Association between cortisol levels and performance in clinical simulation: a systematic review.

OBJECTIVE: To identify how stress measured by salivary cortisol during clinical simulation-based education, or simulation and another teaching method, impacts performance. METHOD: Systematic review of the association between cortisol and performance in simulations. The following databases were used: PubMed, LIVIVO, Scopus, EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS) and Web of Science. Additional searches of gray literature were carried out on Google Scholar and Proquest. The searches took place on March 20, 2023. The risk of bias of randomized clinical trials was assessed using the Cochrane Collaboration Risk of Bias Tool (RoB 2). Inclusion criteria were: simulation studies with salivary cortisol collection and performance evaluation, published in any period in Portuguese, English and Spanish. RESULTS: 11 studies were included which measured stress using salivary cortisol and were analyzed using descriptive synthesis and qualitative analysis. CONCLUSION: Some studies have shown a relationship between stress and performance, which may be beneficial or harmful to the participant. However, other studies did not show this correlation, which may not have been due to methodological issues.

Growth of long bones in European and Japanese quail from the 13th day of incubation to day 35 post-hatch.

This study described the growth, morphometric, biomechanical, and chemical properties of the femur, tibiotarsus, and tarsometatarsus of European and Japanese quail. Analyses were performed at 13 and 15 days of incubation, at hatch, and at 4, 7, 10, 14, 21, 28, and 35 days post-hatch (n=6/subspecies/period). Bone specimens were analyzed by cone-beam computed tomography, biomechanical assays, chemical analyses, and histomorphometry. Variables were fitted by the Gompertz function and its derivative or assessed using the analysis of variance. Analysis of the derivative of Gompertz curves showed that the growth behavior of the tarsometatarsal bone was similar between quail subspecies, and the femur and tibiotarsus of European quail increased first in width and then in length, whereas the opposite occurred in Japanese quail. There was an interaction between quail subspecies and days of growth on femoral, tarsometatarsal, and tibiotarsal bone densities. Femoral and tibiotarsal cross-sectional areas were influenced by the interaction of quail subspecies and day of growth. Interaction effects were significant for breaking strength and phosphorus percentage. European and Japanese quail have different femoral and tibiotarsal growth patterns, especially in the first few days after hatching, whereas tarsometatarsal growth is similar between subspecies.

Association between cortisol levels and performance in clinical simulation: a systematic review / Asociación entre los niveles de cortisol y el rendimiento en simulación clínica: revisión sistemática / Associação entre nível de cortisol e desempenho em simulação clínica: revisão sistemática

ABSTRACT Objective: To identify how stress measured by salivary cortisol during clinical simulation-based education, or simulation and another teaching method, impacts performance. Method: Systematic review of the association between cortisol and performance in simulations. The following databases were used: PubMed, LIVIVO, Scopus, EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS) and Web of Science. Additional searches of gray literature were carried out on Google Scholar and Proquest. The searches took place on March 20, 2023. The risk of bias of randomized clinical trials was assessed using the Cochrane Collaboration Risk of Bias Tool (RoB 2). Inclusion criteria were: simulation studies with salivary cortisol collection and performance evaluation, published in any period in Portuguese, English and Spanish. Results: 11 studies were included which measured stress using salivary cortisol and were analyzed using descriptive synthesis and qualitative analysis. Conclusion: Some studies have shown a relationship between stress and performance, which may be beneficial or harmful to the participant. However, other studies did not show this correlation, which may not have been due to methodological issues.

RESUMEN Objetivo: Identificar cómo el estrés medido por el cortisol salival durante la enseñanza basada en la simulación clínica, o la simulación y otro método de enseñanza, influye en el rendimiento. Método: Revisión sistemática de la asociación entre cortisol y rendimiento en simulaciones. Se utilizaron las siguientes bases de datos: PubMed, LIVIVO, Scopus, EMBASE, Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) y Web of Science. Se realizaron búsquedas adicionales de literatura gris en Google Scholar y Proquest. Las búsquedas se realizaron el 20 de marzo de 2023. El riesgo de sesgo de los ensayos clínicos aleatorios se evaluó mediante la Herramienta de Riesgo de Sesgo (RoB 2) de la Colaboración Cochrane. Los criterios de inclusión fueron: estudios de simulación con recogida de cortisol salival y evaluación del rendimiento, publicados en cualquier periodo en portugués, inglés y español. Resultados: Se incluyeron 11 estudios que midieron el estrés mediante cortisol salival y se analizaron mediante síntesis descriptiva y análisis cualitativo. Conclusión: Algunos estudios mostraron una relación entre el estrés y el rendimiento, que puede ser beneficiosa o perjudicial para el participante. Sin embargo, otros estudios no mostraron esta correlación, lo que puede no haberse debido a cuestiones metodológicas.

RESUMO Objetivo: Identificar como o estresse mensurado por cortisol salivar durante a educação baseada em simulação clínica ou simulação e outro método de ensino, tem impacto no desempenho. Método: Revisão sistemática da associação do cortisol com o desempenho em simulações. Foram utilizadas as seguintes bases de dados: PubMed, LIVIVO, Scopus, EMBASE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Web of Science. Pesquisa adicional de literatura cinzenta foi realizada no Google Scholar e no Proquest. As buscas ocorreram em 20 de março de 2023. O risco de viés dos ensaios clínicos randomizados, foi avaliado pela ferramenta Cochrane Collaboration Risk of Bias Tool (RoB 2). Foram critérios de inclusão: estudos de simulação com coleta de cortisol salivar e avaliação de desempenho, publicados em qualquer período em português, inglês e espanhol. Resultados: 11 estudos foram incluídos, os quais mensuraram o estresse utilizando o cortisol salivar e analisados através da síntese descritiva e da análise qualitativa. Conclusão: Alguns estudos mostraram haver relação entre estresse e desempenho, podendo ser benéfico ou prejudicial ao participante. Porém, outros estudos não apresentaram essa correlação que pode não ter ocorrido por questões metodológicas.

