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Abstract Background Fidelity measurement of implementation strategies is underdeveloped and underreported, and the level of reporting is decreasing over time. Failing to properly measure the factors that affect the delivery of an implementation strategy may obscure the link between a strategy and its outcomes. Barriers to assessing and reporting implementation strategy fidelity among researchers are not well understood. The aims of this qualitative study were to identify barriers to fidelity measurement and pragmatic pathways towards improvement. Methods We conducted in-depth interviews among researchers conducting implementation trials. We utilized a theory-informed interview approach to elicit the barriers and possible solutions to implementation strategy fidelity assessment and reporting. Reflexive-thematic analysis guided coding and memo-writing to determine key themes regarding barriers and solutions. Results Twenty-two implementation researchers were interviewed. Participants agreed that implementation strategy fidelity was an essential element of implementation trials and that its assessment and reporting should improve. Key thematic barriers focused on (1) a current lack of validated fidelity tools with the need to assess fidelity in the short term, (2) the complex nature of some implementation strategies, (3) conceptual complications when assessing fidelity within mechanisms-focused implementation research, and (4) structural issues related to funding and publishing. Researchers also suggested pragmatic solutions to overcome each barrier. Respondents reported using specification and tracking data in the short term until validated tools become available. Participants suggested that researchers with strategy-specific content expertise lead the way in identifying core components and setting fidelity requirements for them. Addressing the third barrier, participants provided examples of what pragmatic prospective and retrospective fidelity assessments might look like along a mechanistic pathway. Finally, researchers described approaches to minimize costs of data collection, as well as more structural accountability like adopting and enforcing reporting guidelines or changing the structure of funding opportunities. Discussion We propose short- and long-term priorities for improving the assessment and reporting of implementation strategy fidelity and the quality of implementation research. Conclusions A better understanding of the barriers to implementation strategy fidelity assessment may pave the way towards pragmatic solutions.

Abstract Background With high rates of HIV and multiple vulnerable subgroups across diverse settings, there is a need for culturally based, HIV stigma reduction interventions. Pregnant women who are living with HIV are especially in need of services to protect not only their own but also their children’s lives. Uptake of HIV services worldwide is hindered by stigma towards persons living with HIV/AIDS. While cultural context plays a key role in shaping HIV stigma, these insights have not yet been fully integrated into stigma reduction strategies. By utilizing the “What Matters Most” stigma framework, we propose that an intervention to counter culturally salient aspects of HIV stigma will improve treatment adherence and other relevant outcomes. A pragmatic clinical trial in Botswana will evaluate the “Mothers Moving towards Empowerment” (MME) intervention, which seeks to address HIV stigma in Botswana and to specifically engage pregnant mothers so as to promote antiretroviral therapy (ART) adherence in the postpartum period. Methods This study will test MME against treatment as usual (TAU) among pregnant mothers diagnosed with HIV and their infants. Outcomes will be assessed during pregnancy and 16 weeks postpartum. Women who meet eligibility criteria are assigned to MME or TAU. Women assigned to MME are grouped with others with similar estimated delivery dates, completing up to eight intervention group sessions scheduled before week 36 of their pregnancies. Primary outcomes among mothers include (i) reducing self-stigma, which is hypothesized to mediate improvements in (ii) psychological outcomes (quality of life, depression and social functioning), and (iii) adherence to antenatal care and ART. We will also examine a set of follow-up infant birth outcomes (APGAR score, preterm delivery, mortality (at

Background: the COVID 19 pandemic causes the death of many people, mainly older adults. Knowing about it is one way to prevent it.Objective: to describe the results of an educational intervention on COVId 19, in older adults.Methods: educational intervention carried out in a universe of 230 older adults, from which a sample of 178 dispensed elderly people belonging to the Family Doctor´s Office No. 4 in Cumanayagua was selected. A diagnosis was made to identify the level of knowledge about COVID-19, in which aspects about the disease were investigated, such as: symptoms, prevention measures, transmission routes. They were also asked about compliance with prevention measures. On that basis, an educational intervention was developed. Results: The 50 % present risk factors; knowledge about symptoms increased from 10.1% before the intervention to 100% after; on transmission routes from 35.9 % to 83.7 % and that of preventive measures from 53.9 % to 91.7 %. They learned to use the mask correctly. The satisfaction of the elderly with the educational actions was high.Conclusions: after the application of educational actions, there was an increase in knowledge about the disease, which may be favorable for its prevention in this group of elderly.

