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Introduction: Active surveillance (AS) is increasingly recognized as an appropriate strategy for selected patients with papillary thyroid microcarcinomas (PTMC). However, some factors, including physician-related ones, hinder its widespread adoption. Methods: To explore the prevailing barriers and the impact of information on attitudes towards AS implementation, we developed a questionnaire that was completed before and after reading a simple information leaflet by 317 doctors working in different work environments. This leaflet provides information about the overdiagnosis of PTMC, the concept of AS, results of early studies, and main advantages and disadvantages of AS. Results: We observed a greater resistance to AS among male physicians who were more likely to maintain the initial recommendation for surgery or referral to a head and neck surgeon than female physicians (77 % vs. 46 %, p = 0.01), regardless of their medical specialty. Fear of disease progression and of the patient losing follow-up were the main concerns. Reading the educational material significantly increased the number of physicians who endorsed AS as an initial approach to PTMC without risk factors from 14 % to 34 % (p < 0,001). This change in attitude was even more significant when doctors were confronted with a case of PTMC in an elderly patient. Gender, medical specialty, age range and academic environment were the factors that were determinants on the influence of the informative leaflet on the decision-making. The leaflet also increased the number of doctors who considered themselves capable of dealing with this patient profile; however, 17 % declared that the place where they worked would not be able to meet the need for periodic assessments and necessary examinations. This was particularly true for the 20 % of the professionals working in rural areas. Conclusion: A simple educational leaflet with basic information presented via social media increased the number of Brazilian physicians who endorsed AS for PTMC management and proved to be a facilitating tool for understanding and accepting it. Our results suggest that this method can be easily extended to larger population.

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The measurement of morphometric traits in horses is important for determining breed qualification and is one of the main selection criteria for the species. The development of an index (HPC) that consists of principal components weighted by additive genetic values allows to explore the most relevant relationships using a reduced number of variables that explain the greatest amount of variation in the data. Genome-wide association studies (GWAS) using HPC are a relatively new approach that permits to identify regions related to a set of traits. The aim of this study was to perform GWAS using HPC for 15 linear measurements as the explanatory variable in order to identify associated genomic regions and to elucidate the biological mechanisms linked to this index in Campolina horses. For GWAS, weighted single-step GBLUP was applied to HPC. The eight genomic windows that explained the highest proportion of additive genetic variance were identified. The sum of the additive variance explained by the eight windows was 95.89%. Genes involved in bone and cartilage development were identified (SPRY2, COL9A2, MIR30C, HEYL, BMP8B, LTBP1, FAM98A, and CRIM1). They represent potential positional candidates for the HPC of the linear measurements evaluated. The HPC is an efficient alternative to reduce the 15 usually measured traits in Campolina horses. Moreover, candidate genes inserted in region that explained high additive variance of the HPC were identified and might be fine-mapped for searching putative mutation/markers.

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Abstract Phubbing, the act of ignoring people during a face-to-face interaction to dedicate attention to the smartphone, is a phenomenon widely observed in today's society. Therefore, this research aimed to carry out the cross-cultural adaptation of the Phubbing Scale to Brazilian Portuguese and examine its psychometric properties. The study included 1,551 Brazilian adults, 61.7% female and 29.9% male, aged from 18 to 76 years (M = 31.6 years; SD = 9.6 years). A socio-demographic questionnaire and the Phubbing Scale were used. Exploratory Factor Analysis, Confirmatory Factor Analysis, Network Analysis and Mann-Whitney Test were performed. The results confirmed the bifactorial version of the Phubbing Scale with good fit indices (CFI = 0.99; TLI = 0.99; α = 0.83). The Phubbing Scale showed adequate psychometric properties and internal consistency for use in Brazil.

Resumo Comportamento de Phubbing, ato de ignorar as pessoas durante uma interação presencial para dedicar atenção ao smartphone, é um fenômeno amplamente observado na sociedade atual. Diante disto, o objetivo desta pesquisa foi realizar a adaptação transcultural da Escala de Phubbing para a população brasileira e examinar suas propriedades psicométricas. Participaram da pesquisa 1.551 adultos brasileiros, sendo 61,7 % do sexo feminino e 29,9% do sexo masculino, com idades entre 18 e 76 anos (M = 31,6 anos; DP = 9,6 anos). Foram utilizados o questionário sociodemográfico e a Escala de Phubbing. Foram realizadas Análise Fatorial Exploratória, Análise Fatorial Confirmatória, Análise de Rede e Teste de Mann-Whitney. Os resultados confirmaram a versão bifatorial da Escala de Phubbing com bons índices de ajustes (CFI = 0,99; TLI = 0,99; α = 0,83). A Escala de Phubbing apresentou propriedades psicométricas e consistência interna adequadas para utilização no contexto brasileiro.

