ABSTRACT Introduction: Leprosy (Hansen's disease) is a neglected infectious disease that affects skin and peripheral nerves, triggering neuropathies and complications such as deformities and disabilities. Objective: determine epidemiological and clinical characteristics of patients with Leprosy in the Dermatological Specialties Center of the Ministry of Public Health and Social Welfare of Paraguay, from January 2021 to December 2022. Methodology: descriptive, observational, retrospective, cross-sectional study. Data management and analysis was carried out in an electronic spreadsheet (Excel from Microsoft Office 365 version 2405), then descriptive statistics were performed. Results: 123 cases of leprosy were diagnosed, 45 (36.58 %) were women and 78 (63.42 %) were men; the ages were between 17 and 86 years, the most affected range was 41 to 50 years. 112 cases (91.06 %) were multibacillary leprosy. The most frequent sign was infiltrated plaque, present in 88 cases (71.54 %). 58 patients (47.15 %) presented lepromatous reactions, 31 cases of type 1 (53.45 %). 34 cases (27.64 %) presented grade 1 disability and 10 cases (8.13 %) grade 2 disability. Conclusion: The profile of the patient with leprosy was male between 41 and 50 years, the majority being multibacillary cases. Early diagnosis and adequate treatment are essential to reduce the burden of the disease and disabilities.

RESUMEN Introducción: lepra (enfermedad de Hansen) es una patología infecciosa desatendida que afecta piel y nervios periféricos, desencadenando neuropatías y complicaciones como deformidades y discapacidades. Objetivos: determinar características epidemiológicas y clínicas de pacientes con lepra en el Centro de Especialidades Dermatológicas del Ministerio de Salud Pública y Bienestar Social de Paraguay, de enero 2021 a diciembre 2022. Metodología: estudio descriptivo, observacional, retrospectivo, de corte transversal. La gestión y análisis de datos se realizó en planilla electrónica (Excel del programa Microsoft Office 365 versión 2405), luego se realizó estadística descriptiva. Resultados: se diagnosticaron 123 casos de lepra, 45 (36,58 %) eran mujeres y 78 (63,42 %) varones; las edades estaban entre 17 y 86 años, el rango más afectado fue de 41 a 50 años. Eran lepra multibacilar 112 casos (91,06%). El signo más frecuente fue la placa infiltrada, presentada en 88 casos (71,54%). 58 pacientes (47,15%) presentaron reacciones lepromatosas, siendo, 31 casos de tipo 1 (53,45 %). 34 casos (27,64%) presentaron discapacidad grado 1 y 10 casos (8,13%) discapacidad grado 2. Conclusión: el perfil del paciente con lepra fue del sexo masculino entre 41 a 50 años, siendo la mayoría casos multibacilares. Es fundamentales el diagnóstico precoz y el tratamiento adecuado para reducir la carga de la enfermedad y las discapacidades.

Resumen: Introducción: En inicios del año 2015 se implementa el convenio de complementación público-privado entre los dos principales prestadores del Departamento de San José - Uruguay: AMSJ y ASSE San José, conformándose así la Unidad Departamental de Medicina Paliativa de San José (UDMP). El convenio tiene como principal objetivo asegurar la asistencia paliativa a todos los usuarios de los prestadores involucrados con los principios fundamentales de calidad, equidad y accesibilidad, siguiendo los lineamientos del Plan Nacional de Cuidados Paliativos del Ministerio de Salud Pública de Uruguay. El objetivo es describir y analizar la experiencia de la implementación del primer modelo de complementación público-privado del país en Cuidados Paliativos (CP). Metodología: Estudio descriptivo analítico, retrospectivo que incluye datos de los primeros siete años de funcionamiento del convenio. Resultados: El convenio de complementación público-privado en el Departamento de San José, permitió la creación de un equipo interdisciplinario que asistió en forma continua a 1422 pacientes provenientes de zonas urbanas y rurales, portadores de diversas patologías. La cobertura departamental de CP aumentó de forma significativa, pasando de 24 % en 2014 a 57% en 2021. Estos resultados se lograron implementando un modelo de asistencia paliativa que asegura la continuidad asistencial en internación, consultorio y domicilio, que permitió respetar la autonomía del paciente, logrando el fallecimiento de 67% de los pacientes en su hogar. La satisfacción de usuarios y familiares de la asistencia brindada fue evaluada como muy buena. Conclusiones: El convenio de complementación resultó ser una herramienta eficiente para favorecer el acceso a CP, evitando la superposición de equipos en la asistencia domiciliaria en todo el departamento de San José.