Introduction: Bacteremia is a common but life-threatening infectious disease. However, a well-defined rule to assess patient risk of bacteremia and the urgency of blood culture is lacking. The aim of this study is to establish a predictive model for bacteremia in septic patients using available big data in the emergency department (ED) through logistic regression and other machine learning (ML) methods. Material and Methods: We conducted a retrospective cohort study at the ED of National Cheng Kung University Hospital in Taiwan from January 2015 to December 2019. ED adults (≥18 years old) with systemic inflammatory response syndrome and receiving blood cultures during the ED stay were included. Models I and II were established based on logistic regression, both of which were derived from support vector machine (SVM) and random forest (RF). Net reclassification index was used to determine which model was superior. Results: During the study period, 437,969 patients visited the study ED, and 40,395 patients were enrolled. Patients diagnosed with bacteremia accounted for 7.7% of the cohort. The area under the receiver operating curve (AUROC) in models I and II was 0.729 (95% CI, 0.718–0.740) and 0.731 (95% CI, 0.721–0.742), with Akaike information criterion (AIC) of 16,840 and 16,803, respectively. The performance of model II was superior to that of model I. The AUROC values of models III and IV in the validation dataset were 0.730 (95% CI, 0.713–0.747) and 0.705 (0.688–0.722), respectively. There is no statistical evidence to support that the performance of the model created with logistic regression is superior to those created by SVM and RF. Discussion: The advantage of the SVM or RF model is that the prediction model is more elastic and not limited to a linear relationship. The advantage of the LR model is that it is easy to explain the influence of the independent variable on the response variable. These models could help medical staff identify high-risk patients and prevent unnecessary antibiotic use. The performance of SVM and RF was not inferior to that of logistic regression. Conclusions: We established models that provide discrimination in predicting bacteremia among patients with sepsis. The reported results could inspire researchers to adopt ML in their development of prediction algorithms.

Introdução: O hábito de sucção de chupeta é comum em crianças, sendo este objeto um veículo de contaminação e transmissão de microrganismos causadores de doenças, necessitando, dessa forma, de uma correta desinfecção. Objetivo: Avaliar as práticas de desinfecção de chupetas realizadas pelos responsáveis de crianças que tenham ou que já tiveram o hábito de usar chupeta. Material e Métodos: Após a aprovação ética, foi aplicado questionário semiestruturado (12 questões) a pais e avós de crianças que mantinham o hábito da chupeta ou que o interromperam há no máximo dois anos. As questões versaram sobre hábitos de desinfecção de chupetas, acesso a instrução sobre a desinfecção e a profissionais de saúde, incluindo dentistas. A associação entre variáveis categóricas foi estabelecida pelo teste Qui-quadrado e das variáveis contínuas pela correlação de Pearson. O nível de significância adotado foi de 5%. Resultados: Foram considerados para a amostra 104 questionários. A média de idade dos respondentes foi de 32 anos, sendo a maioria mulheres (91,3%). A idade média das crianças que usaram a chupeta foi de 26 meses. Apesar de água sob fervura ser o método de desinfecção das chupetas mais relatado (35,6%), 15,4% dos respondentes relataram usar apenas água corrente. Além disso, apenas 20,2% dos respondentes receberam alguma instrução de profissionais de saúde sobre a desinfecção, e somente 29,8% relataram já ter levado a criança ao dentista. A associação entre a frequência de desinfecção de chupetas e a frequência de ida ao cirurgião-dentista apresentou significância estatística. Conclusão: O conhecimento por pais e familiares sobre a desinfecção de chupetas não se mostrou adequado neste estudo. Tal fato pode estar relacionado à falta de acesso à informação, por meio de profissionais de saúde.

