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RATIONALE AND OBJECTIVES: Although PBL is widely used in several countries, especially in medicine courses, its application in teaching other higher education courses, which involve fundamentals applied to radiology, is still little explored. Therefore, we aim to evaluate the implementation of Problem-Based Learning (PBL) in a higher education institution's radiology and biomedicine technologist course, focusing on specific radiology-related disciplines. MATERIALS AND METHODS: An interventional study was developed with 78 students. An active methodology model was created and implemented for one of the groups of participants. At the beginning of each semester, students of both groups were evaluated with pre-tests. At the end of the semesters, the students performed a post-test and a validated evaluation of the discipline methodology. Repeated measures generalized linear regressive models with robust error estimators were used to evaluate test outcomes. RESULTS: A significant interaction among the methodologies was found (p=0.020), with better results from students exposed to the active methodology (initial and final grades were 7.18 and 7.57 in the active methodology, respectively, and 7.45 and 6.89 in the traditional methodology, respectively). In addition, students' evaluation regarding the quality of the methodology was favorable to the active methodology with statistical significance (p<0.05) in 16 of the 22 items evaluated. CONCLUSIONS: The students' positive response and performance were attributed to the interaction and innovation of the methodology compared to conventional methods, highlighting the effectiveness of PBL in higher education in radiology and its potential for more participatory and contextualized learning.

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BACKGROUND: The COVID-19 pandemic has caused significant disruptions to everyday life and has had social, political, and financial consequences that will persist for years. Several initiatives with intensive use of technology were quickly developed in this scenario. However, technologies that enhance epidemiological surveillance in contexts with low testing capacity and healthcare resources are scarce. Therefore, this study aims to address this gap by developing a data science model that uses routinely generated healthcare encounter records to detect possible new outbreaks early in real-time. METHODS: We defined an epidemiological indicator that is a proxy for suspected cases of COVID-19 using the health records of Emergency Care Unit (ECU) patients and text mining techniques. The open-field dataset comprises 2,760,862 medical records from nine ECUs, where each record has information about the patient's age, reported symptoms, and the time and date of admission. We also used a dataset where 1,026,804 cases of COVID-19 were officially confirmed. The records range from January 2020 to May 2022. Sample cross-correlation between two finite stochastic time series was used to evaluate the models. RESULTS: For patients with age 18 years, we find time-lag () = 72 days and cross-correlation () ~ 0.82, = 25 days and ~ 0.93, and = 17 days and ~ 0.88 for the first, second, and third waves, respectively. CONCLUSIONS: In conclusion, the developed model can aid in the early detection of signs of possible new COVID-19 outbreaks, weeks before traditional surveillance systems, thereby anticipating in initiating preventive and control actions in public health with a higher likelihood of success.

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Abstract Objective The purpose of this study was to evaluate the clinical-epidemiological profile, associated risk factors and clinical outcomes of patients with acute myeloid leukemia (AML), identifying the main causes of morbidity and mortality and overall survival rate of patients at five years of follow-up. Method This was a retrospective cohort study evaluating the prognosis and clinical outcomes of 222 patients diagnosed with AML at three large hematology centers in Ceará (northeastern Brazil) over a period of five years. Results The mean age at diagnosis was 44.1 ± 16 years, with a female prevalence of 1.3:1. No additional relevant risk factors associated with the development of AML were found, except for the well-established cytogenetic assessment. The overall 5-year survival rate was 39.4% (95%CI: 35.47 - 42.17). The main causes of death were disease progression (37.72%; n = 84) and sepsis (31.58%; n = 70). Conclusion The clinical outcomes in our sample of AML patients were similar to those of other reported groups. Disease progression and infection were the main causes of death. Access to diagnostic flow cytometry and karyotyping was greater in our sample than in the national average. As expected, overall survival differed significantly according to the risk, as determined by cytogenetic testing.