Resumen El Comportamiento de Phubbing, el acto de ignorar a las personas durante una interacción cara a cara para dedicar su atención al teléfono inteligente, es un fenómeno ampliamente observado en la sociedad actual, por tanto, el objetivo de esta investigación fue realizar la adaptación transcultural de la Escala Phubbing al portugués brasileño y examinar sus propiedades psicométricas. Un total de 1551 adultos brasileños participaron en la encuesta, 61,7% mujeres y 29,9% hombres, con edades entre 18 y 76 años (M = 31,6 años; SD = 9,6 años). Se utilizó el cuestionario sociodemográfico y la Escala de Phubbing. Se realizaron Análisis Factorial Exploratorio, Análisis Factorial Confirmatorio, Análisis de Redes y Prueba de Mann-Whitney. Los resultados confirmaron la versión bifactorial de la Escala de Phubbing con buenos índices de ajuste (CFI = 0,99; TLI = 0,99; α = 0,83). La Escala de Phubbing mostró propiedades psicométricas y consistencia interna adecuadas para su uso en el contexto brasileño.

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OBJECTIVE: To review the current literature on the relationship between sleep, nutritional status and eating behavior, as well as mechanisms associated with these elements in children. DATA SOURCE: The literature research was conducted in the PubMed, LILACS and Scopus databases, using the following terms: "Child"; "Nutritional status"; "Sleep"; "Physical activity OR Physical activities OR Exercise". The articles included were those that met the research objective. Review articles, letters to authors, or guidelines were excluded. DATA SYNTHESIS: 402 articles were initially found in the literature search. After careful analyses of the title and abstract, and application of inclusion criteria, only 24 studies were included in the present review. Most studies (n=13) suggest that short sleep duration (<9-10 hours/night) is associated with overweight/obesity in children. Only three studies did not show associations between overweight/obesity and sleep variables. Short sleep duration is also associated with poor food quality, higher intake of soft drinks and stimulant beverages before bedtime, as well as micronutrient deficiency. CONCLUSIONS: Sleep duration is related to overweight and obesity development in infants. Changes in dietary pattern are also related to sleep debt, being one of the mechanisms that contribute to excessive weight gain. It is necessary that health professionals understand the importance of sleep quality in the nutritional status maintenance in children.

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OBJECTIVE: A multicentric, cross-sectional study was carried out to determine the prevalence and risk factors for Coronavirus disease 2019 in medical students and residents from four universities and affiliated hospitals in Brazil. METHODS: A survey about contamination risk and symptoms was sent to all participants through email and WhatsApp. Prevalence was measured by the self-report of positive polymerase chain reaction or serological test. Univariate and multivariate analyses were performed, and odds ratio and 95% confidence interval were calculated. RESULTS: Prevalence of infection by Sars-CoV-2 was 14.9% (151/1011). The disease was more prevalent in residents and interns than in undergraduate students. Contact with an infected relative outside the hospital or with colleagues without using personal protective equipment was associated with higher contamination. Contact with patients without wearing goggles and higher weekly frequency of contact were the two factors independently associated with the infection by Coronavirus disease 2019 in the multivariate analysis. CONCLUSIONS: Medical students, interns, and residents have a higher prevalence of Coronavirus disease 2019 than the general population, in which the last two groups are significantly at higher risk. Contacting patients at a higher weekly frequency increases the risk for infection. The use of goggles should be reinforced when contacting patients.

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SUMMARY OBJECTIVE: A multicentric, cross-sectional study was carried out to determine the prevalence and risk factors for Coronavirus disease 2019 in medical students and residents from four universities and affiliated hospitals in Brazil. METHODS: A survey about contamination risk and symptoms was sent to all participants through email and WhatsApp. Prevalence was measured by the self-report of positive polymerase chain reaction or serological test. Univariate and multivariate analyses were performed, and odds ratio and 95% confidence interval were calculated. RESULTS: Prevalence of infection by Sars-CoV-2 was 14.9% (151/1011). The disease was more prevalent in residents and interns than in undergraduate students. Contact with an infected relative outside the hospital or with colleagues without using personal protective equipment was associated with higher contamination. Contact with patients without wearing goggles and higher weekly frequency of contact were the two factors independently associated with the infection by Coronavirus disease 2019 in the multivariate analysis. CONCLUSIONS: Medical students, interns, and residents have a higher prevalence of Coronavirus disease 2019 than the general population, in which the last two groups are significantly at higher risk. Contacting patients at a higher weekly frequency increases the risk for infection. The use of goggles should be reinforced when contacting patients.

