a generalised hierarchical analysis

Funding Information: This work was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brazil, ID: 88881.187327/2018–01 . Publisher Copyright: © 2021 The Author(s) Copyright: Copyright 2021 Elsevier B.V., All rights reserved.Background: We characterise the loss to follow-up (locally termed abandoned) of tuberculosis treatment with individual and ecological health determinants and to identify the predictive capacity of these risk factors. Methods: A cohort study with individual and ecological characterisation of patients diagnosed with tuberculosis in Sergipe/Brazil from 2015 to 2018 with either loss to follow-up or completion of treatment as a therapeutic outcome was performed. The examined variables were based on the social determinants of health with descriptive analysis, binary logistic regression, a generalised hierarchical model and graphical presentation using a nomogram. Results: The loss to follow-up accounted for 18.21% of the 2,449 studied cases. The characteristics revealed that the highest abandonment percentages were people who: were male (20.0%), had black skin colour (20.3%), were aged 20–39 years (21.8%), had 4–7 years of schooling (23.6%), re-entered treatment after abandonment (36.5%), used alcohol (31.0%), used drugs (39.3%), were smokers (26.5%) and were homeless (55.4%). The ecological characteristics showed that individuals living in municipalities with a high human development index (HDI; odds ratio [OR]: 1.91) and high-income inequality (OR: 1.81) had a greater chance of not finishing the treatment. Most of these variables were identified as predictors in the generalised hierarchical model; the receiver operating characteristic curve (ROC) curve had 0.771 precision and 84.0% accuracy. Conclusion: The group of identified characteristics influenced the loss to follow-up of tuberculosis treatment. This data provides evidence for the early identification of individuals who are at greater risk of abandoning tuberculosis treatment.publishersversionpublishe

Metric measurements and attachment levels of the medial patellofemoral ligament: an anatomical study in cadavers

OBJECTIVE: To determine the metric measurements and to verify the attachment levels of the medial patellofemoral ligament in human cadavers. METHODS: Seventeen knees (eight right and nine left knees) from 10 cadavers (nine male and one female) were dissected and stored in a 10% formaldehyde solution. All of the knees were whole and did not show any macroscopic signs of injuries. RESULTS: The medial patellofemoral ligament was present in 88% of the knees studied, localized transversally between the medial femoral epicondyle and the medial margin of the patella. Its dimensions were quite variable, even between the knees of the same individual. The width of the patellar insertion ranged from 16 to 38.8 mm, with a mean of 27.90 mm, and its mean length was 55.67 mm. The margins of the ligament were concave or rectilinear. At the upper margin, the concave form predominated and was better characterized, while at the lower margin, the rectilinear form predominated. CONCLUSIONS: The medial patellofemoral ligament is a very distinct structure with variable anatomical aspects and is always located in a plane inferior to the vastus medialis obliquus muscle

In hospital care for diabetic foot: a comparison between the estimated cost and the SUS reimbursement

This study aimed to analyze costs for treating patients with diabetic foot cared by the public Brazilian Health System (SUS), comparing the estimated cost with the amount of SUS reimbursement. A cohort prospective study carried out in hospitals that provide services for the Unified Health System in Sergipe, involving 109 hospitalization episodes of patients with diabetes and foot ulcers. We follow these patients day by day and estimated the hospital direct cost and the SUS reimbursement. All patients had type 2 diabetes and the majority of ulcers (64,2%) were classified as Wagner 4 or 5. Forty-three (39,4%) healed without amputation and fifty-two (47,7%) healed with amputation. Fourteen (12,8%) patients died. Hospital direct cost ranged from R$943.72 to R$ 16,378.85; with an average of R$4,461.04. The SUS reimbursement varied from R$ 96.95 to R$2,410.18, with an average of R$ 633.97, usually seven times low. Smaller difference between costs occurred in patients from the Beneficent hospital and higher rates occurred in those treated with minor amputation.Foram seguidas 109 internações de pacientes com diabetes e ulcerações nos pés na rede do Sistema Único de Saúde (SUS) em Sergipe, com o objetivo de estimar o custo direto hospitalar e comparar com os valores do desembolso do SUS. Os dados foram coletados desde a admissão até a alta ou o óbito dos casos incluídos, sendo anotadas as características clínicas dos pacientes e os desfechos das internações. Foram calculados o custo direto estimado e o desembolso do SUS. Todos eram portadores de diabetes tipo 2 e a maioria das ulcerações (64,2%) foram classificadas como Wagner 4 ou 5. Evoluíram com alta sem amputação 43 pacientes (39,4%) e 52 (47,7%) com alta após amputação. Evoluíram para óbito 14 pacientes (12,8%). O custo estimado variou de R$943,72 a R$ 16.378,85, com média de R$4.461,04. O valor do desembolso do SUS variou de R$ 96,95 a R$2.410,18, com média de R$ 633,97, cerca de sete vezes inferior. As menores defasagens entre os custos ocorreram nos pacientes assistidos no Hospital Beneficente e as maiores naqueles tratados com amputações menores.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo (UNIFESP)Centro Paulista de Economia da SaúdeUNIFESPSciEL

