FREE-FARE POLICY AND PHYSICAL ACTIVITY PROMOTION: ITINERARY AND INITIAL REFLECTIONS / POLÍTICA DE TARIFA ZERO E PROMOÇÃO DE ATIVIDADE FÍSICA: ITINERÁRIO E REFLEXÕES INICIAIS

In order to indicate interfaces between the Zero-Fare (ZF) public transport policy and the promotion of physical activity (PA), based on a broader view of health, the text contextualizes the ZF policy and PA in Brazil, discussing the circumstances of PA practiced as a commute, which can be optional or necessary. Recognizing the concern of readers of a newspaper article about the impacts of ZF on the reduction of commuting PA, based on the "PA paradox", reflections are made on its associations with direct and indirect benefits to people's health, so that public policies can prioritize, in addition to free time, commuting PA that is optional, with adequate safety and infrastructure. Alongside the points of convergence, considerations are also given to the consolidation of these interfaces, observing different contextual barriers. ZF is a policy that, in addition to directly and indirectly guaranteeing rights, also dialogues with the PA promotion, based on a broader vision of health. Contrary to the hegemonic model of financing public transportation, which is exclusionary, we understand that the ZF is an important achievement in the field of citizenship and should not be seen as an "enemy" of the PA practice.

Com objetivo de indicar interfaces entre a política de Tarifa Zero (TZ) e a promoção da atividade física (AF), a partir da visão ampliada de saúde, o texto contextualiza a política de TZ e da AF no Brasil, discutindo as circunstâncias das AF praticadas como deslocamento, que podem ser opcionais ou por necessidade. Ao reconhecer a preocupação de leitores de uma matéria jornalística sobre os impactos da TZ na diminuição da AF de deslocamento, com base no "paradoxo da AF", são trazidas reflexões sobre suas associações à benefícios diretos e indiretos à saúde das pessoas, de modo que as políticas públicas possam priorizar, para além do tempo livre, as AF de deslocamentos que são opcionais, com segurança e infraestrutura adequada. Junto aos pontos de convergência, também são feitas ponderações à consolidação dessas interfaces, observando-se distintas barreiras contextuais. A TZ é uma política que, para além da garantia direta e indireta de direitos, também dialoga com a promoção da AF, a partir da visão ampliada de saúde. Na contramão do modelo hegemônico de financiamento do transporte público, que é excludente, entendemos que a TZ é uma conquista importante no âmbito da cidadania e não deve ser vista como "inimiga" da prática de AF.

Use of an assessment system for the allocation of human resources in the intrahospital transport of the patient admitted to an intensive care unit.

INTRODUCTION: Currently, in intensive care units (ICUs), the in-hospital transport (HIT) of patients is carried out without a unified criterion of personnel necessary for it. OBJECTIVE: To evaluate the concordance of the Patient Assessment System for Transport-ICU (PAST-ICU) with the medical criteria (CM) to determine the Human Resources (HR) and identify Adverse Effects (AE). METHODS: Descriptive, cross-sectional and prospective study of the IHT of patients admitted to an area of adult medical-surgical critical patients. The PAST-ICU instrument was created to recommend the HR of HIT. Through the assessment of clinical parameters, the Past-ICU indicates whether the HIT should be performed with (1) a stretcher-bearer (2) Stretcher-bearer/nurse or (3) stretcher-bearer/nurse/doctor. AE were recorded during the hospital transfer. Prior to the IHT, the nurse performed the PAST-ICU and the result was contrasted with the Medical Criteria (MC) responsible for the patient, the latter prevailing. STUDY PERIOD: Phase 1: pilot test 2013-2014. Phase 2: 2015-2021. VARIABLES: Reason and duration HIT, PAST-ICU sheet, checklist, AE. RESULTS: Phase 1: 458 IHT were analyzed. The concordance index between the PAST-ICU and the MC was 84,9% (389 IHT). The Cohen Kappa of 58,5% and p < 0,001. There were a total of 16 AE. Phase 2: 3423 IHT. The Concordance index of 87,2% (2984 TIH). The Cohen Kappa of 63%and the P < 0,001. Registered 49 AE. CONCLUSION: The PAST-ICU could be a useful, safe and reliable tool to adapt the necessary HR. There was good concordance between the PAST-ICU vs the MC to determine the HR in the HIT. The percentage of AE was low.

Safety of helicopter transport in patients with acute coronary syndrome / Seguridad del transporte en helicóptero en pacientes con síndrome coronario agudo

Abstract Background: ST-elevation myocardial infarction (STEMI) systems of care have reduced inter-hospital transfer times and facilitated timely reperfusion goals. Helicopters may be an option when land transportation is not feasible; however, the safety of air transport in patients with acute coronary syndrome (ACS) is a factor to consider. Objetives: The aim of this study was to evaluate the safety of helicopter transport for patients with ACS. Methods: Prospective, observational, and descriptive study including patients diagnosed with ACS within the STEMI network of a metropolitan city transferred by helicopter to a large cardiovascular center to undergo percutaneous coronary intervention. The primary outcome of the study was the incidence of air-travel-related complications defined as IV dislodgement, hypoxia, arrhythmia, angina, anxiety, bleeding, and hypothermia. Secondary outcomes included the individual components of the primary outcome. Results: A total of 106 patients were included in the study; the mean age was 54 years and 84.9% were male. The most frequent diagnosis was STEMI after successful fibrinolysis (51.8%), followed by STEMI with failed fibrinolysis (23.7%) and non-reperfused STEMI (9.4%). Five patients (4.7%) developed at least one complication: IV dislodgement (1.8%) and hypoxemia (1.8%) in two patients and an episode of angina during flight (0.9%). A flight altitude of > 10,000 ft was not associated with complications. Conclusions: The results of this study suggest that helicopter transportation is safe in patients undergoing acute coronary syndrome, despite the altitude of a metropolitan area.

Resumen Antecedentes: Los sistemas de atención de IAMCEST han reducido los tiempos de transferencia interhospitalaria y han facilitado las metas de reperfusión oportuna. Los helicópteros pueden ser una opción cuando el transporte terrestre no es factible; sin embargo, la seguridad del transporte aéreo en pacientes con síndrome coronario agudo (SICA) es un factor a considerar. Objetivos: Evaluar la seguridad del transporte en helicóptero para pacientes con SICA. Métodos: Estudio prospectivo, observacional, descriptivo. Se incluyeron pacientes con diagnóstico de SICA dentro de la red IAMCEST en metrópolis extensa, trasladados en helicóptero a un centro cardiovascular. El resultado primario del estudio fue la incidencia de complicaciones relacionadas con los viajes aéreos definidas cómo desalojo de catéter intravenoso, hipoxia, arritmia, angina, ansiedad, sangrado e hipotermia. Resultados: Total de 106 pacientes; la edad media fue de 54 años y 84,9% eran hombres. La altitud media de vuelo fue de 10,100 pies y la distancia media de vuelo fue de 50,0 km. El diagnóstico más frecuente fue IAMCEST tras fibrinolisis exitosa (51,8%), seguido de IAMCEST con fibrinolisis fallida (23,7%). Cinco pacientes (4,7%) desarrollaron una complicación: desalojo IV (1,8%) e hipoxemia (1,8%) en dos pacientes y un episodio de angina durante el vuelo (0,9%). Una altitud de vuelo mayor de 10,000 pies no se asoció a complicaciones. Conclusiones: Los resultados de este estudio sugieren que el transporte en helicóptero es seguro en pacientes con SICA, incluso en altitudes > 10,000 pies.

