Endometrial cancer treatment and outcomes in Argentina: ECHOS-A real-world study.

Objective: Real-world data for patients with endometrial cancer (EC) are limited, particularly in Latin America. We present treatment pattern findings from ECHOS-A - Endometrial Cancer Health Outcomes Study in Argentina. Materials and methods: A retrospective study using clinical data from privately insured patients with EC diagnosed from 2010 to 2019. Index (diagnosis proxy) was first date of an EC-related health term or treatment. Demographics, clinical characteristics, and FIGO staging were described. Disease progression and survival were assessed until study end, loss to follow-up, or death. Results: Of 805 patients with EC, 77.4 % (n = 623/805) received any treatment and 22.6 % (n = 182/805) received none. Among those treated, 31.8 % (n = 198/623) had first-line (1L) systemic therapy, and 45.5 % (n = 90/198) proceeded to second-line (2L) therapy. Mean follow-up was 33.6 (SD 31.8) months. Of those receiving any treatment, 87.3 % (n = 544/623) had FIGO stage data (I, 62.9 %; II, 18.6 %; III, 13.6 %; IV, 5.0 %). Treatment by class in 1L and 2L, respectively, were platinum chemotherapy, 73.7 %, 36.7 %; non-platinum chemotherapy, 73.7 %, 62.2 %; immunotherapy, 1.0 %, 11.1 %; hormone therapy, 17.7 %, 26.7 %. Carboplatin/paclitaxel was the most frequent 1L (52.5 %) and 2L (14.4 %) regimen. Mean time to progression was 14.1 (SD 16.3) and 8.8 (SD 8.3) months in 1L and 2L, respectively. Adjusted 1- to 5-year risk of progression/death was 46.5-77.5 % and 65.0-86.2 % in 1L and 2L, respectively. Conclusions: Approximately one-quarter of patients with EC received no treatment, and approximately two-thirds were not treated with 1L systemic therapy. Efforts to better understand the reasons for these treatment patterns are crucial for improving patient outcomes.

OCEANIA: real-world study of ovarian cancer treatment patterns across multiple lines of therapy in Argentina and Brazil.

Aim: To evaluate real-world data on treatment patterns in Argentina and Brazil in patients with ovarian cancer.Methods: This study evaluated de-identified antineoplastic exposure data from a private healthcare provider in Argentina and health claims database (Orizon) in Brazil from 2010 to 2019 and 2015 to 2020, respectively.Results: Platinum-based chemotherapy was the most common first-line therapy (Argentina: n =311 [87.6%]; Brazil: n = 1142 [79.3%]). The proportion of patients receiving platinum-based chemotherapy declined across both populations from first- to second-line, while use of non-platinum-based, targeted, and hormone therapies increased. Duration of platinum-based treatment and time to next treatment decreased from first- to fourth-line.Conclusion: There is an unmet need for effective therapies that can prolong time to next treatment in ovarian cancer in Argentina and Brazil.

[Box: see text].

Influence of hydroxyurea on tubular phosphate handling in sickle cell nephropathy.

OBJECTIVE: This study aims to evaluate the markers of tubular phosphate handling in adults with sickle cell anemia (SCA) and the influence of hydroxyurea (HU), the degree of anemia and Hb F concentration on these markers. METHODS: Eighty-eight steady state SCA patients in outpatient follow-up in Fortaleza, Ceara, Brazil and 31 healthy individuals were included in this study. Vitamin D (25OHD) was measured by enzyme-bound fluorescence assay, intact parathyroid hormone (iPTH) by electrochemiluminescence, and serum and urinary phosphate and creatinine by colorimetric methods. Details of Hb F and HU use were obtained from clinical records. Tubular reabsorption of phosphate (TRP) and maximum tubular reabsorption of phosphate (MTRP) were calculated. SCA patients were stratified according to the use of HU, degree of anemia and percentage of Hb F. The significance level was set for p-values <0.05. RESULTS: Compared to controls the 25OHD level (25 ± 11 vs. 30 ± 9 pg/mL) was lower in SCA, while serum phosphate and MTRP were higher (3.86 ± 0.94 vs. 3.46 ± 0.72 and 3.6 ± 1.21 vs. 3.21 ± 0.53, respectively). There was no significant difference in iPTH, TRP and phosphaturia. Serum phosphate showed correlation with TRP (r = 0.32; p-value = 0.008) and MTRP (r = 0.9; p-value <0.001) in SCA. Patients taking HU, especially those with Hb F >10 % presented reduced serum phosphate levels, and TRP and MTRP rates. Those with mild anemia presented reduced serum phosphate levels and MTRP rates. CONCLUSION: Serum phosphate levels and renal phosphate reabsorption rate were increased in SCA. HU use, high Hb F concentration and total Hb were associated with better control of tubular phosphate handling markers.

