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Esta revisão sistemática investiga associações entre fatores socioeconômicos e atraso no tratamento em adultos com carcinoma espinocelular (CEC) de boca e orofaringe. Estudos observacionais foram pesquisados em cinco bases de dados (PubMed, Scopus, Web of Science, Embase e Biblioteca Virtual em Saúde) e literatura cinzenta. Não houve restrição sobre idioma ou ano de publicação. O risco de viés foi avaliado usando a ferramenta do Joanna Briggs Institute. Os pontos de corte representando atraso no tratamento, abordado pelos estudos incluídos, foram definidos como desfecho primário. A certeza das evidências foi avaliada usando a abordagem Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Ao todo, dez estudos de coorte retrospectivo foram incluídos na síntese narrativa. Tipo de plano de saúde, sexo, idade avançada, pacientes não brancos, baixo nível de escolaridade, tratamento em hospital público/regional, necessidade de cuidados de transição e residir em áreas isoladas/remotas foram fatores associados ao atraso no tratamento do CEC. No entanto, as limitações metodológicas para o ajuste para fatores de confusão, a heterogeneidade da definição de atraso (diferentes pontos de corte) e das variáveis socioeconômicas abordadas e a falta de artigos elegíveis de diferentes países resultaram em uma evidência com nível de certeza muito baixo devido a graves riscos de viés, inconsistência e evidência indireta de acordo com o GRADE. Com base nos dados disponíveis, a associação entre fatores socioeconômicos e atraso no tratamento do CEC é inconclusiva. Dada a complexidade dos determinantes do acesso ao tratamento oportuno do CEC, recomendamos mais pesquisas em diferentes países.

This systematic review investigates associations between socioeconomic factors and treatment delay in adults with oral and oropharyngeal squamous cell carcinoma (OOSCC). Observational studies were searched across five databases (PubMed, Scopus, Web of Science, Embase, and Virtual Health Library) and grey literature. No restrictions were imposed about language or year of publication. Risk of bias was analyzed using the Joanna Briggs Institute tool. The primary outcome was defined as the cut-off points of treatment delays, which was addressed by the studies included. The certainty of evidence was assessed following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. In total, 10 retrospective cohort studies were included in the narrative synthesis. Type of insurance plan, sex, older ages, non-white patients, low education level, treatment in public or regional hospital, need for transition care, and living in regional/remote areas were factors associated with treatment delay for OOSCC. However, methodological limitations regarding the adjustment for confounders, the heterogeneity of the definition of delay (different cut-off points), socioeconomic variables, and the lack of eligible articles from different countries resulted in a very low certainty of evidence due to severe issues of bias, inconsistency, and indirectness according to the GRADE guidelines. The association between socioeconomic factors and OOSCC treatment delay is inconclusive by the available data. Given the complexity of the determinants of access to timely OOSCC treatment, further research is recommended in different countries.

Esta revisión sistemática evalúa las asociaciones entre los factores socioeconómicos y el tratamiento tardío en adultos con carcinoma de células escamosas (CCE) oral y orofaríngeo. Se realizaron búsquedas de estudios observacionales en cinco bases de datos (PubMed, Scopus, Web of Science, Embase y Biblioteca Virtual en Salud) y en la literatura gris. No se impusieron restricciones sobre el idioma o el año de publicación. El riesgo de sesgo se evaluó utilizando la herramienta del Instituto Joanna Briggs. Los puntos de cohorte que representan el tratamiento tardío abordado por los estudios incluidos se definieron como el resultado primario. La certeza de la evidencia se evaluó utilizando el enfoque Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En total, se incluyeron diez estudios de cohorte retrospectivos en la síntesis narrativa. El tipo de plan de salud, el sexo, la edad avanzada, los pacientes no blancos, el bajo nivel de educación, el tratamiento en un hospital público/regional, la necesidad de atención transitoria y la residencia en zonas aisladas/remotas fueron los factores asociados con el tratamiento tardío del CCE. Sin embargo, las limitaciones metodológicas para ajustar los factores de confusión, la heterogeneidad de la definición de retraso (diferentes puntos de cohorte) y de las variables socioeconómicas abordadas, y la falta de artículos elegibles de diferentes países dieron como resultado una evidencia con nivel muy bajo de certeza debido a los graves riesgos de sesgo, inconsistencia y evidencia indirecta de acuerdo con GRADE. La asociación entre los factores socioeconómicos y retraso en el tratamiento del CCE no es concluyente según los datos disponibles. Dada la complejidad de los determinantes del acceso al tratamiento oportuno del CCE, se recomienda más estudios de diferentes países.

https://doi.org/10.1590/0102-311xen121324

Socioeconomic factors impacting treatment delays in oral and oropharyngeal squamous cell carcinoma: a systematic review
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Montagnoli, Débora Rosana Alves Braga Silva

; Leite, Vitória Ferreira

; Godoy, Yasmim Silva

; Martins-Pfeifer, Carolina Castro

; Moreno-Drada, Johana Alejandra

; Aguiar, Maria Cássia Ferreira

; Abreu, Mauro Henrique Nogueira Guimarães

; Martins, Renata de Castro

Cadernos de Saúde Pública

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2025, Volume 41 N. 3 elocation e00121324

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

https://doi.org/10.1590/0102-311xen121324

Prevención de Infecciones Respiratorias por VSR: Consenso Interinstitucional
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Martínez de Cuellar, Celia

