Abstract Introduction. The multifactorial etiology of gastroenteritis emphasizes the need for different laboratory methods to identify or exclude infectious agents and evaluate the severity of diarrheal disease. Objective. To diagnose the infectious etiology in diarrheic children and to evaluate some fecal markers associated with intestinal integrity. Materials and methods. The study group comprised 45 children with diarrheal disease, tested for enteropathogens and malabsorption markers, and 76 children whose feces were used for fat evaluation by the traditional and acid steatocrit tests. Results. We observed acute diarrhea in 80% of the children and persistent diarrhea in 20%. Of the diarrheic individuals analyzed, 40% were positive for enteropathogens, with rotavirus (13.3%) and Giardia duodenalis (11.1%) the most frequently diagnosed. Among the infected patients, occult blood was more evident in those carrying pathogenic bacteria (40%) and enteroviruses (40%), while steatorrhea was observed in infections by the protozoa G. duodenalis (35.7%). Children with diarrhea excreted significantly more lipids in feces than non-diarrheic children, as determined by the traditional (p<0.0003) and acid steatocrit (p<0.0001) methods. Moreover, the acid steatocrit method detected 16.7% more fecal fat than the traditional method. Conclusions. Childhood diarrhea can lead to increasingly severe nutrient deficiencies. Steatorrhea is the hallmark of malabsorption, and a stool test, such as the acid steatocrit, can be routinely used as a laboratory tool for the semi-quantitative evaluation of fat malabsorption in diarrheic children.

Resumen Introducción. La etiología multifactorial de la gastroenteritis enfatiza la necesidad de usar diferentes métodos de laboratorio para identificar o excluir agentes infecciosos y evaluar la gravedad de la enfermedad diarreica. Objetivo. Diagnosticar la etiología infecciosa de la diarrea en niños y evaluar algunos marcadores fecales asociados con la integridad intestinal. Materiales y métodos. Se estudiaron 45 niños con enfermedad diarreica, en los cuales se evaluaron la presencia de enteropatógenos y los marcadores de malabsorción. Se analizaron las muestras fecales de 76 niños, mediante las pruebas de esteatocrito tradicional y esteatocrito ácido, para la cuantificación de la grasa. Resultados. Se observó diarrea aguda en el 80 % de los niños y diarrea persistente en el 20 %. De los individuos con diarrea, el 40 % fue positivo para enteropatógenos; los más diagnosticados fueron rotavirus (13,3 %) y Giardia duodenalis (11,1 %). Entre los pacientes infectados, la sangre oculta fue más evidente en aquellos portadores de bacterias patógenas (40 %) o enterovirus (40%), mientras que la esteatorrea se observó en infecciones por el protozoo G. duodenalis (35,7 %). Los niños con diarrea excretaron significativamente más lípidos en las heces que aquellos sin diarrea, según lo determinado por los métodos de esteatocrito tradicional (p<0,0003) y esteatocrito ácido (p<0,0001). Conclusiones. La diarrea infantil puede provocar deficiencias graves de nutrientes. La esteatorrea es distintiva de la malabsorción intestinal y puede detectarse mediante la estimación del esteatocrito ácido. Esta prueba podría utilizarse de forma rutinaria como una herramienta de laboratorio para la evaluación semicuantitativa de la malabsorción de grasas en niños con diarrea.

This paper seeks to bring to the debate the philosophical interrelationships between denialism and nihilism, seeking to unveil the strategies used by the “merchants of doubt” (ORESKES and CONWAY) to influence the population not to adhere to the vaccination against Covid-19, during 2021, through the use of misinformation. In this context, we adopted the Hermeneutics of Historical Consciousness as an interpretative path (RICOEUR, 2010), which enables us to understand the narrative production of intentional disinformation and its collective and social appropriation. HHC offers us an interpretative possibility of the world of the text based on the relationship with history, the past and the experience, as entities affected by the past, which we are. ). In this sense, this paper’s structure has as it starting point a brief debate that seeks to confront Nietzschean nihilism and scientific denialism, in order to confront communication and disinformation and its current dimensions, intermediated by an interpretation of fake news about vaccines that circulated in 2021 and which have President Jair Bolsonaro as a promoter. The narratives posted here for interpretation were denounced by society through the @eufiscalizo app from Fiocruz-RJ and checked through the website https://www.nujocchecagem.com.br/.

Este artículo busca traer a debate las interrelaciones filosóficas entre negacionismo y nihilismo, buscando develar las estrategias utilizadas por los “mercaderes de la duda” (ORESKES y CONWAY) para influenciar a la población a no adherirse a la vacunación contra el Covid-19 durante 2021, através del uso de desinformación. En este contexto, adoptamos la Hermenêutica da Consciência Histórica como camino interpretativo (RICOEUR, 2010), que nos permite comprender la producción narrativa de desinformación intencional y su apropiación colectiva y social. HCH nos ofrece una posibilidad interpretativa del mundo del texto a partir de la relación con la historia, el pasado y la experiencia, como seres afectados por el pasado, que somos. En ese sentido, la estructura de este artículo tiene como punto de partida un breve debate que busca confrontar el nihilismo nietzscheano y el negacionismo científico, para confrontar la comunicación y la desinformación y sus dimensiones actuales, intermediado por una interpretación de las noticias falsas sobre vacunas que circularán en 2021.que tiene al presidente Jair Bolsonaro como promotor. Las narrativas aquí publicadas para su interpretación fueron denunciadas por la sociedad a través de la aplicativo @eufiscalizo da Fiocruz-RJ e conferidas através do site https://www.nujocchecagem.com.br/.

