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Abstract Background Patients with immune-mediated rheumatic diseases (IMRDs) have been prioritized for COVID-19 vaccination to mitigate the infection severity risks. Patients with rheumatoid arthritis (RA) are at a high risk of severe COVID-19 outcomes, especially those under immunosuppression or with associated comorbidities. However, few studies have assessed the safety of the COVID-19 vaccine in patients with RA. Objective To evaluate the safety of vaccines against SARS-CoV-2 in patients with RA. Methods This data are from the study “Safety and Efficacy on COVID-19 Vaccine in Rheumatic Diseases,” a Brazilian multicentric prospective phase IV study to evaluate COVID-19 vaccine in IMRDs in Brazil. Adverse events (AEs) in patients with RA of all centers were assessed after two doses of ChAdOx1 (Oxford/AstraZeneca) or CoronaVac (Sinovac/Butantan). Stratification of postvaccination AEs was performed using a diary, filled out daily and returned at the end of 28 days for each dose. Results A total of 188 patients with RA were include, 90% female. CoronaVac was used in 109 patients and ChAdOx1 in 79. Only mild AEs were observed, mainly after the first dose. The most common AEs after the first dose were pain at the injection (46,7%), headache (39,4%), arthralgia (39,4%), myalgia (30,5%) and fatigue (26,6%), and ChAdOx1 had a higher frequency of pain at the injection (66% vs 32 %, p < 0.001) arthralgia (62% vs 22%, p < 0.001) and myalgia (45% vs 20%, p < 0.001) compared to CoronaVac. The more common AEs after the second dose were pain at the injection (37%), arthralgia (31%), myalgia (23%), headache (21%) and fatigue (18%). Arthralgia (41,4% vs 25%, p = 0.02) and pain at injection (51,4% vs 27%, p = 0.001) were more common with ChAdOx1. No serious AEs were related. With Regard to RA activity level, no significant difference was observed between the three time periods for both COVID-19 vaccines. Conclusion In the comparison between the two immunizers in patients with RA, local reactions and musculoskeletal symptoms were more frequent with ChAdOx1 than with CoronaVac, especially after the first dose. In summary, the AE occurred mainly after the first dose, and were mild, like previous data from others immunizing agents in patients with rheumatoid arthritis. Vaccination did not worsen the degree of disease activity. immunemediated immune mediated (IMRDs COVID19 COVID 19 COVID-1 risks (RA outcomes comorbidities However SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- Safety Diseases, Diseases Brazil (AEs ChAdOx Oxford/AstraZeneca OxfordAstraZeneca Oxford AstraZeneca (Oxford/AstraZeneca Sinovac/Butantan. SinovacButantan Sinovac/Butantan . Sinovac Butantan (Sinovac/Butantan) diary 18 include 90 female 10 79 46,7%, 467 46,7% , 46 7 (46,7%) 39,4%, 394 39,4% 39 4 (39,4%) 30,5% 305 30 5 (30,5% 26,6%, 266 26,6% 26 6 (26,6%) 66% 66 (66 3 % 0.001 0001 0 001 62% 62 (62 22 22% 45% 45 (45 20 20% 37%, 37 37% (37%) 31%, 31 31% (31%) 23%, 23 23% (23%) 21% 21 (21% 18%. 18% (18%) 41,4% 414 41 (41,4 25 25% 0.02 002 02 51,4% 514 51 (51,4 27 27% related level summary COVID1 1 COVID- SARS-CoV (Sinovac/Butantan 9 46,7 (46,7% 39,4 (39,4% 30,5 (30,5 26,6 (26,6% (6 0.00 000 00 (4 (37% (31% (23% (21 (18% 41,4 (41, 0.0 51,4 (51, 46, (46,7 39, (39,4 30, (30, 26, (26,6 ( (37 (31 (23 (2 (18 41, (41 0. 51, (51 (46, (39, (30 (26, (3 (1 (5 (46 (39 (26

https://doi.org/10.1186/s42358-024-00397-5

Predictors of Trypanosoma cruzi PCR positivity in patients with chronic Chagas disease
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de Lima, Ana Carolina Bastos

; Mendes, Veronica Gonçalves

; Ferreira, Roberto Rodrigues

; Nisimura, Lindice Mitie

; Horita, Samuel Iwao Maia

; Veloso, Henrique H

; Costa, Andréa R

; da Silva, Gilberto Marcelo S

; Sangenis, Luiz Henrique C

; Holanda, Marcelo T

; Rimolo, Lorena

; Cunha, Ademir B

; Garzoni, Luciana Ribeiro

; Hasslocher-Moreno, Alejandro Marcel

; Mediano, Mauro Felippe F

; Moreira, Otacílio da Cruz

; Britto, Constança

; Saraiva, Roberto M

Memórias do Instituto Oswaldo Cruz

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2023, Volume 118 elocation e230115

