RESUMO Os cuidados paliativos centram-se na prevenção e alívio do sofrimento, apoiando os utentes com doença grave ou potencialmente fatal e os seus familiares, proporcionando-lhes a melhor qualidade de vida possível. A demência caracteriza-se por declínio progressivo da cognição e estado funcional. Com a sua progressão, os doentes necessitam de níveis crescentes de cuidados, sendo o papel do cuidador mais importante. Este trabalho teve como objetivo avaliar o papel dos cuidados paliativos no cuidador do doente com demência. Realizou-se uma revisão bibliográfica, baseada numa pesquisa em bases de dados de referência de meta-análises, revisões sistemáticas, revisões bibliográficas, ensaios clínicos, normas de orientação clínica, e guidelines publicadas nos últimos 10 anos em português e inglês. Utilizaram-se os termos MeSH: ‘caregiver’, ‘palliative care’ e ‘dementia’. Como resultados, verificou-se que as intervenções que diminuem a exaustão do cuidador incluem participação em programas de educação para a doença, gestão do stress, estratégias de coping, apoio psicossocial, espiritual e apoio ao luto. O médico de família deve adotar uma abordagem holística da demência em fase avançada que inclua os cuidadores como parte recetora de cuidados. A abordagem multidisciplinar em conjunto com a equipa de cuidados paliativos permite implementar estratégias de prevenção da exaustão do cuidador.

ABSTRACT Palliative care focuses on preventing and easing suffering, supporting people facing serious or terminal illnesses and their family members, and providing them with the best possible quality of life. Dementia is characterised by a gradual decline in cognition and functional status. Its’ progression requires increasing levels of care, with caregivers playing a pivotal role. This study aimed to assess the role of palliative care in caring for patients with dementia. The bibliographic review relied on research within reference databases, including meta-analyses, systematic reviews, bibliographic reviews, clinical trials, clinical guidance standards, and guidelines published in the last 10 years in Portuguese and English. The following MeSH terms were used: caregiver, palliative care and dementia. The results showed that interventions such as stress management, educational programs, coping strategies, as well as psychosocial, spiritual and grief support might mitigate caregiver exhaustion. The family doctor must adopt a holistic approach to late-stage dementia that includes caregivers as a receiving party of care. A multidisciplinary approach alongside the palliative care team facilitates the implementation of strategies to prevent caregiver exhaustion.

Resumo O objetivo da pesquisa foi analisar a organização e estrutura que a Rede de Cuidados à Pessoa com Deficiência (RCPD) oferece às crianças com Síndrome Congênita do Zika Vírus (SCZV) na Região de Saúde de Salvador (BA). Trata-se de uma pesquisa qualitativa que cotejou Itinerários Terapêuticos, das crianças com SCZV com a percepção, de gestores e profissionais da RCPD, sobre o funcionamento da rede. Ainda que existam concordâncias entre entrevistados, há problemas evidenciados somente pelas cuidadoras. Não existem mecanismos de regulação assistencial definidos entre os serviços da RCPD, levando as cuidadoras a navegarem pelo sistema de forma desgovernada em busca de assistência. A fragmentação do cuidado revelada impede o cuidado continuado e coordenado entre os diferentes serviços de saúde, resultando em intervenções pontuais. A SCZV coloca a proposta de RCPD em xeque, uma vez que há pouca congruência entre as trajetórias percorridas e a política nacional instituída.

Resumen Analizar la organización y estructura que la Red de Cuidados de la Persona con Discapacidad (RCPD) ofrece a los niños con Síndrome Congénito del Zika Virus (SCZV) en la Región de Salud de Salvador (Estado de Bahia). Investigación cualitativa que compara la experiencia de las cuidadoras de los niños con SCZV por medio de Itinerarios Terapéuticos y la percepción de gestores y profesionales de la RCPD. Aunque existen concordancias entre entrevistados, hay problemas que solamente son puestos en evidencia por las cuidadoras. No hay mecanismos de reglamentación asistencial definidos entre los servicios de la RCPD, haciendo que las cuidadoras naveguen por el sistema de manera desgobernada en busca de asistencia. La fragmentación del cuidado revelada impide el cuidado continuado y coordinado entre los diferentes servicios de salud, resultando en intervenciones puntuales. El SCZV pone en jaque la propuesta de RCPD puesto que hay poca congruencia entre las trayectorias recorridas y la política nacional instituida.

Abstract The aim of this study was to analyze the organization and structure that the Persons with Disabilities Care Network (RCPD) offers children with Congenital Zika Syndrome (CZS) in the Salvador Health Region (BA). We conducted a qualitative study to investigate the experiences of the children’s caregivers based on therapeutic itineraries and the perceptions of RCPD managers and professionals. Despite general agreement between the interviewees, only the caregivers highlighted problems. There are no health care regulation defined among the RCPD services, meaning that caregivers had to browse the system aimlessly to search for care. The fragmentation of care revealed by the findings prevents the provision of continuous care coordinated between the different health services, resulting in ad hoc care interventions. CZS highlights the limitations of the RCPD, demonstrating the incongruence between practice and national policy.