Este artigo busca trazer ao debate as inter-relações filosóficas entre o negacionismo e o niilismo, buscando desvendar as estratégias utilizadas pelos “mercadores da dúvida” (ORESKES e CONWAY) para influenciar a população a não aderir à vacinação contra a Covid-19, durante 2021, através do uso de desinformação. Nesse contexto, adotamos a Hermenêutica da Consciência Histórica como caminho interpretativo (RICOEUR, 2010), que nos permite compreender a produção narrativa da desinformação intencional e sua apropriação coletiva e social. HCH oferece-nos uma possibilidade interpretativa do mundo do texto a partir da relação com a história, o passado e a experiência, como seres afetados pelo passado, que somos. Nesse sentido, a estrutura deste artigo tem como ponto de partida um breve debate que busca confrontar o niilismo nietzschiano e o negacionismo científico, para confrontar a comunicação e a desinformação e suas dimensões atuais, intermediados por uma interpretação das notícias falsas sobre vacinas que circularam em 2021 e que têm o presidente Jair Bolsonaro como promotor. As narrativas aqui postadas para interpretação foram denunciadas pela sociedade através do aplicativo @eufiscalizo da Fiocruz-RJ e conferidas através do site https://www.nujocchecagem.com.br/.

Resumo Objetivo: Realizar uma análise descritiva dos gastos privados diretos domiciliares em saúde e da vulnerabilidade socioeconômica associados à condição de microcefalia, uma das manifestações mais evidentes da síndrome congênita do Zika vírus (SCZ). O surto de microcefalia e outros distúrbios neurológicos em crianças menores de um ano de idade foi associado à infecção pelo vírus Zika, durante a epidemia ocorrida no período de 2015-2016 no Brasil. Método: Noventa e seis entrevistas foram realizadas em dois centros especializados de atendimento às crianças acometidas por microcefalia nas cidades do Rio de Janeiro e Fortaleza. O questionário estruturado abrangeu características sociodemográficas, gastos com desembolso direto associados com a doença e estratégias adotadas pelas famílias para lidarem com os desafios financeiros impostos pela anomalia congênita. Resultados: Os domicílios eram majoritariamente chefiados por não-brancos e pertenciam às classes C e D-E. Os gastos com medicamentos contabilizaram 78% dos gastos médicos, enquanto as despesas com transporte representaram 46% do gasto privado não-médico. A maioria dos domicílios enfrentaram endividamento e redução do consumo doméstico, inclusive de alimentos, a fim de fazer face às despesas incorridas pela doença. Conclusão: A microcefalia parece reforçar a vulnerabilidade socioeconômica das famílias, reforçando o círculo vicioso característico da abordagem conceitual da armadilha saúde-pobreza.

Abstract Objective: To carry out a descriptive analysis of direct private household health expenditures and socioeconomic vulnerability associated with the condition of Microcephaly, one of the most evidence manifestations of Congenital Zika Syndrome (CZS). The outbreak of microcephaly and other neurological disorders in children under one year of age was linked to Zika virus infection during the 2015-2016 epidemic in Brazil. Method: Ninety-six interviews were carried out in two specialized care centers for children with microcephaly in the cities of Rio de Janeiro and Fortaleza, Brazil. The structured questionnaire covered sociodemographic characteristics, out-of-pocket expenditures associated with the disease, and strategies adopted by families to deal with the financial challenges imposed by the congenital anomaly. Results: The households were mostly headed by non-whites and belonged to classes C and D-E. Expenditures on medicines accounted for 78% of medical expenses, while transportation represented 46% of private non-medical expenses. Most households faced debt and reduced domestic consumption, including food, to meet the expenses incurred by the disease. Conclusion: Microcephaly appears to reinforce the socioeconomic vulnerability of families, reinforcing the vicious circle characteristic of the health-poverty trap conceptual approach.

ABSTRACT Objective: To analyze how the journalistic media has described the issues of quality of life (QoL), physical activity (PA) and mental health (MH) of adolescents during the COVID-19 pandemic. Methods: This is a descriptive and qualitative study that used content analysis. Sixty-two journalistic publications were analyzed from a total of 8211 published by the most read newspapers in each Brazilian region between December 2019 and August 2021. Results: The results were grouped and evaluated in three categories: QoL (n=11), PA (n =9) and MH (n=42). In the analyzed period, the adolescents had more time of exposure to screens, contributing to an inadequate diet, a decrease in PA and impairments in QoL. According to the media publications, the pandemic has also contributed to an increase in anxiety, depression, loneliness and fear resulting from the mental and emotional disorganization caused by the abrupt change in routine. Social vulnerability was presented as an aggravating factor in this context. The journalistic media did not pay the necessary attention to adolescents regarding the negative consequences of the pandemic on QoL, PA and MH. Conclusions: The analyzed reports showed that the pandemic caused a decrease in social interaction, feelings of uncertainty, fear and the appearance/exacerbation of symptoms of anxiety, stress and depression. Social vulnerability was presented as another obstacle to be faced in this problem. Objective , (QoL) (PA (MH COVID19 COVID 19 COVID-1 Methods analysis Sixtytwo Sixty two 821 201 2021 Results categories n=11, n11 n n=11 11 (n=11) =9 9 n=42. n42 n=42 . 42 (n=42) period screens diet anxiety depression routine context Conclusions interaction uncertainty appearanceexacerbation appearance exacerbation problem (QoL COVID1 1 COVID- 82 20 202 n1 n=1 (n=11 = n4 n=4 4 (n=42 8 2 n= (n=1 (n=4 (n=

