The impact of an online course on agreement rates of the certainty of evidence assessment using Grading of Recommendations, Assessment, Development, and Evaluation Approach: a before-and-after study.

BACKGROUND AND OBJECTIVE: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach is a systematic method for assessing the certainty of evidence (CoE) and strength of recommendations in health care. We aimed to verify the effects of an online-based GRADE course on multirater consistency in the evaluation of the CoE in systematic reviews (SRs) analysis. STUDY DESIGN AND SETTINGS: Sixty-five Brazilian methodologists and researchers participated in an online course over 8 weeks. Asynchronous lessons and weekly synchronous meetings addressed the GRADE system in the context of CoE assessment. We asked participants to evaluate the CoE of random SRs (two before and another two after the course). Analyzes focused on the multirater agreement with a standard response, in the interrater agreement, and before-after changes in the proportion of participants that rated down the domains. RESULTS: 48 individuals completed the course. Participants presented improvements in the raters' assessment of the CoE using the GRADE approach after the course. The multirater consistency of indirectness, imprecision, and the overall CoE increased after the course, as well as the agreement between raters and the standard response. Furthermore, interrater reliability increased for risk of bias, inconsistency, indirectness, publication bias, and overall CoE, indicating progress in between-raters consistency. After the course, approximately 78% of individuals rated down the overall CoE to a low/very low degree, and participants presented more explanations for the judgment of each domain. CONCLUSION: An online GRADE course improved the consistency and agreement of the CoE assessment by Brazilian researchers. Online training courses have the potential to improve skills in guideline methodology development.

Empowerment of genetic information by women at-risk of being carriers of Duchenne and Becker muscular dystrophies.

The emergence of therapies acting on specific molecular targets for Duchenne and Becker muscular dystrophies (DBMD) led to expanded access of diagnostic DMD analysis. However, it is unclear how much of these advances have also improved healthcare and access to genetic testing for women at-risk of being carriers. This study evaluates the process of genetic counseling and empowerment of genetic information by women from DBMD families. We carried out a cross-sectional study between February and June 2022 in Brazil. The online survey with items regarding sociodemographic data; family history; access to health services; reproductive decisions; and the Genomic Outcome Scale was answered by 123 women recruited from a rare diseases reference service and a nationwide patient advocacy group. Genetic counseling was reported by 77/123 (62.6%) of women and 53.7% reported having performed genetic analysis of DMD. Although the majority knew about the risks for carriers of developing heart disease and muscle weakness, only 35% of potential carriers have had cardiac studies performed at least once in their lives. Country region, type of kinship, number of affected males in the family, age, notion of genetic risk, education level, and participation in advocacy groups were the main factors associated with adequate healthcare access to women and empowerment of genetic information. Education to health professionals and policies to expand access to carrier genetic testing, whether public policies or regulation of pharmaceutical companies' diagnostic programs, is paramount to improve the care of families with DBMD in Brazil.

A Randomized, Open-Label, Non-inferiority Clinical Trial Assessing 7 Versus 14 Days of Antimicrobial Therapy for Severe Multidrug-Resistant Gram-Negative Bacterial Infections: The OPTIMISE Trial Protocol.

INTRODUCTION: Shorter courses of antimicrobials have been shown to be non-inferior to longer, "traditional" duration of therapies, including for some severe healthcare-associated infections, with a few exceptions. However, evidence is lacking regarding shorter regimes against severe infections by multidrug-resistant Gram-negative bacteria (MDR-GNB), which are often caused by distinct strains and commonly treated with second-line antimicrobials. In the duratiOn of theraPy in severe infecTIons by MultIdrug-reSistant gram-nEgative bacteria (OPTIMISE) trial, we aim to assess the non-inferiority of 7-day versus 14-day antimicrobial therapy in critically ill patients with severe infections caused by MDR-GNB. METHODS: This is a randomized, multicenter, open-label, parallel controlled trial to assess the non-inferiority of 7-day versus 14-day of adequate antimicrobial therapy for intensive care unit (ICU)-acquired severe infections by MDR-GNB. Adult patients with severe infections by MDR-GNB initiated after 48 h of ICU admission are screened for eligibility. Patients are eligible if they proved to be hemodynamically stable and without fever for at least 48 h on the 7th day of adequate antimicrobial therapy. After consenting, patients are 1:1 randomized to discontinue antimicrobial therapy on the 7th (± 1) day or to continue for a total of 14th (± 1) days. PLANNED OUTCOMES: The primary outcome is treatment failure, defined as death or relapse of infection within 28 days after randomization. Non-inferiority will be achieved if the upper edge of the two-tailed 95% confidence interval of the difference between the clinical failure rate in the 7-day and the 14-day group is not higher than 10%. CONCLUSION: The OPTIMISE trial is the first randomized controlled trial specifically designed to assess the duration of antimicrobial therapy in patients with severe infections by MDR-GNB. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05210387. Registered on 27 January 2022. Seven Versus 14 Days of Antibiotic Therapy for Multidrug-resistant Gram-negative Bacilli Infections (OPTIMISE).

Radiographic Measures for the Assessment of Frontal and Sagittal Knee Alignments and the Associated Normality Values: A Meta-Analysis.

