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Objective: The present study aims to assess the prevalence of suicidal ideation and identify associations with lifestyle. Methods: This is a cross-sectional study conducted on 971 adolescents (14 to 18 years), of both sexes, attending public schools in Florianópolis, Brazil. Suicidal ideation was the outcome variable, assessed by the question "During the last 12 months, have you, at any time, seriously considered committing suicide (taking your own life)?" The response options were "yes" and "no." Lifestyle was assessed using the Fantastic Lifestyle questionnaire. Total and domain scores were treated as independent variables. Results: The overall prevalence of suicidal ideation was 22.1% (girls = 30.1%, boys = 15.0%, p < 00.5). In both boys and girls, the domains Family and Friends (OR: 0.86; IC95%=0.76-0.97; and OR: 0.75; IC95%=0.68-0.84), Tobacco and Toxics (OR: 0.80; IC95%=0.72-0.90; and OR: 0.71; IC95%=0.64-0.79), Sleep, Seatbelt, Stress, and Safe Sex (OR: 0.87; IC95=0.81-0.94; and OR: 0.87; IC95%=0.82-0.92), Type of Behavior (OR=0,72; IC95%=0.62-0.84; and OR: 0.74; IC95%=0.66-0.83), Insight (OR: 0.65; IC95%=0.58-0.72; and OR: 0.63; IC95%=0.57-0.69), and the overall lifestyle score were negatively associated with suicidal ideation (OR: 0.1; IC95%=0.84-0.94; and OR: 0.92; IC95%=0.90-0.94). Furthermore, in girls, there was a negative association of the Alcohol domain (OR: 0.85; IC95%=0.76-0.96) with suicidal ideation. Conclusion: The prevalence of suicidal ideation is alarming, affecting 2 out of 10 adolescents. Adolescents with lower lifestyle scores, as well as those with poorer scores in behavioral, psychological, and social domains, had the highest likelihood of experiencing suicidal ideation.

Introduction: Treatment-free remission (TFR) is successful in half of the patients with chronic myeloid leukemia who discontinue Imatinib (IM) after sustained molecular response. Methods: In a prospective trial, we used pioglitazone for 3 months before stopping IM in 30 patients. Percentages of peripheral blood lymphocyte subsets were assessed before and after treatment. The relation of these data with duration of IM treatment and TRF were examined. Results: The median time of IM treatment was 117.6 months. After discontinuation, 11 patients had molecular recurrence after 5.2 months (2.4 – 30). The observation time for those remaining in TFR was 46 (26 – 56) months. The independent factors for the maintenance of TFR were the duration of IM treatment and the percentage of double-positive T cells at IM stop. Conclusion: A longer treatment with imatinib was associated with a longer TFR after discontinuation. Pioglitazone could act as an immunomodulator, increasing DP T cells which may contribute to prevent relapse.

In the age of the Internet of Things (IoT), ethical considerations of digitally-led public health surveillance are crucial. However, their application becomes complicated due to an implicit dichotomy of ethical and legal factors. Decision-makers often omit ethical considerations, citing legal ones to justify how public health surveillance is approached and implemented. We propose an analytical framework informed by a further exposition of how influence and power are enacted at the macro, meso, and micro levelscorrelated to a spectrum of ethical practices. We then apply the spectrum of ethical practices to the four use cases of “Healthcare Delivery Using Drones”, “COVID-19 Pandemic in Canada”, “Air Quality and Air Pollution”, and “Heatwaves”. When technology deployment prioritizes efficiency over accessibility, it can exacerbate disparities, especially for individuals with lower socioeconomic status and literacy levels. To mitigate these issues, it is essential to incorporate public deliberation, co-design, and community engagement into decision-making processes. This approach advances the incorporation of diverse perspectives to better frame technology initiatives.

