Escala de actitudes frente al uso de alcohol : describiendo sus parámetros psicométricos

Este estudo objetivou conhecer evidências de validade e consistência interna da Escala de Atitudes frente ao Uso de Álcool (EAFUA). Participaram 259 estudantes universitários de João Pessoa, com idade média de 21 anos, a maioria mulheres (65,6%), que responderam perguntas demográficas e preencheram a EAFUA. Esta é composta por quatro adjetivos bipolares (positivo/negativo; gosto/desgosto; bom/ruim e desejável/indesejável), respondidos em escala de 9 pontos (-4 a +4). Uma análise de componentes principais indicou um componente geral que explicou 82,3% da variância total; seu alfa de Cronbach foi 0,93. A análise fatorial confirmatória reuniu índices de ajuste adequados para essa medida, corroborando sua estrutura unidimensional. Observaram-se diferenças de gênero nessa medida, que foi mais fortemente correlacionada com o uso de álcool (validade convergente) do que com o uso de maconha (validade discriminante). Esses resultados apóiam a adequação da EAFUA, portanto, esta poderá ser utilizada para conhecer o grau de favorabilidade ao uso de álcool entre adultos jovens.This study aimed at knowing the evidences of validity and reliability of the attitudes toward the Alcohol Use Scale (ATAUS). The participants were 259 undergraduate students from João Pessoa, 21 years old average, most of them female (65.6%). They answered to demographic questions and filled the ATAUS, composed by four bipolar adjectives (positive-negative, like-dislike, good-nasty, and desirable-undesirable) rating in a scale of 9-points (-4 to +4). One component was observed according to the principal component analysis, accounting for 82.3% of the total variance, with Cronbach s alpha of 0.93. Confirmatory factor analysis revealed adequate fit indexes, corroborating its one-factor structure. Moreover, it was observed the gender difference in the ATAUS scores, and this measure was positively and more strongly correlated with the alcohol use (convergent validity) than with the marijuana use (discriminant validity). These findings support the psychometric adequacy of the ATAUS. Thus, it can be used in future studies to assess the degree of favorability toward alcohol among young adults.Este estudio tuvo como objetivo conocer evidencias de validez y consistencia interna de la Escala de Actitudes frente al Uso de Alcohol (EAFUA). Participaron 259 estudiantes universitarios de João Pessoa, con edad Media de 21 años, la mayoría mujeres (65,6%), que contestaron a las preguntas demográficas y rellenaron la EAFUA. Ésta está compuesta por cuatro adjetivos bipolares (positivo/negativo; gusto/disgusto; bueno/malo y deseable/indeseable), contestados en escala de 9 puntos (-4 a +4). Un análisis de componentes principales indicó un componente general que explicó 82,3% de la variancia total; su alfa de Cronbach fue 0,93. El análisis factorial confirmatorio reunió índices de ajuste adecuados para esa medida, corroborando su estructura unidimensional. Se observaron diferencias de género en esa medida, que fue más fuertemente correlacionada con el uso de alcohol (validez convergente) de lo que con el uso de marihuana (validez discriminante). Esos resultados apoyan la adecuación de la EAFUA, por tanto, ésta podrá ser utilizada para conocer el grado de favorabilidad al uso de alcohol entre adultos jóvenes

Efetividade do GeneXpert® no diagnóstico da tuberculose em pessoas que vivem com HIV/aids