Objective: The purpose of this literature review was to identify knee alignment assessment methods using radiography in the sagittal and frontal planes and to identify normality values for classifying knee alignment using these methods. Methods: A systematic review with a meta-analysis was conducted. The eligibility criterion was studies that performed radiographic examinations to assess the knee alignment of adults without a history of hip or knee prosthesis surgery. The methodological qualities of the included studies were assessed using the QUADAS-2 tool. A meta-analysis was performed to measure the normality values of knee alignment in the frontal plane. Results: The hip-knee-ankle (HKA) angle was the measure most frequently used to assess knee alignment. Only a meta-analysis of HKA normality values was possible. Thereby, we found normality values of the HKA angle for the overall population, men, and women. The normality values of knee alignment for healthy adults that were found in this study were as follows: overall sample (male and female patients) HKA angle = -0.2° (-2.8° to 2.41°), male patient HKA angle = 0.77° (-2.91° to 7.94°), and female patient HKA angle = -0.67° (-5.32° to 3.98°). Conclusion: This review identified the most common methods and expected values for knee alignment assessment methods using radiography in the sagittal and frontal planes. We suggest HKA angles ranging from -3° to 3° as the cutoff for classifying knee alignment in the frontal plane, in accordance with the normality limits found in the meta-analysis.

Musculoskeletal disorders and work ability of workers at a university campus in southern Brazil.

Background: When performed in unfavorable conditions, work can lead to the development of musculoskeletal disorders and decrease in work ability. Objectives: To identify the differences between three groups of workers (professors, technicians and outsourced workers) as for the sociodemographic profile, work ability, prevalence of musculoskeletal disorders, activity restrictions, and the correlation between the presence of musculoskeletal disorders and activity restrictions with each domain of the Work Ability Index. Methods: The sample consisted of 67 university workers assessed by a Sociodemographic Data Questionnaire, the Nordic Musculoskeletal Symptoms Questionnaire and the Work Ability Index. Descriptive statistics and Kendall's Tau correlation coefficient were used. Results: Professors presented more favorable sociodemographic and lifestyle aspects and higher work ability, while outsourced workers had less favorable sociodemographic and lifestyle aspects and lower work ability. The correlation between activity restrictions and work ability was found in only one domain of Work Ability Index among professors. Among outsourced workers were found correlations on presence of musculoskeletal disorders and activity restrictions with six domains of Work Ability Index. Technicians did not show significant correlation. Conclusions: Outsourced workers presented worse work ability and less favorable sociodemographic and lifestyle aspects among the workers in the study, requiring the maintenance and improvement of work ability in this population.

Introdução: O trabalho, quando realizado em condições desfavoráveis, pode levar ao desenvolvimento de distúrbios musculoesqueléticos e à diminuição da capacidade para o trabalho. Objetivos: Identificar diferenças entre três grupos de trabalhadores (professores, técnicos e terceirizados) em relação a perfil sociodemográfico, capacidade para o trabalho, presença de distúrbios musculoesqueléticos e restrição para atividades e correlacionar a presença de distúrbios musculoesqueléticos e a restrição para atividades com cada domínio do índice de Capacidade para o Trabalho. Métodos: A amostra foi composta por 67 trabalhadores de uma universidade, os quais preencheram um questionário de dados sociodemográficos, o Questionário Nórdico de Sintomas Osteomusculares e o índice de Capacidade para o Trabalho. Foram utilizados estatística descritiva e o teste tau de Kendall para identificar possíveis correlações. Resultados: Os professores apresentaram aspectos sociodemográficos e de estilo de vida mais favoráveis e maior capacidade para o trabalho, enquanto os terceirizados apresentaram aspectos sociodemográficos e de estilo de vida menos favoráveis, além de menor capacidade para o trabalho. Foi encontrada correlação entre restrição para atividades em apenas um dos domínios do Índice de Capacidade para o Trabalho entre professores. Entre os terceirizados, foram encontradas correlações entre a presença de distúrbios musculoesqueléticos e a restrição para atividades em seis domínios do índice de Capacidade para o Trabalho. Os técnicos administrativos não apresentaram correlações significativas. Conclusões: Os trabalhadores terceirizados apresentaram pior capacidade para trabalho e aspectos sociodemográficos e de estilo de vida menos favoráveis entre os trabalhadores do estudo, sendo necessárias a manutenção e a melhora da capacidade para o trabalho desta população.

Seasonality effect on the physiological and productive responses of crossbred dairy cows to the equatorial Amazon climate / Efeito da sazonalidade sobre as respostas fisiológicas e produtivas de vacas leiteiras mestiças ao clima amazônico equatorial

The objective of this study was to evaluate the seasonal effect of months of the year upon the physiological and productive responses of crossbred dairy cows raised in an Amazonian climate. Twenty lactating cows were evaluated, fed on Brachiaria decumbens pasture, with free access to water and mineral supplementation. Data from climate variables air temperature (AT), relative humidity (RH), rainfall (RA) and temperature and humidity index (THI) were recorded dur ing the months of January to April 2019. The physiological data collected were: respiratory rate (RR, mov/min), heart rate (HR, beats/min), rectal temperature (RT, ºC), udder surface temperature (UST, ºC), body surface temperature (BST, ºC), dorsum surface temperature (DST, ºC), front surface temperature (FST, ºC) and rear shin temperature (RST). Milk production (MP) was also measured. There was a significant difference (P<0.05) of RST and RR with values ranging from 34.8 to 35.5°C and 32.0 to 36.2 mov/min, respectively. There were no significant difference (P>0.05) for BST, and the values for MP and THI were 3.8; 3.8; 4.6; 4.1 kg and 77.7; 79.7; 80.6; 80.1, respectively. It was concluded that there was a seasonal effect of the months of the year evaluated on the respiratory rate of animals, however, it did not change the MP and the THI. The Amazon environment is conducive to causing thermal stress in lactating cows raised on pasture, requiring the use of shading to facilitate the ability of these animals to dissipate heat.(AU)