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Until mass vaccination befalls, control of the new betacoronavirus-associated severe acute respiratory syndrome pandemic (SARS-CoV-2) is based on decreasing virus circulation by social distancing and blocking transmission foci after diagnosis. Globally adopted SARS-CoV-2 diagnostic criteria embrace viral RNA detection by quantitative reverse-transcription polymerase chain reaction (qRT-PCR) on nasopharynx secretions, which requires healthcare facilities and specialized personnel for sample collection. To develop an alternative protocol, hydrophilic cotton as the material and saliva as the source for biological sample collection in qRT-PCR/RT-endpoint-PCR SARS-CoV-2 diagnostic methods prepared with local consumables were evaluated using 99 archived nasopharynx samples previously diagnosed as positive for SARS-CoV-2 and 111 prospective saliva samples pared with nasopharynx samples from patients attending the local reference ABC Medical School diagnostic laboratory. The kappa agreement coefficient between the SARS-CoV-2 qRT-PCR and RT-endpoint-PCR was k = 0.97 (95 % CI 0.92-1.00) and k = 0.90 (95 % CI 0.81-0.99), respectively, on SARS-CoV-2-positive archived samples, with the initial qRT-PCR CT under 25. The agreement coefficient of the SARS-CoV-2 alternative saliva diagnostic protocol, when used to test the paired nasopharynx samples, was k = 0.79 (95 % CI 0.56-1,00). These data support that the SARS-CoV-2 diagnostic assay based on self-collected saliva on cotton represents an alternative protocol for mass diagnosis and epidemiological studies in low-income regions.

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ABSTRACT Objective: To review the current literature on the relationship between sleep, nutritional status and eating behavior, as well as mechanisms associated with these elements in children. Data source: The literature research was conducted in the PubMed, LILACS and Scopus databases, using the following terms: "Child"; "Nutritional status"; "Sleep"; "Physical activity OR Physical activities OR Exercise". The articles included were those that met the research objective. Review articles, letters to authors, or guidelines were excluded. Data synthesis: 402 articles were initially found in the literature search. After careful analyses of the title and abstract, and application of inclusion criteria, only 24 studies were included in the present review. Most studies (n=13) suggest that short sleep duration (<9-10 hours/night) is associated with overweight/obesity in children. Only three studies did not show associations between overweight/obesity and sleep variables. Short sleep duration is also associated with poor food quality, higher intake of soft drinks and stimulant beverages before bedtime, as well as micronutrient deficiency. Conclusions: Sleep duration is related to overweight and obesity development in infants. Changes in dietary pattern are also related to sleep debt, being one of the mechanisms that contribute to excessive weight gain. It is necessary that health professionals understand the importance of sleep quality in the nutritional status maintenance in children.

RESUMO Objetivo: Fazer uma revisão da literatura sobre a relação entre sono, estado nutricional e padrão alimentar, bem como mecanismos associados, na população infantil. Fontes de dados: Foram realizadas buscas bibliográficas nas bases PubMed, LILACS e Scopus, usando os seguintes descritores: "Child"; "Nutritional status"; "Sleep"; "Physical activity OR Physical activities OR Exercise". Os artigos que atenderam ao objetivo da pesquisa foram incluídos. Excluíram-se estudos de revisão, cartas para autores ou diretrizes. Síntese dos dados: Inicialmente, 402 artigos foram encontrados na pesquisa. Após análise dos títulos e abstracts e a aplicação dos critérios de exclusão, 24 estudos foram selecionados para a revisão. A maioria dos estudos (n=13) sugere que sono de curta duração (<9-10 horas/noite) está associado com sobrepeso/obesidade na população infantil. Apenas três artigos não reportaram associações entre variáveis do sono e estado nutricional. Curta duração do sono também foi associada a hábitos alimentares ruins, maior consumo de refrigerantes e bebidas estimulantes antes de deitar, bem como deficiência de micronutrientes. Conclusões: A duração do sono tem relação com sobrepeso e obesidade na população infantil. Alterações no padrão alimentar também têm relação com débito de sono, sendo um dos mecanismos que contribuem para o ganho de peso excessivo. É necessário que os profissionais de saúde tomem conhecimento da importância da qualidade do sono para a manutenção do estado nutricional em crianças.

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Metabolic and molecular profiles were reported as different for bovine embryos with distinct kinetics during the first cleavages. In this study, we used this same developmental model (fast vs slow) to determine if the relationship between metabolism and developmental kinetics affects the levels of acetylation or tri-methylation at histone H3 lysine 9 (H3K9ac and H3K9me3, respectively). Fast and slow developing embryos presented different levels of H3K9ac and H3K9me3 from the earliest stages of development (40 and 96 hpi) and up to the blastocyst stage. For H3K9me3, both groups of embryos presented a wave of demethylation and de novo methylation, although it was more pronounced in fast than slow embryos, resulting in blastocysts with higher levels of this mark. The H3K9ac reprogramming profile was distinct between kinetics groups. While slow embryos presented a wave of deacetylation, followed by an increase in this mark at the blastocyst stage, fast embryos reduced this mark throughout all the developmental stages studied. H3K9me3 differences corresponded to writer and eraser transcript levels, while H3K9ac patterns were explained by metabolism-related gene expression. To verify if metabolic differences could alter levels of H3K9ac, embryos were cultured with sodium-iodoacetate (IA) or dichloroacetate (DCA) to disrupt the glycolytic pathway or increase acetyl-CoA production, respectively. IA reduced H3K9ac while DCA increased H3K9ac in blastocysts. Concluding, H3K9me3 and H3K9ac patterns differ between embryos with different kinetics, the second one explained by metabolic pathways involved in acetyl-CoA production. So far, this is the first study demonstrating a relationship between metabolic differences and histone post-translational modifications in bovine embryos.

