Volumetric Absorptive Microsampling in the Analysis of Endogenous Metabolites.

Volumetric absorptive microsampling (VAMS) has arisen as a relevant tool in biological analysis, offering simplified sampling procedures and enhanced stability. Most of the attention VAMS has received in the past decade has been from pharmaceutical research, with most of the published work employing VAMS targeting drugs or other exogenous compounds, such as toxins and pollutants. However, biomarker analysis by employing blood microsampling has high promise. Herein, a comprehensive review on the applicability of VAMS devices for the analysis of endogenous metabolites/biomarkers was performed. The study presents a full overview of the analysis process, incorporating all the steps in sample treatment and validation parameters. Overall, VAMS devices have proven to be reliable tools for the analysis of endogenous analytes with biological importance, often offering improved analyte stability in comparison with blood under ambient conditions as well as a convenient and straightforward sample acquisition model.

Real-world application of the 2022 diagnostic criteria for first-ever episode of optic neuritis.

Optic neuritis (ON) admits diverse differential diagnoses. Petzold proposed diagnostic criteria for ON in 2022, although real-world application of these criteria is missing. We conducted a retrospective review of patients with ON. We classified patients into definite or possible ON, and into groups A (typical neuritis), B (painless), or C (binocular) and estimated the frequency of etiologies for each group. We included 77 patients, with 62% definite and 38% possible ON. CRION and NMOSD-AQP4 negative-ON were less commonly seen in definite ON. Application of the 2022 criteria revealed a lower-than-expected frequency of definite ON, particularly for seronegative non-MS causes.

Aircrew Health: A Systematic Review of Physical Agents as Occupational Risk Factors.

The primary objective of this systematic review was to analyze the main physical agents representing risk factors for commercial aircrew, together with their consequences. The secondary objective was to identify the countries in which studies on the topic were conducted, as well as the quality of the publications available. Thirty-five articles, published between 1996 and 2020, were selected for the review, having met all inclusion criteria. The majority of studies were conducted in the United States, Germany, and Finland and had moderate or low methodological quality of evidence. The main risk factors for aircrew identified in publications were exposure to abnormal air pressure, cosmic radiation, noise, and vibrations. Hypobaric pressure was explored in response to demands for studies on this agent, a factor which may lead to otic and ear barotraumas, as well as acceleration of atherosclerosis of the carotid artery. However, there is a dearth of research exploring this phenomenon.

A comparative study of visual outcome in patients with optic neuritis treated with five or seven days of intravenous corticosteroid treatment.

BACKGROUND: Optic neuritis (ON), a major cause of visual impairment in young adults, is generally associated with rapid visual recovery when treated with intravenous methylprednisolone treatment (IVMPT). However, the optimal duration of such treatment is unknown, ranging from three to seven days in clinical practice. We aimed to compare the visual recovery in patients treated with 5-day or 7-day duration IVMPT. METHODS: We performed a retrospective cohort study of consecutive patients with ON in São Paulo, Brazil, from 2016 to 2021. We compared the proportion of participants with visual impairment in 5-day and 7-day treatment schedules at discharge, at 1 month and between 6 and 12 months after the diagnosis of ON. The findings were adjusted to age, severity of the visual impairment, co-intervention with plasma exchange, time from symptom onset to IVMPT and the etiology of the ON to mitigate indication bias. RESULTS: We included 73 patients with ON treated with 5 or 7-day duration of 1 g/d intravenous methylprednisolone therapy. Visual impairment at 6-12 months in the 5-day or the 7-day treatment groups was similar (57% x 59%, p > 0.9, Odds Ratio 1.03 [95% CI 0.59-1.84]). The results were similar after adjusting for prognostic variables and when observed at different time points. CONCLUSION: Visual recovery is similar in patients treated with 5-day and 7-day duration treatments of 1 g/day intravenous methylprednisolone, suggesting a ceiling effect. Limiting the duration of the treatment can reduce hospital stay and costs, without interfering with clinical benefit.

Efficacy of multivalent recombinant herpesvirus of turkey vaccines against high pathogenicity avian influenza, infectious bursal disease, and Newcastle disease viruses.

