Conectar
by Talyson Aparício Gomes, Joseir Saturnino Cristino, Rafaela Nunes Dávila, Bianca Leite Pereira, Milena Gomes Ferreira, Giulia Lória Aquino, Amanda Braga Cunha, Felipe Nery Braga, Érica da Silva Carvalho, Jacqueline Sachett, Felipe Gomes Murta, Vinicius Azevedo Machado, Wuelton Monteiro
Long-term hospital stays represent a growing challenge for health systems, especially in tertiary hospitals that receive patients with clinically complex pathologies. This phenomenon is often related to social factors, such as abandonment, absence of caregivers and fragility of support networks, and the difficulty of relocation to intermediary institutions. This study aimed to understand the experiences and perceptions of family caregivers and health professionals about prolonged hospital stays in a referral hospital for tropical and infectious diseases in the Brazilian Amazon. This is a qualitative, exploratory study that is based on interviews with ten health professionals and eight family members of patients hospitalized for more than or equal to 180 days. The data were analyzed via thematic analysis. The analyzed cases show an overlap of vulnerabilities, including comorbidities, HIV/AIDS infection and fragility in family ties. The stigma associated with HIV/AIDS and the families’ poor financial conditions hinder care after discharge, making the hospital the only possible space for these patients to stay. The analysis identified five major themes: (1) social hospitalization and institutional dependence; (2) dynamics of family and social ties; (3) routine care and impacts on the lives of caregivers; (4) clinical complexity and obstacles that impede hospital discharge; and (5) the need for public policies and infrastructure. It is concluded that, in the absence of alternatives outside the hospital and effective intersectoral policies, the hospital begins to play a role beyond that of clinical care, and functions as a place to stay and the only space for social bonds for individuals in situations of extreme social vulnerability.
To evaluate the relative strength of clinical and sociodemographic predictors of health-related quality of life (HRQoL) in patients with rheumatoid arthritis (RA) under real-life conditions.
This cross-sectional, observational study included adult patients fulfilling the 2010 American College of Rheumatology-European Alliance of Associations for Rheumatology classification criteria for RA, recruited from 11 public tertiary rheumatology centres in Brazil. To reflect real-life clinical practice, no restrictions were applied regarding disease stage or treatment status. HRQoL was assessed using the 12-item Short Form Health Survey (SF-12). Physical disability was measured by the Health Assessment Questionnaire-Disability Index (HAQ-DI). Clinical and epidemiological variables were evaluated as candidate predictors. Associations were explored using bivariate analyses and multiple linear regression models. Standardised beta coefficients (zβ) were used to estimate the relative strength of independent predictors.
1079 patients were included; 89.4% were women and 56.0% were white, with a mean (SD) age of 57.0 (11.4) years and a median (IQR) disease duration of 152 (84.0–242.0) months.
In multivariate analysis, the following remained independently associated with physical score: HAQ-DI score (β=–3.92, 95% CI (–4.56 to –3.28), zβ=–0.44, p
For mental score, remaining independent predictors were HAQ-DI (β=–5.00, 95% CI (–6.17 to –3.83), zβ=–0.31, p
Physical disability was the strongest determinant of impaired HRQoL in both physical and mental domains among participants with RA. Other relevant determinants of poorer physical HRQoL in descending order of relative strength were non-White race and absence of regular physical activity, while for poorer mental HRQoL, fibromyalgia, race, smoking status, female sex and disease activity. These findings reinforce functional preservation as a key therapeutic target in routine RA care.
Diabetes is a major global public health challenge, with rapidly rising incidence, particularly in low- and middle-income countries. Physical activity is a well-established protective factor against type 2 diabetes (T2DM); however, the population-level impact of realistic modest increases in physical activity remains unclear.
To estimate the burden of T2DM attributable to physical inactivity in Brazil and project the impact of modest increases in physical activity.
We calculated the population attributable fractions (PAFs) and economic costs of diabetes due to physical inactivity in Brazil. We estimated the incidence of T2DM from 2026 to 2050 using data from the National Health Survey (2013 and 2019) and the Global Burden of Disease Study. The relative risk of incident diabetes across the physical activity continuum was extracted from a previous meta-analysis. We modelled scenarios simulating gradual increases in leisure-time physical activity (LTPA) and resistance exercise (RE) and projected economic impacts through 2050.
From 2026 to 2050, 11.7% (95% uncertainty interval, UI 9.5% to 14.1%) of incident T2DM cases in Brazil (~3.7 million) might be attributable to physical inactivity, with higher PAFs among adults with lower education (PAF: 13.7%; 95% UI 11.1% to 16.4%) and in Mixed Race (12%; 95% UI 9.6% to 14.3%) and Black (11.9%; 95% UI 9.5% to 14.2%) populations. In a nonlinear dose-response association, increasing LTPA by 10, 20 or 30 min/day among inactive individuals could prevent 7.0% (2.20 million), 12.9% (4.05 million) and 16.0% (5.02 million) of incident cases, respectively, by 2050. For RE, the same daily increases could prevent 12.0% (3.80 million), 18.7% (5.87 million) and 22.5% (7.07 million) of cases. These increments could significantly reduce healthcare costs, starting at R$1.9 billion for the 10 min LTPA scenario, with the greatest impact observed from RE.
Promoting small increases in physical activity could yield substantial health and economic benefits. Equitable public health strategies are essential to address disparities and halt the growing burden of diabetes in Brazil.
Objetivo: conhecer a percepção do paciente ao revelar o diagnóstico de HIV/AIDS para os familiares.