Metric measurements and attachment levels of the medial patellofemoral ligament: an anatomical study in cadavers

OBJECTIVE: To determine the metric measurements and to verify the attachment levels of the medial patellofemoral ligament in human cadavers. METHODS: Seventeen knees (eight right and nine left knees) from 10 cadavers (nine male and one female) were dissected and stored in a 10% formaldehyde solution. All of the knees were whole and did not show any macroscopic signs of injuries. RESULTS: The medial patellofemoral ligament was present in 88% of the knees studied, localized transversally between the medial femoral epicondyle and the medial margin of the patella. Its dimensions were quite variable, even between the knees of the same individual. The width of the patellar insertion ranged from 16 to 38.8 mm, with a mean of 27.90 mm, and its mean length was 55.67 mm. The margins of the ligament were concave or rectilinear. At the upper margin, the concave form predominated and was better characterized, while at the lower margin, the rectilinear form predominated. CONCLUSIONS: The medial patellofemoral ligament is a very distinct structure with variable anatomical aspects and is always located in a plane inferior to the vastus medialis obliquus muscle

Predisposing factors for amputation of lower extremities in diabetic patients with foot ulceration in the state of Sergipe

OBJECTIVE: To determine the predisposing factors for amputation of lower limbs in diabetic patients with foot ulceration. METHODS: The research was carried out in hospitals, and all diabetic patients with foot ulceration were included. Amputation was studied in relation to age, sex, previous amputation, number of ulcers, time of diagnosis of diabetes mellitus, time of ulceration, average number of days in hospital, Wagner's classification, and presence of foot pulse. RESULTS: We verified that 55% (44/80) of the patients progressed to some type of amputation of the lower limbs; mean age was 61 years, but the occurrence of amputation was significantly higher in the age group between 60 and 90 years (P = 0.03). We did not observe a significant variation in the following variables: time of diagnosis of diabetes, time of ulceration, and hospitalization time in relation to the group of patients who were amputated. Nevertheless, the most severe lesions, when evaluated by Wagner's classification (P <0.001) and by the absence of both distal pulses (P <0.001) of lower limbs, turned out to be very significant in relation to the amputation outcome. CONCLUSION: The severity of lesions, the absence of pulse and age over 60 years were considered predisposing factors for amputation in these patients.OBJETIVO: Determinar os fatores predisponentes para a amputação de membros inferiores nos doentes internados com diabetes melito e úlceras nos pés. MÉTODOS: Foram acompanhados os pacientes diabéticos com úlceras nos pés internados no período de 6 meses e analisadas as amputações nesses doentes em relação à idade, sexo, amputação prévia, número de ulcerações, tempo de diagnóstico do diabete, tempo de ulceração, tempo médio de internação, gravidade das lesões, presença de pulso. RESULTADOS: Verificou-se que 55% (44/80) dos doentes evoluíram para algum tipo de amputação de membros inferiores; a mediana das idades foi de 61 anos, porém a ocorrência de amputação foi significativamente maior na faixa etária dos 60 aos 90 anos (P = 0,03). Não se observou uma variação significativa da mediana do tempo de diagnóstico do diabetes, do tempo de ulceração e do tempo médio de internação em relação ao grupo de pacientes que foram amputados. Entretanto, as lesões mais graves, quando avaliadas pela classificação de Wagner (P <0,001) e pela ausência de detecção dos dois pulsos distais (P <0,001) dos membros inferiores, revelaram-se bastante significativas com relação ao desfecho de amputação. CONCLUSÃO: Foram considerados fatores predisponentes para a ocorrência de amputação nesses doentes a gravidade das lesões, a ausência de pulsos e as idades acima de 60 anos.Universidade TiradentesUniversidade Federal de Sergipe Departamento de MedicinaFundação Universitária de Ciências da Saúde de Alagoas Departamento de Medicina SocialEscola de Ciências Médicas de Alagoas Fundação Universitária de Ciências da Saúde de Alagoas Departamento de Clínica CirúrgicaUniversidade Federal de São Paulo (UNIFESP) Departamento de CirurgiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, Depto. de CirurgiaUNIFESP, EPMSciEL