Vaccines are an essential tool for the control of viral infections in domestic animals. We generated recombinant vector herpesvirus of turkeys (vHVT) vaccines expressing computationally optimized broadly reactive antigen (COBRA) H5 of avian influenza virus (AIV) alone (vHVT-AI) or in combination with virus protein 2 (VP2) of infectious bursal disease virus (IBDV) (vHVT-IBD-AI) or fusion (F) protein of Newcastle disease virus (NDV) (vHVT-ND-AI). In vaccinated chickens, all three vHVT vaccines provided 90-100% clinical protection against three divergent clades of high pathogenicity avian influenza viruses (HPAIVs), and significantly decreased number of birds and oral viral shedding titers at 2 days post-challenge compared to shams. Four weeks after vaccination, most vaccinated birds had H5 hemagglutination inhibition antibody titers, which significantly increased post-challenge. The vHVT-IBD-AI and vHVT-ND-AI vaccines provided 100% clinical protection against IBDVs and NDV, respectively. Our findings demonstrate that multivalent HVT vector vaccines were efficacious for simultaneous control of HPAIV and other viral infections.

"Social malaise... demonic agitation:" anarchism according to the criminology of the French physician Alexandre Lacassagne. / "Mal-estar social... uma agitação demoníaca": o anarquismo segundo a criminologia do médico francês Alexandre Lacassagne.

This article analyzes the way anarchism and its followers were understood in L'assassinat du président Carnot, by the French physician Alexandre Lacassagne. A few months before the book was published, in June 1894, the president of France, Sadi Carnot, had been killed by the Italian anarchist Sante Geronimo Caserio. Lacassagne was called upon to perform the autopsy of Carnot's body and a psychiatric examination of Caserio. The results of these two analyses were published in the aforementioned book. He made his observations on the anarchist in the broader context of criminological debates pursued in the late nineteenth century, which were not restricted solely to the authors of Italian criminology.

O artigo analisa a maneira como o anarquismo e os seus adeptos foram compreendidos na obra do médico Alexandre Lacassagne L'assassinat du président Carnot (1894). Poucos meses antes da circulação do livro, em junho, o presidente da França, Sadi Carnot, foi morto pelo anarquista italiano Sante Geronimo Caserio. Em razão desse atentado, Lacassagne foi convocado para realizar a autópsia do corpo de Carnot e um exame psiquiátrico de Caserio. Os resultados dessas duas análises foram publicados na referida obra. As suas observações sobre o ácrata estavam inseridas nos debates criminológicos promovidos no final do século XIX, os quais não se restringiram unicamente aos autores da criminologia italiana.

¿Podría ser útil la puntuación Apgar quirúrgica para predecir las complicaciones postoperatorias tras la cirugía de fractura femoral proximal? Un estudio retrospectivo de cohorte / Would surgical Apgar score be useful to predict postoperative complications after proximal femoral fracture surgery? A retrospective cohort study

Antecedentes: El Apgar quirúrgico (AQ) es una puntuación evaluadora del riesgo perioperatorio, que evalúa intraoperatoriamente la frecuencia cardiaca mínima, la presión arterial media mínima y la pérdida de sangre estimada. Aunque ha sido validado en múltiples campos quirúrgicos, el AQ sigue siendo controvertido en el campo traumatológico. El objetivo principal de este estudio fue investigar si AQ guarda relación con la incidencia de complicaciones durante los primeros 30 días tras la cirugía de fractura femoral proximal. Métodos: Estudio retrospectivo que incluyó todos los pacientes consecutivos sometidos a cirugía de fractura femoral proximal entre enero y julio de 2019. Se excluyó a los pacientes que carecieran de información sobre el AQ. Se dividió a los pacientes en dos grupos, sobre la base de la incidencia de complicaciones durante los primeros 30 días postoperatorios y el cálculo de su AQ. Se utilizaron curvas ROC (característica operativa del receptor) para evaluar el modelo predictivo de complicaciones. Resultados: El 44% (n = 76) de los 181 pacientes incluidos en el estudio desarrollaron complicaciones durante los primeros 30 días postoperatorios. Ocho pacientes (4,4%) fallecieron durante dicho periodo. La edad media de los pacientes fue de 79 años, y el 30,9% (n = 56) fueron varones. La insuficiencia cardiaca (IC), el uso de marcapasos, la enfermedad renal crónica, la enfermedad pulmonar obstructiva crónica y la demencia estuvieron significativamente asociadas a la morbilidad postoperatoria. No existió correlación significativa entre AQ y la incidencia de complicaciones durante los primeros 30 días postoperatorios. El ABC de AQ como modelo predictivo de complicaciones postoperatorias tras la cirugía de fractura femoral proximal fue de 0,522, lo cual es insuficiente para poder considerarse un modelo predictivo aceptado. Conclusión: Sobre la base de este estudio, concluimos que AQ no es predictivo del desarrollo de complicaciones en los primeros...(AU)

