Perception of Medical Students Regarding Implementing Telemedicine Practice Activities at a University Center in Brazil

Objective: evaluate medical students' perceptions regarding implementing Telemedicine teaching during their undergraduate studies. Methods: this is a cross-sectional qualitative study with 30 medical students. Three focus group sessions were conducted, and the data were analyzed using a content analysis approach. Results/Discussion: the students recognized the importance of digital health strategies and digital information and communication technologies (ICTs) for the healthcare ecosystem. However, some students pointed out that this area is still challenging for some doctors who oppose Telemedicine. They reported a need for training professionals and students, emphasizing the need to improve skills and competencies for teleconsultation and other Telemedicine modalities. They stated that these experiences helped them enhance their empathy skills for establishing a good doctor-patient relationship. When referring to the negative aspects of the experiences, they mentioned the dependence on reliable internet connection and digital tools. Another limitation mentioned was the difficulty in conducting specific physical examination components. Conclusions: the students experienced Telemedicine activities in a safe healthcare environment, learning about the bioethical principles for responsible teleconsultations, understanding the limiting factors of the method, and having the opportunity to improve skills and competencies for their future professional practice.Objective: evaluate medical students' perceptions regarding implementing Telemedicine teaching during their undergraduate studies. Methods: this is a cross-sectional qualitative study with 30 medical students. Three focus group sessions were conducted, and the data were analyzed using a content analysis approach. Results/Discussion: the students recognized the importance of digital health strategies and digital information and communication technologies (ICTs) for the healthcare ecosystem. However, some students pointed out that this area is still challenging for some doctors who oppose Telemedicine. They reported a need for training professionals and students, emphasizing the need to improve skills and competencies for teleconsultation and other Telemedicine modalities. They stated that these experiences helped them enhance their empathy skills for establishing a good doctor-patient relationship. When referring to the negative aspects of the experiences, they mentioned the dependence on reliable internet connection and digital tools. Another limitation mentioned was the difficulty in conducting specific physical examination components. Conclusions: the students experienced Telemedicine activities in a safe healthcare environment, learning about the bioethical principles for responsible teleconsultations, understanding the limiting factors of the method, and having the opportunity to improve skills and competencies for their future professional practice

ABORDAGEM NA EMERGÊNCIA OBSTÉTRICA E SEUS FATORES CLÍNICOS COM EVIDÊNCIAS EM VIOLÊNCIA OBSTÉTRICA: REVISÃO DE LITERATURA

Obstetric violence is an important public health problem and is also an approach to major obstetric emergencies. It is defined as actions aimed at girls' sexual and reproductive health by professionals who work in the health sector or health services. The objective of this study was to analyze the consequences of obstetric violence in the lives of postpartum women under one year of age. This is a qualitative, basic, analytical descriptive study, carried out in a municipality in the interior of the state of Bahia. Semi-structured interviews were carried out with 8 girls who gave birth within a year and were undergoing treatment in a basic health unit. The data was subjected to thematic content analysis. After analysis, the results revealed four empirical categories: experiences with prenatal care; Childbirth experience Awareness and knowledge about violence during childbirth. consequences of obstetric violence in girls' lives These results show the need to promote educational strategies and discussion on the topic of obstetric violence with pregnant women and health professionals. This is due to a lack of preparation and violation of the basic rights of pregnant girls. It is necessary to draw attention to the problem, not only to emphasize it to girls who have suffered or may suffer violence during childbirth, but also to promote in some way the humanization of the prenatal, prenatal, natal and postnatal period.A violência obstetrícia é um importante problema de saúde pública e também entra como uma abordagem dentro das grandes emergências obstétricas. É definida como ações voltadas à saúde sexual e reprodutiva das meninas por profissionais que atuam no setor saúde ou nos serviços de saúde. O objetivo deste estudo foi analisar as consequências da violência obstetrícia na vida de puérperas menores de um ano. Trata-se de um estudo qualitativo, básico, descritivo analítico, realizado em um município do interior do estado da Bahia. Foram realizadas entrevistas semiestruturadas com 8 meninas que deram à luz no período de um ano e estavam em tratamento em uma unidade básica de saúde. Os dados foram submetidos à análise de conteúdo temática. Após análise Os resultados evidenciaram quatro categorias empíricas: experiências com o pré-natal; Experiência de parto Conscientização e conhecimento sobre violência no parto. consequências da violência obstetrícia na vida das meninas Esses resultados mostram a necessidade de promover estratégias educacionais e discussão sobre o tema da violência obstetrícia com gestantes e profissionais de saúde. Isto se deve à falta de preparação e à violação dos direitos básicos das meninas grávidas. É necessário chamar a atenção para o problema enfatizá-lo não apenas às meninas que sofreram ou poderão sofrer violência durante o parto, mas também promover de alguma forma a humanização do período pré-natal, pré-natal, natal e pós-natal

