No Association of Angiotensin-Converting Enzyme Insertion/Deletion (ACE I/D) Gene Polymorphism in the Susceptibility to Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients: An Updated Meta-Analysis.

Diabetic retinopathy (DR) is a complex and multifactorial pathology encompassing environmental, metabolic, and polygenic influences. Among the genes possibly involved in the development and progression of DR, the Angiotensin I-converting enzyme (ACE) gene stands out, which presents an insertion (I) or deletion (D) polymorphism of a 287 bp Alu repetitive sequence in intron 16. Thus, this study aimed to perform a systematic review with meta-analysis to elucidate the relationship between the ACE gene (I/D) polymorphism (rs1799752) and the development and progression of DR in type 2 diabetic patients. PubMed/MEDLINE, Embase, Web of Science, and Scopus databases were systematically searched to retrieve articles that investigated the association between ACE gene (I/D) polymorphism in DR patients. Sixteen articles were included in the systematic review. The results describe no significant association between the polymorphism and DR risk (OR = 1.12; CI = 0.96-1.31; and p = 0.1359) for genotypic analysis by the dominant model (II vs. ID+DD). Moreover, we also observed no significant association between the D allele on the allele frequency analysis (I vs. D) and the DR risk (OR = 1.10; CI = 0.98-1.23; and p = 0.1182). Forest plot analysis revealed that the discrepancy between previous studies most likely arose from variations in their sample sizes. In conclusion, I/D polymorphism appears to be not involved in the susceptibility to and progression of the DR in type 2 diabetic patients.

Consecutive Liver and Bone Marrow Transplantation for Erythropoietic Protoporphyria: Case Report and Literature Review.

BACKGROUND: Erythropoietic protoporphyria (EPP) is a rare inherited disease of heme biosynthesis resulting in the accumulation of protoporphyrin, characterized by liver failure in a minority of cases. Although liver transplant (LT) is the therapeutic strategy for advanced hepatic disease, it does not correct the primary defect, which leads to recurrence in liver graft. Thus, hematopoietic stem cell transplantation (HSCT) is an approach for treating EPP. METHODS: We aim to describe the first sequential LT and HSCT for EPP performed in Latin America, besides reviewing the present-day literature. RESULTS: The patient, a 13-year-old female with a history of photosensitivity, presented with symptoms of cholestatic and hepatopulmonary syndrome and was diagnosed with EPP. Liver biopsy demonstrated cirrhosis. She was submitted to a successful LT and showed improvement of respiratory symptoms. However, she had disease recurrence on the liver graft. She underwent a myeloablative HSCT using a matched unrelated donor, conditioning with BuCy (busulfan and cyclophosphamide), and GvHD (graft vs. host disease) prophylaxis with ATG (thymoglobulin), tacrolimus and methotrexate. Neutrophil engraftment occurred on D+18. She has presented mixed chimerism, but normalization of PP levels, being 300 days after HSCT, in good state of health and normal liver function. CONCLUSIONS: Consecutive LT and HSCT for EPP is a procedure that has been described in 10 cases in the literature and, even though these patients are a highly diversified population, studies have shown favorable results. This concept of treatment should be considered in patients with established liver disease.

Nível de atividade física de fisioterapeutas de um hospital público / Level of physical activity of physical therapists at a public hospital

Objetivo: avaliar o nível de atividade física dos fisioterapeutas e identificar o perfil socioeconômico desses profissionais de um hospital público de grande porte em Goiânia. Métodos: Trata-se de um estudo observacional, transversal e quantitativo realizado de abril a agosto de 2020. Foram incluídos fisioterapeutas de ambos os sexos, contratados há no mínimo seis meses, e que assinaram o termo de consentimento livre e esclarecido. Excluídos da pesquisa aqueles em férias ou licença médica no período da coleta de dados. Para avaliar o nível de atividade física utilizou-se o Questionário Internacional de Atividade Física (IPAQ), e um questionário para conhecer o perfil socioeconômico desses profissionais. As variáveis contínuas foram apresentadas como média e desvio padrão, enquanto as categóricas, em frequência absoluta e relativa. Resultados: Grande parte dos indivíduos é do sexo feminino (73,5%) com maior prevalência de inativos (76%), sendo que (49,9%) cumprem carga horária maior que 30 horas semanais. Do total da amostra (61,8%) tem pelo menos especialização na sua formação profissional. Conclusão: Os fisioterapeutas do serviço público apresentam o nível de atividade física reduzido, com maior proporção classificados como inativos, segundo a OMS.

Purpose: evaluate the level of physical activity of physical therapists and identify the socioeconomic profile of these professionals in a large public hospital in Goiânia. Methods: This is an observational, cross-sectional and quantitative study carried out from April to August 2020. Physical therapists of both sexes, hired for at least six months, and who signed a free and informed consent form, were included. The research excluded those on vacation or sick leave during the data collection period. In order to assess the level of physical activity, the International Physical Activity Questionnaire (IPAQ) was used, as well as a questionnaire to learn about the socioeconomic profile of these professionals. Continuous variables were presented as mean and standard deviation, while categorical variables were in absolute and relative frequency. Results: Most of the individuals are female (73.5%) with a higher prevalence of inactive people (76%), and (49.9%) working more than 30 hours per week. From the total sample, 61.8% were at least specialists in their areas. Conclusion: Public service physical therapists have a reduced level of physical activity, with a greater proportion being classified as inactive, according to WHO.

Moral distress and moral resilience of nurse managers.