Abstract: En | Text: En | PDF: En

BACKGROUND A positive Trypanosoma cruzi polymerase chain reaction (PCR) is associated with a worse prognosis in patients with chronic Chagas disease (CD). OBJECTIVES To study the association of clinical, electrocardiographic, and echocardiographic characteristics and biomarker blood levels with positive T. cruzi PCR in chronic CD. METHODS This is a single-centre observational cross-sectional study. Positive T. cruzi PCR association with clinical, electrocardiographic, and echocardiographic characteristics, and biomarker blood levels were studied by logistic regression analysis. p values < 0.05 were considered significant. FINDINGS Among 333 patients with chronic CD (56.4% men; 62 ± 10 years), T. cruzi PCR was positive in 41.1%. Stepwise multivariate logistic regression showed an independent association between positive T. cruzi PCR and diabetes mellitus {odds ratio (OR) 0.53 [95% confidence interval (CI) 0.30-0.93]; p = 0.03}, right bundle branch block [OR 1.78 (95% CI 1.09-2.89); p = 0.02], and history of trypanocidal treatment [OR 0.13 (95% CI 0.04-0.38); p = 0.0002]. Among patients with a history of trypanocidal treatment (n = 39), only four (10%) patients had a positive T. cruzi PCR. MAIN CONCLUSIONS Among several studied parameters, only diabetes mellitus, right bundle branch block, and history of trypanocidal treatment showed an independent association with positive T. cruzi PCR. History of trypanocidal treatment was a strong protective factor against a positive T. cruzi PCR. (PCR . (CD) clinical electrocardiographic T singlecentre single centre crosssectional cross sectional analysis 005 0 05 0.0 significant 33 56.4% 564 56 4 (56.4 men 6 1 years, years , years) 411 41 41.1% odds OR (OR 053 53 0.5 95% 95 [95 (CI 0.300.93 030093 0.30 0.93 30 93 0.30-0.93] 0.03, 003 0.03 03 0.03} 178 78 1.7 (95 1.092.89 109289 1.09 2.89 09 2 89 1.09-2.89) 0.02, 002 0.02 02 0.02] 013 13 0.1 0.040.38 004038 0.04 0.38 04 38 0.04-0.38) 0.0002. 00002 0.0002 0002 0.0002] n 39, 39 39) 10% (10% parameters (CD 00 0. 3 56.4 5 (56. 41.1 9 [9 300 0.300.9 03009 030 0.3 093 0.9 0.30-0.93 17 7 1. (9 092 1.092.8 10928 109 1.0 289 2.8 8 1.09-2.89 01 040 0.040.3 00403 004 038 0.04-0.38 0000 0.000 000 (10 56. (56 41. [ 0.300. 0300 0.30-0.9 ( 1.092. 1092 28 2. 1.09-2.8 0.040. 0040 0.04-0.3 0.00 (1 (5 0.300 0.30-0. 1.092 1.09-2. 0.040 0.04-0. 0.30-0 1.09-2 0.04-0 0.30- 1.09- 0.04-

https://doi.org/10.1590/0074-02760230115

Profile of oropharyngeal dysphagia patients in a teaching hospital in Northern Brazil: a descriptive cross-sectional study Brazil crosssectional cross sectional
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Gonçalves, Ives Marcelo Pinheiro

; Pontes-Silva, André

; Zica, Matheus Morbeck

; Barasuol, Aldair Martins

; Maciel, Erika da Silva

; Quaresma, Fernando Rodrigues Peixoto

Revista da Associação Médica Brasileira

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2023, Volume 69 N. 10 elocation e20230611

Abstract: En | Text: En | PDF: En

SUMMARY OBJECTIVE: The aim of this study was to describe the profile of patients with oropharyngeal dysphagia in a teaching hospital in the public health system in northern Brazil. METHODS: This is a descriptive cross-sectional study. All procedures of this study were approved by the ethics committee. A convenience sample composed of participants aged >18 years, of both sexes, with any underlying pathology admitted to the medical clinic on exclusive oral feeding, alternatively enteral or gastric tube feeding (Gastrostomy), or associated by both routes, whose swallowing assessment was performed by a Speech-Language Pathologist. Data from the database/medical records were investigated from March 2020 to September 2021. RESULTS: The sample consisted of 44 patients diagnosed with oropharyngeal dysphagia, with a higher frequency of males (63.64%) aged over 60 years (70.45%). Almost half of the evaluated patients were diagnosed with neurological disorders (47.73%) and had dysphagia associated with other underlying diseases (31.82%). Excluding patients with neurological disorders, trauma/polytrauma, and respiratory disorders from the last group, some patients (11.36%) had two concomitant underlying diseases. CONCLUSION: According to the sample of this study, the profile of oropharyngeal dysphagia patients includes pneumonia, respiratory failure, bronchoaspiration, and the consequent need for ventilatory support. OBJECTIVE Brazil METHODS crosssectional cross sectional committee 18 >1 sexes Gastrostomy, Gastrostomy , (Gastrostomy) routes SpeechLanguage Speech Language Pathologist databasemedical database 202 2021 RESULTS 4 63.64% 6364 63 64 (63.64% 6 70.45%. 7045 70.45% . 70 45 (70.45%) 47.73% 4773 47 73 (47.73% 31.82%. 3182 31.82% 31 82 (31.82%) traumapolytrauma trauma polytrauma trauma/polytrauma group 11.36% 1136 11 36 (11.36% CONCLUSION pneumonia failure bronchoaspiration support 1 > (Gastrostomy 20 63.64 636 (63.64 704 70.45 7 (70.45% 47.73 477 (47.73 318 31.82 3 8 (31.82% 11.36 113 (11.36 2 63.6 (63.6 70.4 (70.45 47.7 (47.7 31.8 (31.82 11.3 (11.3 63. (63. 70. (70.4 47. (47. 31. (31.8 11. (11. (63 (70. (47 (31. (11 (6 (70 (4 (31 (1 ( (7 (3

https://doi.org/10.1590/1806-9282.20230611

Physical Training Improves Cardiac Structure and Function of Rats After Doxorubicin-Induced Cardiomyopathy DoxorubicinInduced Doxorubicin Induced
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Souza, Fernanda Rodrigues