BackgroundAgeTech (technology for older people) offers digital solutions for older adults supporting aging in place, including digital health, assistive technology, Internet of Things, medical devices, robotics, wearables, and sensors. This study underscores the critical role of standards and guidelines in ensuring the safety and effectiveness of these technologies for the health of older adults. As the aging demographic expands, the focus on robust standards becomes vital, reflecting a collective commitment to improving the overall quality of life for older individuals through thoughtful and secure technology integration. ObjectiveThis scoping review aims to investigate the current state of standards and guidelines applied in AgeTech design and development as reported in academic literature. We explore the existing knowledge of these standards and guidelines and identify key gaps in the design and development of AgeTech guidelines and standards in scholarly publications. MethodsThe literature review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Searches were carried out across multiple databases, including Scopus, IEEE, PubMed, Web of Science, EBSCO, CINAHL, Cochrane, and Google Scholar, using a search string incorporating concepts such as “older people,” “technology,” and “standards or guidelines.” Alternative terms, Boolean operators, and truncation were used for comprehensive coverage in each database. The synthesis of results and data analysis involved both quantitative and qualitative methods. ResultsInitially, 736 documents were identified across various databases. After applying specific inclusion and exclusion criteria and a screening process, 58 documents were selected for full-text review. The findings highlight that the most frequently addressed aspect of AgeTech standards or guidelines is related to “design and development,” constituting 36% (21/58) of the literature; “usability and user experience” was the second most prevalent aspect, accounting for 19% (11/58) of the documents. In contrast, “privacy and security” (1/58, 2%) and “data quality” (1/58, 2%) were the least addressed aspects. Similarly, “ethics,” “integration and interoperability,” “accessibility,” and “acceptance or adoption” each accounted for 3% (2/58) of the documents. In addition, a thematic analysis identified qualitative themes that warrant further exploration of variables. ConclusionsThis study investigated the available knowledge regarding standards and guidelines in AgeTech design and development to evaluate their current status in academic literature. The substantial focus on assistive technologies and ambient assisted living technologies confirmed their vital role in AgeTech. The findings provide valuable insights for interested parties and point to prioritized areas for further development and research in the AgeTech domain.

RESUMO Objetivo Determinar a incidência da obstrução congênita do ducto nasolacrimal em crianças com síndrome de Down e seu tratamento. Métodos Estudo retrospectivo observacional de 33 prontuários de crianças com síndrome de Down, atendidas em um Ambulatório de Especialidades Jardim Peri Peri, no período de 7 de julho 2004 a 14 de outubro de 2009. Resultados Das 33 crianças com a síndrome de Down, nove (27,27%) tiveram obstrução congênita do ducto nasolacrimal, sendo cinco do sexo feminino, e seis (66,66%) apresentaram obstrução bilateral. A cura com o tratamento conservador se observou em sete crianças (77,77%), e duas (22,22%) necessitaram de intervenção cirúrgica. Conclusão O tratamento conservador obteve alta taxa de cura na obstrução congênita do ducto nasolacrimal na síndrome de Down.