BACKGROUND: Moral distress is a phenomenon that can lead to an imbalance of the mind and body. There are many coping strategies to overcome the obstacles that lead the subject to this condition. Some coping strategies are capable of being achieved through the cultivation of moral resilience. AIM: The aim is to identify the strategies of moral resilience in the nursing management of University Hospitals in Brazil. RESEARCH DESIGN: The research design is the qualitative study with discursive textual analysis. PARTICIPANTS AND RESEARCH CONTEXT: : 44 nurse managers and nurses in leadership positions participated in a total of 30 University Hospitals in Brazil. Data were collected online, using a questionnaire with open questions. ETHICAL CONSIDERATIONS: The Ethics Committee approved the study. Participants received information about the research, agreed to respond to the questionnaire, and were guaranteed anonymity. FINDINGS: Personal adaptive strategies (intrapersonal and interpersonal) and organizational collaborative strategies (intrinsic and transformational management) emerged from this process. The intrapersonal strategies involved elements of rationality, flexibility, rebalancing practices, moral courage, and detachment. The interpersonal strategies addressed support networks, team involvement, and dialog. Organizational strategies dealt with actions which reorient ethical infrastructure, ethical education, and psychological protection, as well as fostering dialogical relationships, empowerment, and cooperation. CONCLUSION: From the perspective of social historical construction, it is understood that developing personal and organizational strategies is essential to cultivating moral resilience.

Convalescent plasma for COVID-19 in hospitalised patients: an open-label, randomised clinical trial.

BACKGROUND: The effects of convalescent plasma (CP) therapy in hospitalised patients with coronavirus disease 2019 (COVID-19) remain uncertain. This study investigates the effect of CP on clinical improvement in these patients. METHODS: This is an investigator-initiated, randomised, parallel arm, open-label, superiority clinical trial. Patients were randomly (1:1) assigned to two infusions of CP plus standard of care (SOC) or SOC alone. The primary outcome was the proportion of patients with clinical improvement 28 days after enrolment. RESULTS: A total of 160 (80 in each arm) patients (66.3% critically ill, 33.7% severely ill) completed the trial. The median (interquartile range (IQR)) age was 60.5 (48-68) years; 58.1% were male and the median (IQR) time from symptom onset to randomisation was 10 (8-12) days. Neutralising antibody titres >1:80 were present in 133 (83.1%) patients at baseline. The proportion of patients with clinical improvement on day 28 was 61.3% in the CP+SOC group and 65.0% in the SOC group (difference -3.7%, 95% CI -18.8-11.3%). The results were similar in the severe and critically ill subgroups. There was no significant difference between CP+SOC and SOC groups in pre-specified secondary outcomes, including 28-day mortality, days alive and free of respiratory support and duration of invasive ventilatory support. Inflammatory and other laboratory marker values on days 3, 7 and 14 were similar between groups. CONCLUSIONS: CP+SOC did not result in a higher proportion of clinical improvement on day 28 in hospitalised patients with COVID-19 compared to SOC alone.

O uso de aplicativo de celular para medir frequência cardíaca e saturação periférica de oxigênio / The use of cellular application to measure heart rate and peripheral oxygen saturation

Avaliar a associação da medida de frequência cardíaca (FC) e saturação periférica de oxigênio (SpO2 ) utilizando um aplicativo de celular e um monitor multiparamétrico. Métodos: Estudo experimental e randomizado entre participantes saudáveis. Investigou o aplicativo Samsung Health® e o monitor multiparamétrico da marca Midway®, modelo: PM-60. O estudo foi estruturado em quatro etapas. Para análise estatística, aplicou correlação de Pearson e Spearman, com nível de significância de 5%. Resultados: Dos 150 participantes a idade média foi de 22,3±4,5 anos, o sexo feminino foi predominante (71,3%). Verificouse forte correlação da FC medida pelo monitor com a FC do aplicativo de celular (r=0,93) indicando correlação positiva (p<0,001). A SpO2 medida por monitor multiparamétrico e pelo aplicativo de celular revelou um r=0,05 (p=0,51), o que atesta uma correlação nula e não significativa. Conclusão: Não houve correlação entre a medida da SpO2 do monitor multiparamétrico e do aplicativo Samsung Health®, não sendo confiável a utilização deste aplicativo para monitorar e gerenciar o sinal vital SpO2 em pessoas saudáveis. A FC medida com o aplicativo é significativa, e pode ser utilizada para monitorar e gerenciar esse sinal vital.

Assess the association of the measure of heart rate (HR) and oxygen saturation (SpO2 ) using a mobile application and a multiparameter monitor. Methods: Study experimental and randomized healthy participants. Investigated the application Samsung Health® and multiparameter monitor Midway® make, model: PM-60. The study was divided into four stages. Statistical analysis was applied Pearson and Spearman correlation with 5% significance level. Results: Of the 150 participants average age was 22.3±4.5 years, females were predominant (71.3%). There was a strong correlation HR measured by the monitor application to cell FC (r=0.93) indicating a positive correlation (p<0.001). SpO2 measured by multiparameter monitor and the mobile application revealed r=0.05 (p=0.51), which demonstrates a zero and no significant correlation. Conclusion: There was no correlation between the SpO2 measurement of the multiparameter monitor and the Samsung Health® app, not being trusted to use this application to monitor and manage the vital sign SpO2 in healthy people. The HR measured with the application is significant, and can be used to monitor and manage this vital sign.

