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Tuberculosis (TB) in people living with HIV (PLHIV) is usually paucibacillary and the smear microscopy has limitations and may lead to high proportions of non-confirmed pulmonary tuberculosis (NC-PTB). Despite culture being the reference method, it usually takes 6 to 8 weeks to produce the results. This study aimed to analyze the effect of a rapid molecular test (Xpert) in the confirmatory rate of PTB among PLHIV, from 2010 to 2020, in São Paulo state, Brazil. This is an ecological study with time series analysis of the trend and the NC-PTB rates before and after Xpert implementation in 21 municipalities. The use of Xpert started and gradually increased after 2014, while the rate of NC-PTB in PLHIV decreased over this time, being more significant between late 2015 and mid-2017. The city of Ribeirão Preto stands out for having the highest percentage (75.0%) of Xpert testing among PLHIV and for showing two reductions in the NC-PTB rate. The cities with low Xpert coverage had a slower and smaller decrease in the NC-PTB rate. Despite being available since 2014, a significant proportion of PLHIV suspected of PTB in the state of São Paulo did not have an Xpert ordered by the doctors. The implementation of Xpert reduced the NC-PTB rates with growing effect as the coverage increased in the municipality.

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Objetivo: Verificar a percepção de enfermeiros com experiência em educação, a respeito da proposta metodológica de treinamento baseado em simulação virtual usando uma plataforma de treinamento imersivo. Métodos: Uma plataforma educacional foi desenvolvida baseada em simulação virtual e metodologias ativas para o engajamento, aprendizado e avaliação dos alunos. A mesma emprega um processo andragógico na construção do conteúdo expondo os enfermeiros a situações simuladas da sua prática diária com foco na melhoria de sua atitude. Os conteúdos são relacionados aos cuidados específicos com o acesso venoso periférico, desde a punção, manutenção, prevenção e manejo de complicações. Foi composto um comitê de especialistas com 12 enfermeiras, com experiência mínima de cinco anos na área da educação, que praticaram o treinamento simulado, e posteriormente, preencheram um formulário da percepção que foi tabulado e analisado pelos pesquisadores do projeto. Resultados: 92% das enfermeiras acreditam que o treinamento simulado aproxima os usuários dos desafios da prática diária, e que realmente pode contribuir para a consolidação do conhecimento. Com relação ao conteúdo experimentado nos roteiros, 67% das profissionais consideraram a proposta "muito importante ou imprescindível" e 33% entenderam ser "importante". Conclusões: A percepção geral das enfermeiras foi muito positiva, especialmente com relação à importância do conteúdo apresentado, à proposta metodológica de imersão em cenários próximos à realidade, que trouxeram os desafios da prática; além das questões problematizadoras que possibilitaram uma reflexão para a melhor tomada de decisão.

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BACKGROUND: To analyze the influence of the COVID-19 pandemic on the process of diagnosis and monitoring of drug-resistant pulmonary tuberculosis (TB) cases reported in the state of Paraná, Brazil, from 2015 to 2020. METHODS: Ecological study with quantitative approach. This study was based on diagnosed cases of pulmonary TB reported in the Notifiable Disease Information System in residents of Paraná; as well as through the number of confirmed cases of COVID-19 in the state epidemiological bulletin for the year 2020. The study data were analyzed using descriptive statistics. RESULTS: It was found that, although the number of reported pulmonary TB cases (drug-resistant and general) increased between 2015 and 2019, there was a drop in notification in 2020, the first year of the COVID-19 pandemic. The notification of TB cases was also influenced monthly during the year according to the increase in the number of COVID-19 cases. For cases of drug-resistant pulmonary TB, the provision of diagnostic tests and Directly Observed Treatment decreased by more than half in 2020, especially when compared to 2019. CONCLUSIONS: In view of these findings, the influence of COVID-19 on the diagnosis and monitoring of drug-resistant and general pulmonary TB cases is evident, showing that the pandemic has compromised the advances of recent decades in achieving the goals established for its eradication by 2035.