; Campuzano de Rolón, Ana

; Giménez, Edgar

; Weber, Ernesto

; Lovera, Dolores

; Rolón, Roger

; Pavlicich, Viviana

; Jiménez, Hassel Jimmy

; Benítez-I, Irene

; Zorrilla, Carolina Ruíz

; Irrazbal, María

; Ovelar, Patricia

; Suarez, Zully Sánchez, María José Velázquez, Sheila Estigarribia, Gladys Moreno, Luis Aguilar, Gloria Araujo, José Modesto González de Soto, Mirta Ghesi, Cristina Godoy, Laura Castro, Héctor Fonseca, Rosanna

Pediatría (Asunción)

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aug 2024, Volume 51 N. 2 Pages 140 - 151

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

ABSTRACT Respiratory syncytial virus (RSV) infections constitute a significant cause of morbidity, hospitalization, school and work absenteeism, as well as mortality worldwide, including in Paraguay. Currently, tools for RSV prevention are available. In 2012, Paraguay approved the use of palivizumab (MedImmune, USA), a monoclonal antibody produced through recombinant DNA technology. This antibody is administered in 5 doses, every 30 days and is indicated in infants born prematurely and those with cardiopulmonary disorders. Furthermore, a novel tool for RSV prevention has recently become available. Nirsevimab, a long-acting monoclonal antibody specific to the prefusion conformation of the F protein, has been approved by both the European Medicines Agency (EMA) and the Food and Drug Administration (FDA). This monoclonal antibody is indicated for the prevention of acute lower respiratory tract infections caused by RSV in newborns and infants born during or entering their first RSV season, as well as in premature infants and infants up to 24 months of age who remain vulnerable to severe RSV disease during their second RSV season. After analyzing the epidemiological situation of RSV in our country and evaluating the evidence of efficacy, efficiency, and effectiveness of this monoclonal antibody, academic institutions, scientific societies, and non-governmental and governmental organizations developed consensus guidelines on a new prevention alternative for the prevention of RSV infections, suggesting the incorporation of Nirsevimab in children under 12 months of age before their first RSV season and replacing Palivizumab. The new monoclonal has the potential to change the panorama of RSV infections in infants and produce an impact on the reduction of infant mortality and morbidity reducing the burden on the health system by decreasing hospital bed occupancy both in wards and in intensive care units, as well as the decrease in the burden on caregivers, physicians and health care providers.

RESUMEN Las infecciones por el VSR en constituyen una causa importante de morbilidad, hospitalización, ausentismo escolar y laboral, así como de mortalidad, en el mundo, así como en el Paraguay.En la actualidad, existen herramientas para la prevención del VSR. En el año 2012, el Paraguay, ha incorporado el palivizumab (MedImmune, EE. UU.), anticuerpo monoclonal, producido por tecnología de DNA recombinante. Este anticuerpo se administra en 5 dosis, cada 30 días y está indicado en lactantes nacidos prematuros y aquellos con trastornos cardiopulmonares. Por otro lado, actualmente se cuenta con una nueva herramienta para la prevención del VSR. El anticuerpo monoclonal de vida media prolongada Nirsevimab, específico para la conformación de prefusión de la proteína F, aprobado por EMA y FDA. Este monoclonal, está indicado para la prevención de las Infecciones respiratorias agudas bajas, causada por VSR en recién nacidos y lactantes nacidos durante o al ingresar a su primera temporada de VSR, en prematuros y lactantes hasta los 24 meses de edad que siguen siendo vulnerables a la enfermedad grave por VSR durante su segunda temporada de VSR. Luego de analizar la situación epidemiológica del VSR en el país así como la evidencia de eficacia, eficiencia y efectividad de este monoclonal; instituciones académicas, sociedades científicas, organizaciones no gubernamentales y gubernamentales se reunieron y elaboraron un consenso interinstitucional para la prevención de las infecciones por VSR, sugiriendo la incorporación del Nirsevimab, en menores de 12 meses de edad antes de su primera temporada de VSR y en reemplazo del Palivizumab, debido a que el nuevo monoclonal tiene el potencial de cambiar el panorama de las infecciones por VSR en el lactante y producir un impacto en la reducción la mortalidad y morbilidad infantil; reduciendo la carga al sistema de salud, en lo que se refiere a la disminución de la ocupación de camas hospitalarias tanto en sala como en unidades de cuidados intensivos, así como la disminución de la carga para los cuidadores, médicos y proveedores de atención médica y la mortalidad infantil.

https://doi.org/10.31698/ped.51022024009

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023 202 20 2
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Marin-Neto, José Antonio