Cuidar da pessoa em situação critica no serviço de urgência: contributos do enfermeiro especialista para a qualidade dos cuidados / Caring for the critically ill person in the emergency department: the specialist nurse's contribution to the quality of care

Este relatório de estágio surge no âmbito do curso de Mestrado em Enfermagem Médico- Cirúrgica e pretende evidenciar as experiências e atividades desenvolvidas no sentido de adquirir e desenvolver competências especializadas. A estrutura do relatório teve como linha orientadora os domínios de competências definidas para o Enfermeiro Especialista pela Ordem dos Enfermeiros, enquadradas nos domínios académicos preconizados pela Instituição de Ensino. O perfil de conhecimentos e competências do Enfermeiro Especialista na área da pessoa em situação crítica deve responder de forma competente à frágil e complexa situação clínica, sendo o seu papel suportado por um quadro de competências diferenciadas enquadradas no respeito pelo Ser Humano e pelos seus direitos inalienáveis. Focados no crescimento e desenvolvimento de competências especificas na área da pessoa em situação crítica, bem como no contributo da visão diferenciada do Enfermeiro Especialista na melhoria da qualidade dos cuidados, procuramos dar resposta aos problemas encontrados na prática clínica. Das atividades desenvolvidas destacamos a criação de um fluxograma de apoio ao enfermeiro triador no encaminhamento interno dos doentes e de um protocolo terapêutico de atuação no adulto com febre na triagem de manchester. Evidenciamos também, o investimento resiliente no desenvolvimento e implementação de um protocolo complexo, no âmbito da prestação de cuidados em contexto de urgência, ao doente em estado de agitação/agressividade que visa mitigar um problema recorrente. No domínio académico da investigação desenvolvemos um estudo qualitativo com recurso à técnica de Focus Group, com o objetivo de construir um modelo de documentação padronizado, simplificado e facilitador do registo de enfermagem que documente a atuação do enfermeiro na avaliação e intervenção ao doente, durante o transporte inter-hospitalar. As conclusões deste estudo de investigação validaram um modelo de registo sustentado numa mnemónica, uniformizadora e facilitadora dos registos de enfermagem durante o transporte inter-hospitalar do doente crítico. Consideramos que as experiências que decorreram deste estágio foram fundamentais e permitiram o desenvolvimento das competências inerentes ao Enfermeiro Especialista.

This internship report appears within the scope of the Master's degree in Medical-Surgical Nursing and aims to highlight the experiences and activities developed in order to acquire and develop specialized skills. The structure of the report was guided by the domains of competences defined for the Specialist Nurse by the Order of Nurses, framed in the academic domains recommended by the Educational Institution. The profile of knowledge and skills of the Specialist Nurse in terms of people in critical situations must respond competently to the fragile and complex clinical situation, with their role supported by a framework of differentiated skills framed in respect for the Human Being and their inalienable rights . Focused on the growth and development of specific skills in the area of people in critical situations, as well as the contribution of the Specialized Nurse's differentiated vision to improving the quality of care, we seek to respond to problems encountered in clinical practice. The activities developed highlight the creation of a flowchart to support the triage nurse in the internal referral of patients and a therapeutic protocol for working with adults with fever in the manchester triage. We also highlight the resilient investment in the development and implementation of a complex protocol, within the scope of providing care in an emergency context, to patients in an agitated/aggressive state that aims to mitigate a recurring problem. In the academic domain of research, we developed a qualitative study using the Focus Group technique, with the objective of building a standardized, simplified documentation model that facilitates the nursing record that documents the nurse's role in evaluating and intervening with the patient, during the inter-hospital transport. The conclusions of this research study validated a recording model based on a mnemonic, standardizing and facilitating nursing records during the inter-hospital transport of critically ill patients. We consider that the experiences that took place during this internship were fundamental and allowed the development of skills inherent to Specialist Nurses.

Safety of helicopter transport in patients with acute coronary syndrome.

BACKGROUND: ST-elevation myocardial infarction (STEMI) systems of care have reduced inter-hospital transfer times and facilitated timely reperfusion goals. Helicopters may be an option when land transportation is not feasible; however, the safety of air transport in patients with acute coronary syndrome (ACS) is a factor to consider. OBJETIVES: The aim of this study was to evaluate the safety of helicopter transport for patients with ACS. METHODS: Prospective, observational, and descriptive study including patients diagnosed with ACS within the STEMI network of a metropolitan city transferred by helicopter to a large cardiovascular center to undergo percutaneous coronary intervention. The primary outcome of the study was the incidence of air-travel-related complications defined as IV dislodgement, hypoxia, arrhythmia, angina, anxiety, bleeding, and hypothermia. Secondary outcomes included the individual components of the primary outcome. RESULTS: A total of 106 patients were included in the study; the mean age was 54 years and 84.9% were male. The most frequent diagnosis was STEMI after successful fibrinolysis (51.8%), followed by STEMI with failed fibrinolysis (23.7%) and non-reperfused STEMI (9.4%). Five patients (4.7%) developed at least one complication: IV dislodgement (1.8%) and hypoxemia (1.8%) in two patients and an episode of angina during flight (0.9%). A flight altitude of > 10,000 ft was not associated with complications. CONCLUSIONS: The results of this study suggest that helicopter transportation is safe in patients undergoing acute coronary syndrome, despite the altitude of a metropolitan area.

ANTECEDENTES: Los sistemas de atención de IAMCEST han reducido los tiempos de transferencia interhospitalaria y han facilitado las metas de reperfusión oportuna. Los helicópteros pueden ser una opción cuando el transporte terrestre no es factible; sin embargo, la seguridad del transporte aéreo en pacientes con síndrome coronario agudo (SICA) es un factor a considerar. OBJETIVOS: Evaluar la seguridad del transporte en helicóptero para pacientes con SICA. MÉTODOS: Estudio prospectivo, observacional, descriptivo. Se incluyeron pacientes con diagnóstico de SICA dentro de la red IAMCEST en metrópolis extensa, trasladados en helicóptero a un centro cardiovascular. El resultado primario del estudio fue la incidencia de complicaciones relacionadas con los viajes aéreos definidas cómo desalojo de catéter intravenoso, hipoxia, arritmia, angina, ansiedad, sangrado e hipotermia. RESULTADOS: Total de 106 pacientes; la edad media fue de 54 años y 84,9% eran hombres. La altitud media de vuelo fue de 10,100 pies y la distancia media de vuelo fue de 50,0 km. El diagnóstico más frecuente fue IAMCEST tras fibrinolisis exitosa (51,8%), seguido de IAMCEST con fibrinolisis fallida (23,7%). Cinco pacientes (4,7%) desarrollaron una complicación: desalojo IV (1,8%) e hipoxemia (1,8%) en dos pacientes y un episodio de angina durante el vuelo (0,9%). Una altitud de vuelo mayor de 10,000 pies no se asoció a complicaciones. CONCLUSIONES: Los resultados de este estudio sugieren que el transporte en helicóptero es seguro en pacientes con SICA, incluso en altitudes > 10,000 pies.