OBJECTIVE To identify and synthesize the scientific knowledge produced regarding the effectiveness of the GeneXpert test in the diagnosis of pulmonary tuberculosis (TB) in people living with HIV/AIDS. METHODS Integrative literature review, which was searched on Embase, Scopus, PubMed, Cinahl, Academic Search Premier, Socindex, and LILACS platforms, in December 2019. The studies surveyed went through two stages of selection: reading of titles and abstracts by two reviewers independently; using the Rayyan platform and reading. Nineteen primary studies in English, Portuguese, and Spanish that answered the study’s guiding question were included: How effective is the GeneXpert test in the diagnosis of pulmonary TB in people living with HIV/AIDS? RESULTS The use of GeneXpert substantially increased the detection of TB cases among the population co-infected with HIV/AIDS, with sensitivity ranging from 68% to 100%, superior to sputum smear microscopy. Specificity ranged from 91.7% to 100%; the positive predictive value from 79.2% to 96.1%; and the negative predictive value from 84.6% to 99.3%. These values were considered similar to sputum smear microscopy by most studies. We also compared these results with different ways of performing culture and other molecular tests, being considered inferior only to the Xpert Ultra. CONCLUSION It is possible to affirm that places with a high incidence of HIV/AIDS would benefit from the implementation of the GeneXpert test, entailing effectiveness in diagnosing pulmonary TB in this population when compared to sputum smear microscopy, a widely used test for detection of cases.OBJETIVO Identificar e sintetizar o conhecimento científico produzido a respeito da efetividade do teste GeneXpert no diagnóstico da tuberculose (TB) pulmonar em pessoas vivendo com HIV/aids. MÉTODOS Revisão integrativa da literatura, cuja busca foi feita nas plataformas Embase, Scopus, PubMed, Cinahl, Academic Search Premier, Socindex e Lilacs, em dezembro de 2019. Os estudos levantados passaram por duas etapas de seleção: leitura dos títulos e resumos por dois revisores de forma independente, utilizando a plataforma Rayyan e leitura integral dos mesmos. Foram incluídos 19 estudos primários em inglês, português e espanhol que respondiam à pergunta norteadora do estudo: Qual é a efetividade do teste GeneXpert no diagnóstico da TB pulmonar em pessoas que vivem com HIV/aids? RESULTADOS A utilização do GeneXpert aumentou substancialmente a detecção de casos de TB entre a população coinfectada com HIV, com sensibilidade que variou de 68% a 100%, sendo superior à baciloscopia. A especificidade variou de 91,7% a 100%; o valor preditivo positivo, de 79,2% a 96,1%; e o valor preditivo negativo, de 84,6% a 99,3%, valores considerados semelhantes à baciloscopia pela maioria dos estudos. O teste também foi comparado com as diferentes formas de realização da cultura e outros testes moleculares, sendo considerado inferior apenas ao Xpert Ultra. CONCLUSÃO É possível afirmar que locais com alta incidência de HIV se beneficiariam com a implantação do teste GeneXpert, uma vez que sua efetividade no diagnóstico da TB pulmonar nessa população é expressiva quando comparada à baciloscopia, teste que foi por muito tempo amplamente utilizado para a detecção dos casos

PATOLOGIA DO QUADRIL DAS CRIANÇAS: UMA REVISÃO INTEGRATIVA

Many of the pathologies that affect the hip in adults have their origins in childhood, making the early diagnosis of these conditions through specific pediatric orthopedic evaluation extremely important. Research shows that late diagnoses are associated with a considerable increase in the number of sequelae. This article consists of an integrative review, which aims to analyze and discuss the main hip pathologies in children, in order to expand the knowledge of students and professionals in the area about the subject in question. The work consists of an integrative literature review, in which a basic, qualitative, exploratory and bibliographic research was carried out in the databases. Hip pathology in children is a field of medical study and treatment that encompasses a variety of conditions and problems that affect the hip joint in younger individuals. These conditions can range from congenital problems to disorders acquired over time. It is critical to understand that healthy hip development is crucial for children's mobility and quality of life, and any issues in this area must be addressed with care and attention. In summary, hip pathologies in children encompass a variety of conditions, from developmental dysplasia of the hip to proximal epiphysis of the femur. Early diagnosis and adequate treatment are essential to avoid complications and long-term sequelae.Muitas das patologias que afetam o quadril de adultos têm suas origens na infância, tornando o diagnóstico precoce dessas condições por meio de avaliação ortopédica pediátrica específica de extrema importância. Pesquisas demonstram que diagnósticos tardios estão associados a um aumento considerável no número de sequelas. O presente artigo consiste em uma revisão integrativa, no qual tem como objetivo analisar e discutir acerca das principais patologias de quadril das crianças, no intuito de ampliar os conhecimentos de estudantes e profissionais da área acerca do tema em questão. O trabalho consiste em uma revisão de literatura do tipo integrativa, na qual foi realizada uma pesquisa dos tipos básica, qualitativa, exploratória e bibliográfica, nas bases de dados. A patologia do quadril em crianças é um campo de estudo e tratamento médico que abrange uma variedade de condições e problemas que afetam a articulação do quadril em indivíduos mais jovens. Essas condições podem variar desde problemas congênitos até distúrbios adquiridos ao longo do tempo. É fundamental entender que o desenvolvimento saudável do quadril é crucial para a mobilidade e a qualidade de vida das crianças e qualquer problema nessa área deve ser abordado com cuidado e atenção. Em suma, as patologias do quadril em crianças abrangem uma variedade de condições, desde a displasia do desenvolvimento do quadril até a epifisiólise proximal do fêmur. O diagnóstico precoce e o tratamento adequado são fundamentais para evitar complicações e sequelas a longo prazo

Manual Hippocampal Subfield Segmentation Using High-Field MRI: Impact of Different Subfields in Hippocampal Volume Loss of Temporal Lobe Epilepsy Patients