RESUMO Objetivo: A apneia obstrutiva do sono (AOS) é uma doença crônica altamente prevalente, associada a morbidade e mortalidade. Embora tratamentos efetivos para a AOS estejam disponíveis comercialmente, seu fornecimento não é garantido pelos fluxos de atendimento em todo o Brasil, tornando necessária a judicialização. Este estudo teve como objetivo apresentar dados referentes ao volume de processos judiciais relacionados ao acesso ao diagnóstico e tratamento da AOS no Brasil. Métodos: Estudo descritivo de abrangência nacional, avaliando o período entre janeiro de 2016 e dezembro de 2020. O número de demandas judiciais foi analisado de acordo com o objeto da demanda (diagnóstico ou tratamento). As projeções das despesas totais foram realizadas de acordo com o número de demandas judiciais. Resultados: Foram identificados 1.462 processos judiciais (17,6% e 82,4% referentes a diagnóstico e tratamento, respectivamente). A projeção dos gastos com o diagnóstico da AOS nas esferas pública e privada foi de R$ 575.227 e R$ 188.002, respectivamente. A projeção dos gastos com o tratamento da AOS nas esferas pública e privada foi de R$ 2.656.696 e R$ 253.050, respectivamente. Houve redução do número de demandas judiciais entre 2017 e 2019. Conclusões: A judicialização como estratégia de acesso a recursos diagnósticos e terapêuticos relacionados à AOS é uma prática recorrente, resultando em ineficiência e iniquidade. A redução do número de demandas judiciais entre 2017 e 2019 pode ser explicada pela expansão das políticas locais de saúde ou por barreiras na jornada dos pacientes com AOS, como dificuldades de encaminhamento para atendimento especializado e a baixa disponibilidade de recursos diagnósticos. Objetivo (AOS prevalente mortalidade comercialmente Brasil Métodos nacional 201 2020 tratamento. . tratamento) Resultados 1462 1 462 1.46 17,6% 176 17 6 (17,6 824 82 4 82,4 respectivamente respectivamente) R 575227 575 227 575.22 188002 188 002 188.002 2656696 2 656 696 2.656.69 253050 253 050 253.050 Conclusões recorrente iniquidade 20 202 146 46 1.4 17,6 (17, 8 82, 57522 57 22 575.2 18800 18 00 188.00 265669 65 69 2.656.6 25305 25 05 253.05 14 1. 17, (17 5752 5 575. 1880 0 188.0 26566 2.656. 2530 253.0 (1 188. 2656 2.656 253. ( 265 2.65 26 2.6 2.

ABSTRACT Objective: Obstructive sleep apnea (OSA) is a highly prevalent chronic disease, associated with morbidity and mortality. Although effective treatment for OSA is commercially available, their provision is not guaranteed by lines of care throughout Brazil, making legal action necessary. This study aimed at presenting data related to the volume of legal proceedings regarding the access to diagnosis and treatment of OSA in Brazil. Methods: This was a descriptive study of national scope, evaluating the period between January of 2016 and December of 2020. The number of lawsuits was analyzed according to the object of the demand (diagnosis or treatment). Projections of total expenses were carried out according to the number of lawsuits. Results: We identified 1,462 legal proceedings (17.6% and 82.4% related to diagnosis and treatment, respectively). The projection of expenditure for OSA diagnosis in the public and private spheres were R$575,227 and R$188,002, respectively. The projection of expenditure for OSA treatment in the public and private spheres were R$2,656,696 and R$253,050, respectively. There was a reduction in the number of lawsuits between 2017 and 2019. Conclusions: Legal action as a strategy for accessing diagnostic and therapeutic resources related to OSA is a recurrent practice, resulting in inefficiency and inequity. The reduction in the number of lawsuits between 2017 and 2019 might be explained by the expansion of local health care policies or by barriers in the journey of patients with OSA, such as difficulties in being referred to specialized health care and low availability of diagnostic resources. Objective (OSA disease mortality available Brazil necessary Methods scope 201 2020 treatment. . treatment) Results 1462 1 462 1,46 17.6% 176 17 6 (17.6 824 82 4 82.4 respectively respectively) R575227 R 575 227 R$575,22 R188002 188 002 R$188,002 R2656696 2 656 696 R$2,656,69 R253050 253 050 R$253,050 Conclusions practice inequity 20 202 146 46 1,4 17.6 (17. 8 82. R57522 57 22 R$575,2 R18800 18 00 R$188,00 R265669 65 69 R$2,656,6 R25305 25 05 R$253,05 14 1, 17. (17 R5752 5 R$575, R1880 0 R$188,0 R26566 R$2,656, R2530 R$253,0 (1 R575 R$575 R188 R$188, R2656 R$2,656 R253 R$253, ( R57 R$57 R18 R$188 R265 R$2,65 R25 R$253 R5 R$5 R1 R$18 R26 R$2,6 R2 R$25 R$ R$1 R$2, R$2

