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The global rise in companion animal populations, particularly dogs and cats, is driven by emotional and social benefits for owners, and their population management is becoming critically important to avoid a plethora of adverse effects on themselves, humans, and wildlife. We estimated the size and density of the owned canine and feline population in Chile and evaluated the status of microchipping, registration, sterilization rates, and the proportion of owned animals that roam unsupervised. A cross-sectional household survey in 36 districts was conducted and standard inferential statistics was employed to analyze differences between cats and dogs, sexes within each species, and between rural and urban areas. Additionally, two negative binomial models with mixed effects were developed to predict the number of dogs and cats per households. Two methods were used to compare population size estimates at the country level, multiplying: (1) the estimated mean number of companion animals per household by the estimated number of households at the country level, and (2) the estimated human:dog and human:cat ratios by the total human population. The study involved 6333 respondents, of which 76% (74% urban; 83% rural) owned companion animals (dogs and/or cats). Individuals in rural multi-person households increase the probability of owning dogs and/or cats. Additionally, women exhibit a greater inclination towards cat and dog ownership compared to men, while those over 30 years old demonstrate lower rates of companion animal ownership in contrast to the 18-30 age group for both species. The overall human:dog and human:cat ratios estimated were 2.7:1, and 6.2:1, respectively. The estimated total number of owned dogs and cats in Chile ranged from 9.6 to 10.7 million, depending on the methodological approach, while national median density of companion animals was 12 dogs per km2 (ranging from 0.02 to 7232) and 5 cats per km2 (ranging from 0.01 to 3242). This nationwide study showed one of the highest percentages of households with companion animals in Latin America and relatively low registration and sterilization rates, highlighting the need to strength long-term public policies to control populations of companion animals and promote responsibility in pet ownership.

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Epilepsy is a neurological disorder characterized by spontaneous recurrent seizures. While 20% to 30% of epilepsy cases are untreatable with Anti-Epileptic Drugs, some of these cases can be addressed through surgical intervention. The success of such interventions greatly depends on accurately locating the epileptogenic tissue, a task achieved using diagnostic techniques like Stereotactic Electroencephalography (SEEG). SEEG utilizes multi-modal fusion to aid in electrode localization, using pre-surgical resonance and post-surgical computer tomography images as inputs. To ensure the absence of artifacts or misregistrations in the resultant images, a fusion method that accounts for electrode presence is required. We proposed an image fusion method in SEEG that incorporates electrode segmentation from computed tomography as a sampling mask during registration to address the fusion problem in SEEG. The method was validated using eight image pairs from the Retrospective Image Registration Evaluation Project (RIRE). After establishing a reference registration for the MRI and identifying eight points, we assessed the method's efficacy by comparing the Euclidean distances between these reference points and those derived using registration with a sampling mask. The results showed that the proposed method yielded a similar average error to the registration without a sampling mask, but reduced the dispersion of the error, with a standard deviation of 0.86 when a mask was used and 5.25 when no mask was used.

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BACKGROUND: The World Health Organization recommends incorporating patient-reported experience measures and patient-reported outcome measures to ensure care processes. New technologies, such as mobile apps, could help report and monitor patients' adverse effects and doubts during treatment. However, engaging patients in the daily use of mobile apps is a challenge that must be addressed in accordance with the needs of people. OBJECTIVE: We present a qualitative case study documenting the process of identifying the information needs of breast cancer patients and health care professionals during the treatment process in a Chilean cancer institution. The study aims to identify patients' information requirements for integration into a mobile app that accompanies patients throughout their treatment while also providing features for reporting adverse symptoms. METHODS: We conducted focus groups with breast cancer patients who were undergoing chemotherapy (n=3) or who completed chemotherapy between 3 months and 1 year (n=1). We also surveyed health care professionals (n=9) who were involved in patient care and who belonged to the oncology committee of the cancer center where the study took place. Content analysis was applied to the responses to categorize the information needs and the means to satisfy them. A user interface was designed according to the findings of the focus groups and was assessed by 3 trained information system and user interaction design experts from 2 countries, using heuristic evaluation guidelines for mobile apps. RESULTS: Patients' information needs were classified into 4 areas: an overview of the disease, information on treatment and day-to-day affairs, assistance on the normality and abnormality of symptoms during treatment, and symptoms relevant to report. Health care professionals required patients to be provided with information on the administrative and financial process. We noted that the active involvement of the following 4 main actors is required to satisfy the information needs: patients, caregivers, social network moderators, and health professionals. Seven usability guidelines were extracted from the heuristic evaluation recommendations. CONCLUSIONS: A mobile app that seeks to accompany breast cancer patients to report symptoms requires the involvement of multiple participants to handle the reports and day-to-day information needs. User interfaces must be designed with consideration of the patient's social conventions and the emotional load of the disease information.

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Convolutional neural networks (CNNs) have been widely used to build deep learning models for medical image registration, but manually designed network architectures are not necessarily optimal. This paper presents a hierarchical NAS framework (HNAS-Reg), consisting of both convolutional operation search and network topology search, to identify the optimal network architecture for deformable medical image registration. To mitigate the computational overhead and memory constraints, a partial channel strategy is utilized without losing optimization quality. Experiments on three datasets, consisting of 636 T1-weighted magnetic resonance images (MRIs), have demonstrated that the proposal method can build a deep learning model with improved image registration accuracy and reduced model size, compared with state-of-the-art image registration approaches, including one representative traditional approach and two unsupervised learning-based approaches.

