Abstract Objective To measure patient safety culture from Intensive Care Unit nurses’ perspective. Methods This is a cross-sectional descriptive study carried out with 65 nurses from Intensive Care Units of a tertiary public hospital, by completing the Hospital Survey on Patient Safety Culture questionnaire, using simple descriptive statistics for data analysis and following the Agency for Healthcare Research and Quality’s guidelines. Results Of the total, 50% of nurses did not report any adverse events in the last 12 months; 50.8% of professionals assigned a fair score to patient safety in their work area/unit at the hospital; none of the dimensions had a rate of positive responses >75%, only isolated items such as C2 (Professionals are free to say when they see something that may negatively affect patient care), with 84.6%. Dimensions 6 (Nonpunitive responses to errors), 9 (Teamwork across hospital units) and 11 (Overall perceptions of safety) showed all items with an average percentage below (50%), and Dimension 6 (Nonpunitive responses to errors) was the weakest (22.5%). Conclusion This study showed a low rate of adverse event reporting and nurses’ perception of a punitive culture on the part of their superiors. Gaps in the safety culture were evidenced, which need to be reassessed in order to seek strategies to improve and strengthen care, making care increasingly qualified and safe.

Resumen Objetivo Medir la cultura de seguridad del paciente bajo la perspectiva de los enfermeros de Unidades de Cuidados Intensivos. Métodos Estudio descriptivo transversal llevado a cabo con 65 enfermeros asistenciales de las Unidades de Cuidados Intensivos de un hospital público terciario por medio del cuestionario Hospital Survey on Patient Safety Culture ; se utilizó la estadística descriptiva simple para el análisis de los datos; y se siguieron las instrucciones de la Agency for Healthcare Research and Quality. Resultados Del total de los enfermeros, el 50 % no realizó ninguna notificación de evento adverso en los últimos 12 meses; el 50,8 % de los profesionales calificó como Regular la seguridad del paciente en su área/unidad de trabajo del hospital; ninguna de las dimensiones presentó índice de respuestas positivas >75 %, solo en ítems aislados como el C2 (“Los profesionales tienen libertad para decir si ven algo que puede afectar negativamente el cuidado del paciente”), con un 84,6 %. La dimensión 6 (Respuesta no punitiva a los errores), la dimensión 9 (Trabajo en equipo entre unidades) y la 11 (Percepción global de seguridad) presentaron un porcentaje promedio inferior a (50 %) en todos los ítems; la dimensión 6 (Respuesta no punitiva a los errores) fue la más frágil (22,5 %). Conclusión Este estudio evidenció un bajo índice de notificación de eventos adversos y la percepción de los enfermeros de una cultura punitiva por parte de sus superiores. Se observaron vacíos en la cultura de seguridad que deberían ser reevaluados para buscar estrategias de mejora y fortalecimiento del cuidado, para que la atención sea cada vez más calificada y segura.

Resumo Objetivo Mensurar a cultura de segurança do paciente na perspectiva dos enfermeiros de Unidades de Terapia Intensiva. Métodos Estudo descritivo transversal desenvolvido com 65 enfermeiros assistenciais das Unidades de Terapia Intensiva de um hospital público terciário por meio do preenchimento do questionário Hospital Survey on Patient Safety Culture, utilizando a estatística descritiva simples para análise dos dados, seguindo as orientações da Agency for Healthcare Research and Quality’s. Resultados Do total, 50% dos enfermeiros não realizaram nenhuma notificação de evento adverso nos últimos 12 meses; 50,8% dos profissionais atribuíram nota Regular à Segurança do Paciente na sua área/unidade de trabalho no hospital; nenhuma das Dimensões apresentou taxa de respostas positivas >75%, apenas itens isolados como o C2 (“Os profissionais têm liberdade para dizer ao ver algo que pode afetar negativamente o cuidado do paciente”), com 84,6%. As Dimensões 6 (Respostas não punitivas aos erros), 9 (Trabalho em equipe entre as unidades hospitalares) e 11 (Percepções gerais sobre segurança) apresentaram todos os itens com percentual médio abaixo de (50%); a Dimensão 6 (“Respostas não punitivas aos erros”) foi a mais frágil (22,5%). Conclusão Este estudo evidenciou baixa taxa de notificação de eventos adversos e percepção dos enfermeiros de uma cultura punitiva por parte de seus superiores; evidenciaram-se lacunas na cultura de segurança que precisam ser reavaliadas para buscar estratégias de melhoria e fortalecimento do cuidado, tornando a assistência, cada vez mais, qualificada e segura.