Resumen Analizar la organización y estructura que la Red de Cuidados de la Persona con Discapacidad (RCPD) ofrece a los niños con Síndrome Congénito del Zika Virus (SCZV) en la Región de Salud de Salvador (Estado de Bahia). Investigación cualitativa que compara la experiencia de las cuidadoras de los niños con SCZV por medio de Itinerarios Terapéuticos y la percepción de gestores y profesionales de la RCPD. Aunque existen concordancias entre entrevistados, hay problemas que solamente son puestos en evidencia por las cuidadoras. No hay mecanismos de reglamentación asistencial definidos entre los servicios de la RCPD, haciendo que las cuidadoras naveguen por el sistema de manera desgobernada en busca de asistencia. La fragmentación del cuidado revelada impide el cuidado continuado y coordinado entre los diferentes servicios de salud, resultando en intervenciones puntuales. El SCZV pone en jaque la propuesta de RCPD puesto que hay poca congruencia entre las trayectorias recorridas y la política nacional instituida. (RCPD (SCZV Estado Bahia. Bahia . Bahia) entrevistados asistencia salud puntuales instituida

Resumo O objetivo da pesquisa foi analisar a organização e estrutura que a Rede de Cuidados à Pessoa com Deficiência (RCPD) oferece às crianças com Síndrome Congênita do Zika Vírus (SCZV) na Região de Saúde de Salvador (BA). Trata-se de uma pesquisa qualitativa que cotejou Itinerários Terapêuticos, das crianças com SCZV com a percepção, de gestores e profissionais da RCPD, sobre o funcionamento da rede. Ainda que existam concordâncias entre entrevistados, há problemas evidenciados somente pelas cuidadoras. Não existem mecanismos de regulação assistencial definidos entre os serviços da RCPD, levando as cuidadoras a navegarem pelo sistema de forma desgovernada em busca de assistência. A fragmentação do cuidado revelada impede o cuidado continuado e coordenado entre os diferentes serviços de saúde, resultando em intervenções pontuais. A SCZV coloca a proposta de RCPD em xeque, uma vez que há pouca congruência entre as trajetórias percorridas e a política nacional instituída. (RCPD (SCZV BA. BA . (BA) Tratase Trata se Terapêuticos percepção rede entrevistados assistência saúde pontuais xeque instituída (BA

Abstract The aim of this study was to analyze the organization and structure that the Persons with Disabilities Care Network (RCPD) offers children with Congenital Zika Syndrome (CZS) in the Salvador Health Region (BA). We conducted a qualitative study to investigate the experiences of the children’s caregivers based on therapeutic itineraries and the perceptions of RCPD managers and professionals. Despite general agreement between the interviewees, only the caregivers highlighted problems. There are no health care regulation defined among the RCPD services, meaning that caregivers had to browse the system aimlessly to search for care. The fragmentation of care revealed by the findings prevents the provision of continuous care coordinated between the different health services, resulting in ad hoc care interventions. CZS highlights the limitations of the RCPD, demonstrating the incongruence between practice and national policy. (RCPD (CZS BA. BA . (BA) childrens s professionals interviewees problems services interventions policy (BA

RESUMO A metástase ocular é uma patologia incomum, principalmente quando se considera a íris como sítio da metástase. Apesar de incomum, a metástase ocular possui o câncer de mama como um de seus principais sítios primários. Ocasionalmente, a manifestação oftalmológica pode ser primária a qualquer outra clínica. Este artigo relata o caso de uma paciente com carcinoma de mama ductal invasivo com presumida metástase em corpo ciliar e íris em olho direito. O diagnóstico precoce interfere de forma significativa na evolução do quadro, sendo necessário o acompanhamento oftalmológico. incomum primários Ocasionalmente clínica direito quadro oftalmológico

ABSTRACT Ocular metastasis is an uncommon pathology, especially when considering the iris as the site of metastasis. Although uncommon, eye metastasis has breast cancer as one of its main primary sites. Occasionally, the ophthalmologic manifestation may be primary to any other clinical manifestation. This article reports the case of a patient with invasive ductal breast carcinoma with presumed metastasis in the ciliary body and iris in the right eye. Early diagnosis significantly affects the evolution of the condition, requiring ophthalmologic follow-up. pathology sites Occasionally condition followup. followup follow up. up follow-up

Resumen Este artículo tiene como objetivo comprender el proceso de identificación y pertenencia racial de personas negras de piel clara mediante el análisis de expresiones artístico-culturales y los efectos subjetivos en su racialización. Optamos por analizar aquí las expresiones artístico-culturales aportadas por los/as participantes y los efectos subjetivos en la construcción de su identidad como negro/a. La inmersión en prácticas artístico-culturales, expresadas a través de múltiples dimensiones del lenguaje en el cuerpo performativo, puede impulsar una identidad negra positiva, construyendo imágenes identificatorias que estimulan otras narrativas sobre uno mismo, su cuerpo y su negritud. Entre las expresiones artístico-culturales aportadas por los/as participantes, destacan el Sopapo poético, el slam y el rap, que son formas de comunidad a través de la escrevivencias, los corpoemas, la oralidad y las experiencias audaces. Podemos concluir que las producciones estéticas de la negritud son fundamentales para el proceso de convertirse en negro/a. artísticoculturales artístico culturales racialización losas as negroa negro negro/a artísticoculturales, culturales, performativo positiva mismo poético rap escrevivencias corpoemas audaces