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OBJECTIVE: The intermediate-risk (IR) category includes tumors with different degrees of aggression. We aimed to identify the risk factors associated with unfavorable response to initial treatment and compare the effect of low/high radioactive iodine (RAI) therapy. METHODS: A total of 614 IR patients were selected from a database, during 1972-2015. All patients underwent total thyroidectomy and RAI therapy and were reclassified after 12-18 months into the favorable (complete/indeterminate) response group and the unfavorable (biochemical/incomplete structural) response group. A total of 92 patients were assessed for late response (mean: 9.19 ± 5.73 years). Age, gender, tumor size, histology, multifocality, vascular invasion, extrathyroidal extension, presence and number of lymph node metastasis, and stimulated thyroglobulin at ablation (sTg) were evaluated. RESULTS: Mean age at diagnosis was 41.47 ± 15.81 years, and 83.6% of the patients were female. Within 12-18 months after initial therapy, unfavorable response was detected in 41.2% of the patients and was associated, in multivariate analysis, with lymph node metastasis (p = 0.041; odds ratio [OR] = 1.9), presence of more than five metastatic lymph nodes (p = 0,017; OR = 2.6), and sTg > 10 ng/mL (p = 0.005; OR = 10.0). For patients with a longer follow-up, sTg >10 ng/mL was associated with unfavorable response (p = 0.002; OR = 6.8). A higher RAI dose was not related to better prognosis at the end of the follow-up. CONCLUSION: A sTg level of >10 ng/mL and lymph node metastasis were associated with an unfavorable response 12-18 months after initial treatment. A RAI dose below 150 mCi was proven sufficient to treat IR patients.

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OBJECTIVE: Although thyroid microcarcinoma (TMC) usually has a favorable prognosis, some patients present a higher risk of disease recurrence or persistence. Thus, we aimed at identifying possible risk factors associated with an incomplete response to therapy in TMC. METHODS: This was a retrospective study of 517 patients with TMC treated with total thyroidectomy, with or without radioactive iodine (RAI) therapy, reclassified after 1.1 ± 0.4 years according to the response to treatment into "favourable" (excellent/indeterminate) or "unfavorable" (biochemical/structural incomplete) responses. We evaluated participants' age, sex, tumor size, histological variants, multifocality, presence of vascular/lymphatic/perineural invasion, extrathyroidal extension, metastatic lymph nodes (LN), and distant metastasis. The effect of RAI therapy on the response range was analyzed in a given subgroup. RESULTS: The mean age observed was 46.4 ± 12.0 years, and 89.7% were female. We noted 97.5% with papillary carcinoma, 27.8% with multifocality and 11.2% with LN metastasis. Although the majority of patients had a low risk of recurrence/persistence (78%), 75% were submitted to RAI therapy. Incomplete response (20.7%) was associated with multifocality (p=0.041; OR=1.619) and metastatic LN (p=0.041; OR=1.868). These variables were strongly correlated (p=0.000; OR=3.283). No cut-off of tumor size was identified as a predictor of incomplete response by the receiver operating curve analysis. RAI treatment did not influence the response of patients with multifocality or LN metastasis. CONCLUSION: Multifocality and LN metastasis are independent risk factors for incomplete response in TMC patients and are strongly correlated. Additional RAI therapy was not associated with a more favorable response in these subgroups.

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The aim of this study was to verify the effect of the inclusion of coat color on the genetic parameter estimation for linear measurements in Campolina horses. Two models (1 and 2) were applied. For model 1, coat color effect was not included as variable of the contemporary group formation; in model 2, it was included. Model 2 presented the best fitting with a Deviance Information Criterion (DIC) of -979,459.020 compared with -1,818,458.572 DIC from model 1. The average of heritability estimates ranged from low to high magnitude (0.15 to 0.53) for model 1 and from moderate to high magnitude for model 2 (0.21 to 0.47). The estimated values varied according to the analyses (models 1 and 2). The highest heritability was found for withers height (0.52), croup height (0.53), and back height (0.51). The genetic correlations ranged from values of moderate to high magnitude for models 1 (0.23 to 0.98) and 2 (0.29 to 0.99), respectively. The finding that genetic variance differed among models 1 and 2 may indicate that genotypes react differently to different coat colors, a fact implying the existence of interaction between these traits and the effect under study. The coat color influence might be explained as a pleiotropic effect of the genes that cause this phenotypic variation and also influence morphometric measures. The inclusion of the coat color effect better estimated the additive genetic variance of morphometric traits in horses. As a consequence, the genetic parameters were also more accurately estimated when it is included in the evaluation model.