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INTRODUCTION: Chronic back pain (CBP) is a major cause of years lived with disability. Social inequalities increase the prevalence and burden of CBP. Management of CBP was affected by restricted access to non-pharmacological treatments and outdoor activities during COVID-19 pandemic. OBJECTIVE: To determine the prevalence of CBP among patients with COVID-19 as well as the impact of having CBP in COVID-19 outcome in our low-income population. METHODS: Retrospective cohort of individuals with confirmed COVID diagnosis from May 2020 - March 2021, at Hospital Regional UNIMED (HRU) in Fortaleza, Ceará, Brazil. Data included comorbidities and household income. RESULTS: Among 1,487 patients, 600 (40.3%) were classified as having CBP. Mean age as well as income were similar in CBP and non-CBP groups, with more women in the CBP group. Hypertension and asthma, but not diabetes, were more prevalent in those with CBP. Need for emergency care, hospitalization, and admission to intensive care unit were similar regardless of having CBP. Dyspnea was more common in CBP vs. non-CBP groups, with 48.8% vs. 39.4% percentages, respectively (p = 0.0004). CONCLUSION: Having CBP prior to COVID did not impact the acute clinical outcome of COVID individuals of a low-income population.

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Self-efficacy consists of the judgment of one's abilities to perform actions required to achieve a given performance, which has been considered predictive of performance. In academics, it means personal convictions in accomplishing a task to a defined degree of quality. Numerous studies have investigated medical students' self-efficacy in traditional and PBL curricula. However, few studies have addressed the hybrid PBL scenario (Hpbl) that simultaneously contemplates PBL, traditional teaching, and practical activities. An even smaller number have evaluated the factors associated with this entity. With these considerations, we aimed to investigate the self-efficacy belief in the hPBL curriculum and the factors associated with this entity. This quantitative observational cross-sectional study was held between August 2022 and November 2022 in Fortaleza, a city in Northeast Brazil with almost 3 million inhabitants. The medical course has 12 semesters. The first two semesters use traditional teaching and cover the basic cycle, followed by the third to eighth semesters which correspond to the pre-clinical and clinical cycle. From the third semester onwards, traditional teaching and PBL are used simultaneously, which we call a hybrid model of PBL. The scale "Scale of Self-efficacy in Higher Education" was applied, a questionnaire validated for the Portuguese language consisting of 34 questions, with answers on a Likert-type scale with ten points, divided into five dimensions. To verify the association between sociodemographic factors and self-efficacy, simple and multiple linear models with robust errors were used. In total, 412 students participated in this study, most of them women (70.1%). The average age of students was 22.9 years. All domains had medians greater than 8, which means strong self-efficacy. The following factors were associated with higher self-efficacy scores in general after the multivariate analysis: female gender (8.6 vs. 8.3, p-value = 0.014), working (8.8 vs. 8.5, p-value = 0.019) and participating in extracurricular activities (8.7 vs. 8.1, p-value = 0.019). We conclude that medical students studying in hybrid learning models showed strong levels of self-efficacy. In addition, participating in extracurricular activities was associated with higher self-efficacy scores and males presented lower levels of self-efficacy.

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INTRODUCTION: During the COVID-19 pandemic, the literature highlighted an increased risk of child abuse and the use of negative parenting practices. Furthermore, pregnancy during this time may have been challenging and generated different feelings regarding the pandemic and motherhood. Many pregnant women had other young children, underscoring the need to understand this scenario better. Therefore, the present study examined the predictive effect of indicators of mental health disorders, emotional discomfort with motherhood, and negative perceptions of COVID-19 on negative parenting practices. METHODS: The study used a cross-sectional design. Pregnant women (n = 303) who had other children younger than six years answered an online questionnaire during the physical distancing period due to COVID-19 in Fortaleza. A partially latent structural equation model (SEM) was used to test direct and indirect relations between the variables. RESULTS: The results revealed a direct positive relation between maternal mental health and the variables COVID-19 feelings, emotional discomfort with motherhood, and negative parenting practices. The stronger relationship was between maternal mental health and emotional discomfort with motherhood. The COVID-19 negative feelings also showed a direct positive relation to emotional discomfort with motherhood. Additionally, older mothers and those with fewer children tended to have less mental health disorders. Furthermore, being in a later trimester of pregnancy was linked to more negative feelings about motherhood. DISCUSSION: The study suggests that mothers experiencing mental health challenges are more likely to feel discomfort with motherhood and use negative parenting practices, highlighting a need for intervention.

