ABSTRACT Objective: To analyze characteristics of the home visit (HV) in Brazil, 2012 and 2017. Methods: Ecological study, with panel data whose units of analysis were the Primary Health Care teams in Brazil, participants of the 1st and 3rd cycles of the Program to Improve Access and Quality of Primary Care of the Unified Health System. Descriptive, inferential and spatial analyzes (alpha=5%) were performed. Results: There was an increase in the proportion of teams that carried out home visits at a frequency defined based on risk and vulnerability analysis and actively searched for people with respiratory symptoms and women with delayed and altered cytopathological examination. In the heat maps, the Northeast, Southeast and South regions had a higher concentration of teams that carried out the HV and carried out an active search. Conclusion: The maintenance and qualification of HVs must be a priority in Brazil, since there are few countries in the world with such capillarity of health services, reaching the homes of millions of people.

RESUMO Objetivo: Analisar características da visita domiciliar (VD) no Brasil em 2012 e 2017. Métodos: Estudo ecológico com dados em painel cujas unidades de análise foram as equipes de saúde da Atenção Primária à Saúde no Brasil, participantes do 1º e 3º ciclos do Programa de Melhoria do Acesso e Qualidade da Atenção Básica do Sistema Único de Saúde. Foram realizadas análises descritivas, inferenciais e espaciais (alpha=5%). Resultados: Houve aumento na proporção de equipes que realizavam visita domiciliar com periodicidade definida a partir da análise de risco e vulnerabilidade e na de busca ativa de pessoas com sintomáticos respiratórios e de mulheres com exame citopatológico atrasado e alterado. Nordeste, Sudeste e Sul foram as regiões com maior concentração de equipes que realizavam a VD e faziam busca ativa. Conclusão: A manutenção e qualificação das VD deve ser uma prioridade no Brasil, uma vez que poucos são os países no mundo com tamanha capilaridade dos serviços de saúde, alcançando os domicílios de milhões de pessoas.

Abstract In the modern world, cancer is a growing cause of mortality, but archeological studies have shown that it is not exclusive to modern populations. The aim of this study is to examine the epidemiologic, social, and clinicopathologic features of head and neck cancers in ancient populations. To do this, we extracted all records that described malignant lesions in the head and neck region available in the Cancer Research in Ancient Bodies Database (CRAB). The estimated age, sex, physical condition of the remains (skeletonized, mummified), anatomic location of tumors, geographic location, chronology, tumor type, and methods of tumor diagnosis were collected. One hundred and sixty-seven cases were found, mostly originating from Europe (51.5%). Most records were of adults between 35 and 49 years of age (37.7%). The most involved site was the skullcap (60.4%), and the most common malignancies were metastases to the bone (65.3%) and multiple myeloma (17.4%). No primary soft tissue malignancies were registered. The results of our study indicate that head and neck cancers were present in ancient civilizations, at least since 500,000 BCE. The available data can help to improve the current understanding of the global distribution of head and neck cancer and its multidimensional impacts on populations in the contemporary world.

ABSTRACT BACKGROUND AND OBJECTIVES: Low back pain is among the most disabling conditions worldwide, and among the epigenetic factors, methylation in CpG islands of gene promoter regions can modulate gene expression, potentially correlating with the development of the disease and providing insights into the choice of treatment. The objective of this study was to assess the efficacy of therapy using modified ILIB related to DNA methylation processes in low back pain. Secondary objectives of this study included investigating pain intensity, gender, sociodemographic data, and physical-functional profile. METHODS: This prospective study was conducted in a municipality in the southern region of Brazil. The sample consisted of 30 participants of both genders, with an average age of 41.77 years. The following aspects were analyzed: anthropometric characteristics, global methylation using the ELISA method, pain level, physical activity level, functional disabilities, and hesitancy level related to work and physical activity-related activities. RESULTS: A statistically significant association was observed between methylation levels before and after treatment application for the experimental and placebo groups (p < 0.005), demonstrating a mean responsiveness between methylation and treatment (d = 0.5). However, there were no other statistically significant associations correlated with the other work variables. CONCLUSION: The results obtained in this study suggest the need for further research related to the identification of specific genes in methylation, as well as the standardization of dosimetry used for transcutaneous ILIB laser application in the radial artery.

