contraceptivos em território angolano é incipiente, resultado de políticas públicas e boa governança pouco efetivas, bem como a interferência externa pouco resolutiva. Estes, são reforçados pela herança colonial, que propicia abordagens em desacordo com as necessidades locais. É fundamental que os direitos sexuais e reprodutivos sejam encarados como questão política, de saúde pública e inerente à dignidade humana, para além da perspectiva eugenista de controle de natalidade.

ABSTRACT This report consists of what Conceição Evaristo calls 'writing and living' - the writing of black women, which mixes with experience, their memories, and the memories of their people, aiming to disturb consciences and echo our stories. The author's 'writing, living and self-seeing' is recognized as the 'writing of the soul', from where each woman writes considering the world she lives in. It aims to briefly reflect on access to medicines, focusing on the access to contraceptive methods in Angola, based on the author's experience. It is a qualitative study, and data were collected through documentary research, field study, and interviews. Content analysis was adopted for data processing. Access to contraceptive methods in Angolan territory is incipient, a result of ineffective public policies and good governance, as well as ineffective external interference. These are reinforced by colonial heritage, which provides approaches in disagreement with local needs. Sexual and reproductive rights must be seen as a political and public health issue inherent to human dignity, beyond the eugenic perspective of birth control.

Stress assessment awareness among practitioners during dental procedures: a cross-sectional study

Aim: Patient anxiety during dental procedures impacts oral health and well-being. Dental practitioners are vital in managing this stress. Our study aims to explore, analyze, and draw comparisons regarding the understanding and awareness levels of stress and anxiety assessment during routine dental procedures among general dental practitioners and specialists. Method: A self-administered questionnaire was sent to 503 Indian dental practitioners, encompassing both general dentists and specialists. Comprising 13 sections, the questionnaire covered demographic information and delved into topics such as dental anxiety assessment tools, familiarity with stress-reducing techniques, and awareness of the impact of anxiety on treatment outcomes. Following this, data analysis was performed using SPSS software, employing a range of descriptive and inferential statistics, including the Chi-square test. Results: Significant knowledge disparities were observed. While 78.3% of specialists assessed patient stress, only 75% of general dentists did, with no statistical difference (p=0.386). Both groups recognized the impact of gender dynamics and environmental factors on stress, but these findings lacked significant differences (p=0.314, p=0.40, p=0.86). However, specialists showed significantly more awareness of the link between stress and periodontal disease (p=0.043), genetics' role in stress (p=0.008), and the implications of epigenetics for stress and oral health (p=0.000). Conclusion: This study highlights a noticeable knowledge gap between general dentists and specialists in assessing patient stress during dental procedures. While both groups share similar views on gender dynamics and environmental factors, significant differences exist in their awareness of connections between stress, periodontal disease, genetics, and epigenetics. Targeted educational efforts are necessary to bridge this knowledge gap, improve patient care, and advance dental medicine

Anatomic barriers to paraspinal blocks: a cadaver case series

Abstract The paraspinal space is intriguing in nature. There are several needle tip placements described in compact anatomical spaces. This has led to an incertitude regarding the appropriate anatomic locations for needle tip positions. Through our cadaver models we try to resolve the issues surrounding needle tip positions clarifying anatomical spaces and barriers. Further we propose an anatomical classification based on our findings in cadaveric open dissections and cross and sagittal sections.

Habilidades sociais na especialidade da enfermagem em oncologia: estudo qualitativo / Social skills in the nursing specialty in oncology: qualitative study / Habilidades sociales en la especialidad de enfermería en oncología: estudio cualitativo

Objetivo: compreender o significado das habilidades sociais atribuído por enfermeiros especialistas em enfermagem em oncologia. Método: estudo qualitativo, exploratório, que aplicou a Teoria Fundamentada nos Dados e o Interacionismo Simbólico. Participaram 14 enfermeiros de um dos grupos amostrais, especialistas em oncologia, de hospital oncológico. Aplicamos a entrevista semiestruturada, on-line, de maio de 2021 a dezembro de 2022. A análise seguiu a codificação aberta, axial e integração, e aplicamos o paradigma da codificação. Resultados: a categoria paradigmática 'condição do fenômeno' é apresentada face o aspecto semântico e de reconhecimento da aplicação das habilidades sociais. A categoria Percepções e significados das habilidades sociais para enfermeiros oncologistas alicerçou-se nas subcategorias: reagindo ao termo, e atribuindo significados e valores às habilidades sociais na especialidade da enfermagem em oncologia. Conclusão: os enfermeiros reconhecem as habilidades sociais e sua importância na oncologia. Desse modo, reitera-se a importância da articulação teórico-prático para qualificar a prática na oncologia(AU)