Ventilação não invasiva versus oxigenoterapia em fase final dos cuidados paliativos oncológicos: uma revisão sistemática / Non-invasive Ventilation versus Oxygenotherapy in the end stage of Oncology Palliative Care: a Systematic Review

Introdução: A Organização Mundial da Saúde define como Cuidados Paliativos abordagens que melhoram a qualidade de vida dos pacientes (adultos e crianças) e de suas famílias que enfrentam problemas associados a doenças de risco de vida. Um dos principais objetivos dos Cuidados Paliativos é o alívio da dispneia. Objetivo: Esta revisão sistemática buscou encontrar na literatura evidências que indicam a efetividade das intervenções não invasivas para alívio da dispneia em fase final dos cuidados paliativos. Metodologia: Utilizou-se o guia metodológico da Cochrane Handbook. Resultados: Após a pesquisa inicial,110 artigos foram encontrados, 11 foram removidos por duplicação, 86 excluídos por não preencherem os critérios de inclusão. Após filtragem, 13 estudos foram recuperados em texto completo, e após leitura dos textos completos, 11 não corresponderam aos critérios de elegibilidade. Dois estudos foram incluídos na síntese qualitativa para avaliação da qualidade metodológica, e passaram para a síntese quantitativa. Nesta revisão sistemática, 230 pacientes incluídos foram alocados de forma aleatória para VNI (n=113) e Oxigenoterapia (n=117) seguindo uma randomização simples. Conclusão: Esta revisão sistemática apontou que as duas intervenções são métodos capazes de melhorar a dispneia dos pacientes em fase final dos Cuidados Paliativos Oncológicos, contudo a VNI mostrou ser superior à oxigenoterapia convencional e ao HFCN, principalmente nos pacientes hipercápnicos. Embora o HFCN também tenha apresentado dados significativos, seu uso ainda é controverso.

Introduction: The World Health Organization defines Palliative Care as approaches that improve the quality of life of patients (adults and children) and their families who face problems associated with lifethreatening diseases. One of the main objectives of Palliative Care is the relief of dyspnea. Objective: This systematic review sought to find evidence in the literature that indicates the effectiveness of non-invasive interventions for the relief of dyspnea in the final stage of palliative care. Methodology: The Cochrane Handbook methodological guide was used. Results: After the initial search, 110 articles were found, 11 were removed by duplication, 86 were excluded for not meeting the inclusion criteria, after filtering 13 studies were retrieved in full text, and after reading the full texts, 11 did not meet the criteria eligibility criteria. Two studies were included in the qualitative synthesis to assess methodological quality, and moved on to the quantitative synthesis. In this systematic review, 230 included patients were randomly allocated to NIV (n = 113) and oxygen therapy (n = 117) following simple randomization. Conclusion: This systematic review pointed out that the two interventions are methods capable of improving the dyspnea of patients in the final stage of Oncology Palliative Care, however NIV has been shown to be superior to conventional oxygen therapy and HFCN, especially in hypercapnic patients. Although HFCN has also presented significant data, its use is still controversial. Although supplemental oxygen therapy is widely prescribed, there is little evidence of benefit

Association between moral distress and supporting elements of moral deliberation in nurses.

OBJECTIVE: to identify the association between moral distress and the supporting elements of moral deliberation in Brazilian nurses. METHOD: a cross-sectional study conducted with Brazilian nurses working in health services at different complexity levels. The research protocol consisted of the Brazilian Scale of Moral Distress in Nurses, a sociodemographic and labor questionnaire, and a list of bases and ethical elements used for moral deliberation. For analysis, descriptive statistics, chi-square test, and Poisson regression were used. RESULTS: 1,226 nurses took part in the study. The 12 elements associated with the moral deliberation process were classified as important for nurses' actions, especially the professional experience acquired, code of ethics/law of professional practice, and ethical and bioethical principles. The relationship of moral distress showed higher prevalence in the Beliefs, culture and values of the patient, Beliefs and personal values, and Intuition and Subjectivity elements. CONCLUSION: the results showed a balance between the subjective criteria of professional experience and the objective ones of deontology for moral deliberation.

Effectiveness of Trastuzumab for Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer in a Real-Life Setting: One Decade of Experience Under National Treatment Coverage Regulations.

PURPOSE: Trastuzumab has shown an overall survival (OS) benefit in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC), in both the adjuvant and the metastatic setting. We assessed the effectiveness of trastuzumab in patients treated in daily practice according to national treatment coverage protocols and compared our results with those reported by randomized clinical trials. These coverage protocols included patient selection criteria similar to those of those clinical trials and were developed by the Uruguayan National Resource Fund (FNR), the agency that has funded these prescriptions for more than a decade. PATIENTS AND METHODS: We included all patients with HER2-positive BC treated with trastuzumab under FNR coverage approved between January 1, 2006, and December 31, 2016. The source of data was the FNR database, and primary outcome was OS, analyzed through Cox proportional hazards regression analysis. RESULTS: A total of 1,944 women were included: 1,085 women (55.8%) were postmenopausal and 1,240 (63.7%) had HER2 and hormone receptor-positive BC. Trastuzumab was administered as adjuvant therapy to 1,233 patients (63.5%), of whom 154 also received it as a neoadjuvant treatment. Three hundred nineteen patients (16.4%) received trastuzumab for advanced disease. Five-year OS in the adjuvant setting was 86.4% (95% CI, 84.0% to 88.7%). The median survival of patients with advanced BC was 25.1 months (95% CI, 10.1 to 42.5 months). CONCLUSION: Our survival results are not inferior to those reported in clinical trials, in both adjuvant and advanced settings. Importantly, these results support the relevance and the feasibility of treating patients in routine practice, following coverage protocols based on patient selection criteria and methods supported by positive clinical trials. In addition, these results favor quality and appropriate access to BC treatment in our country.