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ABSTRACT Objective: Although thyroid microcarcinoma (TMC) usually has a favorable prognosis, some patients present a higher risk of disease recurrence or persistence. Thus, we aimed at identifying possible risk factors associated with an incomplete response to therapy in TMC. Subjects and methods: This was a retrospective study of 517 patients with TMC treated with total thyroidectomy, with or without radioactive iodine (RAI) therapy, reclassified after 1.1 ± 0.4 years according to the response to treatment into "favorable" (excellent/indeterminate) or "unfavorable" (biochemical/structural incomplete) responses. We evaluated participants' age, sex, tumor size, histological variants, multifocality, presence of vascular/lymphatic/perineural invasion, extrathyroidal extension, metastatic lymph nodes (LN), and distant metastasis. The effect of RAI therapy on the response range was analyzed in a given subgroup. Results: The mean age observed was 46.4 ± 12.0 years, and 89.7% were female. We noted 97.5% with papillary carcinoma, 27.8% with multifocality and 11.2% with LN metastasis. Although the majority of patients had a low risk of recurrence/persistence (78%), 75% were submitted to RAI therapy. Incomplete response (20.7%) was associated with multifocality (p=0.041; OR=1.619) and metastatic LN (p=0.041; OR=1.868). These variables were strongly correlated (p=0.000; OR=3.283). No cut-off of tumor size was identified as a predictor of incomplete response by the receiver operating curve analysis. RAI treatment did not influence the response of patients with multifocality or LN metastasis. Conclusion: Multifocality and LN metastasis are independent risk factors for incomplete response in TMC patients and are strongly correlated. Additional RAI therapy was not associated with a more favorable response in these subgroups.

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Objetivos: Avaliar se o Método Canguru tem impacto nas taxas de aleitamento materno exclusivo, peso, tempo de internação e taxas de reinternação. Método: Trata-se de uma coorte retrospectiva, que incluiu recém-nascidos pré-termo de muito baixo peso ao nascer, os quais foram divididos em dois grupos: GCCo ­ composto por aqueles assistidos na Unidade de Cuidados Intermediários Neonatal Convencionais; GCCa ­ composto por aqueles que foram assistidos na Unidade de Cuidados Intermediários Neonatal Canguru. Resultados: O grupo GCCa apresentou resultados superiores nas taxas de aleitamento materno exclusivo, no momento da alta hospitalar, primeira consulta ambulatorial, quarto mês de idade gestacional corrigida, além de menores taxas de reinternação. Conclusão: As segunda e terceira etapas do Método Canguru favoreceram a prática e manutenção do aleitamento materno exclusivo, além de apresentarem menores taxas de reinternação até o sexto mês de idade gestacional corrigida(AU)

Purpose: To evaluate whether the Kangaroo Method would have an impact on the rates of exclusive breastfeeding, weight, length of hospital stay and rates of hospital readmission. Methods: This is a retrospective cohort, which included very-low-weight preterm newborns. These were divided into two groups: GCCo - composed of those assisted in the Conventional Neonatal Intermediate Care Unit; GCCa - composed of those who were assisted at the Kangaroo Neonatal Intermediate Care Unit. Results: The GCCa group showed better results in exclusive breastfeeding rates at the time of hospital discharge and during outpatient follow-up - first outpatient consultation corrected fourth month of gestational age, in addition to lower rates of readmission. Conclusion: The second and third stages of the Kangaroo Method favored the practice and maintenance of exclusive breastfeeding, in addition to presenting lower rates of readmission until the sixth month of corrected gestational age(AU)

Objetivos: Evaluar si el Método Canguro tendría un impacto en las tasas de lactancia materna exclusiva, peso, tiempo de estancia hospitalaria y tasas de reingreso. Método: Se trata de un grupo retrospectivo, que incluyó a recién nacidos prematuros de muy bajo peso al nacer. Estos se dividieron en dos grupos: GCCo - compuesto por los atendidos en la Unidad de Cuidados Intermedios Neonatales Convencionales; GCCa - compuesto por los que fueron atendidos en la Unidad de Cuidados Intermedios Neonatales Canguro. Resultados: El grupo GCCa mostró resultados superiores en las tasas de lactancia materna exclusiva al momento del alta hospitalaria y durante el seguimiento ambulatorio - primera consulta ambulatoria en el cuarto mes de edad gestacional corregida, además de menores tasas de reingreso. Conclusión: La segunda y tercera etapa del Método Canguro favoreció la práctica y la prolongación de la lactancia materna exclusiva, además de presentar menores tasas de reingreso hasta el sexto mes de edad gestacional corregida(AU)