RESUMO Objetivo: Analisar como a mídia jornalística tem descrito as questões de qualidade de vida (QV), atividade física (AF) e saúde mental (SM) de adolescentes durante a pandemia da COVID-19. Métodos: Trata-se de um estudo descritivo e qualitativo que utilizou a análise de conteúdo. Foram analisadas 62 publicações jornalísticas do total de 8.211 veiculadas pelos jornais mais lidos de cada região brasileira entre dezembro de 2019 e agosto de 2021. Resultados: Os resultados foram agrupados e avaliados em três categorias: QV (n=11), AF (n=9) e SM (n=42). No período analisado as publicações jornalísticas sugerem que os adolescentes apresentaram maior tempo de exposição a telas, contribuindo para uma alimentação inadequada, diminuição da AF e prejuízos na QV. A pandemia também contribuiu com aumento da ansiedade, depressão, solidão e medo resultantes da desorganização mental e emocional causada pela mudança abrupta de rotina. A vulnerabilidade social apresentou-se como um fator agravante nesse contexto. As mídias jornalísticas não deram a atenção necessária aos adolescentes no que se refere às consequências negativas da pandemia na QV, AF e SM. Conclusões: As reportagens analisadas mostraram que a pandemia causou diminuição na interação social, sentimentos de incerteza, medo e o aparecimento/exacerbação de sintomas de ansiedade, estresse e depressão. A vulnerabilidade social apresentou-se como mais um obstáculo a ser enfrentado nesta problemática. Objetivo , (QV) (AF (SM COVID19. COVID19 COVID 19. 19 COVID-19 Métodos Tratase Trata conteúdo 6 8211 8 211 8.21 201 2021 Resultados categorias n=11, n11 n n=11 11 (n=11) n=9 n9 9 (n=9 n=42. n42 n=42 . 42 (n=42) telas inadequada ansiedade depressão rotina apresentouse apresentou contexto Conclusões incerteza aparecimentoexacerbação aparecimento exacerbação problemática (QV COVID1 1 COVID-1 821 21 8.2 20 202 n1 n=1 (n=11 n= (n= n4 n=4 4 (n=42 COVID- 82 2 8. (n=1 (n (n=4

Abstract This systematic review aimed to answer the focused question: “What are the benefits of subgingival periodontal therapy on blood hematological and biochemical index, biomarkers of inflammation and oxidative stress, quality of life, and periodontal pathogen counts in patients with obesity and periodontitis?”. A systematic literature search was performed in six databases: PubMed, Embase, LILACS, Web of Science, Cochrane and SCOPUS and other sources, and a manual search was conducted as well. Inclusion criteria were randomized and non-randomized clinical trials, and before-and-after studies on patients with obesity subjected to periodontal therapy. The results were synthesized qualitatively. Risk of bias within studies was assessed using RoB 2 and ROBINS-I tools. The certainty of evidence was evaluated following the GRADE approach. Three randomized controlled trials and 15 before-and-after studies were included. Randomized controlled trials were considered to have a low risk of bias, as compared to before-and-after studies assessed as having low, serious, and critical risks of bias. Non-surgical periodontal therapy plus azithromycin, chlorhexidine, and cetylpyridinium chloride reduced blood pressure and decreased serum levels of HbA1c, hsCRP, IL-1β, and TNF-α. Salivary resistin level also decreased in patients with obesity and periodontitis after therapy and chlorhexidine mouth rinse. Before-and-after data suggest an improvement in total cholesterol, LDL, triglycerides, insulin resistance, C3, GCF levels of TNF-α, chemerin, vaspin, omentin-1, visfatin, 8-OHdG, and periodontal pathogen counts after therapy. question What index stress life periodontitis. . periodontitis?” databases PubMed Embase LILACS Science sources well nonrandomized non beforeandafter before qualitatively ROBINSI ROBINS I tools approach 1 included serious Nonsurgical Non surgical azithromycin HbA1c HbAc HbA c hsCRP IL1β, IL1β ILβ IL 1β, 1β β IL-1β TNFα. TNFα TNF α. α TNF-α rinse Beforeandafter Before cholesterol LDL triglycerides resistance C3 C TNFα, α, chemerin vaspin omentin1, omentin1 omentin 1, omentin-1 visfatin 8OHdG, 8OHdG OHdG 8 OHdG, 8-OHdG periodontitis? omentin-