Resumo: Introdução: No início de 2015, foi implementado o acordo de complementaridade público-privado entre os dois principais prestadores do Departamento de San José Uruguai: AMSJ e ASSE San José, formando assim a Unidade Departamental de Medicina Paliativa de San José (UDMP). O principal objetivo do acordo é garantir cuidados paliativos a todos os usuários dos prestadores envolvidos, com os princípios fundamentais de qualidade, equidade e acessibilidade, seguindo as diretrizes do Plano Nacional de Cuidados Paliativos do Ministério de Saúde Pública do Uruguai. El objetivo es descrever e analisar a experiência de implementação do primeiro modelo de complementação público-privada em Cuidados Paliativos (CP) do país. Metodologia: Estudo descritivo, analítico, retrospectivo que inclui dados dos primeiros sete anos de vigência do convênio. Resultados: O acordo de complementação público-privada no Departamento de San José permitiu a criação de uma equipe interdisciplinar que atendeu continuamente 1.422 pacientes de áreas urbanas e rurais, com diversas patologias. A cobertura departamental do CP aumentou significativamente, de 24% em 2014 para 57% em 2021. Estes resultados foram alcançados através da implementação de um modelo de cuidados paliativos que garante a continuidade dos cuidados no internamento, no consultório e no domicílio, o que permitiu respeitar a autonomia do doente, atingindo a morte de 67% dos doentes no domicílio. A satisfação dos usuários e familiares com a assistência prestada foi avaliada como muito boa. Conclusões: O convênio de complementação revelou-se uma ferramenta eficiente para promover o acesso à CP, evitando a sobreposição de equipes na atenção domiciliar em todo o departamento de San José.

Abstract: Introduction: At the beginning of 2015, the public-private complementarity agreement was implemented between the two main providers of the Department of San José Uruguay: AMSJ and ASSE San José, thus forming the Departmental Unit of Palliative Medicine of San José (UDMP). The main objective of the agreement is to ensure palliative care to all users of the providers involved, with the fundamental principles of quality, equity and accessibility, following the guidelines of the National Palliative Care Plan of the Ministry of Public Health of Uruguay. The objective is describe and analyze the experience of implementing the country's first public-private complementation model in Palliative Care (PC). Methodology: Descriptive, analytical, retrospective study that includes data from the first seven years of operation of the agreement. Results: The public-private complementation agreement in the Department of San José allowed the creation of an interdisciplinary team that continuously assisted 1,422 patients from urban and rural areas, with various pathologies. Departmental CP coverage increased significantly, from 24% in 2014 to 57% in 2021. These results were achieved by implementing a palliative care model that ensures continuity of care in hospitalization, office and home, which allowed the patient's autonomy to be respected, achieving the death of 67% of patients at home. The satisfaction of users and family members with the assistance provided was evaluated as very good. Conclusions: The complementation agreement turned out to be an efficient tool to promote access to CP, avoiding the overlap of teams in home care throughout the department of San José.

Abstract: Hospitals, as the main entities providing medical services, face the crucial question of how to ensure the fairness and accessibility of medical services in strengthening the construction of integrity ethics. Patient-centered care is the code of conduct for medical services, requiring hospitals to provide high-quality and efficient medical services. This study delves into patients’ experiences, needs, and expectations regarding the construction of integrity ethics in hospitals, aiming to offer guidance and practical pathways for protecting patient rights, promoting reforms in the medical service system, and building trust-based doctor-patient relationships. In the context of an aging population and the goal of achieving universal health coverage, it is essential to allocate medical resources reasonably, ensuring the quality and credibility of medical services. Based on the stance of protecting patient rights, this study analyzes the current state of China’s medical service system and proposes specific measures to improve the quality of medical services and patient satisfaction, striving to provide valuable references for fostering positive interaction between patients and hospitals.

Resumen: Los hospitales, como principales entidades proveedoras de servicios médicos, se enfrentan a un punto crucial: cómo garantizar la equidad y la accesibilidad de los servicios médicos en el fortalecimiento de la construcción de la ética de la integridad. La atención centrada en el paciente es el código de conducta de los servicios médicos, que exige a los hospitales la prestación de servicios médicos eficientes y de alta calidad. Este estudio profundiza en las experiencias, necesidades y expectativas de los pacientes en relación con la construcción de una ética de la integridad en los hospitales, con el objetivo de ofrecer orientación y vías prácticas para proteger sus derechos, promover reformas en el sistema de servicios médicos y construir relaciones médico-paciente basadas en la confianza. En el contexto del envejecimiento de la población y el objetivo de lograr una cobertura sanitaria universal, es esencial asignar los recursos médicos de manera razonable, garantizando la calidad y la credibilidad de los servicios médicos. Partiendo de la postura de proteger los derechos del paciente, este estudio analiza el estado actual del sistema de servicios médicos en China y propone medidas concretas para mejorar su calidad y la satisfacción del paciente, esforzándose por ofrecer referencias para promover una interacción positiva entre pacientes y hospitales.

Resumo: Hospitais, como principais entidades fornecedoras de serviços médicos, enfrentam a questão crucial de como garantir equidade e acessibilidade dos serviços médicos no fortalecimento da construção de integridade ética. Cuidados centrados no paciente é o código de conduta para serviços médicos, requerendo que hospitais forneçam serviços médicos de alta qualidade e eficientes.Esse estudo investiga as experiências, necessidades e expectativas dos pacientes a respeito da construção de integridade ética nos hospitais, visando oferecer diretrizes e caminhos práticos para a proteção dos direitos dos pacientes, promovendo reformas no sistema de serviços médicos e construindo relações médico-paciente baseadas na confiança. No contexto do envelhecimento da população e do objetivo de alcançar cobertura universal da saúde, é essencial alocar recursos médicos de forma satisfatória, garantindo a qualidade e credibilidade dos serviços médicos. Baseado na orientação de proteger os direitos dos pacientes, esse estudo analisa o estado atual do sistema de serviços médicos da China e propõe medidas específicas para melhorar a qualidade dos serviços médicos e a satisfação dos pacientes, aspirando fornecer referências valiosas para promover uma interação positiva entre pacientes e hospitais.

