ABSTRACT Purpose: to implement and assess hearing health interventions for school students, using Dangerous Decibels® Program activities in partnership with the Young Doctor Project, approaching noise-induced hearing loss prevention. Methods: the study encompassed 41 students, aged 12 to 14 years, from two schools in inland São Paulo and a social institution for public school students. Activities were based on the Young Doctor Project and the Dangerous Decibels® Brazil Program. The students answered a questionnaire administered in three situations: before the intervention (pre), right after the intervention (post), and 4 months after the intervention. The ANOVA, Friedman (p < 0.001), and Tukey´s (p < 0.05) statistical tests were used. Results: the 41 students who participated in the program were protagonists of knowledge, spreading the content they learned to another 954 students in the three schools through cultural workshops. The analysis of program effectiveness revealed improved results right after the intervention and 4 months afterward. Conclusion: combining these two programs encouraged the protagonism of young people to increase their involvement with the community. Moreover, the students changed their attitude toward potentially dangerous sounds.

RESUMO Objetivo: implementar e avaliar intervenções em saúde auditiva para escolares, utilizando as atividades do Programa Dangerous Decibels ®, em parceria com o Projeto Jovem Doutor, abordando aspectos preventivos da perda auditiva induzida por níveis de pressão sonora elevados. Métodos: participaram do estudo 41 escolares, com idade entre 12 e 14 anos, de duas escolas no interior de São Paulo e uma Instituição Social direcionada a estudantes de escolas públicas. As atividades foram baseadas no Projeto Jovem Doutor e no programa Dangerous Decibels ® Brasil. Os escolares responderam a um questionário aplicado em três situações, antes da intervenção (pré), logo após a intervenção (pós) e quatro meses após a intervenção. Foram utilizados os testes estatísticos ANOVA, FRIEDMAN; p<0,001 e TUKEY; p<0,05. Resultados: os 41 escolares que participaram do programa atuaram como protagonistas do conhecimento, multiplicando o conteúdo aprendido através das oficinas culturais, envolvendo 954 escolares das três escolas. Ao analisar a eficácia do programa, observou-se melhora nos resultados logo após a intervenção e, também, após 4 meses. Conclusão: a união desses dois programas incentivou o protagonismo juvenil, objetivando o maior envolvimento dos estudantes junto da comunidade. Foi possível observar a mudança de atitude dos escolares frente aos sons potencialmente perigosos.

Patients and the general public are under insurmountable psychological pressure which may lead to various psychological problems, such as anxiety, fear, depression, and insomnia, causing, consequently, the impaired quality of life. Psychological crisis intervention plays a pivotal role in the overall deployment of health-related quality of life and disease control. A novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2), a pathogen of the new coronavirus disease (COVID-19), has affected several sector activities, including people's health. To enhance infection control methods, appropriate interventions, and public health policies, the present study aims to assess the fear and peri-traumatic stress during the Covid-19 in Brazil. Method: A cross-sectional survey has been conducted from April 12th to 18th using the Peri-Traumatic Distress Scale (CPDI) and the Fear Scale (FCV-19S) aiming to measure the peri-traumatic stress and fear as psychological reactions during the COVID-19 pandemic. For that purpose, an online spreadsheet was used to send the questionnaire and scales to a sample of 1844 participants as a collecting information tool. After the data analysis, the individuals were separated into 4 groups: Group 1 (1232) population without chronic health conditions; group 2 (298) patients with previous psychological suffering, group 3 (229) patients with cardiovascular diseases, group 4 (71) patients with diabetes. For analysis, G1 and were considered control for comparison with groups 2, 3 and 4 in accordance with One-Way Anova followed by Bonferroni test. Results: All the groups showed the CPDI and FCV-19S increased in comparison with the G1 group. Concerning CPDI, the G 3 was increased when compared to G1, G2 and G4. The G3 had the FCV-19S higher in comparison with G1, G2 and G4. The Wilcoxon-Mann-Whitney test showed a statistical difference between the control group in comparison with 2 and 3 groups (Mann-Whitney p&lt; 0.05). Conclusion: The COVID-19 pandemic had a significant impact on the Brazilian population, with patients with heart disease and hypertension presenting the highest numbers of stress and fear, with numbers comparable and even higher than those who reported previous psychological distress.