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ABSTRACT Objective: The intermediate-risk (IR) category includes tumors with different degrees of aggression. We aimed to identify the risk factors associated with unfavorable response to initial treatment and compare the effect of low/high radioactive iodine (RAI) therapy. Subjects and methods: A total of 614 IR patients were selected from a database, during 1972-2015. All patients underwent total thyroidectomy and RAI therapy and were reclassified after 12-18 months into the favorable (complete/indeterminate) response group and the unfavorable (biochemical/incomplete structural) response group. A total of 92 patients were assessed for late response (mean: 9.19 ± 5.73 years). Age, gender, tumor size, histology, multifocality, vascular invasion, extrathyroidal extension, presence and number of lymph node metastasis, and stimulated thyroglobulin at ablation (sTg) were evaluated. Results: Mean age at diagnosis was 41.47 ± 15.81 years, and 83.6% of the patients were female. Within 12-18 months after initial therapy, unfavorable response was detected in 41.2% of the patients and was associated, in multivariate analysis, with lymph node metastasis (p = 0.041; odds ratio [OR] = 1.9), presence of more than five metastatic lymph nodes (p = 0,017; OR = 2.6), and sTg > 10 ng/mL (p = 0.005; OR = 10.0). For patients with a longer follow-up, sTg >10 ng/mL was associated with unfavorable response (p = 0.002; OR = 6.8). A higher RAI dose was not related to better prognosis at the end of the follow-up. Conclusion: A sTg level of >10 ng/mL and lymph node metastasis were associated with an unfavorable response 12-18 months after initial treatment. A RAI dose below 150 mCi was proven sufficient to treat IR patients.

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The scope of this integrative review of the literature was to assess if the Kangaroo-Mother Care Method as implemented in Brazil, from the first stage to outpatient follow-up, has an influence on breastfeeding. Brazilian research published in national and international journals in Portuguese, English or Spanish in the leading research databases between the years 2000 to 2017 was included, with full articles available and theme related to the scope of this study. A total of 1328 articles were located and articles not conducted in Brazil, literature review articles and themes not related to the Kangaroo-Mother Care Method were excluded, with 21 studies eventually being selected. The research results indicated a positive influence of the Kangaroo-Mother Care Method on breastfeeding and establishing a mother-child bond. However, the third stage or outpatient follow-up proved not to be effective in maintaining breastfeeding. Greater participation of primary care in home care provided to preterm newborns is necessary, with a view to promoting exclusive breastfeeding up to six months of age and extended up to two years of age.

Esta revisão integrativa da literatura teve como objetivo verificar se o Método Canguru, conforme instituído no Brasil, desde a primeira etapa até o acompanhamento ambulatorial, tem influência sobre o aleitamento materno. Foram incluídas pesquisas realizadas no Brasil, publicadas em periódicos nacionais e internacionais, nas principais bases de dados, em português, inglês ou espanhol, nos anos de 2000 a 2017, disponíveis na íntegra e com a temática relacionada com o objetivo deste estudo. Foram encontrados 1328 artigos sendo excluídos artigos não realizados no Brasil, artigos de revisão da literatura e de temáticas não relacionadas com o Método Canguru, sendo então selecionados 21 estudos. As pesquisas encontradas apontaram para uma influência positiva do Método Canguru sobre o aleitamento materno e estabelecimento de vínculo entre mãe-filho. No entanto, a terceira etapa ou acompanhamento ambulatorial, não se mostrou eficaz na manutenção do aleitamento materno. Faz-se necessário maior participação da atenção básica nos cuidados domiciliares prestados ao recém-nascido pré-termo, com vistas à promoção do aleitamento materno exclusivo até os seis meses de idade e complementado até os dois anos.

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Resumo Esta revisão integrativa da literatura teve como objetivo verificar se o Método Canguru, conforme instituído no Brasil, desde a primeira etapa até o acompanhamento ambulatorial, tem influência sobre o aleitamento materno. Foram incluídas pesquisas realizadas no Brasil, publicadas em periódicos nacionais e internacionais, nas principais bases de dados, em português, inglês ou espanhol, nos anos de 2000 a 2017, disponíveis na íntegra e com a temática relacionada com o objetivo deste estudo. Foram encontrados 1328 artigos sendo excluídos artigos não realizados no Brasil, artigos de revisão da literatura e de temáticas não relacionadas com o Método Canguru, sendo então selecionados 21 estudos. As pesquisas encontradas apontaram para uma influência positiva do Método Canguru sobre o aleitamento materno e estabelecimento de vínculo entre mãe-filho. No entanto, a terceira etapa ou acompanhamento ambulatorial, não se mostrou eficaz na manutenção do aleitamento materno. Faz-se necessário maior participação da atenção básica nos cuidados domiciliares prestados ao recém-nascido pré-termo, com vistas à promoção do aleitamento materno exclusivo até os seis meses de idade e complementado até os dois anos.

