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COVID-19 is a global public health crisis, which in addition to making victims is changing the living habits of the population. The objective of this study was to investigate the impacts of social isolation on the physical and mental health of older adults and to learn how they are informing themselves about the pandemic. It is a qualitative study with a phenomenological basis, composed by telephone interviews with 35 older adults (70,5 ± 4,7 years) of both genders, members of a Brazilian University of Third Age, during the period of the pandemic. The testimonies revealed a considerable degree of concern about the possibility of being infected by the virus, increased anxiety due to tragic news, the growing number of deaths, the collapse of the Brazilian economy and the rising unemployment rate. The group reported sleep disorders, joint pain, loss of appetite, weight loss, and reduced functional capacity. Everyone felt sufficiently informed about COVID-19. The main means of gaining information about the pandemic was radio, followed by TV, dialogue with family and friends, and WhatsApp. Only 30% of the participants used WhatsApp, praised because of its multiple functions and the ability to re-read the news.

This descriptive paper presents the model of the Brazilian Universities of the Third Age (U3A). In a country with 208 million inhabitants and accelerated population aging, U3A's set of regular courses, lectures, workshops and group dynamics serve as a low-cost and high-efficacy strategy that promotes lifelong education and social integration. Although their conceptual basis has been inherited from their European counterparts, over the years, Brazilian U3As have developed their own model of functioning, by adapting already existing methodologies and creating new ones matching with the needs and interests of the Brazilian older adults, in accordance with their physical and financial resources. One unique feature of the Brazilian model of U3A is the wide and diverse offer of sports and leisure activities, which is generally under the responsibility of the Physical Education courses of federal, state or private universities. Having physical activity promotion as a key element goes beyond transfer and exchange of knowledge as it also encourages active and healthy aging in a more holistic approach. Thus, in the Brazilian context, the U3A play an important role in the social and economic development of the country.

Background: Brazil is one of the countries with the highest rates of caesarean sections (CS), reaching almost 90% of births in the private sector. A quality improvement project called "Adequate Childbirth Project (PPA)" was conceived to reduce CS in the private sector. This project consisted of four primary components: "Governance", "Participation of Women", "Reorganization of Care" and "Monitoring". This paper aims to evaluate: (1) which specific activities of the PPA had the largest effect on the probability of a woman having a vaginal delivery; (2) which primary component of the PPA had the largest effect on the probability of vaginal delivery and (3) which scenarios combining the implementation of different activities planned in the PPA had a higher effect on the probability of vaginal delivery. Methods: A sample of 12 private hospitals participating in the PPA was evaluated. We used a Bayesian Network (BN) to capture both non-linearities and complex cause-effect relations. The BN integrated knowledge from experts and data from women to estimate 26 model parameters. The PPA was evaluated in 2473 women belonging to groups 1–4 of the Robson classification, who were divided into two groups: those participating or not participating in the PPA. Results: The probability of a woman having a vaginal delivery was 37.7% higher in women participating in the PPA. The most important component of the project that led to an increase in the probability of vaginal delivery was "Reorganization of Care", leading to a 73% probability of vaginal delivery among women in labor. The activity that had the greatest effect on the type of delivery was access to best practices during labor, with a 72% probability of vaginal delivery. Considering the 12 scenarios combining the different activities of the PPA, the best scenarios included: a non-scheduled delivery, access to information about best practices, access to at least 4 best practices during labor and respect of the birth plan, with an 80% probability of vaginal delivery in the best combinations. Conclusion: PPA has been shown to be an effective quality improvement program, increasing the likelihood of vaginal delivery in private Brazilian hospitals. Plain English Summary: Introduction: Brazil boasts one of the highest rates of caesarean sections (CS) globally, with nearly 90% of births in private facilities being delivered via CS. In response, the 'Adequate Childbirth Project – PPA' was launched as a quality improvement initiative aimed at curbing CS rates in private healthcare. Its goal is to improve the quality of childbirth and reduce the number of CS in private healthcare. The project has four main parts: 'Governance', 'Participation of Women', 'Reorganization of Care', and 'Monitoring'. Method: an evaluative study was conducted across 12 private hospitals involved in the PPA, involving 2473 women who were categorized into PPA participants and non-participants. They used a method called a cause-effect network to see which parts of the PPA helped more women have vaginal deliveries. Results: They found that women in the PPA were 37.7% more likely to have a vaginal delivery. Giving women access to good practices during labor and birth was really important. Also, 'Reorganization of Care' was the most important part of the project. It led to a 73% chance of vaginal delivery for women in labor. Conclusion: The PPA is effective in helping more women in private hospitals have vaginal deliveries. This means it's a good program for improving childbirth in Brazil's private hospitals. [ABSTRACT FROM AUTHOR]