Nível de conhecimento dos estudantes de medicina sobre dispositivos intrauterinos na Universidade Federal de Sergipe / Knwoledge level of medicine students on intrauterine devices in the Federal University of Sergipe

Objetivo: o presente estudo objetivou descrever o conhecimento dos estudantes de medicina da Universidade Federal de Sergipe (UFS) sobre os dispositivos intrauterinos (DIUs); reconhecer o método contraceptivo de primeira escolha para indicação entre os estudantes e identificar diferenças de acordo com o ano de curso. Métodos: foi realizado estudo descritivo observacional transversal por meio de questionário, com perguntas objetivas e assertivas sobre pontos-chave no entendimento dos DIUs que foram julgadas como verdadeiras ou falsas pelos estudantes. Questionários com 4 ou mais afirmativas julgadas corretamente foram considerados como satisfatórios. Os questionários foram aplicados no Hospital Universitário da UFS. Para a análise inferencial, a avaliação das variáveis categóricas foi realizada através do teste Qui-quadrado ou do Teste Exato de Fisher. A avaliação das variáveis numéricas entre dois grupos foi realizada através do teste de t de Student e entre mais de dois grupos com ANOVA, seguido do pós-teste de Tukey. O nível de significância foi estabelecido em 0.05. Resultados: participaram do estudo 219 alunos dos três últimos anos de Medicina, com idade média de 24,5 ± 3,79 anos de idade e sendo 122 (55,70%) participantes masculinos e 97 (44,29%) femininos. Entre os anos de curso, foram 64 (29,22%) do quarto ano, 89 (40,63%) do quinto e 66 (30,13%) do sexto. A grande maioria dos alunos – 214 (98%) – referiu conhecer os DIUs e 216 (99%) também demonstrou conhecimento satisfatório sobre o método. Na comparação das respostas a cada item, houve diferença estatística apenas em relação ao item A (p=0,017). O quarto ano teve mais respostas incorretas, quando comparado aos demais (30%, 12% e 15%). Não houve diferença significativa nas escolhas de métodos a se prescrever, tanto na comparação entre sexos como entre anos. Conclusões: conclui-se, portanto, que a grande maioria dos estudantes conhece os DIUs e apresenta conhecimento satisfatório sobre o método

Checklist of the dipterofauna (Insecta) from Roraima, Brazil, with special reference to the Brazilian Ecological Station of Maracá

Roraima is a Brazilian state located in the northern portion of the Amazon basin, with few studies regarding its biodiversity. The Ecological Station of Maracá (Brazil, state of Roraima) harbors the third largest Brazilian pluvial island and is composed of a transitional landscape of savanna and Amazon rainforest components. Despite its ecological importance and strategic localization, few studies covered the dipterofauna of this locality. An updated checklist addressing 41 families of true flies (Diptera) occurring in Roraima is presented based on the literature and the specimens collected during a field expedition that occurred in 2015. This checklist brings several improvements such as new records of 165 taxa to the state of Roraima, 29 taxa to Brazil, and 259 morphotypes, mostly likely representing undescribed species

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