Nocardiosis: a single-center experience and literature review.

INTRODUCTION: Nocardiosis is a rare bacterial infection caused by Nocardia spp. However, an increasing incidence has been described whereby data about epidemiology and prognosis are essential. METHODS: A retrospective descriptive study was conducted among patients with positive Nocardia spp. culture, from January 2019 to January 2023, at a Terciary Hospital in Portugal. RESULTS: Nocardiosis was considered in 18 cases with a median age of 63.8-years-old. At least one immunosuppressive cause was identified in 70% of patients. Five patients had Disseminated Nocardiosis (DN). The lung was the most common site of clinical disease (77.8%) and Nocardia was most commonly identified in respiratory tract samples. The most frequently isolated species were Nocardia nova/africana (n = 7) followed by Nocardia cyriacigeorgica (n = 3) and Nocardia pseudobrasiliensis (n = 3). The majority of the patients (94.4%) received antibiotic therapy, of whom as many as 55.6% were treated with monotherapy. The most frequently prescribed antibiotic was trimethoprim-sulfamethoxazole. Selected antimicrobial agents were generally effective, with linezolid and cotrimoxazole (100% Susceptibility [S]) and amikacin (94% S) having the most activity against Nocardia species. The median (IQR) duration of treatment was 24.2 (1‒51.4) weeks for DN; The overall one-year case fatality was 33.3% (n = 6) and was higher in the DN (66.7%). No recurrence was observed. CONCLUSION: Nocardiosis is an emerging infectious disease with a poor prognosis, particularly in DN. This review offers essential epidemiological insights and underscores the importance of gaining a better understanding of the microbiology of nocardiosis. Such knowledge can lead to the optimization of antimicrobial therapy and, when necessary, guide appropriate surgical interventions to prevent unfavorable outcomes.

Dominican Adolescents' Preferences for Content, Design, and Functionality of a Mobile Application for Type 1 Diabetes Mellitus Self-management.

OBJECTIVE: The purpose of this interdisciplinary study was to determine Dominican adolescents' preferences for the content, functionality (i.e. food's glycemic index list, and amount of insulin based on foods' carbohydrate count), and design of a culturally and linguistically relevant mobile application (app) for type 1 diabetes mellitus (T1DM) self-management. The app would facilitate T1DM self-management education and support by addressing providers' challenges in monitoring patients' disease progression and promoting patient adherence to recommended lifestyle changes. Findings inform an app development process that considers the linguistic and cultural values, norms, and structures of people with T1DM and their providers in the Dominican Republic. METHODS: Phone interviews were conducted with 23 adolescents (14 to 18 years of age), using a semistructured questionnaire. The research team conducted the data analysis using NVivo through a deductive and inductive approach. RESULTS: The findings suggest that, regardless of the context, adolescents with T1DM desire similar features and functionalities in a self-management app. Overall, participants preferred an app with a graphic format that has accessible information, a straightforward design, and instructional videos. Participants also desired that an app provide information and reminders about proper eating and insulin administration timing and be a vehicle to access a social network to foster mutual support and encouragement. CONCLUSIONS: Our study highlights adolescents' perspectives on components for inclusion in an app for T1DM self-management. Participants' recommendations for the app's potential usability, contents, and design features will be used to guide the development of a new app to promote engagement and foster better health outcomes.

Nocardiosis: a single-center experience and literature review

ABSTRACT Introduction: Nocardiosis is a rare bacterial infection caused by Nocardia spp. However, an increasing incidence has been described whereby data about epidemiology and prognosis are essential. Methods: A retrospective descriptive study was conducted among patients with positive Nocardia spp. culture, from January 2019 to January 2023, at a Terciary Hospital in Portugal. Results: Nocardiosis was considered in 18 cases with a median age of 63.8-years-old. At least one immunosuppressive cause was identified in 70% of patients. Five patients had Disseminated Nocardiosis (DN). The lung was the most common site of clinical disease (77.8%) and Nocardia was most commonly identified in respiratory tract samples. The most frequently isolated species were Nocardia nova/africana (n = 7) followed by Nocardia cyriacigeorgica (n = 3) and Nocardia pseudobrasiliensis (n = 3). The majority of the patients (94.4%) received antibiotic therapy, of whom as many as 55.6% were treated with monotherapy. The most frequently prescribed antibiotic was trimethoprim-sulfamethoxazole. Selected antimicrobial agents were generally effective, with linezolid and cotrimoxazole (100% Susceptibility [S]) and amikacin (94% S) having the most activity against Nocardia species. The median (IQR) duration of treatment was 24.2 (1-51.4) weeks for DN; The overall one-year case fatality was 33.3% (n = 6) and was higher in the DN (66.7%). No recurrence was observed. Conclusion: Nocardiosis is an emerging infectious disease with a poor prognosis, particularly in DN. This review offers essential epidemiological insights and underscores the importance of gaining a better understanding of the microbiology of nocardiosis. Such knowledge can lead to the optimization of antimicrobial therapy and, when necessary, guide appropriate surgical interventions to prevent unfavorable outcomes.