Background: Brazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project ("Projeto Parto Adequado"- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication. This research aims to evaluate the implementation of PPA in private hospitals in Brazil. Method: Evaluative hospital-based survey, carried out in 2017, in 12 private hospitals, including 4,322 women. We used a Bayesian network strategy to develop a theoretical model for implementation analysis. We estimated and compared the degree of implementation of two major driving components of PPA—"Participation of women" and "Reorganization of care" – among the 12 hospitals and according to type of hospital (belonging to a health insurance company or not). To assess whether the degree of implementation was correlated with the rate of vaginal birth data we used the Bayesian Network and compared the difference between the group "Exposed to the PPA model of care" and the group "Standard of care model". Results: PPA had a low degree of implementation in both components "Reorganization of Care" (0.17 – 0.32) and "Participation of Women" (0.21 – 0.34). The combined implementation score was 0.39–0.64 and was higher in hospitals that belonged to a health insurance company. The vaginal birth rate was higher in hospitals with a higher degree of implementation of PPA. Conclusion: The degree of implementation of PPA was low, which reflects the difficulties in changing childbirth care practices. Nevertheless, PPA increased vaginal birth rates in private hospitals with higher implementation scores. PPA is an ongoing quality improvement project and these results demonstrate the need for changes in the involvement of women and the care offered by the provider. [ABSTRACT FROM AUTHOR]

Incorrect postural habits developed already at an early age are predictors of low back pain and functional limitations in adult life. Postural education programs (PEPs) are activities developed in Physical Education classes with the aim of promoting healthy habits. One tool used by PEPs is comics. The objective of this study was to develop comics and apply them as a teaching tool in PEPs for students aged seven to ten years. The procedures were based on individual empowerment principles, including creation activities, reading, painting, crosswords, and discussion of comics. The activities strengthened the students' interactions, gaining new knowledge that required cognitive and expressive resources to interpret, associate, and conceptualize themes of correct body posture. During six weeks of intervention, knowledge about body posture, anatomy, and health promotion exercises increased significantly in relation to the beginning of activities. The comic book proved to be an effective, attractive, and low-cost didactic resource. [ABSTRACT FROM AUTHOR]

In 2020 and 2021, the SARS-CoV-2 coronavirus spread rapidly across the world, causing the COVID-19 pandemic with millions of deaths. One of the measures to protect life was confinement, which negatively affected physical and mental health, especially of the older population. The aim of this study is to present and evaluate the methodological procedures of a telehealth and eHealth program "U3A in Motion", which was composed of videos of physical exercises and activities to promote the mental health and well-being of the older Brazilian population during the COVID-19 pandemic. The procedures included the planning, editing, and dissemination of videos through WhatsApp, and also on the YouTube platform, Instagram, and on a website. A total of 82 videos were created. The action reached 350 older adults from the local community in the northeast of Brazil, as well as being accessed by approximately 3000 other older adults from institutions in the southern region of Brazil. Based on the evaluation of activities through telephone interviews, it was found that older adults participating in the "U3A in Motion" program during confinement were highly motivated to access exercise activities, mainly via mobile phones, and reported a positive effect on physical and mental health. [ABSTRACT FROM AUTHOR]

In 2030, Brazil will have the fifth largest population on the planet. Currently, the country has 211.8 million inhabitants. Thus, promoting healthy aging is a fundamental political and social strategy. The objective of this paper is to present the public policies created in Brazil in the last 30 years to promote healthy aging, considering challenges such as demographic transition, socioeconomic diversity, and territorial extension. This is a literature review study carried out on the LILACS, MEDLINE, and SciELO databases and a collection of information from Brazilian government websites and international institutions in the area of health and social development. The findings show that, since 1990, policies have been implemented, including the Unified Health System, the Family Health Strategy, the Family Health Support Center, the Municipal Academy Program, and the Third Age Universities. This can broaden and qualify the understanding of how health policies for older adults evolve globally. [ABSTRACT FROM AUTHOR]

