FATORES QUE INFLUENCIAM A ADESÃO DA TERAPIA ANTIRRETROVIRAL (TARV)

The scope of the present work is to report the factors that influence adherence to antiretroviral therapy (TARV) and to propose strategies for the young population living with HIV. This is an integrative review, in which a search was made for studies published in the form of an article between the years 2016 to 2021. As inclusion criteria, articles were sought that deal with the following themes: I) HIV; II) AIDS; III) HIV infections; IV) Antiretroviral therapy; V) Adherence to treatment; VI) Immunosuppression; and VII) Anti-HIV Antibodies, published in Portuguese, English or Spanish and available in full text. It was observed that, in the year 2020, 27.5 million infected people received the medication. However, in individuals up to 14 years old it was shown that only 54% received it, against the global rate of 73%. Without treatment, the risk of morbidity and mortality increases, quality of life is lost, psychiatric conditions develop and costs for the health system increase. The adversities for effective treatment are the strictness of taking the medication, as well as the complex list of medication doses and their side effects; Cultural, psychological and personal issues also interfere negatively in the treatment. In conclusion, in order to address these issues and increase the young population in treatment, the incentive for self-care and reduction of socioeconomic and cultural interference, it is necessary to create clinics adapted to the adolescent public with their demands met and adherence groups where there is sharing of experiences with each other.El objetivo del presente estudio es informar los factores que influyen en el adeforefactor de la terapia antirretroviral (TARV) y proponer estrategias para la población joven que vive con el VIH. Se trata de una revisión integradora, en la que se realizó una búsqueda de estudios publicados en forma de artículo entre los años 2016 y 2021. Como criterios de inclusión, se buscaron artículos que trataran los siguientes temas: I) VIH; II) SIDA; III) Infecciones por VIH; IV) Terapia antirretroviral; V) Adherencia al tratamiento; VI) Inmunosupresión; e VII) Anticuerpos contra el VIH, publicados en portugués, español o inglés y disponibles en forma de texto completo. Se observó que en 2020, 27,5 millones de personas infectadas recibieron el medicamento. Sin embargo, en individuos de hasta 14 años de edad se demostró que solo el 54% lo recibió, contra la tasa general del 73%. Sin tratamiento, el riesgo de morbilidad y mortalidad aumenta, se pierde la calidad de vida, se desarrollan afecciones psiquiátricas y aumentan los costos para el sistema de salud. Entre las adversidades para un tratamiento efectivo está el rigor de tomar el medicamento, así como la compleja lista de dosis de medicamentos y sus efectos secundarios; Los problemas culturales, psicológicos y personales también provienen de la intervención negativa en el tratamiento. Se concluye que, para suplir estos temas y aumentar el subtratamiento de la población joven, el incentivo para el autocuidado y la reducción de la injerencia socioeconómica y cultural, es necesario crear clínicas adaptadas al público.O escopo do presente trabalho é relatar os fatores que influenciam a adesão da terapia antirretroviral (TARV) e propor estratégias para a população jovem convivendo com o HIV. Trata-se de uma revisão integrativa, na qual foi feita uma busca por estudos publicados na forma de artigo entre os anos de 2016 a 2021. Como critérios de inclusão, buscaram-se artigos que tratam das temáticas: I) HIV; II) AIDS; III) Infecções por HIV; IV) Terapia antiretroviral; V) Adesão ao tratamento; VI) Imunossupressão; e VII) Anticorpos Anti-HIV, publicados em língua portuguesa, inglesa ou espanhola e disponíveis na forma de texto completo. Observou-se que, no ano de 2020, 27,5 milhões de pessoas infectadas receberam a medicação. Entretanto, em indivíduos até 14 anos foi mostrado que apenas 54% a receberam, contra a taxa global de 73%. Sem o tratamento, aumenta-se o risco de morbimortalidade, perde-se qualidade de vida, desenvolve-se quadros psiquiátricos e o consequente aumento dos custos para o sistema de saúde. Dentre as adversidades para o tratamento de forma efetiva está a rigorosidade da tomada do medicamento, bem como a complexa lista de doses medicamentosas e seus efeitos colaterais; questões culturais, psicológicas e pessoais também vem por intervir negativamente no tratamento. Conclui-se que, para suprir essas questões e aumentar a população jovem em tratamento, o incentivo para o autocuidado e redução da interferência socioeconômica e cultural, é necessário a criação de clínicas adaptadas para o público adolescentes com suas demandas atendidas e de grupos de adesão onde haja compartilhamento de experiências entre si

FATORES QUE INFLUENCIAM A ADESÃO DA TERAPIA ANTIRRETROVIRAL (TARV)