; Rassi Jr, Anis

; Oliveira, Gláucia Maria Moraes

; Correia, Luís Claudio Lemos

; Ramos Júnior, Alberto Novaes

; Luquetti, Alejandro Ostermayer

; Hasslocher-Moreno, Alejandro Marcel

; Sousa, Andréa Silvestre de

; Paola, Angelo Amato Vincenzo de

; Sousa, Antônio Carlos Sobral

; Ribeiro, Antonio Luiz Pinho

; Correia Filho, Dalmo

; Souza, Dilma do Socorro Moraes de

; Cunha-Neto, Edecio

; Ramires, Felix Jose Alvarez

; Bacal, Fernando

; Nunes, Maria do Carmo Pereira

; Martinelli Filho, Martino

; Scanavacca, Maurício Ibrahim

; Saraiva, Roberto Magalhães

; Oliveira Júnior, Wilson Alves de

; Lorga-Filho, Adalberto Menezes

; Guimarães, Adriana de Jesus Benevides de Almeida

; Braga, Adriana Lopes Latado

; Oliveira, Adriana Sarmento de

; Sarabanda, Alvaro Valentim Lima

; Pinto, Ana Yecê das Neves

; Carmo, Andre Assis Lopes do

; Schmidt, Andre

; Costa, Andréa Rodrigues da

; Ianni, Barbara Maria

; Markman Filho, Brivaldo

; Rochitte, Carlos Eduardo

; Macêdo, Carolina Thé

; Mady, Charles

; Chevillard, Christophe

; Virgens, Cláudio Marcelo Bittencourt das

; Castro, Cleudson Nery de

; Britto, Constança Felicia De Paoli de Carvalho

; Pisani, Cristiano

; Rassi, Daniela do Carmo

; Sobral Filho, Dário Celestino

; Almeida, Dirceu Rodrigues de

; Bocchi, Edimar Alcides

; Mesquita, Evandro Tinoco

; Mendes, Fernanda de Souza Nogueira Sardinha

; Gondim, Francisca Tatiana Pereira

; Silva, Gilberto Marcelo Sperandio da

; Peixoto, Giselle de Lima

; Lima, Gustavo Glotz de

; Veloso, Henrique Horta

; Moreira, Henrique Turin

; Lopes, Hugo Bellotti

; Pinto, Ibraim Masciarelli Francisco

; Ferreira, João Marcos Bemfica Barbosa

; Nunes, João Paulo Silva

; Barreto-Filho, José Augusto Soares

; Saraiva, José Francisco Kerr

; Lannes-Vieira, Joseli

; Oliveira, Joselina Luzia Menezes

; Armaganijan, Luciana Vidal

; Martins, Luiz Cláudio

; Sangenis, Luiz Henrique Conde

; Barbosa, Marco Paulo Tomaz

; Almeida-Santos, Marcos Antonio

; Simões, Marcos Vinicius

; Yasuda, Maria Aparecida Shikanai

; Moreira, Maria da Consolação Vieira

; Higuchi, Maria de Lourdes

; Monteiro, Maria Rita de Cassia Costa

; Mediano, Mauro Felippe Felix

; Lima, Mayara Maia

; Oliveira, Maykon Tavares de

; Romano, Minna Moreira Dias

; Araujo, Nadjar Nitz Silva Lociks de

; Medeiros, Paulo de Tarso Jorge

; Alves, Renato Vieira

; Teixeira, Ricardo Alkmim

; Pedrosa, Roberto Coury

; Aras Junior, Roque

; Torres, Rosalia Morais

; Povoa, Rui Manoel dos Santos

; Rassi, Sergio Gabriel

; Alves, Silvia Marinho Martins

; Tavares, Suelene Brito do Nascimento

; Palmeira, Swamy Lima

; Silva Júnior, Telêmaco Luiz da

; Rodrigues, Thiago da Rocha

; Madrini Junior, Vagner

; Brant, Veruska Maia da Costa

; Dutra, Walderez Ornelas

; Dias, João Carlos Pinto

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 6 elocation e20230269

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.36660/abc.20230269

Condiciones de salud de los indígenas hitnü potencialmente expuestos a petróleo crudo (Arauca, Colombia)
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Rivero-Rubio, Carolina Navarro-Rodríguez, Angélica I. Castro-Reyes, María C. Araújo-Quintana, Óscar Moreno-Montoya, José Estévez-García, Jesús A. Martínez-Silva, Pablo A. Idrovo, Álvaro J. Amaya-Castellanos, Claudia

Biomédica

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dec 2022, Volume 42 N. 4 Pages 679 - 696

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Introducción. El pueblo hitnü vive en condiciones sanitarias precarias, con inseguridad alimentaria y víctima de la violencia sociopolítica en Arauca (Colombia). Además, se sospecha que pueden estar afectados por la exposición a los hidrocarburos del petróleo. Objetivo. Identificar los eventos de salud del perfil de morbilidad y mortalidad de los indígenas hitnü que podrían asociarse con la exposición a petróleo crudo. Materiales y métodos. Se realizó un estudio transversal con indígenas hitnü, durante febrero y marzo de 2021, época de sequía. Se aplicó un cuestionario de hogares y uno individual para recolectar datos del ambiente peridomiciliario, ocupaciones y otras actividades, así como datos sociodemográficos, signos, síntomas y hallazgos de un examen médico. La potencial asociación con los hidrocarburos se exploró considerando tres grupos, según su localización: cabecera de Arauca, resguardo Aspejená (no expuestos) y resguardos de San José del Lipa y La Vorágine (expuestos por su cercanía al río Ele y afluentes). Con listados libres, se exploraron las causas de muerte. El estudio incorporó un riguroso manejo intercultural en todos sus componentes. Resultados. Participaron 576 indígenas de 16 asentamientos. El agua consumida pudo servir como medio de exposición a los hidrocarburos. Los problemas de salud fueron muy variados e incluían enfermedades infecciosas y crónicas, malnutrición y trauma. Las masas en el cuello se asociaron con residir en los resguardos ancestrales (RP=3,86; IC95% 1,77-8,39), territorios potencialmente expuestos al petróleo. Las causas de muerte más relevantes fueron el homicidio, los tumores y la tuberculosis. Conclusión: Por su posible asociación con los hidrocarburos, es prioritario el estudio intercultural de linfoadenopatías entre indígenas potencialmente expuestos al petróleo.

