Efficacy of Crohn's disease exclusion diet in treatment -naïve children and children progressed on biological therapy: a retrospective chart review.

BACKGROUND: Recent trials suggested that the Crohn's disease (CD) exclusion diet (CDED) plus partial enteral nutrition (PEN) is a safe and effective strategy in remission induction of paediatric-onset CD. However, real-world evidence regarding the safety and efficacy of the CDED plus PEN approach is still lacking. The present case-series study reported our experience with the outcomes of CDED plus PEN in the paediatric-onset CD at disease onset and after the loss of response to biologics. METHODS: We conducted a retrospective chart review on children who were treated with CDED plus PEN through the period from July 2019 and December 2020. Clinical and laboratory data were retrieved and compared at baseline, 6, 12, and 24 weeks of treatment. The primary endpoint of the present study was the rate of clinical remission. RESULTS: The present study retrieved the data from 15 patients. Of them, nine patients were treatment naïve at the time of initiation of CDED plus PEN (group A) and the remaining patients relapsed on biologics before treatment. All patients in groups A and B exhibited clinical remission in week six, which was sustained until week 12. At the end of the follow-up, the clinical remission rate was 87% and 60% in groups A and B, respectively. No side effects were observed in both groups. In group A, the faecal calprotectin (FC) and albumin improved at week six, week 12, and week 24 (p < 0.05). The erythrocyte sedimentation rate (ESR) improved significantly at week 12 (p = 0.021) and week 24 (p = 0.027). At the same time, the haemoglobin and iron levels showed significant improvement only at week 24. For group B, only FC showed numerical reductions over time that did not reach the level of statistical significance. CONCLUSION: Treatment with CDED plus PEN was well tolerated and achieved an excellent clinical remission rate in treatment-naive patients. However, the benefit of CDED plus PEN was less in patients who initiated the strategy after losing the response to biologics.

Patient-centered outcomes in non-small-cell lung cancer: a real-world perspective.

Aims: To assess non-small-cell lung cancer (NSCLC) patient-centered outcomes in the real world. Methods: This is a prospective study of NSCLC patients treated at a private cancer care institution in Brazil between 2014 and 2019. Results: The report comprises 337 patients. Advanced stage was associated with higher symptom burden - fatigue (p = 0.03), pain (p < 0.001) and arm pain (p = 0.022) - and worse global, social and physical functioning (all p < 0.001). In the first 2 years, most factors evolved to either improvement or stability: cough (p = 0.02), pain (p = 0.002), global functioning (p < 0.001) and emotional functioning (p < 0.001). Staging (p < 0.001), fatigue (p = 0.001) and gender (p = 0.004) were independently associated with overall survival. Conclusions: Our results demonstrate the feasibility of conducting real-world prospective analysis of patient-centered outcomes.

Lay abstract This study looked at patient-centered outcomes in lung cancer in a real-world setting. Standardized quality-of-life questionnaires were used to actively measure patients' perception of their functional well-being and health in a clinical setting. Three hundred thirty-seven patients were enrolled in a private cancer center in Brazil between 2014 and 2019. We demonstrated that patients diagnosed at advanced stages presented with more symptoms and lower capacity to perform daily activities. However, symptoms and functioning tended to improve during treatment. Our results show that it is possible to put patients at the heart of cancer care and use their experience to guide clinical approach.

A Structure Shaped by Fire, but Also Water: Ecological Consequences of the Variability in Bark Properties Across 31 Species From the Brazilian Cerrado.

Bark is a structure involved in multiple physiological functions, but which has been traditionally associated with protection against fire. Thus, little is known about how the morpho-anatomical variations of this structure are related to different ecological pressures, especially in tropical savanna species, which are commonly subjected to frequent fire and drought events. Here we evaluated how the structural and functional variations of bark are related to the processes of resilience and resistance to fire, as well as transport and storage of water in 31 native species from the Brazilian Cerrado. Because of their thick bark, none of the trees analyzed were top-killed after a severe fire event. The structural and functional variations of the bark were also associated with water storage and transport, functions related to properties of the inner bark. In fact, species with a thicker and less dense inner bark were the ones that had the highest water contents in the wood, bark, and leaves. Lower bark density was also related to higher stem hydraulic conductivity, carbon assimilation, and growth. Overall, we provide strong evidence that in addition to protection from fire, the relative investment in bark also reflects different strategies of water use and conservation among many Cerrado tree species.