Background: The surgical Apgar score (SAS) is a perioperative risk evaluation score, which considers intraoperative minimum heart rate, minimum mean arterial pressure and estimated blood loss. Although validated in multiple surgical fields, SAS remains quite controversial in the orthopedic one. The main purpose of this study was to investigate if SAS relates with the occurrence of complications during the first 30-days after proximal femoral fracture surgery. Methods: Retrospective study including all consecutive patients submitted to proximal femoral fracture surgery between January and July 2019. Patients with no information about SAS were excluded. Patients were divided in two groups, based on the occurrence of complications during the first 30 post-operative days and their SAS calculated. Receiver operating characteristic (ROC) curves were used to assess SAS power as a predictive model of complications. Results: Forty-two percent (n = 76) of the 181 patients included in the study developed complications during the first 30 postoperative days. Eight patients (4,4%) died during that period. The patient's mean age was 79 years and 30,9% (n = 56) were men. Heart failure, pacemaker use, chronic kidney disease, chronic obstructive pulmonary disease and dementia were significantly associated with post-operative morbidity. There was no significant correlation between SAS and the occurrence of complications during the first 30 postoperative days. The AUC of SAS as a predictive model for postoperative complications after proximal femoral fracture surgery was 0,522, being insufficient to be considered an accepted model of prediction. Conclusion: Based on this study, we conclude that SAS is not predictive of the development of complications in the first 30 post-operative days in patients submitted to proximal femoral fracture surgery. However, other clinical factors have been identified as associated with postoperative morbidity...(AU)

Measures to assess quality of postnatal care: A scoping review.

High quality postnatal care is key for the health and wellbeing of women after childbirth and their newborns. In 2022, the World Health Organization (WHO) published global recommendations on maternal and newborn care for a positive postnatal care experience in a new WHO PNC guideline. Evidence regarding appropriate measures to monitor implementation of postnatal care (PNC) according to the WHO PNC guideline is lacking. This scoping review aims to document the measures used to assess the quality of postnatal care and their validity. The review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Five electronic bibliographic databases were searched together with a grey literature search. Two reviewers independently screened and appraised identified articles. All data on PNC measures were extracted and mapped to the 2022 WHO PNC recommendations according to three categories: i) maternal care, ii) newborn care, iii) health system and health promotion interventions. We identified 62 studies providing measures aligning with the WHO PNC recommendations. For most PNC recommendations there were measures available and the highest number of recommendations were found for breastfeeding and the assessment of the newborn. No measures were found for recommendations related to sedentary behavior, criteria to be assessed before discharge, retention of staff in rural areas and use of digital communication. Measure validity assessment was described in 24 studies (39%), but methods were not standardized. Our review highlights a gap in existing PNC measures for several recommendations in the WHO PNC guideline. Assessment of the validity of PNC measures was limited. Consensus on how the quality of PNC should be measured is needed, involving a selection of priority measures and the development of new measures as appropriate.

Mental health throughout the medical career: A comparison of depression, anxiety, and stress levels among medical students, residents, and physicians.

BACKGROUND: Different stages of a physician's career may be associated with different types of mental health impairment. AIMS: This study aimed to compare symptoms of anxiety, depression, and stress and their associated factors among medical students, medical residents, and physicians. METHODS: A cross-sectional study was conducted. Data collection included sociodemographic data, religiosity (Duke University Religion Index), and mental health (21-item Depression, Anxiety and Stress Scale - DASS-21) data. The comparison between the groups was performed using ANOVA, and the associated factors were evaluated via linear regression models. RESULTS: The sample consisted of 1,417 participants: 778 medical students, 190 medical residents, and 468 established physicians. Medical students had significantly higher depression, anxiety, and stress scores as compared to medical residents and established physicians. However, regarding DASS 21 scores, no significant differences were found between established physicians and medical residents. The factors associated with mental health in the different groups showed that being married and male were associated with better mental health among physicians and medical residents, while the factors of male gender, being in later years of the course, and lower religious attendance were associated with better mental health in students. CONCLUSION: Medical students had worse mental health outcomes when compared to residents and established physicians. Interventions are needed to minimize suffering during medical education and career.

