Search

Background Nowadays, transvenous lead extraction (TLE) is considered an essential technique in lead management strategy. Since 2011, a multidisciplinary approach was undertaken in our centre involving electrophysiologists, cardiac surgeons and anaesthesiologists to improve cross- unit cooperation and minimize complications and mortality. The present paper reports procedural outcomes and complications of our lead extraction experience. Methods We retrospectively collected and analysed data from all consecutive patients undergoing cardiac implantable electronic device leads TLE at the IRCCS Centro Cardiologico Monzino between January 2011 and November 2017. Results One-hundred fifty patients (111 males, 68 ± 13 years) underwent extraction procedures. The most common extraction indication were infections (86.7%) and TLE was carried out by laser-based approach in 88 (58.6%) patients, by mechanical dilating sheaths in 58 (38.7%) patients and by a combined approach (TLE + open surgical intervention) in 4 (2.7%) patients. Procedural success was obtained in 146 (97.3%) cases with only 3 (2.0%) major complications with 2 cases of structural injury with tamponade requiring emergent median sternotomy. Open surgery extraction was required in 4 patients, after an attempt to TLE, due to leads strict adhesion to cardiac or vascular structures, whereas in 5 (3.3%) cases, the treatment of choice was a combined approach consisting in transvenous leads extraction followed by planned surgery. Conclusions TLE is a complex procedure that sometimes leads to fatal complications. In our single center experience, a multidisciplinary approach involving electrophysiologist, cardiac surgeon, anaesthesiologist in an operating room allows a safer approach and major complications treatment.

Background: Extemporaneous compounding (EC) involves the preparation of a therapeutic product for specific patient need. However, there is a potential relationship between this procedure and the occurrence of health incidents (HI). The use of trigger tools increases HI identification. Objective: This study assessed the performance of EC as a trigger to detect potential health incidents arising from this procedure. Method: A one-month observational and cross-sectional study was performed in internal medicine ward and intensive care unit of medium-sized hospital. Data collection was carried out in 5 stages: all triggered patients with dysphagia or enteral feeding tube with prescription of EC were included; EC executed in prescribed standardized drugs was observed; the procedure was compared with the hospital guide and scientific literature; HI monitoring and their evaluation using WHO and NCC MERP algorithms; a search for pharmaceutical alternatives (PA) that would avoid the observed EC. Results: 197 patients were recruited. Almost half of them were triggered by EC from 84 standardized drugs. 48 patients met the inclusion criteria. 28 adverse drug reactions, 01 therapeutic ineffectiveness, and 29 medication errors were identified. EC as a trigger tool showed a PPV value of 0.38. Only 24 drugs have PA available in the market, which could avoid one third of all observed EC. Conclusion: It was possible to detect potentially HI in one of two patients with enteral feeding tubes using EC as a trigger tool. The use of EC as a trigger tool contributes to identifying potential HI arising from drugs, which have not gotten pharmaceutical alternatives to be administered via enteral feeding tube.

O consumo de psicofármacos é considerado um problema de saúde pública devido ao potencial de dependência e ocorrência de eventos adversos. Nesse contexto, o presente estudo teve como objetivo caracterizar o consumo de psicofármacos dispensados em unidades básicas de saúde de Ribeirão Preto, São Paulo, Brasil. Conduziu-se um estudo ecológico, com consulta à base de dados Hygia de 2008 a 2012. Foram extraídas as variáveis: psicofármaco dispensado, quantidade dispensada no ano, sexo e faixa etária dos pacientes. Para cada psicofármaco foi calculada a dose diária definida por 1.000 habitantes/dia (DDD/1.000PD), a dose diária definida por 1.000 habitantes/dia considerando-se 75% da população (DDD75%/1.000PD) que retiraram medicamento pelo Sistema Único de Saúde (SUS) e a dose diária prescrita (DDP). Comparou-se a taxa de crescimento populacional com a de crescimento do consumo dos medicamentos. Foram identificados 1.577.241 pacientes que retiraram medicamentos no período avaliado, dos quais 287.373 (18,2%) utilizaram pelo menos um sujeito a controle especial. Houve aumento do consumo total dos psicofármacos (DDD/1.000PD), porém, após a comparação com a taxa de crescimento populacional, apenas a da sertralina (p = 0,021), risperidona (p = 0,034) e do clonazepam (p = 0,043) foram superiores. As DDP de sete fármacos estavam maiores que a DDD da Organização Mundial da Saúde (OMS). As discrepâncias entre DDD e DDP podem ser úteis como estratégia para triar pacientes elegíveis ao cuidado farmacêutico, pois podem contribuir na prevenção de morbimortalidade relacionada ao uso de medicamentos. The consumption of psychotropic drugs is considered a public health problem, due to the potential for addiction and the occurrence of adverse events. In this context, the current study aimed to characterize the consumption of psychotropic medications dispensed in primary healthcare units in Ribeirão Preto, São Paulo State, Brazil. This ecological study consulted the Hygia database from 2008 to 2012. The following variables were extracted: psychotropic drugs dispensed, amount dispensed per year, and patients’ sex and age bracket. For each psychotropic drug, we calculated the defined daily dose per 1,000 inhabitants/day (DDD/1,000PD), defined daily dose per 1,000 inhabitants/day considering 75% of the population (DDD75%/1,000PD) who withdrew medicines through the Brazilian Unified National Health System (SUS), and the prescribed daily dose (PDD). The study compared the population growth rate to the growth in the medicines’ consumption. A total of 1,577,241 patients were identified who withdrew medications during the study period, of whom 287,373 (18.2%) used at least one drug subject to special control. There was an increase in the total consumption of psychotropic drugs (DDD/1,000PD), but comparison to the population growth rate showed that only sertraline (p = 0.021), risperidone (p = 0.034), and clonazepam (p = 0.043) presented higher growth rates. The PDD for seven drugs were higher than the World Health Organization (WHO) DDD. Identifying discrepancies between DDD and PDD can be useful as a strategy for screening patients eligible for pharmaceutical care, since they can contribute to the prevention of morbidity and mortality related to medications. El consumo de psicofármacos está considerado un problema de salud pública, debido al potencial de dependencia y ocurrencia de eventos adversos. En este contexto, el presente estudio tuvo como objetivo caracterizar el consumo de psicofármacos dispensados en unidades básicas de salud de Ribeirão Preto, São Paulo, Brasil. Se realizó un estudio ecológico, con consulta a la base de datos Hygia de 2008 a 2012. Se extrajeron las variables: psicofármaco dispensado, cantidad dispensada al año, sexo y franja de edad de los pacientes. Para cada psicofármaco se calculó la dosis diaria definida por 1.000 habitantes/día (DDD/1.000PD), la dosis diaria definida por 1.000 habitantes/día, considerándose un 75% de la población (DDD75%/1.000PD) que consiguieron el medicamento por el Sistema Único de Salud (SUS) y la dosis diaria prescrita (DDP). Se comparó la tasa de crecimiento poblacional con la de crecimiento por consumo de medicamentos. Se identificaron a 1.577.241 pacientes que obtuvieron medicamentos durante el período evaluado, entre los cuales 287.373 (18,2%) utilizaron por lo menos uno sujeto a un control especial. Hubo un aumento en el consumo total de los psicofármacos (DDD/1000PD), no obstante, tras la comparación con la tasa de crecimiento poblacional, solamente la de consumo de sertralina (p = 0,021), risperidona (p = 0,034) y del clonazepam (p = 0,043) fueron superiores. Las DDP de siete fármacos eran mayores a la DDD de la Organización Mundial de la Salud. Las discrepancias entre DDD y DDP pueden ser útiles como estrategia para triar pacientes elegibles para el cuidado farmacéutico, puesto que pueden contribuir a la prevención de morbimortalidad relacionada con el uso de medicamentos.