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Medical education was greatly affected by the COVID-19 pandemic, and remote teaching through lectures and classes through videoconferencing was heavily used. However, the need to use cameras led to scopophobia, which is the fear of being watched, which can lead to psychological symptoms. Despite the relevance and prevalence of depression and the increase in the use of cameras for learning, research evaluating the impact of scopophobia on students' mental health is surprisingly scarce. Hence, to fill up this gap, a cross-sectional study was carried out in medical schools in Brazil. To assess the presence of depressed mood, the Patient Health Questionnaire-9 (PHQ-9) was applied. We used logistic regression models to verify the associations. The overall prevalence of positive PHQ9 found in our study was 62%. By studying the factors associated with a high risk of scopophobia, we could identify that the PHQ was statistically associated with scopophobia (odds ratio 2.43 (confidence interval 1.11-5.26), adjusted p value = .0269). Also, a lower family income, a higher number of household inhabitants, and female gender were associated. These results suggest that scopophobia is associated with depression, leading us to believe that interventions to mitigate this risk in students are opportune, especially if targeted at lower-income students.

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Abstract Introduction Chronic back pain (CBP) is a major cause of years lived with disability. Social inequalities increase the prevalence and burden of CBP. Management of CBP was affected by restricted access to non-pharmacological treatments and outdoor activities during COVID-19 pandemic. Objectives To determine the prevalence of CBP among patients with COVID-19 as well as the impact of having CBP in COVID-19 outcome in our low-income population. Methods Retrospective cohort of individuals with confirmed COVID diagnosis from May 2020 - March 2021, at Hospital Regional UNIMED (HRU) in Fortaleza, Ceará, Brazil. Data included comorbidities and household income. Results Among 1,487 patients, 600 (40.3%) were classified as having CBP. Mean age as well as income were similar in CBP and non-CBP groups, with more women in the CBP group. Hypertension and asthma, but not diabetes, were more prevalent in those with CBP. Need for emergency care, hospitalization, and admission to intensive care unit were similar regardless of having CBP. Dyspnea was more common in CBP vs. non-CBP groups, with 48.8% vs. 39.4% percentages, respectively (p = 0.0004). Conclusion Having CBP prior to COVID did not impact the acute clinical outcome of COVID individuals of a low- income population.

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Resumo Introdução: Avaliação e manejo adequados da dor têm se tornado uma preocupação cada vez maior dos profissionais de saúde. Segundo a definição de cuidados paliativos da Organização Mundial da Saúde, são importantes a identificação precoce, a avaliação e o tratamento da dor. Objetivo: Este estudo teve como objetivos desenvolver e avaliar um aplicativo para dispositivos móveis voltado para o ensino de abordagem da dor em cuidados paliativos. Método: Foi desenvolvido um aplicativo móvel, seguido de sua utilização por médicos residentes e de avaliação qualiquantitativa prospectiva. Aplicou-se o teste de conhecimento. Obtiveram-se a usabilidade do aplicativo, por meio da System Usability Scale (SUS), e a satisfação, por meio do Net Promoter Score (NPS). Os dados foram tabulados no Microsoft Office Excel® e exportados para o software Statistical Package for the Social Sciences (SPSS) versão 20.0 (IBM): na realização das análises, adotou-se uma confiança de 95%. Para a análise qualitativa das avaliações, o conteúdo das respostas foi transcrito e organizado em nuvens de palavras para destacar as ideias centrais. O estudo foi aprovado pelo Comitê de Ética do Centro Universitário Christus. Resultado: Desenvolveu-se o PaliPain App, aplicativo constituído de casos clínicos de pacientes em cuidados paliativos com manifestações de dor, além de questões, vídeos e imagens, disponibilizado nas plataformas Android e iOS. Utilizaram o aplicativo 13 médicos residentes. A média de acertos de questões no pré-teste sobre dor em cuidados paliativos aumentou de 6,08 para 7,54 após manuseio do aplicativo. Na avaliação sobre a usabilidade do aplicativo, obtivemos na SUS uma média de 89,2, acima do nível considerado adequado de 70,0. Na avaliação de satisfação, 54% dos médicos responderam com pontuação 10 à pergunta: "Em uma escala de 0 a 10, quanto você recomendaria o aplicativo PaliPain a um amigo ou colega?". Conclusão: O PaliPain App, desenvolvido e disponibilizado nas plataformas Android e iOS, foi bem avaliado pelos médicos residentes, apresentando ótimos escores de usabilidade e de satisfação. Identificamos que houve ganho de conhecimento, com pontuação média na resolução de questões aumentando de 6,08 para 7,54 após livre uso da aplicação. O PaliPain App pode ser uma ferramenta útil para ensino de abordagem de dor para médicos residentes.