Objetivo: comparar el número de citologías oncóticas planificadas y las realizadas en la ciudad de Río de Janeiro entre los años 2013 y 2022 . Métodos: utilizando la población femenina de Río de Janeiro, se estimó cuántas pruebas se deberían realizar si se recomienda el tamizaje. realizado por el Ministerio de Salud se realizó de manera ideal y luego se comparó con la cantidad de pruebas disponibles en la base de datos pública. Resultados: En este periodo se realizaron 1.364.325 frente a una estimación de 7.886.720. Después del ajuste por el uso de asistencia sanitaria complementaria, la pandemia y los exámenes fuera de la edad recomendada, se observó el 36% del ideal. Conclusión: la cantidad realizada está muy por debajo de lo ideal, incluso después de ajustes, lo que aumenta los costos para el servicio público de salud, haciendo necesarias nuevas políticas públicas para mejorar el seguimiento.

Objetivo: comparar a quantidade de colpocitologias oncóticas ideias e a realmente realizadas no município do Rio de Janeiro entre os anos de 2013 e 2022. Métodos: através da população feminina do Rio de Janeiro, foi feita estimativa de quantos exames deveriam ser realizados caso o rastreio preconizado pelo Ministério da Saúde fosse feito de forma ideal e posteriormente foi comparado com a quantidade de exames disponíveis na base de dados pública. Resultados: foram realizados 1.364.325 nesse período comparado a 7.886.720 estimados. Após ajuste pelo uso de saúde suplementar, pandemia e exames fora da idade recomendada, observou-se 36% do ideal. Conclusão: a quantidade realizada está muito abaixo da ideal, mesmo após os ajustes, o que aumenta custos para o serviço de saúde pública, sendo necessárias novas políticas públicas para melhorar o rastreamento.

Objective: to compare the number of planned oncotic smear tests and those actually performed in the city of Rio de Janeiro between the years 2013 and 2022 . Methods: using the female population of Rio de Janeiro, an estimate was made of how many tests should be carried out if screening recommended by the Ministry of Health was done in an ideal way and was subsequently compared with the number of tests available in the public database. Results: 1,364,325 were carried out in this period compared to an estimated 7,886,720. After adjustment for the use of supplementary healthcare, the pandemic and exams outside the recommended age, 36% of the ideal was observed. Conclusion: the quantity carried out is far below ideal, even after adjustments, which increases costs for the public health service, making new public policies necessary to improve tracking.

Abstract Objective: This study evaluates the association between fiber intake and obesity in Brazilian adolescents, according to sex and having meals with parents/guardians. Methods: We used data from the Study on Cardiovascular Risks in Adolescents (ERICA) (12-17 years), a cross-sectional study conducted between 2013 and 2014 in all cities with more than 100,000 inhabitants. Obesity was classified based on World Health Organization criteria for BMI. Fiber intake was obtained from a 24-hour dietary recall, and the following values were considered adequate: for males, ≥25g/day (aged 9-13 years) and ≥31g/day (aged 14-17 years); for females, ≥22g/day (aged 9-13 years) and ≥25g/day (aged 14-17 years). The categories for lunch and dinner with parents/guardians were “never/rarely/sometimes” versus “every day/almost every day”. Poisson regression models were used to examine the associations between obesity and fiber intake adjusted for covariates and stratified by sex and meals. Results: 69,627 adolescents were evaluated, 50.2% male and mean age 14.4 years (SD=1,6). A lower prevalence of obesity was observed in adolescents with adequate fiber intake who had lunch “every day/almost every day” (females: PR=0.51; 95%CI: 0.36-0.72; males: PR=0.59; 95%CI: 0.42-0.82) and dinner with their parents/guardians (females: PR=0.48; 95%CI: 0.35-0.65; males: PR=0.58; 95%CI: 0.42-0.78). Conclusion: Adolescents who frequently had meals with their parents/guardians and reported adequate fiber consumption had a lower prevalence of obesity.

Resumen Objetivo: Este estudio tiene como objetivo evaluar la asociación entre el consumo de fibra y la obesidad en adolescentes brasileños, según el sexo y la frecuencia de las comidas con padres/tutores. Métodos: Se utilizaron datos del Estudio de Riesgos Cardiovasculares en Adolescentes (ERICA) (12-17 años), un estudio transversal realizado entre 2013 y 2014 en todas las ciudades con más de 100.000 habitantes. La obesidad se clasificó según los criterios de IMC de la Organización Mundial de la Salud. La ingesta de fibra se obtuvo a partir de un recordatorio dietético de 24 horas, y se consideraron valores adecuados los siguientes: para varones de 9 a 13 años, ≥25 g/día y de 14 a 17 años, ≥31 g/día; para mujeres de 9 a 13 años, ≥22 g/día y de 14 a 17 años, ≥25 g/día. Las categorías para el almuerzo y la cena con padres/tutores fueron: “nunca/rara vez/a veces” vs. “todos los días/casi todos los días”. Se utilizaron modelos de regresión de Poisson para examinar las asociaciones entre la obesidad y la ingesta de fibra, ajustadas por covariables y estratificadas por sexo y comidas. Resultados: Se evaluaron 69.627 adolescentes, 50,2% varones, con una edad media de 14,4 años (DE=1,6). Se observó una menor prevalencia de obesidad en los adolescentes con una ingesta adecuada de fibra y que almorzaban “todos los días/casi todos los días” (mujeres: PR=0,51; IC95%: 0,36-0,72; varones: PR=0,59; IC95%: 0,42-0,82) y cenaban con sus padres/tutores (mujeres: PR=0,48; IC95%: 0,35-0,65; varones: PR=0,58; IC95%: 0,42-0,78). Conclusión: Los adolescentes que comían frecuentemente con sus padres/tutores y reportaban un consumo adecuado de fibra tenían una menor prevalencia de obesidad.