RESUMO JUSTIFICATIVA E OBJETIVOS: A lombalgia está entre as condições mais incapacitantes no mundo e; dentre os fatores epigenéticos, a metilação em ilhas CpG de regiões promotoras de genes pode modular a expressão gênica permitindo uma possível correlação ao desenvolvimento da doença, como também pode trazer esclarecimentos a respeito do tratamento a ser escolhido. O objetivo deste estudo foi verificar a eficácia da terapia através do uso do ILIB modificado relacionada ao processo de metilação de DNA na lombalgia. Os objetivos secundários deste estudo foram a investigação da intensidade da dor, sexo, dados sociodemográficos e perfil físico-funcional. MÉTODOS: Este estudo, desenvolvido em um município da região sul do Brasil, caracteriza-se como prospectivo. A amostra deste estudo foi composta por 30 participantes, de ambos os sexos, com idade média de 41,77 anos. Foram analisados os seguintes aspectos: características antropométricas, metilação global através do método ELISA, nível de dor, nível de atividade física, incapacidades funcionais e nível de hesitação para realizar atividades relacionada ao trabalho e atividade física. RESULTADOS: Observou-se associação estatisticamente significativa entre os níveis de metilação antes e a após aplicação do tratamento para grupo experimental e placebo (p<0,005) demostrando uma média responsividade entre as variáveis metilação e tratamento (d=0,5). No entanto, não houve nenhuma outra associação estatística correlacionada as demais variáreis do trabalho. CONCLUSÃO: Os resultados obtidos neste estudo sugerem que há necessidade mais estudos relacionados a identificação de genes específicos na metilação, além da necessidade de padronização de dosimetria utilizadas para aplicação do laser ILIB de forma transcutânea, em artéria radial.

Resumen Marco contextual: Conocimiento de los cuidadores familiares sobre la gestión de los cuidados de los niños con gastrostomía en el proceso de asistencia. Objetivo: Analizar el acceso de los cuidadores familiares a los conocimientos sobre cómo cuidar a los niños con gastrostomía en casa. Metodología: Aplicada la dinámica cuerpo-conocimiento del método creativo sensible, con 10 familiares de lactantes y preescolares hospitalizados. Estudio realizado entre junio y diciembre de 2019 en un hospital público de Río de Janeiro, Brasil. Se utilizó el análisis léxico, del software Iramuteq®. Resultados: Los cuidadores accedieron a dos fuentes de conocimiento en la preparación del alta hospitalaria. La primera, la formación con directrices y demostración de procedimientos en el campo de la ciencia enfermera. La segunda, la observación libre de los cuidados prestados por los profesionales sanitarios. Hubo cuidadores que no recibieron instrucciones y mostraron limitaciones en la preparación para el alta. Conclusión: Vivir con una gastrostomía moviliza a la familia para conseguir unos cuidados seguros, basados en los conocimientos de enfermería. Los enfermeros deben prestar atención a las necesidades de los familiares dentro de la continuidad de los cuidados en el domicilio.

Resumo Enquadramento: Conhecimento de familiares cuidadores sobre a gestãodo cuidado de crianças com gastrostomia no processo de cuidar. Objetivo: Analisar o acesso de familiares cuidadores a conhecimentos sobre como cuidar de crianças com gastrostomia em casa. Metodologia: Aplicado a dinâmica corpo-saber do método criativo sensível, com10 familiares de lactentes e pré-escolares, em internamento. Estudo realizado entre junho e dezembro de 2019, em um hospital público do Rio de Janeiro, Brasil. Utilizou-se a análise lexical, do software Iramuteq®. Resultados: Cuidadores acederam a duas fontes de conhecimentos na preparação para a alta do internamento. A primeira, treino com orientações e demonstração de procedimentos do campo da ciência de enfermagem. A segunda, observação livre dos cuidados prestados pelos profissionais de saúde. Houve cuidadores que não receberam instruções, demonstrando limitação na preparação para a alta. Conclusão: Viver com gastrostomia mobiliza a família para cuidados seguros, dependentes de conhecimentos de enfermagem. Os enfermeiros precisam atentar para às necessidades dos familiares, na continuidade do cuidar em casa.

Abstract Background: Family caregivers’ information on caring for a child’s gastrostomy at home. Objective: To analyze family caregivers’ access to pediatric gastrostomy home care education. Methodology: This study used an arts-based creative research method (Dinâmica Corpo-Saber do Método Criativo Sensível) with ten family members of hospitalized infants and preschool-aged children. The study was conducted between June and December 2019 in a public hospital in Rio de Janeiro, Brazil. Lexical analysis was performed using the IRAMUTEQ® software. Results: Family caregivers had access to two sources of information to prepare for their children’s hospital discharge. The first was the education received through nurses’ guidance and demonstration of procedures. The second was the caregivers’ observation of health professionals’ care delivery to their children. Some family caregivers received no guidance, showing limitations in discharge preparation. Conclusion: Families of children fed via gastrotomy tube must be mobilized to deliver safe care based on nursing knowledge. Nurses must consider family members’ needs regarding the continuity of care at home.

