Conectar
by Catarina Simões, Diana S. Vasconcelos, Raquel Xavier, Xavier Santos, Catarina Rato, D. James Harris
Fire has long been recognized as an important ecological and evolutionary force in plant communities, but its influence on vertebrate community ecology, particularly regarding predator-prey interactions, remains understudied. This study reveals the impact of wildfires on the diet of Podarcis lusitanicus, a lizard species inhabiting a fire-prone region in the Iberian Peninsula. In order to explore diet variability associated with different local burn histories, we evaluated P. lusitanicus diet across three types of sites in Northern Portugal: those had not burned since 2016, those burned in 2016, and those more recently burned in 2022. Podarcis lusitanicus is a generalist arthropod predator with dietary flexibility. Given the turnover of arthropod species after fire, it is expected to find variations in diet caused by different fire histories, especially between unburned and recently burned sites. From DNA metabarcoding of faecal samples, our study revealed that while prey richness remained unaffected by wildfire regime, significant shifts occurred in diet composition between more recently burned and unburned areas. Specifically, we found that differences in diet composition between these two fire regimes were due to the presence of Tapinoma ants and jumping spiders (Salticus scenicus). These prey were present in the diets of lizards occupying unburned areas, while these were absent in areas burned in 2022. Interestingly, diets in unburned areas and areas burned in 2016 showed no significant differences, highlighting the lizards’ ecological flexibility and the habitat’s resilience over time. The ant species T. topitotum was found in dominance in both burned areas, suggesting that this species may be fire tolerant. In addition, families such as Cicadellidae and Noctuidae were found to be more associated with more recently burned areas. The use of DNA metabarcoding in this study was essential to provide a more detailed and accurate view of predator-prey interactions in ecosystems susceptible to fire, and therefore a better understanding of changes in prey consumption in this fire-adapted ecosystem.To explore health professionals’ perspectives on the barriers and enablers of healthcare access for older adults in Cambodia.
A qualitative study based on semi-structured interviews conducted in Khmer, recorded, transcribed, translated into English and analysed using an abductive thematic analysis approach.
Phnom Penh, Cambodia.
A purposive sample of 11 health professionals serving in diverse roles and sectors participated in the study.
Three key barriers emerged: (1) institutional barriers, (2) patient-specific access barriers and (3) communication barriers. However, four key enablers were also identified: (1) supportive healthcare environment, (2) reaching out to improve access to health services, (3) peer and community engagement and (4) government direct support to access healthcare. Despite previous policy efforts, gaps in the implementation of healthcare services for older adults persist across all health facilities. Health professionals identified that improving healthcare access for older adults in Cambodia requires a multifaceted strategy involving proactive outreach, health promotion, financial assistance and stronger community and family support.
Effective policy implementation requires collaboration among stakeholders and the active involvement of older adults in programme design to enhance dignity and well-being in Cambodia’s ageing population.
by Denis Sereno, Tahar Kernif, Renato Leon, Kholoud Kahime, Souad Guernaoui, Chaymaa Harkat, Mario J. Grijalva, Omar Hamarsheh, Anita G. Villacis, Bachir Medrouh, Thiago Vasconcelos Dos Santos, Razika Beniklef, Naouel Eddaikra, Phlippe Holzmuller
IntroductionLeishmaniases are a vector-borne parasitic diseases with diverse clinical manifestations involving multiple Leishmania species and animal hosts. While most leishmaniasis cases are caused by a few well characterized Leishmania species, reports describe infections by unconventional or emerging Leishmania taxa, atypical clinical presentations from classical species, and occurrences of atypical Leishmania in animal hosts. These underrecognized infections present diagnostic and therapeutic challenges and are rarely reflected in surveillance systems or clinical guidelines. A systematic mapping of this evolving landscape is needed to guide future diagnostics, policy, and research priorities.
Methods and analysisFollowing the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines, we will search PubMed, Embase, Cochrane Library (CENTRAL), PROSPERO, Web of Science, and Global Index Medicus, as well as relevant grey literature. Eligible studies will include human cases with clinical presentations that diverge from those typically associated with well-characterized Leishmania species, reports involving unconventional or emerging Leishmania species, and animal cases of veterinary relevance caused by non-classical species, regardless of study design. Dual independent screening of records and data extraction using a standardized charting form will be conducted. Discrepancies between reviewers will be resolved by consensus. Data will be summarized descriptively through tables, figures, and thematic synthesis. Research gaps will be identified to inform future studies and public health strategies.
