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Objetivo: identificar características clínicas das paradas cardiopulmonares e reanimações cardiopulmonares ocorridas em ambiente intra-hospitalar. Método: estudo quantitativo, prospectivo e observacional, a partir de informações de prontuários de pacientes submetidos a manobras de reanimação devido à parada cardiopulmonar entre janeiro e dezembro de 2021. Utilizou-se um instrumento baseado nas variáveis do modelo de registro Utstein. Resultados: em 12 meses foram registradas 37 paradas cardiopulmonares. A maioria ocorreu na unidade de terapia intensiva respiratória, com causa clínica mais prevalente hipóxia. 65% dos pacientes foram intubados no atendimento e 57% apresentaram ritmo atividade elétrica sem pulso. A duração da reanimação variou entre menos de cinco a mais de 20 minutos. Como desfecho imediato, 57% sobreviveram. Conclusão: dentre os registros analisados, a maior ocorrência de paradas cardiopulmonares foi na unidade de terapia intensiva respiratória, relacionada à Covid-19. Foram encontrados registros incompletos e ausência de padronização nas condutas.

Objective: identify the clinical characteristics of cardiopulmonary arrests and cardiopulmonary resuscitations in the in-hospital environment. Method: this is a quantitative, prospective and observational study based on information from the medical records of patients who underwent resuscitation maneuvers due to cardiopulmonary arrest between January and December 2021. An instrument based on the variables of the Utstein registration protocol was used. Results: thirty-seven cardiopulmonary arrests were recorded in 12 months. The majority occurred in a respiratory intensive care unit, with hypoxia being the most prevalent clinical cause. Sixty-five percent of the patients were intubated and 57% had pulseless electrical activity. The duration of resuscitation ranged from less than five to more than 20 min. As for the immediate outcome, 57% survived. Conclusion: among the records analyzed, the highest occurrence of cardiopulmonary arrests was in respiratory intensive care units, and they were related to Covid-19. Moreover, incomplete records and a lack of standardization in cardiopulmonary resuscitation procedures were found.

Objetivo: Identificar las características clínicas de paros cardiopulmonares y reanimaciones cardiopulmonares que ocurren en un ambiente hospitalario. Método: estudio cuantitativo, prospectivo y observacional, realizado a partir de información presente en historias clínicas de pacientes sometidos a maniobras de reanimación por paro cardiorrespiratorio entre enero y diciembre de 2021. Se utilizó un instrumento basado en las variables del modelo de registro Utstein. Resultados: en 12 meses se registraron 37 paros cardiopulmonares. La mayoría ocurrió en la unidad de cuidados intensivos respiratorios, la causa clínica más prevalente fue la hipoxia. El 65% de los pacientes fue intubado durante la atención y el 57% presentaba un ritmo de actividad eléctrica sin pulso. La duración de la reanimación varió entre menos de cinco y más de 20 minutos. Como resultado inmediato, el 57% sobrevivió. Conclusión: entre los registros analizados, la mayor cantidad de paros cardiopulmonares se dio en la unidad de cuidados intensivos respiratorios, relacionada con Covid-19. Se encontraron registros incompletos y falta de estandarización en el procedimiento.

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Objetivo: analisar os registros perioperatórios baseados nas etapas de sistematização da assistência de enfermagem perioperatória em um hospital regional público do agreste de Pernambuco. Método: estudo transversal, descritivo, com abordagem quantitativa, obtido com dados secundários, conduzido em um hospital público. A amostra foi composta por 276 prontuários de indivíduos que se submeteram a procedimentos anestésico-cirúrgicos, durante os meses de janeiro a maio de 2023. Utilizou-se a análise descritiva e inferencial. Resultados: a efetuação dos registros da sistematização da assistência de enfermagem perioperatória foi predominante na maioria do período perioperatório, com respectiva significância principalmente no pré-operatório. Conclusão: as atividades satisfatórias corresponderam à visita pré-operatória de enfermagem, histórico, diagnóstico e prescrição de enfermagem. Já as fragilidades identificadas destacaram-se a ausência de reservas sanguíneas, a verificação de alergia e a colocação de placa de eletrocautério, inserção de sonda vesical, a efetuação do controle de perdas sanguíneas, fisiológicas e secreção gástrica.

Objective: analyzing perioperative records based on the phases of systematization of perioperative nursing care in a public regional hospital in Pernambuco's harsh region. Method: a cross-sectional, descriptive study with a quantitative approach, using secondary data, conducted in a public hospital. The sample consisted of 276 medical records of individuals who underwent anesthetic-surgical procedures between January and May 2023. Descriptive and inferential analysis was used. Results: the recording of the systematization of perioperative nursing care was predominant in the majority of the perioperative period, with significance mainly in the preoperative period. Conclusion: the satisfactory activities corresponded to the preoperative nursing visit, history, diagnosis, and nursing prescription. The weaknesses identified were the lack of blood reserves, checking for allergies and placing the electrocautery plate, inserting a urinary catheter, controlling blood loss, physiological loss, and gastric secretion.