Growth of breast muscles in European and Japanese quail raised in meat production system: a morphological analysis.

Growth curves have been described in the quail but with no attention to the muscle composing of the breast. The description of the characteristics of growth curves to body weight and to breast muscle was the aim of this study. Morphological development of Musculus supracoracoideus and Musculus pectoralis in European and Japanese quail was assessed from the final incubation of to 35 days. Gompertz models were adjusted with maximum growth rates to body weight, breast weight, and Musculus pectoralis and supracoracoideus weight at 17.6; 22.2; 23.5, and 21.4 days. The European quail had a higher body and breast weight at maturity. Musculus supracoracoideus developed faster in both subspecies but with larger Musculus pectoralis. Both musculus had a greater number of fibers type IIA and largest fibers IIB, with quadratically increasing in fiber diameter with age in both subspecies and muscles. At 35 days, results of meat quality indicated similarity between genders and subspecies, with darker and redness breast meat in Japanese quail. In conclusion, breast weight gain was a result of type IIA and IIB fiber hypertrophy in both muscles and, despite the difference in size and aptitude, Japanese and European quail showed similar body and muscle growth patterns.

Productive performance, breast growth and digestive system development in European quail subjected to post-hatch fasting for different periods.

This study assessed the effect of different periods of post-hatch fasting on animal performance and breast and digestive system growth in European quail. Quail chicks were distributed in a completely randomized design, with four fasting periods (0, 24, 36, and 48 hs) and four replications of 40 birds per treatment. In 1 to 14-day-old chicks, weight gain decreased with increasing fasting time. Compensatory gain was observed from 15 days of age onward. Fasted quail had a lower length and relative weight of the digestive system than fed animals for up to 14 days. Histologically, the duodenal villus height was significantly lower in 3-day-old quail fasted for 36 hs than in those fasted for 48 hs, but this effect was not observed at 7 days. Scanning electron microscopy showed no differences in the small intestinal mucosa between fasted and fed birds at 3 days of age. Post-hatch fasting reduced the relative weight of the breast in quail aged 1 to 14 days but did not affect type IIa and IIb fiber diameter at 35 days. On the basis of these results, it is recommended that European quail raised for meat should not be fasted for more than 48 hs post-hatch.

Detection of coinfection with Primate Erythroparvovirus 1 and arboviruses (DENV, CHIKV and ZIKV) in individuals with acute febrile illness in the state of Rio Grande do Norte in 2016.

BACKGROUND: Arthropod-borne viruses, known as arboviruses, pose substantial risks to global public health. Dengue (DENV), Chikungunya (CHIKV) and Zika (ZIKV) viruses stand out as significant concerns in Brazil and worldwide. Their overlapping clinical manifestations make accurate diagnosis a challenge, underscoring the need for reliable laboratory support. This study employs a comprehensive molecular diagnostic approach to track viral infections in individuals with acute febrile illness, a period marked by widespread outbreaks of DENV, CHIKV and ZIKV. METHODS: Between January and August 2016, we received a total of 713 serum samples obtained from individuals with acute febrile illness, previously tested for DENV, CHIKV or ZIKV, with initial negative results, from LACEN-NATAL. Of the total 713 samples, 667 were from females (354 of them pregnant) and 46 from males. Molecular diagnosis was conducted using the Multiplex RT-qPCR technique for simultaneous detection of DENV, CHIKV and ZIKV. Additionally, we performed differential diagnosis by RT-qPCR for other viruses of the Flavivirus, Alphavirus Enterovirus genera and qPCR for Primate Erythroparvovirus 1 (B19V) species, in accordance with Ministry of Health guidelines. RESULTS: Among the 713 cases, 78.2% tested positive for viral infections, including 48% with CHIKV viremia, 0.6% with DENV and 0.1% with ZIKV. Arboviral coinfections totaled 2.4%, including DENV-CHIKV (1.7%) and CHIKV-ZIKV (0.7%). Moreover, 8% exhibited B19V viremia. Simultaneous infections were identified in 17.5%, encompassing B19V-CHIKV (17.1%), B19V-DENV (0.1%), and B19V-ZIKV (0.3%) Triple infections were observed in 1.3% of cases with B19V-DENV-CHIKV (1%) and B19V-CHIKV-ZIKV (0.3%). CONCLUSION: Molecular testing demonstrated high efficacy in diagnosing prevalent arboviruses and detecting multiple coinfections. This approach helps to elucidate etiologies for symptomatic cases, especially during arbovirus outbreaks, and aids comprehensive surveillance. Our findings underscore the importance of monitoring co-circulating pathogens, such as B19V, with implications for clinical management, particularly in pregnant individuals. This study enhances our understanding of arbovirus epidemiology and reinforces the critical role of molecular diagnosis in disease surveillance and control.