Abstract Introduction: The Hitnü indigenous people live in precarious sanitary conditions, with food insecurity and being victims of sociopolitical violence in Arauca, Colombia. In addition, it is possible that they may be affected by exposure to hydrocarbons found in oil. Objective: To identify the health outcomes of morbidity and mortality profiles of the Hitnü people that could be associated with the exposure to crude oil. Materials and methods: A cross-sectional study was carried out with Hitnü indigenous people, during February and March, 2021, time of drought. A household questionnaire was applied, and one individual to collect data from the environment around the house, occupations and other activities, as well as data from sociodemographic, signs, symptoms, and findings of a medical examination. The potential association with hydrocarbons was explored considering three groups: inhabitants in Arauca city, Aspejaná reserve (not exposed), and San José del Lipa and La Vorágine reserves (exposed by the Ele river and tributaries). With free listings, causes of death were explored. The study incorporated a rigorous intercultural management in all its components. Results: A total of 576 indigenous people from 16 settlements participated. The water consumed could serve as means of exposure to hydrocarbons. Health problems were very varied, including infectious and chronic diseases, malnutrition, and trauma. The masses on the neck were associated with residing in the ancestral reserves (PR = 3.86; CI95% 1.77-8.39), territories with potential exposure to crude-oil. The most relevant causes of death were homicide, tumors, and tuberculosis. Conclusion: For its possible association with exposure to hydrocarbons, it is a priority to start the intercultural study of lymphadenopathies in indigenous communities potentially exposed to crude oil.

https://doi.org/10.7705/biomedica.6591

[SciELO Preprints] - Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy
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Marin-Neto, José Antonio Rassi Jr., Anis Moraes Oliveira, Gláucia M. Lemos Correia, Luís Claudio Novaes Ramos Jr., Alberto Hasslocher-Moreno, Alejandro Marcel Luquetti Ostermayer, Alejandro Sousa, Andréa Silvestre de Amato Vincenzo de Paola, Angelo Sobral de Sousa, Antonio Carlos Pinho Ribeiro, Antonio Luiz Correia Filho, Dalmo Moraes de Souza, Dilma do Socorro Cunha-Neto, Edecio J. A. Ramires, Felix Bacal, Fernando Pereira Nunes, Maria do Carmo Martinelli Filho, Martino Ibrahim Scanavacca, Maurício Magalhães Saraiva, Roberto Alves de Oliveira Júnior, Wilson M. Lorga-Filho, Adalberto de Jesus Benevides de Almeida Guimarães, Adriana Lopes Latado Braga, Adriana Sarmento de Oliveira, Adriana V. L. Sarabanda, Alvaro Yecê das Neves Pinto, Ana Assis Lopes do Carmo, André Schmidt, André Costa, Andréa Rodrigues da Ianni, Barbara Maria Markman Filho, Brivaldo Eduardo Rochitte, Carlos Thé Macedo, Carolina Mady, Charles Chevillard, Christophe Bittencourt das Virgens, Cláudio Marcelo Nery de Castro, Cleudson De Paoli de Carvalho Britto, Constança Felícia Pisani, Cristiano do Carmo Rassi, Daniela C. Sobral Filho, Dario Rodrigues Almeida, Dirceu A. Bocchi, Edimar T. Mesquita, Evandro de Souza Nogueira Sardinha Mendes, Fernanda Pereira, Francisca Tatiana Sperandio da Silva, Gilberto Marcelo de Lima Peixoto, Giselle Glotz de Lima, Gustavo H. Veloso, Henrique Turin Moreira, Henrique Bellotti Lopes, Hugo Masciarelli Francisco Pinto, Ibraim Pinto Dias, João Carlos Bemfica, João Marcos Silva-Nunes, João Paulo Soares Barreto-Filho, José Augusto Kerr Saraiva, José Francisco Lannes-Vieira, Joseli Menezes Oliveira, Joselina Luzia V. Armaganijan, Luciana Martins, Luiz Cláudio C. Sangenis, Luiz Henrique Barbosa, Marco Paulo Almeida-Santos, Marcos Antônio Simões, Marcos Vinicius Shikanai-Yasuda, Maria Aparecida Vieira Moreira, Maria da Consolação Higuchi, Maria de Lourdes Costa Monteiro, Maria Rita de Cássia Felix Mediano, Mauro Felippe Maia Lima, Mayara T. Oliveira, Maykon Moreira Dias Romano , Minna Nitz, Nadjar de Tarso Jorge Medeiros, Paulo Vieira Alves, Renato Alkmim Teixeira, Ricardo Coury Pedrosa, Roberto Aras, Roque Morais Torres, Rosália dos Santos Povoa, Rui Manoel Rassi, Sérgio Gabriel Salles Xavier, Sérgio Marinho Martins Alves , Silvia B. N. Tavares, Suelene Lima Palmeira, Swamy da Silva Junior, Telêmaco Luiz da Rocha Rodrigues, Thiago Madrini Junior, Vagner Maia da Costa , Veruska Dutra, Walderez

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Publication date: 2022-10-11

Abstract: En Pt

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.nbsp; Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities. nbsp; Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.nbsp; The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.nbsp; The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.nbsp; nbsp;nbsp; Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.

Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.nbsp;nbsp;nbsp; Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.nbsp;

https://doi.org/10.1590/SciELOPreprints.4820

[SciELO Preprints] - CONTRADICTIONS OF HAVING THE STABLE JOB: ANALYSES ABOUT GENDER RELATIONS BETWEEN WOMEN AND THEIR WORK
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Siqueira, Anna Carolina Arena Moreno , Cláudia Roberta de Castro

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Publication date: 2022-07-13

Abstract: En Pt

This study investigated the conceptions of female nurses about the imbrications between gender attributions and aspects of the organization of their work, in the context of the precariousness of the global work and employment relationships.nbsp; This study was conducted at a public maternity hospital located in São Paulo – Brazil and was based on a qualitative approach. Data was gathered by ethnography and 10 in-depth interviews. The data collection was organized into two kinds of databases: ‘Field Journals’ and ‘Interviews Database’, which were analyzed bynbsp; ‘Triangulation Method’ according to the conceptual framework of hermeneutical referential. Female nurses were in charge to provide financially for the family since they had the ‘stable job’ at the house (being public servants) whereas their partners worked under contract. Those women had to conciliate the shift work with housework and motherhood. Their resting time was reduced, mainly the night workers and they complained about social loss related to the shift schedule. Thus, despite having the guarantee of employment, the burden of the precarious global labor market that subjugates their partners fell on these women's shouldersnbsp; andnbsp; had negative impacts on their physical and mental health.

Neste estudo investigaram-se as concepções de trabalhadoras da enfermagem de uma maternidade pública paulistana sobre as consequências dos imbricamentos entre atribuições de gênero e a precarização das relações de trabalho. Foi utilizada metodologia qualitativa, com observações etnográficas e entrevistas em profundidade, produzindo ‘Diários de Campo’ e ‘Banco de Narrativas’, analisados pela técnica de triangulação de métodos, sob referencial hermenêutico-filosófico. As trabalhadoras explicitaram ocupar a posição de ‘chefe de família’, com responsabilidade de provimento do lar. Elas eram detentoras do vínculo de trabalho seguro (funcionárias públicas) e ganhavam mais que seus parceiros: eles eram celetistas ou tinham contrato informal de trabalho. Elas relataram a necessidade de conciliação dos turnos de trabalho com tarefas domésticas e cuidado dos filhos. O tempo para descanso era reduzido, principalmente para as do turno noturno, e todas referiram perdas sociais por causa dos plantões. Apesar de possuírem a garantia do emprego, o ônus das relações precarizadas do mercado de trabalho brasileiro a que estavam submetidos seus parceiros recaiam sobre essas mulheres, com impactos negativos para sua saúde física e mental.

https://doi.org/10.1590/SciELOPreprints.4383

Validation of the Family Health Behavior Scale for the Brazilian population
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Preto, Luiza Tweedie

; Scarpatto, Camila H.

; Ley, Laura Lessa Gaudie

; Silveira, Carolina

; Salerno, Margareth Rodrigues

; Moreno, Jennette Palcic

; Castro, Stela Maris de Jezus

; Booij, Linda

; Mattiello, Rita

Jornal de Pediatria

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feb 2022, Volume 98 N. 1 Pages 84 - 91

Abstract: En | Text: En | PDF: En

Abstract Objective: To validate the Family Health Behavior Scale (FHBS) for Brazilian families. Methods: The sample included 272 children aged 5 to 12 years old. Caregivers and their healthy answered the FHBS and questions about physical activity. In addition, anthropometric measurements of the children’s weight and height were performed, as well as the bioimpedance exam. The scale was translated and the following validities were assessed: content (qualitative analysis and content validity index), construct (factor analysis) and concurrent validity (difference between domains and the total score with the categories of BMI, fat percentage and physical activity). Reliability (Cronbach's alpha, ceiling-floor effect, two-half test, intraclass correlation and Bland – Altman) was also assessed. Results: FHBS instrument performed well with regard to the psychometric properties in the Brazilian population. The content validity index was 0.987. Fit indices of the factor analysis were considered satisfactory, according to Bartlett's sphericity test (χ 2 = 1927, df = 351; p < 0.001) and the Kaiser-Meyer-Olkin index (KMO = 0.789). Concurrent validity, the differences between the mean of the domains and the total score between the categories of BMI (p = 0.011), percentage of fat (0.004) and physical activity (p < 0.001) were all significant. The reliability results were Cronbach's alpha internal consistency = 0.83, adequate ceiling-floor effect, 0.8105 (0.09 SD) two-half test, 0.626 intraclass correlation (95% CI: 0.406 to 0.777) and Bland – Altman -0.840 (-22.76 to 21.07). Conclusion: The FHBS adapted for the Brazilian population showed evidence of adequate psychometric performance.

https://doi.org/10.1016/j.jped.2021.04.002

Exploratory study of the hoaxes spread via WhatsApp in Spain to prevent and/or cure COVID-19
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Moreno-Castro, Carolina Vengut-Climent, Empar Cano-Orón, Lorena Mendoza-Poudereux, Isabel

Gaceta Sanitaria

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dec 2021, Volume 35 N. 6 Pages 534 - 540

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Objective: To review the hoaxes' characteristics spread through WhatsApp in Spain during COVID-19 lockdown and identify what kind of substances were promoted for consumption or application. Method: A phone number was activated to receive hoaxes via WhatsApp. A total of 2353 messages were collected, and among those 584 different hoaxes were identified and validated, between March 18 and April 18, 2020. From these 584 hoaxes, a sub-sample of 126 was selected, exclusively related to the object of study, and a content analysis table with fourteen registration fields was applied. Besides, the averages and medians of the quantitative fields were extracted. Results: Most of the messages received were texts (39%) and videos (30%). In the majority, the acting subject was presented as medical personnel (36.5%) or as an anonymous person (30.9%). The videos lasted between 2' 40” and 18' 18”, while the audios ranged between 1' 35” and 7' 48”. Regarding the gender of the informant, there was a significant difference, with 45.2% being male, and 13.5%, female and 41.3% non-identifiable. Conclusions: One out of five false health claims received was about prevention or cure of the coronavirus, based on the principle of medical authority, and basically promoting the use and consumption of substances of natural origin.