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3D standard reference brains serve as key resources to understand the spatial organization of the brain and promote interoperability across different studies. However, unlike the adult mouse brain, the lack of standard 3D reference atlases for developing mouse brains has hindered advancement of our understanding of brain development. Here, we present a multimodal 3D developmental common coordinate framework (DevCCF) spanning mouse embryonic day (E) 11.5, E13.5, E15.5, E18.5, and postnatal day (P) 4, P14, and P56 with anatomical segmentations defined by a developmental ontology. At each age, the DevCCF features undistorted morphologically averaged atlas templates created from Magnetic Resonance Imaging and co-registered high-resolution templates from light sheet fluorescence microscopy. Expert-curated 3D anatomical segmentations at each age adhere to an updated prosomeric model and can be explored via an interactive 3D web-visualizer. As a use case, we employed the DevCCF to unveil the emergence of GABAergic neurons in embryonic brains. Moreover, we integrated the Allen CCFv3 into the P56 template with stereotaxic coordinates and mapped spatial transcriptome cell-type data with the developmental ontology. In summary, the DevCCF is an openly accessible resource that can be used for large-scale data integration to gain a comprehensive understanding of brain development.

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Background: Although several studies have estimated gestational syphilis (GS) incidence in several countries, underreporting correction is rarely considered. This study aimed to estimate the level of under-registration and correct the GS incidence rates in the 557 Brazilian microregions. Methods: Brazilian GS notifications between 2007 and 2018 were obtained from the SINAN-Syphilis system. A cluster analysis was performed to group microregions according to the quality of GS notification. A Bayesian hierarchical Poisson regression model was applied to estimate the reporting probabilities among the clusters and to correct the associated incidence rates. Findings: We estimate that 45,196 (90%-HPD: 13,299; 79,310) GS cases were underreported in Brazil from 2007 to 2018, representing a coverage of 87.12% (90%-HPD: 79.40%; 95.83%) of registered cases, where HPD stands for the Bayesian highest posterior density credible interval. Underreporting levels differ across the country, with microregions in North and Northeast regions presenting the highest percentage of missed cases. After underreporting correction, Brazil's estimated GS incidence rate increased from 8.74 to 10.02 per 1000 live births in the same period. Interpretation: Our findings highlight disparities in the registration level and incidence rate of GS in Brazil, reflecting regional heterogeneity in the quality of syphilis surveillance, access to prenatal care, and childbirth assistance services. This study provides robust evidence to enhance national surveillance systems, guide specific policies for GS detection disease control, and potentially mitigate the harmful consequences of mother-to-child transmission. The methodology might be applied in other regions to correct disease underreporting. Funding: National Council for Scientific and Technological Development; The Bill Melinda Gates Foundation and Wellcome Trust.

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BACKGROUND: Evidence comparing different exercise modalities in individuals undergoing hemodialysis remains incipient. Our aim was to conduct a systematic review and network meta-analysis of randomized clinical trials to compare and synthesize the efficacy of five different intradialytic exercise modalities and home-based training in this population. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Studies were searched in PubMed/MEDLINE, Cochrane Library, Embase, Cinahl, and Scopus from their inception to 19 September 2022. We used traditional random-effects models and Bayesian network meta-analysis models. The risk of bias was assessed using the RoB v.2.0 tool, and the assessment of confidence in the results through the Confidence in Network Meta-Analysis (CINeMA) tool. RESULTS: Seventy-eight studies involving 3326 participants were included. Our network meta-analysis showed that combined training was the intervention with the best performance to increase VO2 peak [mean difference (MD) = 3.94 ml/kg/min; 95% credible interval (CrI), 2.38 to 5.76] and to reduce diastolic blood pressure (MD = -5.19 mmHg; 95%CrI, -9.35 to -0.96) compared to the usual care group. Inspiratory muscle training was the intervention that most improved the 6-minute walk test distance (MD = 70.97 m; 95%CrI, 18.09 to 129.87). C-reactive protein decreased in resistance training (MD = -2.6 mg/l; 95%CrI, -4.97 to -0.33) and aerobic training (MD = -1.4 mg/l; 95%CrI, -3.15 to -0.06). Kt/V improved in aerobic training (MD = 0.11; 95%CrI, 0.02 to 0.18), and SF-36 physical functioning outcomes improved in resistance training (MD = 10.66 points; 95%Crl, 1.91 to 20.22). No intradialytic exercise modality was superior to others or comparable with home-based training in improving the evaluated outcomes. Subgroup analysis revealed that exercise interventions >12 weeks improved functional capacity more than interventions ≤12 weeks, and that combined training reduces diastolic blood pressure only after 12 weeks of follow-up. Furthermore, our results suggest that moderate or moderate-to-vigorous intensity training leads to more pronounced improvements in functional capacity, whereas mild or mild-to-moderate intensity training does not have the same effect. In this review, most of the included studies were assessed as having some concern, which resulted in a low to very low level of confidence in the overall findings. CONCLUSIONS: Both intradialytic training and home-based training can promote benefits for individuals undergoing hemodialysis, with no evidence of the superiority of either training modality over the other.