Resumo Este artigo tem como objetivo compreender o processo de identificação e pertencimento racial de pessoas negras de pele clara mediante análise das expressões artístico-culturais e os efeitos subjetivos para sua racialização. Optamos por analisar aqui as expressões artístico-culturais trazidas pelos/as participantes e os efeitos subjetivos no constituir-se como negro/a. A imersão em práticas artístico-culturais, expressas por meio de múltiplas dimensões da linguagem pelo corpo performático, pode impulsionar a identidade negra positiva, construindo imagens identificatórias que estimulam outras narrativas sobre si, seu corpo e sua negritude. Dentre as expressões artístico-culturais trazidas pelos/as participantes destacam-se o Sopapo poético, o slam e o rap, que são formas de aquilombamento por meio de escrevivências, dos corpoemas, das oralituras e das atrevivências. Podemos concluir que as produções estéticas de negritude são fundamentais para o processo de tornar-se negro. artísticoculturais artístico culturais racialização pelosas pelos constituirse constituir se negroa negro negro/a artísticoculturais, culturais, performático positiva si destacamse destacam poético rap escrevivências corpoemas atrevivências tornarse tornar

Abstract This article aims to understand the process of racial identification and belonging of light-skinned Black individuals through the analysis of artistic-cultural expressions and their subjective effects on their racialization. We chose to examine here the artistic-cultural expressions brought by the participants and the subjective effects on their self-identification as Black. Immersion in artistic-cultural practices, expressed through multiple dimensions of language in the performative body, can promote positive Black identity by constructing identifying images that stimulate other narratives about oneself, one's body, and one's blackness. Among the artistic-cultural expressions brought by the participants, the poetic Sopapo, Slam, and rap stand out as forms of aquilombamento through escrevivências, corpoemas, oralitura, and atrevivências. We can conclude that the aesthetic productions of blackness are essential to the process of becoming Black. lightskinned light skinned artisticcultural artistic cultural racialization selfidentification self practices body oneself ones one s Sopapo Slam escrevivências corpoemas oralitura atrevivências

Abstract Background Cognitive impairment, anxiety, and depression are present in patients with heart failure (HF), but their mutual correlation in hospitalized patients is not well established. Objectives The aims of this study were to identify the presence of cognitive impairment and the most affected domain, to investigate possible associations of cognitive impairment with depression and/or anxiety, and to observe whether they correlated with occurrence of readmission within 30 days following hospital discharge. Methods This is a prospective observational study including patients with HF from a private hospital. Psychological distress and cognition were evaluated by the Hospital Anxiety and Depression Scale (HADS) and by the Mini Mental State Exam (MMSE), respectively. Clinical data were obtained from the medical record at the time of inclusion, and outpatient follow-up was performed 30 days after discharge via telephone calls. Results This study included 71 patients (83% men, 75 ± 11 years). Cognitive impairment was present in 53.5% of the patients, and recall memory was the most altered cognitive domain. The proportion of possible/probable anxiety and depression was 21.1% and 34.2% in patients with cognitive impairment, respectively. However, only depression demonstrated association with cognitive impairment (p = 0.018). Cognitive impairment, anxiety, and depression showed no relationship with the occurrence of readmission within 30 days. Conclusions Cognitive impairment and depressive symptoms are prevalent and associated, and recall memory was the most altered cognitive domain in patients hospitalized with HF. However, there was no relationship between these factors and readmission within 30 days. HF, , (HF) established andor or 3 HADS (HADS MMSE, MMSE (MMSE) respectively inclusion followup follow up calls 7 83% 83 (83 men 1 years. years . years) 535 53 5 53.5 possibleprobable probable 211 21 21.1 342 34 2 34.2 However p 0.018. 0018 0.018 0 018 0.018) associated (HF (MMSE 8 (8 53. 21. 34. 001 0.01 01 ( 00 0.0 0.