Organizational Risk Factors for Aircrew Health: A Systematic Review of Observational Studies.

Addressing the field of health and safety at work, the primary objective of the present systematic review was to analyze the organizational risk factors for aircrew health according to professional category (flight attendants and pilots/co-pilots) and their consequences. The secondary objective was to identify the countries in which studies were carried out, focusing on the quality of content of the publications. The Medline/Pubmed, Cochrane, Web of Science, and Scopus databases were searched for eligible studies according to PRISMA statements. The risk of bias and the methodological quality of the studies were assessed using the Newcastle-Ottawa scale and Loney tools. Of the 3230 abstracts of articles screened, 36 studies met the inclusion criteria. Most of the research conducted on risk factors for the work organization of aircrew was carried out in the United States and the European Union and had moderate or low-quality methodology and evidence. However, the findings are homogeneous and allow the most prevalent organizational risk factors for the health of aircrew to be determined, namely, high work demand, long hours, and night work. Consequently, the most pervasive health problems were sleep disturbances, mental health disorders, musculoskeletal disorders, and fatigue. Thus, the regulation of the aircrew profession must prioritize measures that minimize these risk factors to promote better health and sleep for these professionals and, consequently, to provide excellent safety for workers and passengers.

Would surgical Apgar score be useful to predict postoperative complications after proximal femoral fracture surgery? - A retrospective cohort study.

BACKGROUND: The surgical Apgar score (SAS) is a perioperative risk evaluation score, which considers intraoperative minimum heart rate, minimum mean arterial pressure and estimated blood loss. Although validated in multiple surgical fields, SAS remains quite controversial in the orthopedic one. The main purpose of this study was to investigate if SAS relates with the occurrence of complications during the first 30-days after proximal femoral fracture surgery. METHODS: Retrospective study including all consecutive patients submitted to proximal femoral fracture surgery between January and July 2019. Patients with no information about SAS were excluded. Patients were divided in two groups, based on the occurrence of complications during the first 30 post-operative days and their SAS calculated. Receiver operating characteristic (ROC) curves were used to assess SAS power as a predictive model of complications. RESULTS: Forty-two percent (n = 76) of the 181 patients included in the study developed complications during the first 30 postoperative days. Eight patients (4,4%) died during that period. The patient's mean age was 79 years and 30,9% (n = 56) were men. Heart failure, pacemaker use, chronic kidney disease, chronic obstructive pulmonary disease and dementia were significantly associated with post-operative morbidity. There was no significant correlation between SAS and the occurrence of complications during the first 30 postoperative days. The AUC of SAS as a predictive model for postoperative complications after proximal femoral fracture surgery was 0,522, being insufficient to be considered an accepted model of prediction. CONCLUSION: Based on this study, we conclude that SAS is not predictive of the development of complications in the first 30 post-operative days in patients submitted to proximal femoral fracture surgery. However, other clinical factors have been identified as associated with postoperative morbidity. In the future, prospective-based studies with higher samples may better clarify the role of SAS in this context.

"Mal-estar social... uma agitação demoníaca": o anarquismo segundo a criminologia do médico francês Alexandre Lacassagne / "Social malaise... demonic agitation: "anarchism according to the criminology of the French physician Alexandre Lacassagne

Resumo O artigo analisa a maneira como o anarquismo e os seus adeptos foram compreendidos na obra do médico Alexandre Lacassagne L'assassinat du président Carnot (1894). Poucos meses antes da circulação do livro, em junho, o presidente da França, Sadi Carnot, foi morto pelo anarquista italiano Sante Geronimo Caserio. Em razão desse atentado, Lacassagne foi convocado para realizar a autópsia do corpo de Carnot e um exame psiquiátrico de Caserio. Os resultados dessas duas análises foram publicados na referida obra. As suas observações sobre o ácrata estavam inseridas nos debates criminológicos promovidos no final do século XIX, os quais não se restringiram unicamente aos autores da criminologia italiana.

Abstract This article analyzes the way anarchism and its followers were understood in L'assassinat du président Carnot, by the French physician Alexandre Lacassagne. A few months before the book was published, in June 1894, the president of France, Sadi Carnot, had been killed by the Italian anarchist Sante Geronimo Caserio. Lacassagne was called upon to perform the autopsy of Carnot's body and a psychiatric examination of Caserio. The results of these two analyses were published in the aforementioned book. He made his observations on the anarchist in the broader context of criminological debates pursued in the late nineteenth century, which were not restricted solely to the authors of Italian criminology.