DisseminationThis review will use data from published sources and findings will be disseminated through publication in a peer-reviewed journal, presentations at scientific conferences, and sharing with relevant stakeholders. The results are intended to inform clinicians, researchers, and policymakers about the evolving landscape of leishmaniasis and to highlight priorities for future research and surveillance.
by Juliana Rodrigues Tovar Garbin, Franciéle Marabotti Costa Leite, Ana Paula Brioschi dos Santos, Larissa Soares Dell’Antonio, Cristiano Soares da Silva Dell’Antonio, Luís Carlos Lopes-Júnior
A comprehensive understanding of the factors influencing the epidemiological dynamics of COVID-19 across the pandemic waves—particularly in terms of disease severity and mortality—is critical for optimizing healthcare services and prioritizing high-risk populations. Here we aim to analyze the factors associated with short-term and prolonged hospitalization for COVID-19 during the first three pandemic waves. We conducted a retrospective observational study using data from individuals reported in the e-SUS-VS system who were hospitalized for COVID-19 in a state in a southeast state of Brazil. Hospitalization duration was classified as short or prolonged based on a 7-day cutoff, corresponding to the median length of hospital stay during the second pandemic wave. Bivariate analyses were performed using the chi-square test for heterogeneity. Logistic regression models were used to estimate odds ratios (ORs) and their respective 95% confidence intervals (CIs), with statistical significance set at 5%. When analyzing hospitalization duration across the three waves, we found that 51.1% (95%CI: 49.3–53) of hospitalizations in the first wave were prolonged. In contrast, short-duration hospitalizations predominated in the second (54.7%; 95% CI: 52.4–57.0) and third (51.7%; 95% CI: 50.2–53.2) waves. Factors associated with prolonged hospitalization varied by wave. During the first wave, older adults (≥60 years) (OR=1.67; 95%CI: 1.35–2.06), individuals with ≥10 symptoms (OR=2.03; 95%CI: 1.04–3.94), obese individuals (OR=2.0; 95%CI: 1.53–2.74), and those with ≥2 comorbidities (OR=2.22; 95%CI: 1.71–2.89) were more likely to experience prolonged hospitalization. In the second wave, he likelihood of extended hospital stays was higher among individuals aged ≥60 years (OR=2.04; 95%CI: 1.58–2.62) and those with ≥2 comorbidities (OR=1.77; 95%CI: 1.29–2.41). In the third wave, prolonged hospitalization was more frequent among older adults (OR=1.89; 95%CI: 1.65–2.17,), individuals with 5–9 symptoms (OR=1.52; 95%CI: 1.20–1.92), obese individuals (OR=2.2; 95%CI: 1.78–2.73), and those with comorbidities (OR=1.45; 95%CI: 1.22–1.72 and OR=2.0; 95%CI: 1.69–2.45). In conclusion, we identified variations in hospitalization patterns across the pandemic waves, although the differences were relatively subtle. These variations likely reflect gradual shifts in the risk factors associated with prolonged hospital stays. Our findings highlight t the importance of implementing targeted public health interventions, particularly those designed to reduce disease severity and improve clinical outcomes among vulnerable populations at greater risk of extended hospitalization.While group, task-oriented, community-based exercise programs (CBEPs) delivered in-person can increase exercise and social participation in people with mobility limitations, challenges with transportation, cost and human resources, threaten sustainability. A virtual delivery model may help overcome challenges with accessing and delivering in-person CBEPs. The study objective is to estimate the short-term effect of an 8-week, virtual, group, task-oriented CBEP called TIME™ (Together in Movement and Exercise) at Home compared with a waitlist control on improving everyday function in community-dwelling adults with mobility limitations.