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The experiments reported in this research paper address the effects of replacing ground corn (GC) with full-fat corn germ (FFCG) on nutrient intake and digestibility, nitrogen utilization efficiency, performance, and predicted methane production in dairy cows fed cactus cladodes and sugarcane. We hypothesized that the inclusion of FFCG in the diet would not alter the performance of lactating cows but would reduce the predicted methane production in vivo. Ten multiparous Holstein cows at 90 ± 10 d of lactation and yielding 24.2 ± 3.5 kg milk/d were assigned to dietary treatments consisting of different levels of replacement of GC by FFCG (0; 25; 50; 75 and 100% of diet dry matter) in a replicated 5 × 5 Latin square design with 21-d periods. Methane production was predicted using an automated gas in vitro production system. Except for ether extract intake, which increased, the intake of all nutrients decreased linearly with the replacement of GC by FFCG. The digestibility of dry matter, organic matter and neutral detergent fiber reduced, whereas the digestibility of ether extract increased linearly with FFCG. There were no changes in the digestibility of crude protein. The nitrogen intake and daily excretion in urine and feces decreased, while nitrogen use efficiency increased linearly. There was no significant effect of diets on nitrogen balance or microbial protein synthesis and efficiency. The yield of protein, lactose and total solids in milk showed a quadratic behavior. On the other hand, milk fat yield and energy-corrected milk yield decreased linearly with the replacement of GC by FFCG. No effect on pH or ammonia nitrogen was observed. The production of methane (CH4, g/kg DM) and total CH4 (g/d), and CH4 intensity decreased linearly with the replacement of GC by FFCG. In conclusion, FFCG has been shown to be an effective source of fat to reduce methane production in dairy cows, partially supporting our initial hypothesis. However, as it decreases milk fat production, it is not recommended to replace more than 50% of GC by FFCG for lactating cows fed cactus cladodes and sugarcane.

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OBJECTIVE: This study aimed to verify risk factors associated with gastroschisis mortality in three neonatal intensive care units located in the state of Espírito Santo, Brazil. METHODS: A retrospective cohort study of neonates with gastroschisis was performed between 2000 and 2018. Prenatal, perinatal, and postsurgical variables of survival or nonsurvival groups were compared using chi-square statistical test, t-test, Mann-Whitney U test, and logistic regression. Tests with p<0.05 were considered statistically determined. RESULTS: A total of 142 newborns were investigated. Mean maternal age, gestational age, and birth weight were lower in the group of nonsurvival (p<0.05). Poor clinical conditions during admission, complex gastroschisis, closure with silo placement, the use of blood products, surgical complications, and short bowel syndrome were more frequent in the nonsurvival group (p<0.05). Complex gastroschisis [adjusted odds ratio (OR) 3.74, 95% confidence interval (95%CI) 1.274-11.019] and short bowel syndrome (adjusted OR 7.55, 95%CI 2.177-26.225) increased the risk of death. Higher birth weight inversely reduced the risk for mortality (adjusted OR 0.99, 95%CI 0.997-1.000). CONCLUSION: Complex gastroschisis and short bowel syndrome increased the risk of death, with greater birth weight being inversely correlated with the risk of mortality. The findings of this research can contribute to the formulation of protocols to improve the quality and safety of care in order to reduce neonatal mortality associated with gastroschisis.

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SUMMARY OBJECTIVE: This study aimed to verify risk factors associated with gastroschisis mortality in three neonatal intensive care units located in the state of Espírito Santo, Brazil. METHODS: A retrospective cohort study of neonates with gastroschisis was performed between 2000 and 2018. Prenatal, perinatal, and postsurgical variables of survival or nonsurvival groups were compared using chi-square statistical test, t-test, Mann-Whitney U test, and logistic regression. Tests with p<0.05 were considered statistically determined. RESULTS: A total of 142 newborns were investigated. Mean maternal age, gestational age, and birth weight were lower in the group of nonsurvival (p<0.05). Poor clinical conditions during admission, complex gastroschisis, closure with silo placement, the use of blood products, surgical complications, and short bowel syndrome were more frequent in the nonsurvival group (p<0.05). Complex gastroschisis [adjusted odds ratio (OR) 3.74, 95% confidence interval (95%CI) 1.274-11.019] and short bowel syndrome (adjusted OR 7.55, 95%CI 2.177-26.225) increased the risk of death. Higher birth weight inversely reduced the risk for mortality (adjusted OR 0.99, 95%CI 0.997-1.000). CONCLUSION: Complex gastroschisis and short bowel syndrome increased the risk of death, with greater birth weight being inversely correlated with the risk of mortality. The findings of this research can contribute to the formulation of protocols to improve the quality and safety of care in order to reduce neonatal mortality associated with gastroschisis.