Vivências de trabalho precoce de adolescentes em medida socioeducativa / Experience of child labor of adolescents complying with a social-educational measure / Vivencias de trabajo infantil de adolescentes en medidas socioeducativas

Este artigo tem como objetivo analisar a vivência de trabalho precoce de adolescentes e jovens em cumprimento de medida socioeducativa, no estado da Paraíba. Os instrumentos utilizados foram um Questionário Mosquito Diagnóstico e uma Entrevista Semiestruturada. A análise foi realizada com o software Iramuteq, (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), através da Análise Hierárquica Descendente, que gerou seis classes: significado do trabalho; infância e escola; condições objetivas de vida; trabalho, drogas e ato infracional; consequências do trabalho infantil; e trabalho infantojuvenil. A perspectiva teórica utilizada foi a psicologia histórico-cultural e os dados discutidos a partir do conceito de vivência. Conclui-se que as vivências e situações sociais de desenvolvimento foram caracterizadas pelo trabalho precoce que oportunizou o envolvimento com atos infracionais e as instituições responsáveis pela garantia de direitos em vez de garantir a proteção social, criminalizaram por meio de medidas socioeducativas.(AU)

This article aims to analyze the experience of child labor of adolescents and youngsters that are complying a social-educational measure, in the State of Paraíba. The instruments utilized were a Questionnaire Mosquito Diagnóstico and a Semi-Structured Interview. The analysis was performed by using the Iramuteq software (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), by using Descending Hierarchical Analysis, which generated six classes: meaning of labor; childhood and school; objective conditions of life; labor, drugs, and act of infraction; consequences of child labor; and child labor. The theoretical perspective used was historical-cultural psychology and the data were discussed from the concept of experience. It was concluded that the experiences and social situations of development were characterized by child labor, which enabled the involvement with acts of infraction; and the institutions responsible for guaranteeing rights, instead of guaranteeing social protection, criminalized by using social-educational measures.(AU)

Este artículo tiene como objetivo analizar la vivencia precoz de adolescentes y jóvenes que cumplen medidas socioeducativas en el estado de Paraíba (Brasil). Los instrumentos utilizados fueron un Cuestionario Mosquito Diagnóstico y una entrevista semiestructurada. El análisis se realizó con el software Iramuteq (Interface de R pour les Multidimensionnelles Analyzes de Textes et de Questionnaires), mediante análisis jerárquico descendente, que generó seis clases: Significado del trabajo; Infancia y escuela; Condiciones objetivas de vida; Trabajo, drogas y acto de infracción; Consecuencias del trabajo infantil; y Trabajo infantojuvenil. La perspectiva teórica que se utilizó fue la psicología histórico-cultural, y los datos se discutieron desde el concepto de vivencia. Se concluye que las vivencias y situaciones sociales de desarrollo se caracterizaron por trabajo infantil que permitió la participación en infracciones y que las instituciones responsables de garantizar los derechos en lugar de la protección social los criminalizaron mediante medidas socioeducativas.(AU)

A Mobile App (AMOR Mama) for Women With Breast Cancer Undergoing Radiation Therapy: Functionality and Usability Study.

BACKGROUND: Mobile apps targeting women with breast cancer can facilitate access to information, improve well-being, and record reports of treatment-related symptoms. However, it is important to confirm the benefits of these apps before they are used as a tool in clinical care. OBJECTIVE: The aim of this study was to evaluate the functionality and the usability of a mobile app created to guide and monitor patients with breast cancer undergoing radiation therapy. METHODS: The evaluation process of the mobile app was performed in 2 steps with 8 professionals, including nurses, physician, medical physicists, and communication networks engineer. The first step was the focus group, which allowed obtaining suggestions proposed by the participants regarding the improvement of the mobile app. The second step was the individual filling in of an evaluation tool to obtain objective measures about the mobile app. A minimum concordance index of 80% was considered to ensure the adequacy of the material. RESULTS: After the mobile app was evaluated by 8 professionals, only 1 item of the evaluation tool, that is, concerning the potentiality of the app to be used by users of different educational levels, obtained a concordance index <80%. CONCLUSIONS: The mobile app titled "AMOR Mama" was considered suitable, which suggests its contribution to an educational health technology to guide and monitor patients with breast cancer undergoing radiation therapy. More studies with this target population should be carried out to assess the performance and quality of the mobile app during its use.

Stress level experienced by participants in realistic simulation: a systematic review.

OBJECTIVES: to identify the available evidence regarding stress levels experienced by participants in education based on a realistic simulation. METHODS: systematic review that included randomized clinic trials on electronic databases: Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Latin-American and Caribbean Literature in Health Sciences, LIVIVO, PubMed, Scopus, and Web of Science. The additional search was performed on Google Scholar and OpenGrey. All searches occurred on September 24, 2020. The methodologic quality of the results was evaluated by the Cochrane Collaboration Risk of Bias Tool. RESULTS: eighteen studies were included, which evaluated the participants' stress using physiologic, self-reported measures, or the combination of both. Stress as experienced in a high level in simulated scenarios. CONCLUSIONS: evidence of the study included in this systematic review suggest that stress is experienced in a high level in simulated scenarios.

Chikungunya virus ECSA lineage reintroduction in the northeasternmost region of Brazil.

The Northeast region of Brazil registered the second-highest incidence proportion of Chikungunya fever in 2019. In that year, an outbreak consisting of patients presenting with febrile disease associated with joint pain was reported by the public primary health care service in the city of Natal, in the state of Rio Grande do Norte, in March 2019. At first, the aetiological agent of the disease was undetermined. Since much is still unknown about chikungunya virus' (CHIKV) genomic diversity and evolutionary history in this northeasternmost state, we used a combination of portable whole-genome sequencing, molecular clock, and epidemiological analyses that revealed the reintroduction of the CHIKV East-Central-South-African (ECSA) lineage into Rio Grande do Norte. We estimated that the CHIKV ECSA lineage was first introduced into Rio Grande do Norte in early June 2014, while the 2019 outbreak clade diverged around April 2018, during a period of increased Chikungunya incidence in the Southeast region, which might have acted as a source of virus dispersion towards the Northeast region. Together, these results confirm that the ECSA lineage continues to spread across the country through interregional importation events, likely mediated by human mobility.