Objetivo: Descrever o perfil epidemiológico da mortalidade por mieloma múltiplo e neoplasias malignas de plasmócitos no território brasileiro. Material e métodos: Trata-se de um estudo descritivo com abordagem quantitativa acerca da mortalidade por mieloma múltiplo e neoplasias malignas de plasmócito no Brasil, no período de 2012 a 2022. Os dados foram obtidos através do Departamento de Informática do Sistema Único de Saúde (DATASUS). Para o presente estudo foram analisadas as variáveis: ano de processamento, faixa etária, cor/raça e sexo. Resultados: Observou-se que ocorreram 34.595 óbitos por residência decorrentes de mieloma múltiplo e neoplasias malignas de plasmócitos em todo o país durante a série temporal de 2012 e 2022, tendo 2012 (2.403 ou 6,9%) e 2022 (3.679 ou 10,6%) sido os anos com mais e menos registros. No que tange à idade prevalente de falecimentos, a incidência se deu entre 60 e 69 anos, com o total de 10.134 (29,3%). Além disso, foi notado que a população masculina foi a que mais pereceu em decorrência da doença, com 17.861 (51,6%). Por fim, a taxa de óbitos segundo cor/raça foi a que mais variou, com 20.013 (57,8%), 2.958 (8,6%), 165 (0,5%), 10.173 (39,4%), 42 (0,1%) e 1.244 (3,6%) sendo brancos, pretos, amarelos, pardos, indígenas e ignorados, respectivamente. Discussão: Neste estudo foi possível identificar que a faixa etária mais afetada, de 60 a 69 anos, apontando que essas neoplasias têm mais incidência nas idades mais avançadas. Com relação à cor/raça, 57,8% dos óbitos ocorreram em indivíduos brancos, o que vai de encontro com as evidências sobre a prevalência maior nessa população. Houve também um aumento considerável no número de óbitos ao longo dos anos, com um pico em 2022. Esse dado sugere tanto a melhoria no rastreio desses tipos de câncer quanto o envelhecimento da população brasileira. A predominância de óbitos entre homens (51,6%) pode indicar uma maior susceptibilidade masculina a essas doenças, bem como diferenças de acesso e resposta ao tratamento. Conclusão: Portanto, é evidente a relevância da análise dos casos de mieloma múltiplo e sua influência no Brasil. É possível ver a prevalência aumentada em indivíduos de cor branca e para as idades de 60+, indicando a importância do rastreamento para um diagnóstico precoce, aumentando assim as taxas de sobrevida. Contudo, cada caso possui sua individualidade e deve ser levado em conta durante a escolha do tratamento, para que um desfecho positivo possa ser observado.

Traditional public health surveillance efforts are generally based on self-reported data. Although well validated, these methods may nevertheless be subjected to limitations such as biases, delays, and costs or logistical challenges. An alternative is the use of smart technologies (eg, smartphones and smartwatches) to complement self-report indicators. Having embedded sensors that provide zero-effort, passive, and continuous monitoring of health variables, these devices generate data that could be leveraged for cases in which the data are related to the same self-report metric of interest. However, some challenges must be considered when discussing the use of mobile health technologies for public health to ensure digital health equity, privacy, and best practices. This paper provides, through a review of major Canadian surveys and mobile health studies, an overview of research involving mobile data for public health, including a mapping of variables currently collected by public health surveys that could be complemented with self-report, challenges to technology adoption, and considerations on digital health equity, with a specific focus on the Canadian context. Population characteristics from major smart technology brands—Apple, Fitbit, and Samsung—and demographic barriers to the use of technology are provided. We conclude with public health implications and present our view that public health agencies and researchers should leverage mobile health data while being mindful of the current barriers and limitations to device use and access. In this manner, data ecosystems that leverage personal smart devices for public health can be put in place as appropriate, as we move toward a future in which barriers to technology adoption are decreasing.

The Brazilian government has adopted measures that aim to influence students' spatial mobility. The extent and success of such measures require detailed knowledge of the mobility determinants. Gravity models are the appropriate tool for analyzing the flows of college students from their place of origin to their destination. To analyze the determinants of student flows, we estimate a negative binomial regression model with Brazilian data. The results show the deterrence effect of distance on mobility, as the total costs of entering a university increase with the distance between the place of origin and the destination institution. Places with lower living costs and smaller university centers (campuses) are attraction factors to students, as are the possibility of having non-reimbursable financing and a larger number of study programs.

Background Public health surveillance involves the collection, analysis and dissemination of data to improve population health. The main sources of data for public health decision-making are surveys, typically comprised of self-report which may be subject to biases, costs and delays. To complement subjective data, objective measures from sensors could potentially be used. Specifically, advancements in personal mobile and wearable technologies enable the collection of real-time and continuous health data. Objective In this context, the goal of this work is to apply a mobile health platform (MHP) that extracts health data from the Apple Health repository to collect data in daily-life scenarios and use it for the prediction of stress, a major public health issue. Methods A pilot study was conducted with 45 participants over 2 weeks, using the MHP to collect stress-related data from Apple Health and perceived stress self-reports. Apple, Withings and Empatica devices were distributed to participants and collected a wide range of data, including heart rate, sleep, blood pressure, temperature, and weight. These were used to train random forests and support vector machines. The SMOTE technique was used to handle imbalanced datasets. Results Accuracy and f1-macro scores were in line with state-of-the-art models for stress prediction above 60% for the majority of analyses and samples analysed. Apple Watch sleep features were particularly good predictors, with most models with these data achieving results around 70%. Conclusions A system such as the MHP could be used for public health data collection, complementing traditional self-reporting methods when possible. The data collected with the system was promising for monitoring and predicting stress in a population.