Association between moral distress and supporting elements of moral deliberation in nurses / Associação entre distresse moral e elementos apoiadores da deliberação moral em enfermeiros / Asociación entre distrés moral y elementos de apoyo de la deliberación moral en enfermeros

Objective: to identify the association between moral distress and the supporting elements of moral deliberation in Brazilian nurses. Method: a cross-sectional study conducted with Brazilian nurses working in health services at different complexity levels. The research protocol consisted of the Brazilian Scale of Moral Distress in Nurses, a sociodemographic and labor questionnaire, and a list of bases and ethical elements used for moral deliberation. For analysis, descriptive statistics, chi-square test, and Poisson regression were used. Results: 1,226 nurses took part in the study. The 12 elements associated with the moral deliberation process were classified as important for nurses' actions, especially the professional experience acquired, code of ethics/law of professional practice, and ethical and bioethical principles. The relationship of moral distress showed higher prevalence in the Beliefs, culture and values of the patient, Beliefs and personal values, and Intuition and Subjectivity elements. Conclusion: the results showed a balance between the subjective criteria of professional experience and the objective ones of deontology for moral deliberation.(AU)

Objetivo: identificar a associação entre o distresse moral e os elementos apoiadores da deliberação moral em enfermeiros brasileiros. Método: estudo transversal realizado com enfermeiros brasileiros atuantes em serviços de saúde de diferentes níveis de complexidade. O protocolo de pesquisa constituiu-se da Escala Brasileira de Distresse Moral em Enfermeiros, questionário sociodemográfico e laboral, e uma lista de bases e elementos éticos utilizados para deliberação moral. Para análise empregou-se estatística descritiva, teste do qui-quadrado e regressão de Poisson. Resultados: participaram do estudo 1.226 enfermeiros. Os 12 elementos associados ao processo de deliberação moral foram classificados com importância para atuação dos enfermeiros, destacando-se a experiência profissional adquirida, Código de Ética/Lei do Exercício profissional, e, princípios éticos e bioéticos. A relação do distresse moral evidenciou maiores prevalências nos elementos Crenças, cultura e valores do paciente, Crenças e valores pessoais e, Intuição e Subjetividade. Conclusão: os resultados apontaram um equilíbrio entre critérios subjetivos da experiência profissional e objetivos da deontologia para a deliberação moral.(AU)

Objetivo: identificar la asociación entre el distrés moral y los elementos de apoyo de la deliberación moral en los enfermeros brasileñas. Método: estudio transversal realizado con enfermeros brasileños que trabajan en servicios de salud de diferentes niveles de complejidad. El protocolo de investigación consistió en la Escala Brasileña de Distrés Moral en Enfermeros, un cuestionario sociodemográfico y laboral, y una lista de bases y elementos éticos utilizados para la deliberación moral. Para el análisis, se utilizó estadística descriptiva, prueba de chi-cuadrado y regresión de Poisson. Resultados: 1.226 enfermeros participaron en el estudio. Los 12 elementos asociados con el proceso de deliberación moral se clasificaron como importantes para el desempeño de los enfermeros, destacando la experiencia profesional adquirida, el Código de Ética/Derecho de Práctica Profesional y los principios éticos y bioéticos. La relación de distrés moral mostró una mayor prevalencia en los elementos Creencias, cultura y valores del paciente, Creencias y valores personales y, Intuición y Subjetividad. Conclusión: los resultados mostraron un equilibrio entre los criterios subjetivos de la experiencia profesional y los objetivos de ética para la deliberación moral.(AU)

Sofrimento moral de enfermeiros gerentes em um hospital universitário / Nurse managers' moral suffering in a university hospital / Sufrimiento moral en enfermeros gerentes de un hospital universitario

Objetivo: Descrever situações geradoras e elementos envolvidos no processo de sofrimento moral na experiência de enfermeiros gerentes de um hospital público do sul do Brasil. Método: Estudo descritivo e exploratório de abordagem qualitativa, realizado durante o período de março a setembro de 2014 cujas informações foram coletadas mediante entrevista semiestruturada. Participaram da pesquisa 17 enfermeiros gerentes. Os dados foram organizados no software Atlas.Ti© e analisados segundo a técnica de análise textual discursiva. Resultados: Emergiram três categorias: Organização e Condições de trabalho, Gestão de Pessoas e O Ser Gerente. Conclusão: Constatou-se que os gerentes vivenciam o sofrimento moral decorrente de situações conflituosas relacionadas às condições de trabalho, profissionais insubordinados, falta de autonomia, assédio moral e as múltiplas faces da função gerencial. Assim, buscou-se contribuir para área da saúde, nos aspectos de sensibilizar moralmente os profissionais para as atividades que desempenham e no tocante ao sofrimento moral

Objective: Describe generating situations and elements involved in moral distress process in nurse managers experience of a public hospital in southern Brazil. Method: Descriptive and exploratory study, nature of qualitative approach, conducted from march 2014 to september 2014 and whose information was collected through semi-structured interview. There was a participation of 17 nurses managers. Data were organized in the software Atlas. Ti© and analyzed according to the technique of discursive and textual analysis. Results: Three categories emerged: Organization and working conditions, People management, and Being the Manager. Conclusions: It was found that the managers experience moral distress arise from conflicting situations related to working conditions, insubordinate professionals, lacking of autonomy, psychological harassment and the multiple faces of the managerial function. Accordingly, it was sought to contribute to the health area, in the aspects of morally sensing the professionals for the activities they perform and regarding moral distress