Covid-19 pandemic continues to spread exponentially worldwide, especially in America. By mid-June, 2020, Brazil is one of the most affected countries with more than one million cases and up to 50,000 deaths. This study aims to assess the fear and peri-traumatic stress during the Covid-19 pandemics in Brazil, to enhance infection control methods, appropriate interventions, and public health policies. A cross-sectional survey has been conducted from April 12th to 18th using the Peri-Traumatic Distress Scale (CPDI) and the Fear Scale (FCV-19S) aiming to measure the peri-traumatic stress and fear as psychological reactions during the Covid-19 pandemic. For that purpose, an online spreadsheet was used to send the questionnaire and scales to a sample of 1844 participants as a collecting information tool. Both scales showed a correlation factor of (r=0,660). Results highlight significant gender differences as in both scales women’s mean scores are higher showing that it is paramount that women’s voices were represented in policy spaces as socially constructed gender roles place them in a strategic position to enhance multi-level interventions (primary and secondary effects of Covid-19), equitable policies, and new approaches to control the pandemic.

BACKGROUND Thrombocytopenia in malaria involves platelet destruction and consumption; however, the cellular response underlying this phenomenon has still not been elucidated. OBJECTIVE To find associations between platelet indices and unbalanced Th1/Th2/Th17 cytokines as a response to thrombocytopenia in Plasmodium vivax infected (Pv-MAL) patients. METHODS Platelet counts and quantification of Th1/Th2/Th17 cytokine levels were compared in 77 patients with uncomplicated P. vivax malaria and 37 healthy donors from the same area (endemic control group - ENCG). FINDINGS Thrombocytopenia was the main manifestation in 55 patients, but was not associated with parasitaemia. The Pv-MAL patients showed increases in the mean platelet volume (MPV), which may be consistent with larger or megaplatelets. Contrary to the findings regarding the endemic control group, MPV and platelet distribution width (PDW) did not show an inverse correlation, due the increase in the heterogeneity of platelet width. In addition, the Pv-MAL patients presented increased IL-1β and reduced IL-12p70 and IL-2 serum concentrations. Furthermore, the reduction of these cytokines was associated with PDW values. MAIN CONCLUSIONS Our data demonstrate that an increase in MPV and the association between reductions of IL-2 and IL-12 and PDW values may be an immune response to thrombocytopenia in uncomplicated P. vivax malaria.