Resumen Objetivo: Examinar las características de los bulos difundidos por WhatsApp en España durante el confinamiento por la pandemia de COVID-19 e identificar qué tipo de sustancias se promovieron para su ingesta o uso. Método: Se habilitó un número de teléfono para recibir bulos por WhatsApp. Se recibieron 2353 mensajes, de los que se identificaron y validaron 584 bulos distintos, entre el 18 de marzo y el 18 de abril de 2020. De los 584 bulos, se seleccionó una submuestra de 126 relacionados con el objeto de estudio y se aplicó una ficha de análisis de contenido con 14 campos de registro. Además, se extrajeron las medias y medianas de los campos cuantitativos. Resultados: La mayor parte de los mensajes fueron cadenas de texto (39%) y vídeos (30%). En la mayoría, el sujeto se presentaba como personal médico (36,5%) o como persona anónima (30,9%). Los vídeos tuvieron una duración de entre 2' 40” y 18' 18”, mientras que los audios fueron de entre 1' 35” y 7' 48”. Con respecto al sexo, se apreció una gran diferencia: el 45,2% de los protagonistas fueron hombres, frente al 13,5% de mujeres; el 41,3% no era identificable. Conclusiones: Uno de cada cinco bulos recibidos fue sobre prevención o curación del coronavirus, argumentados sobre el principio de autoridad médica y básicamente promoviendo el uso y consumo de sustancias de origen natural.

https://doi.org/10.1016/j.gaceta.2020.07.008

10.

Exploratory study of the hoaxes spread via WhatsApp in Spain to prevent and/or cure COVID-19
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Moreno-Castro, Carolina Vengut-Climent, Empar Cano-Orón, Lorena Mendoza-Poudereux, Isabel

Gaceta Sanitaria

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dec 2021, Volume 35 N. 6 Pages 534 - 540

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

https://doi.org/10.1016/j.gaceta.2020.07.008

11.

Uso del cine como herramienta de aprendizaje en salud pública
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Tuesca-Molina, Rafael

; Rodríguez-Ávila, Nuria

; Moreno-Castro, Carolina

Educación Médica Superior

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sep 2021, Volume 35 N. 3 elocation e2133

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

RESUMEN Introducción: El abordaje de las epidemias/pandemias debe llevarse a cabo desde una enseñanza transversal que involucre un pensamiento completo. Objetivo: Evaluar diferentes herramientas pedagógicas para el aprendizaje significativo activo en el aula. Métodos: Estudio de caso (n = 10), sin grupo de control, en el contexto de un seminario internacional. Se empleó una encuesta de percepciones y creencias ante pandemias, a través de la estrategia didáctica para observar, reflexionar y aplicar mediante el cine, y otros insumos para apoyar el aprendizaje. Resultados: Los docentes se mostraron favorables a la utilización del cine en el aula durante la propuesta metodológica, y apoyaron los instrumentos empleados para el aprendizaje y la dinámica docente en situaciones epidemiológicas. Asimismo, mejoró el proceso pedagógico, el análisis de los fenómenos desde la perspectiva local, la capacidad de objetivar situaciones que fomenten un pensamiento complejo y el uso de la interdisciplinariedad en el aula. Conclusiones: La incorporación del género de “cine pandémico”, acompañado de la estrategia ORA, el uso de cuestionario de percepciones y creencias, y otros insumos, mejora el proceso de enseñanza-aprendizaje, favorece el abordaje de problemas de pensamiento complejo, y mejora la empatía entre docentes y estudiantes en el aula.

ABSTRACT Introduction: Approach to epidemics/pandemics must be carried out from transversal teaching that involves complete thinking. Objective: To assess different pedagogical tools for active meaningful learning in the classroom. Methods: Case study (n= 10), without a control group, carried out in the context of an international seminar. A survey of perceptions and beliefs during pandemics was used by means of the didactic strategy to observe, reflect and apply through cinema and other elements to support learning. Results: The professors supported the use of cinema in the classroom during the methodological proposal, as well as the instruments used for learning and teaching dynamics in epidemiological situations. Likewise, there was an improvement of the pedagogical process, the analysis of phenomena from the local perspective, the ability to objectify situations that promote complex thinking, and the use of interdisciplinarity in the classroom. Conclusions: The incorporation of the pandemic cinema genre, accompanied by the observation-relation-application strategy, the use of a perceptions and beliefs questionnaire, as well as other elements, improves the teaching-learning process, favors the approach to complex thinking problems, and improves empathy between professors and students in the classroom.

12.