Abstract Diabetic ketoacidosis is caused by extreme insulin deficiency and is characterized by dehydration, hyperglycemia, acidosis, and ketosis. Treatment includes basic life support, parenteral hydration to replace fluids and electrolytes and insulin therapy to reverse acidosis, ketosis, and normalize blood glucose levels. Management requires following guidelines for strict clinical and laboratory monitoring to avoid complications and obtain a favorable clinical outcome. The guidelines published in our previous Consensus on Diabetic Ketoacidosis diagnosis and treatment are presented, modified according to the latest changes in ISPAD (International Society of Pediatric and Adolescent Diabetes) and the Ministry of Public Health and Social Welfare Diabetes Program guidelines.

RESUMEN La cetoacidosis diabética constituye la manifestación extrema del déficit de insulina caracterizada por deshidratación, hiperglicemia, acidosis y cetosis. El tratamiento incluye soporte vital básico, hidratación parenteral para reposición de líquidos y electrolitos, insulinoterapia, con el objetivo de revertir la acidosis, la cetosis y obtener glucemia cercanas a lo normal. Exige un monitoreo estricto clínico y laboratorial siguiendo guías de manejo para evitar complicaciones y obtener una evolución favorable. Se presentan las modificaciones en las directrices publicadas en el Primer Consenso de diagnóstico y tratamiento de la Cetoacidosis diabética, en base a las actualizaciones sugeridas por la ISPAD (International Society of Pediatric and Adolescent Diabetes) y el Programa de Diabetes del Ministerio de Salud Pública y Bienestar Social (MSPBS).

Resumen Introducción : Las consecuencias económicas de la cobertura obligatoria, vía judicial, de medicamentos de alto precio constituye un problema creciente, que amerita conocer sus características locales para aportar posibles soluciones. Objetivo : Identificar medicamentos, enfermedades, impacto económico y factores contextuales de la ju dicialización de medicamentos de alto precio (MEP) Argentina. Métodos : Estudio descriptivo cuali-cuantitativo que analizó retrospectivamente recursos de amparos legales por MEP de tres bases de datos nacionales y provinciales durante 4 años, evaluando relación existente entre am paros con aprobación regulatoria, inclusión de los MEP al paquete de beneficios y relación con notas periodísticas. Resultados : Se incluyeron 405 amparos provenientes principalmente del Ministerio de Salud Nacional. Los tres medicamentos más judicializados fueron nusiner sen (21.7%), palbociclib (5.9%) y agalsidasa-alfa (4.7%). Solo el 69.4% de los medicamentos se encontraban aprobados para la comercialización en Argentina al momento del amparo; el 45.7% se encontraban incorpo rados al Sistema Único de Reintegros y el 16.8% contaban con informe de la Comisión Nacional de Evaluación de Tecnologías Sanitarias y Excelencia Clínica (CONETEC), negativa en el 87.1% de casos. El tiempo promedio des de la solicitud hasta la provisión del medicamento fue de 150 días. Se observó una correlación temporal entre la aparición del MEP en la prensa nacional gráfica y la presentación de amparos de dicho MEP. Conclusiones : La judicialización se concentró en medicamentos de altísimo precio para enfermedades poco frecuentes u oncológicas. Los fallos fueron mayo ritariamente a favor del demandante, siendo los tiempos de acceso al medicamento prolongados. Los medios de comunicación anticiparon los procesos judiciales.

Abstract Introduction : The economic consequences of manda tory coverage, through judicial means, of high-priced medications constitutes a growing problem, which mer its knowing its local characteristics to provide possible solutions. Objective : To identify medications, diseases involved, economic impact and contextual factors of the judi cialization of high-priced medications in the Argentine Health System(MEP). Methods : Quali-quantitative descriptive study that retrospectively analyzed legal protection resources by MEP from three national and provincial databases from January 2017 to December 2020, evaluating the exist ing relationship between lawsuits with regulatory ap proval, inclusion in benefit packages and relationship with journalistic articles for the three most frequently prosecuted drugs. Results : 405 lawsuits were included, mainly from the Ministry of National Health. The three most prosecuted medications were nusinersen (21.7%), palbociclib (5.9%) and agalsidase-alfa (4.7%). Only 69.4% of medications were approved for marketing in Argentina at the time of the protection; 45.7% were incorporated into the Single Reimbursement System, and 16.8% had a report from the National Commission for the Evaluation of Health Technologies and Clinical Excellence (CONETEC), which was negative in 87.1% of cases. The average time from request to provision of the medication was 150 days. A temporal correlation was observed between the appear ance of the MEP in the national graphic press and the appeals occurrence. Conclusions : Judicialization focused on very high-priced medications for rare or oncological diseases. The rulings were mostly in favor of the plaintiff, and access times to the medication took a long time. The mass media anticipated the judicial processes.