Objective: to analyze survival and factors associated with increased risk of death for older adults diagnosed with COVID-19, living in the Northeast region of Brazil. Method: retrospective observational study developed with secondary data provided by the Brazilian Ministry of Health, between June 14 and December 26, 2020. The Kaplan-Meyer method, the time-dependent cox regression model was used, including covariates (age, sex, skin color, comorbidities, admission to the ICU, ventilatory support). Results: out of 9,306 individuals analyzed, 55.9% died and 44.1% survived. The highest risk of death was observed for those aged 80-89 (HR=1.95), brown-skinned (HR=1.99), with immunodeficiency (HR=1.259) or kidney disease (HR=1.147), admitted to the ICU (HR=1,795) and in use of ventilatory support (HR=1606). Conclusion: among older adults residing in the Northeast region of Brazil, there was a higher risk of death from COVID-19 for octogenarians, brown-skinned, with comorbidities, hospitalization in the ICU, followed by the use of ventilatory support. The creation of health prevention strategies that identify older adults with these profiles is suggested to prevent deaths in future pandemic situations. [ABSTRACT FROM AUTHOR]

Objectives: To analyse the use of polymyxins for the treatment of ventilator-associated pneumonia (VAP) at a teaching hospital where carbapenem-resistant gram-negative bacteria are endemic. Patients and methods: This was a historical cohort study of patients receiving polymyxins to treat VAP in ICUs at a public university hospital in southern Brazil between January 1, 2017 and January 31, 2018. Results: During the study period, 179 cases of VAP were treated with polymyxins. Of the 179 patients, 158 (88.3%) were classified as having chronic critical illness. Death occurred in 145 cases (81.0%). Multivariate analysis showed that the factors independently associated with mortality were the presence of comorbidities (P<0.001) and the SOFA score of the day of polymyxin prescription (P<0.001). Being a burn patient was a protective factor for mortality (P<0.001). Analysis of the 14-day survival probability showed that mortality was higher among the patients who had sepsis or septic shock at the time of polymyxin prescription (P = 0.028 and P<0.001, respectively). Acinetobacter baumannii was identified as the etiological agent of VAP in 121 cases (67.6%). In our cohort, polymyxin consumption and the incidence density of VAP were quite high. Conclusions: In our study, comprised primarily of chronically critically ill patients, there was a high prevalence of VAP caused by multidrug-resistant bacteria, consistent with healthcare-associated infections in low- and middle-income countries. Presence of comorbidities and the SOFA score at the time of polymyxin prescription were predictors of mortality in this cohort. Despite aggressive antimicrobial treatment, mortality was high, stressing the need for antibiotic stewardship. [ABSTRACT FROM AUTHOR]

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• We investigated, over 28 epidemiological weeks in the year 2020, risk factors for death in 1,544 Brazilians (60 years or older) with laboratory evidence for SARS-CoV-2. • We found that 48% of patients admitted to the ICU who underwent RT-PCR testing, and had a positive result for COVID-19, died. • A set of comorbidities and symptoms were identified as responsible for the increased chances of death of patients aged 60-105 years infected with COVID-19 admitted to the ICU. • The analysis of the Brazilian government's database showed an absence of information in the system in relation to the RT-PCR test. Infection with the new coronavirus responsible for Severe Acute Respiratory Syndrome (SARS-CoV-2) continues to spread worldwide. In Brazil, there are already more than 230 thousand dead, many of these older adults. To present the clinical characteristics of older Brazilian adults infected by COVID-19, in the epidemiological weeks (EW) 34-52, and to verify factors responsible for the increased risk of death. Retrospective and observational study conducted with secondary publicly available data, provided by the Brazilian Ministry of Health. 1,544 confirmed cases of registered COVID-19 infection were included between August 16 and December 26, 2020, aged 60 or older. Outcomes: Demographic data, comorbidity, symptoms for disease, clinical information: days of hospitalization, chest X-ray, type of RT-PCR. 48% of patients admitted to the ICU with evidence for SARS-CoV-2 died. Symptoms and comorbidities related to increased chance of death (OR) were immunodeficiency (188%), kidney disease (166%), neurological disease (103%), dyspnea (86%), pneumopathy (55%), O 2 saturation <95% (53%), respiratory discomfort (49%), age (36%), sore throat (31%), and sex (0.5%). There was a 5% increase in the chance of death for each year of life. Heart disease and Diabetes mellitus were the most frequent comorbidities, but did not indicate an increased risk of death from SARS-CoV-2 infection. Age, sex, sore throat, dyspnea, respiratory discomfort, O 2 saturation <95%, neurological disease, pneumopathy, immunodeficiency, and kidney disease were significantly associated with risk of death from COVID-19. [ABSTRACT FROM AUTHOR]