Objective: to understand the meaning of social skills attributed by specialist nurses in oncology nursing. Method: a qualitative, exploratory study, which applied Grounded Theory and Symbolic Interactionism. The participants were 14 nurses from one of the sample groups, specialists in oncology, from an oncological hospital. We applied semi-structured interviews, online, from May 2021 to December 2022. The analysis followed open, axial, and integration coding, and the coding paradigm. Results: we present the paradigm condition category, given the semantic aspect and recognition of the application of social skills. The category Perceptions and meanings of social skills for oncology nurses was based on the subcategories: reacting to the term, and attributing meanings and values to social skills in the specialty of nursing in oncology. Conclusion: nurses recognize social skills and their importance in oncology. We reinforce the importance of theoretical-practical articulation to qualify the practice in oncology(AU)

Objetivo: comprender el significado de las habilidades sociales atribuido por enfermeros especialistas en enfermería oncológica. Método: estudio cualitativo, exploratorio, que aplicó la Teoría Fundamentada y el Interaccionismo Simbólico. 14 enfermeros, expertos en oncología, participaron en uno de los grupos de muestreo de un hospital oncológico. Aplicamos entrevistas semiestructuradas, en línea, de mayo de 2021 a diciembre de 2022. El análisis siguió la codificación abierta, axial y de integración, y aplicamos el paradigma de la codificación. Resultados: se presentó la categoría paradigmática 'condición del fenómeno' ante el aspecto semántico y de reconocimiento de la aplicación de habilidades sociales. La categoría 'Percepciones y significados de las habilidades sociales para enfermeros de oncología' se basó en las subcategorías: reaccionando al término y atribuyendo significados y valores a las habilidades sociales en la especialidad de enfermería en oncología. Conclusión: los enfermeros reconocen las habilidades sociales y su importancia en la oncología. Siendo así, reforzamos la importancia de la articulación teórico-práctica para cualificar la práctica en oncología(AU)

Identification of rare atypical BCR-ABL1 transcript: A case report

CML is characterized by the presence of a BCR-ABL1 fusion transcript. Several guidelines have been published for its detection and molecular monitoring. Here, a case is described of chronic myeloid leukemia presenting in the blast phase with a rare variant transcript, with a discussion on possible red flags in its detection and genetic testing and description of the patient's clinical characteristics. This case highlights the pitfalls of using real-time quantitative reverse-transcription polymerase chain reaction (RQ-PCR) for diagnosis of CML, especially when the clinical picture and the test results are discordant.

Evaluation of contact angle and mechanical properties of resin monomers filled with graphene oxide nanofibers

Abstract This in vitro study synthesized hybrid nanofibers embedded in graphene oxide (GO) and incorporated them into experimental resin composite monomers to evaluate their physical-mechanical properties. Inorganic-organic hybrid nanofibers were produced with precursor solutions of 1% wt. GO-filled Poly (d,l-lactide, PLA) fibers and scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) characterized the morphology and chemical composition of the spun fibers. Resin composite monomers were developed and a total of 5% nanofibers were incorporated into the experimental materials. Three groups were developed: G1 (control resin monomers), G2 (resin monomers/PLA nanofibers), and G3 (resin monomers/inorganic-organic hybrid nanofibers). Contact angle (n=3), flexural strength (n=22), elastic modulus (n=22), and Knoop hardness (n=6) were evaluated. The mean of the three indentations was obtained for each sample. The normality of data was assessed by QQ Plot with simulated envelopes and analyzed by Welch's method (p<0.05). Overall, SEM images showed the regular shape of nanofibers but were non-aligned. Compositional analysis from EDS (n=6) revealed the presence of carbon and oxygen (present in GO composition) and Si from the functionalization process. The results of contact angle (°) and hardness (Kg/mm2) for each group were as follow, respectively: G1 (59.65±2.90; 37.48±1.86a), G2 (67.99±3.93; 50.56±1.03b) and G3 (62.52±7.40; 67.83±1.01c). The group G3 showed the highest Knoop hardness values (67.83 kg/mm2), and the flexural strength of all groups was adversely affected. The experimental resin composite composed of hybrid nanofibers with GO presented increased hardness values and hydrophilic behavior.