O objetivo desse estudo foi avaliar os efeitos sazonais dos meses do ano sobre as respostas fisiológicas e produtivas de vacas leiteiras mestiças criadas em clima amazônico. Foram avaliadas 20 vacas lactantes, alimentadas com pasto de Brachiaria decumbens, com acesso livre a água e suplementação mineral. Foram registrados dados das variáveis climáticas temperatura do ar (TA), umidade relativa do ar (UR), precipitação pluviométrica (PP) e índice de temperatura e Umidade (ITU) durante os meses de janeiro a abril de 2019. Os dados fisiológicos coletados foram: frequência respiratória (FR, mov/min), frequência cardíaca (FC, bat./min), temperatura retal (TR, ºC), temperatura superficial do úbere (TSU, ºC), temperatura superfície corporal (TSC, ºC), temperatura superficial do dorso (TSD, ºC), temperatura superficial da fronte (TSF, ºC) e temperatura superficial da canela (TSCA, °C). Também foi mensurada a produção de leite (PL, kg). Houve diferença significativa (P<0,05) da TSCA e FR com valores variando de 34,8 a 35,5°C e 32,0 a 36,2 mov/min, respectivamente. Não houve diferença significativa (P>0,05) para TSC e os valores observados para PL e ITU foram 3,8; 3,8; 4,6; 4,1 kg e 77,7; 79,7; 80,6; 80,1, respectivamente. Houve efeito sazonal dos meses avaliados sobre a taxa respiratória dos animais, no entanto, isso não alterou a PL nem o ITU. O ambiente amazônico é propício a causar estresse térmico em vacas lactantes mantidas a pasto, sendo necessário o uso de sombreamento para facilitar a capacidade de dissipação de calor corporal desses animais.(AU)

Applicability of management tools in a family dairy farm: a case study / Aplicabilidade de ferramenta de gestão em propriedade leiteira familiar: estudo de caso

This study aimed to describe the application of the management tool GUT matrix in a family dairy farm in the state of Acre to identify the main weaknesses and propose adequate tools to allow better management of the causes of the three biggest identified problems. This is a case study carried out on a single property located in the municipality of Rio Branco - Acre in May 2022. Information was collected by applying a semi-structured form with 267 questions. The GUT matrix allo-wed ranking the three main weaknesses of the property, namely: "lack of zootechnical bookkeeping," "long calving interval," and "failure in feeding management." The management tools proposed to the producer, seeking to guide and organize the activities of the property, consisted of 5W2H and Ishikawa diagram.(AU)

Objetivou-se descrever a aplicação da ferramenta de gestão, "matriz GUT", em uma propriedade leiteira familiar no estado do Acre para identificar os principais pontos fracos e propor ferramentas adequadas para permitir melhor gerenciamento das causas dos 3 maiores problemas identificados. Trata-se de um estudo de caso realizado em propriedade única localizada no município de Rio Branco - AC em maio de 2022, as informações foram coletadas por meio de formulário semiestruturado contendo 267 questões. A matriz GUT permitiu ranquear os 3 principais pontos fracos da propriedade, sendo: "falta de escrituração zootécnica", "intervalo entre partos longo" e "Falha no manejo alimentar". As ferramentas de gestão propostas ao produtor, buscando orientar e organizar as atividades da propriedade consistiram no 5W2H e Diagrama de Ishikawa.(AU)

Risk Factors for Back Pain among Southern Brazilian School Children: A 6-Year Prospective Cohort Study.

Risk factors associated with back pain vary in different countries. Given the lack of studies in Latin America, our study aimed to assess back pain and its associated factors for six years in Southern Brazilian school children. All children attending the fifth grade of Teutônia, Brazil, were invited to participate in the study. Only schoolchildren who did not report back pain were included in the first assessment. The schoolchildren completed the Back Pain and Body Posture Evaluation Instrument (BackPEI) during three assessments (2011, 2014, and 2017). BackPEI assesses the presence of back pain and possible associated risk factors (postural, behavioral, and sociodemographic). Generalized estimated equations (GEE) were used to perform a Poisson regression model with robust variance for longitudinal analysis. After six years of follow-up, 75 schoolchildren completed all the assessments. The risk factors associated with back pain were spending more than six hours daily watching television, lifting objects from the ground adopting an inadequate posture, using another backpack type different from those with two straps, and carrying a backpack in an asymmetric way. These results are important in guiding the planning of public policies to minimize this public health problem.