ABSTRACT Objective To analyze the karyotype test and myeloid panel with next-generation sequencing findings in patients with myelofibrosis, and to compare transplant characteristics in patients referred for bone marrow transplantation. Methods Retrospective, single-center study with patients diagnosed with myelofibrosis treated at Hospital Israelita Albert Einstein between 2010 and 2020. Results A total of 104 patients with myelofibrosis were examined. Patients who had not been submitted to tests in our service were excluded. The final sample comprised 69 patients. Of these 69, 56 were submitted to karyotyping and 22 to myeloid panel with next-generation sequencing. Karyotype was normal in 60% of the patients and altered in 40%. The prevalence of high-risk molecular mutations was higher in patients referred for bone marrow transplantation (100% versus 50%). The median follow-up of transplant patients was 2.4 years and the overall survival at 2 years was 80% (95%CI: 62-100%). Conclusion The molecular analysis enables estimating the patient’s risk and thus instituting more aggressive treatment such as bone marrow transplant for patients at higher risk, being a relevant tool to guide therapy. Given the significance of molecular analysis for therapeutic decision-making in myelofibrosis, collection and disclosure of data on the prevalence of cytogenetic changes and findings of next-generation sequencing in affected patients is important. nextgeneration next generation Retrospective singlecenter single center 201 2020 10 examined excluded 6 5 60 40 40% highrisk high 100% 100 (100 50%. 50 50% . 50%) followup follow up 24 4 2. 80 95%CI 95CI CI 95 (95%CI 62100%. 62100 62 62-100%) patient s therapy decisionmaking decision making important 20 202 1 (10 8 9 62100% 6210 62-100% (1 621 62-100 ( 62-10 62-1 62-

ABSTRACT Wind energy is an important electricity source. Even though it is cleaner than other energy sources in terms of greenhouse gas emissions, gathering energy from the wind has impact on organisms that fly, including bats. Understanding whether and how bat activity patterns are affected by environmental variables may be useful when trying to mitigate these impacts, for example bat mortality from collisions with wind turbines. Northeastern Brazil concentrates one of the world’s largest wind potentials and has thousands of wind turbines in operation. In spite of this scenario, there is a lack of basic information, such as the presence of bat species and their activity patterns in those wind farms. We used passive acoustic monitoring to assess species richness and species composition and obtain data on activity patterns of insectivorous bats in four wind farm complexes in northeastern Brazil. We also investigated the possible correlation between environmental variables (wind speed and direction, air temperature and humidity, and percentage of moon illumination) and bat activity. The acoustic monitoring carried out for 30 nights produced approximately 120,000 bat passes of 29 sonotypes and four families. Environmental variables may influence bat activity, but in a site-specific way, i.e., although the environmental conditions of wind-energy complexes were similar, there was not an activity pattern common to all. Considering such specificities, we strongly recommend long-term specific on-site monitoring in each wind complex, avoiding generalizations for the environmental licensing of wind energy in Brazil.

Abstract The topical glucocorticoid budesonide has been prescribed before and after sinus lift surgery as adjuvant drug treatment for maxillary sinus membrane inflammation. However, there is no study on the effects of budesonide on the regenerative process of bone grafting biomaterials. We investigated the effect of the association of budesonide with some biomaterials on the growth and differentiation capacity of pre-osteoblastic cells (MC3T3-E1 subclone 4). Xenogeneic (Bio-Oss and Bio-Gen) and synthetic hydroxyapatites (Osteogen, Bonesynth, and HAP-91) were tested in conditioned medium (1% w/v). The conditioned medium was then supplemented with budesonide (0.5% v/v). Cell viability was assessed using the MTT assay (48, 96, and 144 h), and mineralized nodules were quantified after 14 days of culture using the Alizarin Red Staining. Alkaline phosphatase activity was assessed through the release of thymolphthalein at day seven. All biomaterials showed little or no cytotoxicity. The Bio-Gen allowed significantly less growth than the control group regardless of the experimental time. Regarding differentiation potential of MC3T3-E1, the HAP-91-conditioned medium showed remarkable osteoinductive properties. In osteodifferentiation, the addition of budesonide favored the formation of mineral nodules when cells were cultured in medium conditioned with synthetic materials, whereas it weakened the mineralization potential of cells cultured in xenogeneic medium. Regardless of whether budesonide was added or not, Osteogen and Bio-Oss showed higher alkaline phosphatase activity than the other groups. Budesonide may improve bone formation when associated with synthetic biomaterials. Conversely, the presence of this glucocorticoid weakens the mineralization potential of pre-osteoblastic cells cultured with xenogeneic hydroxyapatites.

Abstract Background Cognitive impairment, anxiety, and depression are present in patients with heart failure (HF), but their mutual correlation in hospitalized patients is not well established. Objectives The aims of this study were to identify the presence of cognitive impairment and the most affected domain, to investigate possible associations of cognitive impairment with depression and/or anxiety, and to observe whether they correlated with occurrence of readmission within 30 days following hospital discharge. Methods This is a prospective observational study including patients with HF from a private hospital. Psychological distress and cognition were evaluated by the Hospital Anxiety and Depression Scale (HADS) and by the Mini Mental State Exam (MMSE), respectively. Clinical data were obtained from the medical record at the time of inclusion, and outpatient follow-up was performed 30 days after discharge via telephone calls. Results This study included 71 patients (83% men, 75 ± 11 years). Cognitive impairment was present in 53.5% of the patients, and recall memory was the most altered cognitive domain. The proportion of possible/probable anxiety and depression was 21.1% and 34.2% in patients with cognitive impairment, respectively. However, only depression demonstrated association with cognitive impairment (p = 0.018). Cognitive impairment, anxiety, and depression showed no relationship with the occurrence of readmission within 30 days. Conclusions Cognitive impairment and depressive symptoms are prevalent and associated, and recall memory was the most altered cognitive domain in patients hospitalized with HF. However, there was no relationship between these factors and readmission within 30 days.