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PURPOSE: During reconstructive surgery, knee and hip replacements, and orthognathic surgery, small misalignments in the pose of prosthesis and bones can lead to severe complications. Hence, the translational and angular accuracies are critical. However, traditional image-based surgical navigation lacks orientation data between structures, and imageless systems are unsuitable for cases of deformed anatomy. We introduce an open-source navigation system using a multiple registration approach that can track instruments, implants, and bones to precisely guide the surgeon in emulating a preoperative plan. METHODS: We derived the analytical error of our method and designed a set of phantom experiments to measure its precision and accuracy. Additionally, we trained two classification models to predict the system reliability from fiducial points and surface matching registration data. Finally, to demonstrate the procedure feasibility, we conducted a complete workflow for a real clinical case of a patient with fibrous dysplasia and anatomical misalignment of the right femur using plastic bones. RESULTS: The system is able to track the dissociated fragments of the clinical case and average alignment errors in the anatomical phantoms of [Formula: see text]  mm and [Formula: see text]. While the fiducial-points registration showed satisfactory results given enough points and covered volume, we acknowledge that the surface refinement step is mandatory when attempting surface matching registrations. CONCLUSION: We believe that our device could bring significant advantages for the personalized treatment of complex surgical cases and that its multi-registration attribute is convenient for intraoperative registration loosening cases.

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OBJECTIVES: To evaluate the effectiveness of newborn screening for sickle cell disease in eastern Jamaica by determining what proportion of screen-positive infants were registered with the Sickle Cell Unit by 2 months (60 days) of age and identifying parents' perceptions of facilitators and barriers impacting age at registration. STUDY DESIGN: This cross-sectional study used a mixed method approach. Ages at diagnosis confirmation and first clinic visit were recorded for screen-positive infants born between February 1, 2015, and November 15, 2017. All parents were invited to complete the survey, and early and late attendees were invited to participate in the qualitative aspect of the study. A researcher-designed questionnaire and an interview guide based on the Capability, Opportunity, Motivation, Behavior, and health belief models examined factors that may affect time to registration. Quantitative data were analyzed to yield descriptive statistics using Stata®v14. All interview data were coded. Similar codes were grouped together into themes. RESULTS: Most (97.7%) of the 133 screen-positive infants had their diagnosis confirmed. Only 40% had their first clinic visit by age 60 days. Denial of the diagnosis, poor communication, and the costs of treatment and transportation were perceived barriers to registration, whereas family support was a facilitator. CONCLUSIONS: Diagnosis confirmation was almost universal, but most infants did not attend clinic by 2 months of age. In-depth interviews have identified several facilitators and barriers that can be targeted to improve early registration.

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Background and objectives: due to the increase in the number of cases of the new coronavirus in the city of Codó-MA, there was a need to carry out a study on the spread of COVID-19 in the municipality in order to have a better knowledge and understanding of the problem. A study was carried out on the spread of COVID-19 in the city of Codó-MA, comparing the quantitative data on the number of cases in 2020 and 2021 between May and July and using the epidemiological model Susceptible-Infectious-Isolated-Recovered (SIQR). Methods: we collected daily data from the epidemiological bulletins made available by the Municipal Health Department of Codó (SEMUS-Codó), we chose the SIQR compartmental model to carry out the simulations, we assumed hypotheses and estimated the parameters in order to design the scenarios. We simulated scenarios such as social distancing of healthy individuals and social isolation of infected individuals. Results: in early 2020, cases increased more frequently than in early 2021, and approximately 20% of those infected were in social isolation. According to projections, more than 80% of cases of COVID-19 were not accounted for in Codó. In 2021, there was greater underreporting than in 2020, approximately 82% and 85%, respectively. Conclusion: from the results, the authors conclude that the social isolation of those infected is a more efficient method to contain an epidemic than the total blockade of the population and that the high number of underreported cases is because most of these cases are asymptomatic.(AU)

Justificativa e objetivos: devido ao aumento do número de casos do novo coronavírus na cidade de Codó-MA, viu-se a necessidade para fazer um estudo sobre a propagação da COVID-19 no município para a ter melhor conhecimento e entendimento do problema. Foi realizado um estudo sobre a disseminação da COVID-19 na cidade de Codó-MA, sendo comparados os dados quantitativos dos números de casos nos anos de 2020 e 2021 entre os meses de maio e julho e utilizando o modelo epidemiológico Suscetíveis-Infecciosos-Isolados-Recuperados (SIQR). Métodos: coletamos os dados diários dos boletins epidemiológicos disponibilizados pela Secretaria Municipal de Saúde de Codó (SEMUS- Codó), escolhemos o modelo compartimental SIQR para a realização das simulações, supomos hipóteses e estimamos os parâmetros para podermos projetar os cenários. Simulamos cenários, tais como distanciamento social dos indivíduos sadios e isolamento social dos indivíduos infectados. Resultados: no início de 2020, os casos aumentaram com mais frequência do que no início de 2021, e aproximadamente 20% dos infectados estavam em isolamento social. De acordo com as projeções, mais de 80% dos casos de COVID-19 não foram contabilizados em Codó. Em 2021, houve maior subnotificação do que em 2020, aproximadamente 82% e 85%, respectivamente. Conclusão: a partir dos resultados, os autores concluem que o isolamento social dos infectados é um método mais eficiente para conter uma epidemia do que o bloqueio total da população e que o alto número de casos subnotificados são porque a maioria desses casos são assintomáticos.(AU)