Resumo Este estudo in vitro sintetizou nanofibras híbridas embebidas em óxido de grafeno (GO), incorporando-as à uma resina composta experimental de monômeros para avaliar suas propriedades físico-mecânicas. Nanofibras híbridas inorgânica-orgânicas foram produzidas com soluções precursoras de fibras poli (d, l-lactídeo, PLA) preenchidas com GO a 1% em peso e microscopia eletrônica de varredura (MEV) e espectroscopia de raio-X de energia dispersiva (EDS) caracterizaram a morfologia e composição química das fibras. Monômeros de resina composta foram desenvolvidos e um total de 5% de nanofibras foi incorporado aos materiais experimentais. Três grupos foram desenvolvidos: G1 (monômeros de resina controle), G2 (monômeros de resina/ nanofibras de PLA) e G3 (monômeros de resina/nanofibras híbridas inorgânico-orgânicas). Ângulo de contato (n=3), resistência à flexão (n=22), módulo de elasticidade (n=22) e dureza Knoop (n=6) foram avaliados. A média das três endentações foi obtida para cada amostra. A normalidade dos dados foi avaliada pelo QQ Plot com envelopes simulados e analisada pelo método de Welch (p<0,05). No geral, as imagens de MEV mostraram forma regular de nanofibras, mas não alinhadas. A análise composicional de EDS (n=6) revelou a presença de carbono e oxigênio (presentes na composição do GO) e Si resultante do processo de funcionalização. Os resultados do ângulo de contato (°) e dureza (Kg/mm2) para cada grupo foram os seguintes, respectivamente: G1 (59,65±2,90; 37,48±1,86a), G2 (67,99±3,93; 50,56±1,03b) e G3 (62,52±7,40; 67,83±1,01c). G3 apresentou os maiores valores de dureza Knoop (67,83 kg/mm2), e a resistência à flexão de todos os grupos foi prejudicada. A resina composta experimental composta por nanofibras híbridas com GO apresentou maiores valores de dureza e comportamento hidrofílico.

Food consumption is associated with frailty in edentulous older adults: evidence from the ELSI-Brazil study / Consumo alimentar está associado à fragilidade em adultos mais velhos edêntulos: evidências do estudo ELSI-Brasil

Abstract This cross-sectional study aimed to evaluate the association between food consumption (meat, fish, and fruits and vegetables), anthropometric indicators (body mass index, waist circumference, and waist-to-height ratio), and frailty; and to verify whether these associations vary with edentulism. We used data from 8,629 participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) (2015-16). Frailty was defined by unintentional weight loss, weakness, slow walking speed, exhaustion, and low physical activity. Statistical analyses included multinomial logistic regression. Of the participants, 9% were frail and 54% pre-frail. Non-regular meat consumption was positively associated with pre-frailty and frailty. Non-regular fish consumption, and underweight were associated only with frailty. Models with interactions reveled a marginal interaction between meat consumption and edentulism (p-value = 0.051). After stratification, non-regular meat consumption remained associated with frailty only in edentulous individuals (OR = 1.97; 95%CI 1.27-3.04). Our results highlight the importance of nutritional assessment, oral health, and public health-promoting policies to avoid, delay and/or reverse frailty in older adults.