Metodologia: Trata-se de um estudo do tipo descritivo com abordagem qualitativa realizado nos meses de maio a junho de 2017, em um ambulatório de um hospital do município de Fortaleza, Ceará – Brasil, o qual possui atendimento especializado em IST/HIV/AIDS. Para a coleta de dados, utilizou-se um roteiro semi estruturado e a análise dos dados foi feito a partir conteúdo temática de Minayo (2007). O estudo foi aprovado pelo Comitê de Ética em Pesquisa da referida instituição (CEP193/2009).
Resultados: As categorias que surgiram foram: “A escolha para quem irá contar”; “Reação dos familiares com a revelação do diagnóstico”; “Sentimentos após a revelação do diagnóstico” e “Benefícios vivenciados com a revelação do diagnóstico”. Verificou-se que a revelação diagnóstica representou uma facilitação na adesão ao tratamento e o apoio psicológico no convívio familiar.
Conclusão: A maioria dos participantes se sentiu mais segurança em revelar o seu diagnóstico para um membro familiar como pai, mãe, irmão ou companheiro, apesar do medo das mudanças que poderiam ser causadas devido a essa revelação como preconceito, não aceitação, abandono, depressão, tristeza, medo de transmissão e morte.
Ophthalmic complaints account for a substantial proportion of presentations to emergency and acute eye care services, yet initial assessment or referral is frequently performed by non-ophthalmologist healthcare professionals. Previous single-centre studies suggest that one-third of referrals are incorrectly diagnosed, potentially delaying appropriate management of vision-threatening conditions. However, the overall magnitude of diagnostic error and patterns of misdiagnosis across healthcare settings remain unclear. This study aims to systematically review and synthesise the evidence on the diagnostic concordance of ophthalmic referral diagnoses made by non-ophthalmologists in acute eye care.
A systematic review and meta-analysis will be conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) guidance and registered with PROSPERO. MEDLINE (Ovid), Embase (Ovid) and the Cochrane CENTRAL database will be searched from inception to April 2025. Studies evaluating the diagnostic accuracy of referrals made by non-ophthalmologist healthcare professionals in emergency or acute eye care settings will be included. Two reviewers will independently screen studies, extract data and assess risk of bias using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) framework adapted for referral-diagnosis studies. The primary outcome will be diagnostic concordance between referral and final ophthalmologist diagnosis. Where appropriate, pooled concordance proportions will be synthesised using a random-effects meta-analysis. Condition-specific 2x2 diagnostic accuracy analyses will only be undertaken where valid binary target conditions and sufficient denominators are reported. Heterogeneity will be assessed using Cochran’s Q test and the I² statistic with subgroup analyses exploring differences by referring clinician type and anatomical location of ophthalmic pathology.
Ethical approval is not required for this study as it will synthesise data from previously published studies; findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic conferences.
CRD420261352717.
by Teresa Cunha, Fróði Gregersen, Lars G. Hanson, Axel Thielscher
PurposeMagnetic resonance current density imaging (MRCDI) can non-invasively validate electric field simulations in volume conductor head models. Weak electric currents are injected using scalp electrodes while measuring the MR phase perturbations caused by the tiny magnetic fields (1–2 nT) induced by the current flow in tissue. MRCDI generally has a low signal-to-noise ratio, making it susceptible to technical imperfections and physiological noise. In this technical note, we tested and optimized simultaneous multi-slice (SMS) EPI for time-efficient and robust brain MRCDI.
MethodsMRCDI data was acquired in a phantom and five human brains using SMS-EPI optimized for measuring current-induced phase perturbations. Multiband factors and interslice gaps were systematically varied and the resulting image quality assessed. In particular, the impact of interslice signal leakage on the measured phase was tested.
ResultsCurrent-free acquisitions showed the expected noise amplification with decreasing interslice distances. However, physiological noise generally dominated the human data, masking potential SMS-related penalties and making the overall noise levels identical to single-slice EPI for interslice gaps of at least 12 mm and multiband factors between 3 and 5. Upon application of electric currents, the phantom data revealed subtle artifacts for multiband factors 5 and 6, even for large gaps. Nevertheless, artifacts were absent in the human brain for multiband factors up to 5, where the performance of SMS-EPI approached that of single-slice measurements for sufficient interslice distances.
ConclusionOptimized SMS-EPI with multiband factors up to 5 and minimum interslice gaps of 12 mm performs on par with single-slice EPI, making it attractive for increasing brain coverage in MRCDI.
Objetivo principal: identificar qué actividades guían el trabajo de la enfermera en una unidad de cuidados intensivos para adultos. Metodología: revisión integradora, realizada sobre la base de Literatura Latinoamericana y del Caribe en Ciencias de la Salud y Sistema de Análisis y Recu-peración de Literatura Médica en línea, entre enero y febrero de 2019. La búsqueda resultó en 15 producciones, que fueron analizadas a través del análisis de contenido temático. Resultados principales: a partir del análisis de los estudios, surgió la siguiente categoría temática: “Actividades que guían el trabajo de la enfermera en una unidad de cuidados intensivos para adultos”, destacando: observación y vigilancia constantes, manejo de instrumentos tecnológicos e interpretación de información de estos dispositivos, desempeño y comunicación entre un equipo multidisciplinario, realizando una evaluación y plan de atención al paciente. Conclusión principal: aunque algunas actividades pueden caracterizarse como técnicas, también existen aquellas que involucran la subjetividad de las enfermeras, dirigidas a una atención más individualizada y guiadas por el ejercicio de la autonomía.
FreshRSS