Effect of turbinate surgery on mucociliary clearance. A systematic review and metanalysis / Efecto de la cirugía turbinal en el aclaramiento mucociliar. Revisión sistemática y metaanálisis

Despite the fact that turbinate surgery provides satisfactory results regarding nasal obstruction, most of these procedures are destructive, to some extent, for the respiratory epithelium. There are valid hypotheses suggesting either that turbinate surgery may improve mucociliary clearance (MCC) by improving rhinitis, as well hypotheses suggesting that these surgeries may impair it by damaging the nasal ciliated epithelia. This systematic review is designed with the objective of exploring the effect of turbinate surgery on MCC. Pubmed (Medline), the Cochrane Library, EMBASE, SciELO were analyzed. Four authors members of the YO-IFOS rhinology study group independently analyzed the articles. Extracted variables encompassed: sample size, age, indication for surgery, surgical technique, method used to measure mucociliary clearance, mucociliary transport time before and after surgery, and main outcome. 15 studies with a total population of 1936 participants (1618 patients excluding healthy controls) met the inclusion criteria. 9 studies could be combined in a metanalysis, wich revealed a non-statistically significant decrease of 3.86 min in MCTT after turbinate surgery (p = 0.06). The subgroup analysis of the 5 cohorts who underwent microdebrider turbinoplasty reached statistical significance under a random effect model, revealing a 7.02 min decrease in MCTT (p < 0.001). The laser turbinoplasty subgroup, composed of 4 cohorts, also reached significance, although the difference was lower than that for microdebrider turbinoplasty, 1.01 min (p < 0.001). This systematic review and meta-analysis suggests that turbinate surgery does not compromise mucociliary clearance. The available evidence also suggests that turbinate surgery with mucosa sparing techniques improves MCC, while with aggressive techniques it increases or remains the same. ... . (AU)

A pesar de que la cirugía turbinal tiene efectos positivos en la ventilación nasal, gran parte de estos procedimientos son agresivos con el epitelio respiratorio. Existen hipótesis que sugieren que la cirugía turbinal puede mejorar el aclaramiento mucociliar (AMC) al mejorar la rinitis, así como alterarlo al lesional el epitelio nasal. Esta revisión se diseña con el objetivo de explorar el efecto de la cirugía turbinal en el AMC. Se revisó Pubmed (Medline), the Cochrane Library, EMBASE, SciELO. 4 autores miembros de YO-IFOS grupo de estudio en rinología, analizaron de manera independiente los artículos. Las variables analizadas fueron tamaño muestral, edad, indicación quirúrgica, técnica quirúrgica, método de medición de AMC, AMC antes y después de la cirugía y resultado principal. Se incluyeron 15 estudios con 1936 participantes (1618 excluyendo controles sanos). 9 estudios fueron combinados en un metanálisis que demostró una diferencia no estadísticamente significativa de -3,86 minutos en AMC tras cirugía (p = 0,06). El análisis por subgrupos de las 5 cohortes sometidas a turbinoplastia con microdebridador si fueron estadísticamente significativas con una diferencia de -7,02 minutos (p < 0,001). El grupo sometido a laser (4 cohortes) también obtuvo diferencia estadística, aunque menor, -1,01 minutos (p < 0,001). Esta revision y metaanálisis sugiere que la cirugía turbinal no afecta al aclaramiento mucociliar. La evidencia disponible también sugiere que las técnicas menos agresivas con la mucosa mejoran el AMC, mientras que las agresivas podrían aumentarlo o no modificarlo. Este efecto beneficioso se observa desde el 1º al 3º mes postquirúrgico. Sin embargo, para poder obtener adecuadas conclusiones, debe existir un método estandarizado para medir el AMC, así como un método para describir adecuadamente la extensión quirúrgica. (AU)

Wildlife mortality risk posed by high and low traffic roads.

Wildlife mortality due to collisions with vehicles (roadkill) is one of the predominant negative effects exerted by roads on many wildlife species. Reducing roadkill is therefore a major component of wildlife conservation. Roadkill is affected by various factors, including road attributes and traffic volume. It is theorized that the effect of traffic volume on roadkill probability should be unimodal. However, empirical evidence for this theory is lacking. Using a large-scale roadkill database of 18 wildlife species in Israel, encompassing 2846 km of roads over 10 years, we explored the effects of traffic volume and road attributes (e.g., road lighting, verge vegetation) on roadkill probability with a multivariate generalized linear mixed model. A unimodal effect of traffic volume was identified for the striped hyena (Hyaena hyaena), whereas 5 species demonstrated a novel quadratic U-shaped effect (e.g., golden jackal [Canis aureus]). Four species showed a negative linear effect (e.g., wild boar [Sus scrofa]). We also identified varying effects of road attributes on roadkill. For instance, road lighting and roadside trees decreased roadkill for several species, whereas bus stops and concrete guardrails led to increased roadkill. The theorized unimodal effect of traffic volume may only apply to large, agile species, and the U-shaped effect could be related to intraspecies variability in traffic avoidance behavior. In general, we found that both high-traffic and low-traffic roads can pose a high mortality risk for wildlife. It is therefore important to monitor roadkill on low-traffic roads and adapt road attributes to mitigate roadkill. Road design for effective roadkill mitigation includes reducing the use of concrete guardrails and median barriers where possible and avoiding dense bushes in verge landscaping. These measures are complemented by employing wildlife detection systems, driver warnings, and seasonal speed reduction measures on low-traffic roads identified as roadkill hotspots.

Riesgo de mortalidad de fauna presentado por las carreteras de mucho y poco tráfico Denneboom et al. 23­229 Resumen La mortalidad de fauna por colisiones con vehículos es uno de los efectos negativos predominantes que tienen las carreteras sobre muchas especies. Por lo tanto, la reducción de esta mortalidad es un componente principal de la conservación de la fauna. Esta mortalidad se ve afectada por varios factores, incluyendo las características de la carretera y el volumen de tráfico. Se piensa que el efecto del volumen de tráfico sobre la probabilidad de las colisiones debería ser unimodal; sin embargo, la evidencia empírica para esta teoría no es suficiente. Usamos una base de datos de colisiones de 18 especies de fauna en Israel que engloba 2,846 km de carreteras durante diez años para explorar con un modelo mixto lineal generalizado multivariado los efectos del volumen de tráfico y las características de la carretera (p. ej., iluminación, vegetación de borde) sobre la probabilidad de colisiones. Identificamos un efecto unimodal del volumen del tráfico para la hiena rayada (Hyaena hyaena), mientras que cinco especies demostraron un efecto cuadrático novedoso en forma de U, como el chacal dorado (Canis aureus). Cuatro especies mostraron un efecto negativo lineal, como el jabalí salvaje (Sus scrofa). También identificamos varios efectos de las características de la carretera sobre las colisiones. Por ejemplo, la iluminación y los árboles en los bordes disminuyeron las colisiones para varias especies, mientras que las paradas de camión y los quitamiedos de concreto resultaron en un incremento de las colisiones. La teoría del efecto unimodal del volumen de tráfico podría aplicar sólo para especies grandes y ágiles, mientras que el efecto en forma de U podría relacionarse con la variabilidad de comportamiento para evitar colisiones que hay entre las especies. En general, descubrimos que tanto las carreteras con poco y mucho tráfico pueden representar un riesgo de mortalidad para la fauna. Por lo tanto, es importante monitorear las colisiones en las carreteras con poco tráfico y adaptar las características de la carretera para mitigar las colisiones. El diseño de las carreteras para una mitigación efectiva incluye reducir el uso de quitamiedos de concreto y barreras centrales en donde sea posible y evitar los arbustos densos en el paisajismo de los bordes. Estas medidas están complementadas con el uso de sistemas de detección de fauna, señalamientos para los conductores y medidas estacionales de reducción de la velocidad en las carreteras de poco tráfico identificadas como puntos calientes de colisiones.

Effect of turbinate surgery on mucociliary clearance. A systematic review and metanalysis.