Background: In June 2009, the World Health Organization (WHO) raised the global alert level for the A(H1N1)pdm09 influenza pandemic and at that time sustained transmission in Brazil was established. It was urgent to carry out studies that evaluated possible risk factors for death from Influenza A(H1N1) to improve case management strategies to reduce the lethality of the disease. This study aimed to identify risk factors for death from Influenza A(H1N1), including the effectiveness of the vaccine against influenza A(H1N1) concerning mortality. Methods: A case-control of incident cases of influenza A(H1N1) reported in the Epidemiological Information Systems of the states of São Paulo, Paraná, Pará, Amazonas, and Rio Grande do Sul was conducted. Results: 305 participants were included, 70 of them cases and 235 controls, distributed as follows: Amazonas – 9 cases/10 controls, Pará – 22 cases/77 controls, São Paulo – 19 cases/49 controls, Paraná – 10 cases/54 controls, Rio Grande do Sul – 10 cases/45 controls. These participants had a mean age of 30 years, with 33 years among cases and 25 years among controls. There was a predominance of females both among cases and controls. Biological (age), pre-existing diseases (congestive heart failure, respiratory disease, and diabetes mellitus), and care factors (ICU admission) associated with death from Influenza A(H1N1) were identified. Conclusion: The risk factors identified in this investigation allowed subsidizing the elaboration of clinical conducts, but also indicate important aspects for facing “new” influenza epidemics that are likely to occur in our country.

This text resumes and reviews the debate proposed in a previous essay, published at the height of the pandemic (2021), entitled “Education and digital technologies in the pandemic: cycles of precariousness”, in which I denounced the precarious conditions in which the Brazilian school always operates. In the serious contingency of the pandemic, this precariousness was materialized in the form of few or no infrastructure and training conditions to carry out, with some professional dignity, what was called “emergency remote teaching”. In this new essay, in addition to reviewing the previously discussed issues, I return to the still usual and fertile notion of “digital literacies”, in particular discussing a proposal from the early 2000s and another one published in Brazil in 2016. I also report some typical episodes, if they are not generalizable, about what we learned about technologies and teaching during the pandemic, however traumatic and painful the compulsory experience was. I conclude by narrating some setbacks and inconsistencies that we are experiencing in post-pandemic times and calling for a reflection on what was learned.

Este texto retoma e revisa o debate proposto em ensaio anterior, publicado ainda no auge da pandemia, intitulado “Educação e tecnologias digitais na pandemia: ciclos da precaridade”, em que denunciei as condições precárias em que a escola brasileira sempre opera. Na contingência grave da pandemia, essa precariedade se materializou na forma de pouca ou nenhuma condição infraestrutural e de formação para levar a cabo, com alguma dignidade profissional, o que se denominou “ensino remoto emergencial”. Neste novo ensaio, além de repassar as questões anteriormente discutidas, retomo a ainda usual e fértil noção de “letramentos digitais”, em especial discutindo uma proposta do início dos anos 2000 e outra publicada no Brasil em 2016. Relato também episódios que provavelmente guardam alguma tipicidade, se não possibilidade de generalização, sobre o que aprendemos sobre tecnologias e ensino durante a pandemia, por mais traumática e dolorosa que a experiência compulsória tenha sido. Finalizo narrando alguns contratempos e inconciliações que temos vivido em tempos pós-pandêmicos e chamando a uma reflexão sobre o aprendido.

RESUMO Objetivou-se descrever a condição de saúde bucal de idosos institucionalizados, com enfoque no edentulismo, na necessidade de prótese e na Autopercepção de Saúde Bucal (ASB), e explorar a associação com fatores individuais. Um estudo transversal foi realizado em Ponta Grossa, município do Sul do Brasil, com amostra de conveniência de idosos residentes em três Instituições de Longa Permanência para Idosos. Por meio de questionário estruturado, foram coletados dados sobre características demográficas, de saúde geral e bucal e acesso a serviços de saúde. No exame bucal, avaliou-se o Índice de dentes permanentes Cariados, Perdidos e Obturados (CPO-D), número de dentes presentes, uso e necessidade de prótese dentária e presença de lesões bucais. Foram avaliados 130 idosos, a maioria com mais de 80 anos (62,20%). O CPO-D médio foi de 30,62 (desvio-padrão 2,85), 62,31% dos idosos eram edêntulos, 41,54% usavam e 79,23% necessitavam de prótese dentária. As lesões bucais foram identificadas em 35,42% dos avaliados, e 64,86% dos idosos classificaram a ASB como boa. Conclui-se que a saúde bucal dos participantes foi considerada ruim, do ponto de vista clínico, levando em consideração a alta prevalência de edentulismo e a necessidade do uso de prótese dentária.