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OBJECTIVE: To analyze the profile of immigrants with tuberculosis (TB) and to identify the associated vulnerability characteristics. METHODS: A cross-sectional study which used TB-WEB data from cases residing in São Paulo in 2016 (203 immigrants and 6,069 non-immigrants). The variables were analyzed using prevalence ratio and confidence intervals. RESULTS: Among the immigrant cases, 67% were Bolivians. When compared to non-immigrants, immigrants were younger and frequently indigenous or presenting yellow ethnicity. They were also associated with a higher education level. We observed less immigrants having extrapulmonary TB and comorbidities, such as HIV/AIDS, diabetes mellitus, or drug use. Compared to cured cases, immigrants were not associated with treatment default and death, but they were associated with transfer to another state/country. CONCLUSIONS: Younger individuals and higher education levels were identified among immigrants, as well as a lower occurrence of comorbidities and drug use. It is believed that these results have led immigrants to more favorable outcomes of TB treatment.

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Introduction: global disparity in outcomes of gastroschisis is visible. Survival rates in high-income countries have improved since 1960, and are currently around 100%, due to progress in pediatric surgery and neonatal intensive care. However, in low- and middle-income countries mortality rates can reach all cases. Objective: this study aims to map the existing literature on gastroschisis in Brazil within a global context.Methods: scoping Review. PubMed, Scielo Brazil, Biblioteca Virtual em Saúde (BVS) and Google Scholar, were searched from January 2000 to May 2020.Results: eight studies met the inclusion criteria. The consolidated data of 912 patients were: Mean maternal age of 20.7 years, antenatal diagnosis rate of 80.2%, cesarean section rate of 77.7%. Mean of hospital stay of 40.8 days. Mean mortality rate of 25.3 %. Risk factors associated with death were: prematurity, low birth weight, low APGAR score, reinterventions, sepsis, birth-to-surgery interval greater than 4 hours, fewer prenatal visits, delayed prenatal diagnosis.Conclusion: studies on gastroschisis in Brazil were scarce, most of carried out in southeast of country. This study suggests that there are regional contrasts on gastroschisis outcomes in Brazil. The worst results are in regions with low economic resources, a similar situation found in international literature. This review should be validated with future studies to investigate the situation of pregnant women with fetuses with gastroschisis, especially in low-resource regions, in Brazil.

Introdução: a disparidade global nos resultados da gastrosquise é visível. Taxas de sobrevivência em países de alta renda melhoraram desde 1960 e atualmente estão em torno de 100%, devido ao progresso da cirurgia pediátrica e da terapia intensiva neonatal. No entanto, em países de media e baixa renda, as taxas de mortalidade continual elevadas. Objetivo: este estudo tem como objetivo mapear a literatura existente sobre gastrosquise no Brasil e discutir as evidências disponíveis em um contexto global.Método: revisão de escopo. Foram pesquisados o PubMed, o Scielo Brasil, a Biblioteca Virtual em Saúde (BVS) e o Google Scholar no período de janeiro de 2000 a maio de 2020.Resultados: oito estudos preencheram os critérios de inclusão e os dados encontrados de 912 pacientes foram: idade materna média de 20.7 anos, média do diagnóstico antenatal de 80.2%, taxa média de cesarianas de 77.7%, tempo de permanência hospitalar médio de 40.8 dias e taxa média de mortalidade 25.3%. Os fatores de risco associados ao óbito encontrados foram a prematuridade, baixo peso ao nascer, APGAR baixo, reintervenções cirúrgicas, sepse, intervalo nascimento-cirurgia maior que 4 horas, poucas consultas do pré-natal e diagnóstico antenatal tardio.Conclusão: estudos sobre gastrosquise no Brasil são escassos, a maioria realizada no Sudeste do país. Os piores desfechos estão em regiões com poucos recursos econômicos, situação semelhante à encontrada na literatura internacional. Esta revisão deve ser validada com estudos futuros que investiguem a situação de gestantes portadoras de fetos com gastrosquise, especialmente em regiões de poucos recursos, no Brasil.