A randomised controlled trial incorporating a type 1 effectiveness-implementation hybrid design is being conducted in four Canadian metropolitan centres. We aim to stratify 200 adults with self-reported mobility limitations by site, participation alone or with a partner, and functional mobility level, and randomise them using REDCap software to either TIME™ at Home or a waitlist control group. During TIME™ at Home classes (2 classes/week, 1.5 hours/class), two trained facilitators stream a 1-hour exercise video and facilitate social interaction prevideo and postvideo using Zoom. A registered healthcare professional at each site completes three e-visits to monitor and support implementation. Masked evaluators with physical therapy training evaluate participants and their caregivers at 0, 2 and 5 months using Zoom. The primary outcome is the change in everyday function from 0 to 2 months, measured using the physical scale of the Subjective Index of Physical and Social Outcome. The study is powered to detect an effect size of 0.4, given α=0.05, power=80% and a 15% attrition rate. Secondary outcomes are mobility, well-being, reliance on walking aids, caregiver assistance, caregiver mood, caregiver confidence in care-recipient balance and cost-effectiveness. A multimethod process evaluation is proposed to increase understanding of implementation fidelity, mechanisms of effect and contextual factors influencing the complex intervention. Qualitative data collection immediately postintervention involves interviewing approximately 16 participants and 4 caregivers from the experimental group, and 8 participants and 4 caregivers from the waitlist control group, and all healthcare professionals, and conducting focus groups with all facilitators to explore experiences during the intervention period. A directed content analysis will be undertaken to help explain the quantitative results.
TIME™ at Home has received ethics approval at all sites. Participants provide verbal informed consent. A data safety monitoring board is monitoring adverse events. We will disseminate findings through lay summaries, conference presentations, reports and journal articles.
Non-communicable diseases (NCDs), such as diabetes, cardiovascular diseases and cancer, are major global public health concerns. Diet quality—particularly the consumption of ultra-processed foods—has been associated with increased risk of NCDs. Traditional cohort studies are often expensive and logistically complex. The NutriNet-Brasil cohort leverages a web-based approach, offering a cost-effective and practical solution for comprehensive data collection and long-term follow-up.
Recruitments began in January 2020 through mass media, social media campaigns and collaborations with health organisations. Eligible participants are adults (aged ≥18 years) living in Brazil with internet access. Participants complete self-administered online questionnaires covering dietary intake, health status and other health determinants. Dietary assessment is based on the Nova classification system, which categorises foods by their level of processing.
Over 88 000 participants have completed the initial questionnaire. The cohort is predominantly women (79.9%) and highly educated (67.9% had completed higher education). The web-based design enabled the development and application of innovative dietary assessment tools, including the Nova24h and the Nova24hScreener, specifically designed to evaluate food processing levels. These tools have shown good performance in capturing dietary patterns and are central to the cohort’s aim. The online platform facilitates efficient recruitment, data collection and participant retention.
NutriNet-Brasil is pioneering the development of web-based cohort methodologies and instruments tailored to food processing research. Future work includes leveraging collaborations with national and international research centres to conduct multidisciplinary analyses and inform public health policies.
The COVID-19 pandemic’s unprecedented nature has exposed significant vulnerabilities in most public health systems and highlighted the importance of coordinated responses across various levels of government. A global debate emerged on the types of health measures necessary to curb the rapid spread of contagious and/or lethal diseases. However, some of these measures involved restricting individual rights, raising significant ethical, legal and public health questions. The protocol of this systematic review aims to address a critical gap in the literature by analysing how Public Health Surveillance services worldwide implemented compulsory right-restricting measures during the COVID-19 pandemic, and what impacts these measures had on public health outcomes and individual rights.
This protocol focuses on studies about right-restricting measures enacted by Public Health Surveillance services during the COVID-19 pandemic. It will be unrestrictive as to period (starting in 2019, when the outbreak was identified), language or publication status in a preliminary stage. It will include only peer-reviewed publications, discarding opinion articles, editorials, conference papers and non-peer-reviewed publications. Considering the PICo strategy, the research question of this systematic review can be formulated as follows: Problem—right-restricting measures enacted by Public Health Surveillance services; Interest—implementation modalities and impacts on individual rights and public health outcomes; Context—COVID-19 pandemic. This protocol will use the following databases: Pubmed, Cochrane/CENTRAL, Embase, Scopus and Web of Science. Considering the various measures that may have been adopted, the following categories of analysis will be used: (i) Public Health Surveillance as a field, (ii) the various specific areas of Health Surveillance, (iii) law enforcement, (iv) right-restricting measures and consent, (v) interactions between right-restricting measures and routine Public Health Surveillance functions, (vi) differences between countries and (vii) Health Surveillance lessons learnt from the COVID-19 pandemic. These categories are not strictly mutually exclusive; however, each study will be assigned to the category most aligned with its primary focus. To ensure the validity and reliability of findings, each study will have its risk of bias assessed at both the study and outcome levels.