Antecedentes y objetivos debido al incremento en el número de casos del nuevo coronavirus en la ciudad de Codó-MA, surgió la necesidad de realizar un estudio sobre la propagación del COVID-19 en el municipio con el fin de tener un mejor conocimiento y comprensión de el problema. Se realizó un estudio sobre la propagación del COVID-19 en la ciudad de Codó-MA, comparando datos cuantitativos del número de casos en 2020 y 2021 entre mayo y julio y utilizando el modelo epidemiológico Susceptible-Infeccioso-Aislado-Recuperado (SIQR). Métodos: recolectamos datos diarios de los boletines epidemiológicos que pone a disposición la Secretaría Municipal de Salud de Codó (SEMUS-Codó), elegimos el modelo compartimental SIQR para realizar las simulaciones, asumimos hipótesis y estimamos los parámetros para poder diseñar los escenarios. Simulamos escenarios como el distanciamiento social de personas sanas y el aislamiento social de personas infectadas. Resultados: a principios de 2020, los casos aumentaron con más frecuencia que a principios de 2021, y aproximadamente el 20% de los infectados se encontraban en aislamiento social. Según proyecciones, en Codó no se contabilizaron más del 80% de los casos de COVID-19. En 2021 hubo mayor subregistro que en 2020, aproximadamente 82% y 85%, respectivamente. Conclusión: de los resultados, los autores concluyen que el aislamiento social de los contagiados es un método más eficiente para contener una epidemia que el bloqueo total de la población y que el alto número de casos subregistrados se debe a que la mayoría de estos casos son asintomáticos.(AU)

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Objetivo: O registro dos dados referentes a Terapia Nutricional Enteral (TNE) é importante para assegurar o procedimento e comunicação sistemática da assistência. Com o estudo, objetivou-se analisar os registros de enfermagem referentes à inserção de cateteres nasogástricos (CNG) e nasoenterais (CNE) considerando o sub-registro e não conformidades encontradas em prontuários e durante observação dos pacientes. Métodos: estudo observacional, transversal com abordagem quantitativa, mediante a aplicação de instrumento para coleta de dados de pacientes internados em um Hospital Universitário no Pará entre agosto de 2019 a julho de 2020. Resultados: Foram identificadas 191 inserções de cateteres por enfermeiros, sendo 43 (22,52%) reinserções sub-registradas e 148 (77,48%) apresentaram não conformidades. Discussão: O sub-registro e as não conformidades interferem na qualidade da assistência de enfermagem, fragilizam as ações de segurança do paciente, além de apresentarem repercussões legais. Conclusão: Os dados apresentados neste artigo foram primordiais para a detecção de lacunas na assistência de enfermagem. (AU)

Objective: The recording of data referring to Enteral Nutrition Therapy (ENT) is important to ensure the procedure and systematic communication of care. The objective was to analyze the nursing records regarding the insertion of nasogastric (CNG) and nasoenteral (CNE) catheters, considering the under-recording and non-conformities found in medical records and during patient observation. Methods: observational, cross-sectional study with a quantitative approach, through the application of an instrument to collect data from patients admitted to a University Hospital in Pará between August 2019 and July 2020. Results: 191 insertions of catheters by nurses were identified, of which 43 (22.52%) underreported reinsertion and 148 (77.48%) presented non-conformities. Discussion: Under-registration and non-compliance interfere with the quality of nursing care, weaken patient safety actions, in addition to having legal repercussions. Conclusion: The data presented in this article were essential for the detection of gaps in nursing care. (AU)

Objetivo: El registro de los datos referentes a la Terapia de Nutrición Enteral (ENT) es importante para garantizar el procedimiento y la comunicación sistemática de los cuidados. El objetivo fue analizar los registros de enfermería con respecto a la inserción de catéteres nasogástricos (GNC) y nasoenterales (CNE), considerando el subregistro y las no conformidades encontradas en los registros médicos y durante la observación de los pacientes. Métodos: estudio observacional, transversal con abordaje cuantitativo, mediante la aplicación de un instrumento para recolectar datos de pacientes internados en un Hospital Universitario de Pará entre agosto de 2019 y julio de 2020. Resultados: fueron identificadas 191 inserciones de catéteres por enfermeros, de de los cuales 43 (22,52%) subreportaron reinserción y 148 (77,48%) presentaron no conformidades. Discusión: El subregistro y el incumplimiento interfieren en la calidad de la atención de enfermería, debilitan las acciones de seguridad del paciente, además de tener repercusiones legales. Conclusión: Los datos presentados en este artículo fueron esenciales para la detección de lagunas en el cuidado de enfermería. (AU)