Introduction: Head and neck neoplasms represent 17.6% worldwide. Cancer of the oral cavity is one of the most common that appear in this region, being 95% epidermoid carcinoma with a poor prognosis of survival because they develop from premalignant lesions dangerously asymptomatic, the reason why the precocious detection is imperative. Objective: Characterize potentially malignant oral disorders through epidemiological, clinical and topographical aspects in adults served at the Montalvo health subcenter. Methods: A descriptive and cross-sectional study was conducted on 99 patients treated at the Montalvo health subcentre in Ambato, Ecuador, from November 2012 to January 2013. The data were collected in the stomatological medical history, which included: general data, interrogation and physical examination of the oral cavity. The potentially malignant oral disorders considered were leukoplakia, erythroleukoplakia, erythroplasia and the palate of the inverted smoker. The descriptive statistic and the Sperman chi square statisticwast were applied. It was worked with confidentiality in the handling of the data obtained and with the authorization corresponding to the consent.. Results: Patients over 60 years of age accounted for the most affected age group for 60.6%, with a female predominance (54.5%). The skin color did not make a significant difference. The most common disorder was leukoplakia (30%), followed by erythroleukoplakia (15%) erythroplasia (11%). 75.8% of patients had no symptoms, however 73% of injured cases had physical trauma. The most common location of leukoplakia was the mucosa of the cheek and the base of the tongue. Conclusion: Leukoplakia, erythroleukoplakia and erythroplasia were the most common potentially malignant oral disorders, most commonly located at the base of the tongue and mucosa of the carrillo, with predominance in patients over 60 years of age and in patients over 60 years of age and in Women.

Introdução: A disfunção temporomandibular (DTM) representa uma das principais causas de dor na região orofacial. A dimensão vertical de oclusão (DVO) refere-se à posição vertical da mandíbula em relação à maxila e seu restabelecimento correto é essencial nas reabilitações protéticas, pois variações deste parâmetro podem influenciar negativamente os quadros de DTM. Objetivo: Avaliar a presença de disfunção temporomandibular em pacientes portadores de prótese total e sua possível associação com a redução de dimensão vertical de oclusão. Material e Métodos: A amostra foi composta de 31 pacientes voluntários, com idades entre 42 e 87 anos, de ambos os sexos, sendo portadores de prótese total, atendidos na Clínica de Prótese Total Removível da Faculdade de Odontologia da Universidade Federal de Juiz de Fora. A análise da redução de DVO foi realizada através dos testes métrico, estético e fonético e o diagnóstico de DTM foi estabelecido a partir do Eixo I do RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders). Os dados foram tabulados e submetidos à análise estatística descritiva no programa pelo SPSS (Statistical Package for the Social Science) versão 15.0 para Windows. Para comparação das variáveis categóricas entre os grupos de DTM ​ foi utilizado o teste Qui-quadrado com nível de significância admitido de 5% (p0,05).

Aim: To determine parent´s perceptions and concerns about inhaled therapy and their relation to disease control. Methods: A questionnaire was applied by interviewing parents of 119 asthmatic children attending the Pediatric Allergy or Pneumology outpatient clinic. Results: Eighty-one (68%) parents expressed concerns and worries about the use of inhaled therapy in their children, either with controlled or partially/uncontrolled asthma (65% Vs 78% p=0.22). Regarding their beliefs about inhaled therapy, 11% (n=13) stated that they considered pMDI’s/DPI’s less effective than nebulizers. When questioned about the knowledge of their child's acute exacerbation therapy, 91.5% (n=109) reported knowing it, albeit only 40% (n=44) did answer it correctly. Nine parents said they were unaware of their children’s reliever treatment. Discussion: We expected to find parental concerns about inhaled therapy, but such a high percentage wasn´t expected. A substantial number of parents believe that their children can become addicted or dependent on the use of the inhaler. This finding reinforces the misconceptions parents do have regarding inhaled therapy. There is a higher proportion of parents with concerns in the group with partially/uncontrolled asthma, although it was not statistically significant. The majority of patients/parents reported knowing the reliever plan in an exacerbation, although most of them could not explain the plan correctly. These results are worrying, as they show parents have an inappropriate knowledge of reliever measures. Therefore, we suggest that improvements in education about inhaled therapy should be made, including the regular review of the inhalation technique and the reliever plan in every consultation.