Despite the fact that turbinate surgery provides satisfactory results regarding nasal obstruction, most of these procedures are destructive, to some extent, for the respiratory epithelium. There are valid hypotheses suggesting either that turbinate surgery may improve mucociliary clearance (MCC) by improving rhinitis, as well hypotheses suggesting that these surgeries may impair it by damaging the nasal ciliated epithelia. This systematic review is designed with the objective of exploring the effect of turbinate surgery on MCC. Pubmed (Medline), the Cochrane Library, EMBASE, SciELO were analyzed. Four authors members of the YO-IFOS rhinology study group independently analyzed the articles. Extracted variables encompassed: sample size, age, indication for surgery, surgical technique, method used to measure mucociliary clearance, mucociliary transport time before and after surgery, and main outcome. 15 studies with a total population of 1936 participants (1618 patients excluding healthy controls) met the inclusion criteria. 9 studies could be combined in a metanalysis, wich revealed a non-statistically significant decrease of 3.86 min in MCTT after turbinate surgery (p = 0.06). The subgroup analysis of the 5 cohorts who underwent microdebrider turbinoplasty reached statistical significance under a random effect model, revealing a 7.02 min decrease in MCTT (p < 0.001). The laser turbinoplasty subgroup, composed of 4 cohorts, also reached significance, although the difference was lower than that for microdebrider turbinoplasty, 1.01 min (p < 0.001). This systematic review and meta-analysis suggests that turbinate surgery does not compromise mucociliary clearance. The available evidence also suggests that turbinate surgery with mucosa sparing techniques improves MCC, while with aggressive techniques it increases or remains the same. This beneficial effect is evident since the first to third month after surgery. However, for solid conclusions, a standard way to measure MCTT should be stablished, as well as a method to appropriately describe the extension of the surgery.

Desigualdades regionais no acesso ao parto hospitalar no Estado do Rio de Janeiro, Brasil: redes de deslocamento, distância e tempo (2010-2019) / Regional inequalities in access to hospital birth in the state of Rio de Janeiro, Brazil: travel networks, distance, and time (2010-2019) / Desigualdades regionales en el acceso al parto hospitalario en el estado de Río de Janeiro, Brasil: redes de desplazamiento, distancia y tiempo (2010-2019)

Resumo: A dificuldade de acesso aos serviços de atenção ao parto está associada à mortalidade infantil e neonatal e à morbimortalidade materna. Neste estudo, dados do Sistema Único de Saúde (SUS) foram utilizados para mapear a evolução da acessibilidade geográfica ao parto hospitalar de risco habitual no Estado do Rio de Janeiro, Brasil, correspondentes a 418.243 internações nos biênios 2010-2011 e 2018-2019. Foram estimados os fluxos de deslocamento, as distâncias percorridas e o tempo de deslocamento intermunicipal entre o município de residência e de internação das gestantes. Houve um crescimento de 15,9% para 21,5% na proporção de gestantes que precisaram se deslocar. A distância percorrida aumentou de 24,6 para 26km, e o tempo de deslocamento de 76,4 para 96,1 minutos, com grande variação entre as Regiões de Saúde (RS). As gestantes residentes na RS Centro Sul se deslocaram mais frequentemente (37,4-48,9%), e as residentes nas RS Baía da Ilha Grande e Noroeste percorreram as maiores distâncias (90,9-132,1km) e levaram mais tempo para chegar ao hospital no último biênio (96-137 minutos). A identificação dos municípios que receberam gestantes de muitos outros municípios e daqueles que atenderam maior volume de gestantes (núcleos e polos de atração, respectivamente) refletiu a indisponibilidade e as disparidades no acesso aos serviços. As desigualdades regionais e a redução da acessibilidade alertam para a necessidade de adequar a oferta à demanda e de revisar a distribuição dos serviços de atenção ao parto no Rio de Janeiro. O estudo contribui para as pesquisas e o planejamento sobre o acesso a serviços de saúde materno-infantil, além de servir como referência para outros estados do país.

Abstract: Difficult access to birth care services is associated with infant and neonatal mortality and maternal morbidity and mortality. In this study, data from the Brazilian Unified National Health System (SUS) were used to map the evolution of geographic accessibility to hospital birth of usual risk in the state of Rio de Janeiro, Brazil, corresponding to 418,243 admissions in 2010-2011 and 2018-2019. Travel flows, distances traveled, and intermunicipal travel time between the pregnant women's municipality and hospital location were estimated. An increase from 15.9% to 21.5% was observed in the number of pregnant women who needed to travel. The distance traveled increased from 24.6 to 26km, and the travel time from 76.4 to 96.1 minutes, with high variation between Health Regions (HR). Pregnant women living in HR Central-South traveled more frequently (37.4-48.9%), and those living in the HRs Baía da Ilha Grande and Northwest traveled the largest distances (90.9-132.1km) and took more time to get to the hospital in 2018-2019 (96-137 minutes). The identification of municipalities that received pregnant women from many other municipalities and municipalities that treated a higher number of pregnant women (hubs and attraction poles, respectively) reflected the unavailability and disparities in access to services. Regional inequalities and reduced accessibility highlight the need to adapt supply to demand and review the distribution of birth care services in the state of Rio de Janeiro. This study contributes to research and planning on access to maternal and child health services and can be used as a reference study for other states in the country.

Resumen: La dificultad para acceder a los servicios de atención al parto está asociada con la mortalidad infantil y neonatal, y con la morbimortalidad materna. En este estudio, se utilizaron datos del Sistema Único de Salud (SUS) para mapear la evolución de la accesibilidad geográfica al parto hospitalario de riesgo habitual en el estado de Río de Janeiro, Brasil, correspondiente a 418.243 hospitalizaciones en los bienios 2010-2011 y 2018-2019. Se estimaron los flujos de desplazamiento, las distancias recorridas y el tiempo de desplazamiento intermunicipal entre el municipio de residencia y la hospitalización de las mujeres embarazadas. Hubo un aumento del 15,9% al 21,5% en la proporción de mujeres embarazadas que necesitaron desplazarse. La distancia recorrida aumentó de 24,6 a 26km y el tiempo de desplazamiento de 76,4 a 96,1 minutos, con gran variación entre las Regiones de Salud (RS). Las mujeres embarazadas residentes en la RS Centro Sul se desplazaron con mayor frecuencia (37,4-48,9%), y las residentes en las RS Baía da Ilha Grande y Noroeste recorrieron las mayores distancias (90,9-132,1km) y tardaron más en llegar al hospital en el últimos bienio (96-137 minutos). La identificación de los municipios que recibieron mujeres embarazadas de muchos otros municipios y de aquellos que atendieron a un mayor volumen de mujeres embarazadas (núcleos y polos de atracción, respectivamente) reflejó la indisponibilidad y las disparidades en el acceso a los servicios. Las desigualdades regionales y la reducida accesibilidad alertan sobre la necesidad de adaptar la oferta a la demanda, y de revisar la distribución de los servicios de atención al parto en el estado de Rio de Janeiro. El estudio contribuye a las investigaciones y a la planificación sobre el acceso a los servicios de salud materno-infantil, y puede servir como referencia para otros estados del país.