Estresse ocupacional no serviço de atendimento móvel de urgência / Occupational stress in the mobile emergency care service / Etrés ocupacional en servicios de atención móvil de urgencia

Este estudo busca avaliar os níveis de estresse ocupacional na equipe do Serviço de Atendimento Móvel de Urgência (SAMU) da cidade de Marília, tratando-se de uma pesquisa de natureza descritiva e investigatória. A coleta de dados deu-se com base em uma ficha de identificação do participante e do instrumento Escala de Estresse no Trabalho, uma adaptação para o português do questionário original em inglês Job Stress Scale, elaborado em 1988 por Tõres Theorell. Os dados foram analisados utilizando-se o software EPIINFO versão 6.02. A população pesquisada foi composta de 60 indivíduos das diversas categorias profissionais (enfermeiras, técnicos de enfermagem, recepcionistas, médicos e motoristas). Em análise percebeu-se que os sujeitos apresentaram, ao mesmo tempo, altos níveis de demanda (exigências e pressões psicológicas exercidas pelo trabalho), controle (capacidade do indivíduo em empregar suas habilidades intelectuais para exercer seu trabalho e ter autoridade para decidir como realizá-lo) e apoio social (qualidade das relações desenvolvidas pelo sujeito com seus superiores e colegas de trabalho), configurando um estado em que o profissional vivencia seu trabalho de maneira ativa, havendo pouca probabilidade de manifestação do estresse ocupacional. Tais resultados diferem grandemente da impressão sustentada pelo público leigo e pelos próprios profissionais de saúde de outras áreas a respeito dos níveis de estresse relacionado ao trabalho no serviço de urgência e emergência, evidenciando a necessidade de se analisar os serviços de saúde sob o olhar científico, de maneira a desmistificar crenças e impressões que, muitas vezes, não condizem com a realidade.

La presente investigación descriptiva busca evaluar los niveles de estrés ocupacional en el equipo del Servicio de Atención Móvil de Urgencia (SAMU) de la ciudad de Marília. La recogida de datos fue realizada a través de una ficha de identificación del participante y de la herramienta Escala de Estrés en el Trabajo, una adaptación para el portugués del cuestionario original en inglés Job Stress Scale, elaborado en 1988 por Töres Theorell. Los datos fueron analisados por médio del software EPIINFO versión 6.02. Sesenta individuos de distintas categorias profesionales (enfermeras, técnicos de enfermería, recepcionistas, médicos y chóferes) integraron la población objeto de estudio. En el análisis se observó que los sujetos presentan, al mismo tiempo, altos niveles de demanda (exigencias y presiones psicógicas del trabajo), control (capacidad de emplear sus habilidades intelectuales para realizar su tarea y tener autoridad para decidir cómo hacerlo), y apoyo social (calidad de las relaciones establecidas por el sujeto con sus superiores y colegas de trabajo), configurando un estado en el cual el profesional vivencia su trabajo de manera activa, con pocas probabilidades de manifestar el estrés ocupacional. Dichos resultados difieren enormemente de la impresión que tienen el público en general y los profesionales de otras áreas sobre los niveles de estrés relacionados al trabajo en los servicios de urgencia y emergencia. Tal hecho pone en evidencia la necesidad de analizar los servicios de salud bajo la mirada científica, de manera a desmistificar creencias e impresiones que, muchas veces, no corresponden a la realidad.

This study aims to evaluate the levels of job stress among Marilia's Mobile Emergency Care Service professionals, consisting of an exploratory and descriptive study. Data collection was performed by a subject's identification formula and the instrument Escala de Estresse No Trabalho, an adaptation for Portuguese of the original questionnaire Job Stress Scale, created in 1988 by Töres Theorell. Data was analyzed using the software EPIINFO version 6.02. The research's population was composed of 60 individuals from different categories (nurses, nursing technicians, receptionists, physicians and drivers), and the analysis showed that the subjects have, at the same time, high levels of demand (exigencies and psychological pressures exerted by the job), control (the individual's capacity to use their intellectual abilities to exercise his or her work and have authority to decide how to do it) and social support (quality of the relationships established by the subject with their bosses and coworkers), consisting of a situation in which the professionals actively experience their work, with a low probability of job stress manifestation. These results remarkably differ from the impression sustained by nonprofessional people and even by health professionals of other specialties about the levels of stress related to the work on emergency, showing the necessity of analyzing the health services under a scientific point of view, in order to demystify beliefs and impressions that often do not match reality.

Problematizações acerca da naturalização da violência contra a mulher / Problematizations about the naturalization of violence against women

O presente trabalho apresenta a proposta de problematização acerca da maneira como vêm sendo conduzidos os atendimentos de violência contra a mulher por profissionais da saúde e demais serviços públicos. Considerando que esse tipo de violência parece estar relacionado aos modos de subjetivação baseados em categorias de gênero, sendo padronizadas as formas de ser homem e mulher, percebe-se que a psicologia pode advir como instrumento de desnaturalização/ despsicologização, ampliando a questão para o social e não a reduzindo a um problema individual, da mulher. Pretende-se, a partir de uma aposta ético-política, utilizando os conceitos de biopoder e governamentalidade, proposto por Michel Foucault, (re)pensar tais práticas para a construção de novas ferramentas para o enfrentamento desse tipo de violência.