Resumo Fundamento: A prevalência e os desfechos clínicos em pacientes com insuficiência cardíaca com fração de ejeção do ventrículo esquerdo preservada pós-infarto agudo do miocárdio ainda não foram bem elucidados. Objetivo: Analisar a prevalência de insuficiência cardíaca com fração de ejeção do ventrículo esquerdo preservada no infarto agudo do miocárdio e sua associação com a mortalidade. Métodos: Pacientes com infarto agudo do miocárdio (n = 1.474) foram incluídos prospectivamente. Pacientes admitidos sem insuficiência cardíaca (Killip = 1), com insuficiência cardíaca com fração de ejeção do ventrículo esquerdo preservada (Killip > 1 e fração de ejeção do ventrículo esquerdo ≥ 50%) e com insuficiência cardíaca sistólica (Killip > 1 e fração de ejeção do ventrículo esquerdo < 50%) foram comparados. A associação entre insuficiência cardíaca sistólica e com fração de ejeção do ventrículo esquerdo preservada, com a mortalidade hospitalar foi testada em modelos ajustados. Resultados: Dentre os incluídos, 1.256 (85,2%) pacientes foram admitidos sem insuficiência cardíaca (72% homens, 67 ± 15 anos), 78 (5,3%) com insuficiência cardíaca com fração de ejeção do ventrículo esquerdo preservada (59% homens, 76 ± 14 anos) e 140 (9,5%) com insuficiência cardíaca sistólica (69% homens, 76 ± 14 anos), com mortalidade, respectivamente, de 4,3; 17,9 e 27,1% (p < 0,001). A regressão logística (ajustada para sexo, idade, troponina, diabetes e índice de massa corporal) demonstrou que insuficiência cardíaca com fração de ejeção do ventrículo esquerdo preservada (odds ratio de 2,91; intervalo de confiança de 95% de 1,35-6,27; p = 0,006) e insuficiência cardíaca sistólica (odds ratio de 5,38; intervalo de confiança de 95% de 3,10-9,32; p < 0,001) se associaram à mortalidade intra-hospitalar. Conclusão: Um terço dos pacientes com infarto agudo do miocárdio admitidos com insuficiência cardíaca apresentou fração de ejeção do ventrículo esquerdo preservada. Apesar de esse subgrupo ter evolução mais favorável que os pacientes com insuficiência cardíaca sistólica, ele apresentou risco de morte três vezes maior do que o grupo sem insuficiência cardíaca. Pacientes com infarto agudo do miocárdio e insuficiência cardíaca com fração de ejeção do ventrículo esquerdo preservada apresentaram elevado risco em curto prazo e mereceram especial atenção e monitorização durante a internação hospitalar.

Abstract Background: The prevalence and clinical outcomes of heart failure with preserved left ventricular ejection fraction after acute myocardial infarction have not been well elucidated. Objective: To analyze the prevalence of heart failure with preserved left ventricular ejection fraction in acute myocardial infarction and its association with mortality. Methods: Patients with acute myocardial infarction (n = 1,474) were prospectively included. Patients without heart failure (Killip score = 1), with heart failure with preserved left ventricular ejection fraction (Killip score > 1 and left ventricle ejection fraction ≥ 50%), and with systolic dysfunction (Killip score > 1 and left ventricle ejection fraction < 50%) on admission were compared. The association between systolic dysfunction with preserved left ventricular ejection fraction and in-hospital mortality was tested in adjusted models. Results: Among the patients included, 1,256 (85.2%) were admitted without heart failure (72% men, 67 ± 15 years), 78 (5.3%) with heart failure with preserved left ventricular ejection fraction (59% men, 76 ± 14 years), and 140 (9.5%) with systolic dysfunction (69% men, 76 ± 14 years), with mortality rates of 4.3%, 17.9%, and 27.1%, respectively (p < 0.001). Logistic regression (adjusted for sex, age, troponin, diabetes, and body mass index) demonstrated that heart failure with preserved left ventricular ejection fraction (OR 2.91; 95% CI 1.35–6.27; p = 0.006) and systolic dysfunction (OR 5.38; 95% CI 3.10 to 9.32; p < 0.001) were associated with in-hospital mortality. Conclusion: One-third of patients with acute myocardial infarction admitted with heart failure had preserved left ventricular ejection fraction. Although this subgroup exhibited more favorable outcomes than those with systolic dysfunction, this condition presented a three-fold higher risk of death than the group without heart failure. Patients with acute myocardial infarction and heart failure with preserved left ventricular ejection fraction encounter elevated short-term risk and require special attention and monitoring during hospitalization.