Although underdiagnosed, delirium is a common and potentially preventable problem in older patients, being associated with morbimortality. Drugs have been associated with the development of delirium in the geriatric population and may be considered the most easily reversible trigger. Polypharmacy, prescription of deliriogenic, anticholinergic and potentially inappropriate drugs are contributing factors for the occurrence of the disturb. Furthermore, changes in pharmacokinetic and pharmacodynamic parameters, which are intrinsic of the aged process, may contribute for cognitive impairment. Identification and reversal of clinical conditions associated with delirium are the first step to treat the disturbance, as well as mitigation of environmental factors and the exposition to deliriogenic drugs. Current evidence does not support the prescription of antipsychotics and benzodiazepines for the treatment of delirium. However, the judicious use of first- or second-generation antipsychotics can be considered in severe cases. Multi-component non-pharmacological, software-based intervention to identify medications that could contribute to delirium, predictive models, tools, training of health professionals and active actions of pharmacovigilance may contribute to the screening, prevention, and management of delirium in older people. Besides, it is also important to improve the report of drug-induced delirium in medical records, to develop properly risk management plans and avoid cascade iatrogenesis.

INTRODUCTION This systematic review aimed to assess antibiotic use in Brazilian hospitals in the 21st century, as well as to understand the different drug utilization metrics adopted to assess the consumption of these drugs. METHODS We systematically reviewed five databases (MEDLINE [Medical Literature Analysis and Retrieval System Online], CENTRAL [The Cochrane Central Register of Controlled Trials], EMBASE® [Excerpta Medica Database], Scopus [Elsevier’s abstract and citation database], and LILACS [Literatura Latino-Americana e do Caribe em Ciências da Saúde]) for observational or experimental studies that assessed antibiotic utilization in Brazilian hospitals. The main outcomes were the drug utilization metrics and the consumption of antibiotics. RESULTS We included 23 studies, of which 43.5% were carried out in adult and pediatric care units, 39.1% in adult units, and 17.4% in pediatric units. Regarding the complexity of healthcare, 26.1% of the studies were performed in intensive care units. Two drug utilization metrics were used in these studies: the defined daily dose (DDD) and the percentage of antibiotic prescriptions. The most commonly used antibiotic classes were third-generation cephalosporins, carbapenems, fluoroquinolones, and combinations of penicillins when the DDD was the adopted drug utilization metric. CONCLUSIONS Although few studies have been conducted, existing data indicate a high use of broad-spectrum antibiotics. We found that the lack of standardized antibiotic utilization metrics impaired the mapping of drug consumption at the national level.

Adiponectin exerts relevant actions in immunity and is modulated in several disorders, such as multiple sclerosis (MS). In this study, we characterized adiponectin expression and profiles in cerebrospinal fluid (CSF) from MS patients to investigate its potential relationship with the severity and progression of the disease. Total adiponectin in CSF was measured by ELISA in 66 unrelated CSF MS patients and compared with 24 age- and sex-matched controls. Adiponectin oligomer profiles were analysed by Western blotting and FPLC chromatography. Total CSF adiponectin was significantly increased in MS patients compared with controls (9.91 ng/mL vs 6.02 ng/mL) (p 0.001). Interestingly, CSF adiponectin positively correlated with CSF IgG, and CSF/serum albumin directly correlated with CSF/serum adiponectin. Our data demonstrated that CSF adiponectin predicts a worse prognosis: patients with the progressive form of MS had higher levels compared with the relapsing remitting form; patients with higher EDSS at baseline and a higher MS severity score at 4.5-year follow-up had significantly elevated adiponectin levels with respect to patients with a less severe phenotype. Finally, the adiponectin oligomerization profile was altered in CSF from MS patients, with a significant increase in HMW and MMW. The correlation of CSF adiponectin with the severity and prognosis of MS disease confirmed the role of this adipokine in the inflammatory/immune processes of MS and suggested its use as a complementary tool to assess the severity, progression and prognosis of the disease. Further studies on larger MS cohorts are needed to clarify the contribution of adiponectin to the etiopathogenesis of MS.

Made available in DSpace on 2020-12-10T17:32:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-05-04 ProReitoria de Extensao Universitaria da UNESP (PROEX-UNESP) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Introduction: A solid patient safety culture lies at the core of an effective event reporting system in a health care setting requiring a professional commitment for event reporting identification. Therefore, health care settings should provide strategies in which continuous health care education comes up as a good alternative. Traditional lectures are usually more convenient in terms of costs, and they allow us to disseminate data, information, and knowledge through a large number of people in the same room. Taking in consideration the tight money budgets in Brazil and other countries, it is relevant to investigate the impact of traditional lectures on the knowledge, skills, and attitudes to incident reporting system and patient safety culture. Objective: The study aim was to assess the traditional lecture impact on the improvement of health care professional competency dimensions (knowledge, skills, and attitudes) and on the number of health care incident reports for better patient safety culture. Participants and Methods: An open-label, nonrandomized trial was conducted in ninety-nine health care professionals who were assessed in terms of their competencies (knowledge, skills, and attitudes) related to the health incident reporting system, before and after education intervention (traditional lectures given over 3 months). Results: All dimensions of professional competencies were improved after traditional lectures (P < .05, 95% confidence interval). Conclusions: traditional lectures are helpful strategy for the improvement of the competencies for health care incident reporting system and patient safety. Univ Sao Paulo, Sao Paulo, Brazil Univ Estadual Paulista, Sao Paulo, Brazil Univ Estadual Paulista, Sao Paulo, Brazil CAPES: 001