; Campos, Érica Carolina

; Lopes, Leandro Teixeira Paranhos

; Rodrigues, Clesnan Mendes

; Gonçalves, Danilo Lemes Naves

; Beletti, Marcelo Emílio

; Mantovani, Matheus Matioli

; Duarte, Poliana Rodrigues Alves

; Gonçalves, Alexandre

; Resende, Elmiro Santos

International Journal of Cardiovascular Sciences

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dec 2022, Volume 35 N. 6 Pages 718 - 726

Abstract: En | Text: En | PDF: En

Abstract Background: The use of doxorubicin in chemotherapy has been associated with cardiotoxicity and heart failure. Physical exercise produces favorable morphofunctional adaptations in the cardiovascular system and may reverse cardiac dysfunction in patients undergoing chemotherapy. Objective: To assess the effects of physical training on myocardial structure, cardiac function, and exercise tolerance in Wistar rats initiated after the onset of cardiotoxicity-induced cardiotoxicity. Methods: This study investigated 30 adult male Wistar rats randomly divided into four groups: control (C), exercise (EX), doxorubicin (DX), and doxorubicin and exercise (DXEX). The DX and DXEX groups received six doses of doxorubincin from 1.25 mg/kg body weight up to a cumulative dose of 7.5 mg/kg. Injections were administered intraperitoneally three times a week for two weeks; after this stage, the EX and DXEX groups started physical training (swimming) sessions three times a week with a load of 5% of their body weight. Echocardiography and exercise tolerance tests were performed. Generalized linear models were used in statistical analysis, and a p<0.05 was set as statistically significant. Results: Left ventricular shortening fraction and ejection fraction were reduced in the DX group compared to C, EX, and DXEX. The DXEX group showed greater tolerance to effort when compared to the DX and C groups. Conclusion: Physical training, initiated after the onset of doxorubicin-induced cardiotoxicity, improved cardiac function and exercise tolerance in rats. Background failure Objective structure cardiotoxicityinduced induced Methods 3 , (C) (EX) DX, (DX) . (DXEX) 125 1 25 1.2 mgkg mg kg 75 7 5 7. weeks stage swimming (swimming performed analysis p005 p 0 05 p<0.0 significant Results Conclusion doxorubicininduced (C (EX (DX (DXEX 12 2 1. p00 p<0. p0 p<0 p<

https://doi.org/10.36660/ijcs.20210095

Representatividade ecológica e extensão total de áreas protegidas pelas unidades de conservação no estado do Ceará, Brasil
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Gomes, Francisco Vladimir Silva

; Santos, Ana Maria Ferreira dos

; Guerra, Renan Gonçalves Pinheiro

; Queiroz, Liana Rodrigues

; Menezes, Marcelo Oliveira Teles de

; Moro, Marcelo Freire

Sociedade & Natureza

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2022, Volume 34 elocation e64481

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo As metas de Aichi, das quais o Brasil foi signatário, previam que, até 2020, pelo menos 17% de áreas terrestres e águas continentais e 10% das áreas marinhas e costeiras fossem englobados em áreas protegidas. Finalizado o prazo da meta, o Brasil conta, oficialmente, com 30% da área continental e 27% da área marinha protegidas, todavia distribuídas desigualmente em seu território. Neste estudo, computou-se a cobertura de 98 UCs e um corredor ecológico no estado do Ceará (CE) e foi avaliada sua distribuição entre os vários ambientes naturais do estado. Destarte, buscou-se avaliar a representatividade da conservação promovida pelas UCs em relação aos diferentes ecossistemas estaduais. Os resultados apontam que 92,4% da área protegida corresponde ao regime de Uso Sustentável, distribuída prioritariamente em ecossistemas de exceção do bioma Caatinga, como as áreas costeiras e encraves úmidos e sub-úmidos. Essas áreas apresentam relevância ambiental com rica biodiversidade e geodiversidadade, com interesse socioeconômico, mas o desenho atual de UCs deixou pouco protegida a vegetação de caatinga, ecossistema predominante do estado. Ademais, a predominância de UCs de uso sustentável trazem menos proteção jurídica para salvaguardar a biodiversidade, especialmente aquelas com baixo grau legal de proteção, como a categoria Área de Proteção Ambiental que corresponde à maior cobertura estadual. Conclui-se que a configuração espacial das UCs estaduais ainda está distante do ideal em termos de extensão e representatividade, com poucas áreas protegidas na vegetação de caatinga e pequena extensão de UCs de proteção integral.

Abstract Among the targets of the Aichi Accord, of which Brazil was a signatory, was the commitment to protect at least 17% of its terrestrial and continental waters and 10% of all marine and coastal areas by 2020. When the target window closed, Brazil had 30% of those projected continental and 27% of the marine areas protected. Those areas, however, are unevenly distributed throughout the country, with the Amazon region exceeding 30% of the projected protection, while only approximately 8% of the Caatinga region has been considered. In this study, we computed the coverage of 98 designated Conservation Areas (CAs) and an ecological corridor in Ceará State (CE) and evaluated their distributions among that state’s various natural environments. Our results indicated that 92.6% % of the total officially protected areas corresponded to Uso Sustentável categories (US), which means sustainable use in English ,largely distributed among ecosystems outside the Caatinga domain, including coastal areas and humid and sub-humid enclaves. Those CAs contain rich bio- and geo-diversities of significant socioeconomic interest, although they do little to protect caatinga vegetation - the predominant ecosystem in the state. Additionally, the predominance of US CAs provide limited legal safeguards to biodiversity, especially among those CAs with low levels of legal protection, such as the category of Área de Proteção Ambiental (APA), which means Environmental Protection Areas in English, which account for the greatest coverage in the state. We conclude that the spatial configuration of state CAs is distant from ideal in terms of their extensions and representativeness, with few areas of protected caatinga vegetation and limited areas with full protection.