Objetivo: analizar los registros perioperatorios a partir de las etapas de sistematización de la atención de enfermería perioperatoria en un hospital público regional de la zona rural de Pernambuco. Método: estudio descriptivo transversal, con enfoque cuantitativo, a partir de datos secundarios, realizado en un hospital público. La muestra estuvo compuesta por 276 historias clínicas de personas sometidas a procedimientos anestésico-quirúrgicos, de enero a mayo de 2023. Se utilizó análisis descriptivo e inferencial. Resultados: el registro de la sistematización de la atención de enfermería perioperatoria predominó en la mayor parte del periodo perioperatorio, con significación principalmente en el periodo preoperatorio. Conclusión: las actividades satisfactorias correspondieron a la visita de enfermería preoperatoria, registro, diagnóstico y prescripción de enfermería. Las debilidades identificadas incluyeron falta de reservas de sangre, comprobación de alergias y colocación de placa de electrocauterio, inserción de sonda vesical, control de la pérdida de sangre, fisiológica y secreción gástrica.

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BACKGROUND: The use of technologies has had a significant impact on patient safety and the quality of care and has increased globally. In the literature, it has been reported that people die annually due to adverse events (AEs), and various methods exist for investigating and measuring AEs. However, some methods have a limited scope, data extraction, and the need for data standardization. In Brazil, there are few studies on the application of trigger tools, and this study is the first to create automated triggers in ambulatory care. OBJECTIVE: This study aims to develop a machine learning (ML)-based automated trigger for outpatient health care settings in Brazil. METHODS: A mixed methods research will be conducted within a design thinking framework and the principles will be applied in creating the automated triggers, following the stages of (1) empathize and define the problem, involving observations and inquiries to comprehend both the user and the challenge at hand; (2) ideation, where various solutions to the problem are generated; (3) prototyping, involving the construction of a minimal representation of the best solutions; (4) testing, where user feedback is obtained to refine the solution; and (5) implementation, where the refined solution is tested, changes are assessed, and scaling is considered. Furthermore, ML methods will be adopted to develop automated triggers, tailored to the local context in collaboration with an expert in the field. RESULTS: This protocol describes a research study in its preliminary stages, prior to any data gathering and analysis. The study was approved by the members of the organizations within the institution in January 2024 and by the ethics board of the University of São Paulo and the institution where the study will take place. in May 2024. As of June 2024, stage 1 commenced with data gathering for qualitative research. A separate paper focused on explaining the method of ML will be considered after the outcomes of stages 1 and 2 in this study. CONCLUSIONS: After the development of automated triggers in the outpatient setting, it will be possible to prevent and identify potential risks of AEs more promptly, providing valuable information. This technological innovation not only promotes advances in clinical practice but also contributes to the dissemination of techniques and knowledge related to patient safety. Additionally, health care professionals can adopt evidence-based preventive measures, reducing costs associated with AEs and hospital readmissions, enhancing productivity in outpatient care, and contributing to the safety, quality, and effectiveness of care provided. Additionally, in the future, if the outcome is successful, there is the potential to apply it in all units, as planned by the institutional organization. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55466.

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This paper documents the occurrence of the genus Umbilicaria in the Argentine Islands-Kyiv Peninsula region of the Graham Coast in the maritime Antarctic. The presence of seven Umbilicaria species (U. africana, U. antarctica, U. aprina, U. decussata, U. kappenii, U. nylanderiana and U. umbilicarioides) in the ice-free areas of the Argentine Islands-Kyiv Peninsula region were confirmed. The species of U. africana and U. aprina are documented from the studied region for the first time. This study moves the southern distribution limit of U. africana about 300 km to the south: to the Argentine Islands-Kyiv Peninsula region. The distribution maps of Umbilicaria species for the studied region and maritime Antarctica are prepared.