Una mirada histórico-geográfica de las pandemias: para entender de manera compleja la COVID-19
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TUESCA MOLINA, RAFAEL RODRÍGUEZ-AVILA, NURIA MORENO-CASTRO, CAROLINA

Revista Salud Uninorte

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apr 2021, Volume 37 N. 1 Pages 189 - 204

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

RESUMEN El abordaje para la investigación de brotes/pandemias es una actividad desafiante, necesaria y retadora para los salubristas y epidemiólogos. Esta actuación permite que los servicios de epidemiología y de vigilancia profundicen el conocimiento de la enfermedad, recaben datos históricos de episodios pandémicos, caractericen vulnerables, planteen hipótesis e intervengan los factores de riesgos en un contexto ambiental y sociocultural determinado con una actuación local y una perspectiva global. Se considera un abordaje sindémico, de tal manera que conjugan aspectos de determinantes sociales interconectados y profundizando en la pandemia.

ABSTRACT The outbreak/pandemic investigation approach is a challenging, necessary and challenging activity for health professionals and epidemiologists. This approach allows epidemiology and surveillance services to deepen their knowledge of the disease, collect historical data on pandemic episodes, characterize vulnerabilities, develop hypotheses and intervene risk factors in a given environmental and sociocultural context with local action and a global perspective. A syndemic approach is considered, in such such a way that it combines aspects of interconnected social determinants and deepening in the pandemic.

https://doi.org/10.14482/sun.37.1616.242

13.

Consenso de hemofilia en México
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López-Arroyo, José L. Pérez-Zúñiga, Juan M. Merino-Pasaye, Laura E. Saavedra-González, Azucena Alcivar-Cedeño, Luisa María Álvarez-Vera, José Luis Anaya-Cuellar, Irene Arana-Luna, Luara L. Ávila-Castro, David Bates-Martín, Ramón A. Cesarman-Maus, Gabriela Chávez-Aguilar, Lénica A. Peña-Celaya, José A. de la Espitia-Ríos, María E. Estrada-Domínguez, Patricia Fermín-Caminero, Denisse Flores-Patricio, Willy García Chávez, Jaime García-Lee, María T. González-Pérez, María del Carmen González-Rubio, María del Carmen González-Villareal, María Guadalupe Ramírez-Moreno, Fabiola Hernández-Colin, Ana K. Hernández-Ruiz, Eleazar Herrera-Olivares, Wilfrido Leyto-Cruz, Faustino Loera-Fragoso, Sergio Martínez-Ríos, Annel Miranda-Madrazo, María R. Morales-Hernández, Alba Nava-Villegas, Lorena Orellana-Garibay, Juan J. Palma-Moreno, Orlando G. Paredes-Lozano, Eugenia P. Peña-Alcántara, Paula Pérez-Lozano, Uendy Pichardo-Cepín, Yayra M. Reynoso-Pérez, Ana Carolina Rodríguez-Serna, Mishel Rojas-Castillejos, Flavio Romero-Rodelo, Hilda Ruíz-Contreras, Josué I. Segura-García, Adela Silva-Vera, Karina Soto-Cisneros, Paulina M. Tapia-Enríquez, Ana L. Tavera-Rodríguez, Martha G. Teomitzi-Sánchez, Óscar Tepepa-Flores, Fredy Valencia-Rivas, María D. Valle-Cárdenas, Teresa Varela-Constantino, Ana Javier-Morales, Adrián Martínez-Ramírez, Mario A. Tena-Cano, Sergio Terrazas-Marín, Ricardo Vilchis-González, Shendel P. Villela-Peña, Atenas Mena-Zepeda, Verónica Alvarado Ibarra, Martha

Gaceta médica de México

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2021, Volume 157 Suppl. 1 Pages S1 - S37

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

resumen está disponible en el texto completo

Abstract Hemophilia is a hemorrhagic disorder with a sex-linked inherited pattern, characterized by an inability to amplify coagulation due to a deficiency in coagulation factor VIII (hemophilia A or classic) or factor IX (hemophilia B). Sequencing of the genes involved in hemophilia has provided a description and record of the main mutations, as well as a correlation with the various degrees of severity. Hemorrhagic manifestations are related to levels of circulating factor, mainly affecting the musculoskeletal system and specifically the large joints (knees, ankles and elbows). This document is a review and consensus of the main genetic aspects of hemophilia, from the inheritance pattern to the concept of women carriers, physiopathology and classification of the disorder, the basic and confirmation studies when hemophilia is suspected, the various treatment regimens based on infusion of the deficient coagulation factor as well as innovative factor-free therapies and recommendations for the management of complications associated with treatment (development of inhibitors and/or transfusion transmitted infections) or secondary to articular hemorrhagic events (hemophilic arthropathy). Finally, relevant reviews of clinical and treatment aspects of hemorrhagic pathology charachterized by acquired deficiency of FVIII secondary to neutralized antibodies named acquired hemophilia.

https://doi.org/10.24875/gmm.m20000451

14.

Oral health services coverage in Medellín, 2015
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Restrepo-Zea, Jairo Humberto Castro-García, Paula Andrea Casas-Bustamante, Lina Patricia Betancur-Romero, John Edison López-Hernández, Mayra Alejandra Moreno-López, Carolina Rangel-Valencia, Vanessa

Revista Facultad de Odontología Universidad de Antioquia

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dec 2020, Volume 32 N. 2 Pages 6 - 17