RESUMO Introdução: A dermatite atópica é uma dermatose crónica, inflamatória e pruriginosa de alta prevalência, principalmente na infân-cia, constituindo um problema relevante para a saúde pública. Diversos fatores se associam a um maior risco para dermatite atópica: genéticos, psicológicos, infecciosos, alimentares, ambientais, entre outros e a dermatite atópica pode estar associada a outras manifestações de atopia, como asma e rinite. Este estudo objetivou determinar o perfil epidemiológico e a prevalência de antecedentes pessoais e familiares de alergia em crianças com der-matite atópica atendidas num serviço de referência, comparando à literatura existente. Métodos: Estudo transversal e descritivo, de base hospitalar, envolvendo crianças de ambos os gêneros com menos de 18 anos com diagnóstico clínico de dermatite atópica (critérios de Hanifin e Rajka) atendidas no Ambulatório de Dermatologia Pediátrica do Hospital Municipal Universitário de Taubaté (H.MUT), SP - Brasil, de outubro de 2018 a abril de 2019. Foram colhidos dados epidemiológicos e relacionados com o histórico pessoal e familiar de alergias obtidos por levantamento de prontuários. Microsoft Excel 2019 utilizado para análise e compilação dos dados. Resultados: Dos 440 atendimentos realizados no período, 35 (7,9%) foram de dermatite atópica, 23 no sexo feminino (65,7%), 15 de fototipo IV (42,9%) com idade média 7,7 anos (desvio padrão=4,3), com duração de doença de 2 meses a 14 anos (média 5,3 anos - desvio padrão=4,3). Trinta e um pacientes (88,6%) manifestaram o quadro até o quinto ano de vida. Histórico pessoal de alergias estava presente em 77,1% (27 indivíduos), com predomínio da rinite alérgica e em faixas etárias mais elevadas. Histórico familiar positivo em 62,9% (22 indivíduos). Conclusão: Estudo pioneiro na região, permitiu determinar o perfil epidemiológico dos pacientes portadores de dermatite atópica do Ambulatório de Dermatologia Pediátrica do H.MUT, revelando início precoce e maior prevalência no sexo feminino e em fototipo alto. Além disso, identificou a prevalência de antecedentes pessoais e de histórico familiar de alergia nesses pacientes, dados concordes com a literatura.

ABSTRACT Introduction: Atopic dermatitis is a chronic, inflammatory and pruritic dermatosis of high prevalence, especially in childhood, constituting a relevant problem for public health. Several factors are associated with an increased risk for atopic dermatitis: genetic, psychological, infec-tious, food, environmental, among others, and atopic dermatitis may be associated with other manifestations of atopy, such as asthma and rhinitis. This study aimed to determine the epidemiological profile and the prevalence of personal and family history of allergy in children with atopic dermatitis attended at a reference service, comparing it to the existing literature. Methods: Hospital-based, cross-sectional and descriptive study, involving children of both genders under 18 years old with a clinical diagnosis of atopic dermatitis (Hanifin and Rajka criteria) attended at the Pediatric Dermatology Outpatient Clinic of the Hospital Municipal Universitário de Taubaté (H.MUT), SP - Brazil, from October 2018 to April 2019. Epidemiological data and data related to personal and family history of allergies were collected from medical records. Microsoft Excel 2019 was used for data analysis and compilation. Results: Of the 440 consultations carried out in the period, 35 (7.9%) were for atopic dermatitis, 23 females (65.7%), 15 phototype IV (42.9%) with mean age 7.7 years (standard deviation=4.3), with disease duration from 2 months to 14 years (mean 5.3 years - standard deviation=4.3). Thirty-one patients (88.6%) manifested the condition up to the fifth year of life. Personal history of allergies was present in 77.1% (27 individuals), with a predominance of allergic rhinitis and in older age groups. Positive family history in 62.9% (22 individuals). Conclusion: Pioneer study in the region; it allowed the determination of the epidemiological profile of patients with atopic dermatitis at the Pediatric Dermatology Clinic of the H.MUT, revealing an early onset and higher prevalence in females and in individuals with high phototypes. In addition, it identified the prevalence of personal and family history of allergy in these patients, data consistent with the literature.