Food environment of bus terminals in the Rio de Janeiro metropolitan region / Ambiente alimentar de terminais rodoviários da região metropolitana do Rio de Janeiro

ABSTRACT PURPOSE To describe and analyze the healthiness of formal and informal food establishments in bus terminals of the metropolitan region of the state of Rio de Janeiro. METHOD An audit was conducted in 156 formal and 127 informal food establishments located in 14 bus terminals of the five most populous cities of the metropolitan region of Rio de Janeiro. Proportions of types of establishments and means (95%CI) of food availability indicators in formal and informal settings were calculated. For the formal setting, prices, proportions of accepted payment methods, days and hours of operation, and food categories with displayed advertising were described. RESULTS The healthiness of food establishments in bus terminals was low (less than 36%). On average, ultra-processed food subgroups were 250% more available for purchase than fresh or minimally processed food. Purchasing food at these places was convenient because several forms of payment were available, and the opening hours of the establishments followed the peaks of movement. In addition, 73.3% of the advertising referred to ultra-processed drinks, and the cost-benefit of buying ultra-processed food was better than fresh or minimally processed food. CONCLUSION The food environment of bus terminals in the metropolitan region of Rio de Janeiro promotes unhealthy eating. Regulatory public policies should focus on initiatives to limit the wide availability and advertising of ultra-processed food in spaces of great circulation of people.

RESUMO OBJETIVO Descrever e analisar a saudabilidade dos estabelecimentos com venda formal e informal de alimentos em terminais rodoviários da região metropolitana do Rio de Janeiro. MÉTODOS Realizou-se auditoria em 156 estabelecimentos formais e 127 pontos informais de venda de alimentos localizados em 14 terminais rodoviários das cinco cidades mais populosas da região metropolitana do Rio de Janeiro. Foram calculadas proporções de tipos de estabelecimentos e médias (IC95%) de indicadores de disponibilidade de alimentos nos ambientes formal e informal. Para o ambiente formal, foram descritos preços, proporções das formas de pagamento aceitas, dias e horários de funcionamento e categorias de alimentos com propaganda exposta. RESULTADOS A saudabilidade dos pontos de venda de alimentos nos terminais rodoviários era baixa (inferior a 36%). Em média, estavam disponíveis para compra 250% mais subgrupos de alimentos ultraprocessados do que in natura ou minimamente processados. Adquirir comida nesses locais era conveniente porque diversas formas de pagamento estavam disponíveis e os horários de funcionamento dos estabelecimentos acompanhavam os picos de movimentação. Além disso, 73,3% das propagandas se referiam a bebidas ultraprocessadas e o custo-benefício da compra de alimentos ultraprocessados era melhor que o de alimentos in natura ou minimamente processados. CONCLUSÃO O ambiente alimentar dos terminais rodoviários da região metropolitana do Rio de Janeiro promove uma alimentação não saudável. Políticas públicas de regulação devem se concentrar em iniciativas que limitem a ampla disponibilidade e publicidade de alimentos ultraprocessados nesses espaços de grande circulação de pessoas.

Efectos de un programa de intervención escolar para promover el desplazamiento activo en bicicleta de los adolescentes / Effects of a School-Based Intervention Program to Promote Adolescents' Active Commuting by Cycling / Efeitos de um programa de intervenção escolar para promover o ciclismo ativo entre adolescentes

Resumen: Objetivo: El objetivo del presente estudio fue evaluar los efectos de un programa escolar sobre la satisfacción de la competencia y la predisposición a participar en una Unidad Didáctica (UD) de bicicleta todo terreno (BTT) en Educación Física, así como el estado de la conducta de desplazarse en bicicleta. Método: Se realizó un diseño cuasiexperimental, sin grupo control, en el que participaron 98 estudiantes españoles (M=13.95±0.67; 50% chicas) de un centro educativo. El programa de intervención, basado en estrategias de apoyo a la competencia, consistió en una UD de BTT (12 sesiones), el plan de acción tutorial (4 sesiones) y una actividad extraescolar. Resultados: Se encontró un incremento en la satisfacción de competencia (únicamente en los chicos) y la predisposición hacia la UD de BTT en los dos géneros. Asimismo, se incrementó en un 39 % en los chicos y 43 % en las chicas, los estados de "Acción" y "Mantenimiento" en la conducta de desplazarse en bicicleta. Conclusión: Este programa multicomponente, basado en estrategias de apoyo a la competencia, parece ser efectivo para promover el desplazamiento activo en bicicleta entre los adolescentes.

Abstract: Objective: This study aimed to evaluate the effects of a school-based intervention program on competence satisfaction, the predisposition to participate in a cycling Didactic Unit (DU) in Physical Education, and the behavior of commuting by bicycle. Method: The study had a quasi-experimental design without a control group, in which 98 Spanish students (M=13.95±0.67; 50% girls) from a high school participated. The intervention program based on supporting competence consisted of a cycling DU (12 sessions), a tutorial action plan (4 sessions), and an extracurricular activity. Results: An increase in competence satisfaction was found only in boys, and the predisposition towards cycling DU was found in both genders. Likewise, the states of "Action" and "Maintenance" in the behavior of commuting by bicycle increased by 39% in boys and 43% in girls. Conclusion: This multi-component program based on strategies to support competence effectively promotes active bicycle commuting among adolescents.

Resumo: Objetivo: O objetivo do presente estudo era avaliar os efeitos de um programa escolar sobre a satisfação com a competição e a predisposição para participar de uma Unidade Didática (UD) relativa ao ciclismo de montanha (MTB) em Educação Física, bem como o estado do comportamento do ciclista. Métodos: noventa e oito estudantes espanhóis (M=13,95±0,67; 50% meninas) de uma escola participaram de um projeto quase experimental, sem grupo de controle. O programa de intervenção, baseado em estratégias de apoio à competência, consistiu em um MTB UD (12 sessões), o plano de ação tutorial (4 sessões) e uma atividade extracurricular. Resultados: Encontramos um aumento na satisfação com a competência (somente em meninos) e predisposição para a MTB em ambos os sexos. Além disso, os estados de "Ação" e "Manutenção" no comportamento ciclístico aumentaram em 39% nos meninos e 43% nas meninas. Conclusão: Este programa multicomponente, baseado em estratégias de apoio à competência, parece ser eficaz na promoção do ciclismo ativo entre os adolescentes.

Transporte inter-hospitalar da pessoa em situação crítica: Vivências dos enfermeiros de uma ilha de Cabo Verde / Inter-hospital transport of the critically ill: The experience of nurses from a Cape Verdean Island / Transporte interhospitalario de pacientes en estado crítico: Experiencias del personal de enfermería en una isla de Cabo Verde

Resumo Enquadramento: A transferência inter-hospitalar da pessoa em situação crítica entre ilhas de um país insular decorre da necessidade de acesso a recursos de maior complexidade, cujas condições de transporte/assistência são determinantes para a sobrevivência do doente. Objetivo: Identificar os principais sentimentos e dificuldades vivenciados pelos enfermeiros de uma ilha de Cabo Verde no que concerne ao transporte inter-hospitalar da pessoa em situação crítica. Metodologia: Estudo qualitativo, por entrevista semiestruturada a um grupo focal de enfermeiros. Resultados: Das principais dificuldades apontadas emergiram como subcategorias - Carência/dificuldades ao nível dos meios de transporte; carência de recursos materiais apropriados para assistência durante o transporte; Dificuldades para assegurar o conforto e privacidade do doente; Problemas ao nível da rede referenciação/comunicação inter-hospitalar; Ausência de médico durante o transporte; Problemas relativos ao regresso dos enfermeiros ao hospital de origem. Um leque de sentimentos negativos como a angústia, o medo, as preocupações, entre outros, decorrem das dificuldades vivenciadas. Conclusão: Os relatos dos enfermeiros possibilitam um primeiro diagnóstico da situação, ao nível dos recursos, planeamento e efetivação do transporte.