Off-label drug use in an adult intensive care unit of a Brazilian hospital

Abstract The objective of this study was to determine the prevalence and describe the factors associated with off-label drug use in an adult intensive care unit (ICU) of a Brazilian hospital. An analytical, cross-sectional, prospective study was conducted in the adult ICU population from March 2018 to May 2018. Off-label use of medication was classified by indication, dosage, route of administration, type and volume of diluent, and duration of administration. Most patients were female (57.89%), non-elderly (56.14%), and had a mean age of 54.44 ± 17.15 years. The prevalence of off-label drug use was 70.31%, but was not associated with the clinical severity of the patients. A statistically significant association was observed between label use of drugs and prescribing potentially inappropriate medicines (PIM). The most common reasons for off-label drug use were therapeutic indication (19.58%) and volume of diluent (23.30%). Drug administration by enteral tubes accounted for the largest number of off-label uses due to route of administration (90.85%). There was a higher prevalence of off-label use of systemic antimicrobials (14.44%) and norepinephrine (9.28%). Our study provided a broad characterization of off-label drug use in an adult ICU and showed why it is important for health professionals to evaluate the specific risks and benefits of this practice

Association between asthma and sleep hours in Brazilian adolescents: ERICA

Abstract Objective To investigate the association between asthma and sleep duration in participants of the Study of Cardiovascular Risks in Adolescents. Materials and methods Cross-sectional, national, school-based study, involving adolescents aged 12-17 years. In the period between 2013−14, data from 59,442 participants were analyzed. Bivariate analysis between current asthma and short sleep duration, defined as < 7 h/night, was performed separately with the other variables analyzed: sex, age group, type of school, weight categories, and common mental disorders. Then, different generalized linear models with Poisson family and logarithmic link functions were used to assess the independence of potential confounding covariates associated with both asthma and short sleep duration in the previous analysis. Crude and adjusted prevalence ratios and respective 95% confidence intervals were calculated, and a value of p < 0.05 was considered significant for all analyses performed. Results Prevalence of current asthma was 13.4%, being significantly higher among students with short sleep duration (PR: 1.17; 95% CI: 1.01-1.35; p = 0.034). This remained significant even after adjusting for the other study covariates. Conclusion There was a positive association between the prevalence of current asthma and short sleep duration among Brazilian adolescents. Considering the high prevalence and morbidity of the disease in this age group, the promotion of sleep hygiene should be considered as a possible health strategy aimed at contributing to better control of asthma in this population.

Severe asthma and eligibility for biologics in a Brazilian cohort.

OBJECTIVE: This study aims to describe the eligibility for biologic therapies for severe asthma (SA) in a cohort of patients attending the Program for Control of Asthma (ProAR) in Bahia, Brazil. METHODS: Data from SA patients (≥18 years old) attending the ProAR, that were included in a case-control study conducted from 2013 to 2015, were used to reassess patients according to a modified ERS/ATS 2014 SA criteria. Patients were then classified according to the eligibility for SA biological therapy based on current prescription labels. RESULTS: From 544 patients in the cohort, 531 (97.6%) were included and 172 (32.4%) were identified as SA patients according to the ERS/ATS 2014 modified criteria. Of these 172 patients, 69 (40.1%) were ineligible for any of the biologicals approved for asthma (omalizumab, mepolizumab, reslizumab and benralizumab), 60 (34.9%) patients were eligible for one of the biological therapies, and 10 (5.8%) patients were eligible for all biological therapies. CONCLUSIONS: More than half of patients with SA were eligible for biologic therapy in our study, but none of them received this form of treatment. Almost half of them were not eligible to any of the approved biologics, however. The variability and overlap in patients' eligibility highlight the importance of evaluating each patient individually for a more personalized treatment approach. While there is a need to increase access for some of those eligible that may really need a biologic treatment, continuous efforts are required to develop alternatives to those who are not eligible.

Association between asthma and sleep hours in Brazilian adolescents: ERICA.