This study assessed the effect of subclinical mastitis on the productivity and inflammatory markers in Jersey dairy cows. Blood, milk, and milk yield data were collected from 59 Jersey dairy cows reared under a semi-extensive system. Milk samples were collected from individual collectors and evaluated for their somatic cell count (SCC), lactose (Lact), protein, fat, total and defatted dry extracts (DDE), casein, freezing point, and milk urea nitrogen (MUN) levels. After milking, blood was collected by puncturing the coccygeal arteriovenous complex. In the serum samples, the inflammatory biomarkers paraoxonase-1, albumin, and total plasma protein levels were analyzed using colorimetric methods. Samples of the entire diet provided and pastures were submitted for bromatological analysis. Additionally, the body condition score, number of lactations, milk yield, days of lactation, calving interval, number of inseminations until conception, calving-conception interval, and days of pregnancy were analyzed. The cows were categorized based on their SCC into a subclinical mastitis group (SubG), with SCC levels greater than or equal to 200,000 cells/mL, and a control group (CG), with SCC levels below 200,000 cells/mL. Blood metabolic variables, milk quality, and milk production data were analyzed using multivariate regression, analysis of variance, and logistic regression using the SAS® program. The multivariate regression analysis revealed that several markers, such as Lact, total protein, and casein, influenced milk composition, predicting over 97% of the data. The SubG showed lower concentrations of Lact (4.37 vs. 4.47%; P = 0.0002), MUN (20.55 vs. 23.85 mg/dL; P = 0.02), and DDE (9.24 vs. 9.50%; P = 0.02) compared with the CG; moreover, animals in the SubG had a higher number of lactations compared with those in the CG (4.30 vs. 2.69; P = 0.0039). Cows with a Lact content lower than 4.265% (quartile 25%), compared with those with Lact content greater than 4.565% (quartile 100%), were 52 times more likely to have subclinical mastitis. Jersey dairy cows with subclinical mastitis have lower Lact, urea, and defatted dry extract levels in their milk as well as a higher number of lactations. Therefore, Lact levels in milk serve as a good diagnostic marker of subclinical mastitis in Jersey cows. Subclinical mastitis in Jersey dairy cows did not decrease milk yield nor effect reproductive performance.

ABSTRACT: Faster phenotyping tools are crucial for field progeny selection. We conducted research comparing two water deficit simulation methods on contrasting cultivars for water deficit tolerance. In a first step, we conducted two experiments: one for seed germination in sand at 10% and 70% water retention capacity, being analyzed seedling emergence and growth; other for seed germination in stress simulation by moistening the germination paper with PEG solution at -0.6 MPa, being analyzed seed germination. These experiments were used to distinguish characteristics of two maize lineages with different response to drought, being 57 - sensitive and 91 - tolerant. After that, we produced hybrid progenies from these lines at generations F1, F2, and F2:3 and applied the stress simulation by moistening the germination paper with -0.6 MPa of PEG solution. The seedling size was analyzed trough image analysis by the GroundEye® system. We could distinguish both lines and its hybrids through the stress simulation and image analysis. The results indicate that maize cultivars can be phenotyped for water deficit tolerance either 5 days postsowing through stress simulation or via image analysis of root length from seedlings germinated under -0.6 MPa. This method provides faster, more accurate, and more cost-effective methods for assessing water deficit tolerance in maize cultivars.