Abstract Difficult airway management in pediatrics during anesthesia represents a major challenge, requiring a careful approach, advanced technical expertise, and accurate protocols. The task force of the Brazilian Society of Anesthesiology (SBA) presents a report containing updated recommendations for the management of difficult airways in children and neonates. These recommendations have been developed based on the consensus of a panel of experts, with the objective of offering strategies to overcome challenges during airway management in pediatric patients. Grounded in evidence published in international guidelines and expert opinions, the report highlights crucial steps for the appropriate management of difficult airways in pediatrics, encompassing assessment, preparation, positioning, pre-oxygenation, minimizing trauma, and, paramountly, the maintenance of arterial oxygenation. The report also delves into additional strategies involving the use of advanced tools, such as video laryngoscopy, flexible intubating bronchoscopy, and supraglottic devices. Emphasis is placed on the simplicity of implementing the outlined recommendations, with a focus on the significance of continuous education, training through realistic simulations, and familiarity with the latest available technologies. These practices are deemed essential to ensure procedural safety and contribute to the enhancement of anesthesia outcomes in pediatrics. challenge approach expertise protocols SBA (SBA neonates experts patients opinions assessment preparation positioning preoxygenation, preoxygenation pre oxygenation, oxygenation pre-oxygenation trauma paramountly tools laryngoscopy bronchoscopy devices education simulations technologies

ABSTRACT. Brazil has high soil loss rates due to its tropical and subtropical climate characteristics. In this sense, soil use and management practices may minimize such losses. In this study, experimental plots were monitored for eight years in southern Brazil during natural rainfall events. Treatments were as follows: I) bare soil under conventional tillage, II) barley-oat/ soybeans succession under conventional tillage, III) oat-lupine-vetch/ maize succession under conventional tillage, IV) barley-oat/ soybeans succession under no-tillage, and V) oat-lupine-vetch/ maize succession under no-tillage. Data on rainfall amount and erosivity indices (EI30, EI20, and EI10) were subjected to regression analyses, evaluating the effects of climatic variables on soil and water losses. We could also analyze crop species, conventional and no-tillage systems, and winter and summer seasons. The highest soil and water losses occurred in treatments under conventional tillage. In addition, soybeans treatments increased soil and water losses. Maize under no-tillage was the most efficient practice, as it had soil losses (3.4 times) and water losses (1.5 times) lower than soybeans under conventional tillage. Rainfall amounts and EI30 were better correlated with soil and water losses in conventional tillage treatments. However, EI10 could better explain the soil losses from the conservationist treatment. ABSTRACT characteristics sense study events follows I II barleyoat/ barleyoat barley oat/ oat barley-oat III oatlupinevetch/ oatlupinevetch lupine vetch/ vetch oat-lupine-vetch IV notillage, notillage no V notillage. EI30, EI (EI30 EI20 analyses species systems seasons addition practice 3.4 34 3 4 (3. times 1.5 15 1 5 (1. EI3 However EI1 treatment (EI3 EI2 3. (3 1. (1 (EI (

Abstract A male of Pteronura brasiliensis (Carnivora: Mustelidae) was found dead on the banks of the Rio Negro, in the Pantanal wetlands of Mato Grosso do Sul state, Aquidauana municipality. Two ticks found attached to its skin were morphologically identified as a second-instar nymph of Ornithodoros rostratus (Argasidae) and a male of Amblyomma sculptum (Ixodidae). In order to complement the morphological identification, these tick specimens were subjected to DNA extraction, and tested using PCR assays to confirm the molecular identity the specimens. Also, the tick DNA samples were tested and were negative in the PCR assays for all the pathogens tested. We also examined 30 batches, consisting of 174 individuals of O. rostratus deposited in the Acari Collection of the Butantan Institute, and we found material from four Brazilian states, including one batch containing 2 males and 2 females from Aquidauana, of Mato Grosso do Sul state, collected from the soil. This was therefore the first record of O. rostratus parasitizing P. brasiliensis and the first locality record (Aquidauana). Likewise, A. sculptum is commonly found in the Pantanal and is reported here for the second time parasitizing the giant otter, which is a host little studied regarding the ectoparasites. Carnivora (Carnivora Mustelidae Negro state municipality secondinstar instar Argasidae (Argasidae Ixodidae. Ixodidae . (Ixodidae) identification extraction Also 3 batches 17 O Institute states soil P Aquidauana. (Aquidauana) Likewise otter ectoparasites (Ixodidae 1 (Aquidauana