La axotomía de un nervio periférico conduce a la interrupción de la continuidad del axón, con degeneración walleriana en el segmento distal de la neurona. El proceso postraumático del nervio lesiona el axón y su vaina de mielina y el material dañado es invadido por fagocitos hematógenos, que remueven con el tiempo la gran mayoría de las fibras de mielina y otras células endoneurales. Este hecho permitió el seguimiento del trayecto nervioso intrapulmonar, después de la sección del tronco vago-simpático cervical en la rata, por la aparición en el proceso degenerativo de productos de desintegración de lípidos de la mielina, teñidos con Sudán III y IV. El objetivo del trabajo fue poner en evidencia y se demostró el trayecto de las fibras autónomas intrapulmonares y su relación con las divisiones más finas de los bronquios respiratorios, por la función que el sistema autónomo tiene en el asma bronquialThe axotomy of a peripheral nerve leads to the interruption of the continuity of the axon with wallerian degeneration in the distal segment of the neuron. The posttraumatic process of the nerve injures the axon and its sheath of myelin and the damaged material is invaded by haematogenous phagocytes that with the course of time remove most of the myelin fibers and other endoneural cells. This fact allowed to follow the nervous intrapulmonary pathway after the section of the vagosympathetic cervical trunk in the rat, due to the appearance in the degenerative process of products of the desintegration of lipids from myelin, stained with Sudan III and IV. The aim of this paper was to show the pathway of the autonomic intrapulmonary fibers and their relationship with the thinnest divisions of the respiratory bronchi, taking into account the function of the autonomic nervous system in bronchial asthma

Spondylodiscitis in childhood is rare and has non-specific clinical features, requiring a high index of suspicion.The authors describe a nine month-old female infant, who presented at the emergency room (ER) with a torticollis for four days, without fever or trauma. Cervical X-rays were normal, and she received symptomatic treatment. Six days after, she returned to the ER with the same torticollis and also irritability, anorexia, and cervical hyper-extension. The CT scan showed cervical spondylodiscitis (C6-C7) with pre-vertebral abscess. The laboratory results only revealed a slightly elevated Sedimentation Rate. Treatment was systemic vancomycin, gentamicin and metronidazol for six weeks, followed by two weeks of oral flucloxacillin. The causative organism was not identified. The symptoms and the abscess resolved during the first week of treatment. Five days after finishing the antibiotics the magnetic resonance showed partial C6-C7 fusion, without neurologic compression or functional disability.Cervical spondylodiscitis with abscess is rare, especially in this age group. This case also emphasizes the importance of investigating an acquired persistent torticollis.

Bexiga neurogênica é o termo utilizado para designar a disfunção vesical decorrente de uma lesão do sistema nervoso, cuja causa pode ser congênita ou adquirida. Sua terapêutica consiste em diferentes técnicas, porém todas têm como principal objetivo preservar a função renal e prevenir o aparecimento de lesões na região perianal. O intuito deste trabalho é reconhecer o hábito urinário do portador de bexiga neurogênica através do diário miccional, na tentativa de estabelecer a melhor conduta de reeducação da função vesical. A metodologia empregada foi a revisão de literatura específica sobre disfunção miccional de origem neurogênica. Observa-se que o diário miccional é um método investigativo simples, barato e de extrema importância para caracterizar o hábito miccional do paciente, permitindo ao enfermeiro estabelecer a terapia mais adequada em relação ao tipo de bexiga e às necessidades de cada indivíduo. Desta forma, pode-se obter a adesão ao tratamento, impedir as possíveis complicações e promover o desenvolvimento da autonomia do paciente. É papel do profissional de saúde, em especial do enfermeiro, garantir qualidade de vida e a reintegração social dessaspessoas.