Walking is an important and popular form of physical activity for health, whose trends of decline among Brazilian adolescents over the years remain unknown. The purpose of this study was to analyze the secular trend and sociodemographic correlates of walking among adolescents in southern Brazil (2007–2017/18). Two cross-sectional surveys, conducted in 2007 and 2017/18, gathered data from 1967 adolescents in Florianopolis, Brazil, using a standard protocol. We collected data on the weekly frequency and duration of walking practice. Gender, age, and socioeconomic status (SES) were modeled in logistic regression analysis. Overall, the weekly volume (time) spent walking declined by 43.1% over the years. In all gender, age, and SES subgroups, walking declined from 31.5% to 51.7%. Compared to 2007 adolescents, girls (OR: 4.14; 95% CI: 2.66–6.43), younger adolescents (15 years: OR: 3.23; 95% CI: 1.74–5, 98; 16 years: OR: 4.36; 95% CI: 2.66–7.15) and those with low SES (OR: 3.48; 95% CI: 2.13–5.68) and high SES (OR: 3.39; 95% CI: 2.21–5.20) were the 2017/18 groups most likely to be inactive on the walk. This study reveals a decline in walking among adolescents in southern Brazil, affecting all analyzed sociodemographic groups. Girls, younger adolescents, and individuals from both ends of the socioeconomic spectrum showed higher probabilities of inactivity in this form of physical activity. Targeted public policies aimed at promoting walking and addressing the specific needs of girls, youth, and various socioeconomic groups are necessary.

Objective: To investigate the differences between boys and girls in the present variables, and assess the possible associations between self-esteem and teasing in school physical education classes, self-efficacy, and physical activity among adolescents. Method: The sample included 944 adolescents aged 14 to 19 years (mean =16.52, SD = 1.12, 53.6% male), enrolled in public high schools in Florianópolis, Santa Catarina, Brazil. Information was collected on age, body mass index, physical activity level, self-efficacy, teasing experiences in physical education classes, and self-esteem (dependent variable). Self-esteem was assessed using the Rosenberg Self-esteem Scale. Results: Adolescents had a mean self-esteem score of 28.71 (out of 40), with boys having higher scores than girls (29.66 vs. 27.61, p < .001). In both sexes, adolescents who reported lower levels of teasing in physical education classes had higher self-esteem. Boys with high self-efficacy and higher levels of physical activity had higher self-esteem scores. Conclusion: Experiencing teasing in school physical education classes was a predictor of self-esteem in adolescents of both sexes, and self-efficacy and physical activity were predictors of self-esteem in boys.

Abstract Objective To describe and compare the nutritional status of adolescents using three criteria for nutritional status classification (Conde & Monteiro, International Obesity Task Force - IOTF and Word Health Organization - WHO), to analyze the correlation between these three criteria as for the overweight proportion, and to investigate whether factors associated with overweight and obesity differ among the three criteria. Methods Demographic (gender, age, geographic area) and anthropometric (body weight, height) variables were measured in 33.728 adolescents aged 11 to 17 years. The following criteria were investigated: IOTF (2000); Conde & Monteiro (2006); and WHO (2007). Results The overall overweight prevalence was 20.6% for the Conde & Monteiro criteria; 15.3% for the IOTF criteria and 20.1% for the WHO criteria. Both for boys and girls, the estimated overweight prevalence using the Conde & Monteiro and WHO criteria were higher than that using the IOTF criteria. Higher concordance was found between the Conde & Monteiro (2006) and WHO (2007) criteria for all age groups. Regarding associated factors, similar associations were found for the three criteria for higher BMI classification: being male, 11–12 and 13–14 years of age and living in the Midwestern, Southeastern and Southern regions of Brazil. Conclusion The criteria for BMI classification estimate overweight prevalence in a different way, and the criteria proposed by Conde & Monteiro resulted in higher prevalence in both sexes. Higher concordance between the Conde & Monteiro and WHO criteria was found for all age groups. The groups most vulnerable to showing overweight and obesity for the three criteria for BMI classification were males, age 11–12 and 13–14 years, and living in the Midwestern, Southeastern and Southern regions of Brazil. Overweight and obesity are considered a public health problem prevalent among adolescents in Brazil, regardless of the criteria adopted.