Abstract Introduction Glycemic control is important to avoid diabetes complications in individuals with cancer. There is no evidence for HbA1c and fructosamine as reliable biomarkers in these conditions. There are particularities in caring for patients with diabetes and cancer that can alter these biomarkers. Objective The aim of this study was to evaluate HbA1c and fructosamine as glycemic biomarkers in people with type 2 diabetes and cancer, undergoing clinical or surgical oncological treatment. Methods The authors conducted a single-center, retrospective analysis with people who have cancer and diabetes. Comparison of glycemic biomarkers (HbA1c, fructosamine, and Self-Monitoring of Blood Glucose [SMBG]) was performed including evaluation in individuals undergoing chemotherapy, using glucocorticoids, with anemia, hypoproteinemia or with reduced estimated Glomerular Filtration Rate (eGFR). Results There was a strong positive correlation between fructosamine and HbA1c (n = 318, r= 0.66, p < 0.001) in people with diabetes and cancer even in those under chemotherapy (n = 101, r= 0.61, p < 0.001) or using glucocorticoids (n = 96, r= 0.67, p<0.001). There was a strong correlation between HbA1c and fructosamine in subjects with anemia (n = 111, r= 0.66, p < 0.001), hypoproteinemia (n = 54, r= 0.67, p < 0.001), or with eGFR ≥ 60 mL/min/1.73 m2 (n = 189, r= 0.70, p < 0.001), and moderate correlation with hypoalbuminemia (n = 21, r= 0.54, p = 0.001) and with reduced eGFR (n = 67, r= 0.57, p < 0.001). The correlations between fructosamine and HbA1c with SMBG were moderate (n = 164, r= 0.49, p < 0.001; n = 111, r= 0.55, p < 0.001, respectively), strong in subjects undergoing chemotherapy, with hypoalbuminemia or hypoproteinemia, and at least moderate, if eGFR < 60 mL/min/1.73 m2 or with anemia. Conclusions Fructosamine and HbA1c can be used as glycemic biomarkers in people with diabetes and cancer, even in those with anemia, hypoproteinemia, or undergoing chemotherapy.

Resumen Introducción: El uso de dispositivos móviles para el cuidado de la salud ha sido cada vez más frecuente en los últimos años. Los estudios muestran el inmenso potencial de esta tecnología como instrumento para favorecer el desarrollo de habilidades personales y sociales, en el sentido de adquirir un mayor control y poder de decisión sobre la atención de la salud. Objetivo: El objetivo de esta revisión de alcance es mapear las intervenciones de salud móvil para mejorar los resultados de salud en la infancia. Método: La revisión considerará estudios que incluyan el uso de la salud móvil por parte de profesionales de la salud o miembros de la familia para cuidar la salud infantil. Esta revisión de alcance incluirá diseños de estudios observacionales experimentales, cuasiexperimentales y descriptivos con un enfoque cuantitativo o cualitativo. Se considerarán disertaciones, pero se excluirán los resúmenes de congresos, carteles, editoriales, comentarios y artículos de opinión. La búsqueda se limitará a los estudios publicados en inglés, español y portugués después de 2010. Las bases de datos que se buscarán incluyen PubMed (MEDLINE), CINAHL (a través de EBSCO), Embase, PsycINFO (a través de EBSCO), Scielo, Web of Science, LILACS, Health System Evidence y bases de datos de literatura gris como la base de datos ProQuest Dissertations and Theses Global, OpenGrey, EThOS y PaperFirst. Después de la selección de resúmenes / títulos para su inclusión por dos investigadores independientes, se seleccionarán los estudios de texto completo y se proporcionarán las razones de la exclusión. Los datos serán extraídos de los artículos incluidos en la revisión por dos investigadores independientes, utilizando el instrumento de extracción de datos. Resultados: Se presentarán en forma de tablas según PRISMA-ScR. Conclusiones: Este estudio proporcionará evidencia sobre el desarrollo e implementación de herramientas en línea para promover la salud infantil.