Abstract Introduction: Pain evaluation has become an increasingly relevant concern for healthcare workers. According to the World Health Organization's definition of Palliative Care, early identification, evaluation, and treatment of pain are important. Objective: Developing and rating an app for mobile devices that focuses on teaching the subject of pain management in Palliative Care. Research Methodology: The app was developed as a learning tool and tested by resident physicians while undergoing a qualitative and quantitative prospective evaluation. Mock tests were taken. The usability of the app was rated through the System Usability Scale (SUS), and satisfaction with the app was rated through the Net Promoter Score (NPS). The data was charted by using Microsoft Office Excel ® and was exported to the Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM) software: an analysis was run with a 95% confidence interval. As for the qualitative analysis of the resident physicians' evaluations, all available content was transcribed and properly organized in word clouds in order to highlight the most important pieces of feedback that the physicians presented regarding the app. The study was approved by the Ethics Committee. Main Results: The PaliPain App was developed as a database filled with clinical cases of patients undergoing palliative care who were experiencing varying levels of pain, and also presents analysis of test questions, videos and images. It was made available for the Android and iOS platforms. The average correct answers in a mock test about pain management during palliative care rose from 6.08 to 7.54. Thirteen resident physicians made use of the app. In the evaluation of the app's usability, the average SUS score was 89.2. In the evaluation of user satisfaction, 54% of the resident physicians answered the question "from a scale of 0 to 10, what is the likelihood of you recommending the PaliPan app to a friend or colleague?" with a score of 10. Conclusion: The PaliPain App, developed and available on Android and iOS platforms, was well evaluated by resident physicians, presenting excellent scores for both usability and satisfaction. We identified that there was a gain in knowledge, with an average score in the resolution of questions increasing from 6.08 to 7.54 after free use of the application. The PaliPan app could be a useful tool to teach the subject of pain to resident physicians.

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INTRODUCTION: The increasing worldwide number of adults with congenital heart disease (CHD) demands greater attention from health professionals. The purpose of this report is to describe the clinical demographic profile, frequency, and invasive treatment status of adults with CHD in a public reference hospital in northeastern Brazil. METHODS: This is a retrospective cross-sectional study including 704 patients attended between August 2016 and August 2020. Data were collected from virtual database. RESULTS: Patients' age varied from 17 to 81 years (mean 32±14; median 27 years); 294 (41.8%) patients were male, and 410 (58,2%) were female; 230 (32,7%) had diagnosis from age 18 and up. Cardiac complexity categories were "simple defects" (134 [19%] patients), "moderate complexity" (503 [71.5%]), and "great complexity" (67 [9.5%]). Atrial septal defect (ASD) was diagnosed in 216 (30.7%) patients, ventricular septal defect (VSD) in 101 (14.3%), tetralogy of Fallot in 93 (13.2%), and other CHD in 294 (41.8%). New York Heart Association (NYHA) functional classes were I (401 [57%]), II (203 [28.8%]), III (76 [10.8%]), and IV (24 [3.4%]). Complications were arrhythmias (173 [24%]) and severe pulmonary hypertension (69 [9.8%]). Invasive treatments were corrective surgery (364 (51.6%]), reoperation (28 [4.0%]), palliation (11 [1.6%]), interventional catheterization (12 [1.7%]), surgery plus interventional catheterization (5 [0.7%]), and preoperation (91 [12.9%]). Treatment was not required in 102 (14,5%) patients, and 91 (12.9%) were inoperable. CONCLUSION: The leading diagnosis was ASD. Frequency of unrepaired patients was high, mainly ASD, due to late diagnosis, which favored complications and denotes a matter of great concern.