Patients and the public were not involved in the design, conduct, reporting or dissemination plans of this systematic review. The results will be presented in one or more articles to be submitted to scientific journals and may also be presented at scientific conferences and to public policy makers.
This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 20 November 2024 (registration number CRD42024613039).
COVID-19 in children is generally of short duration, but some may take longer to recover. This study investigated the time to symptom resolution following SARS-CoV-2 infection among children in a community setting on the outskirts of an urban centre in Brazil.
Prospective cohort study.
This is a community-based cohort of children living in Manguinhos, a favela in Rio de Janeiro. The cohort was followed through home visits and telephone monitoring of symptoms. The analysis focused on symptomatic children from this cohort with confirmed SARS-CoV-2 infection. Recovery time was defined as the interval between the first date with symptoms and the first date without symptoms following a positive SARS-CoV-2 test.
A total of 1276 children (boys and girls aged 2–
COVID-19 recovery time, assessed based on change points on the symptom persistence probability curve (Kaplan-Meier).
Among children who tested positive, 148 (60%) were symptomatic. The median recovery time was 11 days (IQR: 7–16). Two inflection points were identified on the Kaplan-Meier curve: days 16 and 34. Children who were ill during the Omicron wave took longer to recover. More boys became asymptomatic within the first 15 days; about 93% of girls recovered by day 33, and boys were more common among those who recovered in ≥34 days. Children aged 6–
Among children from a vulnerable area in Rio de Janeiro, recovery time was longer than that reported in other countries, with 9.5% of children experiencing persistent symptoms for more than 33 days. These findings are crucial for understanding the implications of COVID-19 in specific socioeconomic contexts and the dynamics of paediatric recovery in community settings.
To identify and contextualise evidence-based strategies for implementing deprescribing practices at different levels of healthcare in Brazil, through the development of an evidence brief for policy that includes stakeholder deliberation and considers barriers, facilitators and equity aspects.
This protocol outlines the development of an evidence brief for policy using a mixed-methods design. It involves synthesising evidence for health policies by integrating global research and local evidence through three stages: stakeholder exchange, evidence brief development and external endorsement. The Supporting Policy-Relevant Reviews and Trials tools for evidence-informed health policies will guide both the synthesis of strategies and the facilitation of deliberative dialogues. The synthesis will encompass evidence from systematic reviews and meta-analysis on deprescribing strategies across healthcare levels, focusing on effectiveness, harms, costs, perceptions, barriers, facilitators and equity. Studies proposing strategies not yet implemented will be excluded. Study selection and data extraction will be conducted independently and in duplicate. The methodological quality of included studies will be assessed using the A Measurement Tool for Assessing the Methodological Quality of Systematic Reviews-2 criteria. Synthesised evidence will be used to develop evidence-based strategies, which will then be presented in deliberative dialogues for endorsement by stakeholders and adaptation to the Brazilian context. Endorsement rates will be classified as high, moderate or low based on predefined criteria.
This study was approved by the University of Sorocaba Research Ethics Committee (certificate 82098324.7.0000.5500). Informed consent will be obtained from all participants. Findings will be disseminated through peer-reviewed publications and conference presentations.