Abstract The scope of this integrative review of the literature was to assess if the Kangaroo-Mother Care Method as implemented in Brazil, from the first stage to outpatient follow-up, has an influence on breastfeeding. Brazilian research published in national and international journals in Portuguese, English or Spanish in the leading research databases between the years 2000 to 2017 was included, with full articles available and theme related to the scope of this study. A total of 1328 articles were located and articles not conducted in Brazil, literature review articles and themes not related to the Kangaroo-Mother Care Method were excluded, with 21 studies eventually being selected. The research results indicated a positive influence of the Kangaroo-Mother Care Method on breastfeeding and establishing a mother-child bond. However, the third stage or outpatient follow-up proved not to be effective in maintaining breastfeeding. Greater participation of primary care in home care provided to preterm newborns is necessary, with a view to promoting exclusive breastfeeding up to six months of age and extended up to two years of age.

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In many cell types, epigenetic changes are partially regulated by the availability of metabolites involved in the activity of chromatin-modifying enzymes. Even so, the association between metabolism and the typical epigenetic reprogramming that occurs during preimplantation embryo development remains poorly understood. In this work, we explore the link between energy metabolism, more specifically the tricarboxylic acid cycle (TCA), and epigenetic regulation in bovine preimplantation embryos. Using a morphokinetics model of embryonic development (fast- and slow-developing embryos), we show that DNA methylation (5mC) and hydroxymethylation (5hmC) are dynamically regulated and altered by the speed of the first cleavages. More specifically, slow-developing embryos fail to perform the typical reprogramming that is necessary to ensure the generation of blastocysts with higher ability to establish specific cell lineages. Transcriptome analysis revealed that such differences were mainly associated with enzymes involved in the TCA cycle rather than specific writers/erasers of DNA methylation marks. This relationship was later confirmed by disturbing the embryonic metabolism through changes in α-ketoglutarate or succinate availability in culture media. This was sufficient to interfere with the DNA methylation dynamics despite the fact that blastocyst rates and total cell number were not quite affected. These results provide the first evidence of a relationship between epigenetic reprogramming and energy metabolism in bovine embryos. Likewise, levels of metabolites in culture media may be crucial for precise epigenetic reprogramming, with possible further consequences in the molecular control and differentiation of cells.

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RESUMO O objetivo deste estudo foi traduzir e adaptar a escala de utilidade clínica de Tyson e Connell para o português brasileiro, além de avaliar sua confiabilidade interexaminador e intraexaminador. O processo de tradução e adaptação transcultural foi desenvolvido em cinco estágios: tradução; síntese das traduções; retrotradução; avaliação pelo comitê de especialistas; e teste da versão pré-final. Para avaliação da confiabilidade intra e interexaminador da escala, 20 instrumentos de avaliação foram analisados de forma independente por dois examinadores (confiabilidade interexaminador). Além disso, um dos examinadores fez todas as avaliações, em dois momentos distintos, com um intervalo de 30 dias entre uma e outra (confiabilidade intraexaminador). A tradução e a adaptação transcultural foram realizadas de forma sistemática, seguindo os critérios propostos, de modo que houve apenas pequenas alterações em dois itens para tornar a escala mais útil a todos os instrumentos disponíveis na literatura. Em relação à confiabilidade interexaminador da escala de utilidade clínica de Tyson e Connell-Brasil, o valor encontrado foi CCI=0,85 (IC 95%, 0,79-0,87), enquanto para a confiabilidade intraexaminador o resultado foi CCI=0,89 (IC 95%, 0,85-0,93). Os resultados deste processo indicaram adequado grau de equivalência semântica, conceitual e cultural. Além disso, as medidas de confiabilidade intra e interexaminadores foram consideradas adequadas. Esses achados demonstraram que a escala é adequada para avaliar a utilidade clínica de instrumentos de avaliação comumente utilizados em pacientes. Dessa forma, deve ser incorporada na prática clínica e em pesquisas para a escolha do melhor instrumento.

RESUMEN O objetivo deste estudo foi traduzir e adaptar a escala de utilidade clínica de Tyson e Connell para o português brasileiro, além de avaliar sua confiabilidade interexaminador e intraexaminador. O processo de tradução e adaptação transcultural foi desenvolvido em cinco estágios: tradução; síntese das traduções; retrotradução; avaliação pelo comitê de especialistas; e teste da versão pré-final. Para avaliação da confiabilidade intra e interexaminador da escala, 20 instrumentos de avaliação foram analisados de forma independente por dois examinadores (confiabilidade interexaminador). Além disso, um dos examinadores fez todas as avaliações, em dois momentos distintos, com um intervalo de 30 dias entre uma e outra (confiabilidade intraexaminador). A tradução e a adaptação transcultural foram realizadas de forma sistemática, seguindo os critérios propostos, de modo que houve apenas pequenas alterações em dois itens para tornar a escala mais útil a todos os instrumentos disponíveis na literatura. Em relação à confiabilidade interexaminador da escala de utilidade clínica de Tyson e Connell-Brasil, o valor encontrado foi CCI=0,85 (IC 95%, 0,79-0,87), enquanto para a confiabilidade intraexaminador o resultado foi CCI=0,89 (IC 95%, 0,85-0,93). Os resultados deste processo indicaram adequado grau de equivalência semântica, conceitual e cultural. Além disso, as medidas de confiabilidade intra e interexaminadores foram consideradas adequadas. Esses achados demonstraram que a escala é adequada para avaliar a utilidade clínica de instrumentos de avaliação comumente utilizados em pacientes. Dessa forma, deve ser incorporada na prática clínica e em pesquisas para a escolha do melhor instrumento.