Prioriza SUS: proposta para o aperfeiçoamento da gestão do SUS por meio do planejamento, do monitoramento e da avaliação da ação governamental

O objetivo deste texto é analisar problemas do Brasil no campo da saúde, com destaque para a gestão do Sistema Único de Saúde (SUS), visando à elaboração e à recomendação de ações concretas a fim de assegurar o acesso da população a bens e serviços de saúde de forma universal, igualitária e integral por meio desse sistema. Utilizou-se do arcabouço metodológico da análise de políticas públicas para exame de problemas da área da saúde e proposição de soluções. O problema público, que é a distância entre a situação atual e a almejada sob o ponto de vista de um ator relevante, foi definido como a dificuldade de acesso tempestivo, efetivo e equitativo à atenção à saúde. Elaborou-se uma árvore do problema e várias causas foram identificadas, elegendo-se para análise neste estudo o problema estrutural do SUS que foi denominado "gestão estratégica deficiente". Entre suas causas, estão os processos de planejamento, monitoramento e avaliação deficientes e insuficientes. Este trabalho propõe algumas ações para enfrentamento desse problema. Foi realizado um fórum de política pública com a participação de pesquisadores, técnicos e gestores do SUS com relevante conhecimento sobre o tema, a fim de discutir a proposta preliminar de ações. As contribuições dos participantes do fórum foram incorporadas, aperfeiçoando-se as ações inicialmente propostas e agregando-se nova ação ao rol de medidas sugeridas como resposta ao problema estrutural sob análise. Por fim, recomenda-se a avaliação da propriedade das soluções sugeridas nas discussões que poderão ocorrer sob a iniciativa do Ministério da Saúde, visando à pactuação de ações que promovam o planejamento, o monitoramento e a avaliação no SUS e, com isso, o aprimoramento de sua gestão estratégica.

The objective is to analyze problems of the health sector in Brazil, with emphasis on the management of the SUS, aiming at the elaboration of concrete interventions proposals to ensure the population's access to universal, egalitarian and comprehensive healthcare. The methodological framework of public policy analysis was used to examine healthcare problems and propose solutions. The public problem, which is the distance between current and desired situation from the point of view of a relevant actor was defined as "difficulty in timely, effective and equitable access to health care". A problem tree was created, and several causes were identified. This study concentrates in a structural problem of the SUS that was called 'deficient strategic management', which has among its causes "deficient and insufficient planning, monitoring and evaluation processes". Some actions were proposed to face this problem. Next, a public policy forum was held with the participation of SUS researchers, workers, and managers with relevant knowledge on the subject, to discuss the preliminary actions proposal. Contributions from forum participants were incorporated, improving the actions initially proposed and adding a new action to the list of measures suggested as a response to the structural problem under analysis. Finally, it is recommended to evaluate the appropriateness of the solutions suggested in the discussions that may take place under the initiative of the Ministry of Health, with the objective of agreeing on actions that promote planning, monitoring and evaluation in the SUS and, with that, the improvement of its strategic management.

Prioriza SUS: aspectos metodológicos do desenvolvimento do projeto / Nota Técnica n. 104 (Disoc) : Prioriza SUS : aspectos metodológicos do desenvolvimento do projeto

Esta Nota Técnica apresenta os métodos aplicados no desenvolvimento do projeto Prioriza SUS, que tem por objetivo discutir problemas do Sistema Único de Saúde (SUS) que criam barreiras para o acesso da população aos serviços e bens de saúde e propor soluções exequíveis para aqueles definidos como prioritários.

[Total expenditure of the municipalities on primary healthcare in Brazil: a method to adjust the declared expenditure from 2015 to 2020]. / Gasto total dos municípios em atenção primária à saúde no Brasil: um método para ajuste da despesa declarada de 2015 a 2020.