CRD42024548845.
by Ana Paula Cândido Oliveira, Daniela Alencar Vieira, Cristiane Wanderley Cardoso, Tereza Magalhães, Rosangela Oliveira Anjos, Eduardo José Farias Borges Reis, Kionna Oliveira Bernardes Santos, Guilherme Sousa Ribeiro
Work ability is a subjective concept that reflects the balance between an individual’s perception of the physical, mental, and social demands of work and their competence and resources to meet those demands. The COVID-19 crisis significantly impacted health, work, and socioeconomic conditions worldwide. However, few studies have examined work ability in disadvantaged urban communities during this period. To analyze factors associated with work ability within the context of social vulnerability during the COVID-19 pandemic, we conducted a cross-sectional study in a low-income neighborhood in Salvador, Brazil, between February and June 2022. Sociodemographic, health, and labor data were collected, and work ability was assessed using the Work Ability Index (WAI), a widely used tool for evaluating work ability. Multivariable analyses based on a hierarchical model were run to investigate factors associated with low WAI scores. The study included 292 workers aged ≥16 years (59.6% women; median age 41 years). Most workers (84.6%) were classified as having adequate work ability based on their WAI scores. Multivariable analyses found that inadequate work ability was more frequent among women (prevalence ratio [PR]: 1.89, 95% confidence interval [CI]: 1.02-3.48), individuals who self-rated their health as moderate/good (PR: 5.91; 95% CI: 1.45-24.05) or poor/very poor (PR: 21.62; 95% CI: 5.14-90.91) compared to those with excellent/very good health, and those reporting diabetes (PR: 2.1; 95% CI: 1.13-3.9). Working >40 hours per week (PR: 0.47; 95% CI: 0.28-0.96) was negatively associated with inadequate work ability, suggesting that individuals with adequate work ability may be selected for longer working hours. A history of COVID-19 was not associated with inadequate work ability. These findings suggest that targeted interventions to improve work ability in low-income communities should prioritize women and workers with chronic health conditions, such as diabetes.Chronic wounds may develop when there is a delay or disturbance in one of the stages of the healing process, presenting challenging financial, clinical, and quality-of-life costs. Therefore, continuous efforts have been made to develop dressings that optimise wound healing. In recent years, nanotechnology has revolutionised wound care, enabling the development of innovative materials with high efficiency that positively impact the healing process. Nanoparticles have been extensively used in wound dressings because of their specific properties, such as a high surface area-to-volume ratio, increased surface reactivity, and improved biocompatibility, representing a unique tissue repair tool. This review article addresses advances in the use of organic nanoparticles in the field of skin regeneration, considering papers published in the last 5 years, and highlighting the effects of this class of materials on the wound healing process. The analysis of the literature shows that the materials being considered are carbon-based and organic materials, including polymeric, cellulosic, lipid, and liposome nanoparticles, which are covered in this review (inorganic nanoparticles are not considered). Furthermore, important aspects to prevent the development of chronic wounds are presented, as well as general characteristics of wounds, the healing process, and their particularities.
This study aimed to compare the perceptions of quality of life (QoL) and mental health among medical students and their peers in other university courses in Brazil through a cross-sectional analysis. We hypothesised that medical students face greater psychological challenges due to the demanding nature of their academic workload. Previous studies have indicated that medical training is associated with a decline in empathy and an increase in stress and anxiety, particularly during the clinical phase, when students face greater exposure to patient care and emotionally demanding experiences. These factors contribute to decreased psychological well-being, highlighting the need for targeted interventions in medical education. To address these challenges, this study investigates the specific impact of medical education on students’ mental health and QoL, aiming to identify potential structural changes that could mitigate these negative outcomes.
A cross-sectional study was conducted in private higher education institutions in Brazil.
Data were collected online via the QuestionPro platform in August 2024, encompassing 32 units located across 14 states and 4 geographic regions in Brazil.
The sample included 10 844 students, 33.7% of whom were enrolled in medicine and 66.3% in other fields (administration, agronomy, agribusiness, systems analysis and development, architecture, architecture and urbanism, biomedicine, computer science, accounting, economics, social communication/advertising and propaganda, law, physical education, nursing, civil engineering, computer engineering, production engineering, electrical engineering, mechatronics engineering, aesthetics and cosmics, pharmacy, physics, physiotherapy, speech, speech therapy, environmental management, commercial management, human resources management, financial management, history, Portuguese-English literature, logistics, marketing, mathematics, veterinary medicine, nutrition, dentistry, pedagogy, management processes, psychology, advertising and propaganda, computer networks, social work, information systems and theology). The inclusion criterion was as follows: regularly enrolled students. The exclusion criteria were refusal to provide consent and incomplete questionnaires.