Stress indicators in cattle submitted to different pre-slaughter rest times / Indicadores de estresse em bovinos submetidos a diferentes tempos de descanso no pré-abate

The objective of this study was to determine the effect of pre-slaughter time about some blood constituents used as stress indicators in the evaluation of animal welfare in cattle. In the practice of ethology, animal welfare is assessed through physiological and behavioral indicators. For the determination of serum biomarkers of animal stress, a total of 180 animals was used, divided into two major groups according to the time of pre-slaughter. In the acceptable group, the animals had a pre-slaughter time up to 24 hours and in the not acceptable group the pre-slaughter time was greater than 24 h. These two groups were split up into three animal categories (males, females and castrated males). In this study, 30 samples were collected from each animal category of the two groups, acceptable and not acceptable, totaling 180 samples. Samples were separated for analysis of muscle enzymes creatine kinase and lactate dehydrogenase (CK and LDH), glucose and cortisol. Physiological values, regardless of the animal category and pre-slaughter time, were higher than the normal values of reference, expressing the prior management effect on animal welfare. The data clearly show a need to update and adapt the entire production chain to animal welfare practices, with the objective of producing competitive quality meat in the world market.(AU)

O objetivo do estudo foi avaliar o efeito do tempo de pré-abate sobre alguns constituintes sanguíneos utilizados como indicadores de estresse na avaliação do bem-estar animal em bovinos. Na prática da etologia, o bem-estar animal é avaliado por meio de indicadores fisiológicos e comportamentais. Para a determinação sérica de biomarcadores de estresse animal utilizaram-se 180 animais, divididos em dois grupos de acordo com o tempo de pré-abate: até 24 horas ou acima de 24 horas. Esses dois grupos subdividiram-se em três categorias animais (machos não-castrados, machos castrados ou fêmeas). Foram coletadas 30 amostras de cada categoria animal nos dois grupos, totalizando 180 amostras. Foram separadas amostras para análise de enzimas musculares creatina quinase e lactato desidrogenase (CK e LDH), glicose e cortisol. Os valores fisiológicos, independentemente da categoria animal e do tempo de pré-abate, foram superiores aos valores de referência, expressando o efeito do manejo prévio sobre o bem-estar dos animais. Os dados evidenciam claramente a necessidade de atualização e adequação de toda a cadeia produtiva às práticas de bem-estar animal, com o objetivo de produzir carne de qualidade competitiva no mercado mundial.(AU)

Mineral composition in commercial cuts of Colossoma macropomum (Cuvier, 1818) and Arapaima gigas(Schinz, 1822) in ideal weight class for commercialization / Composição mineral em cortes comerciais de Colossoma macropomum (Cuvier, 1818) e Arapaima gigas (Schinz, 1822) na classe de peso ideal para comercialização

The aimed of this study was to evaluate the mineral composition in commercial cuts of tambaqui (Colossoma macropomum) and pirarucu (Arapaima gigas). Were compared to the minimum values of daily consumption of minerals recommended by the World Health Organization (WHO). The experimental design was completely randomized, with processing performed in triplicate. Data were submitted to ANOVA. If ANOVA appeared statistically significant (α=0.05), the means were compared by Tukey's Test. There was a difference (p<0.05) between commercial cuts of the tambaqui for different minerals. Tambaqui ribs and band presented the highest values of total iron 1.08 ± 0.12 mg/100g compared to other commercial cuts. The mineral elements Na+, K+, Ca2+ and Mg2+ expressed the highest values for the tambaqui steak, 301.00 ± 80.58, 457.00 ± 129.33, 36.00 ± 4.36 and 46.90 ± 4.68 mg/100g, respectively. There was a difference (p<0.05) between commercial cuts of the pirarucu for different minerals. The mineral elements Total Iron, Na+, K+ and Ca2+ expressed the highest values for pirarucu loin, 0.80 ± 0.07, 406.00 ± 117.50, 529.30 ± 130.58 and 32.00 ± 5.12 mg/100g, respectively. However, Mg2+ expressed a higher value for pirarucu tail fillet 37.10 ± 4.99 mg/100g. The tambaqui steak and pirarucu loin were the cuts that best met the minimum needs for mineral supply.(AU)

O objetivo do estudo foi avaliar a composição mineral em cortes comerciais de tambaqui (Colossoma macropomum) e pirarucu (Arapaima gigas). Foram comparados aos valores mínimos de consumo diário de minerais recomendados pela Organização Mundial da Saúde (OMS). O delineamento experimental foi inteiramente casualizado, com processamento realizado em triplicata. Os dados foram submetidos à ANOVA. Caso a ANOVA parecesse estatisticamente significativa (α=0,05), as médias foram comparadas pelo Teste de Tukey. Houve diferença (p<0,05) entre cortes comerciais de tambaqui para os diferentes minerais. A costela e a banda de tambaqui apresentaram os maiores valores de ferro total 1,08 ± 0,12 mg/100g em relação aos demais cortes comerciais. Os elementos minerais Na+, K+, Ca2+ e Mg2+ expressaram os maiores valores para posta de tambaqui, 301,00 ± 80,58, 457,00 ± 129,33, 36,00 ± 4,36 e 46,90 ± 4,68 mg/100g, respectivamente. Houve diferença (p<0,05) entre cortes comerciais de pirarucu para diferentes minerais. Os elementos minerais Ferro Total, Na+, K+ e Ca2+ expressaram os maiores valores para o lombo de pirarucu, 0,80 ± 0,07, 406,00 ± 117,50, 529,30 ± 130,58 e 32,00 ± 5,12 mg/100g, respectivamente. No entanto, o Mg2+ expressou maior valor para filé da cauda de pirarucu 37,10 ± 4,99 mg/100g. Em destaque, a posta de tambaqui e o lombo de pirarucu foram os cortes que mais atenderam às necessidades mínimas de suprimento mineral. (AU)