Objetivo: Describir la generación de situaciones y elementos relacionados con el proceso de sufrimiento moral en enfermeros gerentes de un hospital público en el sur de Brasil. Método: Estudio descriptivo y exploratorio de enfoque cualitativo, realizado durante el período de marzo a septiembre de 2014 y cuyas informaciones fueron obtenidas por medio de entrevista semiestructurada. Participaron de la investigación 17 enfermeros gerentes. Los datos fueron organizados en el software Atlas.Ti© y analizados de acuerdo con el método de análisis textual discursiva. Resultados: Se desarrollarán tres categorías: Organización y Condiciones de trabajo, Gestión de personas, y el Ser Gerente. Conclusión: Se concluyó que los gerentes experimentan el sufrimiento moral resultante de situaciones conflictivas relacionadas con las condiciones de trabajo, profesionales insubordinados, falta de autonomía, acoso moral y las múltiples facetas de la función gerencial. Así, se buscó contribuir al área de la salud, en los aspectos de sensibilizar moralmente a los profesionales para las actividades que desempeñan y en lo tocante al sufrimiento moral

Covid-19: como a disseminação de fake news pode influenciar a população durante a pandemia / COVID-19: how fake news can influence the population during the pandemic

Introdução: O novo coronavírus e a pandemia de Covid-19 têm mostrado que o ceticismo, a disseminação de fake news e a desvalorização da ciência podem formar uma tríade capaz de causar impactos significantes no enfrentamento da pandemia. Objetivo: Identificar as notícias falsas classificadas pelo Ministério da Saúde (MS) como fake news inseridas na temática sobre coronavírus e Covid-19, publicadas e compartilhadas através das mídias sociais durante um perí odo específico, e observar sua influência na população. Método: A busca das notícias foi realizada através do banco de dados do MS sobre fake news, sendo utilizado o filtro de busca por tema "Covid-19", no período de 01 de janeiro de 2020 a 01 de junho de 2020. Resultado: Foram encontrados 36 registros sobre o assunto. As notícias constituíram seis categorias, analisadas e contra-argumentadas com base em literaturas de natureza científica. Os dados encontrados foram tabulados e organizados por data de publicação, categoria, título da notícia e veículo de informação. As categorias que mais resultaram em fake news foram "tratamento/cura" e "prevenção'". Sobre as mídias empregadas como veiculadoras das notícias, o WhatsApp apresentou-se como o mais utilizado, totalizando 18 registros. Sobre as datas de divulgação das notícias, o mês de março foi o que mais apresentou publicação de fake news, totalizando 19 notícias. Considerações Finais: O compartilhamento de informações sobre medidas preventivas ineficazes, utilização de alimentos e medicamentos sem embasamento científico, e a divulgação de número de casos divergente do divulgado pelas autoridades sanitárias em saúde podem, portanto, influir em prejuízos à saúde da população.

Introduction: The new coronavirus and the Covid-19 pandemic have shown that skepticism, the spread of fake news, and the devaluation of science can make a triad able to cause significant impacts to face the pandemic. Objective: Identify false pieces of news classified by the Brazilian Health Ministry (MS) as fake news on the theme about Coronavirus and Covid-19, published and shared through social media during a specific period, and observe its influence in the population. Method: The search was carried out through the Brazilian Health Ministry database on fake news, using the search filter with the theme "Covid-19", from January 1, 2020 to June 1, 2020. Result: There were 36 records about the topic. The pieces of news were classified into six categories, analyzed, and discussed by scientific literature. Data found were classified and organized by date of publication, category, news headline, and information broadcaster. The topics that most resulted in fake news were "treatment/cure" and "prevention". Referring to the media used as news channels, WhatsApp was the most used, with a total of 18 pieces of news transmitted through it. Regarding the news release dates, March was the month that most presented fake news publications, reaching a total of 19. Final Considerations: The sharing of information on ineffective preventive measures, the use of food and medicine without a proven scientific foundation, and the dissemination of case numbers different of the one informed by sanitary authorities in health can, therefore, cause damage to the health of the population.

Desafios atuais da bioética brasileira / Current challenges of the Brazilian bioethics / Desafíos actuales de la bioética brasileña

Resumo Este estudo tem como objetivo analisar os desafios atuais da bioética no Brasil. Trata-se de pesquisa exploratória, analítica, de abordagem qualitativa e perspectiva histórico-social. Utilizou-se a técnica de entrevista semiestruturada, e a seleção dos participantes (14 pesquisadores brasileiros) se deu por conveniência e amostragem por bola de neve. Dos resultados surgiram quatro eixos: características da bioética brasileira; desafio de ultrapassar fronteiras; dificuldade de aproximação à política da bioética; e introdução desse campo do conhecimento no âmbito acadêmico. Concluiu-se que, como processo em permanente devir, a bioética transpôs diversas barreiras desde que chegou ao país e, à medida que avança e se constitui como campo de conhecimento e ação política, novos desafios se apresentam. Aprovação CEP-UFSC CAAE 04382612.0.0000.0121