https://doi.org/10.14393/sn-v34-2022-64481

Assessment of stress and anxiety in mice with colorectal cancer submitted to physical exercise
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Silva Junior, Udenilson Nunes da

; Boutrik, Amanda

; Gonçalves, Alessandra de Figueiredo

; Neves, Marcelo Barbosa

; Alves, Gabriela Rodrigues

; Fagundes, Letícia Silva

; Abreu, Antônio Carlos de

; Aydos, Ricardo Dutra

; Ramalho, Rondon Tosta

Acta Cirúrgica Brasileira

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2022, Volume 37 N. 5 elocation e370508

Abstract: En | Text: En | PDF: En

ABSTRACT Purpose: To evaluate the effect of physical exercise on the behavior of rodents with colorectal cancer induced through the use of elevated plus maze. Methods: We used 40 male hairless mice induced to colorectal cancer, divided into five groups: G1) submitted to pre- and post-induction swimming; G2) pre- and post-induction ladder; G3) post-induction swimming; G4) post-induction ladder; G5) sedentary. At the end of the 14th week, the animals were submitted to the plus maze test. Results: The mean length of stay in the open arm for G1 was 4.17 ± 6.50; G2 37.52 ± 40.7; G3 85.84 ± 42.5; G4 32.92 ± 23.17; and G5 4.09 ± 4.43. In the closed arm, it was 264 ± 23.43 in G1, 187.60 ± 47.73 in G2, 147.50 ± 40.03 in G3, 182.00 ± 40.40 in G4, and in G5 235.36 ± 14.28. In the center, G1 remained 31.86 ± 20.18, G2 74.85 ± 28.37, G3 66.69 ± 19.53, G4 60.55 ± 10.46, and G5 60.55 ± 23.65. Conclusions: Aerobic exercise for seven weeks after tumor induction showed less impact on the behavior of the animals. On the other hand, it significantly increased the animals’ stress level when applied for 14 weeks before and after tumor induction. Purpose Methods 4 groups G pre postinduction post swimming ladder sedentary th week test Results 417 17 4.1 6.50 650 6 50 3752 37 52 37.5 40.7 407 7 8584 85 84 85.8 42.5 425 42 5 3292 32 92 32.9 23.17 2317 23 409 09 4.0 443 43 4.43 26 2343 23.4 18760 187 60 187.6 4773 47 73 47.7 14750 147 147.5 4003 03 40.0 18200 182 00 182.0 4040 40.4 23536 235 36 235.3 1428 28 14.28 center 3186 31 86 31.8 2018 20 18 20.18 7485 74 74.8 2837 28.37 6669 66 69 66.6 1953 19 53 19.53 6055 55 60.5 1046 10 46 10.46 2365 65 23.65 Conclusions hand 1 41 4. 6.5 375 3 37. 40. 858 8 85. 42. 329 9 32. 23.1 231 2 0 44 4.4 234 23. 1876 187. 477 47. 1475 147. 400 1820 182. 404 2353 235. 142 14.2 318 31. 201 20.1 748 74. 283 28.3 666 66. 195 19.5 605 60. 104 10.4 236 23.6 6. 14. 20. 28. 19. 10.

https://doi.org/10.1590/acb370508

Official Position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry—part II (clinical aspects): interpretation, reporting, and special situations
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Maeda, Sergio Setsuo

; Albergaria, Ben-Hur

; Szejnfeld, Vera Lúcia

; Lazaretti-Castro, Marise

; Arantes, Henrique Pierotti

; Ushida, Marcela

; Domiciano, Diogo Souza

; Pereira, Rosa Maria Rodrigues

; Marin-Mio, Rosângela Villa

; Oliveira, Mônica Longo de

; Mendonça, Laura Maria Carvalho de

; Prado, Mirley do

; Souza, Guilherme Cardenaz de

; Palchetti, Cecília Zanin

; Sarni, Roseli Oselka Saccardo

; Terreri, Maria Teresa

; Castro, Luiz Claudio Gonçalves de

; Artoni, Silvana Martinez Baraldi

; Amoroso, Lizandra

; Karcher, Débora Emy

; Prado, Carla M.

; Gonzalez, Maria Cristina

; Pinheiro, Marcelo de Medeiros

Advances in Rheumatology

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2022, Volume 62 elocation 11

Abstract: En | Text: En | PDF: En

Abstract Objective: To present an updated and evidence-based guideline for the use of dual-energy x-ray absorptiometry (DXA) to assess body composition in clinical practice. Materials and methods: This Official Position was developed by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism ( Associação Brasileira de Avaliação Óssea e Osteometabolismo , ABRASSO) and experts in the field who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications in the area of body composition assessment. In this second part of the Official Position, the authors discuss the interpretation and reporting of body composition parameters assessed by DXA and the use of DXA for body composition evaluation in special situations, including evaluation of children, persons with HIV, and animals. Conclusion: This document offers recommendations for the use of DXA in body composition evaluation, including indications, interpretation, and applications, to serve as a guiding tool in clinical practice and research for health care professionals in Brazil.

https://doi.org/10.1186/s42358-022-00240-9

Distance learning course improves primary care dentists’ diagnosis and self-efficacy in the management of oral lesions
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CARDOSO, Fernanda Brochier