Dados de mundo real: o impacto econômico da inclusão de antineoplásicos orais para as operadoras de saúde no Sistema de Saúde Suplementar do Brasil / Real world data: the economic impact of including oral antineoplastic agents for health care providers in the Brazilian Supplementary Health System

Objetivo: Avaliar o incremento mensal do custo por beneficiário da incorporação das terapias antineoplásicas orais se aprovado o PL nº 6.330/2019. Métodos: As características clínicas e dos medicamentos utilizados em pacientes em tratamento oncológico foram coletadas da base de dados de mundo real Auditron®, plataforma de avaliações de solicitações de pré-autorização de procedimentos médicos. Com base nas características dos pacientes, foram avaliadas as possibilidades de uso dos medicamentos antineoplásicos orais, conforme as diretrizes da NCCN e ESMO. O cálculo do custo incremental foi realizado utilizando o número total de pacientes diagnosticados com uma neoplasia específica e o número de pacientes aptos a receber antineoplásicos orais. Foi utilizada lista de preços CMED para cálculo dos custos de aquisição de medicamentos. Resultados: O custo incremental da incorporação de 34 drogas antineoplásicas orais em 2019 foi de R$ 5.362.642.580 (R$ 3.944.321.786- R$ 6.483.413.466), representando impacto mensal de R$ 9,50 por beneficiário. O custo incremental da incorporação de 21 drogas antineoplásicas orais em 2021 era de R$ 2.028.538.791 (R$ 1.485.919.710-R$ 3,016,407,794), representando impacto mensal de R$ 3,59 por beneficiário. Conclusão: A incorporação das drogas antineoplásicas orais acarretariam um baixo incremento mensal por beneficiário.

Objective: To evaluate the monthly increase in the cost per member of incorporating all oral neoplastic therapies if approved the bill 6,330/2019. Methods: The clinical characteristics and medications used by patients undergoing cancer treatment were collected from the real-world Auditron® database, a platform for evaluating requests for pre-authorization of medical procedures. Based on the characteristics of each patient, the possibility of using oral antineoplastic drugs according to the NCCN and ESMO guidelines was evaluated. The incremental cost calculation was performed using the total number of patients diagnosed with a specific neoplasm and the number of patients eligible to receive oral anticancer drugs. CMED price list was used to calculate drug acquisition costs. Results: The incremental cost of incorporating 34 neoplastic drugs in 2019 was R$ 5,362,642,580 (R$ 3,944,321,786- R$ 6,483,413,466), representing a monthly impact of R$ 9.50 per member. The incremental cost of incorporating 21 neoplastic drugs in 2021 was R$ 2,028,538,791 (R$ 1,485,919,710-R$ 3,016,407,794), representing a monthly impact of R$ 3.59 per beneficiary. Conclusion: The incorporation of oral anticancer drugs in the coverage of health plans following international and national treatment guidelines would result in a low monthly increase in the cost per beneficiary.

Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA): Expansion, Content Validation, and Reliability.

The Back Pain and Body Posture Evaluation Instrument (BackPEI) was created in 2013 to assess back pain and its risk factors in school children. However, it does not assess neck pain or the habits of mobile device usage, which are aspects that are often part of school children's lives. Therefore, we aimed to update the BackPEI questionnaire to include new questions assessing aspects related to neck pain and the use of mobile devices and to test the content validity and reliability of the new questions. The updated questionnaire was named Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA). The content was validated by eight experts using the content validity index (CVI). To assess reliability, the BackPEI-CA questionnaire was applied at two different times in 105 school children, and Cohen's kappa (k) and intraclass correlation coefficient (ICC) were calculated. All aspects assessed regarding content validity had a CVI higher than 0.8. The new questions presented moderate and good kappa values and excellent ICC values. The updated version of BackPEI-CA can be used as a clinic tool for assessing the presence, frequency, and intensity of back and neck pain and their risk factors.

Profitability analysis of backgrounding and finishing of beef cattle in western amazon: a multiple-case study / Análise da rentabilidade de sistemas de recria e engorda de bovinos de corte na amazônia ocidental: estudo de múltiplos casos

This study aimed to evaluate the economic profitability of farms for backgrounding and finishing of beef cattle located in the mesoregion of Acre valley, in a multi-case study format. The data used originated from three pre-selected farms from January to December 2018. Data were collected from an inventory of assets and cash flow, which were later tabulated in Excel® software using descriptive statistics through mean, percentage, and standard deviation to present the indicators. The average effective operating cost (EOC) was BRL 1,399,014.34 and the total operating cost (TOC) was BRL 1,444,068.53 and the total cost (TC) was BRL 1,673,860.38. The items that compose the EOC which exerted greater representation on the activity costs were the purchase of animals (79.6%), food (7.8%), and labor (5.9%), respectively. Under these conditions, the three properties studied showed positive gross margins, net margins, and positive results, indicating their profitability in the short, medium, and long term, with possibilities for expansion in the region.(AU)