Adiponectin exerts relevant actions in immunity and is modulated in several disorders, such as multiple sclerosis (MS). In this study, we characterized adiponectin expression and profiles in cerebrospinal fluid (CSF) from MS patients to investigate its potential relationship with the severity and progression of the disease. Total adiponectin in CSF was measured by ELISA in 66 unrelated CSF MS patients and compared with 24 age- and sex-matched controls. Adiponectin oligomer profiles were analysed by Western blotting and FPLC chromatography. Total CSF adiponectin was significantly increased in MS patients compared with controls (9.91 ng/mL vs 6.02 ng/mL) (p

Made available in DSpace on 2021-06-25T11:01:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-05-14 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: Prescription of calcium polystyrene sulfonate (CPS) has been considered a trigger with good performance to detect hyperkalemia related to adverse drug events (ADE). However, CPS prescription may underestimate the rate of ADE. Objective: To compare the performance of the serum potassium level (SPL) >5.0mEq/L and CPS triggers in detecting hyperkalemia related to ADE. Design and setting: A six-month cross-sectional study was conducted in a Brazilian medium-complexity public hospital. Methods: SPL Tests with results >5.0mEq/L and the prescriptions of CPS of all patients hospitalized in the internal medicine and infectious diseases wards were used as trigger tools to detect potential ADE. Primary outcome: patients with hyperkalemia related to ADE. Secondary outcomes: effectiveness of treatments and ADE. Variables analyzed were SPL tests, CPS prescriptions, treatments of hyperkalemia and comorbidities. Positive predictive values (PPV) of CPS and SPL triggers were calculated and compared. Results: In total 2,466 SPL tests were assessed, of which 513 were triggered (>5.0mEq/L). The tests triggered 198 patients with hyperkalemia, of whom 121 had hyperkalemia related to ADE (PPV=0.61). In total, 101 CPS prescriptions triggered tests in 35 patients with hyperkalemia, among whom 21 cases were related to ADE (PPV=0.60). SPL detected 204 ADE (PPV=0.40), while CPS prescription detected 22 (PPV=0.21). Seven pharmacological and four non-pharmacological treatments were identified. CPS showed the lowest effectiveness (PPV=0.71). Conclusion: SPL>5.0mEq/L increased the detection of ADE by 9.3-fold, the number of patients tracked with hyperkalemia related to ADE by 5.8-fold, and doubled the performance in detection of ADE in comparison with the prescription of the CPS trigger. Department of Drugs and Medicines School of Pharmaceutical Sciences São Paulo State University (UNESP) Department of Public Health Bauru School of Dentistry University of São Paulo (USP) University of São Paulo Ribeirão Preto Faculty of Pharmaceutical Sciences Department of Drugs and Medicines School of Pharmaceutical Sciences São Paulo State University (UNESP) CAPES: 001 FAPESP: 2018/07501-9

Após o anúncio da Organização Mundial da Saúde (OMS) sobre a pandemia por COVID-19, buscas relacionadas ao tema geraram uma infodemia. Neste contexto, a infodemiologia permite a compreensão da tendência de comportamento na internet. Os objetivos deste estudo foram analisar, por meio do Google Trends, a evolução das tendências de buscas na internet sobre medicamentos relacionados ao COVID-19 no contexto brasileiro e o impacto de determinados eventos políticos, sanitários e científicos que ocorreram sobre essa tendência. Os termos (n=52) e os eventos (n=38) entre 08 de dezembro de 2019 e 31 de maio de 2021 foram selecionados de acordo com o objetivo do estudo e o conhecimento científico prévio dos pesquisadores. Análise estatística foi aplicada para avaliar o interesse nos termos selecionados antes e após o evento, a associação deste com a variável preditora “porcentagem de primeiras doses aplicadas”, além da influência do tipo de evento no interesse pela busca. Nossos resultados mostraram um aumento das buscas sobre informações relacionadas aos medicamentos que fazem parte do “Kit Covid” ou “Tratamento Precoce”, assim como “Vacina” e “Vacinas” logo após a declaração de pandemia por COVID-19 pela OMS. Quanto aos fármacos aprovados para tratamento de COVID-19 no Brasil, a busca foi maior durante a primeira e segunda ondas da COVID-19 e com o avanço da vacinação, as buscas por “ivermectina” e “hidroxicloroquina” diminuíram. Os dados apresentados trazem à tona a procura por conhecimento sobre medicamentos pela população brasileira em um cenário pandêmico cujo acesso à informação é imediato, mas nem sempre confiável.

There are laws and decrees in our country about spatial accessibility in schools, but how is established the reality for physical education classes occur? This study aimed to analyze the infrastructure of state public schools in a municipality in Bahia concerning architectural accessibility, especially those for Physical Education classes. All elementary schools (final years) and high schools were analyzed using the adaptation of the Ministry of Education's “Spatial Accessibility Manual”. The path from the arrival at school to the court/patio was evaluated. The research showed that only two schools attended a maximum of 50% of the investigated items, while the others presented lower values. For Physical Education classes, items such as the tactile paving, the court with adapted space, and adapted drinking fountain next to the court were not included. In conclusion, the architectural accessibility in these schools is precarious, making inclusion in Physical Education classes difficult. Hay en nuestro país leyes y decretos sobre accesibilidad espacial en las escuelas, pero ¿cómo está la realidad para que ocurra las clases de Educación Física? El objetivo de este estudio fue analizar la infraestructura de escuelas públicas estatales de un municipio bahiano en cuanto a accesibilidad arquitectónica, en especial aquella destinada a las clases de Educación Física. Fueron analizadas todas las escuelas de Primaria (años finales) y Secundaria utilizando la adaptación del “Manual de Accesibilidad Espacial” del Ministerio de la Educación. Se evaluó desde la entrada hasta la cancha/patio de la escuela. Se observó que solo dos escuelas atendieron el máximo de 50% de los ítems investigados, estando las demás con valores inferiores. Para las clases de Educación Física, ítems como piso táctil direccional, cancha con adaptación y bebedero adaptado próximo a la cancha no fueron contemplados. En conclusión, la accesibilidad arquitectónica en esas escuelas es precaria, dificultando la inclusión en las clases de Educación Física. Há em nosso país leis e decretos sobre acessibilidade espacial nas escolas, mas como está a realidade para que ocorra as aulas de educação física? O objetivo deste estudo foi analisar a infraestrutura de escolas públicas estaduais de um município baiano no que diz respeito a acessibilidade arquitetônica, em especial àquela destinada as aulas de Educação Física. Foram analisadas todas as escolas de Ensino Fundamental (anos finais) e Ensino Médio utilizando a adaptação do “Manual de Acessibilidade Espacial” do Ministério da Educação. Avaliou-se da chegada a escola até a quadra/pátio. Observou-se que apenas duas escolas atenderam um máximo de 50% dos itens investigados, estando as demais com valores inferiores. Para as aulas de Educação Física, itens como piso tátil direcional, quadra com espaço adaptado e bebedouro adaptado próximo à quadra não foram contemplados. Conclui-se que a acessibilidade arquitetônica nessas escolas é precária, dificultando a inclusão nas aulas de Educação Física.