RESUMO A pandemia da Covid-19 colocou importantes desafios sanitários e económicos aos Estados e às suas burocracias. Tanto nos países desenvolvidos como nos países em desenvolvimento, as políticas implementadas reativaram as discussões sobre o papel do Estado e os seus graus de intervenção. Da mesma forma, implicaram mudanças nas condições de trabalho dos servidores públicos em função das medidas de cuidado e isolamento adotadas. Estas mudanças tiveram impacto na dinâmica das disputas trabalhistas no sector? Os conflitos registrados apresentaram novas características? Houve diferenças dependendo do nível de governo? Este artigo analisa os conflitos trabalhistas promovidos pelos trabalhadores das Administrações Públicas municipais, provinciais e nacional durante o período 2020-2022. Para caracterizar as estratégias adotadas nesta situação excepcional, são abordados especificamente os tipos de reclamações e o repertório de ações desenvolvidas foram aquelas com ou sem greve. Os dados são comparados também com os registros pré-pandêmicos. A análise desenvolvida alimenta-se da integração de dados da Base de Conflitos Trabalhistas do Ministério do Trabalho, Emprego e Seguridade Social, regulamentos, documentos oficiais e artigos de jornais. Este trabalho procura fornecer evidências empíricas que sirvam ao debate mais amplo sobre as disputas trabalhistas no setor público.

RESUMEN La pandemia de la Covid-19 concitó importantes desafíos sanitarios y económicos para los Estados y sus burocracias. Tanto en países desarrollados como en vías de desarrollo, las políticas implementadas para mitigar su impacto reactivaron las discusiones respecto del rol del Estado y sus grados de intervención. Asimismo, implicaron cambios en las condiciones de trabajo de los empleados de las Administraciones Públicas pues debieron readaptar el modo de desempeñar sus tareas ante las medidas de cuidado y aislamiento dispuestas. ¿Estos cambios impactaron sobre la dinámica de la conflictividad laboral en el sector? ¿Los conflictos laborales registrados presentaron características novedosas? ¿Existieron diferencias según el nivel de gobierno? En este trabajo se analiza el caso argentino considerando los conflictos laborales impulsados por los trabajadores de las Administraciones Públicas municipales, provinciales y nacional durante el período 2020-2022. A fin de determinar las estrategias desplegadas en ese contexto de excepcionalidad, se abordan específicamente los tipos de reclamos planteados y el repertorio de acciones desarrolladas fueran éstas con o sin paro. Asimismo para ampliar la caracterización, los datos son comparados con lo ocurrido durante 2019, año previo a la declaración de la pandemia. El análisis realizado se nutre de la integración de datos provenientes de la Base de Conflictos Laborales del Ministerio de Trabajo, Empleo y Seguridad Social de la Nación (MTEySS), normativas, documentos oficiales y artículos periodísticos. Mediante este trabajo se procura aportar evidencia empírica que sirva al debate más amplio respecto de la conflictividad laboral en el sector público.

ABSTRACT The COVID-19 pandemic raised important health and economic challenges for the States and their bureaucracies. In both developed and developing countries, the policies implemented restarted the discussions regarding the role of the State and its degrees of intervention. Likewise, they implied changes in public servants’ working conditions in light of care and isolation measures taken. Did these changes have an impact on Public Administration labor conflict dynamic? Did labor conflicts present new characteristics under pandemic context? Were there any differences depending on the level of government? This paper analyzes labor conflicts promoted by Argentine public servants of municipal, provincial and national Public Administrations during the period 2020-2022. In order to characterize their strategies in this exceptional situation, the types of claims and their repertoire of actions (strike and non-strike disputes) are specifically addressed. The data are also compared with pre-pandemic figures. The analysis is based on the data of the Labor Conflict Base of the National Ministry of Labor, Employment and Social Security, regulations, official documents and newspaper articles. This work provides empirical evidence that contributes to the broadest debate about the labor conflicts in the public sector.