Abstract Background: Inter-hospital transport of critically ill patients between islands in an island nation is driven by the need for access to more complex health resources. In this context, transport and care delivery conditions are crucial to patient survival. Objective: To identify the main feelings and difficulties of nurses from a Cape Verdean island regarding the inter-hospital transport of critically ill patients. Methodology: This qualitative study was conducted using semi-structured interviews with a focus group of nurses. Results: From the main difficulties identified, the following subcategories emerged: Lack of/difficulties with means of transport; Lack of adequate material resources to assist during transport; Difficulties in ensuring patient comfort and privacy; Problems with inter-hospital referral/communication network; Absence of a physician during transport; and Costs associated with the inability of the nurse to return immediately after delivering the patient. Several negative feelings, such as anguish, fear, and worry, resulted from the difficulties experienced by the nurses. Conclusion: The nurses' statements provide an initial diagnosis of the situation regarding the resources, planning, and execution of inter-hospital transport of critically ill patients.

Resumen Marco contextual: El traslado interhospitalario de un paciente en estado crítico entre islas de un país insular se debe a la necesidad de acceder a recursos más complejos, cuyas condiciones de transporte/asistencia son decisivas para la supervivencia del paciente. Objetivo: Identificar las principales sensaciones y dificultades experimentadas por los enfermeros de una isla de Cabo Verde en relación con el transporte interhospitalario de pacientes en estado crítico. Metodología: Estudio cualitativo, mediante entrevistas semiestructuradas con un grupo focal de enfermeros. Resultados: De las principales dificultades surgieron las siguientes subcategorías - Carencia/dificultades de medios de transporte; Carencia de recursos materiales adecuados para la asistencia durante el transporte; Dificultades para garantizar el confort y la intimidad del paciente; Problemas con la red de derivación/comunicación interhospitalaria; Ausencia de médico durante el transporte; Problemas relacionados con el regreso de los enfermeros al hospital de origen. De las dificultades experimentadas se derivan una serie de sentimientos negativos como angustia, miedo, preocupación, entre otros. Conclusión: Los informes de los enfermeros proporcionan un diagnóstico inicial de la situación, en cuanto a recursos, planificación y ejecución del transporte.

Misleading images of ductal carcinoma in situ: 4 lymph nodes with metastasis / Imágenes equívocas de carcinoma ductal in situ: 4 ganglios linfáticos con metástasis

Since sentinel lymph node examination became routine, findings of benign ectopic breast tissue in lymph nodes have increased. We report images of ductal carcinoma in situ (DCIS) in four lymph nodes in a 76-year-old woman with bilateral breast carcinoma. The right lumpectomy showed intermixed invasive lobular and ductal carcinoma, plus DCIS. 19 nodes were isolated in the axillary lymphadenectomy, 4 of which displayed solid and cribriform DCIS. Myosin and p63 immunohistochemical techniques were positive, suggesting an erroneous diagnosis of “metastatic DCIS”. A further three cases of DCIS in lymph nodes have been previously reported, all with a distinct layer of myoepithelial cells with actin, myosin or p63. Biologically, these images of DCIS in lymph nodes are not credible and three major hypotheses have been proposed to explain these findings: Iatrogenic Mechanical Transport, Revertant DCIS, and primary DCIS of lymph nodes. We consider the first one the most plausible explanation. Our case is unique as several, rare findings are simultaneously observed. More new cases, together with additional immunohistochemical techniques and molecular testing on previous cases, are needed to find a definitive explanation of this histologic finding.(AU)

A partir del uso rutinario del examen del ganglio centinela, los hallazgos de tejido mamario ectópico son frecuentes. Presentamos los hallazgos de carcinoma ductal in situ (CDIS) en 4 ganglios linfáticos en una mujer de 76 años con carcinoma de mama bilateral. La lumpectomía derecha mostró una mezcla de patrones de carcinomas ductal y lobular infiltrante, además de CDIS. De los 19 ganglios aislados, 4 mostraron patrones cribiformes y sólidos de CDIS. La miosina y la p63 fueron positivas, sugiriendo un diagnóstico erróneo de «CDIS metastático». En la literatura se han comunicado 3 casos adicionales de patrones de CDIS en ganglios linfáticos, mostrando capa periférica de células mioepiteliales positivas para actina, miosina o p63. Desde un punto de vista biológico, estos hallazgos de CDIS en ganglios linfáticos son discutibles, proponiéndose 3 hipótesis para explicarlo: transporte mecánico yatrogénico, CDIS revertido y CDIS primario de ganglio linfático. Creemos que la primera alternativa es la más plausible. Nuestro caso es único al mostrar, de modo conjunto, diversos hallazgos infrecuentes. El estudio de nuevos casos, así como la aplicación de técnicas inmunohistoquímicas y moleculares a casos de archivo, arrojarían datos que permitirían llegar a una explicación definitiva de este hallazgo histológico.(AU)

Misleading images of ductal carcinoma in situ: 4 lymph nodes with metastasis.

Since sentinel lymph node examination became routine, findings of benign ectopic breast tissue in lymph nodes have increased. We report images of ductal carcinoma in situ (DCIS) in four lymph nodes in a 76-year-old woman with bilateral breast carcinoma. The right lumpectomy showed intermixed invasive lobular and ductal carcinoma, plus DCIS. 19 nodes were isolated in the axillary lymphadenectomy, 4 of which displayed solid and cribriform DCIS. Myosin and p63 immunohistochemical techniques were positive, suggesting an erroneous diagnosis of "metastatic DCIS". A further three cases of DCIS in lymph nodes have been previously reported, all with a distinct layer of myoepithelial cells with actin, myosin or p63. Biologically, these images of DCIS in lymph nodes are not credible and three major hypotheses have been proposed to explain these findings: Iatrogenic Mechanical Transport, Revertant DCIS, and primary DCIS of lymph nodes. We consider the first one the most plausible explanation. Our case is unique as several, rare findings are simultaneously observed. More new cases, together with additional immunohistochemical techniques and molecular testing on previous cases, are needed to find a definitive explanation of this histologic finding.

Patrones de actividad de mamíferos alrededor de la línea transportadora de gas natural de Camisea en la Reserva Comunal Machiguenga, Cusco, Perú

En el presente trabajo se estudia la actividad horaria de los mamíferos que habitan el área circundante a la línea transportadora de gas de Camisea que atraviesa la Reserva Comunal Machiguenga. Desde febrero del 2020 hasta enero del 2021, se realizó un registro fotográfico mediante cámaras trampa dispuestas a lo largo de la tubería de gas. Los patrones de actividad se estimaron mediante la función de densidad de Kernel. Durante el periodo de estudio, se registraron 25 especies de mamíferos. Se encontró que Dasyprocta kalinowskii y Eira barbara presentan un patrón de actividad diurno; mientras que Cuniculus paca, Tapirus terrestris, Dasypus spp. y Mazama spp. presentan un patrón predominantemente nocturno. Se sugiere que los patrones de actividad observados estarían influenciados por varios factores como la exclusión competitiva entre D. kalinowskii y C. paca, disponibilidad estacional del alimento para T. terrestris, variación de temperatura y precipitación para Dasypus spp., restricciones filogenéticas en Mazama spp., y segregación temporal con otros carnívoros para E. barbara. Se destaca la importancia de la colaboración entre las empresas del rubro energético, las comunidades nativas y las organizaciones gubernamentales.