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The economic trend and the health care landscape are rapidly evolving across Asia. Effective real-world data (RWD) for regulatory and clinical decision-making is a crucial milestone associated with this evolution. This necessitates a critical evaluation of RWD generation within distinct nations for the use of various RWD warehouses in the generation of real-world evidence (RWE). In this article, we outline the RWD generation trends for 2 contrasting nation archetypes: "Solo Scholars"-nations with relatively self-sufficient RWD research systems-and "Global Collaborators"-countries largely reliant on international infrastructures for RWD generation. The key trends and patterns in RWD generation, country-specific insights into the predominant databases used in each country to produce RWE, and insights into the broader landscape of RWD database use across these countries are discussed. Conclusively, the data point out the heterogeneous nature of RWD generation practices across 10 different Asian nations and advocate for strategic enhancements in data harmonization. The evidence highlights the imperative for improved database integration and the establishment of standardized protocols and infrastructure for leveraging electronic medical records (EMR) in streamlining RWD acquisition. The clinical data analysis and reporting system of Hong Kong is an excellent example of a successful EMR system that showcases the capacity of integrated robust EMR platforms to consolidate and produce diverse RWE. This, in turn, can potentially reduce the necessity for reliance on numerous condition-specific local and global registries or limited and largely unavailable medical insurance or claims databases in most Asian nations. Linking health technology assessment processes with open data initiatives such as the Observational Medical Outcomes Partnership Common Data Model and the Observational Health Data Sciences and Informatics could enable the leveraging of global data resources to inform local decision-making. Advancing such initiatives is crucial for reinforcing health care frameworks in resource-limited settings and advancing toward cohesive, evidence-driven health care policy and improved patient outcomes in the region.

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INTRODUCTION AND OBJECTIVES: Despite the huge clinical burden of MASLD, validated tools for early risk stratification are lacking, and heterogeneous disease expression and a highly variable rate of progression to clinical outcomes result in prognostic uncertainty. We aimed to investigate longitudinal electronic health record-based outcome prediction in MASLD using a state-of-the-art machine learning model. PATIENTS AND METHODS: n = 940 patients with histologically-defined MASLD were used to develop a deep-learning model for all-cause mortality prediction. Patient timelines, spanning 12 years, were fully-annotated with demographic/clinical characteristics, ICD-9 and -10 codes, blood test results, prescribing data, and secondary care activity. A Transformer neural network (TNN) was trained to output concomitant probabilities of 12-, 24-, and 36-month all-cause mortality. In-sample performance was assessed using 5-fold cross-validation. Out-of-sample performance was assessed in an independent set of n = 528 MASLD patients. RESULTS: In-sample model performance achieved AUROC curve 0.74-0.90 (95 % CI: 0.72-0.94), sensitivity 64 %-82 %, specificity 75 %-92 % and Positive Predictive Value (PPV) 94 %-98 %. Out-of-sample model validation had AUROC 0.70-0.86 (95 % CI: 0.67-0.90), sensitivity 69 %-70 %, specificity 96 %-97 % and PPV 75 %-77 %. Key predictive factors, identified using coefficients of determination, were age, presence of type 2 diabetes, and history of hospital admissions with length of stay >14 days. CONCLUSIONS: A TNN, applied to routinely-collected longitudinal electronic health records, achieved good performance in prediction of 12-, 24-, and 36-month all-cause mortality in patients with MASLD. Extrapolation of our technique to population-level data will enable scalable and accurate risk stratification to identify people most likely to benefit from anticipatory health care and personalized interventions.

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The order Plecoptera constitutes a relatively small group of aquatic insects, encompassing 17 extant families and comprising over 4400 valid species. In Brazil, the number of valid extant species is 207, located in two families: Perlidae (149) and Gripopterygidae (58). Despite extensive research on the southeastern region of Brazil, there is a notable scarcity of comprehensive studies consolidating geographical records and species richness of Plecoptera in the state of Minas Gerais. This study seeks to increase and refine our understanding of Plecoptera within Minas Gerais, focusing on its diversity and distribution. The initial phase involved a thorough review of articles documenting Plecoptera species in the state. Subsequently, biological material from the Museum of Entomology at the Federal University of Viçosa collection was meticulously identified, and its geographical records were incorporated. Utilizing this dataset, we compiled an updated list of Plecoptera species documented in Minas Gerais. Geographical coordinates of collection points were then mapped and graphically represented to elucidate the geographic and altitudinal distribution of these species. A total of 42 Plecoptera species were identified within the state of Minas Gerais, adding many occurrence records and documenting the first record of Gripopteryx pinima for the state. Despite these advancements, knowledge gaps persist, particularly in the mesoregions of Triângulo/Alto Paranaíba, Oeste de Minas, Vale do Mucuri, and Campo das Vertentes. This endeavor serves as an initial foundation to stimulate further collections and investments in undersampled areas, fostering future monitoring and conservation initiatives for aquatic environments.