OBJECTIVE: To investigate the association between asthma and sleep duration in participants of the Study of Cardiovascular Risks in Adolescents. MATERIALS AND METHODS: Cross-sectional, national, school-based study, involving adolescents aged 12-17 years. In the period between 2013-14, data from 59,442 participants were analyzed. Bivariate analysis between current asthma and short sleep duration, defined as < 7 h/night, was performed separately with the other variables analyzed: sex, age group, type of school, weight categories, and common mental disorders. Then, different generalized linear models with Poisson family and logarithmic link functions were used to assess the independence of potential confounding covariates associated with both asthma and short sleep duration in the previous analysis. Crude and adjusted prevalence ratios and respective 95% confidence intervals were calculated, and a value of p < 0.05 was considered significant for all analyses performed. RESULTS: Prevalence of current asthma was 13.4%, being significantly higher among students with short sleep duration (PR: 1.17; 95% CI: 1.01-1.35; p = 0.034). This remained significant even after adjusting for the other study covariates. CONCLUSION: There was a positive association between the prevalence of current asthma and short sleep duration among Brazilian adolescents. Considering the high prevalence and morbidity of the disease in this age group, the promotion of sleep hygiene should be considered as a possible health strategy aimed at contributing to better control of asthma in this population.

Contribuições do modelo feminista nos estudos da deficiência para uma perspectiva de prática inclusiva educacional baseada na interdependência / Contributions of the feminist model in disability studies to an inclusive educational practice perspective based on interdependence / Contribuciones del modelo feminista en los estudios de discapacidad a una perspectiva de práctica educativa inclusiva basada en la interdependencia

Este trabalho visa problematizar a relação entre deficiência e educação, a partir dos processos de construção de uma Educação Inclusiva. A pesquisa foi realizada com educadoras(es) que atuam na interface da Educação "Especial" e da Educação para Jovens e Adultos (EJA), com os(as) quais exercitamos práticas de conversa na Formação Continuada no município de Vitória/ES. Trata-se de uma pesquisa-intervenção de caráter participativo. Como interlocutores, destacamos as contribuições do Modelo Feminista para os Estudos da Deficiência, buscando observar a diretriz ética do lema "nada sobre nós, sem nós" e o princípio da interdependência. Por fim, ao discutirmos com táticas de trabalho cotidianas, esta pesquisa aponta para o exercício ético-político que envolve o cultivo da interdependência como modos de acesso e afirmação de práticas inclusivas.

This study aims to problematize the relation between disability and education, analyzing the process of building an Inclusive Education. The subjects of this study were educators who work with Special Education in the context of Adult and Youth Education, and agreed to participate in conversations that took place during their professional development meetings in the county of Vitória/ES. It is a participatory research-intervention. The research had as it interlocutors the contributions of the Feminist Model to the Disability Studies, seeking to observe the ethical guideline of the motto "nothing about us, without us" and the interdependence principle. Finally, when discussing with daily work tactics, this research indicates that the ethical-political exercise involves the harvesting of interdependence as the main way to access and affirm the inclusive practices.

Este artículo tiene como objetivo problematizar la relación entre discapacidad y educación, a partir de los procesos de construcción de una Educación Inclusiva. La investigación se realizó con educadores que trabajan en la interface de Educación "Especial" y Educación de Jóvenes y Adultos / EJA, y con quienes practicamos prácticas de conversación en Educación Continua en la ciudad de Vitória / ES. Es una investigación-intervención participativa. Como interlocutores, destacamos las contribuciones del Modelo Feminista y los Estudios de Discapacidad, buscando observar una conducción ética del lema "nada sobre nosotros sin nosotros" y el principio de interdependencia. Finalmente, cuando se discute con tácticas de trabajo diarias, esta investigación apunta para el ejercicio ético-político que involucra el cultivo de la interdependencia como formas de acceso y afirmación de prácticas inclusivas.

Prevalence of Combined Lipid Abnormalities in Brazilian Adolescents and Its Association with Nutritional Status: Data from the Erica Study.

Background: Cardiovascular diseases are the leading cause of death in Brazil and worldwide. The growing incidence of obesity in children and adolescents and its association with lipid abnormalities may worsen this scenario, mainly in developing countries where obesity has reached epidemic levels. Dyslipidemias have several patterns, and the combination of some lipid abnormalities may have higher atherogenic potential. Objectives: To evaluate the prevalence of single or multiple combined lipid abnormalities in adolescents and its association with nutritional status assessed by body mass index. Methods: Data were obtained from the Study of Cardiovascular Risks in Adolescents (ERICA), a school-based, national representative study with Brazilian adolescents between 12 and 17 years of age. Adolescents whose lipid profiles were available were included, and lipid abnormalities were defined as LDL-C ≥ 100 mg/dL, HDL-C < 45 mg/dL, and tryglicerides (TG) ≥ 100 mg/dL. We assessed the prevalence of single or combined lipid abnormalities and correlated this nutritional status with body mass index of low weight, normal, overweight, and obesity. Results: A total of 38,069 adolescents were included, with more than 24,000 of them presenting at least one lipid abnormality (64.7%), and 3.7% showing alterations in all of them. The most prevalent combination was high TG with low HDL-C levels. The higher the BMI, the more lipid abnormalities were found. Conclusions: In this large and representative sample of Brazilian adolescents, the majority had at least one lipid abnormality. Higher BMI was associated with a higher prevalence of combined lipid abnormalities. Highlights: - There is a high prevalence of Brazilian adolescents with dyslipidemias.- BMI was associated with a higher prevalence of combined lipid abnormalities.- BMI can be considered as an indicator of the diagnosis of dyslipidemia in adolescents.