Resumo Introdução: O uso de dispositivos móveis para atendimento à saúde tem sido cada vez mais frequente nos últimos anos. Estudos mostram o imenso potencial dessa tecnologia como instrumento para o desenvolvimento de habilidades pessoais e sociais, no sentido de adquirir maior controle e poder de decisão sobre o cuidado à saúde. Objetivo: Mapear as intervenções móveis de saúde para melhorar os resultados de saúde na infância Metodologia: A revisão considerará estudos que incluem o uso de dispositivos móveis de saúde por profissionais de saúde ou familiares para cuidar da saúde da criança. Esta revisão de escopo incluirá desenhos de estudos observacionais experimentais, quase experimentais e descritivos com abordagem quantitativa ou qualitativa. Dissertações serão consideradas, mas resumos de conferências, pôsteres, editoriais, comentários e artigos de opinião serão excluídos. A pesquisa será limitada a estudos publicados em inglês, espanhol e português, a partir de 2010. As bases de dados a serem pesquisadas incluem PubMed (MEDLINE), CINAHL (via EBSCO), Embase, PsycINFO (via EBSCO), Scielo, Web of Science, LILACS, Health System Evidence e bancos de dados de literatura cinzenta, como o banco de dados ProQuest Dissertations and Theses Global, OpenGrey, EThOS e PaperFirst. Após a triagem dos resumos/títulos para inclusão por dois pesquisadores independentes, os estudos em texto completo serão selecionados os dados serão extraídos dos artigos incluídos, utilizando o instrumento de extração de dados. Resultados: Serão apresentados em forma de tabelas e quadros, de acordo com o PRISMA-ScR. Conclusões: Este estudo fornecerá evidências sobre o desenvolvimento e implementação de ferramentas online de promoção da saúde infantil.

Abstract Introduction: The use of mobile devices for health care has been increasingly frequent in recent years. Studies show the immense potential of this technology as an instrument to favor the development of personal and social skills, in the sense of acquiring greater control and decision-making power over health care. Aim: The objective of this scoping review is to map the mobile health interventions for improving health outcomes in childhood. Method: This protocol was carried out in according to Joanna Briggs Institute methodology and Preferred checklist Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), according to the following steps: review question; eligibility criteria (PCC); literature search strategy; study selection; data extraction and data presentation. The review question is: How are mHealth interventions being applied to improve childhood health outcomes (disease prevention, monitoring or diagnosis)? The review will include experimental, quasi-experimental and descriptive observational study designs with quantitative or qualitative approach. Dissertations will be considered, but conference abstracts, posters, editorials, commentaries, and opinion papers will be excluded. The search will be limited to studies published in English, Spanish and Portuguese in the last 10 years. The databases to be searched include PubMed, CINAHL, Embase, Scielo, Web of Science, LILACS, Health System Evidence, and gray literature databases. Results: The result of the selection flow will be presented in the form of tables and figure, according to PRISMA-ScR. Conclusion: This study will provide evidence on the development and implementation of online tools to promote children's health.

ABSTRACT Objective: The aim of this study was to investigate the factors associated with hypoglycemia and severe hypoglycemia (SH) in individuals with type 1 diabetes mellitus (T1D) in Brazil. Materials and methods: This multicenter, cross-sectional study was conducted between August 2011 and August 2014 across 10 Brazilian cities. The data were obtained from 1,760 individuals with T1D. Sociodemographic and clinical characteristics related to hypoglycemic events in the previous 4 weeks were evaluated. Results: Of 1,760 individuals evaluated, 1,319 (74.9%) reported at least one episode of hypoglycemia in the previous 4 weeks. The main factors associated with hypoglycemia were lower hemoglobin A1c (HbA1c) level, better adherence to self-monitoring of blood glucose (SMBG), and higher education level. Episodes of SH were reported by 251 (19%) individuals who, compared with subjects with nonsevere hypoglycemia, received lower doses of prandial insulin and higher doses of basal insulin, in addition to reporting less frequent use of long-acting basal insulin analogs. The percentage of SH episodes was evenly distributed across all ranges of HbA1c levels, and there were no correlations between the mean number of nonsevere or severe hypoglycemic events and HbA1c values. Higher alcohol consumption and more frequent hospitalizations were independently associated with SH. Conclusion: Although individuals presenting with hypoglycemia had lower HbA1c values than those not presenting hypoglycemia, there were no correlations between the number of nonsevere hypoglycemia or SH and HbA1c values. Also, the frequency of SH was evenly distributed across all ranges of HbA1c values. Better adherence to SMBG and higher education level were associated with hypoglycemia, while alcohol consumption, higher doses of basal insulin, and more frequent hospitalizations in the previous year were associated with SH.