Objetivou-se avaliar a rentabilidade econômica de propriedades rurais de recria e engorda de bovinos de corte localizadas na mesorregião do vale do Acre, no formato de estudo multicasco. Os dados utilizados foram provenientes de três propriedades rurais pré-selecionadas durante o período de janeiro a dezembro de 2018. Foram coletados dados de inventário de bens e fluxo de caixa, posteriormente tabulados no software Excel® utilizando estatística descritiva por meio da média, porcentagem e desvio padrão para apresentar os indicadores. A média do custo operacional efetivo (COE) foi de R $1.399.014,34 e a do custo operacional total (COT) de R$1.444.068,53 e custo total (CT) de 1.673.860,38. Os itens componentes do COE respectivamente, que exerceram maiores representatividades sobre os custos da atividade foram o de compra de animais (79,6%), alimentação (7,8%) e mão de obra (5,9%). Nessas condições, as três propriedades estudadas apresentaram margem bruta, margem líquida e resultado positivos, indicando sua rentabilidade a curto, médio e longo prazo, com possibilidades de expansão na região.(AU)

Cuidados de enfermagem a crianças e adolescentes com necessidades especiais de saúde / Cuidados de enfermería a niños y adolescentes con necesidades especiales de salud / Nursing care for children and adolescents with special health needs

RESUMO Objetivo: investigar as demandas de cuidados, na ótica da equipe de enfermagem, a crianças e adolescentes com necessidades especiais de saúde (CRIANES) hospitalizadas. Método: pesquisa descritiva, exploratória e de abordagem qualitativa. Foram entrevistados 11 profissionais de enfermagem que atuam em Unidade de internação pediátrica de um hospital da região noroeste do Rio Grande do Sul, nos meses de novembro de 2019 a fevereiro de 2020. As enunciações foram duplamente transcritas e submetidas à análise de conteúdo. Resultados: os profissionais elucidaram sobre a presença de familiares cuidadores durante a hospitalização em unidade pediátrica. A equipe manifestou a importância do conhecimento técnico-científico, bem como as potencialidades e fragilidades no processo de trabalho com essa população específica. Considerações finais: A assistência do cuidado de enfermagem com CRIANES exige habilidades técnico-científicas, assim como a criação do vínculo equipe-paciente-família. Desse modo, enfatiza-se a necessidade da educação continuada dos profissionais, para fornecer assistência humanizada e resolutiva, diminuindo os índices de reinternações.

RESUMEN Objetivo: investigar las demandas de atención, en la óptica del equipo de enfermería, a niños y adolescentes con necesidades especiales de salud (NINEAS) hospitalizadas. Método: investigación descriptiva, exploratoria y de abordaje cualitativo. Fueron entrevistados 11 profesionales de enfermería que actúan en Unidad de internación pediátrica de un hospital de la región noroeste de Rio Grande do Sul-Brasil, en los meses de noviembre de 2019 a febrero de 2020. Los relatos fueron doblemente transcriptos y sometidos al análisis de contenido. Resultados: los profesionales aclararon sobre la presencia de familiares cuidadores durante la hospitalización en unidad pediátrica. El equipo relató la importancia del conocimiento técnico-científico, así como las potencialidades y fragilidades en el proceso de trabajo con esa población específica. Consideraciones finales: la asistencia del cuidado de enfermería a NINEAS exige habilidades técnico-científicas, así como la creación del vínculo equipo-paciente-familia. De ese modo, se enfatiza la necesidad de la educación continuada de los profesionales, para proporcionar asistencia humanizada y resolutiva, disminuyendo los índices de reinternaciones.

ABSTRACT Objective: to investigate care demands of children and adolescents with special health care needs (CSHCN) hospitalized from the perspective of the nursing team. Method: descriptive, exploratory and qualitative research. Eleven 11 nursing professionals were interviewed, who work in a pediatric hospitalization unit of a hospital in the northwest region of Rio Grande do Sul, from November 2019 to February 2020. The statements were double transcribed and submitted to content analysis. Results: the professionals elucidated about the presence of family caregivers during hospitalization in the pediatric unit. The team expressed the importance of technical and scientific knowledge, as well as the potential and weaknesses in the work process with this specific population. Final thoughts: Nursing care with CRIANES requires technical and scientific skills, as well as the creation of the team-patient-family bond. Thus, it emphasizes the need for continuing education of professionals, to provide humanized and problem-solving assistance, reducing the rates of readmissions.

Dripping test to assessment the water content in frozen chicken carcases commercialized in Ji-Paraná, Rondônia, Brazil / Dripping test para avaliação do teor de água em carcaças de frango congeladas comercializadas em Ji-Paraná, Rondônia, Brasil

The growth in demand for chicken meat is due to the increase in demand for white meat, as they are considered tasty and at an attractive price. Therefore, the search for quality is essential. In Brazil, the water loss due to the melting of the carcasses is controlled by companies and by the Ministry of Agriculture, Livestock and Supply (MAPA) and, frequently, they analyze water loss from the carcasses above the limits required by the legislation. Given the assumption, the aimed of this study was to evaluate the water losses due to thawing in frozen chicken carcasses marketed in the municipality of Ji-Paraná, Rondônia, Brazil. There 25 carcasses of whole frozen chickens were evaluated, from six brands, lots and different establishments, submitted to standardized conditions for the performance of the Dripping test, in order to verify the percentage of water absorbed by the carcasses. It was found that 48% of the samples showed water loss beyond that allowed by the current legislation, which is 6%. When observing that almost half of the evaluated carcasses showed irregularities in relation to the legislation, it is understood that the companies that supply these products should be better inspected, carrying out Dripping test analyzes periodically to reduce or eliminate this type of crime.(AU)