Abstract This study aims to analyze the current challenges of bioethics in the Brazilian perspective. This is an analytical-exploratory study with a qualitative approach and a social-historical perspective. The semi-structured interview technique was applied. The selection of participants (14 Brazilian bioethics researchers) was performed by convenience and snowball sampling was used. Four axes emerged from the results: Characteristics of the Brazilian Bioethics; the Challenge of overcoming borders; the Challenge of bringing politics to bioethics; and Academic challenges for Brazilian Bioethics. It is concluded that, as a process in permanent transformation, Brazilian Bioethics has overcome several obstacles from the beginning of the discussions and, as it progresses, it grows as a field of knowledge and political action. Aprovação CEP-UFSC CAAE 04382612.0.0000.0121

Resumen Este estudio tiene como objetivo analizar los desafíos actuales de la Bioética en Brasil. Se trata de una investigación exploratoria, analítica, de abordaje cualitativo y con perspectiva histórico-social. Se utilizó la técnica de entrevista semiestructurada. La selección de los participantes (14 investigadores brasileños) se realizó por conveniencia y el muestreo por bola de nieve. De los resultados emergieron cuatro ejes: características de la bioética brasileña; desafío de atravesar las fronteras; dificultad de aproximación a la política de la bioética; e introducción de este campo de conocimiento en el ámbito académico. Se concluye que, en tanto proceso en constante devenir, la bioética transpuso diversas barreras desde que llegó al país y, a medida que avanza y se constituye como campo de conocimiento y de acción política, se presentan nuevos desafíos. Aprovação CEP-UFSC CAAE 04382612.0.0000.0121

Aspectos sociodemográficos e laborais associados ao distresse moral em enfermeiros brasileiros / Aspectos sociodemográficos y laborales asociados al distrés moral en enfermeros brasileños / Sociodemographic and work-related aspects of moral distress in Brazilian nurses

Resumo Objetivo Analisar associações entre distresse moral e características sociodemográficas e laborais de enfermeiros brasileiros. Métodos Estudo transversal realizado em todo território brasileiro, no período de novembro de 2015 a maio de 2016, com uma amostra de 1227 enfermeiros, a partir da aplicação da Escala Brasileira de Distresse Moral em Enfermeiros (EDME-Br), por meio de questionário eletrônico. A análise empregou estatística descritiva e analítica. Resultados Associações estatisticamente significativas foram estabelecidas em todos os seis fatores, são eles: 1. Reconhecimento, poder e identidade pessoal; 2. Cuidado seguro e qualificado; 3. Defesa de valores e de direitos; 4. Condições de trabalho; 5. Infrações éticas; 6. Equipes de trabalho. As variáveis que apresentaram maior número de associações foram: carga horária; pós-graduação, natureza da atenção/complexidade do serviço, natureza, tipo e tempo do vínculo. Destacou-se o papel da experiência e da formação ampliada na maior percepção e/ou vivência do distresse moral. Conclusão A amplitude do estudo e a diversidade do contexto revelam especificidades quanto à ocorrência do distresse moral no cenário brasileiro, reforçando a necessidade de conhecer elementos que participam da experiência moral dos enfermeiros.

Resumen Objetivo analizar asociaciones entre distrés moral y características sociodemográficas y laborales de enfermeros brasileños. Métodos estudio transversal realizado en todo el territorio brasileño, en el período de noviembre de 2015 a mayo de 2016, con una muestra de 1.227 enfermeros, a partir de la aplicación de la Escala Brasileña de Distrés Moral en Enfermeros (EDME-Br), por medio de cuestionario electrónico. El análisis empleó estadística descriptiva y analítica. Resultados se establecieron asociaciones estadísticamente significativas en los seis factores, que son: 1) reconocimiento, poder e identidad personal, 2) cuidado seguro y calificado, 3) defensa de valores y derechos, 4) condiciones de trabajo, 5) infracciones éticas, y 6) equipos de trabajo. Las variables que presentaron mayor número de asociaciones fueron: carga horaria, posgraduación, naturaleza de la atención/complejidad del servicio, naturaleza, tipo y tiempo del vínculo. Se destacó el papel de la experiencia y de la formación ampliada en la mayor percepción o vivencia del distrés moral. Conclusión la amplitud del estudio y la diversidad del contexto revelan especificidades respecto a los casos de distrés moral en el escenario brasileño, lo que refuerza la necesidad de conocer elementos que participan de la experiencia moral de los enfermeros.

Abstract Objective Analyze associations between moral distress and sociodemographic and work-related characteristics of Brazilian nurses. Methods Cross-sectional study developed across the Brazilian territory between November 2015 and May 2016, in a sample of 1227 nurses, based on the application of the Brazilian Moral Distress Scale in Nurses (EDME-Br), by means of an electronic questionnaire. Descriptive and analytical statistics were used for the analysis. Results Statistically significant associations were established in all six factors, namely: 1. Recognition, power and personal identity; 2. Safe and qualified care; 3. Defense of values and rights; 4. Working conditions; 5. Ethical infringements; 6. Work teams. The variables with the largest number of associations were: hour load; graduate degree, nature of service care/complexity, nature, type and duration of employment bond. The role of experience and enhanced education in higher perceived and/or experienced moral distress stood out. Conclusion The range of the study and the diversity of the context reveal specificities in the occurrence of moral distress in the Brazilian context, highlighting the need to discover elements that play a role in the nurses' moral experience.