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INTRODUCTION: This study evaluates the performance of individual and combinations tests used for pediatric tuberculosis diagnosis at a reference center. MATERIALS AND METHODS: Diagnostic test outcomes from children with presumed pulmonary tuberculosis evaluated from January 2005 - July 2010 were compared to a standard diagnosis made by an expert panel of physicians. RESULTS: Presence of at least one sign/symptom, history of contact, or abnormal chest X-ray (aCXR) individually showed the highest sensitivity (85.7%). While the combination of history of contact, at least one sign/symptom, positive tuberculin skin test, and aCXR had low sensitivity of 20%, but the specificity and a positive predictive value were 100%, respectively. The combination of tests used in the International Union Against Tuberculosis and Lung Disease and the Brazilian Ministry of Health systems showed sensitivity of 28.6% and 71.4% and specificity of 95.8% and 97.0%, respectively. CONCLUSIONS: In the absence of a gold standard, the combination of clinical history, tuberculin skin test, and aCXR, as well as the Brazilian scoring system serve as simple, low-cost approach that can be used for pediatric TB diagnosis by first-contact care providers.

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Objetivo: Esse estudo objetivou levantar e caracterizar as aplicações de healthbots em língua portuguesa, considerando seus papéis na transformação digital da jornada do paciente. Métodos: Revisão de literatura narrativa pela qual se investigou a acessibilidade e a objetividade das aplicações, tendo o paciente como usuário final. Os artigos foram analisados quanto ao uso de bots, tecnologias da informação e dispositivos utilizados, objetivo das aplicações, área médica de intervenção e disciplinaridade no desenvolvimento das soluções. Resultados: De treze artigos selecionados na busca contendo aplicações com automatização de tarefas, apenas cinco descreveram a utilização de bots. Conclusão: Os healthbots possuem potencial para promover o aprimoramento da jornada do paciente. Contudo, o desenvolvimento e o emprego de tais aplicações ainda não estão difundidos no Brasil.

Objective: This study aimed to raise and characterize the applications of healthbots in Portuguese, considering their roles in the digital transformation of the patient's journey. Methods: Review of narrative literature through which the accessibility and objectivity of the applications were investigated, with the patient as the end user. The articles were analyzed regarding the use of bots, information technologies and devices used, purpose of applications, medical area of intervention and disciplinary action in the development of solutions. Results: Of thirteen articles selected in the search containing applications with task automation, only five described the use of bots. Conclusion: Healthbots have the potential to improve the patient journey. However, the development and use of such applications are still not widespread in Brazil.

Objetivo: Este estudio tuvo como objetivo plantear y caracterizar las aplicaciones de los healthbots en portugués, considerando sus roles en la transformación digital del viaje del paciente. Métodos: Revisión de literatura narrativa mediante la cual se investigó la accesibilidad y objetividad de las aplicaciones, con el paciente como usuario final. Los artículos fueron analizados en cuanto al uso de bots, tecnologías y dispositivos de información utilizados, finalidad de las aplicaciones, área médica de intervención y acción disciplinaria en el desarrollo de soluciones. Resultados: De trece artículos seleccionados en la búsqueda que contienen aplicaciones con automatización de tareas, solo cinco describieron el uso de bots. Conclusión: los Healthbots tienen el potencial de mejorar el viaje del paciente. Sin embargo, el desarrollo y uso de tales aplicaciones aún no está muy extendido en Brasil.

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Abstract Objective: To characterize the influence of birthplace on outcomes of patients with gastroschisis admitted to three hospitals in a state in Brazil's southeastern region, according to condition inborn (born in a reference center) or outborn (born outside the reference center). Methods: Retrospective multicenter cohort study of patients with gastroschisis. The sample size utilized was of patients admitted in three hospitals with a diagnosis of gastroschisis ICD 10 Q79.3 between January 2000 to December 2018. Patients were divided into two groups, inborn and outborn. Characteristics of prenatal, perinatal and postoperative were compared using statistical tests. The level of significance adopted was P-value < 0.05. Results: In total, 144 cases of gastroschisis were investigated. The outborn patients group had higher rates of absence of antenatal diagnosis (p = 0.001), vaginal delivery (p = 0.001), longer time between birth and abdominal wall closure surgery (p = 0.001), to silo removal (p = 0.001), to first enteral feeding (p = 0.008), for weaning from mechanical ventilation (p = 0.034), used less peripherally inserted central catheter (PICC) and required more venous dissections (p = 0.001), and lower mean of serum sodium (p = 0.015). There were no differences in mortality rates and length of hospital stay between the inborn and outborn groups. Conclusion: Although outborn patients with gastroschisis were less likely to have an antenatal diagnosis and were more prone to a longer time to undergo surgical and feeding procedures, and to spend more time in mechanical ventilation, these disadvantages seemed not to reflect on the death rate and the length of hospital stay of patients from this group.