O crescimento da demanda de carne de frango se deve ao aumento da procura de carnes brancas, por serem con-sideradas saborosas e com preço atrativo. Por isso, a busca pela qualidade é imprescindível. No Brasil, a perda de água pelo degelo das carcaças é controlada pelas empresas e pelo Ministério da Agricultura Pecuária e Abastecimento (MAPA) e, fre-quentemente, analisam perda de água das carcaças acima dos limites exigidos pela legislação. Diante do pressuposto, o obje-tivo desse estudo foi avaliar as perdas de água por degelo em carcaças de frango congeladas comercializadas no município de Ji-Paraná, Rondônia. Foram avaliadas 25 carcaças de frangos congelados inteiros, de seis marcas, lotes e estabelecimentos dis-tintos, submetidos a condições padronizadas para a realização do Dripping test, com a finalidade de verificar o percentual de água absorvida pelas carcaças. Constatou-se que 48% das amostras apresentaram perda de água além do permitido pela legis-lação vigente, que é de 6%. Ao observar que quase a metade das carcaças avaliadas apresentaram irregularidades frente à legis-lação, entende-se que as empresas fornecedoras desses produtos devem ser melhor fiscalizadas, realizando análises de Dripping test periodicamente para reduzir ou eliminar esse tipo de delito.(AU)

Dripping test to assessment the water content in frozen chicken carcases commercialized in Ji-Paraná, Rondônia, Brazil / Dripping test para avaliação do teor de água em carcaças de frango congeladas comercializadas em Ji-Paraná, Rondônia, Brasil

The growth in demand for chicken meat is due to the increase in demand for white meat, as they are considered tasty and at an attractive price. Therefore, the search for quality is essential. In Brazil, the water loss due to the melting of the carcasses is controlled by companies and by the Ministry of Agriculture, Livestock and Supply (MAPA) and, frequently, they analyze water loss from the carcasses above the limits required by the legislation. Given the assumption, the aimed of this study was to evaluate the water losses due to thawing in frozen chicken carcasses marketed in the municipality of Ji-Paraná, Rondônia, Brazil. There 25 carcasses of whole frozen chickens were evaluated, from six brands, lots and different establishments, submitted to standardized conditions for the performance of the Dripping test, in order to verify the percentage of water absorbed by the carcasses. It was found that 48% of the samples showed water loss beyond that allowed by the current legislation, which is 6%. When observing that almost half of the evaluated carcasses showed irregularities in relation to the legislation, it is understood that the companies that supply these products should be better inspected, carrying out Dripping test analyzes periodically to reduce or eliminate this type of crime.

O crescimento da demanda de carne de frango se deve ao aumento da procura de carnes brancas, por serem con-sideradas saborosas e com preço atrativo. Por isso, a busca pela qualidade é imprescindível. No Brasil, a perda de água pelo degelo das carcaças é controlada pelas empresas e pelo Ministério da Agricultura Pecuária e Abastecimento (MAPA) e, fre-quentemente, analisam perda de água das carcaças acima dos limites exigidos pela legislação. Diante do pressuposto, o obje-tivo desse estudo foi avaliar as perdas de água por degelo em carcaças de frango congeladas comercializadas no município de Ji-Paraná, Rondônia. Foram avaliadas 25 carcaças de frangos congelados inteiros, de seis marcas, lotes e estabelecimentos dis-tintos, submetidos a condições padronizadas para a realização do Dripping test, com a finalidade de verificar o percentual de água absorvida pelas carcaças. Constatou-se que 48% das amostras apresentaram perda de água além do permitido pela legis-lação vigente, que é de 6%. Ao observar que quase a metade das carcaças avaliadas apresentaram irregularidades frente à legis-lação, entende-se que as empresas fornecedoras desses produtos devem ser melhor fiscalizadas, realizando análises de Dripping test periodicamente para reduzir ou eliminar esse tipo de delito.

Phrases in Noise Test (PINT) Brazil: influence of the inter-stimulus interval on the performance of children with hearing impairment. / Phrases in Noise Test (PINT) Brasil: influência do intervalo interestímulos no desempenho de crianças com deficiência auditiva.

PURPOSE: This study aimed to investigate, using the PINT Brasil, the influence of the interstimulus interval on the performance of children with moderate and severe hearing loss fitted with hearing aids. METHODS: Ten children with normal hearing (CG) and 20 children with hearing loss (SG) participated in the study. Both groups were assessed using the speech perception test called PINT Brasil in PAUSE and NO PAUSE situations. RESULTS: When comparing the PAUSE and NO PAUSE situations, only the SG presented a statistically significant difference, indicating that the NO PAUSE situation had the best performance. In this situation, the noise oscillations were smaller, and the noise reduction algorithm, which may cause the loss of message information, was not repeatedly activated. CONCLUSION: The interstimulus interval in the PINT Brasil influenced the performance of children with moderate and severe hearing loss fitted with hearing aids. The NO PAUSE situation presented the best results.