Effects of breeder age and short-term temperature stimulation during incubation on performance, organ weight, and carcass yield in male and female broilers / Efeitos da idade da matriz e de alterações curtas de temperatura de incubação no desempenho, peso dos órgãos e rendimento de carcaça em frangos de corte machos e fêmeas

Birds develop thermoregulatory control during the last days of incubation. Different temperature conditioning programs have been proposed to prepare broiler chicks for post-hatch life. This study aimed to investigate the effects of short-term temperature (STT) stimulation and breeder age on hatching performance, embryo development, yolk absorption, and post-hatch performance of male and female broilers. A 2 × 2 factorial completely randomized design was used, with two breeder ages (30 and 60 wk), two temperature incubation programs (control and STT), and 2,520 eggs per treatment. Eggs were distributed in two large-scale commercial incubators with a capacity of 120,960 eggs. The control group was subjected to a standard single-stage incubation program (37.2-37.4 °C), whereas the STT group was subjected to a temperature increment of 1 °C for 4 h on embryonic days 16, 17, 18, and 19. Embryos were analyzed at 16 and 19 days of incubation, and chicks at hatch. At 19 days of incubation, STT conditioning resulted in lower yolk sac weight in embryos from 60-wk-old breeders and higher relative weight of the gastrointestinal tract in embryos from 30-wk-old breeders. At hatch, males had lower residual yolk weight, females had greater length, and chicks from 60-wk-old breeders subjected to STT had higher body weight and relative weight of the gastrointestinal tract. Eggs from 30-wk-old breeders showed higher fertility and hatchability and lower infertility, mortality, and second-grade chick percentages. Regarding performance, it was found that males had higher body weight from 7 to 42 days of age and higher whole leg yields. Females, on the other hand, had higher fat yields. Breeder age and sex influenced gastrointestinal tract development, carcass yield, and performance. A 1 °C increase in incubation temperature for 4 h from days 16 to 19 of incubation affected yolk absorption and digestive tract development in chicks from 60-wk-old breeders without, however, influencing performance results.(AU)

As aves desenvolvem o controle do sistema termorregulatório durante os últimos dias de incubação, dessa forma, diferentes programas temperatura de incubação têm sido descritos para preparar os pintos de corte para a vida pós-eclosão. Objetivou-se nesse estudo, estabelecer os efeitos de alterações curtas na temperatura de incubação e da idade da matriz no desempenho de eclosão, desenvolvimento embrionário, absorção da gema e desempenho pós-eclosão de frangos de corte machos e fêmeas. O delineamento experimental foi inteiramente casualizado em fatorial 2 x 2 com 2 idades de matriz (30 e 60 semanas) e 2 programas de incubação de temperatura, controle (CT) e grupo de treinamento de temperatura de curto prazo (STT) e 2.520 ovos em cada tratamento. Os ovos foram distribuídos em 2 incubadoras comerciais de grande escala com capacidade para 120.960 ovos. O grupo CT seguiu um programa de incubação de estágio único padrão (37,2-37,4°C) e o STT teve um incremento em + 1 ° C por 4 hs nos dias 16, 17, 18 e 19 de incubação. Os embriões foram analisados aos 16 e 19 dias e pintinhos na eclosão. Aos 19 dias de incubação, embriões de matrizes com 60 semanas apresentaram menor peso do saco vitelino e embriões de matrizes com 30 semanas apresentaram maior porcentagem de trato gastrointestinal quando em STT. Na eclosão, os machos apresentaram menor vitelo residual, e as fêmeas apresentaram maior comprimento, pintinhos mais pesados e maior trato gastrointestinal quando originárias de matrizes de 60 semanas de idade e expostos ao STT. Na eclosão, os ovos com 30 semanas de idade apresentaram maior porcentagem de fertilidade e eclodibilidade e menor infertilidade, mortalidade e pintos de secunda categoria. No desempenho, os machos apresentaram maior peso corporal do 7° ao 42° dia e maiores valores de porcentagem de pernas e as fêmeas maiores valores de porcentagem de gordura. A idade das matrizes e o sexo influenciaram o desenvolvimento visceral, o rendimento de carcaça e o desempenho dos frangos de corte. O aumento de 1°C durante 4 horas entre os dias 16 e 19 de incubação afetou a absorção da gema e o trato digestivo em pintos de matrizes com 60 semanas de idade, sem refletir nos resultados de desempenho.(AU)

Stress level experienced by participants in realistic simulation: a systematic review / Nivel de estrés experimentado por participantes en simulación realista: una revisión sistemática / Nível de estresse experimentado por participantes em simulação realística: uma revisão sistemática

ABSTRACT Objectives: to identify the available evidence regarding stress levels experienced by participants in education based on a realistic simulation. Methods: systematic review that included randomized clinic trials on electronic databases: Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Latin-American and Caribbean Literature in Health Sciences, LIVIVO, PubMed, Scopus, and Web of Science. The additional search was performed on Google Scholar and OpenGrey. All searches occurred on September 24, 2020. The methodologic quality of the results was evaluated by the Cochrane Collaboration Risk of Bias Tool. Results: eighteen studies were included, which evaluated the participants' stress using physiologic, self-reported measures, or the combination of both. Stress as experienced in a high level in simulated scenarios. Conclusions: evidence of the study included in this systematic review suggest that stress is experienced in a high level in simulated scenarios.