; WAGNER, Vivian Petersen

; CORRÊA, Ana Paula Borngräber

; MARTINS, Marco Antônio Trevizani

; MARTINS, Manoela Domingues

; D’ÁVILA, Otávio Pereira

; GONÇALVES, Marcelo Rodrigues

; HARZHEIM, Erno

; UMPIERRE, Roberto Nunes

; CARRARD, Vinicius Coelho

Brazilian Oral Research

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2022, Volume 36 elocation e101

Abstract: En | Text: En | PDF: En

Abstract Oral cancer represents a public health issue because of its high mortality rate, resulting mainly from diagnostic delays. Insufficient training in oral diagnosis is usually perceived by dentists. Distance learning could be used as an auxiliary tool to bridge that gap. This study evaluated the impact of a distance learning course on oral mucosal lesion diagnosis offered to public healthcare dentists. Participants of an online course answered a pretest/posttest comprising clinical images of 30 clinical cases. Participants were questioned about the diagnosis and informed their decision on the cases (referring the cases to a specialist or managing them themselves), as a parameter of perceived self-efficacy. A total of 442 dentists enrolled in the course. Their pass rate was 97%. Classification of the nature of the lesions, diagnostic hypotheses, sensitivity, and specificity improved by 13.4%, 10.0%, 13.4%, and 6.6%, respectively (p<0.01, Wilcoxon test). Regarding management, there was a 16.6% reduction in the intention to refer cases, while confidence in the diagnosis of benign lesions increased by 40%. A distance learning course may be useful in continuing education actions for primary care dentists, improving their diagnostic abilities and encouraging them in the management of oral lesions. Moreover, this strategy could contribute to disseminating knowledge to remote regions, particularly among primary health care professionals.

https://doi.org/10.1590/1807-3107bor-2022.vol36.0101

10.

[SciELO Preprints] - Eighteen years in two days: the next steps for remote consultation in Brazil
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Aita Schmitz, Carlos André Rodrigues Gonçalves, Marcelo Nunes Umpierre, Roberto Martins Costa, Manuela Harzheim, Erno Souza da Silva, Rodolfo Goulart Molina-Bastos, Cynthia Ambrosini Mendonça, Marcos Vinícius Katz, Natan

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Publication date: 2021-11-05

Abstract: En Es Pt

This is an opinion article that aims to support the Disease caused by the New Coronavirus of 2019 (COVID-19) post-pandemic regarding the regulation of care through digital resources. Through a literature review, an attempt was made to conceptualize remote consultation and to survey both the historical evolution of technological appropriation by health and the regulation on the subject. Texts covering the pre-pandemic and pandemic periods in Brazil, the United States, the European Union and Australia were evaluated. We tried to highlight the main fallacies, sophisms and dissensions that orbit the theme, as well as the real points where there is a need for greater commitment for decision makers: data security and privacy, reimbursement parity and interstate licensing. It is concluded that the technological appropriation by health has divided the world into at least three segments: those that maintained the autonomy of professionals and patients; those who retarded technological advancement through bureaucracy; and those who forbade advances. The pandemic has generated positive reallocations among these groups and there is a need to refine progress and avoid setbacks.

Este es un artículo de opinión que tiene como objetivo apoyar la discusión pospandémica de la Enfermedad causada por el Nuevo Coronavirus de 2019 (COVID-19) en cuanto a la regulación de la atención a través de recursos digitales. A través de una revisión de la literatura, se intentó conceptualizar la consulta remota y relevar tanto la evolución histórica de la apropiación tecnológica por parte de la salud como la regulación sobre el tema. Se evaluaron los textos que cubren los períodos prepandémico y pandémico en Brasil, Estados Unidos, la Unión Europea y Australia. Intentamos resaltar las principales falacias, sofismas y disensiones que orbitan el tema, así como los puntos reales donde existe la necesidad de un mayor compromiso de los tomadores de decisiones: seguridad y privacidad de los datos, paridad de reembolso y licencias interestatales. Se concluye que la apropiación tecnológica por parte de la salud ha dividido al mundo en al menos tres segmentos: los que mantenían la autonomía de profesionales y pacientes; los que retrasaron el avance tecnológico a través de la burocracia; y los que prohibieron los avances. La pandemia ha generado reasignaciones positivas entre estos grupos y es necesario perfeccionar el progreso y evitar retrocesos.

Este é um artigo de opinião que objetiva subsidiar a discussão pós-pandemia da Doença causada pelo Novo Coronavírus de 2019 (COVID-19) a respeito da regulamentação do atendimento por meio de recursos digitais. Buscou-se, por meio de revisão de literatura, conceituar a consulta remota e fazer um levantamento tanto da evolução histórica da apropriação tecnológica pela saúde como da regulamentação sobre o tema. Foram avaliados textos cobrindo os períodos pré-pandêmico e pandêmico no Brasil, Estados Unidos, União Europeia e Austrália. Procurou-se evidenciar as principais falácias, sofismas e dissensos que orbitam o tema, bem como os reais pontos onde há necessidade de maior empenho para os tomadores de decisão: segurança de dados e privacidade, paridade de reembolso e licenciamento interestadual. Conclui-se que a apropriação tecnológica pela saúde dividiu o mundo em pelo menos três segmentos: os que mantiveram a autonomia de profissionais e pacientes; os que retardaram o avanço tecnológico por meio de burocracia; e os que proibiram os avanços. A pandemia gerou realocações positivas entre esses grupos e existe a necessidade de refinar avanços e evitar retrocessos.

https://doi.org/10.1590/SciELOPreprints.3126

11.