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Resumo Objetivo refletir sobre as implicações e os riscos associados ao novo registro de identificação do Brasil para a população trans. Método trata-se de estudo reflexivo que explora o conceito de identidade social como um fenômeno complexo, fundamentado nos princípios da autodeterminação e da dignidade humana. São consideradas perspectivas feministas pós-humanistas e críticas, que desafiam o essencialismo biológico dos indivíduos, com foco especial na teoria de Judith Butler. Resultados o Brasil está atualmente implementando um registro nacional de identificação capaz de reconhecer a identidade de gênero das pessoas trans. Este estudo aborda as implicações do novo sistema nacional de identificação, incluindo possíveis retrocessos e avanços na luta pelos direitos das pessoas trans. Para proteger a identidade e a segurança dessas pessoas, este artigo defende a criação de um novo sistema de identificação emitido pelo governo que armazene informações pessoais em bancos de dados, exibindo apenas o nome social e o marcador de gênero no cartão. Considerações finais e implicações para a prática as altas taxas de violência contra pessoas trans no Brasil destacam a necessidade urgente do novo sistema. O reconhecimento precoce e o respeito pela identidade de gênero são fundamentais para promover o sucesso do novo sistema.

Resumen Objetivo reflexionar sobre las implicaciones y los riesgos asociados con el nuevo registro de identificación de Brasil para la población trans. Método este es un estudio reflexivo que explora el concepto de identidad social como un fenómeno complejo, fundamentado en los principios de autodeterminación y dignidad humana. Se consideran perspectivas feministas poshumanistas, que desafían el esencialismo biológico, con un enfoque particular en la teoría de Judith Butler. Resultados Brasil se encuentra implementando un registro nacional de identificación que puede reconocer la identidad de género entre personas trans. Este estudio aborda las implicaciones del nuevo sistema nacional de identificación, incluyendo posibles retrocesos y avances en la lucha por los derechos de las personas trans. Para proteger la identidad y la seguridad de estas personas, este artículo aboga por la creación de un nuevo sistema de identificación emitido por el gobierno que almacene información personal en bases de datos, mostrando solo el nombre social y el marcador de género en la tarjeta. Consideraciones finales e implicaciones para la práctica las altas tasas de violencia contra personas trans en Brasil enfatizan la necesidad urgente del nuevo sistema. El reconocimiento temprano y el respeto por la identidad de género son fundamentales para promover el éxito del nuevo sistema nacional de identificación.

Abstract Objective to reflect on the implications and risks associated with Brazil's new identification registry for the trans population. Method this is a reflective study that explores the concept of social identity as a complex phenomenon, grounded in the principles of self-determination and human dignity. To accomplish this, it draws upon feminist post-humanist and critical perspectives, challenging individuals' biological essentialism, with a particular focus on Judith Butler's theory. Results Brazil is currently implementing a national identification registry that can recognize trans individuals' gender identity. This manuscript addresses the implications of the new national identification system, including potential setbacks and advances in the struggle for trans rights. To safeguard people's identity and safety, this article advocates for a novel national government-issued identification system that stores personal information in central databases for linking purposes, displaying only the preferred name and gender marker on the identification card. Final considerations and implication for practice the high rates of anti-trans violence in Brazil emphasize the urgent need for the new system. Early recognition and respect for gender identity are integral to promoting the success of the new national identification system.

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Este estudo compara os registros de óbitos por COVID-19 em 2020 para todo o território nacional. Utilizamos três bases distintas: Registro Civil (RC-Arpen), Sistema de Informação sobre Mortalidade (SIM) e Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe). Há discordâncias entre os números de mortes por COVID-19 divulgados pelas diversas bases e essas diferenças variam em cada Unidade da Federação. A base do RC-Arpen é atualizada mais rapidamente que as outras duas bases do Departamento de Informática do Sistema Único de Saúde - DATASUS (SIM e SIVEP-Gripe), além de ser mais indicada para monitoramentos e pesquisas que abrangem períodos mais recentes. Apesar da atualização mais lenta, as bases do DATASUS apresentam números geograficamente similares e divulgam dados mais detalhados sobre as mortes. Esse detalhamento das informações torna as bases do DATASUS mais adequadas para pesquisas que demandam mais informações sobre o paciente e o tratamento.

This study compares the death records due to COVID-19 in 2020 for Brazilian territory. Three distinct databases were used: Civil Registry (RC-Arpen), Brazilian Mortality Information System (SIM), and Influenza Epidemiological Surveillance Information System (SIVEP-Gripe). We identified differences between the numbers of deaths due to COVID-19 in these databases, varying in each federative unit. The RC database is updated faster than the other two databases (SIM and SIVEP-Gripe) and it is most suited for monitoring and for studies covering recent periods. Despite the slower update, Brazilian Health Informatics Department (DATASUS) databases present geographically similar numbers and disclose more detailed data on deaths. This detailed information improves the DATASUS databases for studies that require more information about the patient and treatment.