ABSTRACT The aim was to describe the oral health status of institutionalized older people, focusing on edentulism, need for dentures, and Self-Perception of Oral Health (SPOH), and to explore the association with individual factors. A cross-sectional study was carried out in Ponta Grossa, in the South of Brazil, with a convenience sample of older people living in three Long Stay Institutions for the Elderly. Using a structured questionnaire, data on demographic, general, and oral health characteristics and access to health services were collected. In the oral examination, the Index of Decayed, Missing and Filled permanent Teeth (DMFT), number of teeth present, use and need for dental prosthesis, and presence of oral lesions were evaluated. 130 older people were evaluated, most of them over 80 years old (62.20%). The mean DMFT was 30.62 (± 2.85), 62.31% of attendees were edentulous, 41.54% used, and 79.23% needed dental prosthesis. Oral lesions were identified in 35.42% of those evaluated and 64.86% of the participants classified their SPOH as good. It is concluded that the oral health of the participants was considered poor, from a clinical point of view, taking into account the high prevalence of edentulism and the need to use dental prosthesis.

Abstract Context: Anxiety disorders are among the most prevalent mental disorders, characterized by an exaggerated and inadequate response to a stimulus. The probability of its appearance in people with mental illness increases considerably when compared to the general population. It is imperative to implement psychotherapeutic interventions that include the relaxation technique. Objective: To systematize the scientific evidence on the results obtained with the use of the relaxation technique, in reducing anxiety in people with mental illness. Methods: Integrative literature review, through research in electronic databases (CINAHL and MEDLINE) carried out in June 2022. Applying a set of descriptors and inclusion and exclusion criteria, a final sample of 7 published studies was obtained between 2012-2022. Results: The analyzed scientific evidence demonstrates beneficial results in the use of the relaxation technique in reducing anxiety and psychotic symptoms in people with mental illness and should be implemented as a psychotherapeutic intervention. Technological advances (virtual reality and online programs) are a great ally to enhance their immediate effects, producing positive effects on hearing, vision and sensory, considerably improving the experience of relaxation. Conclusions: The results obtained reveal that the implementation of various methods of relaxation techniques (muscle, breathing, guided imagery, yoga, biofeedback, bodywareness and guided meditation) have a beneficial therapeutic potential in the immediate reduction of signs and symptoms of anxiety, being enhanced through continuous exposure to the intervention. However, its long-term effects need to be studied further.

Resumen Contexto: Los trastornos de ansiedad se encuentran entre los trastornos mentales más prevalentes, caracterizados por una respuesta exagerada e inadecuada a un estímulo. La probabilidad de su aparición en personas con enfermedad mental aumenta considerablemente en comparación con la población general. Es imperativo implementar intervenciones psicoterapéuticas que incluyan la técnica de relajación. Objetivo: Sistematizar la evidencia científica sobre los resultados obtenidos con el uso de la técnica de relajación, en la reducción de la ansiedad en personas con enfermedad mental. Métodos: Revisión integrativa de la literatura, mediante investigación en bases de datos electrónicas (CINAHL y MEDLINE) realizada en junio de 2022. Aplicando un conjunto de descriptores y criterios de inclusión y exclusión, se obtuvo una muestra final de 7 estudios publicados entre 2012-2022. Resultados: A evidencia científica analizada demuestra resultados beneficiosos en el uso de la técnica de relajación en la reducción de la ansiedad y los síntomas psicóticos en personas con enfermedad mental, y debería implementarse como una intervención psicoterapéutica. Los avances tecnológicos (realidad virtual y programas online) son un gran aliado para potenciar sus efectos inmediatos, produciendo efectos positivos en la audición, la visión y los sentidos, mejorando considerablemente la experiencia de relajación. Conclusiones: Los resultados muestran que la implementación de diversos métodos de técnicas de relajación (muscular, respiratoria, imaginería guiada, yoga, biofeedback, bodywareness y meditación guiada) tienen un potencial terapéutico beneficioso en la reducción inmediata de signos y síntomas de ansiedad, siendo potenciado a través de exposición continua a la intervención. Sin embargo, sus efectos a largo plazo deben estudiarse más a fondo.