Recently, interest on the expenditure on primary healthcare (PHC) has grown due to a series of reforms to its organization and funding. Data on these and other expenses are declared via subfunctions by public health managers through the Brazilian Information System for the Public Budgets in Health (SIOPS). In the public budget, subfunctions detail in which expenditure area the government action was carried out. However, there are problems in the information via subfunctions, and the expenditures in main object areas - such as PHC - are commonly underestimated, if only the records of the specific subfunction are considered. Thus, this article proposes a method to adjust the total expenditure in primary care of each municipality, from 2015 to 2020, allowing for the production of adjusted databases to be used in PHC finance studies in Brazil. Therefore, an investigation based on budgetary-financial execution data in public health actions and services was conducted to produce a methodological framework, observing the following steps: (i) data identification; (ii) development; and (iii) validation of the methodological framework. The methodological framework was created and tested, confirming the validity of the proposed method for adjusting the expenditure declared for PHC in the period from 2015 to 2020. If the adjustment had not been made, the PHC expenditure would have been underestimated by BRL 11.4 billion, in 2015, and BRL 9.6 billion, in 2020, (at current prices), corresponding to a 19.8% and 12.6% underestimation, respectively.

Nos últimos anos, o interesse no gasto em atenção primária à saúde (APS) cresceu em virtude de uma série de reformas realizadas na sua organização e financiamento. Dados sobre esses e outros gastos são declarados por subfunções pelos gestores da saúde por meio do Sistema de Informações sobre Orçamentos Públicos em Saúde (SIOPS). No orçamento público, as subfunções detalham em que área de despesa a ação governamental foi realizada. Contudo há problemas na informação por subfunções, sendo comum que os gastos em áreas finalísticas, como a APS, sejam subestimados, se considerados apenas os registros da subfunção específica. Assim, o objetivo deste artigo é propor um método para ajuste do gasto total de 2015 a 2020 de cada município, em atenção primária, que permita a produção de bases de dados ajustadas a serem utilizadas em estudos sobre o financiamento da APS no Brasil. Para tanto, uma investigação baseada em dados de execução orçamentário-financeira em ações e serviços públicos de saúde (ASPS) foi realizada para a produção de um quadro metodológico, sendo observadas as seguintes etapas: (i) identificação dos dados; (ii) desenvolvimento; e (iii) validação do quadro metodológico. O quadro metodológico foi produzido e testado, confirmando-se a validade do método proposto para ajuste da despesa declarada em APS no período de 2015 a 2020. Caso o ajuste não tivesse sido realizado, a despesa em APS teria sido subestimada em R$ 11,4 bilhões em 2015 e R$ 9,6 bilhões em 2020 (a preços correntes), o que corresponde a um percentual de subestimação de 19,8% e 12,6%, respectivamente.

En los últimos años, el interés por el gasto en atención primaria de salud (APS) ha incrementado debido a una serie de reformas realizadas en su organización y financiación. Los datos sobre estos y otros gastos son declarados por subfunción por los gestores sanitarios a través del Sistema de Información sobre Presupuestos de Salud Pública (SIOPS). En el presupuesto público, las subfunciones detallan el área de gasto en la que se ha llevado a cabo la acción de gobierno. Sin embargo, hay problemas en la información por subfunción, y es común que los gastos en áreas finalistas, como la APS, se subestimen si solo se consideran los registros de la subfunción específica. Así, el objetivo de este artículo es proponer un método para ajustar el gasto total de 2015 a 2020 de cada municipio en atención primaria, permitiendo la producción de bases de datos ajustadas para ser utilizadas en estudios sobre la financiación de la APS en Brasil. Para ello, se realizó una investigación basada en datos sobre la ejecución presupuestaria y financiera en las acciones y servicios de salud pública (ASPS) para la producción de un marco metodológico, observándose las siguientes etapas: (i) identificación de datos; (ii) desarrollo; e (iii) validación del marco metodológico. Se elaboró y se probó el marco metodológico, lo que confirma la validez del método propuesto para ajustar el gasto declarado en APS en el período 2015-2020. Si no se hubiera realizado el ajuste, el gasto en APS se habría subestimado en BRL 11,4 mil millones en 2015 y en BRL 9,6 mil millones en 2020 (a precios corrientes), lo que corresponde a un porcentaje de subestimación del 19,8% y 12,6%, respectivamente.

Molecular Markers in Urinary Bladder Cancer: Applications for Diagnosis, Prognosis and Therapy.

Cancer of the urinary bladder is a neoplasm with considerable importance in veterinary medicine, given its high incidence in several domestic animal species and its life-threatening character. Bladder cancer in companion animals shows a complex and still poorly understood biopathology, and this lack of knowledge has limited therapeutic progress over the years. Even so, important advances concerning the identification of tumour markers with clinical applications at the diagnosis, prognosis and therapeutic levels have recently been made, for example, the identification of pathological BRAF mutations. Those advances are now facilitating the introduction of targeted therapies. The present review will address such advances, focusing on small animal oncology and providing the reader with an update on this field. When appropriate, comparisons will be drawn with bladder cancer in human patients, as well as with experimental models of the disease.