Este estudio compara los registros de defunciones por COVID-19 en 2020 para todo el territorio brasileño. Se utilizaron tres bases diferentes: Registro Civil (RC-Arpen), Sistema de Información de Mortalidad (SIM) y Sistema de Información de Vigilancia Epidemiológica de la Gripe (SIVEP-Gripe). Existen discrepancias entre las cifras de muertes por COVID-19 comunicadas por las distintas bases de datos y estas diferencias varían en cada Unidad Federal. La base de datos RC se actualiza más rápidamente que las otras dos bases de datos del Departamento de Informática del Sistema Único de Salud - DATASUS (SIM y SIVEP-Gripe) y es más adecuada para el seguimiento y las encuestas que abarcan periodos más recientes. A pesar de que la actualización es más lenta, las bases de datos del DATASUS presentan cifras geográficamente similares y revelan datos más detallados sobre las muertes. Este detalle de la información hace que las bases de datos del DATASUS sean más adecuadas para investigaciones que requieren más información sobre el paciente y el tratamiento.

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Resumo Estima-se um déficit de seis milhões de enfermeiros em todo o mundo. Apesar da importância para os sistemas de saúde, estudos sociodemográficos são escassos devido à ausência de dados sistematizados específicos para enfermeiros. O objetivo deste estudo foi comparar a cobertura populacional de enfermeiros no Brasil com base em fontes oriundas do Instituto Brasileiro de Geografia e Estatística (IBGE), nos anos de 2010 e 2015, e do Conselho Federal de Enfermagem (Cofen), nos anos de 2013 e 2019. Em ambas as fontes, houve um aumento médio de 164 mil enfermeiros em todo o Brasil. A taxa de crescimento para o período das pesquisas do IBGE (15,7% ao ano) foi o triplo daquela registrada nos dados do Cofen (5,3% ao ano). A cobertura nos estados do Brasil permanece aquém da recomendação internacional (40 enfermeiros a cada 10 mil habitantes), com maiores déficits nos estados das regiões Norte e Nordeste. As comparações deste estudo reiteram a importância da disponibilidade de dados padronizados e sistematizados para a Enfermagem no Brasil. Indicadores de saúde acurados subsidiam políticas públicas para a redução de iniquidades em saúde, com destaque para a cobertura de enfermeiros, especialmente em regiões de elevadas vulnerabilidades socioeconômicas.

Abstract There is an estimated deficit of six million nurses worldwide. Despite its importance for health systems, sociodemographic studies are scarce due to the absence of systematized data specific to nurses. The objective of this study was to compare the population coverage of nurses in Brazil based on sources from the Brazilian Institute of Geography and Statistics (IBGE), in the years 2010 and 2015, and the Federal Nursing Council (Cofen), in the years 2013 and 2019. In both sources, there was an average increase of 164 thousand nurses throughout Brazil. The growth rate for the period of the IBGE surveys (15.7% per year) was triple that recorded in the Cofen data (5.3% per year). Coverage in the states of Brazil remains below the international recommendation (40 nurses per 10 thousand inhabitants), with greater deficits in the states of the North and Northeast regions. The comparisons in this study reiterate the importance of the availability of standardized and systematized data for Nursing in Brazil. Accurate health indicators subsidize public policies to reduce health inequities, with emphasis on the coverage of nurses, especially in regions with high socioeconomic vulnerabilities.

Resumen Hay un déficit estimado de seis millones de enfermeros en todo el mundo. A pesar de la importancia para los sistemas de salud, estudios sociodemográficos son escasos debido a la ausencia de datos sistematizados específicos para enfermeros. El objetivo de este estudio fue comparar la cobertura poblacional de enfermeros en Brasil a partir de fuentes del Instituto Brasileño de Geografía y Estadística (IBGE), en los años 2010 y 2015, y del Consejo Federal de Enfermería (Cofen), en los años 2013 y 2019. En ambas fuentes, hubo un aumento promedio de 164.000 enfermeros en todo Brasil. La tasa de crecimiento para el período de las encuestas del IBGE (15,7% anual) resultó el triple de la registrada en los datos del Cofen (5,3% anual). La cobertura en los estados de Brasil permanece por debajo de la recomendación internacional (40 enfermeros por 10.000 habitantes), con mayores déficits en los estados de las regiones Norte y Nordeste. Las comparaciones de este estudio reiteran la importancia de la disponibilidad de datos estandarizados y sistematizados para la Enfermería en Brasil. Indicadores precisos de salud apoyan las políticas públicas para reducir las desigualdades en salud, con énfasis en la cobertura de enfermeros, especialmente en regiones de alta vulnerabilidad socioeconómica.