RESUMEN Objetivos: identificar evidencias disponibles sobre el nivel de estrés experimentado por participantes en educación basada en simulación. Métodos: revisión sistemática que incluyó ensayos clínicos randomizados en las bases electrónicas: Cumulative Index to Nursing and Lallied Health Literature, Cochrane Library, Literatura Latinoamericana y de Caribe en Ciencias de la Salud, LIVIVO, PubMed, Scopus y Web of Science. Búsqueda adicional fue realizada en el Google Scholar y OpenGrey. Todas las búsquedas ocurrieron en el día 24 de septiembre de 2020. La calidad metodológica de los estudios fue evaluada por el Cochrane Collaboration Risk of Bias Tool. Resultados: fueron incluidos 18 estudios, los cuales evaluaran el estrés de los participantes por medio de medidas fisiológicas, autoinformados o combinación de ambos. El estrés fue experimentado en nivel elevado en escenarios simulados. Conclusiones: las evidencias de los estudios incluidos en esta revisión sistemática sugieren que el estrés es experimentado en nivel elevado en escenarios simulados.

RESUMO Objetivos: identificar as evidências disponíveis sobre o nível de estresse experimentado por participantes em educação baseada em simulação. Métodos: revisão sistemática que incluiu ensaios clínicos randomizados nas bases eletrônicas: Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Literatura Latino-Americana e do Caribe em Ciências da Saúde, LIVIVO, PubMed, Scopus e Web of Science. A busca adicional foi realizada no Google Scholar e OpenGrey. Todas as buscas ocorreram no dia 24 de setembro de 2020. A qualidade metodológica dos estudos foi avaliada pelo Cochrane Collaboration Risk of Bias Tool. Resultados: foram incluídos 18 estudos, os quais avaliaram o estresse dos participantes por meio de medidas fisiológicas, autorreferidas ou combinação de ambas. O estresse foi experimentado em nível elevado em cenários simulados. Conclusões: as evidências dos estudos incluídos nesta revisão sistemática sugerem que o estresse é experimentado em nível elevado em cenários simulados.

Validation of an educational manual for breast cancer patients undergoing radiotherapy.

OBJECTIVE: to validate the content and appearance of an educational manual for breast cancer patients undergoing radiation therapy. METHOD: methodological research, which had the Theory of Psychometry as a theoretical-methodological reference. The minimum 80% Concordance Index was considered to ensure the adequacy of the material. The sample consisted of 17 experts in the subject area of the educational manual and 12 patients previously submitted to radiotherapy due to the diagnosis of breast cancer. RESULTS: two items of the expert evaluation tool were found to have a concordance index <80%. The other items were considered adequate and/or totally adequate in the three blocks of analysis proposed for the experts: objectives - 89.07%, structure and presentation - 92.94%, and relevance - 93.13%; and good and/or very good in the five blocks of analysis proposed for the patients: objectives, organization, writing style, appearance, and motivation, all with 100% agreement rate. CONCLUSION: the educational manual, after having been perfected based on the suggestions of the sample and the scientific literature, was considered valid according to its content and appearance, suggesting its contribution to the clinical practice of nursing and to the understanding of the treatment to which patients with breast cancer are submitted.

Electronic Reporting Systems in Pharmacovigilance: The Implementation of VigiFlow in Brazil.

Pharmacovigilance is defined by the World Health Organization as the science and practice related to the detection, assessment, understanding and prevention of adverse drug reactions (ADRs). In a well-functioning pharmacovigilance system, information on possible ADRs is collected from patients, health professionals and marketing authorisation holders. Of all data sources for drug safety monitoring, spontaneous reporting systems provide the highest volume of information at the lowest maintenance cost and have proven their value in the early detection of product-related safety issues. At the beginning of 2018, the Brazilian Health Regulatory Agency (Agência Nacional de Vigilância Sanitária-Anvisa) decided to replace the national electronic reporting system in Brazil (Notivisa) with the system provided by Uppsala Monitoring Centre (VigiFlow) for ADR reporting. This paper describes that process and reports on the progress made by Anvisa in terms of making Brazil compliant with international pharmacovigilance standards as well as significantly increasing the number of individual case safety reports collected.

Corn with different particle sizes in laying hens feeding: performance, egg quality and intestinal morphology / Milho com diferentes tamanhos de partículas na alimentação de poedeiras: desempenho, qualidade dos ovos e morfologia intestinal / Maíz con diferentes tamaños de partículas en la alimentación de ponedoras: rendimiento, calidad de los huevos y morfología intestinal

This work was carried out to evaluate the effect of different particle size corn on the performance, egg quality and intestinal morphology of Hisex Brown laying hens. A total of 128 birds were used, in a completely randomized design with four treatments, four replicates and eight birds per experimental unit. Experimental rations had corn with different particle size: 565, 620, 781 and 1085 µm of mean geometric diameter (MGD). Feeding was ad libitum at 8:00 am and 4:00 p.m. The variables analyzed were: feed consumption, laying percentage, egg mass and weight, food conversion (was calculated by dividing the feed consumed by the total egg weight (kg.kg-1) and the number of eggs produced (kg.dozen-1)), shell percentage and thickness, Haugh unit, yolk color index and morphometry analysis of the intestinal mucosa. The use of corn with MGD until to 1085 µm in rations does not affect the performance and eggs quality of Hisex Bronw laying hens. However, there are indications that the intestinal morphometry of laying hens is negatively influenced by the increase in particle size of corn.(AU)