ABSTRACT Objective: We assessed metrics related to inpatient glycemic control using InsulinAPP, an application available for free in Brazil, on the hospitalist-managed ward of our hospital. Subjects and methods: We performed a retrospective study of patients with type 2 diabetes (T2D) admitted from November 2018 to October 2019. InsulinAPP recommends NPH and regular insulins three times a day, in bolus-correction or basal-bolus schemes. Parameters that included BG within range of 70-180 mg/dL, insulin treatment regimen and frequency of hypoglycemia were evaluated. Results: A total of 147 T2D individuals (23% medicine and 77% surgery) were included (mean age 62.3 ± 12.7 years, HbA1c: 8.3 ± 3.0%). The initial insulin regimen was 50% bolus-correction, 47% basal-bolus and 3% with sliding scale insulin. During hospitalization, 71% patients required a bolus-basal regimen. In the first 10 days of the protocol, 71% BG measurements were between 70-180 mg/dL and 26% patients experienced one or more episodes of hypoglycemia < 70 mg/dL, and 5% with BG < 54 mg/dL. Conclusion: The results of this retrospective study indicate the InsulinAPP application using human insulin formulations was effective and safe for the management of hyperglycemia on a hospitalist-managed ward, with more than 70% BG measurements within the therapeutic range and a low rate of hypoglycemia.

ABSTRACT Objective To analyze interstitial glucose behavior during glucocorticoid use in non-diabetic patients receiving chemotherapy for hematologic malignancies. Methods Prospective pilot study carried out to assess interstitial glucose levels in 15 non-diabetic individuals with hematologic malignancies who received glucocorticoids in combination with chemotherapy. The FreeStyle Libre flash monitoring system (Abbott Diabetes Care) was used for up to 14 days to measure interstitial glucose. Results Median age and body mass index were 53 (42-61) years and 25 (23-28) kg/m2 respectively. Interstitial glucose levels >180mg/dL lasting at least one hour were detected in 60% of participants. Interstitial glucose profile parameters (median and peak interstitial glucose levels and percentage of time during which interstitial glucose levels were >180mg/dL) were significantly (p<0.01) higher during glucocorticoid use (115mg/dL, 218mg/dL and 10% respectively) than after glucocorticoid discontinuation (97mg/dL, 137mg/dL and 0% respectively). Mean interstitial glucose levels increased in the afternoon and at night during glucocorticoid use. Conclusion This pilot study was the first to evaluate interstitial glucose levels in non-diabetic individuals using glucocorticoids in treatment of hematologic cancer. Glucocorticoid use during chemotherapy significantly increases interstitial glucose levels in these patients.

Resumo Objetivo Avaliar o efeito de intervenção educativa online na qualidade de vida de gestantes adolescentes. Métodos Estudo quase experimental, do tipo grupo único pré e pós-teste, realizado nas Unidades Básicas de Saúde de Teresina, no período de outubro de 2017 a janeiro de 2018. Amostra de 35 gestantes adolescentes obtida por conveniência e a qualidade de vida avaliada por meio do Instrumento de Qualidade de Vida de Ferrans & Powers. Para escores de distribuição normal foi realizado o teste t e para os de distribuição não-paramétrica o teste Wilcoxon e o nível de significância adotado foi α=0,05. Resultados Após a intervenção educativa online houve melhora da qualidade de vida total (p<0,001) e nos domínios saúde/funcionamento (p<0,001), socioeconômico (p<0,001) e psicológico/espiritual (p<0,001), exceto no domínio família. Conclusão a intervenção educativa online teve efeito na qualidade de vida, permitindo que ela seja incorporada no processo de educação em saúde com gestantes adolescentes na atenção básica à saúde.

Abstract Objective To assess the effect of online educational intervention on pregnant adolescents’ quality of life. Methods This is a quasi-experimental study, of the pre- and post-test single group type, carried out in the Basic Health Units of Teresina, from October 2017 to January 2018. A sample of 35 pregnant adolescents was obtained by convenience. Quality of life was assessed using the Ferrans & Powers Quality of Life Instrument. For scores with normal distribution, Student’s t-test was performed, and for those with non-parametric distribution, the Wilcoxon test was used and the significance level adopted was α=0.05. Results After the online educational intervention, there was an improvement in the total quality of life (p<0.001) and in health/functioning (p<0.001), socioeconomic (p<0.001) and psychological/spiritual (p<0.001) domains, except in the family domain. Conclusion The online educational intervention had an effect on quality of life, allowing it to be incorporated into the health education process with pregnant adolescents in Primary Health Care.