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BACKGROUND: Intimate partner violence (IPV) is a pervasive public health issue that affects millions of women worldwide. Women living below the poverty line experience higher rates of violence and fewer resources to escape or cope with the abuse, and the COVID-19 pandemic has significantly impacted women's economic well-being worldwide. We conducted a cross-sectional study in Ceará, Brazil, on women in families with children living below the poverty line at the peak of the second wave of COVID to assess the prevalence of IPV and its association with common mental disorders(CMD). METHODS: The study population comprised families with children up to six years of age who participated in the cash transfer program "Mais Infância". The families selected to participate in this program must meet a poverty criterion: families must live in rural areas, in addition to a monthly per capita income of less than US$16.50 per month. We applied specific instruments to evaluate IPV and CMD. To access IPV, we used the Partner Violence Screen (PVS). The Self-Reporting Questionnaire (SRQ-20) was used to assess CMD. To verify the association between IPV and the other evaluated factors with CMD, simple and hierarchical multiple logistic models were used. RESULTS: Of the 479 participant women, 22% were positively screened for IPV (95% CI 18.2-26.2). After multivariate adjustment, the chances of CMD are 2.32 higher in women exposed to IPV than in those not exposed to IPV ((95%CI 1.30-4.13), p value = 0.004). CMD was also associated with job loss during the COVID-19 pandemic (ORa 2.13 (95% CI 1.09-4.35), p-value 0.029). In addition to these, separate or single marital status, as well as non-presence of the father at home and food insecurity were associated with CMD. CONCLUSION: We conclude that the prevalence of intimate partner violence in families with children up to six years of age living below the poverty line in Ceará is high and is associated with greater chances of common mental disorders in mothers. Also, job loss and reduced access to food caused by the Covid 19 pandemic exacerbated both phenomena, constituting a double burden generator factor on mothers.

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Background: Child development is an ongoing process that occurs from birth to adolescence and is shaped by various factors, such as genetics, the environment, and experiences [...].

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Maternal educational attainment has been identified as relevant to several child health and development outcomes. This study aimed to evaluate the association of sociodemographic and maternal education factors with child development in families living below the poverty line. A cross-sectional study was conducted through telephone contact from May to July 2021 in Ceará, a state in Northeastern Brazil. The study population comprised families with children up to six years of age participating in the cash transfer program "Mais infância". The families selected to participate in this program must have a monthly per capita income of less than US$16.50. The Ages and Stages Questionnaire version 3 was applied to assess the children's development status. The mothers reported maternal educational attainment as the highest grade and or degree obtained. The final weighted and adjusted model showed that maternal schooling was associated with the risk of delay in all domains except for the fine motor domain. The risk of delay in at least one domain was 2.5-fold higher in mothers with a lower level of schooling (95% CI: 1.6-3.9). The findings of this study suggest that mothers with higher educational attainment have children with better child development outcomes.

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BACKGROUND: Percutaneous liver biopsy is the gold standard technique for establishing the cause of cirrhosis and liver disease activity assessment. However, some cases of steatohepatitis or other chronic liver diseases show a high number of false negative results in samples obtained via the percutaneous route. This fact justifies performing a liver biopsy via the laparoscopic route. However, this is an expensive technique, with morbidities associated with pneumoperitoneum and anesthetic complications. The main objective of this study is to develop a video-assisted technique that uses only a minimally-invasive device for the liver biopsy and the optical trocar. Without additional trocars, this technique constitutes a less invasive procedure than the existing techniques in clinical practice. METHODS: This is a device development and validation study and patients submitted to abdominal laparoscopic surgery and required liver biopsy for moderate to severe steatosis were recruited. The patients were randomized into two groups: laparoscopic liver biopsy technique (n = 10, control group) and mini-laparoscopic liver biopsy technique (n = 8, experimental group). The times associated with procedure performance in both groups were evaluated using the Mann-Whitney or Kruskal-Wallis tests according to data distribution. RESULTS: At baseline, there was no statistical difference regarding gender and type of surgery. The experimental group had a significantly shorter time compared with the group that underwent the traditional procedure in mean procedure time (p = 0.003), biopsy time (p = 0.002) and hemostasis time (p = 0.003). CONCLUSIONS: The mini-laparoscopic biopsy device and technique showed to be capable of safely obtaining sufficient tissue samples, which was minimally invasive and in a shorter time than the classic technique.