Resumo Um macho de Pteronura brasiliensis (Carnivora: Mustelidae) foi encontrado morto às margens do Rio Negro, no Pantanal do estado de Mato Grosso do Sul, município de Aquidauana. Dois carrapatos encontrados aderidos à sua pele foram identificados, morfologicamente, como uma ninfa de segundo ínstar de Ornithodoros rostratus (Argasidae) e um macho de Amblyomma sculptum (Ixodidae). Para complementar a identificação morfológica, esses espécimes de carrapatos foram submetidos à extração de DNA e testados por meio de ensaios de PCR, para confirmar a identidade molecular dos espécimes. Além disso, os extraídos dos carrapatos foram testados e revelaram-se negativos nos ensaios de PCR para todos os patógenos testados. Também foram examinados 30 lotes, compostos por 174 indivíduos de O. rostratus, depositados na Coleção Acari do Instituto Butantan, e encontramos material de quatro estados brasileiros, incluindo-se um lote contendo 2 machos e 2 fêmeas de Aquidauana, estado de Mato Grosso do Sul (MS), coletado do solo. Este foi, portanto, o primeiro registro de O. rostratus parasitando P. brasiliensis e o primeiro registro de localidade (Aquidauana). Da mesma forma, A. sculptum é comumente encontrado no Pantanal e relatado aqui, pela segunda vez, parasitando a ariranha, hospedeiro pouco estudado em relação a ectoparasitas. Carnivora (Carnivora Mustelidae Negro Aquidauana identificados morfologicamente Argasidae (Argasidae Ixodidae. Ixodidae . (Ixodidae) morfológica disso revelaramse revelaram se 3 lotes 17 O Butantan brasileiros incluindose incluindo MS, MS , (MS) solo portanto P (Aquidauana) forma A aqui vez ariranha ectoparasitas (Ixodidae 1 (MS (Aquidauana

Resumen: Este estudio realizó una revisión sistemática en la literatura sobre la asociación de listas de medicamentos potencialmente inapropiados (MPI) en la práctica clínica y los resultados de salud en la población de edad avanzada monitoreada en atención primaria de salud. Para ello, se utilizó el protocolo PRISMA para sistematizar la búsqueda de artículos en las bases de datos PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO y LILACS, además de la literatura gris. Se seleccionaron estudios con ensayos clínicos aleatorizados, incluyendo el uso de criterios explícitos (listas) para identificar y manejar MPI en prescripciones para adultos mayores atendidos en atención primaria. De los 2.400 artículos encontrados, seis se utilizaron para la recolección de datos. Las intervenciones tuvieron una significativa disminución en la cantidad de MPI y eventos adversos de medicamentos y, en consecuencia, en prescripciones potencialmente inapropiadas en adultos mayores polimedicados. Sin embargo, no hubo efectos significativos de las intervenciones en los resultados clínicos negativos (como consultas a servicios de urgencias, hospitalizaciones o muerte) o mejora en las condiciones de salud de los adultos mayores. El uso de listas de MPI puede promover una adecuada prescripción de medicamentos a los adultos mayores en la atención primaria de salud, si bien se necesitan más estudios para determinar los impactos de la reducción de MPI en los resultados clínicos primarios. Resumen (MPI ello PubMed Science Scopus Central LILACS gris aleatorizados (listas 2400 2 400 2.40 encontrados consecuencia polimedicados embargo como urgencias muerte primarios 240 40 2.4 24 4 2.

Abstract: This study is a systematic literature review of the association between lists of potentially inappropriate medications (PIM) in clinical practice and health outcomes of older adults followed up in primary health care. For this purpose, the PRISMA protocol was used to systematize the search for articles in the PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO and LILACS databases, in addition to the gray literature. Studies with randomized clinical trials were selected, using explicit criteria (lists) for the identification and management of PIM in prescriptions of older patients in primary care. Of the 2,400 articles found, six were used for data extraction. The interventions resulted in significant reductions in the number of PIM and adverse drug events and, consequently, in potentially inappropriate prescriptions (PIP) in polymedicated older adults. However, there were no significant effects of the interventions on negative clinical outcomes, such as emergency room visits, hospitalizations and death, or on improving the health status of the older adults. The use of PIM lists promotes adequate medication prescriptions for older adults in primary health care, but further studies are needed to determine the impact of reducing PIM on primary clinical outcomes. Abstract (PIM care purpose PubMed Science Scopus Central databases selected (lists 2400 2 400 2,40 found extraction consequently PIP (PIP However visits death 240 40 2,4 24 4 2,

Resumo: Este estudo revisou sistematicamente a literatura sobre a associação de listas de medicamentos potencialmente inapropriados (MPI) na prática clínica e desfechos de saúde na população idosa acompanhada na atenção primária à saúde. Para tanto, o protocolo PRISMA foi usado para sistematizar a busca de artigos nas bases de dados PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO e LILACS, além da literatura cinzenta. Foram selecionados estudos com ensaios clínicos randomizados, incluindo a utilização de critérios explícitos (listas) para identificar e manejar MPI em prescrições para idosos atendidos na atenção primária. Dos 2.400 artigos encontrados, seis foram utilizados para extração de dados. As intervenções reduziram significativamente o número de MPI e eventos adversos a medicamentos e, consequentemente, nas prescrições potencialmente inadequadas em idosos polimedicados. No entanto, não houve efeitos significativos das intervenções sobre desfechos clínicos negativos (como visitas a serviços de emergência, hospitalizações e óbito) ou melhora das condições de saúde dos idosos. O uso de listas de MPI pode promover a adequação da prescrição de medicamentos para idosos na atenção primária à saúde, mas mais estudos são necessários para determinar os impactos da redução de MPI em desfechos clínicos primários. Resumo (MPI tanto PubMed Science Scopus Central LILACS cinzenta randomizados (listas 2400 2 400 2.40 encontrados consequentemente polimedicados entanto como emergência óbito primários 240 40 2.4 24 4 2.