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Este artigo analisou a judicialização da fosfoetanolamina sintética no Brasil, a partir de estudo exploratório das decisões judiciais da vara de fazenda pública da comarca de São Carlos, em São Paulo, após a interrupção do fornecimento da substância pela Universidade de São Paulo. O estudo catalogou os argumentos constantes da Ação Direta de Inconstitucionalidade 5.501/DF, que julgou inconstitucional a Lei n. 13.269/2016, que autorizou a produção e a prescrição da fosfoetanolamina sintética para quaisquer tipos de câncer (neoplasia maligna) enquanto os estudos clínicos não fossem concluídos. As sentenças de primeira instância concederam a fosfoetanolamina com base no testemunho dos pacientes sobre impactos positivos do uso da substância em sua saúde e pela ausência de registro de efeitos colaterais. Juízes que concederam acesso à fosfoetanolamina tinham ciência da carência de evidências científicas de segurança e eficácia, bem como do necessário registro da substância como medicamento no órgão  regulador, nos termos da legislação sanitária. No Supremo Tribunal Federal, a ausência de evidências científicas e a utilização de legislação para criar exceção casuísta levaram à declaração de inconstitucionalidade da norma pela maioria dos votos. O estudo registra, todavia, certa indisposição do Poder Judiciário em incorporar no processo decisório a avaliação das autoridades de regulação e fiscalização em saúde como fonte da correta avaliação da segurança e eficácia de medicamentos. Em conclusão, o testemunho dos pacientes sobre as perspectivas de cura ou redução do sofrimento, somado à ausência de provas nos processos judiciais sobre os riscos do consumo da fosfoetanolamina, foram cruciais para tais decisões.

This article analyzed the judicialization of phosphoethanolamine in Brazil, based on an exploratory study of court decisions in the district of São Carlos/SP after the supply of the substance was interrupted by the University of São Paulo. The study cataloged the arguments contained in the Direct Action of Unconstitutionality 5,501/DF that deemed Law 13,269/2016, which authorized the production and prescription of synthetic phosphoethanolamine for any type of câncer (malignant neoplasm) unconstitutional, while the clinical studies were not completed. The results indicated that the judges authorized the use of the substance based on the patients' testimony about the positive impacts of the use of phosphoethanolamine on their health and the absence of side effects. The judges were aware of the lack of scientific evidence of safety and efficacy, as well as the obligation to register the substance as a medicine by the regulatory agency, according to health legislation. In the Supreme Court, the mentioned lack of scientific evidence and the strategic use of legislation to create a case-by-case exception led to the declaration of unconstitutionality of the Law by a majority of Ministers votes. The study registers, however, a certain unwillingness of the Judiciary to incorporate in the decision-making process the evaluation of the health regulatory agency as a source of the correct evaluation of medicines. In conclusion, the convinced patients' testimony about the perspectives of cure or reduction of suffering added to the absence of evidence in the legal proceedings regarding the risks of the consumption of phosphoethanolamine was crucial to the judicial decisions.

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New Approach Methodologies (NAMs) are any non-animal-based approaches that can provide information in the context of chemical hazard and safety assessment. The goal is to develop information with equivalent or better scientific quality and relevance than that provided by traditional animal models. Starting with ethical issues, these approaches are gaining regulatory relevance in different global agencies. Since 2008, with the enactment of the Arouca Law-the first Brazilian legislation dedicated to laboratory animals, NAMs are gathering pace in Brazil's regulations. Specific regulations from different sectors include the acceptance of these new methods. However, some regulation is controversial about what is needed to address specific toxicological endpoints. The resulting regulatory uncertainty induces companies to keep on adopting the traditional methods, slowing NAM's development in the country. This work brings a perspective on the regulatory acceptance of NAMs in Brazilian Legislation for the registration of pharmaceuticals, medical devices, food/supplements, and agrochemical products. This text discusses the main issues of NAM adoption for each specific regulation. Therefore, legal acceptance of NAMs results in Brazil is still a process in progress. A collective effort including regulators, industry, contract research organizations (CROs), and the academic environment is needed to build regulatory confidence in the use of NAMs.

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In ophthalmology, the registration problem consists of finding a geometric transformation that aligns a pair of images, supporting eye-care specialists who need to record and compare images of the same patient. Considering the registration methods for handling eye fundus images, the literature offers only a limited number of proposals based on deep learning (DL), whose implementations use the supervised learning paradigm to train a model. Additionally, ensuring high-quality registrations while still being flexible enough to tackle a broad range of fundus images is another drawback faced by most existing methods in the literature. Therefore, in this paper, we address the above-mentioned issues by introducing a new DL-based framework for eye fundus registration. Our methodology combines a U-shaped fully convolutional neural network with a spatial transformation learning scheme, where a reference-free similarity metric allows the registration without assuming any pre-annotated or artificially created data. Once trained, the model is able to accurately align pairs of images captured under several conditions, which include the presence of anatomical differences and low-quality photographs. Compared to other registration methods, our approach achieves better registration outcomes by just passing as input the desired pair of fundus images.

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Introdução: A regulação de registros específicos para os chamados "medicamentos órfãos" tem sido uma estratégia das maiores agências de medicamentos do mundo para fomentar o acesso e monitoramento de tratamento para doenças e agravos de pouca prevalência ou interesse mercadológico. Objetivos: Esse estudo visou identificar o perfil dos medicamentos que se enquadram nessa categoria internacionalmente explorar possíveis lacunas de registro gerados pela ausência de uma norma sanitária específica no Brasil. Métodos: Foram analisadas as bases de dados de registro de medicamentos órfãos de países da União Europeia e dos Estados Unidos da América e os resultados foram comparados com a base registros da Agência brasileira. Resultados: Foram identificados 369 medicamentos registrados como órfãos nos órgãos europeu e estadunidense totalizando 801 indicações clínicas. A maior parte dos medicamentos registrados no âmbito internacional era de agentes anti-neoplásicos e imunomoduladores (N=135; 36,59 %) e de medicamentos que agiam no aparelho digestivo e metabolismo (N=48; 13,01 %). Dos medicamentos órfãos registrados e comercializados no âmbito internacional, quase metade, 177 (47,97 %), não apresentavam registros ativos no Brasil e atendem a 327 indicações clínicas (40,82 %). Conclusão: O Brasil deve analisar afundo os impactos da ausência de um fluxo de registro medicamentos órfãos, que pode afetar diretamente no acesso de tratamento para determinadas doenças raras e negligenciadas.