O insulinoma é o tumor do pâncreas endócrino mais comum em cães, caracterizado pela secreção excessiva de insulina, mesmo na presença de hipoglicemia. Sua etiologia permanece desconhecida, considerado de ocorrência rara e, em geral, maligno. As manifestações clínicas resultam da neuroglicopenia e da liberação de hormônios contra regulatórios, manifestando-se em fraqueza, convulsão, tremores, agitação e até mesmo coma e óbito. O diagnóstico é baseado nos dados de anamnese, sinais clínicos, alterações laboratoriais nas concentrações de glicose sanguínea e insulina sérica em jejum, exames de imagem, como tomografia computadorizada (TC), além de ressecção cirúrgica com envio da amostra para análise histopatológica e imuno-histoquímica. A abordagem terapêutica primordial é a remoção cirúrgica do tumor. Este relato tem como objetivo apresentar o caso de um canino, fêmea, sem raça definida, castrada, seis anos, sem histórico de sinais típicos de insulinoma, mas com hipoglicemia em exame laboratorial e glicosímetro portátil validado. Com base nesse achado, surgiu a suspeita de insulinoma e iniciou-se a investigação com dosagem de insulina sérica e exames de imagem. O diagnóstico foi confirmado pela presença de hiperinsulinemia com hipoglicemia, TC com imagens compatíveis e pancreatectomia parcial, sendo posteriormente enviado o tumor para análise histopatológica e imuno-histoquímica. O tratamento instituído foi a quimioterapia por via oral. Concluiu-se que há possibilidade de diagnosticar o insulinoma antes do aparecimento de sinais clínicos, o que, embora não altere o prognóstico reservado da doença, possibilita um acompanhamento veterinário mais frequente, resultando em uma melhoria na qualidade de vida do animal.

Background: Low literacy is associated with poor cognitive performance and it is a risk factor for dementia. Recently, research suggests an association between levels of mindfulness and cognitive performance of older adults. This study aims to analyze if levels of mindfulness mediate the relationship between years of education and cognitive performance in older adults with low education. Methods: This is a quantitative, observational, and analytical study whose participants were cognitively healthy community-dwelling older adults. Participants were assessed through a sociodemographic questionnaire, ACE-III, Langer Mindfulness Scale – 21 items, and Geriatric Depression Scale. Descriptive and regression analyses were performed, and the significance level was set at p