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen Introducción: a pesar de los avances en la cobertura de la seguridad social en salud, la población colombiana enfrenta barreras al acceso. En salud bucal, si bien el plan de beneficios es amplio, la cobertura de los servicios a cargo de las EPS es baja. Objetivo: analizar la cobertura de los servicios odontológicos entre la población afiliada en Medellín en 2015. Métodos: estudio mixto con un componente central cuantitativo para estimar la cobertura esperada, según necesidad normativa y necesidad expresada, y la cobertura real a partir de registros de prestación de servicios de los afiliados que en 2015 accedieron a servicios odontológicos en la red de seis EPS. También se desarrolló un componente cualitativo, a partir de entrevistas a referentes de salud bucal en las EPS. Resultados: para atender las necesidades de la población afiliada se requerían en el año 9.6 millones de actividades de protección específica y detección temprana, siguiendo los lineamientos normativos, y 6.8 millones de actividades para atender los diagnósticos de caries y periodontitis. La cobertura real apenas habría sido del 10,6%, y en las EPS del estudio entre 16% y 23%. Conclusión: la brecha entre los servicios necesarios y los prestados supera el 70%, lo cual puede deberse especialmente a factores sociales y culturales y a una baja demanda inducida. A la par con mayores recursos, esto debe ser tenido en cuenta para mejorar la cobertura y lograr un mayor impacto en salud bucal.

Abstract Introduction: despite the advances in coverage in social security in health, the Colombian population still faces access barriers. In oral health, although the benefit plan is broad, the coverage of services provided by Health Maintenance Organizations (HMOs)* is low. Objective: analyze dental services coverage among users in Medellín in the year 2015. Methods: mix study with a quantitative approach to estimate expected coverage, according to normative need and expressed need, and real coverage based on service provision records referring to Medellín users who accessed dental services in the HMO network in 2015. A qualitative approach was also conducted via interviews with oral health referents in six HMOs. Results: in order to meet the needs of the affiliated population, 9,6 million specific protection and early detection activities were required in the year, following the normative guidelines, and 6,8 million activities to assist caries and periodontitis patients. Real coverage would have hardly been 10.6% of the city’s population, and in the studied HMOs this value would have been 16% to 23%. Conclusion: the gap between the necessary services and those provided exceeds 70%, which is mainly due to social and cultural factors and low induced demand. In addition to greater resources, this must be taken into account to improve coverage and achieve a greater impact on oral health.

https://doi.org/10.17533/udea.rfo.v32n2a1

15.

Detección molecular de coronavirus bovino asociado al complejo respiratorio bovino en ganado de engorda del valle de Mexicali, Baja California, México
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Orozco-Cabrera, Carolina López-Valencia, Gilberto Muñoz-Del Real, Luis Mario Gaxiola-Camacho, Soila Maribel Castro-del Campo, Nohemí Cueto-González, Sergio Arturo Guerrero-Velázquez, José Guadalupe Moreno-Torres, Kattya Espinoza-Blandón, Kelvin Orlando Gómez-Gómez, Sergio Daniel Trasviña-Muñoz, Enrique Monge-Navarro, Francisco Javier

Revista mexicana de ciencias pecuarias

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dec 2020, Volume 11 N. 4 Pages 933 - 945

Abstract: Es En | Text: Es En | PDF: Es | PDF: En

Resumen El complejo respiratorio bovino (CRB) es la principal causa de enfermedad y muerte en el ganado de engorda en todo el mundo. Es un síndrome infeccioso multifactorial provocado por distintos virus y bacterias que disminuyen la eficiencia productiva y ocasionan pérdidas económicas. En México, el CRB se ha reportado en todas las regiones donde se engorda ganado; sin embargo, esos reportes carecen de información sobre la presencia del coronavirus respiratorio bovino (CVB), haciendo necesario contar con herramientas de diagnóstico confiables y precisas para detectar la presencia de CVB en el ganado que se engorda en México, para proponer las medidas sanitarias apropiadas para su manejo clínico. En este trabajo, se desarrolló una plataforma de diagnóstico molecular de PCR en tiempo real (rt-PCR) que amplifica un fragmento de la proteína S del CVB en muestras de exudado nasal. Al aplicar la plataforma rt-PCR para CVB en bovinos de engorda en aparente estado de salud y con signos de enfermedad respiratoria asociados a CRB se encontró que 19/50 (38 %) resultaron positivos, confirmando la presencia de ese virus en el ganado de la región. Los resultados de este trabajo significan el primer reporte sobre la presencia del CVB asociado al CRB en la región ganadera del noroeste de México y sienta las bases para futuras investigaciones sobre papel que juega este virus en la presentación de la patología del CRB en los sistemas de explotación de bovinos de engorda en nuestra región y el país.

Abstract The bovine respiratory complex (BRC) is the leading cause of disease and death in beef cattle worldwide. It is a multifactorial infectious syndrome caused by different viruses and bacteria that reduce the productive efficiency and cause economic losses. In Mexico, BRC has been reported in all regions where cattle are fattened; however, these reports lack information on the presence of bovine respiratory coronavirus (BCV). This makes it necessary to have reliable and accurate diagnostic tools for detecting the presence of BCV in beef cattle fattened in Mexico, in order to propose appropriate sanitary measures for their clinical management. In this work, a real-time-PCR molecular diagnostic platform (rt-PCR) was developed to amplify a fragment of the BCV S protein in nasal exudate samples. When applying the rt-PCR platform for BCV in seemingly healthy beef cattle with signs of respiratory disease associated to BRC, 19/50 (38 %) were found to be positive, confirming the presence of this virus in the cattle of the region. The results of this work constitute the first report on the presence of the BCV associated to the BRC in the cattle region of northwestern Mexico and establish the bases for future research about the role that this virus plays in the presentation of the pathology of the BRC in beef cattle exploitation systems in this region and across the country.

https://doi.org/10.22319/rmcp.v11i4.5137

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