Há em nosso país leis e decretos sobre acessibilidade espacial nas escolas, mas como está a realidade para que ocorra as aulas de educação física? O objetivo deste estudo foi analisar a infraestrutura de escolas públicas estaduais de um município baiano no que diz respeito a acessibilidade arquitetônica, em especial àquela destinada as aulas de Educação Física. Foram analisadas todas as escolas de Ensino Fundamental (anos finais) e Ensino Médio utilizando a adaptação do “Manual de Acessibilidade Espacial” do Ministério da Educação. Avaliou-se da chegada a escola até a quadra/pátio. Observou-se que apenas duas escolas atenderam um máximo de 50% dos itens investigados, estando as demais com valores inferiores. Para as aulas de Educação Física, itens como piso tátil direcional, quadra com espaço adaptado e bebedouro adaptado próximo à quadra não foram contemplados. Conclui-se que a acessibilidade arquitetônica nessas escolas é precária, dificultando a inclusão nas aulas de Educação Física.

O aperfeiçoamento das técnicas utilizadas nas revisões é importante para sistematizar todo o aumento do conhecimento na Educação Física (EF); entretanto são escassos os artigos que as esclarecem. O objetivo do estudo é apresentar os principais elementos da metassíntese (qualitativo), metanálise (quantitativo) e síntese da pesquisa mista (qualitativo e quantitativo), destacando seus caminhos na EF. Utilizou-se a revisão de literatura para verificar em artigos científicos os métodos apresentam estrutura organizacional que, imparcialmente, promovem atualizações do conhecimento. Conclui-se que raros são os estudos que apresentam elementos das revisões. Além disso, são incipientes as revisões que envolvem a abordagem qualitativa na área da EF, aspecto fundamental para emergir um novo paradigma para as revisões.

Software containers are changing the way applications are designed and executed. Moreover, in the last few years, we see the increasing adoption of container orchestration tools, such as Kubernetes, to simplify the management of multi-container applications. Kubernetes includes simple deployment policies that spread containers on computing resources located in the cluster and automatically scale them out or in based on some cluster-level metrics. As such, Kubernetes is not well-suited for deploying containers in a geo-distributed computing environment and dealing with the dynamism of application workload and computing resources. To tackle the problem, in this paper we present ge-kube (Geo-distributed and Elastic deployment of containers in Kubernetes), an orchestration tool that relies on Kubernetes and extends it with self-adaptation and network-aware placement capabilities. Ge-kube introduces flexible and decentralized control loops that can be easily equipped with different deployment policies. Specifically, we propose a two-step control loop, in which a model-based reinforcement learning approach dynamically controls the number of replicas of individual containers on the basis of the application response time, and a network-aware placement policy allocates containers on geo-distributed computing resources. To address the placement issue, we propose an optimization problem formulation and a network-aware heuristic, which explicitly take into account the non-negligible network delays among computing resources so to satisfy Quality of Service requirements of latency-sensitive applications. Using a surrogate CPU-intensive application and a real application (i.e., Redis), we conducted an extensive set of experiments, which show the benefits arising from the combination of elasticity and placement policies, as well as the advantages of using network-aware placement solutions.