Processo de deliberação moral dos Enfermeiros de competência gerencial e fiscalizatória dos Conselhos de Enfermagem / Moral deliberation process of management and supervisory competencies of the Nursing councils in Brazil

Objetivo: descrever o processo e os valores implicados na deliberação moral dos profissionais de competência gerencial e fiscais, considerando suas atribuições e os problemas éticos encontrados. Metodologia: estudo descritivo e exploratório, abordagem qualitativa, realizado durante o período de novembro 2013 a novembro de 2014, cujas informações foram coletadas por meio de questionário. Participaram da pesquisa 28 profissionais de competência gerencial e 113 profissionais de competência fiscalizatória dos departamentos de fiscalização do exercício profissional de enfermagem brasileira. Os dados foram organizados e analisados segundo a técnica de análise textual discursiva. Resultados: o itinerário proposto pelos participantes revela certa maturidade e conhecimento, constatado através das etapas eleitas. Conclusão: o estudo apontou que os trâmites do processo são fortemente vinculados a aspectos burocráticos e organizacionais. Convém ressaltar que os valores implicados no processo estão relacionados às dimensões ética, legal, subjetiva e profissional. (AU)

Objective: describe the process and values involved in the moral deliberation of professionals with managerial and fiscal competencies, considering their responsibilities and ethical problems encountered. Methodology: Descriptive and exploratory study, qualitative approach, conducted from November 2013 to November 2014 and whose information was collected through questionnaire. There was a participation of 28 management professionals and 113 supervisory professionals from the professional inspection departments of the Brazilian nursing. Data were organized and analyzed according to the technique of discursive and textual analysis. Results: the itinerary proposed by the participants revealed certain maturity and knowledge, which was verified through the elected steps. Conclusion: the study pointed out that the process formalities are strongly linked to bureaucratic and organizational aspects. It is worth mentioning that the values involved in the process are related to ethical, legal, subjective and professional dimensions. (AU)

Objetivo: describir el proceso y los valores implicados en la deliberación moral de los profesionales de competencia gerencial y fiscal, considerando sus atribuciones y los problemas éticos encontrados. Metodología: Estudio descriptivo y exploratorio, enfoque cualitativo, realizado durante el período de Noviembre del 2013 hasta Noviembre del 2014 y cuyas informaciones fueron obtenidas por medio de cuestionario. Participaron de la investigación 28 profesionales de competencia gerencial y 113 profesionales de competencia fiscalizadora de los departamentos de fiscalización del ejercicio profesional de la enfermería brasileña. Los datos fueron organizados y analizados según la técnica del análisis textual discursivo. Resultados: el itinerario propuesto por los participantes revela cierta madurez y conocimiento, lo que fue constatado a través de las etapas elegidas. Conclusión: el estudio determinó que los trámites del proceso están fuertemente vinculados a los aspectos burocráticos y organizacionales. Vale resaltar que los valores implicados en el proceso están relacionados con las dimensiones éticas, legales, subjetivas y profesionales. (AU)

Obstructive sleep apnea syndrome among obese individuals: A cross-sectional study.

INTRODUCTION: The obstructive sleep apnea syndrome (OSAS) is a respiratory illness, characterized by recurrent episodes of apnea and hypopnea, leading to reduction or cessation of the airflow. Obesity is one of the major risk factors for the development of OSAS. To help in the diagnosis of this disease, easily applicable and low-cost questionnaries were developed, such as the Berlin Questionnaire (BQ). OBJECTIVE: To evaluate the efficacy of the BQ for the screening of OSAS among candidates to bariatric surgery in a multidisciplinary preoperative program. METHOD: This is an observational, descriptive and cross-sectional study which evaluated obese individuals that were being prepared for bariatric surgery by means of the BQ. RESULTS: BQ was able to detect that minimal variations in the body mass index, neck circumference and hip-to-waist ratio lead to changes in the risk to develop OSAS; the higher the values of these variables, the higher the risk for OSAS development. CONCLUSION: BQ was an efficient and reliable tool to demonstrate the high risk for OSAS development in individual with obesity.

Obstructive sleep apnea syndrome among obese individuals: A cross-sectional study / Síndrome da apneia obstrutiva do sono em indivíduos portadores de obesidade: um estudo transversal

Summary Introduction: The obstructive sleep apnea syndrome (OSAS) is a respiratory illness, characterized by recurrent episodes of apnea and hypopnea, leading to reduction or cessation of the airflow. Obesity is one of the major risk factors for the development of OSAS. To help in the diagnosis of this disease, easily applicable and low-cost questionnaries were developed, such as the Berlin Questionnaire (BQ). Objective: To evaluate the efficacy of the BQ for the screening of OSAS among candidates to bariatric surgery in a multidisciplinary preoperative program. Method: This is an observational, descriptive and cross-sectional study which evaluated obese individuals that were being prepared for bariatric surgery by means of the BQ. Results: BQ was able to detect that minimal variations in the body mass index, neck circumference and hip-to-waist ratio lead to changes in the risk to develop OSAS; the higher the values of these variables, the higher the risk for OSAS development. Conclusion: BQ was an efficient and reliable tool to demonstrate the high risk for OSAS development in individual with obesity.