Resumen Objetivo Evaluar el efecto de una intervención educativa online en la calidad de vida de embarazadas adolescentes. Métodos Estudio cuasi experimental, tipo grupo único antes y después de la prueba, realizado en las Unidades Básicas de Salud de Teresina, en el período de octubre de 2017 a enero de 2018. Muestra de 35 mujeres embarazadas adolescentes, obtenida por conveniencia, y calidad de vida evaluada mediante el Instrumento de Calidad de Vida de Ferrans & Powers. Para la puntuación de distribución normal se realizó el test-T y para la de distribución no paramétrica, la Prueba de Wilcoxon. El nivel de significación adoptado fue α=0,05. Resultados Luego de la intervención educativa online, hubo una mejora de la calidad de vida total (p<0,001) y de los dominios salud/funcionamiento (p<0,001), socioeconómico (p<0,001) y psicológico/espiritual (p<0,001), excepto en el dominio familia. Conclusión La intervención educativa online tuvo efecto en la calidad de vida, lo que permitió que esta se incorpore en el proceso de educación para la salud para mujeres embarazadas adolescentes en la atención básica en salud.

ABSTRACT Objective: Our aim is to establish genetic diagnosis of congenital generalized lipodystrophy (CGL) using targeted massively parallel sequencing (MPS), also known as next-generation sequencing (NGS). Subjects and methods: Nine unrelated individuals with a clinical diagnosis of CGL were recruited. We used a customized panel to capture genes related to genetic lipodystrophies. DNA libraries were generated, sequenced using the Illumina MiSeq, and bioinformatics analysis was performed. Results: An accurate genetic diagnosis was stated for all nine patients. Four had pathogenic variants in AGPAT2 and three in BSCL2. Three large homozygous deletions in AGPAT2 were identified by copy-number variant analysis. Conclusions: Although we have found allelic variants in only 2 genes related to CGL, the panel was able to identify different variants including deletions that would have been missed by Sanger sequencing. We believe that MPS is a valuable tool for the genetic diagnosis of multi-genes related diseases, including CGL.

RESUMO Este artigo tem por objetivo contribuir para a reflexão no tocante aos impactos da pandemia Covid-19 na população negra, tendo como marco disparador a necessidade premente de analisar as assimetrias que essa emergência sanitária global produz, particularmente em contextos de desigualdade social, como é o caso do Brasil, em que a população em situação de vulnerabilidade social pode ser representada majoritariamente pela população negra, em seus diferentes grupos específicos, tipificados por gênero, por restrições de acesso a educação, proteção social, moradia adequada, serviços de saneamento básico, internet, bem como por ocupação/desocupação, por espaço geográfico, por privação de liberdade, ainda que paradoxalmente, quantitativamente equivalha a maioria da população brasileira, que acumula os piores indicadores.

ABSTRACT This article aims to contribute to the reflection on the impacts of the covid-19 pandemic on the black population, having as a trigger point the urgent need to analyze the asymmetries that the global health emergency produces, particularly in contexts of social inequality, such as is the case in Brazil, where the socially vulnerable population is represented mainly by the black population, in their different specific groups, typified by gender, by restrictions on access to education, social protection, adequate housing, basic sanitation services and the internet, as well as, by occupation/unemployment, by geographic space, and by deprivation of liberty - although, paradoxically, quantitatively it comprises the majority of the Brazilian population, which accumulates the worst indicators.

RESUMO O objetivo deste estudo foi descrever comportamentos de riscos para a saúde em adolescentes e verificar as possíveis associações entre estes. Tratou-se de um estudo transversal, realizado na cidade de Teresina/PI, com 540 adolescentes de 14 a 19 anos. O instrumento utilizado para o levantamento de dados foi uma adaptação do questionário do projeto “COMPAC”. Cerca de 35% dos adolescentes relataram assistir televisão por quatro horas, apenas 22% relataram o uso do computador de uma a duas horas, enquanto 60% afirmaram usar o celular por mais de quatro horas durante a semana. O percentual de adolescentes considerados fisicamente inativos foi superior a 35%. Mais de 15% dos adolescentes consumia bebida alcóolica uma a duas vezes e 11% consumia até duas doses por semana. A quantidade de doses diárias de bebidas alcóolicas foi significativamente associada ao tempo assistindo televisão por semana (OR = 2,45; p = 0,040) e no fim de semana (OR = 2,05; p = 0,032). Foi encontrada alta prevalência de adolescentes fisicamente inativos e de tempo despendido em comportamentos sedentários. Além disso, o comportamento sedentário esteve associado ao consumo de bebidas alcoólicas, Assim, é importante repensar o uso da televisão e do uso álcool no cotidiano dos adolescentes.