الملخص: أهداف البحث: تشير التقديرات إلى أن واحدا فقط من كل خمسة مراهقين يمارس نشاطا بدنيا كافيا، وقد يكون هذا مؤشرا على أن الشعور بالسلامة النفسية بين المراهقين قد انخفض على مر السنين. هدفت هذه المراجعة المنهجية إلى الإبلاغ عن وتلخيص المعرفة المتاحة حول الاتجاهات العلمية للنشاط البدني لدى المراهقين على مر السنين. طرق البحث: تم البحث في سبع قواعد بيانات (شبكة العلوم، وسكوبس/السيفير، وميدلاين/ببميد، ساينس دايركت، وليلكس، و مؤشر التربية البدنية، وسبورت ديسكوس). وتم فحص ١٨٠٩ دراسة. وفقا لإرشادات عناصر التقارير المفضلة للمراجعات المنهجية والتحليلات الوصفية (بريزما). تم فحص الأبحاث ذات الصلة حول الاتجاهات المعرفية عن النشاط البدني لدى المراهقين لإدراجها في توليف سردي. كما تم تقييم خطر التحيز في الدراسات المدرجة.النتائج: استوفت ٤٣ دراسة مع البيانات التي تم جمعها بين عامي ١٩٦٩ و ٢٠١٨ متطلبات التضمين، مع غلبة البيانات من الدول ذات الدخل المرتفع. تم تقدير النشاط البدني في الغالب عن طريق التقرير الذاتي، باستثناء سبع دراسات، وتنوعت السياقات والمجالات التي تم تحليلها. كانت هناك تقارير عن زيادة النشاط البدني في ١٦ دراسة (من ٢.٩٪ إلى ٤٣.٥٪) ، وانخفضت في ١٥ (−٢.٥٪ إلى −٦٩.٥٪) ، واستقرت في ٢٢ (−١٢.٠٪ إلى ١٤.٤٪). الاستنتاجات: على الرغم من أنه قد لوحظ أن النشاط البدني قد زاد في بعض الدول، إلا أن المعلومات المتوفرة قليلة جدا في الدول المنخفضة والمتوسطة الدخل. يجب أن تدعم الجهود إجراء دراسات حول اتجاهات النشاط البدني لدى المراهقين من الدول المحرومة اقتصاديا. Abstract: Objective: One in five adolescents has been estimated to perform sufficient physical activity (PA), thus potentially indicating that PA among adolescents has declined. This systematic review was aimed at reporting and summarizing the available knowledge regarding PA secular trends in adolescents over time. Methods: Seven databases were consulted (Web of Science, Scopus/Elsevier, Medline/PubMed, ScienceDirect, Lilacs, Physical Education Index, and SPORTDiscus), and 1809 studies were examined. According to the PRISMA guidelines, relevant research on secular PA trends in adolescents was screened for inclusion in a narrative synthesis. The risk of bias in the articles included was also assessed. Results: Forty-three studies with data collected between 1969 and 2018 met the inclusion criteria, and data from high-income countries predominated. PA was estimated predominantly by self-reporting, except in seven studies, and diverse contexts and domains were analyzed. Increased PA was reported in 16 studies (from 2.9% to 43.5%), decreased PA was reported in 15 studies (−2.5% to −69.5%), and no change was reported in 22 studies (−12.0% to 14.4%). Conclusions: Although PA has increased in some countries, very little information is available in low- and middle-income countries. Efforts should support studies on PA trends in adolescents from economically disadvantaged countries.

Abstract Background Cognitive functioning is an important dimension among the elderly. Cognitive maintenance is vital for aging due to its association with autonomy and independence. Considering the importance of preventive programs in older adults’ health, this study aims to share an intervention protocol of a falls prevention program for community-dwelling faller older adults with cognitive impairment. Methods This is the protocol of an experimental and longitudinal study, consisting of cognitive stimulation associated with physical exercise in a 16-week fall prevention program. For cognitive intervention, the APG Cognitive Training Protocol will be used. Participants will be assessed pre-and post-intervention and will be randomly allocated to experimental or control groups. The screening protocol is composed of the TUG, FES-I, LAWTON & BRODY, ACE-R, GAI and fall survey instruments, focusing on the assessment of balance and mobility, fear of falling, performance on IADL, cognitive and anxiety tracking, respectively. Discussion This study can determine the long-term effects of multimodal cognitive training, providing evidence for its replication in the provision of care for the elderly. The objective is to promote improvements in the cognitive performance, mobility and balance of the elderly, with a focus on reducing the number of falls, fractures, hospitalizations and institutionalization, serving as an alternative to interrupt the cycle of falls. Trial registration The research was approved by the Research Ethics Committee with Human Beings at the Federal University of São Carlos, CAAE: 3654240.9.0000.5504 and Brazilian Registry of Clinical Trials (REBEC) RBR—3t85fd, registered on the 25th of September, 2020.

Introduction: Due to the complex nature of chronic pain, especially in older adults, a biopsychosocial approach is more effective than an isolated approach for its management. Furthermore, when patients are actively engaged in their pain management, they are more likely to be successful than relying totally on others. Objective: To analyze the self-management strategies currently used by older adults with chronic pain. Method: An integrative review was conducted through seven online databases, searching for scientific studies on this topic published in the last 10 years. Results and conclusion: Fifty-eight studies were included in the final sample. Research on chronic pain self-management for older adults has increased in recent years. Although a diversity of chronic physical painful conditions are being investigated, many conditions are still under-investigated. Online and in-person strategies are currently adopted, demonstrating similar results. Positive results are evidenced by strategies including health promotion, mind control, social participation and take-action fields. Major results come from a combination of strategies focusing on biopsychosocial aspects of pain management. Results include not only the reduction of pain itself, but increased self-efficacy, adoption of health behaviors and improvement of functionality, among others, i.e., improved QoL, despite pain.