The scope of the present work is to report the factors that influence adherence to antiretroviral therapy (TARV) and to propose strategies for the young population living with HIV. This is an integrative review, in which a search was made for studies published in the form of an article between the years 2016 to 2021. As inclusion criteria, articles were sought that deal with the following themes: I) HIV; II) AIDS; III) HIV infections; IV) Antiretroviral therapy; V) Adherence to treatment; VI) Immunosuppression; and VII) Anti-HIV Antibodies, published in Portuguese, English or Spanish and available in full text. It was observed that, in the year 2020, 27.5 million infected people received the medication. However, in individuals up to 14 years old it was shown that only 54% received it, against the global rate of 73%. Without treatment, the risk of morbidity and mortality increases, quality of life is lost, psychiatric conditions develop and costs for the health system increase. The adversities for effective treatment are the strictness of taking the medication, as well as the complex list of medication doses and their side effects; Cultural, psychological and personal issues also interfere negatively in the treatment. In conclusion, in order to address these issues and increase the young population in treatment, the incentive for self-care and reduction of socioeconomic and cultural interference, it is necessary to create clinics adapted to the adolescent public with their demands met and adherence groups where there is sharing of experiences with each other.El objetivo del presente estudio es informar los factores que influyen en el adeforefactor de la terapia antirretroviral (TARV) y proponer estrategias para la población joven que vive con el VIH. Se trata de una revisión integradora, en la que se realizó una búsqueda de estudios publicados en forma de artículo entre los años 2016 y 2021. Como criterios de inclusión, se buscaron artículos que trataran los siguientes temas: I) VIH; II) SIDA; III) Infecciones por VIH; IV) Terapia antirretroviral; V) Adherencia al tratamiento; VI) Inmunosupresión; e VII) Anticuerpos contra el VIH, publicados en portugués, español o inglés y disponibles en forma de texto completo. Se observó que en 2020, 27,5 millones de personas infectadas recibieron el medicamento. Sin embargo, en individuos de hasta 14 años de edad se demostró que solo el 54% lo recibió, contra la tasa general del 73%. Sin tratamiento, el riesgo de morbilidad y mortalidad aumenta, se pierde la calidad de vida, se desarrollan afecciones psiquiátricas y aumentan los costos para el sistema de salud. Entre las adversidades para un tratamiento efectivo está el rigor de tomar el medicamento, así como la compleja lista de dosis de medicamentos y sus efectos secundarios; Los problemas culturales, psicológicos y personales también provienen de la intervención negativa en el tratamiento. Se concluye que, para suplir estos temas y aumentar el subtratamiento de la población joven, el incentivo para el autocuidado y la reducción de la injerencia socioeconómica y cultural, es necesario crear clínicas adaptadas al público.O escopo do presente trabalho é relatar os fatores que influenciam a adesão da terapia antirretroviral (TARV) e propor estratégias para a população jovem convivendo com o HIV. Trata-se de uma revisão integrativa, na qual foi feita uma busca por estudos publicados na forma de artigo entre os anos de 2016 a 2021. Como critérios de inclusão, buscaram-se artigos que tratam das temáticas: I) HIV; II) AIDS; III) Infecções por HIV; IV) Terapia antiretroviral; V) Adesão ao tratamento; VI) Imunossupressão; e VII) Anticorpos Anti-HIV, publicados em língua portuguesa, inglesa ou espanhola e disponíveis na forma de texto completo. Observou-se que, no ano de 2020, 27,5 milhões de pessoas infectadas receberam a medicação. Entretanto, em indivíduos até 14 anos foi mostrado que apenas 54% a receberam, contra a taxa global de 73%. Sem o tratamento, aumenta-se o risco de morbimortalidade, perde-se qualidade de vida, desenvolve-se quadros psiquiátricos e o consequente aumento dos custos para o sistema de saúde. Dentre as adversidades para o tratamento de forma efetiva está a rigorosidade da tomada do medicamento, bem como a complexa lista de doses medicamentosas e seus efeitos colaterais; questões culturais, psicológicas e pessoais também vem por intervir negativamente no tratamento. Conclui-se que, para suprir essas questões e aumentar a população jovem em tratamento, o incentivo para o autocuidado e redução da interferência socioeconômica e cultural, é necessário a criação de clínicas adaptadas para o público adolescentes com suas demandas atendidas e de grupos de adesão onde haja compartilhamento de experiências entre si

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

La renovación de la palabra en el bicentenario de la Argentina : los colores de la mirada lingüística