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Analisar concordância entre diagnósticos de Doença Renal Crônica em prontuários clínicos e pelo critério da Sociedade Brasileira de Nefrologia em Pessoas vivendo com HIV. Trata-se de um estudo descritivo de concordância de diagnósticos, através de levantamento de prontuários. A população do estudo foi de 258 pessoas vivendo com HIV atendidas em um serviço de atendimento especializado localizado em um interior de São Paulo, no ano de 2017. Para cálculo da concordância foi utilizado o índice Kappa, copositividade e conegatividade. Encontramos 6,5% pacientes com Doença Renal Crônica pelo critério da Sociedade Brasileira de Nefrologia; e 5,42% pelo diagnóstico médico. O índice Kappa foi de 0,55; a copositividade de 52,9% e conegatividade de 97,9%. Identificou-se uma concordância dos diagnósticos moderada, copositividade baixa e alta conegatividade. O que aponta uma importância de investigações precisas dos diagnósticos pautados em mais de um critério avaliativo. (AU)

To analyze the agreement between Chronic Kidney Disease diagnoses in clinical records and by the criteria of the Brazilian Society of Nephrology in People Living with HIV. This is a descriptive study of diagnostic agreement, through medical records survey. The study population consisted of 258 people living with HIV attended at a specialized care service located in some interior of São Paulo State, in 2017. To calculate the agreement, the Kappa index, copositivity and connectivity was used. We found 6.5% patients with Chronic Kidney Disease according to the criteria of the Brazilian Society of Nephrology; and 5.42% by medical diagnosis. The Kappa index was 0.55; the copositivity of 52.9% and connectivity of 97.9%. A moderate diagnoses concordance, low copositivity and high connectivity was identified. This indicates the importance of accurate investigations of diagnoses based on more than one evaluative criterion. (AU)

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INTRODUCTION: Prisons context has the potential for the spread of infectious diseases, like HIV and tuberculosis, which prevalence is higher in the people deprived of liberty compared to the general population. OBJECTIVE: to analyze which are the determinants of coinfection tuberculosis and HIV in prisons. METHODOLOGY: Case-control study conducted in the state of São Paulo, Brazil. New cases of tuberculosis in the population deprived of liberty in the period between 2015 and 2017 were considered. Data were obtained through the notification and monitoring system for tuberculosis cases in the state of São Paulo and included sociodemographic and clinical variables and diagnosis and treatment information. The data were analyzed through frequency distribution and bivariate analysis, testing the association of the dependent variable (tuberculosis/HIV coinfection vs. tuberculosis/HIV non-coinfection) with independent variables (sociodemographic, clinical and diagnostics variables) by calculating the odds ratio and p-value. RESULTS: Among the determinants of tuberculosis/HIV coinfection in prisons, we identified: age between 26-35, 36-55 and 56-84 years, notification in hospitals, negative sputum smear microscopy and culture, X-ray suggestive of another pathology, extrapulmonary and mixed clinical form, and alcoholism. A high percentage of death was also identified among coinfected people. CONCLUSIONS: identifying the determinants of the tuberculosis/HIV coinfected individual can assist in the development and implementation of guidelines aimed at controlling both infections in the prison environment.