Association Between Abdominal Waist Circumference and Blood Pressure In Brazilian Adolescents With Normal Body Mass Index: Waist circumference and blood pressure in Adolescents.

Obesity is the most common chronic disease in adolescents. In adults, waist circumference (WC) is associated with the presence of cardiovascular risk factors and is also a better predictor of cardiovascular (CV) risk than body mass index (BMI). The association between WC and CV risk factors in adolescents has been poorly explored so far, mainly in those within the normal BMI range. Objective: To evaluate the association between WC and elevated blood pressure (BP) in adolescents with a normal BMI. Methods: Cross-sectional analysis of 73,399 scholars between 12 and 17 years old from the ERICA study, a school-based, national representative study with Brazilian adolescents. Only those within the normal range of BMI were included. The WC was categorized into quartiles for sex and age (Q1 to Q4). For the analysis, BP values ≥ 90th percentile were considered to indicate elevated BP, what includes hypertension and pre-hypertension. The Poisson Regression model was used and the prevalence ratio was estimated. Results: A total of 53,308 adolescents with normal BMI were included. Prevalence of elevated BP in the overall group was 18.0%. In female adolescents with WC in the lowest quartile for their age, the prevalence of elevated BP was 7.3% (12-14 years) and 6.9% (15-17 years), increasing in the upper quartile to 15.2% and 19.5% respectively, with a prevalence ratio (PR) indicating chance at least two times higher for elevated BP in Q4 (p < 0.001). Similarly, this was observed in boys, with a prevalence of elevated BP of 10.0% and 18.9% in Q1, increasing to 21.4% and 49.6% in Q4 (p < 0.001). Conclusion: In adolescents, there is a strong association of increased WC with BP elevation, even when the BMI is adequate.

Quality of life and its relation with nutritional status in patients with incurable cancer in palliative care.

BACKGROUND: Nutritional impairment is common in cancer patients and adversely affects quality of life (QoL). The aim of this study was to investigate the association between nutritional status and QoL in incurable cancer patients in palliative care. METHODS: A prospective cohort with incurable cancer patients referred to the specialized Palliative Care Unit of the National Cancer Institute in Brazil was conducted. The nutritional risk (NR) was assessed using the Patient-Generated Subjective Global Assessment short form (PG-SGA SF), and cancer cachexia (CC) was defined according to the international consensus. QoL was evaluated using the Quality of Life Questionnaire Core 15 Palliative (QLQ-C15-PAL). Multivariate linear regressions analyses were performed to assess the relationship between the nutritional status and QoL scores. RESULTS: A total of 1039 consecutive patients were included. A high prevalence of NR (85.4%) and CC (78.7%) were observed. The patients with worse nutritional status presented significantly poorer physical, emotional, symptoms domains scales, and overall QoL. CC were significantly associated with QoL scores for dyspnea (p = 0.013), insomnia (p = 0.046), and appetite loss (p = 0.015), while NR were associated with all the QoL domains scales covered in QLQ-C15-PAL. CONCLUSION: Our findings support that impaired nutritional status was associated with poor QoL in incurable cancer patients. NR assessed by PG-SGA SF better reflects physical, emotional, symptom burden, and overall QoL scores. Thus, this tool may contribute in identifying patients at risk of deterioration QoL.

[Quality analysis of self-reported information on sleep duration in schoolchildren in the Study of Cardiovascular Risk Factors in Adolescents (ERICA)]. / Análise da qualidade da informação autorreferida sobre duração do sono de escolares do Estudo de Riscos Cardiovasculares em Adolescentes (ERICA).

The study aimed to assess sleep behavior in adolescents 12 to 17 years of age participating in ERICA (Study of Cardiovascular Risk Factors in Adolescents), based on sociodemographic characteristics, school shift, and type of school, and to describe the correction of inconsistent sleep times in a nationally representative study in Brazil. Data were collected in 2013 and 2014. Four questions were asked on habitual time for sleeping and waking on weekdays and weekends, with 24 possible answers, one for each hour of the day. Analysis of inconsistencies considered the distribution of frequencies of answers as to sleeping and waking times, in addition to compatibility with the school shift. Sleep duration during the week and on weekends was obtained by the difference between sleeping and waking times, and differences of ≤ 4 or ≥ 14 hours were excluded. Mean total sleep duration in seven days was calculated by the formula (weekday sleep duration x 5 + weekend sleep duration x 2)/7. The following groups were created: original data (answers that did not require correction), corrected data (inconsistent, but amenable to correction), and excluded data (inconsistent, and for which there was no criterion for correction). Correction recovered inconsistent information for 5,988 adolescents, 8% of the 74,589 participants. A total of 7,937 (10.6%) answers were excluded. Adolescents whose information was corrected or excluded were younger, predominantly males, from public schools, and from the North of Brazil. Correction minimized losses and lent greater consistency to the data treatment. The study contributes to the improvement of data collection tools in observational studies, lending transparency to the way of dealing with inherent limitations in the data collection method.