Abstract The objective of this study was to describe health risk behaviors in adolescents and to verify the possible associations between them. It was a cross-sectional study conducted in Teresina / PI, with 540 adolescents aged 14 to 19 years. The instrument used for data collection was an adaptation of the “COMPAC” project questionnaire. About 35% of teens reported watching television for four hours, only 22% reported using their computer for one to two hours, while 60% reported using their cell phone for more than four hours during the week. The percentage of adolescents considered physically inactive was greater than 35%. More than 15% of adolescents consumed alcoholic beverages one to two times, and 11% consumed up to two doses per week. The amount of daily doses of alcoholic beverages was significantly associated with TV watching time per week (OR = 2.45, p = 0.040) and at the weekend (OR = 2.05, p = 0.032). It was found a high prevalence of physically inactive adolescents and time spent in sedentary behaviors. In addition, sedentary behavior was associated with alcohol consumption. Thus, it is important to rethink television and alcohol use in adolescents’ daily lives.

RESUMO Objetivo: Verificar a associação entre alfabetismo em saúde inadequado, segundo o Short Assessment of Health Literacy for Portuguese-speaking Adults , e controle glicêmico, em pacientes idosos com diabetes tipo 2, bem como avaliar tal associação no contexto de baixo suporte social, segundo o Medical Outcomes Study . Métodos: Estudo transversal conduzido no centro de referência de diabetes de um hospital universitário. Os participantes foram recrutados entre pacientes com diabetes tipo 2 com idade de 60 anos ou mais, entre maio de 2013 e novembro de 2014. O desfecho primário foi o valor mais recente de hemoglobina glicada obtido nos últimos 6 meses. Resultados: Foram avaliados 398 pacientes idosos com diabetes tipo 2. Destes, 232 não foram considerados elegíveis para participar da pesquisa. A amostra final incluiu 166 participantes. Foi realizada análise de regressão linear múltipla hierárquica com as seguintes variáveis inseridas em três blocos: características sociodemográficas, variáveis clínicas e escore de alfabetismo em saúde. Realizou-se também uma análise de regressão adicional da interação entre alfabetismo em saúde e apoio social como determinante do controle glicêmico. A média de idade dos indivíduos foi 68,0 anos (desvio-padrão de 5,9). O valor médio de hemoglobina glicada foi de 8,5% (desvio-padrão de 1,4). O Short Assessment of Health Literacy for Portuguese-speaking Adults mostrou-se independentemente associado à hemoglobina glicada (B=-0,059; p=0,043). A interação entre suporte social e escore de alfabetismo em saúde (p=0,003) foi determinante para o controle glicêmico. Conclusão: O alfabetismo em saúde está associado ao controle glicêmico. O suporte social pode modificar a relação entre o escore de alfabetismo em saúde e o controle glicêmico.

ABSTRACT Objective: To investigate the association between inadequate functional health literacy, considering the Short Assessment of Health Literacy for Portuguese-speaking Adults, and glycemic control in elderly patients with type 2 diabetes, and to examine this association in low social support settings, according to Medical Outcomes Study . Methods: Cross-sectional study conducted at the diabetes referral center of a university hospital. Participants were recruited among type 2 diabetes patients aged 60 years or older, between May 2013 and November 2014. The primary outcome was the most recent glycated hemoglobin value measured within the last 6 months. Results: A total of 398 elderly patients with type 2 diabetes were evaluated. Of these, 232 were not eligible to participate. The final sample comprised 166 participants. Hierarchical multiple linear regression was performed. The following variables were entered in three blocks: sociodemographic characteristics, clinical variables and health literacy scores. Regression analysis of the interaction between health literacy and social support as a determinant of glycemic control was also performed. Mean age of subjects was 68.0 years (standard deviation of 5.9). Mean glycated hemoglobin value was 8.5% (standard deviation of 1.4). Short assessment of health literacy for Portuguese speaking adults score was independently associated with glycated hemoglobin (B=-0.059; p=0.043). The interaction between social support and health literacy score (p=0.003) was a determinant of glycemic control. Conclusion: Health literacy is associated with glycemic control. Social support may modify the relation between health literacy and glycemic control.

ABSTRACT Objective: To analyze child development in different social groups. Method: A cross-sectional study with children under 3 years old enrolled in basic health units of a municipality in the state of São Paulo, Brazil. Child development was verified by the Ministry of Health's Development Monitoring Form. The Social Class Index was used to classify families into social groups and the predefined hierarchical theoretical model for univariate and multiple logistic regression analysis. Results: The sample consisted of 348 children, in which 29% of the children presented the absence of some developmental milestone expected for their age, while social group and age group were associated with child development in the final model. Children from the least socially inserted groups aged 12 months or older were more likely to be missing some developmental milestone. Conclusion: The proportion of children with the absence of some developmental milestones is high and associated with lower social inclusion. The importance of developmental surveillance by the primary care nursing team is emphasized in order to identify the most vulnerable groups and to implement early interventions which can minimize the negative effects which worsen with age.