Introduction: Football schools have consolidated themselves as an important factor in the development of football players. However, few scientific studies have focused on such fact, especially when it comes to determining the factors that stimulate teenagers to stay in football schools. Aim: to investigate the reasons why a sub-15 category adolescent remains enrolled in a football school and to identify the main barriers to attendance in class. Methodology: a case study, approved by the Ethics Committee, where nine sub-15 category students at Escolinha de Futebol América Júnior (Itabuna-BA) answered a questionnaire about their age, educational level, the main barriers that often result in class absences as well as the Inventário de Motivação à Prática Regular de Atividades Físicas e Esportivas (IMPRAFE-54). Results: The teenagers subject to the questionnaire were in average 13.89 (± 0.93) years old students, of which 88.88% had not completed elementary school. The average number of years these students dedicated to football amounts to 7.56 (± 2.83) years. In addition, health and pleasure were pointed out by teenagers as their main factors to stay in school, followed by these dimensions: competitiveness, aesthetics, sociability and stress control. Finally, illness was pointed out as the main reason for absence in class. Conclusion: Health can be considered the first main factor to determine the attendance rate of teenager students in football schools, being a contributing factor to attendance rate or the very barrier that will cause the absence of students. We also point out the importance of leisure as an additional contributing factor to the attendance rate at Escolinha de Futebol América Junior. Introducción: Las Escuelas de Fútbol se han consolidado como una importante herramienta en la formación de futbolistas. Sin embargo, son pocos los estudios que se insertan en este contexto, especialmente en lo que se refiere a los factores que hacen que los adolescentes permanezcan en la Escolinha. Objetivo: Investigar las razones que llevan a los adolescentes de la categoría sub-15 a permanecer matriculados en una escuela de fútbol y señalar las principales barreras para la asistencia a los entrenamientos. Materiales y Métodos: se trata de un estudio de caso, aprobado por el Comité de Ética, en el que participaron nueve alumnos de la categoría sub-15 de la Escuela de Fútbol América Júnior (Itabuna-BA), quienes respondieron un cuestionario sobre edad, nivel de instrucción, principales barreras que culminaron en las ausencias a clase y el Inventario de Motivación para la Práctica Regular de Actividades Físicas y Deportivas (IMPRAFE-54). Resultados: Los adolescentes tenían una edad promedio de 13,89 (±0,93) años, de los cuales 88,88% tenían Enseñanza Básica II incompleta. El tiempo medio de práctica de fútbol fue de 7,56 (± 2,83) años. También se observó que los adolescentes consideraron la salud y el placer como los principales factores que los hicieron permanecer en la Escolinha, seguidos de las dimensiones: competitividad, estética, sociabilidad y control del estrés. Además, se observó que el principal motivo de ausencia a clases fue por enfermedad. Conclusión: La salud es un factor importante tanto para motivar a los estudiantes a quedarse en la Escolinha como, en su ausencia, para que falten a la escuela. También destacamos la importancia del ocio como elemento que hace que permanezcan en la Escuela de Fútbol América Júnior. Introduzione: Le Scuole Calcio si sono affermate come uno strumento importante nella formazione dei calciatori. Tuttavia, sono pochi gli studi inseriti in questo contesto, soprattutto per quanto riguarda i fattori che fanno rimanere gli adolescenti nell'Escolinha. Obiettivo: Indagare le ragioni che spingono gli adolescenti della categoria under 15 a rimanere iscritti ad una scuola calcio e segnalare i principali ostacoli alla frequenza degli allenamenti. Materiali e Metodi: questo è un caso di studio, approvato dal Comitato Etico, a cui hanno partecipato nove studenti della categoria under 15 della Scuola Calcio América Júnior (Itabuna-BA), che hanno risposto a un questionario su età, livello di istruzione, principali barriere culminate nelle assenze in classe e nell'Inventario della motivazione per la pratica regolare delle attività fisiche e sportive (IMPRAFE-54). Risultati: Gli adolescenti avevano un'età media di 13,89 (±0,93) anni, di cui l'88,88% aveva una scuola elementare II incompleta. Il tempo medio di allenamento del calcio è stato di 7,56 (± 2,83) anni. È stato inoltre osservato che gli adolescenti consideravano la salute e il piacere come i principali fattori che li spingevano a soggiornare nell'Escolinha, seguiti dalle dimensioni: competitività, estetica, socialità e controllo dello stress. Inoltre, abbiamo osservato che il motivo principale dell'assenza dalle lezioni era dovuto alla malattia. Conclusione: la salute è un fattore importante sia per motivare gli studenti a rimanere all'Escolinha sia, in loro assenza, per farli perdere la scuola. Segnaliamo anche l'importanza del tempo libero come elemento che li spinge a soggiornare presso la Scuola Calcio América Júnior. Introdução: As Escolinhas de futebol se consolidaram como uma importante ferramenta na formação de jogadores de futebol. Entretanto, poucos são os estudos inseridos nesse contexto, especialmente a respeito dos fatores que fazem adolescentes permanecerem na Escolinha. Objetivo: Investigar os motivos que levam adolescentes da categoria sub-15 a permanecerem matriculados em uma Escolinha de futebol e apontar as principais barreiras para a assiduidade nos treinos. Materiais e Métodos: trata-se de um estudo de caso, aprovado pelo Comitê de Ética, em que participaram nove alunos da categoria sub-15 da Escolinha de Futebol América Júnior (Itabuna-BA), que responderam a um questionário sobre idade, ní­vel educacional, as principais barreiras que culminaram em faltas nas aulas e o Inventário de Motivação à Prática Regular de Atividades Fí­sicas e Esportivas (IMPRAFE-54). Resultados: Os adolescentes apresentavam média de 13,89 (±0,93) anos, dos quais 88,88% apresentam o ensino Fundamental II incompleto. O tempo médio de prática de futebol foi de 7,56 (± 2,83) anos. Observou-se também que os adolescentes consideraram a saúde e o prazer como os principais fatores que os fizeram permanecer na Escolinha, seguido pelas dimensões: competitividade, estética, sociabilidade e controle do estresse. Além do mais, observamos que o principal motivo de ausência nas aulas era por adoecimento. Conclusão: A saúde é um fator importante tanto para motivar os alunos a permanecerem na Escolinha quanto, em sua ausência, para fazê-los faltar. Pontuamos também a importância do lazer como elemento que os fazem permanecer na Escolinha de Futebol América Júnior. Introdução: As Escolinhas de futebol se consolidaram como uma importante ferramenta na formação de jogadores de futebol. Entretanto, poucos são os estudos inseridos nesse contexto, especialmente a respeito dos fatores que fazem adolescentes permanecerem na Escolinha. Objetivo: Investigar os motivos que levam adolescentes da categoria sub-15 a permanecerem matriculados em uma Escolinha de futebol e apontar as principais barreiras para a assiduidade nos treinos. Materiais e Métodos: trata-se de um estudo de caso, aprovado pelo Comitê de Ética, em que participaram nove alunos da categoria sub-15 da Escolinha de Futebol América Júnior (Itabuna-BA), que responderam a um questionário sobre idade, ní­vel educacional, as principais barreiras que culminaram em faltas nas aulas e o Inventário de Motivação à Prática Regular de Atividades Fí­sicas e Esportivas (IMPRAFE-54). Resultados: Os adolescentes apresentavam média de 13,89 (±0,93) anos, dos quais 88,88% apresentam o ensino Fundamental II incompleto. O tempo médio de prática de futebol foi de 7,56 (± 2,83) anos. Observou-se também que os adolescentes consideraram a saúde e o prazer como os principais fatores que os fizeram permanecer na Escolinha, seguido pelas dimensões: competitividade, estética, sociabilidade e controle do estresse. Além do mais, observamos que o principal motivo de ausência nas aulas era por adoecimento. Conclusão: A saúde é um fator importante tanto para motivar os alunos a permanecerem na Escolinha quanto, em sua ausência, para fazê-los faltar. Pontuamos também a importância do lazer como elemento que os fazem permanecer na Escolinha de Futebol América Júnior.

Rituximab (RTX), a chimeric anti-CD20 monoclonal antibody, has demonstrated good efficacy as treatment in patients with resistant chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), but it is highly immunogenic due to its structure. Ocrelizumab (OCR) is a humanized anti-CD20 antibody, with higher tolerability and a lower immunogenic profile compared to RTX. We present a case of refractory CIDP effectively treated with OCR, switched from RTX after the development of anti-drug antibodies. A 25-year-old man was admitted to our clinic for the onset of distal upper and lower limb weakness and numbness, with electrodiagnostic criteria of CIDP. After several attempted standard CIDP treatments, RTX was introduced due to poor control of clinical relapses. Unfortunately, the patient developed a high anti-drug antibody titer after RTX infusion, with no control of disease. OCR was started as an off-label treatment, resulting in partial recovery from the last recurrence and achieving good prevention of new relapses with no adverse events. We suggest that OCR should be considered as another therapeutic option in refractory CIDP. In the literature, this is the first case of CIDP treated with OCR, demonstrating good efficacy for its anti-CD20 effect and better tolerability because of its lower immunogenicity.