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OBJECTIVE: To characterize the influence of birthplace on outcomes of patients with gastroschisis admitted to three hospitals in a state in Brazil's southeastern region, according to condition inborn (born in a reference center) or outborn (born outside the reference center). METHODS: Retrospective multicenter cohort study of patients with gastroschisis. The sample size utilized was of patients admitted in three hospitals with a diagnosis of gastroschisis ICD 10 Q79.3 between January 2000 to December 2018. Patients were divided into two groups, inborn and outborn. Characteristics of prenatal, perinatal and postoperative were compared using statistical tests. The level of significance adopted was P-value < 0.05. RESULTS: In total, 144 cases of gastroschisis were investigated. The outborn patients group had higher rates of absence of antenatal diagnosis (p = 0.001), vaginal delivery (p = 0.001), longer time between birth and abdominal wall closure surgery (p = 0.001), to silo removal (p = 0.001), to first enteral feeding (p = 0.008), for weaning from mechanical ventilation (p = 0.034), used less peripherally inserted central catheter (PICC) and required more venous dissections (p = 0.001), and lower mean of serum sodium (p = 0.015). There were no differences in mortality rates and length of hospital stay between the inborn and outborn groups. CONCLUSION: Although outborn patients with gastroschisis were less likely to have an antenatal diagnosis and were more prone to a longer time to undergo surgical and feeding procedures, and to spend more time in mechanical ventilation, these disadvantages seemed not to reflect on the death rate and the length of hospital stay of patients from this group.

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Introducción: La tuberculosis es la novena causa de muerte en el mundo y la primera de las enfermedades infecciosas. El objetivo del presente trabajo fue describir la situación epidemiológica de la tuberculosis y el alcance de la respuesta de la estrategia de control en un distrito de salud de la serranía del Ecuador.Materiales y Métodos: estudio descriptivo, con información secundaria de la base de registros de personas con tuberculosis del Distrito de Salud 17D06 Chilibulo ­ Lloa; los datos de identificación personal se mantuvieron bajo estricto carácter anónimo y confidencial.Resultados: En el 2017 y 2018 hubo 39 y 44 casos de tuberculosis; el 61% fue de sexo masculino; el 71,8% fueron mayores a 35 años; la tasa de mortalidad fue de 0.02 y 0.97 por cada 100.000 habitantes. La captación fue del 15,5% en el 2017 y 17,9% en el 2018. Las brechas en captación del sintomático respiratorio, diagnóstico de tuberculosis con baciloscopía positiva y su total estuvieron por encima del 80% en ambos años. De los pacientes que iniciaron tratamiento, el 87,2 % terminaron el mismo en el 2017 y el 31,8% en el 2018. Discusión: La tasa de éxito en el tratamiento en el 2017 es similar a la meta planteada a nivel nacional (87%), algo inferior en el 2018. Los logros en captación también difieren al resto del país (30%), Conclusión: El distrito de salud realiza un adecuado seguimiento en el tratamiento de personas con tuberculosis, pero falla en la captación de sintomáticos respiratorios.

Introduction: Tuberculosis is the ninth cause of death in the world and the first of infec-tious diseases. The objective of this study was to describe the epidemiological situation of tuberculosis and the scope of the response of the control strategy in a health district in the highlands of Ecuador.Materials and methods: descriptive study, with secondary information from the database of records of people with tuberculosis of the Health District 17D06 Chilibulo - Lloa; personal identification data was kept strictly anonymous and confidential.Results: In 2017 and 2018 there were 39 and 44 cases of tuberculosis; 61% were male; 71.8% were older than 35 years; the mortality rate was 0.02 and 0.97 per 100,000 inhabi-tants. The uptake was 15.5% in 2017 and 17.9% in 2018. The gaps in uptake of respiratory symptoms, diagnosis of tuberculosis with positive smear microscopy and its total were abo-ve 80% in both years. Of the patients who started treatment, 87.2% finished it in 2017 and 31.8% in 2018.Discussion: The treatment success rate in 2017 is like the goal set at the national level (87%), somewhat lower than in 2018. The achievements in recruitment also differ from the rest of the country (30%),Conclusion: The health district carries out adequate monitoring in the treatment of people with tuberculosis but fails to capture patients with respiratory symptoms.

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OBJECTIVES: to analyze the care provided to individuals with Tuberculosis (TB)-HIV coinfection in prison units in the state of São Paulo, according to the regional coordination of prisons. METHODS: cross-sectional study conducted between 2016 and 2018. A structured questionnaire was applied to 112 directors or health professionals from 168 prison units. Data were analyzed by frequency distribution and multiple correspondence analysis. RESULTS: 92.9% of participants reported active search for respiratory symptoms, 89.3% offer the directly observed treatment (DOT) for all TB cases, 95.5% anti-HIV testing for all inmates, 92.9% offer HIV follow-up in specialized care services and 59.8% antiretroviral drugs for cases of coinfection. An association was identified between the Northwest and Central regional coordinations and deficient human resources and low performance of actions for the diagnosis and follow-up of cases. CONCLUSIONS: although most prison units perform planned actions for the care of coinfected persons, some places need support to guarantee access to these actions.