Este trabalho foi realizado com o objetivo de avaliar o efeito de diferentes tamanhos de partículas de milho no desempenho, qualidade dos ovos e morfologia intestinal de poedeiras Hisex Brown. Foram utilizadas 128 aves, distribuídas em delineamento inteiramente casualizado, com quatro tratamentos, quatro repetições e oito aves por unidade experimental. As rações experimentais apresentaram milho de diferentes tamanhos de partículas: 565, 620, 781 e 1085 µm de diâmetro geométrico médio (DGM). A alimentação foi ad libitum às 8:00 e 16:00h. As variáveis analisadas foram: consumo de ração, porcentagem de postura, massa e peso dos ovos, conversão alimentar (calculada dividindo-se a ração consumida pelo peso total de ovos (kg/kg) e número de ovos produzidos (kg/dúzia)), porcentagem e espessura da casca, unidade de Haugh, índice e coloração de gema e análise morfométrica da mucosa intestinal. O uso de milho com DGM até 1085 µm nas rações não afeta o desempenho e a qualidade dos ovos de poedeiras Hisex Brown. No entanto, há indicações de que a morfometria intestinal de poedeiras é influenciada negativamente pelo aumento no tamanho das partículas do milho.(AU)

Este estudio ha sido desarrollado con el objetivo de evaluar el efecto de diferentes tamaños de partículas de maíz en el rendimiento, calidad de los huevos y la morfología intestinal de gallinas ponedoras Hisex Brown. Se utilizaron 128 aves, distribuidas en un experimento completamente al azar, con cuatro tratamientos, cuatro repeticiones y ocho aves por unidad experimental. Las raciones experimentales fueron elaboradas con maíz de diferentes tamaños de partículas: 565, 620, 781, 1085 µm de diámetro geométrico medio (DGM). La alimentación fue ad libitum a las 8:00 y a las 16:00h. Las variables analizadas fueron: consumo de ración, porcentaje de postura, masa y peso de los huevos, conversión alimenticia (se calculó dividiendo el alimento consumido por el peso total de huevos (kg/kg) y el número de huevos producidos (kg/docena)), porcentaje y espesor de cáscara, unidad Haugh, índice y coloración de yema, y análisis morfométrica de la mucosa intestinal. La utilización de maíz con DGM de hasta 1085 µm en las raciones no perjudica el rendimiento y la calidad de los huevos de las ponedoras Hisex Brown. Sin embargo, hay indicaciones de que la morfometría intestinal de gallinas ponedoras es influenciada de forma negativa por el aumento del tamaño de las partículas del maíz.(AU)

Corn with different particle sizes in laying hens feeding: performance, egg quality and intestinal morphology / Milho com diferentes tamanhos de partículas na alimentação de poedeiras: desempenho, qualidade dos ovos e morfologia intestinal / Maíz con diferentes tamaños de partículas en la alimentación de ponedoras: rendimiento, calidad de los huevos y morfología intestinal

This work was carried out to evaluate the effect of different particle size corn on the performance, egg quality and intestinal morphology of Hisex Brown laying hens. A total of 128 birds were used, in a completely randomized design with four treatments, four replicates and eight birds per experimental unit. Experimental rations had corn with different particle size: 565, 620, 781 and 1085 µm of mean geometric diameter (MGD). Feeding was ad libitum at 8:00 am and 4:00 p.m. The variables analyzed were: feed consumption, laying percentage, egg mass and weight, food conversion (was calculated by dividing the feed consumed by the total egg weight (kg.kg-1) and the number of eggs produced (kg.dozen-1)), shell percentage and thickness, Haugh unit, yolk color index and morphometry analysis of the intestinal mucosa. The use of corn with MGD until to 1085 µm in rations does not affect the performance and eggs quality of Hisex Bronw laying hens. However, there are indications that the intestinal morphometry of laying hens is negatively influenced by the increase in particle size of corn.(AU)

Este trabalho foi realizado com o objetivo de avaliar o efeito de diferentes tamanhos de partículas de milho no desempenho, qualidade dos ovos e morfologia intestinal de poedeiras Hisex Brown. Foram utilizadas 128 aves, distribuídas em delineamento inteiramente casualizado, com quatro tratamentos, quatro repetições e oito aves por unidade experimental. As rações experimentais apresentaram milho de diferentes tamanhos de partículas: 565, 620, 781 e 1085 µm de diâmetro geométrico médio (DGM). A alimentação foi ad libitum às 8:00 e 16:00h. As variáveis analisadas foram: consumo de ração, porcentagem de postura, massa e peso dos ovos, conversão alimentar (calculada dividindo-se a ração consumida pelo peso total de ovos (kg/kg) e número de ovos produzidos (kg/dúzia)), porcentagem e espessura da casca, unidade de Haugh, índice e coloração de gema e análise morfométrica da mucosa intestinal. O uso de milho com DGM até 1085 µm nas rações não afeta o desempenho e a qualidade dos ovos de poedeiras Hisex Brown. No entanto, há indicações de que a morfometria intestinal de poedeiras é influenciada negativamente pelo aumento no tamanho das partículas do milho.(AU)