Abstract Objective: To describe the changes in alcohol and drug use by Brazilian adolescents during the COVID-19 pandemic (April-August 2021), and to analyze the relationship between alcohol use changes and psychiatric symptomatology. Methods: A secondary analysis with a longitudinal approach was performed with data from a cluster-randomized controlled trial, conductedin73publicmiddleschoolsinthreeBrazilian cities, to evaluate the effectiveness of a drug use prevention program. The sample included 535 students (61% girls; Mage = 15.2 years). Data were collected pre-intervention (February-March 2019), after 9 months (November-December 2019), and after 26 months (April-August 2021), when the students were in their first year of high school. The authors analyzed drug use prevalence (alcohol, binge drinking, tobacco, inhalants, marijuana, cocaine, and crack) in a lifetime, past year, and past month periods, and the association between alcohol use change subsamples with psychiatric symptoms. Logistic regressions were adjusted by sex, age, socioeconomic status, city, and group (control and intervention). Results: The present findings suggest that the COVID-19 pandemic led to a decrease in past-year substance use and in past-month substance use frequency, despite the gradually increased (but decelerating) prevalence of lifetime use. However, some adolescents initiated, maintained, or increased the frequency of their alcohol use. Mainly, they were more likely to present behavioral problems, as well as symptoms of inattentive hyperactivity, and peer and emotional problems. Conclusions: Despite the extensive decline in substance use during the pandemic period, these results suggest an association between previous mental health conditions and behavioral risk factors, leading to increased alcohol consumption and behavioral disorders manifestations. Objective COVID19 COVID 19 COVID-1 AprilAugust April August 2021, 2021 , 2021) symptomatology Methods clusterrandomized cluster randomized trial conductedinpublicmiddleschoolsinthreeBrazilian conductedin publicmiddleschoolsinthreeBrazilian cities program 53 61% 61 (61 girls 152 15 2 15. years. years . years) preintervention pre intervention FebruaryMarch February March 2019, 2019 2019) NovemberDecember November December school alcohol, (alcohol drinking tobacco inhalants marijuana cocaine crack periods sex age status city control intervention. intervention) Results pastyear pastmonth but decelerating However initiated maintained Mainly problems hyperactivity Conclusions period factors manifestations COVID1 1 COVID- 202 5 6 (6 201 20 (

Resumen Introducción: La colecistitis aguda es una de las complicaciones más frecuentes de la colelitiasis. En Colombia no existen estudios sobre su prevalencia, ni sobre las características sociodemográficas de la población afectada. Objetivos: Establecer la prevalencia de la colecistitis aguda en Colombia y describir las características sociodemográficas asociadas. Materiales y métodos: Estudio descriptivo de corte transversal en el que se tomaron datos de los registros individuales de prestación de servicios (RIPS) del periodo 2018 a 2022. Resultados: Se identificaron 343.254 casos de colecistitis aguda en Colombia para una prevalencia de 681 casos por cada 100.000 habitantes con una relación mujer:hombre de 2,3:1. La mayor cantidad de casos reportados fue en el quinquenio de 34 a 39 años. Los departamentos con mayor cantidad de casos se ubican en el sureste del país y son Nariño, Valle del Cauca, Caquetá y Tolima. Conclusión: Se presenta información epidemiológica y sociodemográfica de la colecistitis aguda en Colombia. Existen pocos estudios epidemiológicos de esta enfermedad en Latinoamérica; sin embargo, se encontró una prevalencia similar a la reportada en países como Estados Unidos.

Abstract Introduction: Acute cholecystitis is one of the most common complications of cholelithiasis. In Colombia, there are no studies on its prevalence or the sociodemographic characteristics of the affected population. Objectives: To establish the prevalence of acute cholecystitis in Colombia and describe the associated sociodemographic characteristics. Materials and Methods: A descriptive cross-sectional study was conducted using data from the individual service provision records (RIPS) from 2018 to 2022. Results: A total of 343,254 cases of acute cholecystitis were identified in Colombia, with a prevalence of 681 cases per 100,000 inhabitants and a female-to-male ratio of 2.3:1. The highest number of reported cases was in the 34 to 39-year age group. The departments with the most cases are located in the southeast of the country, including Nariño, Valle del Cauca, Caquetá, and Tolima. Conclusion: This study presents epidemiological and sociodemographic information on acute cholecystitis in Colombia. There are few epidemiological studies on this disease in Latin America, however, the prevalence found is similar to that reported in countries like the United States.

ABSTRACT Penaeus vannamei, or white shrimp, is an economically significant species that dominates shrimp production and represents a rapidly growing industry. However, the culture faces challenges due to high mortality rates due to bacterial and viral diseases. Unlike vertebrates, shrimp rely solely on their innate immunity for defense against pathogens. Introducing probiotics into shrimp culture can enhance growth, survival rates, and immune responses against disease outbreaks caused by pathogenic bacteria or viruses. Common diseases affecting shrimp farms include vibriosis, white spot disease, acute hepatopancreatic necrosis and black gill disease. These diseases can cause severe infections, which lead to high mortality rates. The application of probiotics, such as Bacillus cereus, B. licheniformis, B. subtilis, Lactobacillus sp., Paenibacillus, Pseudomonas sp., Pseudoaltermonas, and yeast, either through diet or direct administration, has demonstrated positive impacts on shrimp health, including enhanced growth, increased immunostimulation, improved gut microbiota, and better water quality parameters. In recent decades, aquafeed has explored effective solutions, such as microdiets, co-feeding (combining commercial feed and probiotics), and various microdiets types, to address aquaculture disease problems. Combining microdiets containing essential nutrients with probiotics has proven to be safer than antibiotics, which can adversely affect animals and the environment. However, further studies are needed to optimize the efficiency of feeding techniques by incorporating probiotics and commercial feed for disease resistance in penaeid shrimp culture. This review discusses commercial feeds and microdiets incorporated with probiotics for P. vannamei culture for growth and disease resistance to enhancement.