OBJETIVO: avaliar a eficácia e a segurança do uso do halo craniano gravitacional como técnica de tratamento de deformidades rígidas da coluna vertebral e rever complicações associadas ao seu tratamento. MÉTODOS: análise retrospectiva de dez pacientes com deformidades rígidas da coluna vertebral: cifose, escoliose, cifoescoliose e hiperlordose cervical. O critério para inclusão dos pacientes foi o uso do halo craniano gravitacional em um período pré-operatório e interoperatório em deformidades rígidas da coluna vertebral. Foram avaliados os prontuários dos pacientes e suas mensurações radiográficas foram feitas em um período pré-operatório, após instalação do halo craniano gravitacional, e no período pós-operatório. As variáveis estudadas foram idade, sexo, valor angular da curva principal, valor angular da curva secundária, valor angular da curva sagital maior, protocolo de tração e tipo de procedimento utilizado. RESULTADOS: em relação ao plano frontal, avaliou-se, no período pré-operatório, a média angular de 89,9º, decrescendo para 65º após a instalação do halo e 56,9º no pós-operatório. Analisando o plano sagital, observou-se no período pré-operatório o valor angular de 77,7º, decrescendo para 55,4º, com o uso do halo-colete, e 46,5º no pós-operatório tardio. CONCLUSÃO: pode-se concluir que o uso da tração halo craniana é um método eficaz no auxílio da correção das deformidades rígidas da coluna vertebral, visto que se conseguiu uma correção significativa das deformidades do período pré-operatório para os períodos pós-instalação do halo e pós-operatório, sem se observar lesão neurológica ou outra grave complicação.

OBJECTIVE: to assess the efficacy and safety of using the gravitational cranial halo as a technique for treating rigid deformities in the spinal column and to revisit complications associated to the treatment. METHODS: a total of ten patients with rigid spinal deformities were studied, with the following deformities: kyphosis, scoliosis, kyphoscoliosis and cervical hyperlordosis. The criterion for including a patient was the use of the gravitational cranial halo in a postoperative period and interoperative period for rigid spinal deformities. The patient medical records and their radiographic measurements were studied and compared in a preoperative period, after the installation of the gravitational cranial halo and in the postoperative period. The aspects analyzed were: age, sex, angular value of the main curvature and angular value of the secondary curvature, angular value of the major sagittal curvature, traction protocol and type of procedure. RESULTS: in the frontal plane, an average angle of 89.9º was found in the preoperative period, decreasing to 65º after the installation of the halo and 56.9º in the postoperative period. In the sagittal plane, an angular value of 77.7º was observed, decreasing to 55.4º with the use of the halo and 46.5º in the postoperative period. CONCLUSION: the conclusion was that the use of cranial halo traction is an efficient method for correcting rigid spinal deformities, taking into account that there was significant correction of the deformities from the preoperative period to the post installation of the halo and the postoperative period, without any neurological lesions or serious complications resulting from the treatment.

OBJETIVO: evaluar, retrospectivamente, la eficacia y la seguridad del uso del halo craneal gravitacional como técnica de tratamiento de deformidades rígidas de la columna vertebral, y rever complicaciones asociadas a su tratamiento. MÉTODOS: ha sido analizado un total de diez pacientes con deformidades rígidas de la columna vertebral: cifosis, escoliosis, cifoscoliosis e hiperlordosis cervical. El criterio para inclusión de los pacientes fue el uso del halo craneal gravitacional en un periodo preoperatorio y interoperatorio en deformidades rígidas de la columna vertebral. Han sido evaluados los prontuarios de los pacientes y sus mediciones radiográficas en un periodo preoperatorio, tras la instalación del halo craneal gravitacional y en el periodo postoperatorio. Las variables estudiadas fueron: edad, sexo, valor angular de la curva principal, valor angular de la curva secundaria, valor angular de la curva sagital mayor, protocolo de tracción y tipo de procedimiento utilizado. RESULTADOS: en relación al plano frontal, se ha evaluado, en el periodo preoperatorio, la media angular de 89,9º, decreciendo para 65,0º tras la instalación del halo y 56,9º en el postoperatorio. Analizando el plano sagital, se observa en el periodo preoperatorio el valor angular de 77,7º, decreciendo para 55,4º con el uso del halo y 46,5º en el postoperatorio. CONCLUSIÓN: se puede concluir que el uso de la tracción de halo craneal es un método eficaz para ayudar a corregir las deformidades de la columna rígida, ya que se logró una significativa corrección de las deformidades antes de la operación por los períodos después de la instalación de halo y postoperatorio, sin previo aviso u otras complicaciones neurológicas graves.