ABSTRACT This study aimed to translate and adapt the Clinical Utility Scale of Tyson and Connell into Brazilian Portuguese, in addition to evaluating intra- and inter-rater reliability. The process of cross-cultural translation and adaptation was developed in five stages: translation, synthesis of translations, retro translation, evaluation by the committee of experts and testing of the pre-final version. To evaluate the intra- and inter-rater reliability of the Clinical Utility Scale of Tyson and Connell, 20 assessment instruments were independently assessed by two examiners (inter-rater reliability). In addition, one of the examiners performed all assessments at two different times with a 30-day interval (intra-rater reliability). The translation and cross-cultural adaptation were performed in a systematic way, following the proposed criteria, and only minor changes in two items were necessary to make the scale more useful to all instruments currently available in the literature. Regarding the inter-rater reliability of the Clinical Utility Scale of Tyson and Connell, the value found was ICC=0.85 (IC 95%, 0,79-0,87), while for intra-rater reliability the result was ICC=0,89 (IC 95%, 0,85-0,93). The results of this process indicated an adequate degree of semantic, conceptual and cultural equivalence. In addition, intra- and inter-rater reliability measures were considered adequate. These findings have shown the scale is adequate to assess the clinical utility of evaluation instruments usually applied to patients. Therefore, it must be incorporated into clinical practice and research when choosing the best evaluation instrument to be used.

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RESUMO Modelo de estudo: Trata-se de um estudo do tipo observacional, descritivo e transversal. Objetivo: Avaliar o comportamento de adesão ao tratamento antirretroviral de pessoas convivendo com HIV/aids que participam de um Grupo de Adesão. Métodos: O questionário foi respondido por 15 pacientes maiores de 18 anos, independente do sexo, com diagnóstico confirmado de AIDS que participam de um Grupo de Adesão em um serviço de dispensação de antirretrovirais, e que após receberem informações pertinentes ao estudo, aceitaram participar voluntariamente, por meio da assinatura do Termo de Consentimento Livre e Esclarecido. Resultado: A maioria dos participantes era do sexo masculino, acima de 40 anos (73,3%) e 26,6% eram economicamente ativos. Quanto à sexualidade, 80% dos entrevistados declararam ser heterossexual. Quanto à escolaridade, 60% não havia completado o ensino médio. O tempo de diagnóstico da doença predominante foi entre 10 e 16 anos, sendo que 46,6% referiram possuir outros problemas de saúde, como toxoplasmose, herpes, tuberculose e leishmaniose. A análise do questionário de adesão mostrou que 33,3% possuía uma boa adesão ao tratamento antirretroviral. Entre as interações droga-droga identificadas, 44,4% ocorreram entre os antirretrovirais. Conclusão: A partir da realização deste estudo foi possível concluir que 66,66% dos entrevistados relataram que em algum momento houve uma descontinuidade do tratamento, revelando uma dificuldade na manutenção do uso dos antirretrovirais em indivíduos convivendo com HIV/AIDS. No contexto da farmacoepidemiologia antirretroviral, as potenciais interações medicamentosas identificadas neste estudo foram eventos que afetam a resposta terapêutica levando a toxicidade (AU)

Study design: This is an observational, descriptive, and cross-sectional study. Objective: Evaluating the adher-ence behavior to the antiretroviral treatment of people living with HIV/Aids who participate in an Adherence Group. Methods: The questionnaire was answered by 15 patients older than 18 years of age, regardless of sex, with a confirmed diagnosis of AIDS participating in an Adherence Group at an antiretroviral dispensing service, who, after receiving information related to the study, agreed to participate voluntarily, by singing the Written Informed Consent Form. Results: The majority of the participants were male, over 40 years old (73.3%) and 26.6% were economically active. Regarding sexuality, 80% of the interviewees stated that they were heterosexual. As for schooling, 60% had not finished high school. The time of diagnosis of the disease predominant was between 10 and 16 years, and 46.6% reported having other health problems, like toxoplasmosis, herpes, tuberculosis, and leishmaniasis. The analysis of the adherence questionnaire showed that 33.3% had good adherence to antiretroviral treatment. Among the drug-drug interactions identified, 44.4% occurred among antirretrovirals. Conclusion: Based on this study, it was possible to conclude that 66,66% at some point there was a discontinuation of treatment, revealing a difficulty in maintaining antiretroviral use in individuals living with HIV/aids. In the scenario of antiretroviral pharmacoepidemiology, the po-tential drug interactions identified in this study were events that affect the therapeutic response leading to toxicity (AU)

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