The consumption of psychotropic drugs is considered a public health problem, due to the potential for addiction and the occurrence of adverse events. In this context, the current study aimed to characterize the consumption of psychotropic medications dispensed in primary healthcare units in Ribeirão Preto, São Paulo State, Brazil. This ecological study consulted the Hygia database from 2008 to 2012. The following variables were extracted: psychotropic drugs dispensed, amount dispensed per year, and patients' sex and age bracket. For each psychotropic drug, we calculated the defined daily dose per 1,000 inhabitants/day (DDD/1,000PD), defined daily dose per 1,000 inhabitants/day considering 75% of the population (DDD75%/1,000PD) who withdrew medicines through the Brazilian Unified National Health System (SUS), and the prescribed daily dose (PDD). The study compared the population growth rate to the growth in the medicines' consumption. A total of 1,577,241 patients were identified who withdrew medications during the study period, of whom 287,373 (18.2%) used at least one drug subject to special control. There was an increase in the total consumption of psychotropic drugs (DDD/1,000PD), but comparison to the population growth rate showed that only sertraline (p = 0.021), risperidone (p = 0.034), and clonazepam (p = 0.043) presented higher growth rates. The PDD for seven drugs were higher than the World Health Organization (WHO) DDD. Identifying discrepancies between DDD and PDD can be useful as a strategy for screening patients eligible for pharmaceutical care, since they can contribute to the prevention of morbidity and mortality related to medications.O consumo de psicofármacos é considerado um problema de saúde pública devido ao potencial de dependência e ocorrência de eventos adversos. Nesse contexto, o presente estudo teve como objetivo caracterizar o consumo de psicofármacos dispensados em unidades básicas de saúde de Ribeirão Preto, São Paulo, Brasil. Conduziu-se um estudo ecológico, com consulta à base de dados Hygia de 2008 a 2012. Foram extraídas as variáveis: psicofármaco dispensado, quantidade dispensada no ano, sexo e faixa etária dos pacientes. Para cada psicofármaco foi calculada a dose diária definida por 1.000 habitantes/dia (DDD/1.000PD), a dose diária definida por 1.000 habitantes/dia considerando-se 75% da população (DDD75%/1.000PD) que retiraram medicamento pelo Sistema Único de Saúde (SUS) e a dose diária prescrita (DDP). Comparou-se a taxa de crescimento populacional com a de crescimento do consumo dos medicamentos. Foram identificados 1.577.241 pacientes que retiraram medicamentos no período avaliado, dos quais 287.373 (18,2%) utilizaram pelo menos um sujeito a controle especial. Houve aumento do consumo total dos psicofármacos (DDD/1.000PD), porém, após a comparação com a taxa de crescimento populacional, apenas a da sertralina (p = 0,021), risperidona (p = 0,034) e do clonazepam (p = 0,043) foram superiores. As DDP de sete fármacos estavam maiores que a DDD da Organização Mundial da Saúde (OMS). As discrepâncias entre DDD e DDP podem ser úteis como estratégia para triar pacientes elegíveis ao cuidado farmacêutico, pois podem contribuir na prevenção de morbimortalidade relacionada ao uso de medicamentos.El consumo de psicofármacos está considerado un problema de salud pública, debido al potencial de dependencia y ocurrencia de eventos adversos. En este contexto, el presente estudio tuvo como objetivo caracterizar el consumo de psicofármacos dispensados en unidades básicas de salud de Ribeirão Preto, São Paulo, Brasil. Se realizó un estudio ecológico, con consulta a la base de datos Hygia de 2008 a 2012. Se extrajeron las variables: psicofármaco dispensado, cantidad dispensada al año, sexo y franja de edad de los pacientes. Para cada psicofármaco se calculó la dosis diaria definida por 1.000 habitantes/día (DDD/1.000PD), la dosis diaria definida por 1.000 habitantes/día, considerándose un 75% de la población (DDD75%/1.000PD) que consiguieron el medicamento por el Sistema Único de Salud (SUS) y la dosis diaria prescrita (DDP). Se comparó la tasa de crecimiento poblacional con la de crecimiento por consumo de medicamentos. Se identificaron a 1.577.241 pacientes que obtuvieron medicamentos durante el período evaluado, entre los cuales 287.373 (18,2%) utilizaron por lo menos uno sujeto a un control especial. Hubo un aumento en el consumo total de los psicofármacos (DDD/1000PD), no obstante, tras la comparación con la tasa de crecimiento poblacional, solamente la de consumo de sertralina (p = 0,021), risperidona (p = 0,034) y del clonazepam (p = 0,043) fueron superiores. Las DDP de siete fármacos eran mayores a la DDD de la Organización Mundial de la Salud. Las discrepancias entre DDD y DDP pueden ser útiles como estrategia para triar pacientes elegibles para el cuidado farmacéutico, puesto que pueden contribuir a la prevención de morbimortalidad relacionada con el uso de medicamentos.

The fast increasing presence of Internet-of-Things and fog computing resources exposes new challenges due to heterogeneity and non-negligible network delays among resources as well as the dynamism of operating conditions. Such a variable computing environment leads the applications to adopt an elastic and decentralized execution. To simplify the application deployment and run-time management, containers are widely used nowadays. The deployment of a container-based application over a geo-distributed computing infrastructure is a key task that has a significant impact on the application non-functional requirements (e.g., performance, security, cost). In this survey, we first develop a taxonomy based on the goals, the scope, the actions, and the methodologies considered to adapt at run-time the application deployment. Then, we use it to classify some of the existing research results. Finally, we identify some open challenges that arise for the application deployment in the fog. In literature, we can find many different approaches for adapting the containers deployment, each tailored for optimizing a specific objective, such as the application response time, its deployment cost, or the efficient utilization of the available computing resources. However, although several solutions for deploying containers exist, those explicitly considering the distinctive features of fog computing are at the early stages: indeed, existing solutions scale containers without considering their placement, or do not consider the heterogeneity, the geographic distribution, and mobility of fog resources.

Safeguards verification of uranium and plutonium in high-radioactivity nuclear material is currently performed using destructive analysis techniques. However, the preparation method is a burden on both the safeguards inspectors and facility operators. While nondestructive assay (NDA) techniques would improve the efficiency and time, there are no passive NDA techniques available to directly verify the U and Pu content. As an alternative, the JAEA and JRC are collaboratively developing the Delayed Gamma-ray Spectroscopy (DGS) active-interrogation NDA technique to evaluate the fissile composition from the unique fission product yield distributions. To analyze the data we are developing an Inverse Monte Carlo (IMC) method that simulates the interrogation and evaluates the individual contributions from the mixed nuclear material to the composite spectrum. While the current nuclear data affects the ability to evaluate the composition, the IMC analysis method can be used to determine the systematic uncertainty contributions and has the potential to improve the nuclear data. We will present the current status of the DGS collaborative work as it relates to the development of the DGS IMC analysis.