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This study aimed to validate and refine an information model on pain management in a Brazilian hospital, considering the institutional culture, using an expert consensus approach. The first stage took place through a computerized questionnaire and Content Validity Index calculation. Pain management attributes were considered validated with 75% consensus among 19 experts. The second stage validated and refined the information model by three experts via an online meeting. Results showed that out of 11 evaluated attributes, five were validated. In the second stage, the inclusion of new attributes was suggested to address institutional culture. The final information model resulted from 23 sets of revised attributes: 12 validated, seven suggested and four not validated. The resulting Brazilian model has the potential to support the implementation of interventions and propose improvements to the institution's electronic system, which can be reused in other institutions.

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Objetivo: Trata-se de uma revisão integrativa cujo objetivo foi sumarizar a literatura atual referente à documentação odontológica e suas aplicações, relacionada à responsabilidade civil do cirurgião-dentista. Metodologia: Foi realizada uma busca nas bases de dados PubMed, LILACS, Scielo e Periódicos CAPES, e na literatura cinza (Google Acadêmico) entre agosto e setembro de 2022, bem como em endereços eletrônicos oficiais para busca de leis e normativas, utilizando a combinação dos descritores: "documentação", "responsabilidade legal", "odontologia" e "odontologia legal". Resultados: Encontrou-se dez publicações no âmbito da odontologia forense quatro relacionadas à documentação odontológica (prontuários, termo de consentimento livre e esclarecido, odontograma, imagens), quatro em relação as ações judiciais, uma sobre prescrição de medicamentos e uma sobre notificação dos casos suspeitos e confirmados de violência. Conclusão: As universidades, instituições de ensino superior e as unidades de saúde tem um papel importante na formação e capacitação do odontólogo para o preenchimento correto das prescrições de medicamentos, de prontuário, de notificações compulsórias, armazenamento de documentos odontológicos, bem como, esclarecimento sobre responsabilidade subjetiva e objetiva do cirurgião dentista, dano e nexo causal... (AU)

Objective: This is an integrative review whose objective was to summarize the current literature regarding dental documentation and its applications, related to the civil liability of the dental surgeon. Methodology: A search was carried out in the databases PubMed, LILACS, Scielo and Periódicos CAPES, and in gray literature (Google Scholar) between August and September 2022, as well as in official electronic addresses to search for laws and regulations, using the combination of descriptors: "documentation", "legal responsibility", "dentistry" and "legal dentistry". Results: Ten publications were found in the field of forensic dentistry, four related to dental documentation (medical records, informed consent form, odontogram, images), four related to legal actions, one on medication prescription and one on case notification suspected and confirmed cases of violence. Conclusion: Universities, higher education institutions and health units have an important role in training and qualifying dentists to correctly fill out medication prescriptions, medical records, compulsory notifications, and storage of dental documents, as well as, clarification on the dentist's subjective and objective liability, damage and causal link... (AU)

Objetivo: Se trata de una revisión integradora cuyo objetivo fue resumir la literatura actual sobre la documentación odontológica y sus aplicaciones, relacionadas con la responsabilidad civil del cirujano dentista. Metodología: Se realizó una búsqueda en las bases de datos PubMed, LILACS, Scielo y Periódicos CAPES, y en literatura gris (Google Scholar) entre agosto y septiembre de 2022, así como en direcciones electrónicas oficiales para buscar leyes y regulaciones, utilizando la combinación de descriptores: "documentación", "responsabilidad legal", "odontología" y "odontología legal". Resultados: Se encontraron diez publicaciones en el campo de la odontología forense, cuatro relacionadas con documentación odontológica (historia médica, consentimiento informado, odontograma, imágenes), cuatro relacionadas con acciones legales, una sobre prescripción de medicamentos y una sobre notificación de casos sospechosos y confirmados. de violencia. Conclusión: Las universidades, instituciones de educación superior y unidades de salud tienen un papel importante en la formación y calificación de los odontólogos para el correcto llenado de recetas de medicamentos, historias clínicas, notificaciones obligatorias y almacenamiento de documentos odontológicos. así como, aclaración sobre la responsabilidad subjetiva y objetiva del odontólogo, daño y nexo causal... (AU)

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Objective: Long COVID, marked by persistent, recurring, or new symptoms post-COVID-19 infection, impacts children's well-being yet lacks a unified clinical definition. This study evaluates the performance of an empirically derived Long COVID case identification algorithm, or computable phenotype, with manual chart review in a pediatric sample. This approach aims to facilitate large-scale research efforts to understand this condition better. Methods: The algorithm, composed of diagnostic codes empirically associated with Long COVID, was applied to a cohort of pediatric patients with SARS-CoV-2 infection in the RECOVER PCORnet EHR database. The algorithm classified 31,781 patients with conclusive, probable, or possible Long COVID and 307,686 patients without evidence of Long COVID. A chart review was performed on a subset of patients (n=651) to determine the overlap between the two methods. Instances of discordance were reviewed to understand the reasons for differences. Results: The sample comprised 651 pediatric patients (339 females, M age = 10.10 years) across 16 hospital systems. Results showed moderate overlap between phenotype and chart review Long COVID identification (accuracy = 0.62, PPV = 0.49, NPV = 0.75); however, there were also numerous cases of disagreement. No notable differences were found when the analyses were stratified by age at infection or era of infection. Further examination of the discordant cases revealed that the most common cause of disagreement was the clinician reviewers' tendency to attribute Long COVID-like symptoms to prior medical conditions. The performance of the phenotype improved when prior medical conditions were considered (accuracy = 0.71, PPV = 0.65, NPV = 0.74). Conclusions: Although there was moderate overlap between the two methods, the discrepancies between the two sources are likely attributed to the lack of consensus on a Long COVID clinical definition. It is essential to consider the strengths and limitations of each method when developing Long COVID classification algorithms.

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We present notable distributional updates for 14 species from western Ecuador (seven amphibians and seven reptiles). Our findings include the northernmost confirmed sighting of Pristimantis kuri and the southernmost documented record of Imantodes inornatus and Lepidoblepharis buchwaldi. Additionally, we document new records and notes on the distribution range of Agalychnis spurrelli, Hyloscirtus alytolylax, Engystomops montubio, Pristimantis muricatus, Pristimantis nyctophylax, Pristimantis walkeri, Chironius flavopictus, Chironius grandisquamis, Dendrophidion graciliverpa, Ninia schmidti, and Urotheca fulviceps. These observations significantly contribute to filling information gaps in our understanding of these species' distributions. The data, derived from samples collected across diverse forested areas in the western region of Ecuador (provinces of Bolívar, Cañar, Guayas, El Oro, and Los Ríos), provide valuable insights into the ecology and conservation of these species.

Presentamos importantes actualizaciones distribucionales para 14 especies del oeste de Ecuador (siete anfibios y siete reptiles). Nuestros hallazgos incluyen el avistamiento confirmado más al norte de Pristimantis kuri y el registro documentado más al sur de Imantodes inornatus y Lepidoblepharis buchwaldi. Además, documentamos nuevos registros y notas sobre el rango de distribución de Agalychnis spurrelli, Hyloscirtus alytolylax, Engystomops montubio, Pristimantis muricatus, Pristimantis nyctophylax, Pristimantis walkeri, Chironius flavopictus, Chironius grandisquamis, Dendrophidion graciliverpa, Ninia schmidti y Urotheca fulviceps. Estas observaciones contribuyen significativamente a llenar vacíos de información en nuestra comprensión de la distribución de estas especies. Los datos, derivados de muestras recolectadas en diversas áreas forestales de la región occidental de Ecuador (provincias de Bolívar, Cañar, Guayas, El Oro y Los Ríos), proporcionan valiosos conocimientos sobre la ecología y conservación de estas especies.

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The Vaupés River stands out as one of the few within the Amazon basin due to its numerous rapids. These riverine fast-flowing sections not only provide habitat to highly specialized fishes but also function as natural barriers hindering the movement of fish along its course. During a fish-collecting expedition in the lower Vaupés River basin in Colombia, 95 species were registered belonging to 30 families and seven orders. Despite recent inventories in the region, our comprehensive sampling efforts particularly focused on the rapids and associated rheophilic fauna, allowing us to contribute the first records of four fish species in Colombia (Mylopluslucienae Andrade, Ota, Bastos & Jégu, 2016, Tometesmakue Jégu, Santos & Jégu, 2002, also first record of the genus, Leptodoraspraelongus (Myers & Weitzman, 1956), and Eigenmanniamatintapereira Peixoto, Dutra & Wosiacki, 2015) and six presumably undescribed species (i.e., Jupiaba sp., Moenkhausia sp., Phenacogaster sp., Bunocephalus sp., Hemiancistrus sp., and Archolaemus sp.). In this study, a commented list of the ichthyofauna of these environments is presented, as well as a photographic catalog of fish species integrated into the CaVFish Project - Colombia.

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BACKGROUND: Globally, the counting of deaths based on gender identity and sexual orientation has been a challenge for health systems. In most cases, non-governmental organizations have dedicated themselves to this work. Despite these efforts in generating information, the scarcity of official data presents significant limitations in policy formulation and actions guided by population needs. Therefore, this manuscript aims to evaluate the accuracy, potential, and limits of probabilistic data relationships to yield information on deaths according to gender identity and sexual orientation in the State of Rio de Janeiro. METHODS: This study evaluated the accuracy of the probabilistic record linkage to obtain information on deaths according to gender and sexual orientation. Data from two information systems were used from June 15, 2015 to December 31, 2020. We constructed nine probabilistic data relationship strategies and identified the performance and cutoff points of the best strategy. RESULTS: The best data blocking strategy was established through logical blocks with the first and last names, birthdate, and mother's name in the pairing strategy. With a population base of 80,178 records, 1556 deaths were retrieved. With an area under the curve of 0.979, this strategy presented 93.26% accuracy, 98.46% sensitivity, and 90.04% specificity for the cutoff point ≥ 17.9 of the data relationship score. The adoption of the cutoff point optimized the manual review phase, identifying 2259 (90.04%) of the 2509 false pairs and identifying 1532 (98.46%) of the 1556 true pairs. CONCLUSION: With the identification of possible strategies for determining probabilistic data relationships, the retrieval of information on mortality according to sexual and gender markers has become feasible. Based on information from the daily routine of health services, the formulation of public policies that consider the LGBTQ + population more closely reflects the reality experienced by these population groups.

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Resumo O estudo visa analisar a prevalência de estadiamento avançado ao diagnóstico do câncer do colo do útero e sua associação com indicadores individuais e contextuais socioeconômicos e de oferta de serviços de saúde no Brasil. Estudo transversal, realizado com casos de câncer do colo do útero em mulheres de 18 a 99 anos, no período de 2006 a 2015, extraídos do Integrador de Registros Hospitalares de Câncer. Variáveis contextuais foram coletadas no Atlas do Desenvolvimento Humano, no Cadastro Nacional de Estabelecimentos de Saúde e no Sistema de Informações Ambulatoriais. Usou-se o modelo de regressão de Poisson multinível com intercepto aleatório. A prevalência de diagnóstico em estádio avançado foi de 48,4%, apresentando associação com idades mais avançadas (RP 1,06; IC 1,01-1,10), raça/cor da pele preta, parda e indígena (RP 1,04; IC 1,01-1,07), menores níveis de escolaridade (RP 1,28; IC 1,16-1,40), ausência de parceiro conjugal (RP 1,10; IC 1,07-1,13), encaminhamento do tipo público ao serviço de saúde (RP 1,07; IC 1,03-1,11) e menor taxa de realização de exame citopatológico (RP 1,08; IC 1,01-1,14). Os resultados reforçam a necessidade de melhorias no programa nacional de prevenção do câncer do colo do útero em áreas com baixa cobertura da citologia oncótica.

Abstract The scope of this study is to analyze the prevalence of advanced stage diagnosis of cervical cancer and its association with individual and contextual socioeconomic and healthcare service indicators in Brazil. A cross-sectional study was conducted using cervical cancer cases in women aged 18 to 99 years, from 2006 to 2015, extracted from the Hospital Cancer Registry (HCR) Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil; the National Registry of Health Institutions (NRHI); and the Outpatient Information System. Multilevel Poisson Regression with random intercept was used. The prevalence of advanced stage diagnosis was 48.4%, revealing an association with older age groups (PR 1.06; CI 1.01-1.10), black, brown, and indigenous race/skin color (PR 1.04; CI 1.01-1.07), lower levels of schooling (PR 1.28; CI 1.16-1.40), no marital partner (PR 1.10; CI 1.07-1.13), public referral to the health service (PR 1.07; CI 1.03-1.11), and lower rates of cytological examination (PR 1.08; CI 1.01-1.14). The results reinforce the need for improvements in the national cervical cancer prevention program in areas with low coverage of oncotic cytology.

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The history of the taxonomy of Trichogramma parasitoid wasps can be divided into two phases. In the first phase, species identifications were based on external morphological characters; however, these identifications proved to be confusing and inaccurate. In the second phase, starting in the 1970s, taxa were identified based on charcteristics of the male genital capsule , leading to a major advance in Trichogramma taxonomy. The history of Trichogramma taxonomy in Brazil is recent and mainly related to species that parasitize agricultural pests. In Brazil, the first phase of Trichogramma taxonomy occurred in the 1960s, while the second phase occurred from the 1980s onward. In this second phase, Trichogramma taxonomy progressed significantly and knowledge of Trichogramma diversity as well as associations with lepidopteran pests improved markedly in Brazil as well as worldwide. The last five decades have seen significant progress in studies in Brazil, with taxonomy evolving from identifications based exclusively on morphological characters to integrative taxonomy, encompassing biology (crosses) and morphometry. This historical outline presents the phases of Trichogramma taxonomy in Brazil, addressing the hurdles encountered in the first descriptions, erroneous records of the species, and species descriptions since the 1980s. We highlight the importance of accurately identifying Trichogramma taxa for their use in biological control, as well as species diversity and associations with lepidopteran hosts.

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Taking into account the complexity of the human brain dynamics, the appropriate characterization of any brain state is a challenge not easily met. Actually, even the discrimination of simple behavioral tasks, such as resting with eyes closed or eyes open, represents an intricate problem and many efforts have been and are being made to overcome it. In this work, the aforementioned issue is carefully addressed by performing multiscale analyses of electroencephalogram records with the permutation Jensen-Shannon distance. The influence that linear and nonlinear temporal correlations have on the discrimination is unveiled. Results obtained lead to significant conclusions that help to achieve an improved distinction between these resting brain states.

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Objectives: Describe the current legislation on electronic medical records (EMR) and telehealth in Latin American countries and analyze the treatment of confidentiality and professional secrecy. Methods: Between March and September 2022, a survey of the regulations in force in 21 Latin American countries was conducted at two levels: the existence of legislation on EMR and telehealth, and the treatment of confidentiality and professional secrecy in EMR and telehealth. A data extraction form was prepared for each country. Data were collected from official on-line sources. The information was analyzed qualitatively and synthesized in tables when possible. Results: The use of EMR is legally regulated in 16 countries. Nineteen countries have legislation on telehealth. All the countries analyzed safeguard confidentiality and professional secrecy through regulations. However, confidentiality and professional secrecy are mentioned in 11 countries in the context of telehealth, and in only nine countries in the context of EMR. Conclusions: Since the start of this century, Latin America has made progress in the legislation of digital tools for health care, such as EMR and telehealth. There is also interest in ethical issues related to the use of EMR and telehealth, particularly confidentiality and professional secrecy, aspects that should be strengthened in digital health.

Objetivo: Descrever a legislação vigente sobre prontuários eletrônicos e telessaúde nos países da América Latina e analisar o tratamento da confidencialidade e do sigilo profissional. Métodos: Entre março e setembro de 2022, realizou-se um levantamento sobre a regulamentação vigente nos 21 países latino-americanos incluídos no estudo, em dois níveis: i) existência de legislação sobre prontuários eletrônicos e telessaúde; e ii) tratamento da confidencialidade e do sigilo profissional em prontuários eletrônicos e telessaúde. Uma planilha para extração de dados foi elaborada para cada país. Os dados foram coletados de fontes oficiais disponíveis on-line. Foi realizada uma análise qualitativa das informações, que foram resumidas em tabelas, quando possível. Resultados: O uso dos prontuários eletrônicos é legalmente regulamentado em 16 países. Quanto à telessaúde, 19 países têm legislação sobre essa ferramenta. Todos os países analisados protegem a confidencialidade e o sigilo profissional por meio de regulamentação. No entanto, no contexto da telessaúde, eles são mencionados em 11 países; já no contexto dos prontuários eletrônicos, em apenas 9 países. Conclusões: Desde o início dos anos 2000, a América Latina vem avançando em relação à legislação sobre ferramentas digitais na atenção à saúde, como prontuários eletrônicos e telessaúde. Há também interesse nas questões éticas relacionadas ao uso de prontuários eletrônicos e telessaúde, especialmente em relação à confidencialidade e ao sigilo profissional, embora esses aspectos precisem ser reforçados na saúde digital.

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Objective: Postpartum hemorrhage (PPH) is the leading cause of maternal death globally. Therefore, prevention strategies have been created. The study aimed to evaluate the occurrence of PPH and its risk factors after implementing a risk stratification at admission in a teaching hospital. Methods: A retrospective cohort involving a database of SISMATER® electronic medical record. Classification in low, medium, or high risk for PPH was performed through data filled out by the obstetrician-assistant. PPH frequency was calculated, compared among these groups and associated with the risk factors. Results: The prevalence of PPH was 6.8%, 131 among 1,936 women. Sixty-eight (51.9%) of them occurred in the high-risk group, 30 (22.9%) in the medium-risk and 33 (25.2%) in the low-risk group. The adjusted-odds ratio (OR) for PPH were analyzed using a confidence interval (95% CI) and was significantly higher in who presented multiple pregnancy (OR 2.88, 95% CI 1.28 to 6.49), active bleeding on admission (OR 6.12, 95% CI 1.20 to 4.65), non-cephalic presentation (OR 2.36, 95% CI 1.20 to 4.65), retained placenta (OR 9.39, 95% CI 2.90 to 30.46) and placental abruption (OR 6.95, 95% CI 2.06 to 23.48). Vaginal delivery figured out as a protective factor (OR 0.58, 95% CI 0.34 to 0.98). Conclusion: Prediction of PPH is still a challenge since its unpredictable factor arrangements. The fact that the analysis did not demonstrate a relationship between risk category and frequency of PPH could be attributable to the efficacy of the strategy: Women classified as "high-risk" received adequate medical care, consequently.

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Objetivo: Analisar os fatores preditores para a elevação do custo direto do tratamento hemodinâmico em pacientes com infarto agudo do miocárdio. Métodos: Estudo transversal, com análise documental de 124 prontuários de pacientes com infarto agudo do miocárdio submetidos a procedimentos hemodinâmicos subsidiados pelo SUS, no período de 2016 a 2017. Foram consideradas como variáveis as características sociais e clínicas, a completitude do prontuário e o custo do tratamento. Resultados: O custo médio do tratamento hemodinâmico é de R$ 6.141,94 reais; sendo que a maioria dos pacientes teve custo de tratamento entre R$ 3 a 5 mil reais. Evidenciou-se que os fatores preditores para o custo são: nível de escolaridade; tempo de internação; e completitude do prontuário. O tipo de procedimento e o diagnóstico do paciente são condições clínicas que não interferem no custo do tratamento. Conclusão: O financiamento do sistema público de saúde é deficitário, pois corresponde a metade do menor nível de custo de tratamento hemodinâmico evidenciado. (AU)

Objective: To analyze the predictive factors for the increase in the direct cost of hemodynamic treatment in patients with acute myocardial infarction. Methods: Cross-sectional study, with documental analysis of 124 medical records of patients with acute myocardial infarction undergoing hemodynamic procedures subsidized by the SUS, in the period from 2016 to 2017. Social and clinical characteristics, completeness of the medical record and cost were considered as variables of the treatment. Results: The average cost of hemodynamic treatment is R$ 6,141.94 reais; and most patients had a treatment cost between R$ 3 to 5 thousand reais. It was evident that the predictive factors for the cost are: level of education; length of stay; and completeness of the medical record. The type of procedure and the patient's diagnosis are clinical conditions that do not affect the cost of treatment. Conclusion: The financing of the public health system is deficient, as it corresponds to half of the lowest level of hemodynamic treatment cost evidenced. (AU)

Objetivo: Analizar los factores predictivos del incremento del coste directo del tratamiento hemodinámico en pacientes con infarto agudo de miocardio. Métodos: Estudio transversal, con análisis documental de 124 historias clínicas de pacientes con infarto agudo de miocardio sometidos a procedimientos hemodinámicos subvencionados por el SUS, en el período de 2016 a 2017. Se consideraron características sociales y clínicas, integridad de la historia clínica y costo. como variables del tratamiento. Resultados: El costo promedio del tratamiento hemodinámico es de R$ 6.141,94 reales; y la mayoría de los pacientes tuvo un costo de tratamiento entre R$ 3 a 5 mil reales. Se evidenció que los factores predictivos del costo son: nivel de educación; duración de la estancia; e integridad del expediente médico. El tipo de procedimiento y el diagnóstico del paciente son condiciones clínicas que no afectan el costo del tratamiento. Conclusión: El financiamiento del sistema público de salud es deficiente, ya que corresponde a la mitad del nivel más bajo de costo de tratamiento hemodinámico evidenciado. (AU)

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BACKGROUND: Several clinical and individual factors may play a role in the survival rate of dental restorations, such as characteristics related to the child's age and oral hygiene, and factors associated with the tooth, such as the type of material and number of surfaces to be restored. AIM: To analyse the survival rate of adhesive restorations on primary teeth and factors associated with restoration survival. DESIGN: The study included dental records of children aged 3-12 years having received adhesive restorations on primary teeth at a Brazilian dental school between 2009 and 2019. A Kaplan-Meier survival curve was used to plot survival rates using the log-rank test. A multivariate Cox regression model was run to identify individual and dental factors associated with restoration failure. RESULTS: The sample comprised 269 restored teeth in 111 children. Survival curves were similar for all materials (p = .20) and types of isolation (p = .05). The annual failure rate was 3.60% for glass ionomer cement, 1.23% for resin-modified glass ionomer cement and 0.40% for composite resin. The following variables were associated with more failures: Class II restoration compared with Class I (HR = 1.96; 95%CI: 1.28-2.99, p < .001), proportion of decayed teeth (HR = 11.89; 95%CI: 2.80-50.57, p < .001) and child's age (HR = 1.17; 95%CI: 1.06-1.29, p < .001). CONCLUSION: The different materials and types of isolation had similar survival rates. Children with more decayed teeth have an increased risk of restoration failure.

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