Background The epidemiological scenario of multidrug-resistant bacteria has brought polymyxins back to medical prescriptions, as they are last-line therapy against carbapenem-resistant bacteria. There is a lack of knowledge of which is the best way to use this drug, especially in critically ill patients. We aimed to evaluate polymyxin use in an intensive care unit (ICU) in a university hospital and to describe its epidemiological characteristics. Methods This historical cohort included all consecutive patients who used polymyxins to treat ventilator-associated pneumonia from January 1, 2017 to January 31, 2018, during hospitalization in an ICU from a public university hospital, endemic for carbapenem-resistant bacteria, in Londrina, Brazil. Microbiological processing for diagnosis followed the guidelines from the Clinical and Laboratory Standards Institute (CLSI). Statistical analyses were performed using MedCalc for Windows, version 18.9 (MedCalc Software, Ostend, Belgium) and significance level adopted was 0.05. Results There were 179 patients; median of age was 57 years (IQR: 40.0 - 70.75). Polymyxin B was the most prescribed polymyxin (97.2%). Most of the patients had comorbidities (72.6%). Age was higher in the group of patients who died (60.0 vs. 36.5 years, P < 0.0001). Comorbidities prevalence was higher in non-survivors (80.7% vs. 38.2%, P < 0.0001). Sequential Organ Failure Assessment (SOFA) score on polymyxin prescribing day was higher in non-survivors (8.0 vs. 7.0, P = 0.0093), as well as Simplified Acute Physiology Score 3 (SAPS 3) score (70.7 vs. 59.35, P = 0.0003). Thirty-day mortality was 43%. Analysis of 14-day survival showed a higher mortality for patients who had sepsis (Log-rank test, P = 0.0284) and septic shock (Log-rank test, P = 0.0065). Acinetobacter baumannii was the most common etiologic agent, in 125 samples (73.9%), with 97.6% of resistance to carbapenem and 5.6% of resistance to polymyxins. Conclusion Polymyxin B was the most prescribed polymyxin. Age was higher in non-survivors, as well as comorbidities prevalence, SOFA and SAPS 3 scores. Patients with sepsis and septic shock showed a 14-day higher mortality. Acinetobacter baumannii was the most isolated agent. Carbapenem resistance was high. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Abstract: Pentoxifylline (PTF), a methylxanthine derivative, has therapeutic use as an antifibrotic agent. In vitro, PTF inhibits the production of collagen and reduces the proliferation of fibroblasts in hypertrophic scars. This study aimed to evaluate changes in the elasticity of hypertrophic scars in the peribuccal area in burned patients, who presented with mouth-opening limitation. Eighteen patients were divided into two groups. The case group (n =10) was treated with PTF 1mgml−1, while in the control group (n =8) no treatment was performed. Measurements of mouth opening (lip-to-lip and tooth-to-tooth distances in mm) were taken, before and after five therapeutic sessions with pentoxifylline with weekly intervals. The variations of these measures (Δ%) were calculated and submitted to statistical analyses. There was a significant improvement in the opening of the mouth, in vermilion distance (V =3.20mm) as much as the dental distance (DD=4.19mm) in the treated group, than in the control group. It was noted that pentoxifylline increases the elasticity of hypertrophic scars in the perioral area. [ABSTRACT FROM AUTHOR]