Resumo: Este estudo revisou sistematicamente a literatura sobre a associação de listas de medicamentos potencialmente inapropriados (MPI) na prática clínica e desfechos de saúde na população idosa acompanhada na atenção primária à saúde. Para tanto, o protocolo PRISMA foi usado para sistematizar a busca de artigos nas bases de dados PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO e LILACS, além da literatura cinzenta. Foram selecionados estudos com ensaios clínicos randomizados, incluindo a utilização de critérios explícitos (listas) para identificar e manejar MPI em prescrições para idosos atendidos na atenção primária. Dos 2.400 artigos encontrados, seis foram utilizados para extração de dados. As intervenções reduziram significativamente o número de MPI e eventos adversos a medicamentos e, consequentemente, nas prescrições potencialmente inadequadas em idosos polimedicados. No entanto, não houve efeitos significativos das intervenções sobre desfechos clínicos negativos (como visitas a serviços de emergência, hospitalizações e óbito) ou melhora das condições de saúde dos idosos. O uso de listas de MPI pode promover a adequação da prescrição de medicamentos para idosos na atenção primária à saúde, mas mais estudos são necessários para determinar os impactos da redução de MPI em desfechos clínicos primários.

Abstract: This study is a systematic literature review of the association between lists of potentially inappropriate medications (PIM) in clinical practice and health outcomes of older adults followed up in primary health care. For this purpose, the PRISMA protocol was used to systematize the search for articles in the PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO and LILACS databases, in addition to the gray literature. Studies with randomized clinical trials were selected, using explicit criteria (lists) for the identification and management of PIM in prescriptions of older patients in primary care. Of the 2,400 articles found, six were used for data extraction. The interventions resulted in significant reductions in the number of PIM and adverse drug events and, consequently, in potentially inappropriate prescriptions (PIP) in polymedicated older adults. However, there were no significant effects of the interventions on negative clinical outcomes, such as emergency room visits, hospitalizations and death, or on improving the health status of the older adults. The use of PIM lists promotes adequate medication prescriptions for older adults in primary health care, but further studies are needed to determine the impact of reducing PIM on primary clinical outcomes.

Resumen: Este estudio realizó una revisión sistemática en la literatura sobre la asociación de listas de medicamentos potencialmente inapropiados (MPI) en la práctica clínica y los resultados de salud en la población de edad avanzada monitoreada en atención primaria de salud. Para ello, se utilizó el protocolo PRISMA para sistematizar la búsqueda de artículos en las bases de datos PubMed, Web of Science, Scopus, Cochrane Central, LIVIVO y LILACS, además de la literatura gris. Se seleccionaron estudios con ensayos clínicos aleatorizados, incluyendo el uso de criterios explícitos (listas) para identificar y manejar MPI en prescripciones para adultos mayores atendidos en atención primaria. De los 2.400 artículos encontrados, seis se utilizaron para la recolección de datos. Las intervenciones tuvieron una significativa disminución en la cantidad de MPI y eventos adversos de medicamentos y, en consecuencia, en prescripciones potencialmente inapropiadas en adultos mayores polimedicados. Sin embargo, no hubo efectos significativos de las intervenciones en los resultados clínicos negativos (como consultas a servicios de urgencias, hospitalizaciones o muerte) o mejora en las condiciones de salud de los adultos mayores. El uso de listas de MPI puede promover una adecuada prescripción de medicamentos a los adultos mayores en la atención primaria de salud, si bien se necesitan más estudios para determinar los impactos de la reducción de MPI en los resultados clínicos primarios.