Abstract This article aims to analyze the clarity and engagement measures of publications on oral cancer in the Instagram profiles of official health agencies in Brazil. An infodemiological study was conducted with 81 profiles. Data collected concerned content classification, account and media, manner of addressing the topic, number of posts, likes, comments, views and hashtags. The clarity of the educational publications was assessed with the Brazilian version of the Clear Communication Index (BR-CDC-CCI). Data analysis involved Spearman’s correlation and the Mann-Whitney test (α = 5%). A total of 775 publications on oral cancer were found. The average BR-CDC-CCI score was 69.8 (SD = 15.5). The clarity of the information was adequate in 9.5% of the educational publications. Positive correlations were found between the number of likes and engagement (comments [r = 0.49], views [r = 0.96]), number of hashtags (r = 0.13) and year of publication (r = 0.21). Publications from the Health Ministry had a significantly higher BR-CDC-CCI score compared to the other profiles. Publications on oral cancer were correlated with engagement, year of publication and number of hashtags. Public agencies increased publications to reach the population, but the clarity of the content was low. Brazil 8 classification media topic posts comments BRCDCCCI. BRCDCCCI BR CDC CCI . (BR-CDC-CCI) Spearmans Spearman s MannWhitney Mann Whitney α 5%. 5 5% 5%) 77 698 69 69. SD 15.5. 155 15.5 15 15.5) 95 9 9.5 r 0.49, 049 0.49 , 0 49 0.49] 0.96, 096 0.96 96 0.96]) 0.13 013 13 0.21. 021 0.21 21 0.21) population low (BR-CDC-CCI 7 6 15. 1 9. 04 0.4 4 09 0.9 0.96] 0.1 01 02 0.2 2 0.

Resumo O objetivo do artigo é analisar a clareza e as medidas de engajamento das publicações sobre câncer bucal nos perfis do Instagram dos órgãos oficiais de saúde no Brasil. Realizou-se um estudo infodemiológico com 81 perfis. Foram coletados dados sobre classificação do conteúdo, conta e mídia, abordagem do tema, número de postagens, curtidas, comentários, visualizações e hashtags. A clareza das publicações educativas foi avaliada pela versão brasileira do Clear Communication Index (BR-CDC-CCI). A análise dos dados envolveu a correlação de Spearman e o teste de Mann-Whitney (α = 5%). Foram encontradas 775 publicações sobre câncer bucal. O escore médio do BR-CDC-CCI foi 69,8 (DP = 15,5). A clareza das informações foi adequada em 9,5% das publicações educativas. Correlações positivas foram encontradas entre o número de curtidas e engajamento (comentários [r = 0,49], visualizações [r = 0,96]), número de hashtags (r = 0,13) e ano de publicação (r = 0,21). Publicações do Ministério da Saúde apresentaram escore do BR-CDC-CCI significativamente maior do que os demais perfis (p = 0,01). As publicações sobre câncer bucal foram correlacionadas com engajamento, ano de publicação e número de hashtags. Os órgãos públicos aumentaram as publicações para atingir a população, mas a clareza do conteúdo foi baixa. Brasil Realizouse Realizou se 8 mídia tema postagens comentários BRCDCCCI. BRCDCCCI BR CDC CCI . (BR-CDC-CCI) MannWhitney Mann Whitney α 5%. 5 5% 5%) 77 698 69 69, DP 15,5. 155 15,5 15 15,5) 95 9 9,5 r 0,49, 049 0,49 , 0 49 0,49] 0,96, 096 0,96 96 0,96]) 0,13 013 13 0,21. 021 0,21 21 0,21) p 0,01. 001 0,01 01 0,01) população baixa (BR-CDC-CCI 7 6 15, 1 9, 04 0,4 4 09 0,9 0,96] 0,1 02 0,2 2 00 0,0 0,

ABSTRACT Discursively analyze the educational objectives present in official documents referring to Residency Programs in the Professional Health Area. Analysis of official Brazilian documents that configure teaching for Residency Programs in the Professional Health Area. Search carried out between February and April 2023 in databases available on the websites of the Federal Government of Brazil and the Health Legislation System of the Ministry of Health. Critical Discourse Analysis was carried out, from Fairclough’s perspective. Nine official documents addressed the educational objectives of Residency Programs in the Professional Health Area. The data were systematized into principles, conceptions, values, and educational strategies that guide the residency programs and organization mode, based on teaching activities. The educational objectives of Residency Programs in the Professional Health Area move towards the technical training of residents, while the discourse on the educational model, expressed in teaching activities, moves towards expanding the concept.

RESUMO Analisar discursivamente os objetivos educacionais presentes nos documentos oficiais referentes aos Programas de Residência em Área Profissional da Saúde. Análise de documentos oficiais brasileiros que configuram o ensino para os Programas de Residência em Área Profissional da Saúde. Busca realizada entre fevereiro e abril de 2023 em bancos de dados disponibilizados nos sites do Governo Federal do Brasil e do Sistema de Legislação da Saúde do Ministério da Saúde. Realizou-se Análise de Discurso Crítica, na perspectiva de Fairclough. Nove documentos oficiais abordavam os objetivos educacionais dos Programas de Residência em Área Profissional da Saúde. Os dados foram sistematizados em princípios, concepções, valores e estratégias educacionais que orientam os programas de residência e em modo de organização, a partir das atividades de ensino. Os objetivos educacionais dos Programas de Residência em Área Profissional da Saúde caminham rumo à formação técnica dos residentes, enquanto o discurso sobre o modelo educacional, expresso nas atividades de ensino, avança para a ampliação do conceito.