The margin of error, calculated as 0.9 percentage points at a 95% CI, was based on a population of 74 684 students enrolled in the private institutions participating in the study.
Primary outcomes included QoL assessment via the WHOQOL-Brief Version and a customised questionnaire developed by the researchers. This questionnaire evaluated variables such as inclusion, accessibility, sports practices, adaptation and satisfaction with undergraduate training. Secondary outcomes assessed factors such as risky substance use, academic satisfaction and mental health conditions, including symptoms of anxiety and depression.
Medical students exhibited significant declines in physical QoL (64.5–57.1, p
This study reveals that medical students in Brazil experience a significant decline in QoL and mental health, particularly in the psychological and physical domains, as they progress through their academic journey. The higher prevalence of anxiety, depression and substance use among medical students than among peers in other fields underscores the intense emotional and academic pressures within medical education. These statistically significant findings highlight the critical need for comprehensive mental health support, curriculum adjustments to promote well-being and inclusive institutional policies. Implementing such measures is vital to enhance student welfare and foster resilient future healthcare professionals. Longitudinal research is necessary to assess the long-term impact of these interventions and to further explore systemic inequalities affecting student well-being.
Percutaneous coronary interventions (PCI) have become a cornerstone in the management of acute coronary syndromes (ACS), yet they carry risks of complications like stent thrombosis and reinfarction. Glycoprotein IIb/IIIa inhibitors, particularly tirofiban, have been employed as adjunctive therapies to reduce these risks. Despite its potential benefits, the use of tirofiban remains a subject of debate, with varying recommendations across major clinical guidelines.
We systematically searched five databases from 1 January 1992 to 1 April 2025, including Medline, Embase, Lilacs, Clinicaltrials.org and Cochrane Central Register of Controlled Trials (CENTRAL), in addition to three grey literature databases. Randomised controlled trials and cluster randomised trials investigating the use of intravenous or intracoronary tirofiban in patients with ACS, unstable angina or myocardial infarction were considered for inclusion. Only published studies in English, Portuguese, Spanish and French were included. Data selection and extraction will be performed independently by two researchers, with any inconsistencies resolved with consensus or by consulting a third senior researcher. The risk of bias will be assessed through the risk of bias measurement tool (Rob-2) for interventions and/or cluster trials by two researchers independently, and the overall certainty of evidence will be assessed by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. A meta-analysis will be carried out if there is sufficient homogeneity between studies, with subgroup analysis being performed if significant heterogeneity is detected. Additionally, a metaregression model will be conducted if sufficient data are available.
As this study involves secondary analysis of published data, ethics approval is not required. The results will be disseminated through peer-reviewed publication, conference presentations and will be shared with relevant clinical guideline committees.
CRD42024585252.
In Brazil, previous research has highlighted that clinical teachers have little interest in teaching palliative care to undergraduate medical students and there is a need to obtain greater understanding of the reasons for this disinterest.
Our objective was to explore the challenges experienced by Brazilian clinical teachers responsible for palliative care in undergraduate medical education.
A qualitative exploratory study using semistructured interviews and analysed by thematic analysis. A total of six teachers responsible for teaching palliative care to medical students in the state of São Paulo, Brazil, were recruited. Interviews were conducted via video conferencing.
Four themes were identified from the data: (1) conflicting ideals on clinical care, (2) teaching in palliative care: from the possible to the ideal, (3) missed teaching opportunities in palliative care and (4) challenges of palliative care in the health system. The main challenge of teaching palliative care was the lack of understanding of the concept and importance of palliative care within the healthcare system.
Challenges in teaching palliative care in Brazil include limited understanding of its importance, conflicting clinical care perspectives and emotional discomfort. Targeted strategies are recommended to prepare clinical teachers, integrate palliative care into curricula and address systemic barriers in similar low and middle income contexts.
To provide evidence of the cost savings of a quality improvement (QI) initiative preventing healthcare-associated infections (HAIs) in critical care settings.
A micro-costing study focused on financial data related to a nationwide multicentric project preventing central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI).
Brazilian public healthcare system.