SAÚDE PRIMÁRIA E PREVENÇÃO DE DSTS: COMO A ATENÇÃO BÁSICA PODE TRANSFORMAR A SAÚDE SEXUAL E REPRODUTIVA

Introduction: Primary Health Care (PHC) is an essential model in the health system, focusing on health promotion and disease prevention, including combating Sexually Transmitted Diseases (STDs). In the context of sexual and reproductive health, PHC is a crucial strategy to improve access and awareness of the population about STD prevention, promoting safe sexual behaviors and early detection of infections, such as HIV. Therefore, this study aims to explore how Primary Health Care can transform sexual and reproductive health, reducing the incidence of STDs and promoting health equity. Methodology: This study used a methodology of bibliographic research and analysis of epidemiological data. Scientific articles published in the last ten years in databases such as PubMed and Google Scholar were selected, focusing on the relationship between primary care and STD prevention. Additionally, data were collected through DATASUS. Results: The data collected reveal that, although HIV notifications in Brazil remain significant, there has been a decrease in infection rates in recent years, possibly due to prevention and awareness-raising actions by PHC, such as the provision of rapid testing and the distribution of condoms. Final Considerations: Primary Health Care has proven to be a pillar in the promotion of sexual and reproductive health and in the prevention of STDs, especially in vulnerable populations. In order to effectively address the problem, it is essential to expand educational programs, strengthen the training of health professionals and ensure that public policies support a robust and accessible care structure.Introdução: A Atenção Primária à Saúde (APS) é um modelo essencial no sistema de saúde, com foco na promoção da saúde e na prevenção de doenças, incluindo o combate às Doenças Sexualmente Transmissíveis (DSTs). No contexto da saúde sexual e reprodutiva, a APS é uma estratégia crucial para melhorar o acesso e a conscientização da população sobre a prevenção de DSTs, promovendo comportamentos sexuais seguros e a detecção precoce de infecções, como o HIV. Diante disso, o presente estudo visa explorar como a Atenção Básica pode transformar a saúde sexual e reprodutiva, reduzindo a incidência de DSTs e promovendo a equidade em saúde. Metodologia: Este estudo utilizou uma metodologia de pesquisa bibliográfica e análise de dados epidemiológicos. Foram selecionados artigos científicos publicados nos últimos dez anos em bases como PubMed e Google Scholar, com foco na relação entre atenção básica e prevenção de DSTs. Adicionalmente, foram coletados dados através do DATASUS, Resultados: Os dados coletados revelam que, embora as notificações de HIV no Brasil permaneçam significativas, houve uma diminuição nas taxas de infecção nos últimos anos, possivelmente devido às ações de prevenção e conscientização da APS, como a oferta de testagens rápidas e a distribuição de preservativos. Considerações Finais: A Atenção Primária à Saúde tem se mostrado um pilar na promoção da saúde sexual e reprodutiva e na prevenção de DSTs, sobretudo em populações vulneráveis. Para um enfrentamento efetivo, é essencial ampliar os programas educativos, fortalecer a capacitação dos profissionais de saúde e garantir que as políticas públicas sustentem uma estrutura robusta e acessível de atendimento

O impacto do excesso de tempo de tela na primeira infância e sua relação com a predisposição ao autismo

Considerando o aumento do tempo de exposição de crianças a dispositivos eletrônicos e as preocupações sobre seus impactos no desenvolvimento infantil, discute-se a possibilidade de o tempo excessivo de tela atuar como um fator de risco para o Transtorno do Espectro Autista (TEA) ou intensificar sintomas já existentes. Objetiva-se analisar a relação entre tempo de tela e TEA, explorando hipóteses neurobiológicas, impactos cognitivos e sociais, além de avaliar se há evidências científicas que sustentam uma relação causal ou apenas uma correlação entre esses fatores. Para tanto, procede-se a uma revisão narrativa da literatura científica, contemplando estudos publicados em bases como PubMed, SciELO, WHO, American Academy of Pediatrics (AAP) e Brazilian Journal of Health Review. Desse modo, observa-se que, embora o uso excessivo de telas possa comprometer o desenvolvimento da linguagem, a interação social e a regulação emocional, não há consenso na literatura sobre sua relação causal com o TEA. O que permite concluir que o tempo de tela pode atuar como um fator agravante de sintomas em crianças predispostas, mas não como um determinante direto para o desenvolvimento do transtorno