El libro reúne trabajos en los que se exponen resultados de investigaciones presentadas por investigadores de Argentina, Chile, Brasil, España, Italia y Alemania en el XII Congreso de la Sociedad Argentina de Lingüística (SAL), Bicentenario: la renovación de la palabra, realizado en Mendoza, Argentina, entre el 6 y el 9 de abril de 2010. Las temáticas abordadas en los 167 capítulos muestran las grandes líneas de investigación que se desarrollan fundamentalmente en nuestro país, pero también en los otros países mencionados arriba, y señalan además las áreas que recién se inician, con poca tradición en nuestro país y que deberían fomentarse. Los trabajos aquí publicados se enmarcan dentro de las siguientes disciplinas y/o campos de investigación: Fonología, Sintaxis, Semántica y Pragmática, Lingüística Cognitiva, Análisis del Discurso, Psicolingüística, Adquisición de la Lengua, Sociolingüística y Dialectología, Didáctica de la lengua, Lingüística Aplicada, Lingüística Computacional, Historia de la Lengua y la Lingüística, Lenguas Aborígenes, Filosofía del Lenguaje, Lexicología y Terminología

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Community mental health care network: an evaluative approach in a Brazilian state

Abstract In recent decades, public policies of the Unified Health System (SUS) in Brazil have structured a community mental health care network (RAPS) based on various community actions and services. This study carried out evaluative research on the implementation of the structure and process dimensions of this care network in Minas Gerais, the second most populous state of Brazil, generating indicators that can enhance the strategic management of the public health system in the strengthening the psychosocial care in the state. The application of a multidimensional instrument, previously validated (IMAI-RAPS), in 795 of the 853 municipalities in Minas Gerais was carried out between June and August 2020. Regarding the structural dimension, we noticed an adequate implementation of services like ‘Family Health Strategy,’ ‘Expanded Family Health Center,’ and ‘Psychosocial Care Centers’ but a lack of ‘Beds in General Hospitals’ destinated to mental health care, ‘Unified Electronic Medical Records’ and ‘Mental Health Training Activities for Professionals.’ In the process dimension, adequate implementation of actions such as ‘Multidisciplinary and Joint Care,’ ‘Assistance to Common Mental Disorders by Primary Health Care,’ ‘Management of Psychiatric Crises in Psychosocial Care Centers,’ ‘Offer of Health Promotion Actions,’ and ‘Discussion of Cases by Mental Health Teams’ point to a form of work consistent with the guidelines. However, we detected difficulties in the implementation of ‘Psychosocial Rehabilitation Actions,’ ‘Productive Inclusion,’ ‘User Protagonism,’ ‘Network Integration,’ and practical activities for the effectiveness of collaborative care. We found a better implementation of the mental health care network in more populous, demographically dense, and socioeconomically developed cities, which shows the importance of regional sharing of services that are not possible for small cities. The evaluation practices of mental health care networks are scarce throughout the Brazilian territory, a fact also found in Minas Gerais, highlighting the need for its expansion not only in the scientific sphere but also in the daily life of the various levels of management

Complete genome sequence of the sugarcane nitrogen-fixing endophyte gluconacetobacter diazotrophicus PAL5

17 p. : il.Background: Gluconacetobacter diazotrophicus Pal5 is an endophytic diazotrophic bacterium that lives in association with sugarcane plants. It has important biotechnological features such as nitrogen fixation, plant growth promotion, sugar metabolism pathways, secretion of organic acids, synthesis of auxin and the occurrence of bacteriocins. Results: Gluconacetobacter diazotrophicus Pal5 is the third diazotrophic endophytic bacterium to be completely sequenced. Its genome is composed of a 3.9 Mb chromosome and 2 plasmids of 16.6 and 38.8 kb, respectively. We annotated 3,938 coding sequences which reveal several characteristics related to the endophytic lifestyle such as nitrogen fixation, plant growth promotion, sugar metabolism, transport systems, synthesis of auxin and the occurrence of bacteriocins. Genomic analysis identified a core component of 894 genes shared with phylogenetically related bacteria. Gene clusters for gum-like polysaccharide biosynthesis, tad pilus, quorum sensing, for modulation of plant growth by indole acetic acid and mechanisms involved in tolerance to acidic conditions were identified and may be related to the sugarcane endophytic and plant-growth promoting traits of G. diazotrophicus. An accessory component of at least 851 genes distributed in genome islands was identified, and was most likely acquired by horizontal gene transfer. This portion of the genome has likely contributed to adaptation to the plant habitat. Conclusion: The genome data offer an important resource of information that can be used to manipulate plant/bacterium interactions with the aim of improving sugarcane crop production and other biotechnological applications

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology