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INTRODUCTION AND OBJECTIVES: Prevalence and mortality of chronic liver disease have risen significantly. In end stage liver disease, the survival of patients is approximately two years. Despite the poor prognosis and high symptom burden of these patients, integration of palliative care is limited. We aim to assess associated factors and trends in palliative care use in recent years. MATERIALS AND METHODS: A Multicenter retrospective cohort of patients with end stage liver disease who suffered in-hospital mortality between 2017 and 2019. Information regarding patient demographics, hospital characteristics, comorbidities, etiology, decompensations, and interventions was collected. Two-sided tests and logistic regression analysis were used to identify factors associated with palliative care use. RESULTS: A total of 201 patients were analyzed, with a yearly increase in palliative care consultation: 26.7 % in 2017 to 38.3 % in 2019. Patients in palliative care were older (65.72 ± 11.70 vs. 62.10 ± 11.44; p = 0.003), had a lower Karnofsky functionality scale (χ=18.104; p = 0.000) and had higher rates of hepatic encephalopathy (32.1 % vs. 17.4 %, p = 0.007) and hepatocarcinoma (61.7 % vs. 26.2 %; p = 0.000). No differences were found for Model for End-stage Liver Disease (19.28 ± 6.60 vs. 19,90 ± 5.78; p = 0.507) or Child-Pugh scores (p = 0.739). None of the patients who die in the intensive care unit receive palliative care (0 % vs 31.6 %; p = 0.000). Half of the palliative care consultations occurred 6,5 days before death. CONCLUSIONS: Palliative care use differs based on demographics, disease complications, and severity. Despite its increasing implementation, palliative care intervention occurs late. Future investigations should identify approaches to achieve an earlier and concurrent care model.

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BACKGROUND: The World Health Organization characterizes infertility as a disease since 2009; however, in many countries, reproductive health is not prioritized. Characterizing a target population and knowing the barriers to accessing reproductive care may allow for a broadening of the discussion on how to provide equal opportunities. The objective of this study was to develop and validate a questionnaire that seeks to identify socioeconomic and cultural characteristics of Brazilian infertile couples to open the discussion on the principle of fair access to health. METHODS: (1) literature review in the main databases, (2) questionnaire elaboration by researchers within the areas of human reproduction and bioethics, concerned with content adequacy and comprehension, using the Google Forms online platform, (3) pilot study - the questionnaire was applied to 54 couples, over 18 years of age, that were seeking treatment for infertility and accepted to participate in the study and (4) statistical analysis - for continuous numerical variables, mean, standard deviation and 95% CI of the means were presented. For discrete numerical variables, median, interquartile range, minimum and maximum were presented. RESULTS: Forty-four questionnaires were fully completed and with adequate answers. The questionnaire proved to be objective and easy to understand. It was possible to obtain information on education, race of the couple, the impact of infertility on the couple's life, socioeconomic conditions, and the main difficulties in accessing medical care for treatment of infertility. CONCLUSION: The questionnaire proved to be feasible in collecting appropriate information to characterize a target population and the only limitation was that there was no academic expert evaluation prior to the pilot test.

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In August 2018, the Federal Council of Medicine (CFM), the body responsible for the supervision and standardization of medical professional practice in Brazil, published a national code of ethics for medical students (CEMS), which standardizes and suggests behaviors, based on the best moral and ethical values, for medical students, supporting the humanization of medicine and indirectly helping teachers and managers of medical courses. The purpose of the study was to evaluate the dissemination and awareness of scientific publications on the Brazilian CEMS code, and consisted of an integrative literature review of all publications related to the Brazilian CEMS published from 2005 to the present. We found 4 studies related to regional and university codes of ethics for medical students published from 2005 to 2022, and regarding the CEMS elaborated by the FCM, we found a single study from its launch in 2018 to 2022. A CEMS has universal importance, facilitating the ethical and human development of future physicians, and despite its importance in the training of physicians, there is a lack of published research on the subject in Brazil.

En agosto de 2018, el Consejo Federal de Medicina (CFM), órgano responsable de la supervisión y normalización de la práctica profesional médica en Brasil, publicó un código nacional de ética para estudiantes de medicina (CEMS), que normaliza y sugiere conductas, basadas en los mejores valores morales y éticos, para los estudiantes de medicina, apoyando la humanización de la medicina y ayudando indirectamente a los profesores y gestores de los cursos de medicina. El propósito del estudio fue evaluar la difusión y el conocimiento de las publicaciones científicas sobre el código de la CEMS brasileña, y consistió en una revisión bibliográfica integradora de todas las publicaciones relacionadas con la CEMS brasileña publicadas desde 2005 hasta la actualidad. Encontramos 4 estudios relacionados con códigos de ética regionales y universitarios para estudiantes de medicina publicados desde 2005 hasta 2022, y con respecto a los CEMS elaborados por la FCM, encontramos un único estudio desde su lanzamiento en 2018 hasta 2022. Un CEMS tiene importancia universal, facilitando el desarrollo ético y humano de los futuros médicos, y, a pesar de su importancia en la formación de los médicos, falta investigación publicada sobre el tema en Brasil.

Em agosto de 2018, o Conselho Federal de Medicina (CFM), órgão responsável pela fiscalização e normatização do exercício profissional médico no Brasil, publicou um código nacional de ética do estudante de medicina (CEMS), que padroniza e sugere condutas, com base nos melhores valores morais e éticos, para os estudantes de medicina, apoiando a humanização da medicina e auxiliando indiretamente os professores e gestores dos cursos de medicina. O objetivo do estudo foi avaliar a disseminação e a conscientização das publicações científicas sobre o código CEMS brasileiro, e consistiu em uma revisão integrativa da literatura de todas as publicações relacionadas ao CEMS brasileiro publicadas de 2005 até o presente. Encontramos 4 estudos relacionados a códigos de ética regionais e universitários para estudantes de medicina publicados de 2005 a 2022 e, com relação ao CEMS elaborado pela FCM, encontramos um único estudo desde seu lançamento em 2018 até 2022. Um CEMS tem importância universal, facilitando o desenvolvimento ético e humano dos futuros médicos, e, apesar de sua importância na formação dos médicos, há uma carência de pesquisas publicadas sobre o assunto no Brasil.

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In August 2018, the Federal Council of Medicine (CFM), the body responsible for the supervision and standardization of medical professional practice in Brazil, published a national code of ethics for medical students (CEMS), which standardizes and suggests behaviors, based on the best moral and ethical values, for medical students, supporting the humanization of medicine and indirectly helping teachers and managers of medical courses. The purpose of the study was to evaluate the dissemination and awareness of scientific publications on the Brazilian CEMS code and consisted of an integrative literature review of all publications related to the Brazilian CEMS published from 2005 to the present. We found 4 studies related to regional and university codes of ethics for medical students published from 2005 to 2022, and regarding the CEMS elaborated by the FCM, we found a single study from its launch in 2018 to 2022. A CEMS has universal importance, facilitating the ethical and human development of future physicians, and despite its importance in the training of physicians, there is a lack of published research on the subject in Brazil.

En agosto de 2018, el Consejo Federal de Medicina (CFM), órgano responsable de la supervisión y normalización de la práctica profesional médica en Brasil, publicó un código nacional de ética para estudiantes de medicina (CEMS), que normaliza y sugiere conductas, basadas en los mejores valores morales y éticos, para los estudiantes de medicina, apoyando la humanización de la medicina y ayudando indirectamente a los profesores y gestores de los cursos de medicina. El propósito del estudio fue evaluar la difusión y el conocimiento de las publicaciones científicas sobre el código de la CEMS brasileña, y consistió en una revisión bibliográfica integradora de las publicaciones relacionadas con la CEMS brasileña publicadas desde 2005 hasta la actualidad. Encontramos 4 estudios relacionados con códigos de ética regionales y universitarios para estudiantes de medicina publicados desde 2005 hasta 2022, y, respecto de los CEMS elaborados por la FCM, encontramos un único estudio desde su lanzamiento en 2018 hasta 2022. Un CEMS tiene importancia universal, facilitando el desarrollo ético y humano de los futuros médicos, y, a pesar de su importancia en la formación de los médicos, falta investigación publicada sobre el tema en Brasil.

Em agosto de 2018, o Conselho Federal de Medicina (CFM), órgão responsável pela fiscalização e normatização do exercício profissional médico no Brasil, publicou um código nacional de ética do estudante de medicina (CEMS), que padroniza e sugere condutas, com base nos melhores valores morais e éticos, para os estudantes de medicina, apoiando a humanização da medicina e auxiliando indiretamente os professores e gestores dos cursos de medicina. O objetivo do estudo foi avaliar a disseminação e a conscientização das publicações científicas sobre o código CEMS brasileiro, e consistiu em uma revisão integrativa da literatura de todas as publicações relacionadas ao CEMS brasileiro publicadas de 2005 até o presente. Encontramos 4 estudos relacionados a códigos de ética regionais e universitários para estudantes de medicina publicados de 2005 a 2022 e, com relação ao CEMS elaborado pela FCM, encontramos um único estudo desde seu lançamento em 2018 até 2022. Um CEMS tem importância universal, facilitando o desenvolvimento ético e humano dos futuros médicos, e, apesar de sua importância na formação dos médicos, há uma carência de pesquisas publicadas sobre o assunto no Brasil.

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BACKGROUND: Infertility is an increasingly prevalent disease in society and is considered by the World Health Organization to be a public health problem. An important ethical issue arises from the clarification of reproductive rights in a fair and equal way. The objective of this study was to deepen and update the knowledge and discussion about the difficulty of accessing infertility treatments in Brazil. METHODS: A cross-sectional observational study was carried out through the application of an online questionnaire that collected the socioeconomic characteristics of couples and identify how barriers to infertility care affect the most vulnerable populations. We included couples who sought medical assistance to achieve pregnancy at two clinics in the states of São Paulo and Minas Gerais. RESULTS: A total of 201 questionnaires were analyzed. Most couples self-declared as white and the average age of wives was 36 years and husbands 38 years. 65% (65%) of couples would proceed with the treatment in a different city to which they lived, 37% evaluated as having easy access to a medical specialist only after indication, and more than half of the participating have thought about giving up the treatment due to some difficulty in accessing it. 39% of participants sought more than one medical service to find better reception, 42% of couples sought more than one medical service to define where it would be better financially, and 67.2% referred to the high cost of treatments, that is, financial issues, as a great difficulty in accessing medical services and/or treatment. Although 72.6% of couples considered having a good quality of life, 54.2% admitted that infertility and the search for treatment generated anxiety/stress in the couple's life. CONCLUSION: There is a need for public education on reproductive health and for policymakers to raise awareness of the importance of the difficulty that many couples face in seeking treatment to become pregnant, especially in countries with less financial resources. Indeed, it is commonly accepted that there is a universal human right to access healthcare of appropriate quality as a matter of justice. Discussion of access to reproductive technologies should be considered taking into account the longstanding ethical debate regarding fertility, fecundity, and infertility, as well as reproductive care.

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O presente documento apresenta o Relatório Final da 2ª Conferência Nacional da Saúde das Mulheres ­ 2ª CNSMU, contendo 285 (duzentas e oitenta e cinco) propostas debatidas nos grupos de trabalho e 16 (dezesseis) moções aprovadas na plenária final por 1.205 (mil duzentos e cinco) delegadas. A 2ª CNSMU que teve como tema central "Saúde das mulheres: Desafios para a integralidade com equidade", foi organizada e realizada em Brasília pelo Conselho Nacional de Saúde (CNS), no período de 17 a 20 de agosto de 2017, contando com 1.778 participantes, sendo 91.2% mulheres e 8.5% homens entre: delegadas/os, participantes livres, membros de comissões organizadoras e convidados. Assim, a 2ª CNSMU consagrou-se como marco na saúde das mulheres brasileiras, por dar visibilidade às diversidades e pluralidades das expressões do feminino, sendo também um espaço de escuta e respeito.

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BACKGROUND: Advance care planning (ACP) and goals of care discussions are important instruments that enable respect for patient autonomy, especially in patients with a life-threatening disease, such as cancer. Despite their well-established benefits, ACP and goals of care discussions are still not frequently performed in clinical oncology practice. Understanding the barriers to this topic is the first step toward developing future interventions that are more likely to improve professional practice and patient satisfaction with care. AIM: To explore Brazilian oncologists' barriers to discuss goals of care and advance care planning. METHODS: A cross-sectional study was developed to identify Brazilian oncologists' barriers to discussing goals of care and ACP. The Decide-Oncology questionnaire was used to identify the importance of these barriers according to oncologists' perceptions. Participants were asked to rank the importance of various barriers to discussing goals of care, ranging from 1 (extremely unimportant) to 7 (extremely important). A quantitative analysis using descriptive statistics was used, including median and interquartile intervals and a qualitative analysis based on Bardin content analysis of the two open questions. RESULTS: Sixty-six oncologists participated in this study. Most of them perceived the patient and family's related barriers as the most important, such as patients' difficulty in understanding their diagnosis and accepting their prognosis. Physician and external related factors, such as lack of training and lack of time for this conversation, were also described as important barriers. Participants with formal training regarding goals of care communication and with experience in palliative care perceived the lack of patients' advanced directives as a significant barrier and manifested more willingness to participate in decision-making about goals of care. The lack of access and of support for referral to palliative care was also considered a significant barrier for ACP and goals of care discussion. CONCLUSION: The identification of barriers that limit the discussion of ACP and early palliative care referrals can certainly help to prioritise the next steps for future studies aimed at improving ACP and helping clinicians to better support patients through shared decision-making based on the patient's values and experiences.

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Resumo O planejamento antecipado de cuidados é um processo de discussões entre profissionais de saúde e pacientes que permite a tomada de decisão compartilhada quanto a objetivos de cuidados de saúde, atuais e/ou futuros, com base nos desejos e valores do paciente e em questões técnicas do cuidado. É considerado fundamental na prestação de cuidados de excelência em fim de vida, permitindo que profissionais de saúde alinhem os cuidados prestados com o que é mais importante para o paciente. Apesar de seus benefícios, ainda é muito pouco realizado na prática clínica, especialmente no Brasil. Considerando a necessidade de guias práticos de planejamento antecipado de cuidados adaptados à realidade brasileira, pautados em estratégias de comunicação empática, este estudo é uma proposta de guia baseada em revisão integrativa da literatura (PubMed e SciELO), com recomendações de evidências atuais, incluindo instrumentos validados para o português (Brasil), para facilitar sua implementação na prática clínica.

Abstract Advance care planning is a process of discussion between healthcare professionals and patients that enables shared decision-making on current and/or future healthcare goals, based on patients' desires and values and technical care issues. Advance care is considered essential in the provision of quality terminal care, allowing healthcare professionals to align the care provided with what is most important to the patient. Despite its benefits, it is still underused in clinical practice, especially in Brazil. Considering the need for practical guides for advance care planning adapted to the Brazilian reality, drawing on empathetic communication strategies, this study is a guide proposal based on an integrative literature review (PubMed and SciELO), with recommendations of current evidence, including instruments validated for Portuguese (Brazil), to facilitate its implementation in clinical practice.

Resumen La planificación anticipada de atención es un proceso de discusión entre los profesionales de la salud y los pacientes que permite la toma de decisiones relacionadas a los objetivos de atención médica actuales y/o futuros, basadas en los deseos y valores del paciente y en cuestiones técnicas de la atención. Resulta ser una apropiada atención terminal, ya que estos profesionales pueden adecuar la atención con los deseos del paciente. Pese a sus beneficios, es poco realizada en la práctica clínica, especialmente en Brasil. Dada la necesidad de guías prácticas para la planificación anticipada de atención, adaptadas a la realidad brasileña y basadas en estrategias comunicativas empáticas, este estudio propone una guía a partir de una revisión integradora de la literatura (PubMed y SciELO), con recomendaciones de evidencia actual, incluidos instrumentos validados para el portugués brasileño para facilitar su aplicación en la práctica clínica.

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Objective: Advance directives are becoming increasingly important as health technologies evolve. We sought to assess psychiatrists' knowledge of advance directives, as this knowledge is fundamental to the implementation and drafting of these personal documents. Methods: A previously published questionnaire that evaluated the knowledge of medical professors was used. The sample, composed of psychiatrists from Rio de Janeiro, Brazil, originated from a publicly available list. During the search process, the COVID-19 pandemic affected Brazil and the rest of the world, which influenced our methodology and results. Results: A total of 40 psychiatrists participated in the study. The results obtained, although not significant, suggested that psychiatrists with an increased time of practice had more knowledge of advance directives. Nevertheless, less than half of the participants had knowledge about this topic. Conclusion: The number of psychiatrists surveyed indicates the need for further studies on the subject. The influence of the COVID-19 pandemic on this study led to findings such as a change in sensitivity when addressing the topic and greater difficulty in contacting professionals.

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The literature about the factors associated with cancer treatment refusal, especially by the older patients is scarce. Therefore, this study aimed to identify predictive factors associated with treatment refusal by older patients with cancer. A systematic review was conducted using three databases, Medline, Web of Science, and Scopus with the key concepts, "refusal treatment" and "cancer" and "decision making" and "elderly" or "aged". The search took place in July 2020 and it included articles published in the last 5 years. Of the 211 articles found, 22 were included in the review. Most studies have focused on head and neck and breast cancer treatment decisions and used a quantitative design. The majority of studies evaluated refusal of surgery interventions. Important factors associated with refusal cancer treatment include gender, marital status, race, having government insurance, advanced cancer, poor performance status (cancer stage III or IV) and Charlson Comorbidity Index ≥2. Thus, there are socio-demographic and clinical variables associated with treatment refusal. More studies with the elderly are needed. Understanding these factors may be useful to recognize situations where active education and support can help elderly patients accept optimal care.

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This study aimed to understand, through the bias of everyday life, the phenomenon of maternal mourning. It is a qualitative pilot study on three bereaved mothers. Semi-structured interviews were used for data collection and content analysis was performed using typical categories of daily life. It was possible to observe significant changes in the mothers' daily lives after their children's deaths; however, they created strategies that minimized such impacts. Losing a child leads to reconstructing one's own history and identity. It is believed that daily life is an important bias, and thus its study could help us understand this phenomenon.

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INTRODUCTION: Asthma affects approximately 10% of the world's population. Sensitization to allergens is an important risk factor, and exposure to allergens is associated with disease severity. METHODS: We performed skin tests to evaluate allergen sensitization to mites, cockroaches, cats, dogs, and molds in 73 asthmatic patients. Enzyme Linked Immunosorbent Assay was used to assay the mite and cockroach allergens found in dust from the bedding, hammocks, bedroom floors, living rooms, and kitchens of 29 patients and 14 controls. RESULTS: Fifty patients (68.5%) had positive skin test responses. There were positive responses to D. pteronyssinus (52.0%), B. tropicalis (53.4%), T. putrescentiae (15.0%), E. maynei (12.3%), L. destructor (8.2%), B. germanica (20.5%), P. americana (21.9%), Felis catus (10.9%), C. herbarium (2.7%), A. alternata (4.1%), and P. notatun (1.3%). The exposure to mite and cockroach allergens was similar in the patients and the controls. The Dermatophagoides pteronyssinus Group 1 levels were highest in the beds and hammocks. The Blattella germanica Group 1 levels were highest in the kitchens, living rooms and hammocks. DISCUSSION: The positive skin tests to mites, cockroaches and cats were consistent with previous studies. D pteronyssinus was the most prevalent home dust mite, and hammocks were a source of allergens. To improve asthma prophylaxis, it is important to determine its association with mite allergen exposure in hammocks.

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INTRODUCTION: Asthma affects approximately 10 percent of the world's population. Sensitization to allergens is an important risk factor, and exposure to allergens is associated with disease severity. METHODS: We performed skin tests to evaluate allergen sensitization to mites, cockroaches, cats, dogs, and molds in 73 asthmatic patients. Enzyme Linked Immunosorbent Assay was used to assay the mite and cockroach allergens found in dust from the bedding, hammocks, bedroom floors, living rooms, and kitchens of 29 patients and 14 controls. RESULTS: Fifty patients (68.5 percent) had positive skin test responses. There were positive responses to D. pteronyssinus (52.0 percent), B. tropicalis (53.4 percent), T. putrescentiae (15.0 percent), E. maynei (12.3 percent), L. destructor (8.2 percent), B. germanica (20.5 percent), P. americana (21.9 percent), Felis catus (10.9 percent), C. herbarium (2.7 percent), A. alternata (4.1 percent), and P. notatun (1.3 percent). The exposure to mite and cockroach allergens was similar in the patients and the controls. The Dermatophagoides pteronyssinus Group 1 levels were highest in the beds and hammocks. The Blattella germanica Group 1 levels were highest in the kitchens, living rooms and hammocks. DISCUSSION: The positive skin tests to mites, cockroaches and cats were consistent with previous studies. D pteronyssinus was the most prevalent home dust mite, and hammocks were a source of allergens. To improve asthma prophylaxis, it is important to determine its association with mite allergen exposure in hammocks.

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