The present study investigates the hourly activity patterns of mammals inhabiting the area surrounding the Camisea gas pipeline that crosses the Machiguenga Communal Reserve. From February 2020 to January 2021, a photographic record was conducted using camera traps placed along the gas pipeline. Activity patterns were estimated using Kernel density functions. During the study period, 25 mammal species were recorded. It was found that Dasyprocta kalinowskii and Eira barbara exhibit a diurnal activity pattern, whereas Cuniculus paca, Tapirus terrestris, Dasypus spp., and Mazama spp. display predominantly nocturnal behavior. It is suggested that observed activity patterns could be influenced by various factors such as competitive exclusion between D. kalinowskii and C. paca, seasonal food availability for T. terrestris, temperature and precipitation variations for Dasypus spp., phylogenetic constraints in Mazama spp., and temporal segregation with other carnivores for E. barbara. The significance of collaboration between energy industry companies, native communities, and governmental organizations is emphasized.

Intervención del helicóptero sanitario de Aragón en los accidentes de tráfico antes y durante la pandemia por covid-19 / Intervention of the Aragon medical helicopter in traffic accidents before and during the covid-19 pandemic

Objetivo: Describir la prevalencia y características de los accidentes de tráfico atendidos por helicópteros sanitarios en un periodo de 5 años y durante el año de confinamiento. Método: Estudio descriptivo transversal sobre la actividad asistencial en los accidentes de tráfico de los Helicópteros Sanitarios del 112 Aragón entre el 1 de enero de 2013 y el 31 de diciembre de 2017 y su comparación con 2020, año de la pandemia por COVID-19. Resultados: De los 1.375 pacientes atendidos durante el periodo 2013-2017, 259 fueron por accidentes de tráfico, siendo aproximadamente el 76% hombres y el 24% mujeres. La media de edad fue de 45 años (± 19,15). Un 93,4% de estos avisos fueron primarios y el 21,2% requeridos por otros servicios extrahospitalarios. El tiempo de respuesta fue, en el 49,6% de los casos, de 30 o menos minutos. La patología más frecuente fue la traumatológica, con un 97,6% de pacientes. El 45,9% de accidentes se produjeron en carreteras comarcales o locales. Durante el año 2020, se atendieron 25 casos por accidentes de tráfico, de un total de 274. La mayoría de pacientes atendidos fueron hombres (92%). La edad media fue de 46,7 años (± 15,25). En el 56% de los casos, los pacientes fueron atendidos en un máximo de 30 minutos, siendo la patología más frecuente la traumatológica, con un 96% de casos. La mitad de accidentes se produjeron en carreteras comarcales y locales. Conclusiones: La utilización del helicóptero sanitario en accidentes de tráfico permite auxiliar a sus víctimas en su mayoría antes de 30 minutos. El tiempo medio de respuesta del helicóptero fue significativamente inferior al tiempo por carretera. La pandemia por COVID-19 redujo el porcentaje de las intervenciones en accidentes de tráfico en relación a las totales del helicóptero y aumentó la atención a hombres frente a mujeres. (AU)

Objective: To describe the prevalence and characteristics of traffic accidents attended by medical helicopters. Method: Describe the prevalence and characteristics of traffic accidents attended by medical helicopters in a period of 5 years and during the year of confinement. Results: Out of the 1,376 patients attended during this period, 259 were due to traffic accidents, with approximately 76% men and 24% women. The mean age was 45 years (± 19,15). 93.4% of these transfers were primary and 21.2% requiered by other out-of-hospital services. The response time was, in the 49.6% of the cases, 30 minutes or less. The most frequent pathology was trauma, with 97.6% of patients. 45.9% of accidents occurred on county or local roads. During the year 2020, 25 cases of traffic accidents were attended, out of a total of 274. The majority of patients attended were men (92%). The mean age was 46.7 years (± 15.25). In 56% of the cases, the patients were treated in a maximum of 30 minutes, the most frequent pathology being traumatology, with 96% of cases. Half of the accidents occurred on county and local roads. Conclusion: The use of the sanitary helicopter in traffic accidents allows to assisting their victims in their majority before 30 minutes. Helicopter mean response time was significantly less than road time. The COVID-19 pandemic reduced the percentage of interventions in traffic accidents in relation to the total number of helicopters and increased attention to men compared to women. (AU)

Norma técnica de transporte seguro de materiales radiactivos / Technical standard for the safe transport of radioactive materials

La presente norma tiene por objeto, establecer los lineamientos técnicos para la protección de la salud de las personas y el medio ambiente, de los efectos de las radiaciones ionizantes durante el transporte de materiales radiactivos en el territorio nacional; establecer los requerimientos para la caracterización y embalaje de los materiales radiactivos y para el transporte de bultos exceptuados, bultos industriales y bultos del Tipo A, del Tipo B(M), y del Tipo B(U); es aplicable a toda persona natural o jurídica, instituciones públicas y autónomas, que realiza transporte de materiales radiactivos por vía terrestre, acuática o aérea, que contengan radionucleidos, en los cuales tanto la concentración de actividad como la actividad total de la remesa, sobrepasen a los valores límites de exención para materiales o remesas, así como del transporte de objetos contaminados, cuyos valores de contaminación excedan los valores limites que se especifican

The purpose of this standard is to establish technical guidelines for the protection of human health and the environment from the effects of ionizing radiation during the transport of radioactive materials within the national territory; establish requirements for the characterisation and packaging of radioactive materials and for the transport of excepted packages, industrial packages and packages of Type A, Type B(M), and Type B(U); is applicable to any natural or legal person, public and autonomous institutions carrying out transport of radioactive materials by land, water or air, containing radionuclides, in which both the activity concentration and the total activity of the consignment exceed the exemption limit values

Relationship between peritoneal solute transport and dialysate inflammatory markers in peritoneal dialysis patients: A cross-sectional study / Relación entre el transporte de soluto peritoneal y los marcadores inflamatorios del diálisis peritoneal en pacientes en diálisis peritoneal: un estudio transversal

Background: The associated factors of peritoneal small solute transport was not fully understood. This research aimed to investigate the connection between dialysate inflammatory markers (e.g. macrophage migration inhibitory factor, MIF) in peritoneal dialysis (PD) effluent and peritoneal solute transport rate (PSTR) properties. Subjects and design: A total of 80 stable PD patients in the First ShaoYang Hospital were enrolled in present study. Overnight PD effluent and serum inflammatory markers including MIF, MCP-1, VEGF, IL-6, TNFα and TGFβ were detected. Pearson correlation analysis and Logistic regression was performed to determine the risk factors for the increased PSTR. Results: A trend toward increased values of MIF, MCP-1 and IL-6 in PD effluent was observed in subjects with high PSTR when compared with those with low PSTR. The Pearson correlation test showed that D/P Cr exhibited positive correlations with dialysis effluent MIF (r=0.32, p=0.01), MCP-1 (r=0.47, p=0.01), IL-6 (r=0.48, p=0.01). Conversely, no significant correlation was found between D/P Cr and TGF-β (r=0.04, p=0.70), TNF-ɑ (r=0.22, p=0.05), VEGF (r=0.02, p=0.86) and serum inflammatory markers. In the unadjusted regression analysis, dialysis effluent MIF (OR 2.41), MCP-1 (OR 1.72), IL-6 (OR 1.55) were associated with high PSTR condition. Multivariate logistic regression analysis showed that the adjusted odds ratios (OR) of dialysis effluent MIF for high PSTR were 2.47 in all subjects (p=0.03). Conclusion: Elevated MIF, MCP-1 and IL-6 levels in PD effluent were associated with increased PSTR. Elevated dialysis effluent MIF levels was an independent risk factor for high PSTR in subjects with PD treatment. (AU)