Espiritualidade e qualidade de vida em médicos que convivem com a finitude da vida / Spirituality and quality of life of physicians who work with the finitude of life

Abstract: Introduction: In the medical field there are still gaps regarding the concept of death and the finitude of life, very often understood as a failure of Medicine and not as an integral part of existence. In this context, the view of death as an error, the failure of a treatment, generates anxiety and demands by doctors themselves, which can affect their physical, mental and spiritual health. Objective: To analyze the relationship between spirituality, religious practices, and quality of life of medical professionals in the field of oncology and palliative care who deal with the finitude of life on a daily basis in a reference hospital in northeastern Brazil. Method: Cross-sectional, analytical and quantitative study with an intentional and convenience sample. Questionnaires were applied to describe the sociodemographic profile, quality of life (WHOQOL - bref) and spirituality using the Brief Religious/Spiritual Coping Scale (Brief RCOPE) and the Spirituality Self Rating Scale (SSRS). Data analysis used the Statistical Package for the Social Sciences (SPSS), version 13.0 for Windows. The study was approved by the REC of IMIP under Opinion 2,890,118. Result: Twenty oncologists and palliative care physicians participated in the study; most were women (55%), of white ethnicity (60%), Catholic (80%) and married (70%). The SSRS scale identified an average score of 21.75. In the Brief RCOPE, the positive aspect scored 2.64, the negative aspect 1.47, and the total aspect 2.04. There was a significant positive association between the SSRS and RCOP results (p=0.0). When associating WHOQOL - bref with Brief RCOPE, a direct relationship with statistical significance of the psychological domain was obtained with total RCOP (p-value: 0.01) and with negative RCOP (p-value: 0.03). Conclusion: The study showed a relationship between spirituality and quality of life, as well as positive aspects of faith for coping with everyday stress, corroborating the discussion of the importance of including spirituality as a protective factor in health.

Resumo: Introdução: Na área médica, ainda existem lacunas no que tange à concepção de morte e à finitude da vida, muitas vezes entendida como falha da medicina e não como parte integrante da existência. Nesse contexto, a visão da morte como um erro, um insucesso de um tratamento, gera ansiedade e cobrança por parte dos próprios médicos, podendo afetar sua saúde física, mental e espiritual. Objetivo: Este estudo teve como objetivo analisar a relação entre espiritualidade, práticas religiosas e qualidade de vida de profissionais médicos da área de oncologia e cuidados paliativos que convivem diariamente com a finitude da vida em hospital de referência do Nordeste brasileiro. Método: Trata-se de um estudo transversal, analítico e quantitativo com amostra intencional e por conveniência. A coleta de dados foi realizada por meio de um questionário sociodemográfico, e adotaram-se os seguintes instrumentos: World Health Organization Quality of Life-bref (WHOQOL-bref), Escala de Coping (Enfrentamento) Religioso-Espiritual Abreviada (CRE-Breve) e Spirituality Self Rating Scale (SSRS). A análise dos dados utilizou o Statistical Package for the Social Sciences (SPSS) 13.0 para Windows. O estudo foi aprovado pelo CEP do IMIP sob o Parecer nº 2.890.118. Resultado: Participaram do estudo 20 médicos oncologistas e paliativistas: a maioria sendo mulheres (55%), brancos (60%), católicos (80%) e casados (70%). A SSRS identificou um escore médio de 21,75. Na Escala CRE-Breve, o aspecto positivo ficou com pontuação de 2,64, o aspecto negativo em 1,47 e o aspecto total com 2,04. Houve associação positiva significativa entre os resultados da SSRS e CRE (p = 0,0). Quando se associou a WHOQOL-bref com a CRE-Breve, foi obtida relação direta com significância estatística do domínio psicológico com CRE total (p-valor: 0,01) e com o CRE negativo (p-valor: 0,03). Conclusão: O estudo apontou uma relação entre a espiritualidade e a qualidade de vida, assim como aspectos positivos da fé para o enfrentamento do estresse cotidiano, corroborando com a discussão da importância de incluir a espiritualidade como fator protetor na saúde.