O papel do enfermeiro na atenção domiciliar deve estar centrado no cuidado seguro ao usuário. Com isso, o objetivo deste relato foi descrever a experiência de uma enfermeira sobre a segurança do paciente atendido pelo Programa Melhor em Casa (PMC) de um município do litoral sul da Bahia apontando as potencialidades e os desafios encontrados. Trata-se de um relato sobre ações desenvolvidas entre 2016 a 2020 no PMC que foi realizado em um município do sul da Bahia. Foram atendidas ocorrências como realização de curativos, administração de medicamentos, aferição de sinais vitais, dentre outros. Além do protocolo de segurança hospitalar, houve a necessidade de desenvolver, junto com a equipe multiprofissional, treinamento, confecção de cartilha e conversas educativas para o paciente, familiares e cuidadores. Ainda, um processo maior de atenção ao ambiente domiciliar e a disponibilização do contato com os profissionais foram estratégias utilizadas. Concluiu-se que o PMC oportuniza um cuidado mais humanizado por estar no lar, mas pode apresentar fragilidade uma vez que utiliza adaptações dos protocolos hospitalares, exigindo da enfermagem maior atenção ao cuidado para garantir a segurança do paciente.

Objetivou-se avaliar a abordagem multiprofissional no contexto do olhar profissional e do sujeito da ação do cuidar de um programa de atividade física regular. Como metodologia, o estudo de método misto, fundamentado no modelo RE-AIM (Reach = alcance, Efficacy = eficácia, Adoption = adoção, Implementation = implementação, Maintanance = manutenção), realizado entre outubro/2015 a agosto/2016, em um município do interior da Bahia, por meio de entrevista semiestruturada com profissionais e pessoas adulto-idosas com doença crônica não transmissível, participantes de um programa de atividade física regular, e inquérito documental em prontuário de saúde. Os resultados evidenciaram os benefícios do trabalho integrador à ação social coletiva em saúde das pessoas, no processo de formação profissional e na melhoria da saúde das pessoas, impactando nos índices pressóricos, de modo à sua diminuição aos níveis limítrofes à promoção da qualidade da saúde e viver humano. Como conclusões: A promoção da qualidade de vida e saúde de pessoas em enfrentamento crônico é alavancada quando exercida através de abordagem multiprofissional e enfoque interdisciplinar, elementos necessários à potencialização de políticas públicas e programas de saúde de impacto à saúde pública.

Patient: Female, 65 Final Diagnosis: Clavicle Kirschner wire migration into left lung Symptoms: No symptoms Medication: — Clinical Procedure: Thoracotomy Specialty: Surgery Objective: Diagnostic/therapeutic accidents Background: Kirschner wires are often used to perform osteosynthesis. Migration through tissue of these wires is a rare but well-known occurrence. Case Report: A 65-year-old female presented with light intensity pain complaints in the upper left chest area; personal history included left clavicle fracture 20 years ago that was treated surgically with fixation using a K-wire. Chest radiography showed the presence of metallic foreign body in the left pulmonary apex. An exploratory axillary thoracotomy was performed, and the foreign body was extracted by a pneumotomy. Conclusions: To obtain satisfactory results with a K-wire, some peculiarities in their application should be respected. The time from orthopedic surgery of the collarbone to migration into the chest of the metal rod used can vary from one day to nearly 20 years. Although the migration mechanism remains unclear, it is likely that it involves shoulder movements, breathing movements, negative intrathoracic pressure, gravitational force, or local bone resorption. Caution should be exercised when orthopedic pins and wires are used for the fixation of fractures and dislocations of the shoulder girdle. If there is migration of the wire, it should be removed immediately to avoid sudden and fatal complications.

Nuclear material in reprocessing facilities is safeguarded by random sample verification with additional process monitoring applied to solution masses and volumes within the tanks to maintain conti...

Para analisar a associação entre fatores sociodemográficos e o estilo de vida em adultos quilombolas baianos com deficiência percebida, 517 entrevistas face-a-face foram consideradas. Foi realizada regressão logística binária para definir a associação entre o Estilo de vida e os fatores sociodemográficos. A escolaridade permaneceu associada a Nutrição, a renda à Atividade Física, o número de filhos com Comportamento Preventivo e Relacionamentos, e o sexo com o Estresse. Então, ter menos escolaridade aumenta a probabilidade para Nutrição negativa, ter renda mais alta aumenta a probabilidade para Atividade Física positiva. Ter mais filhos aumenta a probabilidade do Comportamento Preventivo e Relacionamentos positivos e ser homem para Estresse positivo.

The Japan Atomic Energy Agency (JAEA) is collaborating with the European Commission Joint Research Centre (EC/JRC) to develop delayed gamma-ray spectroscopy (DGS). Toward this, the JAEA Integrated Support Center for Nuclear Nonproliferation and Nuclear Security (ISCN) designed the Delayed Gamma-ray Test Spectrometer (DGTS) that uses a 252 Cf source (DGTS-C). This instrument is used to refine the design for a compact, induced-fission safeguards technique to supplement current nuclear material accountancy in reprocessing facilities. Experiments were performed at PERLA laboratory of the EC/JRC Ispra, Italy site to evaluate the neutron-irradiation and associated instrumentation capabilities to obtain delayed gamma-ray spectral signatures of assayed nuclear material. Neutron count-rate measurements were performed using a 3 He detector and confirmed with MCNP6 models that showed a fluence of ∼87.1×10 − 4 n cm−2 n s r c − 1 . Short time-pattern interrogations of various 235U and 239Pu samples resulted in quantifiable delayed gamma-ray peaks from fission products. The peak intensities and spectral signatures resulted in fissile nuclide distinction and linear mass-correlation results. Consequently, we confirm the practicality of this JAEA/ISCN instrument design for DGS interrogation safeguards capabilities.

We present experimental and MCNP modeled results of neutron flux monitoring in an irradiator, which consists of a252Cf sealed source housed in the center of a cubic block of high-density polyethylene. This work is contributing to our development in the delayed gamma-ray spectroscopy non-destructive assay technique for nuclear safeguards and security applications. We evaluated the thermal and resonance flux values using the Westcott foil activation method for two measurement position count rates of 197Au and 115In. Comparisons between the calculated thermal fluxes from measurements and those from MCNP models show deviations of ~20%. However, both the measured and modeled thermal fluxes are two orders of magnitude higher than the fluxes at the resonance peak energies at both measurement positions, demonstrating that the irradiator is sufficient. Furthermore, this work showed that with a252Cf sealed source of a strength of 4.4 × 106 n.s−1, a thermal flux in the range 2–5 × 104 n.s−1.cm−2 is achievable in our compact irradiator making it suitable for active analysis techniques such as DGS.