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Objetivou-se com esse estudo avaliar os efeitos fisiológicos, o controle de doenças e os efeitos nos componentes de produção, ocasionados pela aplicação do fungicida piraclostrobina, em diferentes estádios fenológicos de genótipos de milho cultivado em segunda safra, no município de Jataí-GO. Utilizou-se o delineamento de blocos ao acaso, no esquema fatorial 3 x 4, com quatro repetições. Os tratamentos consistiram de três genótipos de milho e quatro épocas de aplicação de piraclostrobina. Não houve interação entre genótipos e aplicações para as variáveis avaliadas. A aplicação de piraclostrobina não interfere na fisiologia, desenvolvimento e produtividade de grãos das plantas de milho cultivados em segunda safra e não houve diferença significativa no controle das doenças ferrugem polissora, mancha de cercospora, mancha de bipolares e mancha branca pela aplicação de piraclostrobina nos genótipos estudados.

Objective with this study evaluate the physiological effects, disease control and effects on the production components of pyraclostrobin fungicide, applied at different phenological stages of of second crop corn genotypes, in Jataí city. In randomized blocks in a factorial design 3 x 4 with four replications. The treatments consisted in three corn genotypes and four periods of pyraclostrobin application. There was no interaction between genotype and applications for the variables evaluated. For the majority of the variables the only difference were between genotypes. The application of pyraclostrobin does not interfere in the physiology, development and grain production of maize plants grown in second crop and there was no significant difference in the control of polissora blight,cercospora spot, bipolaris spot stain and white stain by the application of pyraclostrobin in the genotypes studied.

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Objetivou-se com esse estudo avaliar os efeitos fisiológicos, o controle de doenças e os efeitos nos componentes de produção, ocasionados pela aplicação do fungicida piraclostrobina, em diferentes estádios fenológicos de genótipos de milho cultivado em segunda safra, no município de Jataí-GO. Utilizou-se o delineamento de blocos ao acaso, no esquema fatorial 3 x 4, com quatro repetições. Os tratamentos consistiram de três genótipos de milho e quatro épocas de aplicação de piraclostrobina. Não houve interação entre genótipos e aplicações para as variáveis avaliadas. A aplicação de piraclostrobina não interfere na fisiologia, desenvolvimento e produtividade de grãos das plantas de milho cultivados em segunda safra e não houve diferença significativa no controle das doenças ferrugem polissora, mancha de cercospora, mancha de bipolares e mancha branca pela aplicação de piraclostrobina nos genótipos estudados.(AU)

Objective with this study evaluate the physiological effects, disease control and effects on the production components of pyraclostrobin fungicide, applied at different phenological stages of of second crop corn genotypes, in Jataí city. In randomized blocks in a factorial design 3 x 4 with four replications. The treatments consisted in three corn genotypes and four periods of pyraclostrobin application. There was no interaction between genotype and applications for the variables evaluated. For the majority of the variables the only difference were between genotypes. The application of pyraclostrobin does not interfere in the physiology, development and grain production of maize plants grown in second crop and there was no significant difference in the control of polissora blight,cercospora spot, bipolaris spot stain and white stain by the application of pyraclostrobin in the genotypes studied.(AU)

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The article describes the use of blended care as a mechanism of action in the construction of a therapy that uses digital means to improve and support current clinical treatments. The so-called digital therapeutics provides evidence-based therapeutic interventions for patients, who are guided by software to prevent, manage, or treat a medical disorder or disease. They are used independently or together with drugs, devices, or other therapies to optimize patient care and health outcomes. They are similar to popular wellness applications, but with one key difference: they focus on providing clinical results. Broadly speaking, they are evidence-based behavioral treatments delivered online, which can increase accessibility of health care and its efficacy. It is a combination of activities involving face-to-face care and digital care, aiming to provide follow-up of patients' performance in their self-care. Regarding blended care, digital therapeutics acts as an extension of physical care. They are complementary, regardless of the proportion used of each, in the care process of the assisted individual. It works as a bridge between the traditional provision of face-to-face care and eHealth solutions.

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