The Covid-19 pandemic had a great effect on people's health as well as their economic stability. The virus also led to the death of many people. Numerous restrictions were put into place to limit the spread of the virus. In South Africa, one of the restrictions was a national lockdown, which meant that most people could not go to work. This resulted in many people losing their jobs, including many parents. When parents lose their jobs, it does not only affect them, but it also affects their children. Parents 'job loss can sometimes lead to positive outcomes, but in most cases it will have a negative impact on children. There are many ways in which the job loss of parents can have a negative impact on the lives of their children. It affects aspects such as their health, safety, emotional well-being, school performance, future, and so forth. Because of this, it is important to determine how children can be equipped to make sense of their circumstances and to flourish in spite thereof. Practical theology is a field of study that works with cases such as these. The aim of this article is therefore to show, from a practical-theological perspective, how congregational children's ministry can be used to implement faith resources into children's lives to equip them to flourish by strengthening their relationship with God as well as their relationship with other people. This would include resources such as the Bible, prayer, and a biblical perspective on suffering as well as hope. Other resources include family, the church, friends as well as people who have gone through similar situations and who were able to handle it in a healthy way. All of these faith resources can be made a part of children's lives through congregational children's ministry. This would include things such as faith formation (Sunday school and youth groups), church services, mentorship, and the support of parents. When children are equipped through these ministries, it enables them to make sense of their circumstances and helps them to flourish in spite of such challenges.

Die Covid-19-pandemie het 'n groot effek op mense se gesondheid sowel as hulle ekonomiese stabiliteit gehad. Talle beperkings is ingestel om die verspreiding van die virus te beperk. In Suid-Afrika was een van die beperkings 'n nasionale inperking wat veroorsaak het dat die meeste mense nie werk toe kon gaan nie. Dit het daartoe gelei dat talle mense hul werk verloor het. Baie van die mense was ouers. Ouers se werksverlies affekteer nie net hulself nie, maar ook hul kinders. Daar is verskeie maniere waarop ouers se werksverlies kinders negatief kan beïnvloed. Praktiese teologie is 'n studieveld wat met gevalle soos dié werk. Daarom is die doel van hierdie artikel om, vanuit die perspektief van die praktiese teologiese te wys hoe gemeentelike kinderbediening gebruik kan word om geloofshulpbronne in kinders se lewens in te bou sodat hulle van hul omstandighede (ouers se werksverlies) kan sinmaak en ten spyte van hul omstandighede sal kan floreer.

Resumo O objetivo do artigo é analisar a clareza e as medidas de engajamento das publicações sobre câncer bucal nos perfis do Instagram dos órgãos oficiais de saúde no Brasil. Realizou-se um estudo infodemiológico com 81 perfis. Foram coletados dados sobre classificação do conteúdo, conta e mídia, abordagem do tema, número de postagens, curtidas, comentários, visualizações e hashtags. A clareza das publicações educativas foi avaliada pela versão brasileira do Clear Communication Index (BR-CDC-CCI). A análise dos dados envolveu a correlação de Spearman e o teste de Mann-Whitney (α = 5%). Foram encontradas 775 publicações sobre câncer bucal. O escore médio do BR-CDC-CCI foi 69,8 (DP = 15,5). A clareza das informações foi adequada em 9,5% das publicações educativas. Correlações positivas foram encontradas entre o número de curtidas e engajamento (comentários [r = 0,49], visualizações [r = 0,96]), número de hashtags (r = 0,13) e ano de publicação (r = 0,21). Publicações do Ministério da Saúde apresentaram escore do BR-CDC-CCI significativamente maior do que os demais perfis (p = 0,01). As publicações sobre câncer bucal foram correlacionadas com engajamento, ano de publicação e número de hashtags. Os órgãos públicos aumentaram as publicações para atingir a população, mas a clareza do conteúdo foi baixa.

Abstract This article aims to analyze the clarity and engagement measures of publications on oral cancer in the Instagram profiles of official health agencies in Brazil. An infodemiological study was conducted with 81 profiles. Data collected concerned content classification, account and media, manner of addressing the topic, number of posts, likes, comments, views and hashtags. The clarity of the educational publications was assessed with the Brazilian version of the Clear Communication Index (BR-CDC-CCI). Data analysis involved Spearman’s correlation and the Mann-Whitney test (α = 5%). A total of 775 publications on oral cancer were found. The average BR-CDC-CCI score was 69.8 (SD = 15.5). The clarity of the information was adequate in 9.5% of the educational publications. Positive correlations were found between the number of likes and engagement (comments [r = 0.49], views [r = 0.96]), number of hashtags (r = 0.13) and year of publication (r = 0.21). Publications from the Health Ministry had a significantly higher BR-CDC-CCI score compared to the other profiles. Publications on oral cancer were correlated with engagement, year of publication and number of hashtags. Public agencies increased publications to reach the population, but the clarity of the content was low.