Resumo Contexto: As perturbações da ansiedade estão entre as perturbações mentais mais prevalentes, caracterizando-se por uma resposta exagerada e desadequada a um estímulo. A probabilidade do seu aparecimento na pessoa com doença mental aumenta consideravelmente, quando comparado com a população em geral. Torna-se perentório a implementação de intervenções de âmbito psicoterapêutico que incluem a técnica de relaxamento. Objetivo: Sistematizar a evidência científica sobre os resultados obtidos com a utilização da técnica de relaxamento, na redução da ansiedade na pessoa com doença mental. Métodos: Revisão integrativa da literatura, através da pesquisa nas bases de dados eletrónicas (CINAHL e MEDLINE) realizada em junho de 2022. Sendo aplicado um conjunto de descritores e critérios de inclusão e exclusão, obteve-se uma amostra final de 7 estudos, publicados entre 2012-2022. Resultados: A evidência científica analisada demonstra resultados benéficos na utilização da técnica de relaxamento na redução da ansiedade e sintomas psicóticos na pessoa com doença mental, devendo ser implementada como intervenção de âmbito psicoterapêutico. Os avanços tecnológicos (realidade virtual e programas online) são um grande aliado para potencializar os seus efeitos imediatos, produzindo efeitos positivos na audição, visão e sensoriais, melhorando consideravelmente a experiência do relaxamento. Conclusões: Os resultados obtidos revelam que a implementação de diversos métodos de técnica de relaxamento (muscular, respiração, imaginação guiada, yoga, biofeedback, bodywareness e meditação guiada) apresentam um potencial terapêutico benéfico na redução imediata dos sinais e sintomas de ansiedade, sendo potencializado através da exposição contínua à intervenção. Contudo, os seus efeitos a longo prazo devem ser alvo de mais estudo.

ABSTRACT OBJECTIVE To evaluate the accuracy of yellow fever (YF) suspected case definitions from the Brazilian Ministry of Health (BMH) and World Health Organization (WHO), as well as propose and evaluate new definitions of suspected cases, considering confirmed and discarded cases. METHODS The retrospective study was conducted at the Instituto de Infectologia Emílio Ribas (IIER), using the Epidemiologic Surveillance Form of YF cases. From the confirmed and discarded cases of YF, a logistic regression model was developed. The independent variables were used in a proposed definition of a suspected case of YF and its accuracy was evaluated. RESULTS In total, 113 YF suspect cases were reported, with 78 confirmed (69.0%). The definitions by BMH and WHO presented low sensitivity, 59% and 53.8%, and reduced accuracy, 53.1% and 47.8%, respectively. Predictive factors for YF were thrombocytopenia, leukopenia, and elevation of transaminases greater than twice normal. The definition including individual with acute onset of fever, followed by elevation of ALT or AST greater than twice the reference value AND leukopenia OR thrombocytopenia presented high sensitivity (88.3%), specificity (62.9%), and the best accuracy (80.4%), as proposed in the model. CONCLUSION The YF suspected case definitions of the BMH and the WHO have low sensitivity. The inclusion of nonspecific laboratory tests increases the accuracy of YF definition.

Abstract The pandemic caused by coronavirus has resonated throughout different levels of health care in Brazil and, in this context, the present research aimed to evaluate this impact on tertiary dental care provided by the Unified Health System (SUS). Therefore, an ecological study was conducted with data obtained from the Hospital Information System processed by the Portal of the Department of Informatics of SUS. The sample consisted of patients of all sexes and age groups, whose Hospital Admission Authorizations (AIHs) were approved for dental tertiary care procedures from January 2015 to December 2020. Descriptive analyses and the ANOVA test with a significance level set at p < 0.05 were used. When the annual mean numbers of AIHs approved were evaluated, findings showed that on an average, the Southeast region authorized a higher number of procedures (p-value < 0.001), however, in the pandemic year (2020), a reduction of approximately 24.5% of these hospitalizations occurred throughout Brazil, with the Midwest being the region most affected (32.12%). A percentage increase occurred in the Surgical Treatment of Oral sinus/Oral nasal Fistula (16.1%), in addition to a significant decrease in performing procedures for Resection of Mouth Lesion (33.4%). In the pandemic year, there was a reduction of 14% in expenditures related to hospital services and 23.26% related to professional services. It was concluded that the data presented demonstrated a significant reduction in AIHs for tertiary dental care in the pandemic year.