Objetivou-se avaliar o comportamento do sono de adolescentes de 12 a 17 anos, participantes do ERICA (Estudo de Riscos Cardiovasculares em Adolescentes), estudo de representatividade nacional, segundo características sociodemográficas, turno e tipo de escola, e descrever a correção das horas inconsistentes. A coleta de dados ocorreu em 2013 e 2014. Foram feitas quatro perguntas sobre horas habituais de dormir e de acordar durante a semana e no final de semana, com 24 opções de respostas, uma para cada hora do dia. A análise das inconsistências considerou a distribuição de frequências das respostas quanto às horas habituais de dormir e de acordar, além da compatibilidade com o turno. A duração do sono durante a semana e final de semana foi obtida pela diferença entre horas habituais de dormir e de acordar e foi excluída se ≤ 4 ou ≥ 14 horas. A média de sono total da semana foi calculada pela fórmula: (duração do sono durante a semana x 5 + duração do sono no final de semana x 2)/7. Foram criados três grupos: dados originais (respostas que não necessitaram correções), dados corrigidos (inconsistentes, mas passíveis de correção) e dados excluídos (inconsistentes, para os quais não se tinha critério para correção). A correção recuperou informação inconsistente de 5.988 adolescentes (8%) dos 74.589 participantes. Foram excluídas 7.937 (10,6%) respostas. Os adolescentes cujas informações foram corrigidas ou excluídas são mais novos, do sexo masculino, de escolas públicas e da Região Norte. A correção minimizou perdas e conferiu maior consistência ao tratamento dos dados. O estudo contribui para o aprimoramento da construção de instrumentos de coleta de dados em estudos observacionais, tornando transparente a forma de lidar com as limitações inerentes ao método de coleta de dados.

El objetivo fue evaluar el comportamiento del sueño en adolescentes de 12 a 17 años, participantes en el ERICA (Estudio de Riesgos Cardiovasculares en Adolescentes), según características sociodemográficas, turnos y tipos de escuela, donde además se describe la corrección de las horas incompatibles en un estudio de nivel nacional en Brasil. La recogida de datos se realizó en 2013 y 2014. Se hicieron cuatro preguntas sobre las horas habituales de sueño y de despertarse durante la semana y el fin de semana, con 24 opciones de respuesta, una para cada hora del día. El análisis de las incompatibilidades consideró la distribución de frecuencias en las respuestas, respecto a las horas habituales de sueño y de despertarse, además de la compatibilidad con el turno. La duración del sueño durante la semana y fin de semana se obtuvo mediante la diferencia entre horas habituales de sueño y de despertarse y fue excluida si ≤ 4 ó ≥ 14 horas. La media de sueño total de la semana se calculó mediante la fórmula: (duración del sueño durante la semana x 5 + duración del sueño durante el fin de semana x 2)/7. Se crearon tres grupos: datos originales (respuestas que no necesitaron correcciones), datos corregidos (inconsistentes, pero plausibles de corrección) y datos excluidos (inconsistentes en los que no había criterio para la corrección). La corrección recuperó información inconsistente de 5.988 adolescentes (8%) de los 74.589 participantes. Se excluyeron 7.937 (10,6%) respuestas. Los adolescentes cuya información fue corregida o excluida son más jóvenes, sexo masculino, procedentes de escuelas públicas y de la región Norte. La corrección minimizó pérdidas y otorgó una mayor consistencia al tratamiento de los datos. El estudio contribuye al perfeccionamiento de la creación de instrumentos de recogida de datos en estudios observacionales, haciendo transparente la forma de enfrentarse a las limitaciones inherentes del método de recogida de datos.

Overview of meta-analysis on prevention and treatment of childhood obesity / Visão geral das meta-análises sobre prevenção e tratamento da obesidade infantil

Abstract Objectives: This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents. Data source: A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed. Summary of data: A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term. Conclusion: The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.