SUMMARY Introduction: The regulation of specific registrations for the so-called "orphan drugs" has been a strategy of the largest drug agencies in the world to promote access and monitoring of treatment for diseases and conditions of low prevalence or market interest. Aims: This study aimed to identify the profile of drugs that fall into this category internationally and explore possible gaps in registration generated by the absence of a specific health standard in Brazil. Methods: Orphan drug registration databases from countries of the European Union and the United States of America were analyzed and the results were compared with the database of the Brazilian Agency. Results: A total of 369 drugs registered as orphans in European and US agencies were identified, totaling 801 clinical indications. Most of the drugs registered internationally were antineoplastic agents and immunomodulators (N=135; 36.59 %) and drugs that acted on the digestive system and metabolism (N=48; 13.01 %). Of the orphan drugs registered and marketed internationally, almost half, 177 (47.97 %), did not have active registrations in Brazil and meet 327 clinical indications (40.82 %). Conclusion: Brazil must analyze in depth the impacts of the absence of an orphan drug registration flow, which can directly affect access to treatment for certain rare and neglected diseases.

Introducción: La regulación de registros específicos para los denominados "medicamentos huérfanos" ha sido una estrategia de las agencias de drogas más grandes del mundo promover el acceso y seguimiento del tratamiento de enfermedades y condiciones de poca prevalencia o interés de mercado. Objetivos: Identificar el perfil de las drogas que entran en esta categoría a nivel internacional explorar posibles lagunas en los registros generadas por la ausencia de un estándar sistema de salud específico en Brasil. Métodos: Las bases de datos de registro de medicamentos huérfanos de países de la Unión Europea y Estados Unidos da América y los resultados fueron comparados con la base de registros de la Agencia Brasileña. Resultados: Se identificaron 369 medicamentos registrados como huérfanos en órganos europeos y americanos, totalizando 801 indicaciones clínicas. La mayor parte de los medicamentos registrados a nivel internacional fueron agentes antineoplásicos e inmunomoduladores (N=135; 36,59%) y fármacos que actuaron en el aparato digestivo y metabolismo (N=48; 13,01%). De medicamentos huérfanos registrados y vendidos internacionalmente, casi la mitad, 177 (47,97 %), no tenía registros activos en Brasil y atendió 327 indicaciones clínicas (40,82%). Conclusión: Brasil debe analizar en profundidad los impactos de la ausencia de un flujo de registro de medicamentos huérfanos, que puede afectar directamente el acceso al tratamiento para ciertas enfermedades raras y desatendidas.

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In 3D reconstruction applications, an important issue is the matching of point clouds corresponding to different perspectives of a particular object or scene, which is addressed by the use of variants of the Iterative Closest Point (ICP) algorithm. In this work, we introduce a cloud-partitioning strategy for improved registration and compare it to other relevant approaches by using both time and quality of pose correction. Quality is assessed from a rotation metric and also by the root mean square error (RMSE) computed over the points of the source cloud and the corresponding closest ones in the corrected target point cloud. A wide and plural set of experimentation scenarios was used to test the algorithm and assess its generalization, revealing that our cloud-partitioning approach can provide a very good match in both indoor and outdoor scenes, even when the data suffer from noisy measurements or when the data size of the source and target models differ significantly. Furthermore, in most of the scenarios analyzed, registration with the proposed technique was achieved in shorter time than those from the literature.

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Free-roaming dogs are a worldwide problem, with Chile having some of the highest human-to-dog ratios in the world. In 2017, Law 21.020 was promulgated and the federal government developed a national responsible pet ownership program. The objectives of this article are to describe and discuss the dog-related components of the program, to design a tool for determining human-to-dog ratios in Chile, and to make recommendations to managers to improve the program outcomes. The overarching goal of the program was to mitigate the conflict between humans and dogs, but many of the interventions were animal-focused and the indicators did not consider the perception of the Chilean public. Using human density data and known dog populations, we found that as the human density increased, there were fewer dogs per person. Veterinary services and sterilizations were the mainstay of the program and were offered for free to citizens. Education was offered to all ages through public events, as well as municipality and organization activities. The identification of dogs was obligatory for dog owners. Enforcement was not included in the program. The recommendations are to conduct preintervention baseline data collections and to tailor interventions and indicators appropriately; to use dog population size estimates determined at the local level rather than a country-wide estimate; to replace free veterinary services with low-cost sterilization campaigns; to create sustainable plans for education; and to create enforcement teams in communities.