RESUMEN Objetivo: Analizar el desarrollo infantil en distintos grupos sociales. Método: Estudio transversal realizado con niños menores de 3 años registrados en unidades básicas de salud de un municipio del Estado de São Paulo, Brasil. El desarrollo infantil fue verificado con la Ficha de Acompañamiento del Desarrollo, del Ministerio de Salud. Se utilizó el Índice de Reproducción Social para clasificar a las familias en grupos sociales y del modelo teórico jerárquico predefinido para análisis de regresión logística univariada y múltiple. Resultados: La muestra estuvo compuesta de 348 niños. El 29% de los niños presentaban ausencia de algún marco del desarrollo esperado para la edad. En el modelo final, grupo social y rango de edad se asociaron con el desarrollo infantil. Presentaron mayor probabilidad de ausencia de algún marco del desarrollo niños de los grupos menos incluidos socialmente y con edad mayor o igual a 12 meses. Conclusión: La proporción de niños con ausencia de algún marco del desarrollo es elevada y se asoció con la menor inserción social. Se subraya la importancia de la vigilancia del desarrollo por el equipo de Enfermería de la atención primaria para la identificación de los grupos más vulnerables y la intervención precoz que minimice los efectos negativos que se agravan con la edad.

RESUMO Objetivo: Analisar o desenvolvimento infantil em diferentes grupos sociais. Método: Estudo transversal com crianças menores de 3 anos cadastradas em unidades básicas de saúde de um município do estado de São Paulo, Brasil. O desenvolvimento infantil foi verificado com a Ficha de Acompanhamento do Desenvolvimento, do Ministério da Saúde. Utilizou-se do Índice de Reprodução Social para classificar famílias em grupos sociais e do modelo teórico hierárquico predefinido para análise de regressão logística univariada e múltipla. Resultados: A amostra foi composta por 348 crianças. 29% das crianças apresentavam ausência de algum marco do desenvolvimento esperado para a idade. No modelo final, grupo social e faixa etária associaram-se ao desenvolvimento infantil. Apresentaram maior chance de ausência de algum marco do desenvolvimento crianças dos grupos menos inseridos socialmente e com idade maior ou igual a 12 meses. Conclusão: A proporção de crianças com ausência de algum marco do desenvolvimento é elevada e associou-se à menor inserção social. Enfatiza-se a importância da vigilância do desenvolvimento pela equipe de Enfermagem da atenção primária para a identificação dos grupos mais vulneráveis e a intervenção precoce que minimize os efeitos negativos que se agravam com a idade.

Abstract INTRODUCTION: Crotalus envenomations cause serious complications and can be fatal without appropriate treatment. Venom isoforms present and inter/intraspecific variations in the venom composition can result in different symptoms presented by bites by snakes from the same species but from different geographical regions. We comparatively evaluated the local and systemic effects caused by Crotalus durissus terrificus (Cdt), C.d. collilineatus (Cdcolli), and C.d. cascavella (Cdcasc) envenomation. METHODS: Venom chromatography was performed. Proteolytic, phospholipase, and LAAO activities were analyzed. Edema, myotoxicity, hepatotoxicity, nephrotoxicity, and coagulation alterations were evaluated. RESULTS: The venom SDS-PAGE analyses found the presence of convulxin, gyroxin, crotoxin, and crotamine in Cdt and Cdcolli venoms. Crotamine was not present in the Cdcasc venom. Cdt, Cdcollli, and Cdcasc venoms had no proteolytic activity. Only Cdcasc and Cdt venoms had phospholipase activity. LAAO activity was observed in Cdcolli and Cdcasc venoms. Cdcolli and Cdcasc venoms caused 36.7% and 13.3% edema increases, respectively. Cdt venom caused a 10% edema induction compared to those by other venoms. All venoms increased TOTAL-CK, MB-CK, and LDH levels (indicating muscle injury) and ALT, AST, GGT, and ALP levels (markers of liver damage) and were able to induce a neuromuscular blockade. Urea and creatinine levels were also altered in both plasma and urine, indicating kidney damage. Only Cdcolli and Cdcasc venoms increased TAPP and TAP. CONCLUSIONS: Together, these results allow us to draw a distinction between local and systemic effects caused by Crotalus subspecies, highlighting the clinical and biochemical effects produced by their respective venoms.