Resumo Introdução: A reabilitação vestibular se consolida como um recurso fundamental para o controle de sintomas vestibulares e sua feitura no meio aquático é considerada segura para as atividades físicas dos idosos, atua simultaneamente nas desordens musculoesqueléticas e na melhoria do equilíbrio. Objetivo: Avaliar os efeitos de um protocolo de fisioterapia aquática em indivíduos com alterações vestibulares periféricas. Método: Estudo de caso intervencional com amostra intencional pareada de quatro sujeitos, selecionados por conveniência, diagnosticados com vestibulopatias periféricas. Os sujeitos foram submetidos a 12 sessões de fisioterapia aquática para reabilitação vestibular. Foram avaliados quanto à tontura em três momentos: inicial, após seis sessões e ao término dos atendimentos. Os testes aplicados foram: o apoio unipodal para mensurar o equilíbrio estático, a prova dos passos de Fukuda que estima o equilíbrio dinâmico e o protocolo dizziness handicap inventory com o objetivo de verificar o quanto a tontura influencia na vida cotidiana. Resultados: Ao analisar o equilíbrio estático, inicialmente os indivíduos se encontravam nas dimensões adaptativas e anormais e ao término do protocolo todos atingiram a normalidade. Em relação ao equilíbrio dinâmico, os indivíduos inicialmente apresentavam grande comprometimento no desvio angular principalmente para o lado da patologia (75% à esquerda e 25% à direita), conseguiram uma melhoria no fim do estudo. Todavia, não conseguiu atingir a significância estatística. O dizziness handicap inventory obteve diferença estatisticamente significante em sua totalidade (p = 0,0414), onde aborda os fatores físicos, funcionais e emocionais. Conclusão: O protocolo de fisioterapia aquática voltado para reabilitação vestibular de pacientes com comprometimento periférico foi avaliado de forma positiva pelos participantes, considerando-se a melhoria no quadro de tontura (estática e dinâmica) e do seu impacto nas atividades cotidianas.

Abstract Introduction: Vestibular rehabilitation is a fundamental resource for vestibular symptom control. Its performance in the aquatic environment is considered safe for the physical activities of the elderly, because they act simultaneously on musculoskeletal disorders and balance improvement. Objective: To evaluate the effects of an aquatic physiotherapy protocol in individuals with peripheral vestibular alterations. Methods: This was an interventional case study with a paired intentional sample of four subjects, who were selected for convenience. The subjects, all of them diagnosed with peripheral vestibulopathy, were submitted to twelve sessions of aquatic physiotherapy for vestibular rehabilitation, being evaluated for dizziness in three moments: initial, after six sessions and at the end of the sessions. The tests applied were: unipodal support to measure static balance, the Fukuda stepping test, which estimates the dynamic balance and the dizziness handicap inventory protocol, aimed at verifying how dizziness influences daily life. Results: When analyzing the static balance, initially the individuals were in the adaptive and abnormal dimensions, and all reached normality at the end of the protocol. Regarding the dynamic balance, the individuals initially showed marked impairment in the angular deviation, mainly to the side of pathology (75% to the left and 25% to the right), achieving improvement at the end of the study. However, it failed to reach statistical significance. The dizziness handicap inventory showed a statistically significant difference in its totality (p = 0.0414), which addresses the physical, functional and emotional factors. Conclusion: In conclusion, the aquatic physiotherapy protocol for vestibular rehabilitation of patients with peripheral impairment was positively assessed by the participants, considering the improvement in dizziness (static and dynamic) and its impact on daily activities.

Resumo Fundamento Indivíduos com hipercolesterolemia grave apresentam alto risco de desenvolver doença cardiovascular aterosclerótica (DCVA). Muitos deles apresentam hipercolesterolemia familiar (HF). Objetivos Avaliar, a partir da perspectiva dos pacientes, o nível de conhecimento sobre a hipercolesterolemia grave, especialmente em relação a HF, DCVA, percepção de risco, desempenho do rastreamento em cascata e tratamento de indivíduos participantes de um programa de avaliação periódica de saúde. Métodos De um banco de dados de 70.000 brasileiros avaliados entre 2006 e 2016, 1.987 (2,8%) atenderam aos critérios de inclusão (idade ≥ 18 anos e LDL-C ≥ 190 mg/dL ou ≥ 160 mg/dL se sem uso de estatinas ou em terapia com estatinas, respectivamente). Desses, 200 foram aleatoriamente convidados a preencher um questionário extenso. A HF foi diagnosticada em caso de suspeita pelo médico responsável. Resultados Embora 97% da amostra (48±9 anos; 16% do sexo feminino; 95% com ensino superior; 88% em prevenção primária; LDL-C 209±47 mg/dL) tenha apresentado hipercolesterolemia grave, apenas 18% e 29,5% se consideravam de alto risco para desenvolver DCVA e relataram saber sua meta recomendada de LDL-C, respectivamente. Em relação à possibilidade de o colesterol alto ser uma doença hereditária, 58% relataram conhecimento sobre o fato; 24,5% (n = 49) já tinham ouvido falar em HF; e apenas 14% (n = 20) foram previamente identificados com suspeita de HF (idade ao diagnóstico de HF: 35±12 anos; 79% e 31% foram diagnosticados com > 30 e > 40 anos, respectivamente). Apenas 2,5% foram submetidos a testes genéticos; 17%, à rastreamento em cascata; e 17% não faziam uso de tratamento farmacológico. Conclusões Identificou-se uma importante lacuna na percepção de risco, no controle do colesterol e em aspectos relacionados à HF em indivíduos com hipercolesterolemia grave. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Abstract Background Individuals with severe hypercholesterolemia are at a high risk of developing atherosclerotic cardiovascular disease (ASCVD). Many of them have familial hypercholesterolemia (FH). Objectives To assess from a patient perspective the degree of awareness about severe hypercholesterolemia, especially FH, ASCVD risk perception, cascade screening performance, and treatment of individuals participating in a routine health evaluation program. Methods From a database of 70,000 Brazilian individuals evaluated between 2006 and 2016, 1,987 (2.8%) met the inclusion criteria (age ≥ 18 years and LDL-C ≥ 190 mg/dL or ≥ 160 mg/dL, respectively, if not in use of statins or on statin therapy). Two-hundred individuals were randomly invited to complete an extensive questionnaire. FH was diagnosed if suspected by the attending physician. Results Although 97% of the sample (age 48±9 years; 16% women; 95% college/university education; 88% primary prevention; LDL-C 209±47 mg/dL) had severe hypercholesterolemia, only 18% and 29.5% believed to be at high ASCVD risk and reported knowledge of their recommended LDL-C goal, respectively. Fifty-eight percent reported being informed that high cholesterol could be a family disease, 24.5% (n = 49) had ever heard about FH, and merely 14% (n = 29) had been previously identified as suspected of having FH (age at FH diagnosis 35±12 years; 79% and 31% diagnosed, respectively, > 30 and > 40 years old). Only 2.5% underwent genetic tests, 17% underwent cascade screening, and 17% were not in use of pharmacological treatment. Conclusions An important gap in risk perception, cholesterol management, and aspects related to FH was encountered in individuals with severe hypercholesterolemia. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