Approximately 45% of patients receive medical services with minimal or no benefit (low-value care). In addition to the increasing costs to the health system, performing invasive procedures without an indication poses a potentially preventable risk to patient safety. This study aimed to determine whether a managed quality improvement programme could prevent cholecystectomy and surgery for endometriosis treatment with minimal or no benefit to patients.This before-and-after study was conducted at a private hospital in São Paulo, Brazil, which has a main medical remuneration model of fee for service. All patients who underwent cholecystectomy or surgery for endometriosis between 1 August 2020 and 31 May 2021 were evaluated.The intervention consisted of allowing the performance of procedures that met previously defined criteria or for which the indications were validated by a board of experts.A total of 430 patients were included in this analysis. The programme prevented the unnecessary performance of 13% of cholecystectomies (p=0.0001) and 22.2% (p=0.0006) of surgeries for the treatment of endometriosis. This resulted in an estimated annual cost reduction to the health system of US$466 094.93.In a hospital with a private practice and fee-for-service medical remuneration, the definition of clear criteria for indicating surgery and the analysis of cases that did not meet these criteria by a board of reputable experts at the institution resulted in a statistically significant reduction in low-value cholecystectomies and endometriosis surgeries.

Introdução/Objetivo: As vacinas são uma escolha eficaz para o controle de doenças infecciosas, sendo primordial na contenção da pandemia da COVID-19. As vacinas são produtos seguros, porém, não são isentas de eventos adversos. De correndo, assim, na importância de uma avaliação de causalidade de Eventos Supostamente Atribuíveis à Vacinação (ESAVI) com qualquer ocorrência médica indesejada após a vacinação. O estudo possui por objetivo caracterizar os casos de ESAVI contra a COVID-19 quanto à gravidade, à causalidade e as manifestações clínicas. Métodos: Este estudo de coorte retrospectivo foi realizado a partir de casos de ESAVI contra a COVID-19 atendidos no Hospital de Base de São José do Rio Preto entre janeiro de 2021 e julho de 2022. Os dados secundários foram coletados do prontuário eletrônico e do Sistema VaciVida pertinentes as investigações e notificações dos casos. Resultados: Foram analisados 728 casos de ESAVI, sendo 554 (76,10%) em pessoas com idade entre 20 e 59 anos, incidindo mais sobre as mulheres (72,80%). O tempo entre a vacinação e o início de sintomas teve mediana de dois dias, com 290 notificações associada à primeira dose adicional da vacina Pfizer. Segundo a classificação, 262 (35,99%) foram classificados como evento adverso grave por necessitar de hospitalização e, desses, 48 (6,59%) foram óbitos em período temporalmente associado à vacinação. Os casos não graves corresponderam a 64,01% das notificações. Quanto às manifestações clínicas, foram mais relacionadas aos sistemas: neurológico (269 - 60,03%) respiratório (279 - 38,32%), gastrointestinal (269 - 36,95%), tegumentar (128 - 17,58%) e cardiovascular (32 - 4,44%). Do total de casos notificados, 177 (24,31%) foram avaliados e encerrados pelo Centro de Vigilância Epidemiológica de São Paulo. Dentre os não graves, 45 (9,6%) eram reações inerentes a vacina e 3 (0,64%) casos tiveram relação temporal. Em relação aos casos graves, 10 (3,82%) foram classificados com relação temporal consistente, mas sem evidências na literatura. Todos os óbitos investigados foram descartados com relação à causalidade. Conclusão: Este estudo, desenvolvido com dados secundários de um complexo de saúde, não pode ser generalizado para outros serviços. Contudo, considerando os casos encerrados, nota-se que embora haja ocorrência de eventos adversos após a vacina, grande parte dos casos estão associados às reações não graves inerentes ao produto consistentes na literatura.