Adult, paediatric and neonatal intensive care units (ICUs) participating in the QI initiative.
This collaborative QI project implemented a multifaceted strategy to enhance infection-control measures. Participating ICUs reported the number of patients with and without HAIs and information on each HAI’s aggregate average cost (AC), which was analysed following the Brazilian Ministry of Health’s micro-costing guidelines. The 1-year preintervention period evidenced an aggregated AC in adult, paediatric and neonatal ICUs, respectively, of Intl$21 763.5 (95% CI 20 683.6 to 22 843.0), Intl$34 062.4 (95% CI 25 819.6 to 42 304.9) and Intl$32 903.2 (95% CI 29 203.6 to 36 602.4) for CLABSI; Intl$25 202.5 (95% CI 24 276.6 to 26 127.8), Intl$44 753.6 and Intl$17 238.4 for VAP and Intl$19 166.3 (95% CI 17 676.2 to 20 656.1) and Intl$55 873.3 (95% CI 43 563.1 to 68 183.1) for CAUTI (not included neonatal ICUs).
The cost savings were estimated using the HAIs prevented—expenses avoided—during the QI intervention period from September 2021 to December 2023. The HAIs prevented were estimated using the difference between observed and predicted infections based on the aggregated preintervention baseline.
Of the 188 participating ICUs, 31 voluntarily completed and provided the requested financial data with 100% accuracy. Considering the prevented 7342 HAIs for adult, paediatric and neonatal ICUs, respectively: 1647, 86 and 205 CLABSI; 3775, 114 and 118 VAP; and 1377 and 20 CAUTI, we estimated a saving of Intl$175.3 million (95% CI 153.2 to 180.9 million) to the Brazilian unified health system and a resultant estimated return on investment (ROI) of 890%.
This QI collaborative is a value-based initiative preventing HAIs in adult, paediatric and neonatal ICUs in South American settings. The substantial cost savings and a remarkable ROI underscore the economic viability of investing in comprehensive QI infection prevention strategies.
To determine prognostic factors of disability in multiple sclerosis (MS), that is, (1) identify determinants of the dynamics of disability progression; (2) study the effectiveness of disease-modifying treatments (DMTs); (3) merge determinants and DMTs for creating patient-centred prognostic tools and (4) conduct an economic analysis.
Individuals registered in the French Observatoire Francais de la Sclérose en Plaques (OFSEP) database were included in this OFSEP-high definition cohort if they had a diagnosis of MS, were ≥15 years old and had an Expanded Disability Status Scale (EDSS) score
A cohort of 2842 individuals, 73.4% women, mean (SD) age of 42.7 (11.6) years, median disease duration of 8.8 years, has been recruited from July 2018 to September 2020. The course of MS was relapsing remitting in 67.7%, secondary progressive in 11.9%. The mean annual relapse rate was 0.98. The disease-modifying treatment received was highly effective therapy in 50.3% and moderately effective therapy in 30.7%.
The participants will be followed until December 2026. Disease course up to four landmarks will be examined as predictors of disease progression: (1) diagnosis of MS; (2) relapse activity worsening and independent progression; (3) any recent disease activity and (4) any visit with absence of disease activity in the past 5 years. The marginal effectiveness and tolerability of treatments will be assessed. Stratified algorithms will be proposed for medical decision-making. Economic evaluation of disease cost and cost-effectiveness of new DMTs will be conducted from a public payer perspective.