Primary Care Asssement Tool: diferenças regionais a partir da Pesquisa Nacional de Saúde do Instituto Brasileiro de Geografia e Estatística
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Pinto, Luiz Felipe

; Quesada, Leonardo Arêas

; D’Avila, Otavio Pereira

; Hauser, Lisiane

; Gonçalves, Marcelo Rodrigues

; Harzheim, Erno

Ciência & Saúde Coletiva

Journal Metrics
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sep 2021, Volume 26 N. 9 Pages 3965 - 3979

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Em 2019, o Instituto Brasileiro de Geografia e Estatística (IBGE) de forma inédita entre os institutos oficiais de estatística em todo o mundo, incluiu um módulo especial sobre avaliação da atenção primária à saúde em seu principal inquérito populacional de base domiciliar, a Pesquisa Nacional de Saúde (PNS). O inquérito considerou a versão reduzida do instrumento Primary Care Assessment Tool (PCAT), desenvolvida e disseminada por Starfield e Shi para avaliar a existência e extensão das características de estrutura e processos dos serviços de atenção primária em saúde. Trata-se da maior amostra probabilística com o uso desse instrumento já realizada em um único país do mundo que entrevistou usuários com 18 anos ou mais (n = 9.677). Os resultados dos escores gerais do PCAT do Brasil (5,9 [5,8; 5,9]) apontam grandes contrastes regionais e intraregionais, com a região Sul do país destacando-se com as melhores avaliações dos serviços de atenção primária (escore geral = 6,3 [6,2; 6,5]) e a região norte, por outro lado, com as menores (escore geral = 5,5 [5,3; 5,7]). Foram também observadas diferenças estatisticamente significantes e mais favoráveis entre os moradores de domicílios cadastrados pelas equipes de saúde da família, entre os mais idosos e entre que mais utilizam os serviços de saúde (adultos com morbidades referidas).

Abstract In 2019, unprecedentedly among the official statistical institutes worldwide, the IBGE included a particular module on evaluating primary health care in its central population-based population survey, the National Health Survey (PNS-2019). The survey considered the reduced version of the Primary Care Assessment Tool (PCAT), developed and disseminated by Starfield and Shi, to assess the existence and extent of the structure and process characteristics of PHC services. It is the most significant probabilistic sample using this instrument ever conducted in a single country in the world that interviewed users aged 18 or over (n=9,677). The results of the Brazilian overall PCAT scores (5.9 [5.8; 5.9]) point to significant regional and intraregional contrasts, with the South of the country standing out with the best evaluations of primary care services (overall score = 6.3 [6.2; 6.5]) and the North with the worse (overall score = 5,5 [5,3; 5,7]). There were also statistically significant and more favorable differences between residents of households registered by family health teams, among older adults, and those using health services the most (adults with reported morbidities).

https://doi.org/10.1590/1413-81232021269.10112021 127 downloads

12.

Primary Care Asssement Tool: diferenças regionais a partir da Pesquisa Nacional de Saúde do Instituto Brasileiro de Geografia e Estatística
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Pinto, Luiz Felipe

; Quesada, Leonardo Arêas

; D’Avila, Otavio Pereira

; Hauser, Lisiane

; Gonçalves, Marcelo Rodrigues

; Harzheim, Erno

Ciência & Saúde Coletiva

Journal Metrics
- Sobre o periódico
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sep 2021, Volume 26 N. 9 Pages 3965 - 3979

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1413-81232021269.10112021

13.

O Papel da Telessaúde na Pandemia Covid-19: Uma Experiência Brasileira
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Silva, Rodolfo Souza da

; Schmtiz, Carlos André Aita

; Harzheim, Erno

; Molina-Bastos, Cynthia Goulart

; Oliveira, Elise Botteselle de

; Roman, Rudi

; Umpierre, Roberto Nunes

; Gonçalves, Marcelo Rodrigues

Ciência & Saúde Coletiva

Journal Metrics
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jun 2021, Volume 26 N. 6 Pages 2149 - 2157

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O SARS-CoV-2, vírus causador da Covid-19, é o terceiro coronavírus a causar doença grave em humanos e que apresentou disseminação global nas duas últimas décadas. Nesse contexto, diversos departamentos nacionais de saúde pública, entre eles o Ministério da Saúde do Brasil, trouxeram destaque àquilo que era, até então, considerado um serviço de apoio ao sistema de saúde: a telessaúde e a telemedicina. Pretendemos apresentar as ações realizadas por um serviço nacional de telessaúde no Brasil, tanto no suporte aos profissionais de saúde da Atenção Primária à Saúde quanto a pacientes, além de discutir o potencial de reorganizar um sistema de saúde. Estudo de prevalência que sumariza as ações de telemedicina adotadas pelo TelessaúdeRS-UFRGS no período da 9ª à 27ª semana epidemiológica de 2020 para apoio aos serviços de saúde do Sistema Único de Saúde (SUS). Houve aumento de 76,8% da demanda de teleconsultorias telefônicas no período avaliado em comparação com o mesmo período em 2019, sendo 28,8% dessa demanda total decorrente de dúvidas relacionada à Covid-19. A pandemia por Covid-19 demandou rápida resposta com a organização de materiais sobre a doença, uma nova equipe para execução das atividades de telemonitoramento e teleconsultas, além da elaboração de um manual para teleconsultas na Atenção Primária à Saúde.