OBJETIVO: Investigar a influência do intervalo interestímulos no desempenho de crianças com deficiência auditiva de grau moderado e severo, adaptadas com aparelhos de amplificação sonora individuais (AASI), no teste PINT Brasil. MÉTODO: Participaram do estudo 10 crianças com audição normal (GC) e 20 crianças com deficiência auditiva (GE). O teste PINT Brasil foi aplicado nas situações SEM pausa e COM pausa para os dois grupos. RESULTADOS: Na comparação entre as situações SEM pausa e COM pausa, houve diferença significativa apenas para o GE, indicando a SEM pausa com melhor desempenho. Nesta última condição, as oscilações ruidosas foram menores e não houve o acionamento repetido do redutor de ruído, o que possibilita a perda de informações da mensagem. CONCLUSÃO: Conclui-se que o intervalo interestímulos no teste de percepção da fala PINT Brasil influenciou o desempenho das crianças com deficiência auditiva de grau moderado e severo, adaptadas com AASI. O melhor resultado foi encontrado na situação SEM PAUSA.

Hernioplastia com aplicação de tela por laparoscopia em equino com hérnia incisional / Hernioplasty with laparoscopy mesh application in equine with incisional hernia

Background: Incisional hernia in the midline can be a consequence of abdominal surgeries, which incidence is around5.7-18%. Surgical indication occurs in cases of large hernias, and the most common techniques used involve the closingof the musculature in a primary way, with sutures, and the implantation of a mesh on the abdominal wall. Laparoscopichernioplasty emerged as a less invasive option, showing superiority when compared with open surgical techniques in human medicine, however there are few reports describing this technique in equines. So, the aim of this paper is to report acase of hernioplasty, using laparoscopic mesh, in a horse with midline incisional hernia.Case: A 13-year-old castrated male Brasileiro de Hipismo horse, weighing 415 kg, practitioner of classic equestrian, presented an incisional hernia after 14 days from an exploratory laparotomy surgery realized to treat colic syndrome. After 6months, the patient was referred to a Veterinary Medicine Teaching Hospital for the correction of the defect in the abdominal wall. During palpation, the animal did not present local pain or other sign of inflammation, and the hernia measuredapproximately 20 cm in diameter. The animal was submitted to general anesthesia and placed in dorsal decubitus for thehernioplasty surgical procedure. An incision was made in cranial region of the midline, close to the xiphoid to introduce asingle port; the abdomen was inflated with CO2 gas (12 mmHg) and the operating table was tilted in order to displace theorgans cranially, facilitating the laparoscopic procedure. The abdomen was inspected and the presence of a single adherence could be observed, which was disrupted with endoscopic forceps. The mesh was introduced through the single port...(AU)

Evolução do saneamento básico e a sua relação com a saúde pública / Basic sanitation evolution and its relationship with public health

O objetivo deste trabalho é apresentar uma revisão bibliográfica da evolução do saneamento básico brasileiro em 50 anos, mostrando as técnicas atuais tratamento de água e esgoto, e relacionando estes dados com a incidência de Doenças Relacionadas ao Saneamento Ambiental Inadequado (DRSAI). Busca de livros, protocolos e artigos no Google Acadêmico com a pesquisa de palavras-chave correspondentes a (1) "Saneamento Básico and 1970 a 2020", (2) "Saneamento Básico and Realidade no Brasil", (3) "Técnicas de Saneamento", (4) "Saneamento and Urbanização", (5) "Saneamento inadequado and doenças", (6) "Doenças relacionadas ao saneamento ambiental inadequado" e (7) "Saneamento and arboviroses". O saneamento é um direito assegurado por Lei, e deve ser universalizado até 2030, de acordo com os objetivos para o desenvolvimento sustentável. O saneamento básico brasileiro evoluiu em 50 anos, porém ainda não é universal, como por exemplo, cerca de 10% região Norte tem acesso ao esgoto tratado. A ausência do saneamento, ou sua prestação de observadas em locais de acesso desigual ao saneamento básico e também em locais de urbanizados, como no Estado de São Paulo, um dos locais de maior acesso de água e esgoto tratados, apresenta alta incidência de arbovirose. Apesar do prazo para universalização do saneamento básico, o Brasil ainda se encontra distante desse cenário ideal. Além disso, a urbanização também torna o ambiente insalubre, propiciando a incidência de DRSAI. Sendo assim, para melhorias na saúde pública, é imprescindível a existência de um serviço adequado de tratamento e abastecimento de água e esgoto

This work aims to present a bibliographic review about the Brazilian basic sanitation evolution in 50 years, showing water and sewage treatment techniques and relating this data to Diseases Related to Inadequate Environmental Sanitation (DRIES) incidence. Search for books, protocols and articles on Google Scholar with the search for keywords corresponding to (1) "Basic Sanitation and 1970 to 2020", (2) "Basic Sanitation and Brazil's Reality", (3) "Sanitation Techniques", (4) "Sanitation and Urbanization", (5) "Inadequate Sanitation and Diseases", (6) "Diseases Related to Inadequate Environmental Sanitation" and (7) "Sanitation and arboviruses". Sanitation is a right guaranteed by law and clean water and treated sewage shall be universalized until 2030, according to goals for sustainable development. The basic sanitation evolved in 50 years but stills not universal (i.e. about 10% of the Northern region has access to treated sewage). Sanitation absence or its ineffective service bring harm to health with DRIES. DRIES are more observed in places of unequal access to basic sanitation and also in urbanized places, as in the State of São Paulo, one of the places of greater access of treated water and sewage and also with higher incidence of arboviruses. Despite basic sanitation universalization deadline, Brazil is still far from this ideal scenario. Moreover, urbanization makes the environmental unhealthy, providing DRIES incidence. Thus, to public health improvements, proper basic sanitation service is essential