Abstract This cross-sectional study evaluated the association between salivary immunoglobulins, plaque index, and gingival index in Brazilian children with and without type 1 diabetes mellitus (DM1). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for the reporting of observational studies was followed. The DM1 group had 38 children, and an equal number of volunteers matched by sex and age were recruited as controls. Clinical examination was performed for plaque index and gingival index determination. Non-stimulated whole saliva was collected. Concentrations of IgA, IgG, and IgM were determined by ELISA test. Data were tested by the Kolmogorov-Smirnov, Mann-Whitney, and Spearman tests and a multiple linear regression model (p<0.05) was performed. Gingival index was higher in the Control (DM1: 0.16±0.17; Control: 0.24±0.23, p=0.040). In DM1, there was a correlation between IgA and age (rho=0.371, p=0.024), IgM and IgG (rho=0.459, p=0.007), and IgM and gingival index (rho=0.394, p=0.014). In DM1, multiple linear regression showed that age (p=0.041; β=0.363), gingival index (p=0.041; β=0.398), and plaque index (p=0.008; β=-0.506) were good predictors of IgA levels in saliva. Thus, IgA was the only researched immunoglobulin that was directly associated with plaque and gingival indices in Brazilian children with DM1, but not in control subjects. crosssectional cross sectional immunoglobulins DM1. DM . (DM1) STROBE (STROBE followed 3 controls determination Nonstimulated Non stimulated collected test KolmogorovSmirnov, KolmogorovSmirnov Kolmogorov Smirnov, Smirnov Kolmogorov-Smirnov MannWhitney, MannWhitney Mann Whitney, Whitney Mann-Whitney p<0.05 p005 p 0 05 (p<0.05 (DM1 0.16±0.17 016017 16 17 024023 24 23 0.24±0.23 p=0.040. p0040 p=0.040 040 p=0.040) rho=0.371, rho0371 rho 371 (rho=0.371 p=0.024, p0024 p=0.024 , 024 p=0.024) rho=0.459, rho0459 459 (rho=0.459 p=0.007, p0007 p=0.007 007 p=0.007) rho=0.394, rho0394 394 (rho=0.394 p=0.014. p0014 p=0.014 014 p=0.014) p=0.041 p0041 041 (p=0.041 β=0.363, β0363 β β=0.363 363 β=0.363) β=0.398, β0398 β=0.398 398 β=0.398) p=0.008 p0008 008 (p=0.008 β=0.506 β0506 β= 0.506 506 β=-0.506 Thus subjects p<0.0 p00 (p<0.0 (DM 0.16±0.1 01601 02402 2 0.24±0.2 p004 p=0.04 04 rho=0.371 rho037 37 (rho=0.37 p002 p=0.02 02 rho=0.459 rho045 45 (rho=0.45 p000 p=0.00 00 rho=0.394 rho039 39 (rho=0.39 p001 p=0.01 01 (p=0.04 β036 β=0.36 36 β039 β=0.39 (p=0.00 β=0.50 β050 0506 0.50 50 β=-0.50 p<0. p0 (p<0. 0.16±0. 0160 0240 0.24±0. p=0.0 rho=0.37 rho03 (rho=0.3 rho=0.45 rho04 4 (rho=0.4 rho=0.39 (p=0.0 β03 β=0.3 β=0.5 β05 050 0.5 5 β=-0.5 p<0 (p<0 0.16±0 016 0.24±0 p=0. rho=0.3 rho0 (rho=0. rho=0.4 (p=0. β0 β=0. 0. β=-0. p< (p< 0.16± 0.24± p=0 rho=0. (rho=0 (p=0 β=0 β=-0 (p 0.16 0.24 p= rho=0 (rho= (p= β=- 0.1 0.2 rho= (rho

ABSTRACT This study aimed to identify factors associated with colonization by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in adult patients admitted to a Brazilian hospital. This is a cross-sectional study, in which patients underwent a nasal swab and were asked about hygiene behavior, habits, and clinical history. Among the 702 patients, 180 (25.6%) had S. aureus and 21 (2.9%) MRSA. The factors associated with MRSA colonization were attending a gym (OR 4.71; 95% CI; 1.42 – 15.06), smoking habit in the last year (OR 2.37; 95% CI; 0.88 – 6.38), previous hospitalization (OR 2.18; CI 95%; 0.89 – 5.25), and shared personal hygiene items (OR 1.99; 95% CI; 0.71 – 5.55). At the time of admission, colonization by CA-MRSA isolates was higher than that found in the general population. This can be an important public health problem, already endemic in hospitals, whose factors such as those associated with habits (smoking cigarettes) and behaviors (team sports practice and activities in gyms) have been strongly highlighted. These findings may help developing infection control policies, allowing targeting patients on higher-risk populations for MRSA colonization. communityassociated community methicillinresistant methicillin resistant CAMRSA CA (CA-MRSA hospital crosssectional cross sectional behavior history 70 18 25.6% 256 25 6 (25.6% S 2 2.9% 29 9 (2.9% OR 4.71 471 4 71 95 142 1 42 1.4 15.06, 1506 15.06 , 15 06 15.06) 2.37 237 37 088 0 88 0.8 6.38, 638 6.38 38 6.38) 2.18 218 089 89 5.25, 525 5.25 5 5.25) 1.99 199 99 071 0.7 5.55. 555 5.55 . 55 5.55) admission population problem hospitals cigarettes team gyms highlighted policies higherrisk risk 7 25.6 (25.6 2.9 (2.9 4.7 47 14 1. 150 15.0 2.3 23 3 08 8 0. 63 6.3 2.1 52 5.2 1.9 19 07 5.5 25. (25. 2. (2. 4. 15. 6. 5. (25 (2 (

Abstract Objective: To carry out a descriptive analysis of direct private household health expenditures and socioeconomic vulnerability associated with the condition of Microcephaly, one of the most evidence manifestations of Congenital Zika Syndrome (CZS). The outbreak of microcephaly and other neurological disorders in children under one year of age was linked to Zika virus infection during the 2015-2016 epidemic in Brazil. Method: Ninety-six interviews were carried out in two specialized care centers for children with microcephaly in the cities of Rio de Janeiro and Fortaleza, Brazil. The structured questionnaire covered sociodemographic characteristics, out-of-pocket expenditures associated with the disease, and strategies adopted by families to deal with the financial challenges imposed by the congenital anomaly. Results: The households were mostly headed by non-whites and belonged to classes C and D-E. Expenditures on medicines accounted for 78% of medical expenses, while transportation represented 46% of private non-medical expenses. Most households faced debt and reduced domestic consumption, including food, to meet the expenses incurred by the disease. Conclusion: Microcephaly appears to reinforce the socioeconomic vulnerability of families, reinforcing the vicious circle characteristic of the health-poverty trap conceptual approach.