Abstract SARS-CoV-2, the virus that causes Covid-19, is the third coronavirus to cause severe disease in humans and to spread globally in the past two decades. In this context, several national public health departments, including the Brazilian Ministry of Health, highlighted what was, until then, considered a support service to the health system: telehealth and telemedicine. We intend to present the actions carried out by a national telehealth service in Brazil, both as a Primary Health Care (PHC) support service to professionals and to patients, as well as discussing the potential to reorganize a health system. This is a prevalence study that summarizes the measures adopted by Brazilian Telehealth Center from the 9th to the 27th epidemiological weeks of 2020 to support the health services of the Brazilian Unified Health System (SUS). There was an increase of 76.8% in the demand for telephone teleconsultations during the evaluated period compared to the same period in 2019, with 28.8% of the entire demand arising from doubts related to Covid-19. The Covid-19 pandemic demanded a quick response, with the organization of materials about the disease, a new team to carry out telemonitoring and teleconsultation activities, in addition to the creation of a manual for teleconsultations in Primary Health Care.

https://doi.org/10.1590/1413-81232021266.39662020

14.

O Papel da Telessaúde na Pandemia Covid-19: Uma Experiência Brasileira
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Silva, Rodolfo Souza da

; Schmtiz, Carlos André Aita

; Harzheim, Erno

; Molina-Bastos, Cynthia Goulart

; Oliveira, Elise Botteselle de

; Roman, Rudi

; Umpierre, Roberto Nunes

; Gonçalves, Marcelo Rodrigues

Ciência & Saúde Coletiva

Journal Metrics
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jun 2021, Volume 26 N. 6 Pages 2149 - 2157

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1413-81232021266.39662020 1244 downloads

15.

Práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras: uma análise secundária do estudo Fluid-TRIPS
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Freitas, Flavio Geraldo Rezende de

; Hammond, Naomi

; Li, Yang

; Azevedo, Luciano Cesar Pontes de

; Cavalcanti, Alexandre Biasi

; Taniguchi, Leandro

; Gobatto, André

; Japiassú, André Miguel

; Bafi, Antonio Tonete

; Mazza, Bruno Franco

; Noritomi, Danilo Teixeira

; Dal-Pizzol, Felipe

; Bozza, Fernando

; Salluh, Jorge Ibrahin Figueira

; Westphal, Glauco Adrieno

; Soares, Márcio

; Assunção, Murillo Santucci César de

; Lisboa, Thiago

; Lobo, Suzana Margarete Ajeje

; Barbosa, Achilles Rohlfs

; Ventura, Adriana Fonseca

; Souza, Ailson Faria de

; Silva, Alexandre Francisco

; Toledo, Alexandre

; Reis, Aline

; Cembranel, Allan

; Rea Neto, Alvaro

; Gut, Ana Lúcia

; Justo, Ana Patricia Pierre

; Santos, Ana Paula

; Albuquerque, André Campos D. de

; Scazufka, André

; Rodrigues, Antonio Babo

; Fernandino, Bruno Bonaccorsi

; Silva, Bruno Goncalves

; Vidal, Bruno Sarno

; Pinheiro, Bruno Valle

; Pinto, Bruno Vilela Costa

; Feijo, Carlos Augusto Ramos

; Abreu Filho, Carlos de

; Bosso, Carlos Eduardo da Costa Nunes

; Moreira, Carlos Eduardo Nassif

; Ramos, Carlos Henrique Ferreira

; Tavares, Carmen

; Arantes, Cidamaiá

; Grion, Cintia

; Mendes, Ciro Leite

; Kmohan, Claudio

; Piras, Claudio

; Castro, Cristine Pilati Pileggi

; Lins, Cyntia

; Beraldo, Daniel

; Fontes, Daniel

; Boni, Daniela

; Castiglioni, Débora

; Paisani, Denise de Moraes

; Pedroso, Durval Ferreira Fonseca

; Mattos, Ederson Roberto

; Brito Sobrinho, Edgar de

; Troncoso, Edgar M. V.

; Rodrigues Filho, Edison Moraes

; Nogueira, Eduardo Enrico Ferrari

; Ferreira, Eduardo Leme

; Pacheco, Eduardo Souza

; Jodar, Euzebio

; Ferreira, Evandro L. A.

; Araujo, Fabiana Fernandes de

; Trevisol, Fabiana Schuelter

; Amorim, Fábio Ferreira

; Giannini, Fabio Poianas

; Santos, Fabrício Primitivo Matos

; Buarque, Fátima

; Lima, Felipe Gallego

; Costa, Fernando Antonio Alvares da

; Sad, Fernando Cesar dos Anjos

; Aranha, Fernando G.

; Ganem, Fernando

; Callil, Flavio

; Costa Filho, Francisco Flávio

; Dall´Arto, Frederico Toledo Campo

; Moreno, Geovani

; Friedman, Gilberto

; Moralez, Giulliana Martines

; Silva, Guilherme Abdalla da

; Costa, Guilherme

; Cavalcanti, Guilherme Silva

; Betônico, Gustavo Navarro

; Reis, Hélder

; Araujo, Helia Beatriz N.