Resumo Objetivos: Este estudo teve como objetivo avaliar a qualidade das revisões sistemáticas sobre prevenção e tratamento não farmacológico do sobrepeso e da obesidade em crianças e adolescentes. Fontes de dados: Foi realizada uma busca em bases de dados eletrônicas (Medline via Pubmed, Web of Science, Scopus, LILACS, The Cochrane Library e Ensaios Clínicos), incluindo apenas revisões sistemáticas com meta-análise. As revisões foram selecionadas por dois pesquisadores e um terceiro resolveu as divergências. A lista de recomendações do PRISMA foi seguida. Síntese dos dados: Foram identificados 4.574 publicações, e 24 foram incluídas após seleção. Seis publicações eram sobre prevenção da obesidade, 17 sobre tratamento da obesidade e 1 sobre intervenções mistas para prevenção e tratamento da obesidade. As intervenções eram muito heterogêneas e mostraram pouco ou nenhum efeito sobre o peso ou índice de massa corporal. Intervenções mistas que incluíam dieta, exercícios, ações para reduzir o comportamento sedentário e programas que envolviam a escola ou as famílias mostraram alguns efeitos positivos de curto prazo. Revisões que analisaram fatores de risco cardiovascular demonstraram melhoras significativas em curto prazo. Conclusão: As revisões sistemáticas de intervenções para prevenir ou reduzir a obesidade em crianças e adolescentes geralmente mostraram pouco ou nenhum efeito sobre o peso ou índice de massa corporal, embora o perfil cardiovascular possa ter melhorado. Intervenções mistas demonstraram melhores efeitos, mas o impacto em longo prazo dos tratamentos da obesidade de crianças e adolescentes ainda não está claro.

Asthma severity in four countries of Latin America.

BACKGROUND: In Latin America, there is scarce information about severe asthma (SA) according to the ERS/ATS 2014 criteria. This study aimed to compare the demographic, socio, clinical characteristics, treatment, and use of healthcare resources between SA and non-severe asthma (NSA) patients in Argentina, Colombia, Chile and Mexico. METHODS: A cross-sectional study was conducted including 594 asthma patients from outpatient specialized sites. A descriptive analysis was performed comparing SA patients and NSA. Chi-square and Mann Whitney tests were used to assess associations between asthma severity and outcome variables. RESULTS: Using ERS/ATS 2014 criteria, 31.0% of the patients were identified as SA. SA patients were older at diagnosis (mean age 31.64 years vs 24.71 years, p < 0.001) and had higher proportion of uncontrolled asthma than the NSA patients (64.1% vs 53.2%, p < 0.001). SA patients reported a significantly higher proportion of both hospital admission and emergency room (ER) visits due to asthma in the last year, compared with NSA patients, 8.7% vs. 3.7% (p = 0.011) and 37.0% vs. 21.7% (p < 0.001), respectively. CONCLUSIONS: SA patients were older, had greater proportions in some comorbidities and experienced increased healthcare utilization. Also, our results showed that even in patients using the last steps of treatment (GINA step 4 or 5), there was still a higher proportion of uncontrolled disease.

Case report of staghorn calculi in a pediatric patient / Relato de caso de cálculo coraliforme em paciente pediátrico

ABSTRACT This article reports a case of large volume asymptomatic staghorn calculus, and a brief revision of this rare pathology is done. A two-yearold male patient was diagnosed with staghorn calculus and hydronephrosis in the left kidney. The patient underwent surgical therapy with pyelolithotomy, pyeloplasty and placement of a double-J catheter, without complications. Staghorn calculi occupy the pelvis and renal calyces. Their incidence in children is lower than in adults. The average age at diagnosis is between 7 and 10 years. The etiology for calculi is diverse; in children under 4 years, it is especially related with infectious factors and hydronephrosis. The standard procedure for treatment is percutaneous nephrolithotomy.

RESUMEN Presentamos un caso de cálculo del tipo coraliforme de gran volumen, asintomático, y una revisión de esa enfermedad grave. Reportamos el caso de un paciente masculino, de dos años de edad, diagnosticado con cálculo coraliforme e hidronefrosis en riñón izquierdo. Se realizó tratamiento quirúrgico, a base de pielolitotomía, pieloplastia y colocación de un catéter doble J, sin complicaciones. El cálculo coraliforme ocupa la pelvis y los cálices renales. Su incidencia es menor en niños, con media de 7-10 años en el diagnóstico. La etiología es diversa; en menores de 4 años, se refiere específicamente a factores infecciosos e hidronefrosis. El tratamiento estándar es la nefrolitotomía percutánea.

RESUMO Este relato ilustra um caso de cálculo do tipo coraliforme de grande volume, assintomático, acompanhado de uma revisão dessa grave patologia. Relatamos o caso de um paciente do sexo masculino, dois anos de idade, diagnosticado com cálculo coraliforme e hidronefrose em rim esquerdo. Instituiu-se terapêutica cirúrgica, com realização de pielolitotomia, pieloplastia e colocação de cateter duplo-J sem intercorrências. Cálculo renal coraliforme ocupa a pelve e os cálices renais. Sua incidência é menor em crianças, sendo a média de diagnóstico entre 7 e 10 anos. A etiologia é ampla; em menores de 4 anos, relaciona-se especialmente com fatores infecciosos e hidronefrose. O tratamento padrão é a nefrolitotomia percutânea.

Characterization of the rapid test for HIV/AIDS, syphilis and viral hepatitis in pregnant women / Retrato do teste rápido para HIV/AIDS, sífilis e hepatites virais em gestantes

The epidemiological and social importance of the vertical transmission mechanism for public health is indisputable,and as a strategy to guarantee the integrality of care, rapid testing has been decentralized to basic care. Therefore, thisstudy aimed to identify the sociodemographic and behavioral characteristics of the pregnant women tested for HIV/AIDS,syphilis, hepatitis B and C in Manaus, in the year 2014. It was carried out from secondary data in health units registeredand qualified to perform rapid testing. A total of 2,186 female patient records were identified, of which 86.3% werepregnant and 13.7% were not pregnant. Of the 38 units registered and considered suitable, it was found that in 13(34.2%) the exam was not being collected. Regarding the sociodemographic characteristics, it was identified that 43.1%of pregnant women were between 21 and 40 years of age, 53.6% said they were married and/or in a stable union, and 1/3had between 8 and 11 years of education, 47.6% were brown. Regarding the behavioral aspects, 52.9% of the pregnantwomen became aware of the rapid test offered during prenatal consultations, 67.9% declared a sexual preference for men,and an inconsistent condom use with partnerships was predominantly mentioned. Of the 1,886 pregnant women whoperformed the rapid test, 12 (0.6%) had a positive result for syphilis; 18 (1.0%) for HIV/AIDS; 2 (0.1%) for hepatitis B and5 (0.3%) for hepatitis C. Thus, the rapid test offered at the time of the reception in the health unit should be highlighted as a strategy to reach a larger share of the assisted clientele

A importância epidemiológica e social do mecanismo de transmissão vertical para a saúde pública é indiscutível, e comoestratégia para garantir a integralidade do cuidado, a testagem rápida foi descentralizada para a atenção básica. Assim sendo,esta pesquisa objetivou identificar as características sociodemográficas e comportamentais das gestantes testadas para HIV/AIDS, sífilis, hepatite B e C em Manaus, no ano de 2014, sendo realizada a partir de dados secundários nas unidades desaúde cadastradas e habilitadas para realizar a testagem rápida. Foram identificadas 2.186 Fichas de Atendimento demulheres, sendo 86,3% gestantes e 13,7% não gestantes e, das 38 unidades cadastradas e consideradas aptas, constatou-seque em 13 (34,2%) o exame não estava sendo coletado. Com relação às características sociodemográficas, identificou-seque 43,1% das gestantes apresentavam faixa etária entre 21 e 40 anos, 53,6% afirmaram estar casadas e/ou em uniãoestável e 1/3 apresentavam de 8 a 11 anos de estudo, sendo 47,6% da cor parda. Já nos aspectos comportamentais,52,9% das gestantes tomaram conhecimento sobre a oferta do teste rápido durante as consultas de pré-natal, 67,9%declararam preferência sexual por homens, e, predominantemente, foi mencionado o uso inconstante do preservativo comas parcerias fixas e eventuais. Das 1.886 gestantes que realizaram o teste rápido, 12 (0,6%) obtiveram resultado positivopara sífilis; 18 (1,0%) para HIV/AIDS; 2 (0,1%) para hepatite B e 5 (0,3%) para hepatite C. Dessa forma, destaca-se comoestratégia que o teste rápido seja ofertado ainda no momento do acolhimento na unidade de saúde, alcançando, assim,uma parcela maior da clientela assistida

Overview of meta-analysis on prevention and treatment of childhood obesity.

OBJECTIVES: This study aimed to assess the quality of systematic reviews on prevention and non-pharmacological treatment of overweight and obesity in children and adolescents. DATA SOURCE: A search was done in electronic databases (Medline via PubMed, Web of Science, Scopus, LILACS, the Cochrane Library, and Clinical Trials), including only systematic reviews with meta-analysis. Reviews were selected by two researchers, and a third one solved the divergences. PRISMA statement and checklist were followed. SUMMARY OF DATA: A total of 4574 records were retrieved, including 24 after selection. Six reviews were on obesity prevention, 17 on obesity treatment, and one on mixed interventions for prevention and treatment of obesity. The interventions were very heterogeneous and showed little or no effects on weight or body mass index. Mixed interventions that included dieting, exercise, actions to reduce sedentary behavior, and programs involving the school or families showed some short-term positive effects. Reviews that analyzed cardiovascular risk factors demonstrated significant improvements in the short-term. CONCLUSION: The systematic reviews of interventions to prevent or reduce obesity in children and adolescents generally showed little or no effects on weight or body mass index, although cardiovascular profile can be improved. Mixed interventions demonstrated better effects, but the long-term impact of obesity treatments of children and adolescents remains unclear.