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BACKGROUND: Scopophobia can be described in the medical field as the fear of being watched or stared at. Despite the relevance of scopophobia in remote learning scenarios, which have always existed and have been largely expanded during the pandemic in medical education, studies on this topic are exceedingly rare worldwide. Hence, to fill up this gap, a cross-sectional study of medical students was developed to assess the association of scopophobia with the prevalence of online learning fatigue. METHODS: A cross-sectional, quantitative, analytical study was carried out in Medical Schools of Brazil. To assess the risk of scopophobia, questions were developed, based on the literature on the topic. The Zoom Exhaustion & Fatigue Scale (ZEF) was used, and the questions have currently been validated for Brazilian Portuguese. Logistic regression models were also used to assess the relationship of scopophobia risk and ZEF scores. RESULTS: A total of 283 students from Brazil participated in the study. The median age was 23 years, and 64% of the participants were female. In total, 14.5% were considered to be at high risk for scopophobia. It was found that after adjusting for sex, income and number of residents in the household, scopophobia and the total zoom fatigue score remained associated. For the total score, each additional point on the scale increased the chance of scopophobia by 3%, and for the overall domain, 19% (p-values < 0.05). CONCLUSIONS: In conclusion, this study shows a relevant prevalence of students with scopophobia, which requires a differentiated approach on the part of teachers. The causes of scopophobia are often specific and have a psychological origin that goes beyond the usual pedagogical management. Therefore, motivation strategies are necessary in a general, as well as an individualized manner, aiming to favor the improvement of the online teaching and learning process.

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PURPOSE: To assess the prevalence of food insecurity (FI) among families with infants born during the COVID-19 pandemic and its associated factors in Fortaleza, the fifth largest city in Brazil. METHODS: Data from two survey rounds of the Iracema-COVID cohort study collected at 12 (n = 325) and 18 months (n = 331) after birth. FI was measured using the Brazilian Household Food Insecurity Scale. FI levels were described according to potential predictors. Crude and adjusted logistic regressions with robust variance were used to assess factors associated with FI. RESULTS: In the 12- and 18-month follow-ups interviews, there was a 66.5% and 57.1% prevalence of FI, respectively. Over the study period, 3.5% of the families persisted in severe FI and 27.4% in mild/moderate FI. Households headed by mothers, with more children, low education and income, sustained maternal common mental disorders, and that were beneficiaries of cash transfer programs were the most affected by persistent FI. CONCLUSIONS: Although the prevalence of FI decreased in our sample, almost 60% of families in Fortaleza still have no regular access to enough and/or nutritionally appropriate food. We have identified the groups at higher FI risk, which can guide governmental policies.

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Introdução: a insegurança alimentar tem efeitos importantes e agravantes na saúde humana, especialmente na saúde mental das mães e crianças.Objetivo: avaliar as inter-relações do Transtorno mental comum (TMC) e Insegurança Alimentar, em famílias assistidas por programa adicional de transferência de renda no Ceará.Método: estudo transversal foi realizado no Ceará, caracterizado como um dos estados mais pobres do país, em uma amostra de 484 famílias, com crianças menores de seis anos, beneficiárias do Cartão Mais Infância Ceará (CMIC), em 24 municípios. Foram analisados o perfil social e econômico das famílias, moradia, dados sobre a saúde e educação, violência, saúde mental, insegurança alimentar, trabalho e renda. Utilizou-se modelos de Regressão de Poisson, ajustados para o efeito amostral.Resultados: das 484 famílias, 86% encontravam-se em situação de IA;36% apresentavam IA Grave. A presença do TMC materno aumentou em 73% o risco de IA Grave na família (p<0,001). A análise de regressão, mostrou que o TMC se manteve como o fator de risco associado à IA Grave, com mães com TMC mostrando um risco ajustado 64% mais elevado, em comparação às outras mães (p=0,002). Não dispor de água tratada no domicílio, apresentou uma medida ajustada de 55% maior risco de IA Grave (p=0,011).Conclusão: as mães assistidas possuem elevada prevalência de TMC e com perfil de alta vulnerabilidade, sendo necessário suporte social e nutricional, acompanhamento da saúde mental dessas mulheres, para melhor cuidar dos filhos.Palavras-chave: segurança alimentar, criança, saúde mental, nutrição, avaliação de programas.