Há evidências em estudos com alto controle de variáveis e grupos homogêneos (validade interna) de que o exercício físico reduz os índices pressóricos em pessoas com pré-hipertensão (PH). Entretanto, não se sabe ao certo se esses estudos apresentam informações suficientes para que tais exercícios sejam aplicados na prática clínica, no dia-a-dia (validade externa). Objetivo: O objetivo foi avaliar se os artigos científicos sobre programas de exercício físico para pessoas com pré-hipertensão da principal base de dados biomédica apresentam informações suficientes sobre a sua validade interna e externa. Métodos: Foi realizada uma revisão sistemática no PubMed entre 2007 a 2017, de artigos publicados inglês, espanhol ou português. Para seleção dos artigos, dois pareceristas (e um terceiro em caso de discordância) avaliaram o título, o resumo e o texto completo. Após esta etapa, foi realizada a avaliação da validade interna e externa utilizando o check-list do modelo de avaliação RE-AIM. Resultados: Foram encontrados 11.693 artigos para leitura dos títulos. Destes, 7 foram selecionados para leitura dos resumos, 5 artigos para leitura na íntegra, finalizando o processo com 3 artigos selecionados para a análise pelo modelo RE-AIM. Dos artigos selecionados, observou-se que os artigos atenderam apenas 33,33% dos itens das dimensões Alcance (público alvo e participante da pesquisa) e Implementação. No check-list da dimensão Efetividade/Eficácia (resultados) apenas 12,5% foram atendidos. As dimensões Adoção (organização e equipe alvo e participante) e Manutenção não foram contempladas. Conclusão: os artigos apresentam poucas informações a respeito da validade externa, dificultando assim a possibilidade de disseminação desses protocolos de exercício físico para outras realidades.

New active-interrogation nondestructive assay techniques are needed for safeguard purpose. They can be used for the quantification of the fissile composition in high radioactivity nuclear material samples. One of the techniques under evaluation by the Japan Atomic Energy Agency together with the European Commission Joint Research Centre is delayed gamma-ray spectroscopy. It utilizes a combination of high rate neutron sources and moderation to thermal energy to induce fission in the fissile nuclides. This will allow enhancing the amount of observable coming from the fission of the fissile compared with the fertile nuclides that are usually more abundant in the sample. Analyzing the peaks ratios of gamma-rays with energy above 3 MeV emitted by the short lived fission products produced in the sample, it is possible to verify the initial composition of the fissile nuclides. We are currently designing and testing several different systems with the goal to design a practical and compact system that can be installed in current reprocessing facilities. In particular, this paper describes the different systems currently tested focusing on the different neutron source and moderator material and geometry as well as different gamma-ray detectors. We will also show the new neutron and gamma-ray detector systems we will implement for future test and development.

Made available in DSpace on 2019-10-03T17:32:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2019. Added 1 bitstream(s) on 2019-10-04T16:21:01Z : No. of bitstreams: 1 S1516-31802019005006101.pdf: 91945 bytes, checksum: 5ac2217f6db07c64824a5fde384ec8c5 (MD5) Universidade de São Paulo Faculdade de Ciências Farmacêuticas de Ribeirão Preto Universidade Federal do Paraná Department of Pharmacy Universidade Estadual Paulista School of Pharmaceutical Sciences Department of Drugs and Medicines Universidade Estadual Paulista School of Pharmaceutical Sciences Department of Drugs and Medicines

Made available in DSpace on 2019-10-04T12:36:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-03-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Brazilian pharmacovigilance regulations involve 3 spheres: health services, Marketing Authorization Holders (MAHs), and sanitary agency. Drug tolerability began to be effectively assessed in Brazil after the founding of the National Agency of Sanitary Surveillance, which developed the Sentinel Network Project, The objective of the Sentinel Network Project is to increase the adverse drug reaction (ADR) reporting rate by health care professionals in the hospital setting. Pharmacovigilance practices became mandatory for MAHs, and patient tolerability issues were considered in drug policy in Brazil only as recently as 2000. However, despite recent events, the regulatory advancements in pharmacovigilance in Brazil are only equivalent to international practices (ie, those of the European Union). The pharmacovigilance system in the European Union integrates the national authorities, the European Commission, and the European Medicines Agency, which is responsible for the scientific evaluation, supervision, and safety monitoring of medicines for human and veterinary use in the European Union. Furthermore, ADR patient reporting is included in the new EU pharmacovigilance regulations. Numerous possible ways are available to improve the Brazilian pharmacovigilance system, mainly through regulations of biosimilar, nanotechnology, and veterinary medicines or by training health care professionals and patients to report nonserious cases and quality deviations. It is necessary to encourage and develop strategies for decentralizing pharmacovigilance actions in the whole country, as is common practice in several EU countries. Motivating and considering ADR reports by patients and improving feedback and audit practices in health care services and MAHs are also necessary measures. With the inclusion of Brazil as a member of the International Conference of Harmonization, significant changes in pharmacovigilance regulation are expected; these updates, which will consider international standards, will improve signal detection and risk communication. (C) 2019 Elsevier Inc. All rights reserved. Amer Brasiliense State Hosp, Amer Brasiliense, Brazil Sao Paulo State Univ, Sch Pharmaceut Sci, Dept Drugs & Med, Araraquara, Brazil Univ Aveiro, Dept Med Sci, Inst Biomed iBiMED, Aveiro, Portugal Sao Paulo State Univ, Sch Pharmaceut Sci, Dept Drugs & Med, Araraquara, Brazil FAPESP: 2013/12681-2 FAPESP: 2018/07501-9 CNPq: 131206/2017-6 CAPES: 001

A partir da visão de Scolari (2008) sobre hipermediações, o presente artigo pretende elencar potencialidades no uso das técnicas do Jornalismo Guiado por Dados (JGD) na perspectiva da Hipertelevisão. Com base em conceitos de referência e exemplos ilustrativos, propomos uma reflexão acerca do JGD como ferramenta para a construção de extensões narrativas e para o planejamento de coberturas transmídia.Palavras-chave: Hipertelevisão. Jornalismo Guiado Por Dados. Transmídia. Infográfico.