by Isabela Bittencourt Basso, Pedro Felipe de Jesus Freitas, Aline Xavier Ferraz, Ana Julia Borkovski, Ana Laura Borkovski, Rosane Sampaio Santos, Rodrigo Nunes Rached, Erika Calvano Küchler, Angela Graciela Deliga Schroder, Cristiano Miranda de Araujo, Odilon Guariza-Filho
Characteristics of the mandible structures have been relevant in anthropological and forensic studies for sex prediction. This study aims to evaluate the coronoid process, condyle, and sigmoid notch patterns in sex prediction through supervised machine learning algorithms. Cephalometric radiographs from 410 dental records of patients were screened to investigate the morphology of the coronoid process, condyle, and sigmoid notch and the Co-Gn distance. The following machine learning algorithms were used to build the predictive models: Decision Tree, Gradient Boosting Classifier, K-Nearest Neighbors (KNN), Logistic Regression, Multilayer Perceptron Classifier, Random Forest Classifier, and Support Vector Machine (SVM). A 5-fold cross-validation approach was adopted to validate each model. Metrics such as area under the curve (AUC), accuracy, recall, precision, and F1 Score were calculated for each model, and ROC curves were constructed. All tested variables demonstrated statistical significance (pby Gustavo Ferlini Agne, Kellie Adamson, Leah McGlinchey, Olena Kravchuk, Luiz Santos, John Schumacher
Accuracy of a median nerve block is normally assessed by testing skin sensitivity on the medial and dorsal aspects of fetlock and pastern. The present study evaluated subjective and objective analysis of skin surface temperature obtained with two different infrared (IR) thermography cameras (a high-end [FLIR P640] and a smartphone IR thermography device [FLIR One®]) before and after anaesthesia of the median nerve. Thermographic images were obtained at 0, 30, 60 and 90 minutes after performing a median nerve block with 2% mepivacaine hydrochloride. The subjective analysis of thermographic images using the FLIR P640 camera found assessors had >50% agreement for the presence of a nerve block (pThe evidence on products for the prevention of radiodermatitis is limited. The primary objective was to analyse the effectiveness of the spray skin protectant ‘non-burning barrier film’ in the prevention of radiodermatitis with moist desquamation in patients with the anal canal and rectal cancer followed in nursing consultations compared to a standardised moisturiser based on Calendula officinalis and Aloe barbadensis. Single-blind randomised clinical trial. The study was performed in a hospital in Rio de Janeiro, Brazil, with 63 patients undergoing anal canal and rectal cancer treatment, randomised into one of the following two groups: an experimental group, which used a spray skin protectant and a control group, which used a moisturiser. Data were collected using an initial and subsequent evaluation form and were assessed using descriptive and inferential analyses. Participants who used the spray skin protectant had a lower chance of presenting radiodermatitis with moist desquamation and a longer time without this outcome when compared to the control group. The overall incidence of radiodermatitis was 100%, with 36.5% being severe. Furthermore, 17.5% of participants discontinued radiotherapy due to radiodermatitis. There were no differences between the groups regarding the severity of radiodermatitis and the number of patients who discontinued radiotherapy. The skin protectant was effective in preventing radiodermatitis with moist desquamation amongst patients with anal canal and rectal cancer.
The relationship between pain and poor healing is intricate, potentially mediated by psychological stress and aberrations in inflammatory response. The purpose of this study was to examine the biopsychosocial model of pain by assessing the relationships between pain, stress, inflammation and healing in people with chronic wounds.
This was a 4-week prospective observational study to explore the relationship of pain, stress, inflammation and wound healing in a convenience sample of patients with chronic wounds in a chronic care hospital in Canada.
Only subjects over 18 with chronic wounds were recruited into the study. Chronic wounds were defined by the duration of wounds for more than 4 weeks of various aetiologies including wounds caused by pressure injuries, venous disease, arterial insufficiency, surgery or trauma and diabetic neuropathy. Participants were evaluated for pain by responding to the Brief Pain Inventory-Short Form, the McGill Pain Questionnaire-Short Form and the Leeds Assessment of Neuropathic Symptoms and Signs scale. Stress was measured by the Perceived Stress Scale (PSS). All wounds were assessed with the Pressure Ulcer Scale for Healing tool. The levels of matrix metalloproteinases were analysis by obtaining wound fluid from all participants.
A total of 32 individuals with chronic wounds participated in the study. Correlation analysis indicated pain severity was positively and significantly related to pain interference, McGill Pain Questionnaire scores, neuropathic pain and matrix metalloproteinase levels. Logistic regression was used to determine the predictors for high or low perceived stress. The only significant variable that contributed to the stress levels was BPI-I. Results suggested that participants who experienced higher levels of pain interference also had an increased odds to report high level of stress by 1.6 times controlling for all other factor in the model.
Pain is a complex biopsychosocial phenomenon affecting quality of life in people with chronic wounds. Results of this study identified a significant relationship between pain, stress and wound healing.
FreshRSS 