Backgroung: the prevalence of moderate or severe food insecurity (FI) in the world will reach 2.4 billion people in 2020. Common Mental Disorders (CMDs) affect one in five people, reaching all social classes.Objective: to examine the associations between CMDs and FI in the most vulnerable population, mothers of young children.Methods: population-based cross-sectional observational study, interviewing 484 families with children under six years of age, beneficiaries of the cash transfer program Cartão Mais Infância Ceará (CMIC), in 24 municipalities of Ceara. Poisson regression models were used, adjusted for the sampling effect.Results: 86% of the families were in a situation of FI, with 36% expressing a severe FI, a condition compatible with hunger. In relation to CMDs, it was observed that the prevalence of severe FI increased significantly, affecting 53% of mothers with CMDs against 31% of those without the disorder (p<0.001). Regression analysis showed that CMDs remained the risk factor most associated with severe FI, with mothers with CMDs having a 64% higher adjusted risk compared to other mothers (p=0.002). In the final model, the condition of not having treated water at home was associated with a 55% higher adjusted risk of severe FI (p=0.011), and two factors were close to statistical significance, namely: not feeling safe at home (possibility of domestic violence) and growing edible plants at home, with adjusted measures of 48% risk and 13% protection, respectively.Conclusion: 13% of this population live with very high rates of severe FI, compatible with hunger, concomitant with CMDs. As aggravating factors of severe FI and CMDs, public social support programs are necessary to have a real positive impact on the quality of life of this population.

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BACKGROUND: The use of fluids is the most frequently used therapy for circulatory shock. Its inadequate use has adverse effects, requiring hemodynamic goals, highlighting the use of pulse pressure variation due to its high accuracy. One of the problems related to this method is the difficulties in measuring the pulse pressure variation (PPV) in most monitors for clinical use. We assessed the qualitative aspects of perceived usability of a smartphone application (app), which, based on a photograph of the patient's arterial pulse wave, can help measure PPV and help in the diagnosis and management of shock cases. METHODS: To assess the software perceived usability, we used the System Usability Scale (SUS) applied to 30 physicians in 2 tertiary hospitals in Brazil. The software accuracy was measured using a sequence of 3 images with different values ​​of pulse pressure variation, comparing the obtained values ​​ with the gold standard. The educational interface of the app was evaluated qualitativelyfrom the spontaneous testimonies of the selected test participants.The project was approved by the Research Ethics Committee of Centro Universitário Christus. RESULTS: The analysis showed an average SUS of 86.3 points on a scale of 1-100 (above 80.3 is considered the best in terms of interface). The assessment of the application's accuracy when evaluating pulse pressure variation showed that the average variation of the measurements taken by the participants was small, with a good measure of repeatability and reproducibility. The app's educational interface was qualitatively evaluated, being praised by the users. CONCLUSIONS: It can be concluded that the developed mobile application showed excellent qualitative aspects of perceived usability results. More studies with this app will be required to evaluate the potential to help professionals with hemodynamic evaluation in emergency and intensive care settings.

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OBJECTIVE: To evaluate the association of conditional cash transfer policies to mitigate the food insecurity (FI) among families living in poverty during the COVID-19 pandemic in Ceará, Brazil. METHODS: An analytical cross-sectional study was carried out through telephone contact during the period of May-July 2021, during the second wave of the COVID-19 pandemic in Ceará. Families in a situation of high social and economic vulnerability participated in this study (monthly per capita income of less than US$16.50). FI was assessed using the EBIA, a Brazilian validated questionnaire. The participation of families in government programs and public policies was also investigated. Logistic regression models were used to assess the association of the several factors assessed with food insecurity. RESULTS: The prevalence of any food insecurity in this sample was 89.1% (95% Confidence interval (95% CI: 86.2 - 92.1) and of severe food insecurity, 30.3% (95% CI: 26.0 - 34.6). The Mais Infância card program, adopted as a cash transfer supplement in the state of Ceará, was significantly associated with food insecurity (OR 4.2 (95% CI: 1.7 - 10.2), with a p-value of 0.002. In addition, families affected by job losses due to the COVID-19 pandemic presented higher odds of FI. CONCLUSIONS: In this study, 89% of evaluated families presented food insecurity. Conditional cash transfer programs were associated with FI. We highlight the need for policies and interventions to reduce the impact of the COVID-19 pandemic on food insecurity. Such policies can adopt appropriate criteria for defining the participants, as well as connect the participants to an appropriate set of broader social protection measures.

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