RESUMO Objetivo: Analisar o desenvolvimento infantil em diferentes grupos sociais. Método: Estudo transversal com crianças menores de 3 anos cadastradas em unidades básicas de saúde de um município do estado de São Paulo, Brasil. O desenvolvimento infantil foi verificado com a Ficha de Acompanhamento do Desenvolvimento, do Ministério da Saúde. Utilizou-se do Índice de Reprodução Social para classificar famílias em grupos sociais e do modelo teórico hierárquico predefinido para análise de regressão logística univariada e múltipla. Resultados: A amostra foi composta por 348 crianças. 29% das crianças apresentavam ausência de algum marco do desenvolvimento esperado para a idade. No modelo final, grupo social e faixa etária associaram-se ao desenvolvimento infantil. Apresentaram maior chance de ausência de algum marco do desenvolvimento crianças dos grupos menos inseridos socialmente e com idade maior ou igual a 12 meses. Conclusão: A proporção de crianças com ausência de algum marco do desenvolvimento é elevada e associou-se à menor inserção social. Enfatiza-se a importância da vigilância do desenvolvimento pela equipe de Enfermagem da atenção primária para a identificação dos grupos mais vulneráveis e a intervenção precoce que minimize os efeitos negativos que se agravam com a idade.

ABSTRACT Objective: To analyze child development in different social groups. Method: A cross-sectional study with children under 3 years old enrolled in basic health units of a municipality in the state of São Paulo, Brazil. Child development was verified by the Ministry of Health's Development Monitoring Form. The Social Class Index was used to classify families into social groups and the predefined hierarchical theoretical model for univariate and multiple logistic regression analysis. Results: The sample consisted of 348 children, in which 29% of the children presented the absence of some developmental milestone expected for their age, while social group and age group were associated with child development in the final model. Children from the least socially inserted groups aged 12 months or older were more likely to be missing some developmental milestone. Conclusion: The proportion of children with the absence of some developmental milestones is high and associated with lower social inclusion. The importance of developmental surveillance by the primary care nursing team is emphasized in order to identify the most vulnerable groups and to implement early interventions which can minimize the negative effects which worsen with age.

RESUMEN Objetivo: Analizar el desarrollo infantil en distintos grupos sociales. Método: Estudio transversal realizado con niños menores de 3 años registrados en unidades básicas de salud de un municipio del Estado de São Paulo, Brasil. El desarrollo infantil fue verificado con la Ficha de Acompañamiento del Desarrollo, del Ministerio de Salud. Se utilizó el Índice de Reproducción Social para clasificar a las familias en grupos sociales y del modelo teórico jerárquico predefinido para análisis de regresión logística univariada y múltiple. Resultados: La muestra estuvo compuesta de 348 niños. El 29% de los niños presentaban ausencia de algún marco del desarrollo esperado para la edad. En el modelo final, grupo social y rango de edad se asociaron con el desarrollo infantil. Presentaron mayor probabilidad de ausencia de algún marco del desarrollo niños de los grupos menos incluidos socialmente y con edad mayor o igual a 12 meses. Conclusión: La proporción de niños con ausencia de algún marco del desarrollo es elevada y se asoció con la menor inserción social. Se subraya la importancia de la vigilancia del desarrollo por el equipo de Enfermería de la atención primaria para la identificación de los grupos más vulnerables y la intervención precoz que minimice los efectos negativos que se agravan con la edad.

BACKGROUND Fibrosis in the peripheral nerve is the end stage of leprous neuropathy and the cause of the resulting permanent neural function impairments. Preventive measures to avoid this irreversible pathological state are a relief strategy for leprosy sufferers. OBJECTIVES The present study describes the frequency of fibrosis along with its characterisation and pathogenic development. METHODS Six-hundred-and-thirteen nerve samples were sorted from 278 neural leprosy (NL) and 335 non-leprosy neuropathy patients (ON). The total number of samples was histologically examined by routine staining methods (haematoxylin-eosin, Wade staining and Gomori’s trichrome) and fibrosis was evaluated via semi-quantitative estimation. FINDINGS Fibrosis was most frequent in the NL group (33% against 0.4% in ON) while fibrosis in association with endoneurial microfasciculation was found in 38 (41.3%) of the NL samples in the examination of semithin sections. Pericytic activation in the perivascular environment was confirmed to be the source of the fibroblasts and perineurial cells delimiting microfascicles. End-stage fibrosis in leprosy displays an arrangement of microfascicles devoid of neural components (i.e., Schwann cells and axons) lined by an intermediate phenotype of fibroblastic-perineurial cells filled with bundles of collagen fibres. MAIN CONCLUSIONS The present study underscores that fibrosis is frequently the severe end stage of neural leprosy NL pathogeny after analysing the notably distinct development of fibrosis within the neural environment.