Antecedentes: Los factores asociados del transporte peritoneal de pequeños solutos no se conocen completamente. Esta investigación tuvo como objetivo investigar la conexión entre los marcadores inflamatorios del dializado (por ejemplo, el factor inhibidor de la migración de macrófagos [MIF]) en el efluente de diálisis peritoneal (DP) y las propiedades de la tasa de transporte de solutos peritoneal (PSTR). Sujetos y diseño: Se incluyó un total de 80 pacientes con DP estable en el primer Hospital de Shaoyang. Se detectaron efluentes de DP nocturnos y marcadores inflamatorios séricos, incluyendo MIF, MCP-1, VEGF, IL-6, TNF -ɑ, TGF -β. Se realizó un análisis de correlación de Pearson y regresión logística para determinar los factores de riesgo para la PSTR aumentada. Resultados: Se observó una tendencia hacia valores incrementados de MIF, MCP-1 e IL-6 en el efluente de DP en sujetos con PSTR alta, en comparación con aquellos con PSTR baja. La prueba de correlación de Pearson mostró que D/Pcr exhibe correlaciones positivas con el MIF del efluente diálisis (r = 0,32, p = 0,01), MCP-1 (r = 0,47, p = 0,01), IL-6 (r = 0,48, p = 0,01). Por el contrario, no se encontró una correlación significativa entre D/Pcr y TGF-β (r = 0,04, p = 0,70), TNF-ɑ (r = 0,22, p = 0,05), VEGF (r = 0,02, p = 0,86) y marcadores séricos de inflamación. En el análisis de regresión no ajustado, el MIF del efluente diálisis (OR 2,41), la MCP-1 (OR 1,72), la IL-6 (OR 1,55) se asociaron con una PSTR elevada. El análisis de regresión logística multivariante mostró que las odds ratios (OR) ajustadas del MIF del efluente diálisis para PSTR alta fueron de 2,47 en todos los sujetos (p = 0,03). Conclusión: Los niveles elevados de MIF, MCP-1 y IL-6 en el efluente de DP se asociaron con un aumento de la PSTR. Los niveles elevados del MIF del efluente diálisis fueron un factor de riesgo independiente para PSTR elevada en sujetos tratados con DP. (AU)

Escala de Respuestas Emocionales por Estrés al Traslado en Transporte Público / Scale of Emotional Responses due to Commuting Stress in Public Transport

Resumen El traslado cotidiano entre la casa y el trabajo demanda un importante uso de recursos personales y puede llegar a ser estresante. El objetivo fue construir y evaluar una escala de respuestas emocionales por el estrés en el traslado en transporte público para la Zona Metropolitana del Valle de México de manera exploratoria. Método: Se realizó un estudio cualitativo a través de entrevistas semi estructuradas con el propósito de identificar emociones asociadas a la experiencia de estrés por el traslado para desarrollar los reactivos de acuerdo con el contexto. Posteriormente, dos estudios cuantitativos permitieron evaluar las propiedades psicométricas. Participaron 196 y 298 personas respectivamente. La aplicación de la escala se realizó en línea en septiembre de 2020 y abril de 2021. Resultados: la escala incluyó 26 respuestas emocionales asociadas al estrés. En el Análisis Factorial Exploratorio se redujo a nueve emociones negativas (X2=1183, gl=36, p=.001, KMO=.94, 60% de varianza explicada, Alfa ordinal=.93), corroboradas en el Análisis Factorial Confirmatorio (X2=41.87, gl=26, X2/gl=1.61, p=.025; RMR=.036, SRMR=.036, RMSEA=.045; GFI=.997, CFI=.999, TLI=.998). Conclusión: la propuesta exploratoria de la escala para evaluar las respuestas emocionales por el estrés en el traslado presenta valores adecuados para aplicarse en la Zona Metropolitana del Valle de México.

Abstract The stress in urban settings is related to a greater request for personal resources to face situations of daily life, such as the commuting, since in big cities, people spend a lot of time on it, and sometimes is uncomfortable and annoying, which can cause stress. Commuting stress has been assessed, through commuting daily hassles, commuting stressful features and physiological responses, but it is possible assess it through emotional responses. The aim of this study was to develop and assess an exploratory scale of emotional responses for the study of commuting stress by public transport in an urban area of México that is densely populated. Method, a cross sectional design was used, in which a qualitative exploratory study was carried out through 23 individual semi-structured interviews and two focus group, where it was identified the main emotions experienced during the commuting stress to develop the items in the language of the population. Subsequently, those emotions were compared with emotions proposed in previous studies to complement the scale. Thus, 26 emotions were included to assess the commuting stress through emotional responses. Finally, two quantitative studies were carried out to assess the psychometric properties of the scale, in which 196 and 298 people participated, respectively. The scale was applied online in September 2020 and in April 2021. Results, from the 26 emotional stress responses were reduced to nine negative emotions in an Exploratory Factor Analysis (X2=1183, df=36, p=.001, KMO= .94, 60% variance, Alfa ordinal=.93). This solution was corroborated with a Confirmatory Factor Analysis (X2=41.87, d.f.=26, X2/d.f.=1.61, p=.025; RMR= .036, SRMR=.036, RMSEA=.045; GFI=.997, CFI=.999, TLI=.998). Conserve only nine negative emotions is due to statistical analysis but also because some emotions referred to conditions of physical exhaustion or body energy level. On the other hand, positive emotions were related with pleasant commuting situations, not with the commuting stress experience. Conclusion, the exploratory scale to assess the commuting stress through emotional responses presents acceptable values to be applied in this urban area of Mexico.

The metabolites could not be ignored: A comparative study of the metabolite norfluoxetine with its parent fluoxetine on zebrafish (Danio rerio).

The ubiquitous pharmaceuticals in aquatic environments have attracted huge attention due to their significant risks to humans and ecosystems. However, even though the knowledge of the negative effects induced by the parent pharmaceuticals is quite extensive, little is known about their metabolites for a long time. This study provides systematical knowledge about the potential toxicity of metabolite norfluoxetine and its parent fluoxetine on zebrafish (Danio rerio) at the early life stage. The results showed that the metabolite norfluoxetine had similar acute toxicity in fish with the parent fluoxetine. For the altered fish development, there was no significant difference in most cases between the two pharmaceuticals. Compared to the control, the metabolite markedly inhibited the locomotor behavior under light-to-dark transitions, which was comparable to the parent. Norfluoxetine could easily accumulate but hardly eliminate from fish, relative to fluoxetine. In addition, the accumulated fluoxetine in zebrafish may rapidly metabolize to norfluoxetine and then be eliminated through different metabolic pathways. The functional genes related to serotonergic process (5-ht1aa, 5-ht2c, slc6a4b, and vmat), early growth (egr4), and circadian rhythm (per2) were downregulated by both the norfluoxetine and fluoxetine, indicative of the same mode-of-action of norfluoxetine with its parent in these functions. Meanwhile, the alterations caused by norfluoxetine were more pronounced than that of fluoxetine in the genes of 5-ht2c, slc6a4b, vmat, and per2. The molecular docking also confirmed that norfluoxetine could bind with serotonin transporter protein in the same as fluoxetine with a lower binding free energy. Overall, the metabolite norfluoxetine could induce similar and even more toxic effects on zebrafish with the same mode of action. The different and binding energy of the metabolite norfluoxetine and its parent fluoxetine on zebrafish may be responsible for the differentiated effects. It highlights the risks of the metabolite norfluoxetine in the aquatic environment could not be ignored.