Resumo Objetivo: Realizar uma análise descritiva dos gastos privados diretos domiciliares em saúde e da vulnerabilidade socioeconômica associados à condição de microcefalia, uma das manifestações mais evidentes da síndrome congênita do Zika vírus (SCZ). O surto de microcefalia e outros distúrbios neurológicos em crianças menores de um ano de idade foi associado à infecção pelo vírus Zika, durante a epidemia ocorrida no período de 2015-2016 no Brasil. Método: Noventa e seis entrevistas foram realizadas em dois centros especializados de atendimento às crianças acometidas por microcefalia nas cidades do Rio de Janeiro e Fortaleza. O questionário estruturado abrangeu características sociodemográficas, gastos com desembolso direto associados com a doença e estratégias adotadas pelas famílias para lidarem com os desafios financeiros impostos pela anomalia congênita. Resultados: Os domicílios eram majoritariamente chefiados por não-brancos e pertenciam às classes C e D-E. Os gastos com medicamentos contabilizaram 78% dos gastos médicos, enquanto as despesas com transporte representaram 46% do gasto privado não-médico. A maioria dos domicílios enfrentaram endividamento e redução do consumo doméstico, inclusive de alimentos, a fim de fazer face às despesas incorridas pela doença. Conclusão: A microcefalia parece reforçar a vulnerabilidade socioeconômica das famílias, reforçando o círculo vicioso característico da abordagem conceitual da armadilha saúde-pobreza.

Resumo Objetivo: Realizar uma análise descritiva dos gastos privados diretos domiciliares em saúde e da vulnerabilidade socioeconômica associados à condição de microcefalia, uma das manifestações mais evidentes da síndrome congênita do Zika vírus (SCZ). O surto de microcefalia e outros distúrbios neurológicos em crianças menores de um ano de idade foi associado à infecção pelo vírus Zika, durante a epidemia ocorrida no período de 2015-2016 no Brasil. Método: Noventa e seis entrevistas foram realizadas em dois centros especializados de atendimento às crianças acometidas por microcefalia nas cidades do Rio de Janeiro e Fortaleza. O questionário estruturado abrangeu características sociodemográficas, gastos com desembolso direto associados com a doença e estratégias adotadas pelas famílias para lidarem com os desafios financeiros impostos pela anomalia congênita. Resultados: Os domicílios eram majoritariamente chefiados por não-brancos e pertenciam às classes C e D-E. Os gastos com medicamentos contabilizaram 78% dos gastos médicos, enquanto as despesas com transporte representaram 46% do gasto privado não-médico. A maioria dos domicílios enfrentaram endividamento e redução do consumo doméstico, inclusive de alimentos, a fim de fazer face às despesas incorridas pela doença. Conclusão: A microcefalia parece reforçar a vulnerabilidade socioeconômica das famílias, reforçando o círculo vicioso característico da abordagem conceitual da armadilha saúde-pobreza. Objetivo SCZ. SCZ . (SCZ) 20152016 2015 2016 2015-201 Brasil Método Fortaleza sociodemográficas Resultados nãobrancos não brancos DE. DE D E. E D-E 78 médicos 46 nãomédico. nãomédico médico. médico não-médico doméstico alimentos Conclusão saúdepobreza. saúdepobreza pobreza. pobreza saúde-pobreza (SCZ 2015201 201 2015-20 7 4 201520 20 2015-2 20152 2 2015-

Abstract Objective: To carry out a descriptive analysis of direct private household health expenditures and socioeconomic vulnerability associated with the condition of Microcephaly, one of the most evidence manifestations of Congenital Zika Syndrome (CZS). The outbreak of microcephaly and other neurological disorders in children under one year of age was linked to Zika virus infection during the 2015-2016 epidemic in Brazil. Method: Ninety-six interviews were carried out in two specialized care centers for children with microcephaly in the cities of Rio de Janeiro and Fortaleza, Brazil. The structured questionnaire covered sociodemographic characteristics, out-of-pocket expenditures associated with the disease, and strategies adopted by families to deal with the financial challenges imposed by the congenital anomaly. Results: The households were mostly headed by non-whites and belonged to classes C and D-E. Expenditures on medicines accounted for 78% of medical expenses, while transportation represented 46% of private non-medical expenses. Most households faced debt and reduced domestic consumption, including food, to meet the expenses incurred by the disease. Conclusion: Microcephaly appears to reinforce the socioeconomic vulnerability of families, reinforcing the vicious circle characteristic of the health-poverty trap conceptual approach. Objective CZS. CZS . (CZS) 20152016 2015 2016 2015-201 Brazil Method Ninetysix Ninety six Fortaleza characteristics outofpocket pocket disease anomaly Results nonwhites non whites DE. DE D E. E D-E 78 46 nonmedical consumption food Conclusion healthpoverty poverty approach (CZS 2015201 201 2015-20 7 4 201520 20 2015-2 20152 2 2015-