Resumo Introdução: A síndrome da apneia obstrutiva do sono (SAOS) é uma patologia respiratória, caracterizada por episódios recorrentes de apneia e hipopneia, resultando na cessação ou redução do fluxo aéreo. A obesidade é um dos principais fatores de risco para o desenvolvimento da SAOS. Foram criadas formas de auxiliar o diagnóstico da doença por meio de questionários de fácil aplicação e baixo custo, como o questionário de Berlim (QB). Objetivo: Avaliar a eficácia do QB para rastreamento do risco de desenvolvimento da SAOS em indivíduos portadores de obesidade que participaram do grupo multidisciplinar de preparo pré-operatório para cirurgia bariátrica do Hospital de Clínicas da Universidade Estadual de Campinas (HC-Unicamp). Método: O estudo foi observacional, descritivo e transversal, e avaliou portadores de obesidade que participavam do Programa multidisciplinar de preparo pré-operatório para cirurgia bariátrica do HC-Unicamp foram avaliados por meio do QB. Resultados: O QB foi capaz de detectar que mínimas oscilações no índice de massa corpórea (IMC), na circunferência cervical (Ccv), na circunferência da cintura e na relação cintura/quadril (RCQ) podem alterar o risco de desenvolvimento de SAOS, sendo que quanto maior esses valores, maior o risco de desenvolvimento de SAOS. Conclusão: O QB é uma ferramenta eficaz e fidedigna em demonstrar a prevalência do risco alto para o desenvolvimento da SAOS em indivíduos portadores de obesidade, dado esse que, quando correlacionado com IMC, aumento de idade, medida de cintura, Ccv e RCQ, faz o risco tender a aumentar de forma exponencial.

Development and validation of the Bush-Francis Catatonia Rating Scale - Brazilian version.

OBJECTIVE:: This article aims to describe the adaptation and translation process of the Bush-Francis Catatonia Rating Scale (BFCRS) and its reduced version, the Bush-Francis Catatonia Screening Instrument (BFCSI) for Brazilian Portuguese, as well as its validation. METHODS:: Semantic equivalence processes included four steps: translation, back translation, evaluation of semantic equivalence and a pilot-study. Validation consisted of simultaneous applications of the instrument in Portuguese by two examiners in 30 catatonic and 30 non-catatonic patients. RESULTS:: Total scores averaged 20.07 for the complete scale and 7.80 for its reduced version among catatonic patients, compared with 0.47 and 0.20 among non-catatonic patients, respectively. Overall values of inter-rater reliability of the instruments were 0.97 for the BFCSI and 0.96 for the BFCRS. CONCLUSION:: The scale's version in Portuguese proved to be valid and was able to distinguish between catatonic and non-catatonic patients. It was also reliable, with inter-evaluator reliability indexes as high as those of the original instrument.

Development and validation of the Bush-Francis Catatonia Rating Scale - Brazilian version / Desenvolvimento e validação da versão brasileira da escala de classificação de Bush-Francis para catatonia

ABSTRACT Objective: This article aims to describe the adaptation and translation process of the Bush-Francis Catatonia Rating Scale (BFCRS) and its reduced version, the Bush-Francis Catatonia Screening Instrument (BFCSI) for Brazilian Portuguese, as well as its validation. Methods: Semantic equivalence processes included four steps: translation, back translation, evaluation of semantic equivalence and a pilot-study. Validation consisted of simultaneous applications of the instrument in Portuguese by two examiners in 30 catatonic and 30 non-catatonic patients. Results: Total scores averaged 20.07 for the complete scale and 7.80 for its reduced version among catatonic patients, compared with 0.47 and 0.20 among non-catatonic patients, respectively. Overall values of inter-rater reliability of the instruments were 0.97 for the BFCSI and 0.96 for the BFCRS. Conclusion: The scale's version in Portuguese proved to be valid and was able to distinguish between catatonic and non-catatonic patients. It was also reliable, with inter-evaluator reliability indexes as high as those of the original instrument.

RESUMO Objetivo: O artigo tem como objetivo descrever o processo de tradução e adaptação da Escala de Catatonia Bush-Francis (ECBF) e de sua versão reduzida (ICBF) para o Português, bem como sua validação. Métodos: O processo de equivalência semântica foi realizado em quatro passos: tradução, retro-tradução, avaliação da equivalência semântica e estudo-piloto. A validação consistiu em aplicações dos instrumentos em português simultâneas por dois avaliadores em 30 pacientes com catatonia e 30 pacientes sem catatonia. Resultados: Média dos escores totais em pacientes catatônicos foi de 20,07 para a versão completa e 7,80 para versão reduzida, contra 0,47 e 0,20 em pacientes não-catatônicos respectivamente. Valores gerais para confiabilidade inter-observador dos instrumentos foi de 0,97 para ICBF e 0,96 para ECBF. Conclusão: A versão em Português da escala provou ser válida e capaz de diferenciar pacientes catatônicos daqueles sem catatonia. Também mostrou ser confiável, com índices inter-avaliadores tão altos quanto no instrumento original.

Performance of Bipolar Disorder Patients in Attention Testing: Comparison with Normal Controls and Among Manic, Depressive, and Euthymic Phases.

Several studies on cognition in bipolar disorder (BD) have been developed on the last decade. Neuropsychological evaluation of attention in BD patients is fundamental since alterations in attention affect other cognitive functions. Evaluate if performance of BD patients in attention tests varies according to each phase of the disease and verify if there are differences in attention when comparing BD patients with normal controls. The study included 101 BD patients, with ages between 18 and 65 years, being 52 euthymic, 22 manic and 27 depressive, besides 30 normal controls. All subjects were evaluated though Hamilton Depression Scale, Young Mania Rating Scale and Global Assessment of Functioning, bipolar version (CGI-BP). Attention was evaluated through a neuropsychological battery. Normal controls had a better performance in selective attention tests than BD patients. No differences were found among manic, depressive and euthymic phases. Attention is markedly impaired in BD. Nevertheless, the results of this study do not imply that the severity of the attention deficit in BD patients varies according to decease phase.