In patients with temporal lobe epilepsy (TLE), presurgical magnetic resonance imaging (MRI) often reveals hippocampal atrophy, while neuropathological assessment indicates the different types of hippocampal sclerosis (HS). Different HS types are not discriminated in MRI so far. We aimed to define the volume of each hippocampal subfield on MRI manually and to compare automatic and manual segmentations for the discrimination of HS types. The T2-weighted images from 14 formalin-fixed age-matched control hippocampi were obtained with 4.7T MRI to evaluate the volume of each subfield at the anatomical level of the hippocampal head, body, and tail. Formalin-fixed coronal sections at the level of the body of 14 control cases, as well as tissue samples from 24 TLE patients, were imaged with a similar high-resolution sequence at 3T. Presurgical three-dimensional (3D) T1-weighted images from TLE went through a FreeSurfer 6.0 hippocampal subfield automatic assessment. The manual delineation with the 4.7T MRI was identified using Luxol Fast Blue stained 10-μm-thin microscopy slides, collected at every millimeter. An additional section at the level of the body from controls and TLE cases was submitted to NeuN immunohistochemistry for neuronal density estimation. All TLE cases were classified according to the International League Against Epilepsy's (ILAE's) HS classification. Manual volumetry in controls revealed that the dentate gyrus (DG)+CA4 region, CA1, and subiculum accounted for almost 90% of the hippocampal volume. The manual 3T volumetry showed that all TLE patients with type 1 HS (TLE-HS1) had lower volumes for DG+CA4, CA2, and CA1, whereas those TLE patients with HS type 2 (TLE-HS2) had lower volumes only in CA1 (p ≤ 0.038). Neuronal cell densities always decreased in CA4, CA3, CA2, and CA1 of TLE-HS1 but only in CA1 of TLE-HS2 (p ≤ 0.003). In addition, TLE-HS2 had a higher volume (p = 0.016) and higher neuronal density (p < 0.001) than the TLE-HS1 in DG + CA4. Automatic segmentation failed to match the manual or histological findings and was unable to differentiate TLE-HS1 from TLE-HS2. Total hippocampal volume correlated with DG+CA4 and CA1 volumes and neuronal density. For the first time, we also identified subfield-specific pathology patterns in the manual evaluation of volumetric MRI scans, showing the importance of manual segmentation to assess subfield-specific pathology patterns

Comparative complete scheme and booster effectiveness of COVID‐19 vaccines in preventing SARS‐CoV‐2 infections with SARS‐CoV‐2 Omicron (BA.1) and Delta (B.1.617.2) variants: A case–case study based on electronic health records

Background: Information on vaccine effectiveness in a context of novel variants of concern (VOC) emergence is of key importance to inform public health policies. This study aimed to estimate a measure of comparative vaccine effectiveness between Omicron (BA.1) and Delta (B.1.617.2 and sub-lineages) VOC according to vaccination exposure (primary or booster). Methods: We developed a case–case study using data on RT-PCR SARS-CoV2-positive cases notified in Portugal during Weeks 49–51, 2021. To obtain measure of comparative vaccine effectiveness, we compared the odds of vaccination in Omicron cases versus Delta using logistic regression adjusted for age group, sex, region, week of diagnosis, and laboratory of origin. Results: Higher odds of vaccination were observed in cases infected by Omicron VOC compared with Delta VOC cases for both complete primary vaccination (odds ratio [OR] = 2.1; 95% confidence interval [CI]: 1.8 to 2.4) and booster dose (OR = 5.2; 95% CI: 3.1 to 8.8), equivalent to reduction of vaccine effectiveness from 44.7% and 92.8%, observed against infection with Delta, to 6.0% (95% CI: 29.2% to 12.7%) and 62.7% (95% CI: 35.7% to 77.9%), observed against infection with Omicron, for complete primary vaccination and booster dose, respectively. Conclusion: Consistent reduction in vaccine-induced protection against infection with Omicron was observed. Complete primary vaccination may not be protective against SARS-CoV-2 infection in regions where Omicron variant is dominant.Grant no. 2021/PHF/23776; POCI-01-0145-FEDER-022184; Project ALG-D2-2021-06info:eu-repo/semantics/publishedVersio