Resumo Este estudo transversal teve como objetivo avaliar a associação entre consumo alimentar (carnes, peixe e frutas e hortaliças), indicadores antropométricos (índice de massa corporal, circunferência da cintura e relação cintura/estatura) e fragilidade; e verificar se essas associações variam com o edentulismo. Usamos dados de 8.629 participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil) (2015-16). A fragilidade foi definida por perda de peso não intencional, fraqueza, baixa velocidade da marcha, exaustão e baixa atividade física. As análises estatísticas incluíram regressão logística multinomial. Dos participantes, 9% eram frágeis e 54% pré-frágeis. O consumo não regular de carnes foi positivamente associado à pré-fragilidade e fragilidade. O consumo não regular de peixe e o baixo peso foram associados apenas à fragilidade. Modelos com interações revelaram uma interação marginal entre consumo de carnes e edentulismo (p-valor = 0,051). Após estratificação, o consumo não regular de carnes permaneceu associado à fragilidade apenas em indivíduos edêntulos (OR = 1,97; IC95% 1,27-3,04). Nossos resultados destacam a importância da avaliação nutricional, saúde bucal e políticas públicas de promoção da saúde para evitar, retardar e/ou reverter a fragilidade em adultos mais velhos.

THE IMPACT OF SUPPLY CHAIN MANAGEMENT PRACTICES ON PRODUCTIVITY

The purpose of the study is to test the impact of supply chain management practices on productivity of the organisation. Additionally, investigated the relationship between supply chain management practices and organisational productivity. The type of research used is descriptive in nature.. The study was conducted on the basis of various factors like risk management, process, delivery and planning and how organisational productivity can be improved through these factors of supply chain management practices. The paper revealed that there is a relationship between supply chain management practices and organisational productivity. It also revealed that there is an impact of supply chain management practices on organisational productivity. As far as the researcher is aware,this paper is rst to investigate the impact of supply chain management practices on organisational productivity with factors like quality management, inventory management and transportation and the researcher has done the study on different factors like risk management, planning, process and delivery

Incremental innovations in operation theaters

Background: The field of ophthalmology has been built upon continuous innovations. COVID?19 pandemic has been an important driving force behind many innovations in ophthalmology and other branches of medicine. Innovations in ophthalmology has been a key to surgical progress. The process of promoting innovation in surgery is imperative in the evolving practice of ophthalmology. Purpose: In this video we demonstrate some incremental innovations in operation theaters which help in increasing the efficiency and improving the performance of a surgeon. These innovations also provide a more comfortable environment for the patient undergoing the surgery. Synopsis: A few incremental innovations that are described in our video also help in preventing the spread of COVID infection during surgery. This video also showcases a few wet lab innovations that help train residents in their surgical skills. Highlights: Use and reuse of simple materials make it cost effective and ecofriendly. These incremental innovations help in the smooth running of operation theaters. Thus, they are small improvements in the existing setup and help in creating a smooth and error free OT flow

Chop and tumble nucleotomy – A technique for safe nuclear emulsification in posterior polar cataract

A modified phaco chop technique for nuclear emulsification in posterior polar cataracts with nuclear sclerosis that avoids hydrodissection or nuclear rotation has been described. After performing a vertical chop maneuver to divide the nucleus, two pie-shaped nuclear fragments are removed from either side of the initial chop. The remaining nuclear fragments are then sequentially tumbled toward the center using the second instrument and emulsified while maintaining an intact epinuclear shell, which safeguards the fragile posterior capsule. The technique was successfully performed in 62 eyes of 54 patients with posterior polar cataract and grade II–IV nuclear sclerosis. The Chop and Tumble nucleotomy is a safe and effective technique for phacoemulsification in posterior polar cataracts with nuclear sclerosis, where hydrodissection and nuclear rotation are typically avoided

A Case Series of Histoid Leprosy with a Brief Comparison of the Clinical Features with that of Lepromatous Leprosy

Histoid leprosy (HL) is a rare highly bacilliferous variant of lepromatous leprosy (LL). We are describing here a case series of HL in a tertiary care centre along with a comparison of the clinical features with cases of LL encountered in the same centre. There were 6 cases of HL in our centre for the past 10 years accounting for 1.86% of the total number of leprosy cases. HL constituted 11.54% of the total LL cases. 4 cases were de novo HL and 2 cases due to relapse. Papules, plaques and nodules were the commonest primary skin lesions. The distribution was localised in HL, mainly confined to the upper and lower limbs, while in LL it was symmetrical and generalised and mainly localised to the trunk. Superciliary madarosis, ear lobe infiltration, glove and stocking type of anaesthesia were found in the majority of LL, while lacking in HL patients. Type 2 lepra reaction and Grade 2 disability was much more common in LL, than HL. A very important finding in this case series is that the mean BI and MI of HL was more than in LL. All the patients were given of MB-MDT for 12 months and in patients who had initial BI of 4+ or more were given 24 months treatment and there were no cases of relapse after release from treatment

Post mastectomy pain syndrome at an Indian tertiary cancer centre and its impact on quality of life

Background: Literature on Post mastectomy pain in the Indian population is scarce. Most literature is from the West. The current study aimed to identify the incidence of post?mastectomy pain syndrome (PMPS), pain severity, and its impact on quality of life in Indian patients. Method: Prospective observational study of 120 women undergoing mastectomy between March and December 2017, followed until 6 months after surgery. The Brief Pain Inventory (BPI) questionnaire and the quality of life questionnaire (QLQ) by the European Organization for Research and Treatment of Cancer (EORTC) and known as (EORTC?QLQ 30) were used to identify the impact on function and quality of life. Results: A 35.8% PMPS incidence was identified at 6 months after mastectomy. Pain was located in the anterior chest wall (41.8%), axilla (32.6%), and medial upper arm (25.6%). Most (48.8%) patients described it as dull aching and of mild intensity (55.8%). No significant association of age, BMI, surgery, Intercostobrachial nerve (ICBN) dissection, postoperative pain severity, pain history {dysmenorrhea, headache}, and postoperative radiotherapy with PMPS was found. Pain interfered with daily activities and quality of life in those with PMPS, as deduced from BPI and EORTC?QLQ. Conclusion: PMPS is very much a problem affecting the quality of life in our set of patients. Most women tried to cope and accept the pain as part of the treatment process. This shows the need for creating awareness about PMPS among healthcare providers and patients alike. Early identification and treatment of post mastectomy pain should be an essential aspect of patient care

SEMICONDUCTOR INDUSTRY IN INDIA- USHERING ITS WAY INTO A NEW ERA

This paper focuses on the current state of the semiconductor industry at the global level as well as in India. With semiconductor chips emerging as the new gold, its demand is highest now than it was ever before. The demand for semiconductor chips in India is said to reach a gure of whopping US 110 billion dollars by 2030. In recent years, this industry has witnessed a crunch in its supply due to supply-side and demand-side constraints. This paper sheds light on the causes of these limits. Moreover, many countries are acquainted with this industry's scope in the future. India recognizes its dependence on countries like China for semiconductors. So, it aims to become a manufacturing hub for this industry and not just remain a fabless industry. However, India is encountering hurdles in this process. With this perception, this study has tried to explore India's initiatives in this direction. Keeping in mind India's vision of Aatmanirbhar Bharat, it seems like it's a long and rough road ahead to make the semiconductor industry in India, a self-reliant industry. This analytical study infers that overcoming these obstacles is going to become increasingly onerous.

Pancycle Aortic Incompetence and Double Alternans in Pediatric Heart Failure

A 12?year?old boy presented with bicuspid aortic valve, severe aortic regurgitation, and dilated dysfunctional left ventricle in heart failure. He underwent aortic valve replacement with a 23 mm TTK Chitra heart valve prosthesis (tilting disk). He was gradually weaned off milrinone and noradrenaline in the intensive care. Echocardiography showed severe left ventricular dysfunction with an ejection fraction of 24%. The radial pulse was regular and of normal volume but exactly half that of the heart rate. Evaluation of the rhythm and echocardiography revealed an interesting hemodynamic phenomenon with double alternans.

Cardiopulmonary Bypass Surgery?Cold Alert!

The term 揷old agglutinin (CA)� refers to a group of disorders caused by anti?erythrocyte autoantibodies that preferentially bind RBCs at cold temperatures (4癈�癈). CAs contribute to 10 to 15% of autoimmune hemolytic anemia. We report a case of CAs diagnosed intraoperatively during emergency mitral valve replacement.