Este estudio ha sido desarrollado con el objetivo de evaluar el efecto de diferentes tamaños de partículas de maíz en el rendimiento, calidad de los huevos y la morfología intestinal de gallinas ponedoras Hisex Brown. Se utilizaron 128 aves, distribuidas en un experimento completamente al azar, con cuatro tratamientos, cuatro repeticiones y ocho aves por unidad experimental. Las raciones experimentales fueron elaboradas con maíz de diferentes tamaños de partículas: 565, 620, 781, 1085 µm de diámetro geométrico medio (DGM). La alimentación fue ad libitum a las 8:00 y a las 16:00h. Las variables analizadas fueron: consumo de ración, porcentaje de postura, masa y peso de los huevos, conversión alimenticia (se calculó dividiendo el alimento consumido por el peso total de huevos (kg/kg) y el número de huevos producidos (kg/docena)), porcentaje y espesor de cáscara, unidad Haugh, índice y coloración de yema, y análisis morfométrica de la mucosa intestinal. La utilización de maíz con DGM de hasta 1085 µm en las raciones no perjudica el rendimiento y la calidad de los huevos de las ponedoras Hisex Brown. Sin embargo, hay indicaciones de que la morfometría intestinal de gallinas ponedoras es influenciada de forma negativa por el aumento del tamaño de las partículas del maíz.(AU)

Corn with different particle sizes in laying hens feeding: performance, egg quality and intestinal morphology

This work was carried out to evaluate the effect of different particle size corn on the performance, egg quality and intestinal morphology of Hisex Brown laying hens. A total of 128 birds were used, in a completely randomized design with four treatments, four replicates and eight birds per experimental unit. Experimental rations had corn with different particle size: 565, 620, 781 and 1085 ?m of mean geometric diameter (MGD). Feeding was ad libitum at 8:00 am and 4:00 p.m. The variables analyzed were: feed consumption, laying percentage, egg mass and weight, food conversion (was calculated by dividing the feed consumed by the total egg weight (kg.kg-1) and the number of eggs produced (kg.dozen-1)), shell percentage and thickness, Haugh unit, yolk color index and morphometry analysis of the intestinal mucosa. The use of corn with MGD until to 1085 ?m in rations does not affect the performance and eggs quality of Hisex Bronw laying hens. However, there are indications that the intestinal morphometry of laying hens is negatively influenced by the increase in particle size of corn.

Validação de um manual de orientações para pacientes submetidas à braquiterapia ginecológica / Validación de un manual de orientaciones para pacientes sometidas a braquiterapia ginecológica / Validation of a guidance manual for patients undergoing brachyterapy for gynecologic cancer

RESUMO Objetivo: validar o conteúdo de manual de orientações direcionado a mulheres com câncer ginecológico submetidas à braquiterapia. Método: pesquisa metodológica, realizada por 15 peritos na área temática do manual, entre enfermeiras, médicos, psicólogas e nutricionistas. Para que o manual fosse considerado válido, era necessário atingir Índice de Concordância mínimo de 80% entre os peritos. Resultados: dos 21 itens avaliados, três não alcançaram o índice mínimo estabelecido, e foram reformulados com base nas sugestões dos participantes e literatura atual. Todos os outros itens foram considerados adequados e/ou totalmente adequados nos três domínios avaliativos: objetivos - 81,3%, estrutura e apresentação - 86,6%, e relevância - 94,6%. Conclusão: o manual educativo foi validado quanto ao conteúdo, podendo ser utilizado como complemento às orientações verbais fornecidas durante a consulta de enfermagem para promoção do autocuidado, e facilitar a comunicação entre profissional de saúde e paciente, no que concerne ao seu tratamento.

RESUMEN: Objetivo: validar el contenido de manual de orientaciones para mujeres con cáncer ginecológico sometidas a braquiterapia. Método: investigación metodológica, hecha por 15 expertos por área temática, entre enfermeras, médicos, psicólogas y nutricionistas. Para que el manual fuera válido, se necesita alcanzar el Índice de Concordancia mínimo de 80% entre los expertos. Resultados: de los 21 ítems evaluados, tres no obtuvieron el índice mínimo establecido, siendo reformulados con base en las sugerencias de los participantes y de literatura actual. Todos los demás ítems se los consideraron adecuados y/o totalmente adecuados en los tres ámbitos evaluativos: objetivos - 81,3%, estructura y presentación - 86,6%, y relevancia - 94,6%. Conclusión: se validó el manual educativo en cuanto al contenido y éste se puede utilizar como complemento a las orientaciones verbales fornecidas durante la consulta de enfermería para promoción del autocuidado y facilitar la comunicación entre profesional de salud y paciente acerca del tratamiento.

ABSTRACT Objective: to validate the content of a guidance manual for women undergoing brachytherapy for gynecologic cancer. Method: methodological research conducted by 15 experts in the topic addressed in the manual, including nurses, doctors, psychologists and nutritionists. A minimum level of agreement of 80% between the experts was required for the validation of the manual. Results: Of the 21 items assessed, three did not reach the minimum level of consensus established and were reformulated based on the suggestions of the participants and on the current literature. All other items were considered appropriate and/or totally appropriate in the three assessment domains: objectives - 81.3%, structure and presentation - 86.6%, and relevance - 94.6%. Conclusion: the educational manual was validated for its content and can be used as a complement to the verbal guidelines provided during nursing consultations to promote self-care, and to facilitate communication between healthcare professionals and patients regarding the treatment.

Validation of an educational manual for breast cancer patients undergoing radiotherapy / Validação de manual educativo para pacientes com câncer de mama submetidas à radioterapia / Validación de manual educativo para pacientes con cáncer de mama sometidas a radioterapia

Objective: to validate the content and appearance of an educational manual for breast cancer patients undergoing radiation therapy. Method: methodological research, which had the Theory of Psychometry as a theoretical-methodological reference. The minimum 80% Concordance Index was considered to ensure the adequacy of the material. The sample consisted of 17 experts in the subject area of the educational manual and 12 patients previously submitted to radiotherapy due to the diagnosis of breast cancer. Results: two items of the expert evaluation tool were found to have a concordance index <80%. The other items were considered adequate and/or totally adequate in the three blocks of analysis proposed for the experts: objectives - 89.07%, structure and presentation - 92.94%, and relevance - 93.13%; and good and/or very good in the five blocks of analysis proposed for the patients: objectives, organization, writing style, appearance, and motivation, all with 100% agreement rate. Conclusion: the educational manual, after having been perfected based on the suggestions of the sample and the scientific literature, was considered valid according to its content and appearance, suggesting its contribution to the clinical practice of nursing and to the understanding of the treatment to which patients with breast cancer are submitted.

Objetivo: validar o conteúdo e a aparência de um manual educativo para pacientes com câncer de mama submetidas à radioterapia. Método: pesquisa metodológica, que teve a Teoria da Psicometria como referencial teórico-metodológico. Foi considerado o Índice de Concordância mínimo de 80% para garantir a adequação do material. Compuseram a amostra 17 peritos na área temática do manual educativo e 12 pacientes previamente submetidas à radioterapia devido ao diagnóstico de câncer de mama. Resultados: dois itens do instrumento de avaliação destinados aos peritos obtiveram Índice de Concordância <80%. Os demais itens foram considerados adequados e/ou totalmente adequados nos três blocos de análise propostos para os peritos: objetivos - 89,07%, estrutura e apresentação - 92,94%, e relevância - 93,13%; e bom e/ou muito bom nos cinco blocos de análise propostos para as pacientes: objetivos, organização, estilo da escrita, aparência, e motivação, todos com Índice de Concordância de 100%. Conclusão: o manual educativo, após ter sido aperfeiçoado com base nas sugestões da amostra e na literatura científica, foi considerado válido segundo o conteúdo e aparência, sugerindo sua contribuição para a prática clínica da enfermagem e para a compreensão do tratamento, ao qual pacientes com câncer de mama são submetidas.

Objetivo: validar el contenido y la apariencia de un manual educativo para pacientes con cáncer de mama sometidas a radioterapia. Método: investigación metodológica, que utilizó la Teoría de la Psicometría como referencial teórico metodológico. Fue considerado el Índice de Concordancia mínimo de ٨0% para garantizar la adecuación del material. Compusieron la muestra 17 peritos en el área temática del manual educativo y 12 pacientes previamente sometidas a radioterapia debido al diagnóstico de cáncer de mama. Resultados: dos ítems del instrumento de evaluación destinado a los peritos obtuvieron Índice de Concordancia <80%. Los demás ítems fueron considerados adecuados y/o totalmente adecuados en los tres bloques de análisis propuestos para los peritos, obteniéndose los siguientes resultados: objetivos 89,07%; estructura y presentación 92,94%; y, relevancia 93,13%. En los cinco bloques de análisis propuestos para las pacientes se obtuvo bueno y/o muy bueno, con Índice de Concordancia de 100% para: objetivos, organización, estilo de escritura, apariencia, y motivación. Conclusión: el manual educativo, después de haber sido perfeccionado con base en las sugerencias de la muestra y en la literatura científica, fue considerado válido según contenido y apariencia, sugiriendo que puede contribuir para la práctica clínica de la enfermería y para la comprensión del tratamiento al cual son sometidas las pacientes con cáncer de mama.

Evidence on the Use of Mobile Apps During the Treatment of Breast Cancer: Systematic Review.

BACKGROUND: Cancer is a major cause of morbidity, disability, and mortality worldwide, and breast cancer is the most common cause of death in women. Different modalities of cancer treatment can have adverse effects that reduce the quality of life of patients and lead to treatment interruptions, if not managed properly. The use of mobile technologies has brought innovative possibilities for improving health care. Mobile apps can help individuals manage their own health and well-being and may also promote healthy lifestyles and information access. OBJECTIVE: The aim of this study was to identify available evidence on the use of mobile apps to provide information and facilitate communication regarding self-care management related to the adverse effects of toxicities owing to breast cancer therapy. METHODS: This systematic review includes studies which were identified using a search strategy adapted for each electronic database: CINAHL, Cochrane Library, LILACS, LIVIVO, PubMed, SCOPUS, and Web of Science. In addition, a gray literature search was performed using Google Scholar. All the electronic database searches were conducted on April 17, 2019. Two investigators independently reviewed the titles and abstracts of the studies identified and then read the full text of all selected papers. The quality of the included studies was analyzed by the Cochrane Collaboration Risk of Bias Tool and the Methodological Index for Non-Randomized Studies. RESULTS: A total of 9 studies which met the eligibility criteria-3 randomized clinical trials and 6 nonrandomized studies published in English from 2010 to 2018-were considered for this systematic review; 396 patients with breast cancer, as well as 40 experts in the medical and nursing fields, and 3 software engineers were included. CONCLUSIONS: The evidence from the studies included in this systematic review is currently limited but suggests that mobile apps for women with breast cancer might be an acceptable information source that can improve patient well-being; they can also be used to report symptoms and adverse treatment-related effects and promote self-care. There is a need to test more evidence-based apps in future randomized clinical trials.