Brazilian consensus on the treatment of fibromyalgia

UNIFESP Ambulatório de FibromialgiaUFPR HC ambulatório de fibromialgiaUNIFESPUNIFESP Setor de reumatismos de partes molesPUC-SP Departamento de MedicinaPUC-Campinas Hospital Universitário Serviço de ReumatologiaSociedade Brasileira de ReumatologiaSanta Casa de Belo Horizonte Ambulatório de Fibromialgia Programa de Residência Médica em ReumatologiaFMUSP HC Serviço de ReumatologiaSanta Casa de Campo Grande Setor de Reumatologia programa de Residência em Clínica MédicaUniversidade Federal de Ciências da Saúde de Porto AlegreUNiSULUniversidade Federal do Espírito Santo Hospital Universitário serviço de ReumatologiaSociedade Brasileira de Clínica MédicaSociedade Brasileira para o Estudo da DorAssociação Brasileira de Medicina Física e ReabilitaçãoUniversidade de São Paulo Faculdade de MedicinaUniversidade Federal FluminenseAcademia Brasileira de Neurologia Departamento de DorEuropean Neurological Society Subcomitê de DorPeripheral Nerve SocietyFMUSP Grupo de MãoSociedade Brasileira de ortopedia e TraumatologiaAxia.Bio farmacoeconomia e pesquisa em saúdeUNIFESP Núcleo de Gestão de PesquisasUNIFESP, Ambulatório de FibromialgiaUNIFESP, Setor de reumatismos de partes molesUNIFESP, Núcleo de Gestão de PesquisasSciEL

Beyond trees: Mapping total aboveground biomass density in the Brazilian savanna using high-density UAV-lidar data

Tropical savanna ecosystems play a major role in the seasonality of the global carbon cycle. However, their ability to store and sequester carbon is uncertain due to combined and intermingling effects of anthropogenic activities and climate change, which impact wildfire regimes and vegetation dynamics. Accurate measurements of tropical savanna vegetation aboveground biomass (AGB) over broad spatial scales are crucial to achieve effective carbon emission mitigation strategies. UAV-lidar is a new remote sensing technology that can enable rapid 3-D mapping of structure and related AGB in tropical savanna ecosystems. This study aimed to assess the capability of high-density UAV-lidar to estimate and map total (tree, shrubs, and surface layers) aboveground biomass density (AGBt) in the Brazilian Savanna (Cerrado). Five ordinary least square regression models esti-mating AGBt were adjusted using 50 field sample plots (30 m × 30 m). The best model was selected under Akaike Information Criterion, adjusted coefficient of determination (adj.R2), absolute and relative root mean square error (RMSE), and used to map AGBt from UAV-lidar data collected over 1,854 ha spanning the three major vegetation formations (forest, savanna, and grassland) in Cerrado. The model using vegetation height and cover was the most effective, with an overall model adj-R2 of 0.79 and a leave-one-out cross-validated RMSE of 19.11 Mg/ha (33.40%). The uncertainty and errors of our estimations were assessed for each vegetation formation separately, resulting in RMSEs of 27.08 Mg/ha (25.99%) for forests, 17.76 Mg/ha (43.96%) for savannas, and 7.72 Mg/ha (44.92%) for grasslands. These results prove the feasibility and potential of the UAV-lidar technology in Cerrado but also emphasize the need for further developing the estimation of biomass in grasslands, of high importance in the characterization of the global carbon balance and for supporting integrated fire management activities in tropical savanna ecosystems. Our results serve as a benchmark for future studies aiming to generate accurate biomass maps and provide baseline data for efficient management of fire and predicted climate change impacts on tropical savanna ecosystems

First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation

OBJECTIVES: The aim of this manuscript is to describe the first year of our experience using extracorporeal membrane oxygenation support. METHODS: Ten patients with severe refractory hypoxemia, two with associated severe cardiovascular failure, were supported using venous-venous extracorporeal membrane oxygenation (eight patients) or veno-arterial extracorporeal membrane oxygenation (two patients). RESULTS: The median age of the patients was 31 yr (range 14-71 yr). Their median simplified acute physiological score three (SAPS3) was 94 (range 84-118), and they had a median expected mortality of 95% (range 87-99%). Community-acquired pneumonia was the most common diagnosis (50%), followed by P. jiroveci pneumonia in two patients with AIDS (20%). Six patients were transferred from other ICUs during extracorporeal membrane oxygenation support, three of whom were transferred between ICUs within the hospital (30%), two by ambulance (20%) and one by helicopter (10%). Only one patient (10%) was anticoagulated with heparin throughout extracorporeal membrane oxygenation support. Eighty percent of patients required continuous venous-venous hemofiltration. Three patients (30%) developed persistent hypoxemia, which was corrected using higher positive end-expiratory pressure, higher inspired oxygen fractions, recruitment maneuvers, and nitric oxide. The median time on extracorporeal membrane oxygenation support was five (range 3-32) days. The median length of the hospital stay was 31 (range 3-97) days. Four patients (40%) survived to 60 days, and they were free from renal replacement therapy and oxygen support. CONCLUSIONS: The use of extracorporeal membrane oxygenation support in severely ill patients is possible in the presence of a structured team. Efforts must be made to recognize the necessity of extracorporeal respiratory support at an early stage and to prompt activation of the extracorporeal membrane oxygenation team