Resumo Este artigo discorre sobre a presença do desenho como ferramenta doutrinadora, de técnicas rígidas e temas angelicais, na formação educacional das meninas através do ensino do bordado no final do século XIX e início do XX. Assim, é analisado como bordar foi um saber transposto do espaço doméstico para a vivência escolar, consolidando a concepção deste trabalho manual como uma atividade exclusivamente feminina e destacando a integração entre o desenhar e o bordar ao longo de sua prática em sala de aula. A compreensão deste tema é costurada pela análise acerca do cenário político e social da época, através do desenvolvimento da educação formal e os ideais de feminilidade vigentes entre o Brasil colonial, imperial e republicano. A partir deste estudo, identificam-se aspectos que influenciam no século XXI a continuidade da criação de bordaduras no cenário brasileiro.

Abstract This article discusses about the presence of drawing as an indoctrinate tool, of rigid technic and angelical themes, in formal education for girls through the teaching of embroidering during the final years of the 19th and early 20th Century. Thereby, it is analysed how embroidery was a knowledge transposed from domestic field to academic experience consolidating this manual work as an exclusively feminine activity and highlighting the integration between drawing and embroider throughout their classroom practice. The comprehension of this theme is sewn by the analyses of the political and social scenario of the time through the development of formal education and the prevailing of femininity ideals between colonial, imperial and republican Brazil. Based on this study, it is identified aspects that have influenced the continuity of the creation of embroidery in the 21st Century.

Resumen Este artículo analiza la presencia del dibujo como herramienta adoctrinadora, de técnicas rígidas y temas angelicales, en la educación de las niñas a través de la enseñanza del bordado a finales del siglo XIX y principios del XX. Así, se analiza cómo el bordado fue un conocimiento transpuesto del espacio doméstico a la experiencia escolar consolidando la concepción de esta obra manual como una actividad exclusivamente femenina y destacando la integración entre dibujo y bordado a lo largo de su práctica en el aula. La comprensión de este tema está cosida por el análisis sobre el escenario político y social de la época a través del desarrollo de la educación formal y los ideales de feminidad prevalecientes entre el Brasil colonial, imperial y el republicano. A partir de este estudio, identificamos aspectos que influyen en el siglo XXI en la continuidad de la creación de bordado en el escenario brasileño.

Résumé Cet article traite de la présence du dessin comme outil d’endoctrinement, de techniques rigides et de thèmes angéliques, dans l’éducation des filles à travers l’enseignement de la broderie à la fin du XIXe siècle et au début du XXe siècle. Ainsi, il est analysé comment la broderie a été une connaissance transposée de l’espace domestique à l’expérience scolaire consolidant la conception de ce travail manuel comme une activité exclusivement féminine et soulignant l’intégration entre le dessin et la broderie le long de son pratique en classe. La compréhension de ce thème est cousue par l’analyse sur le scénario politique et social de l’époque à travers le développement de l’éducation formelle et les idéaux de féminité qui prévalent entre le Brésil colonial, impérial et républicain. A partir de cette étude, nous identifions les aspects qui influencent au XXIe siècle la continuité de la création de broderie dans le scénario brésilien.