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: a pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial

Background: Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB. Methods: We nested a two-period, fixed-order pharmacokinetic substudy within the open-label, multicentre, randomised, controlled, non-inferiority ODYSSEY trial at research centres in South Africa, Uganda, and Zimbabwe. Children (aged 4 weeks to <18 years) with HIV-associated TB who were receiving rifampicin and twice-daily dolutegravir were eligible for inclusion. We did a 12-h pharmacokinetic profile on rifampicin and twice-daily dolutegravir and a 24-h profile on once-daily dolutegravir. Geometric mean ratios for trough plasma concentration (Ctrough), area under the plasma concentration time curve from 0 h to 24 h after dosing (AUC0–24 h), and maximum plasma concentration (Cmax) were used to compare dolutegravir concentrations between substudy days. We assessed rifampicin Cmax on the first substudy day. All children within ODYSSEY with HIV-associated TB who received rifampicin and twice-daily dolutegravir were included in the safety analysis. We described adverse events reported from starting twice-daily dolutegravir to 30 days after returning to once-daily dolutegravir. This trial is registered with ClinicalTrials.gov (NCT02259127), EudraCT (2014–002632-14), and the ISRCTN registry (ISRCTN91737921). Findings: Between Sept 20, 2016, and June 28, 2021, 37 children with HIV-associated TB (median age 11·9 years [range 0·4–17·6], 19 [51%] were female and 18 [49%] were male, 36 [97%] in Africa and one [3%] in Thailand) received rifampicin with twice-daily dolutegravir and were included in the safety analysis. 20 (54%) of 37 children enrolled in the pharmacokinetic substudy, 14 of whom contributed at least one evaluable pharmacokinetic curve for dolutegravir, including 12 who had within-participant comparisons. Geometric mean ratios for rifampicin and twice-daily dolutegravir versus once-daily dolutegravir were 1·51 (90% CI 1·08–2·11) for Ctrough, 1·23 (0·99–1·53) for AUC0–24 h, and 0·94 (0·76–1·16) for Cmax. Individual dolutegravir Ctrough concentrations were higher than the 90% effective concentration (ie, 0·32 mg/L) in all children receiving rifampicin and twice-daily dolutegravir. Of 18 children with evaluable rifampicin concentrations, 15 (83%) had a Cmax of less than the optimal target concentration of 8 mg/L. Rifampicin geometric mean Cmax was 5·1 mg/L (coefficient of variation 71%). During a median follow-up of 31 weeks (IQR 30–40), 15 grade 3 or higher adverse events occurred among 11 (30%) of 37 children, ten serious adverse events occurred among eight (22%) children, including two deaths (one tuberculosis-related death, one death due to traumatic injury); no adverse events, including deaths, were considered related to dolutegravir. Interpretation: Twice-daily dolutegravir was shown to be safe and sufficient to overcome the rifampicin enzyme-inducing effect in children, and could provide a practical ART option for children with HIV-associated TB

Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial

BACKGROUND: Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS: This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS: Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124–159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION: The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir

Observation of γγ → ττ in proton-proton collisions and limits on the anomalous electromagnetic moments of the τ lepton

The production of a pair of τ leptons via photon–photon fusion, γγ → ττ, is observed for the f irst time in proton–proton collisions, with a significance of 5.3 standard deviations. This observation is based on a data set recorded with the CMS detector at the LHC at a center-of-mass energy of 13 TeV and corresponding to an integrated luminosity of 138 fb−1. Events with a pair of τ leptons produced via photon–photon fusion are selected by requiring them to be back-to-back in the azimuthal direction and to have a minimum number of charged hadrons associated with their production vertex. The τ leptons are reconstructed in their leptonic and hadronic decay modes. The measured fiducial cross section of γγ → ττ is σfid obs = 12.4+3.8 −3.1 fb. Constraints are set on the contributions to the anomalous magnetic moment (aτ) and electric dipole moments (dτ) of the τ lepton originating from potential effects of new physics on the γττ vertex: aτ = 0.0009+0.0032 −0.0031 and |dτ| &lt; 2.9×10−17ecm (95% confidence level), consistent with the standard model

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data