; Hortiz Júnior, Helio Anjos

; Guimaraes, Helio Penna

; Urbano, Hugo

; Maia, Israel

; Santiago Filho, Ivan Lopes

; Farhat Júnior, Jamil

; Alvarez, Janu Rangel

; Passos, Joel Tavares

; Paranhos, Jorge Eduardo da Rocha

; Marques, José Aurelio

; Moreira Filho, José Gonçalves

; Andrade, Jose Neto

; Sobrinho, José Onofre de C

; Bezerra, Jose Terceiro de Paiva

; Alves, Juliana Apolônio

; Ferreira, Juliana

; Gomes, Jussara

; Sato, Karina Midori

; Gerent, Karine

; Teixeira, Kathia Margarida Costa

; Conde, Katia Aparecida Pessoa

; Martins, Laércia Ferreira

; Figueirêdo, Lanese

; Rezegue, Leila

; Tcherniacovsk, Leonardo

; Ferraz, Leone Oliveira

; Cavalcante, Liane

; Rabelo, Ligia

; Miilher, Lilian

; Garcia, Lisiane

; Tannous, Luana

; Hajjar, Ludhmila Abrahão

; Paciência, Luís Eduardo Miranda

; Cruz Neto, Luiz Monteiro da

; Bley, Macia Valeria

; Sousa, Marcelo Ferreira

; Puga, Marcelo Lourencini

; Romano, Marcelo Luz Pereira

; Nobrega, Marciano

; Arbex, Marcio

; Rodrigues, Márcio Leite

; Guerreiro, Márcio Osório

; Rocha, Marcone

; Alves, Maria Angela Pangoni

; Rosa, Maria Doroti

; Dias, Mariza D’Agostino

; Martins, Miquéias

; Oliveira, Mirella de

; Moretti, Miriane Melo Silveira

; Matsui, Mirna

; Messender, Octavio

; Santarém, Orlando Luís de Andrade

; Silveira, Patricio Júnior Henrique da

; Vassallo, Paula Frizera

; Antoniazzi, Paulo

; Gottardo, Paulo César

; Correia, Paulo

; Ferreira, Paulo

; Torres, Paulo

; Silva, Pedro Gabrile M. de Barros e

; Foernges, Rafael

; Gomes, Rafael

; Moraes, Rafael

; Nonato filho, Raimundo

; Borba, Renato Luis

; Gomes, Renato V

; Cordioli, Ricardo

; Lima, Ricardo

; López, Ricardo Pérez

; Gargioni, Ricardo Rath de Oliveira

; Rosenblat, Richard

; Souza, Roberta Machado de

; Almeida, Roberto

; Narciso, Roberto Camargo

; Marco, Roberto

; waltrick, Roberto

; Biondi, Rodrigo

; Figueiredo, Rodrigo

; Dutra, Rodrigo Santana

; Batista, Roseane

; Felipe, Rouge

; Franco, Rubens Sergio da Silva

; Houly, Sandra

; Faria, Sara Socorro

; Pinto, Sergio Felix

; Luzzi, Sergio

; Sant’ana, Sergio

; Fernandes, Sergio Sonego

; Yamada, Sérgio

; Zajac, Sérgio

; Vaz, Sidiner Mesquita

; Bezerra, Silvia Aparecida Bezerra

; Farhat, Tatiana Bueno Tardivo

; Santos, Thiago Martins

; Smith, Tiago

; Silva, Ulysses V. A.

; Damasceno, Valnei Bento

; Nobre, Vandack

; Dantas, Vicente Cés de Souza

; Irineu, Vivian Menezes

; Bogado, Viviane

; Nedel, Wagner

; Campos Filho, Walther

; Dantas, Weidson

; Viana, William

; Oliveira Filho, Wilson de

; Delgadinho, Wilson Martins

; Finfer, Simon

; Machado, Flavia Ribeiro

Revista Brasileira de Terapia Intensiva

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apr 2021, Volume 33 N. 2 Pages 206 - 218

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Descrever as práticas de ressuscitação volêmica em unidades de terapia intensiva brasileiras e compará-las com as de outros países participantes do estudo Fluid-TRIPS. Métodos: Este foi um estudo observacional transversal, prospectivo e internacional, de uma amostra de conveniência de unidades de terapia intensiva de 27 países (inclusive o Brasil), com utilização da base de dados Fluid-TRIPS compilada em 2014. Descrevemos os padrões de ressuscitação volêmica utilizados no Brasil em comparação com os de outros países e identificamos os fatores associados com a escolha dos fluidos. Resultados: No dia do estudo, foram incluídos 3.214 pacientes do Brasil e 3.493 pacientes de outros países, dos quais, respectivamente, 16,1% e 26,8% (p < 0,001) receberam fluidos. A principal indicação para ressuscitação volêmica foi comprometimento da perfusão e/ou baixo débito cardíaco (Brasil 71,7% versus outros países 56,4%; p < 0,001). No Brasil, a percentagem de pacientes que receberam soluções cristaloides foi mais elevada (97,7% versus 76,8%; p < 0,001), e solução de cloreto de sódio a 0,9% foi o cristaloide mais comumente utilizado (62,5% versus 27,1%; p < 0,001). A análise multivariada sugeriu que os níveis de albumina se associaram com o uso tanto de cristaloides quanto de coloides, enquanto o tipo de prescritor dos fluidos se associou apenas com o uso de cristaloides. Conclusão: Nossos resultados sugerem que cristaloides são usados mais frequentemente do que coloides para ressuscitação no Brasil, e essa discrepância, em termos de frequências, é mais elevada do que em outros países. A solução de cloreto de sódio 0,9% foi o cristaloide mais frequentemente prescrito. Os níveis de albumina sérica e o tipo de prescritor de fluidos foram os fatores associados com a escolha de cristaloides ou coloides para a prescrição de fluidos.

Abstract Objective: To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS. Methods: This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice. Results: On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only. Conclusion: Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.

https://doi.org/10.5935/0103-507x.20210028 273 downloads

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