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Background Medical schools have used mindfulness meditation as a strategy to assist students in stress management. This study aimed to seek evidence regarding the effectiveness of mindfulness-based training programs in reducing psychological distress and promoting the well-being of medical students. Methods We conducted a systematic review and meta-analysis. Cochrane Library, Embase, PubMed/MEDLINE, PsycINFO/PsycNet, LILACS/BVS, ERIC (ProQuest), Web of Science, OpenGrey, and Google Scholar were searched for randomized clinical trials published until March 2022, without time or language restrictions. Two authors independently screened the articles, extracted data using a standardized extraction form, and assessed the methodological quality of the included studies using the Cochrane’s Risk of Bias 2 (ROB 2) tool and the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Results Of the 848 articles retrieved, 8 met the inclusion criteria. Mindfulness-based training improved the outcomes: mindfulness (small post-intervention effect: SMD = 0.29; 95% CI: 0.03 to 0.54; p  = 0.03; I 2  = 46%; high evidence quality, and small effect at follow-up: SMD = 0.37; 95% CI: 0.04 to 0.70; p  = 0.03; I 2  = 53%; low evidence quality), psychological well-being/health (there was no statistically significant difference between the groups in the post-intervention effect: SMD =  − 0.27; 95% CI: − 0.67 to 0.13; p  = 0.18; I 2  = 76%; moderate evidence quality, and a significant difference at follow-up: SMD =  − 0.73; 95% CI: − 1.23 to − 0.23; p  = 0.004; I 2  = 61%; low evidence quality), and stress (small post-intervention effect: SMD =  − 0.29; CI of 95%: − 0.56 to − 0.02; p  = 0.04; I 2  = 57%; moderate evidence quality, and moderate effect at follow-up: SMD =  − 0.45, 95% CI: − 0.67 to − 0.22, p  = 0.0001, I 2  = 0%, moderate evidence quality). The quality of evidence for the anxiety, depression, and resilience outcomes is low and for the empathy outcome, very low. Conclusion The results indicate that the students who participated in the mindfulness training perceived improvements in the stress and psychological distress symptoms and improved health perception and psychological well-being. However, the significant heterogeneity among studies should be considered when interpreting these findings. Systematic review registration PROSPERO CRD42020153169.

Burns are tissue traumas caused by energy transfer and occur with a variable inflammatory response. The consequences of burns represent a public health problem worldwide. Inhalation injury (II) is a severity factor when associated with burn, leading to a worse prognosis. Its treatment is complex and often involves invasive mechanical ventilation (IMV). The primary purpose of this study will be to assess the evidence regarding the frequency and mortality of II in burn patients. The secondary purposes will be to assess the evidence regarding the association between IIs and respiratory complications (pneumonia, airway obstruction, acute respiratory failure, acute respiratory distress syndrome), need for IMV and complications in other organ systems, and highlight factors associated with IIs in burn patients and prognostic factors associated with acute respiratory failure, need for IMV and mortality of II in burn patients. This is a systematic literature review and meta-analysis, according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). PubMed/MEDLINE, Embase, LILACS/VHL, Scopus, Web of Science, and CINAHL databases will be consulted without language restrictions and publication date. Studies presenting incomplete data and patients under 19 years of age will be excluded. Data will be synthesized through continuous (mean and standard deviation) and dichotomous (relative risk) variables and the total number of participants. The means, sample sizes, standard deviations from the mean, and relative risks will be entered into the Review Manager web analysis software (The Cochrane Collaboration). Despite the extensive experience managing IIs in burn patients, they still represent an important cause of morbidity and mortality. Diagnosis and accurate measurement of its damage are complex, and therapies are essentially based on supportive measures. Considering the challenge, their impact, and their potential severity, IIs represent a promising area for research, needing further studies to understand and contribute to its better evolution. The protocol of this review is registered on the International prospective register of systematic reviews platform of the Center for Revisions and Disclosure of the University of York, United Kingdom (https://www.crd.york.ac.uk/prospero), under number RD42022343944.

Study objectives A cross-sectional study including 246 workers from primary health care services in Federal District, Brazil. Data collection took place from October to December 2019 through the Medical Office Survey on Patient Safety Culture (MOSPSC) application. Patient safety culture was considered positive when the score was above 60%. For comparisons between the categories of health care professionals', the ANOVA and Kruskal-Wallis test were used for composite percent positive scores, and Pearson's chi-square or Fishers exact test for frequency and percentage of positive responses. The overall MOSPSC composite percent positive score was 49.9%. Among the 12 dimensions, only three showed a positive patient safety culture: Teamwork (73.1%), Organizational learning (62.9%), and Patient care tracking/follow-up (60.1%). The percentage of positive responses on overall quality assessment (78.1%) and overall patient safety assessment (78.0%) showed a positive evaluation. There was no significant difference in the composite percent positive score of overall MOSPSC (p = 0.135) and the percentage of positive responses on overall patient safety assessment (p = 0.156) between the categories of health care professionals. Overall quality assessment showed a significant difference between job roles (p < 0.001), in which nursing /health care technicians showed a significantly lower score than other job roles. The patient safety culture assessment showed a weakness in the patient safety in the PHC services. The MOSPSC and nine of its dimensions presented a negative safety culture assessment, regardless of the high scores in the overall patient safety and quality assessments.

This study aims to describe the seasonal pattern of burn-related mortality in Brazil from 2000 to 2022, using data from the Mortality Information System (SIM). Additionally, the study examines the place of occurrence and compares seasonality across different etiologies, months, and days of the week. It also evaluates the risk of death by etiology and the attributable risk of seasonality across the different regions of the country. An increase in burn-related mortality is observed during rainy periods, with the most significant impact in the Southeast and Northeast. The daily risk of death from thermal burns is substantially higher in the Southeast. Mortality peaks in January and February, with a decline in June. Thermal and electrical burns display distinct seasonal patterns at annual and weekly levels. Factors such as electrical infrastructure, occupational activities, and demographic indicators may help explain these trends. This study can enhance prevention strategies and guide the allocation of resources for burn treatment, as well as encourage further research into other factors associated with burn mortality.

IntroductionVentilator-induced diaphragmatic dysfunction is increasingly recognised as an important complication of prolonged mechanical ventilation (MV) and a major contributor to difficult weaning and extubation failure. Although bedside diaphragmatic ultrasound has emerged as a useful tool for assessing diaphragm function, conventional indices such as diaphragm excursion and thickening fraction may be influenced by ventilatory mechanics and patient effort. Speckle-tracking ultrasound (STU), a deformation-based technique adapted from echocardiography, allows assessment of diaphragmatic strain and strain rate and may provide a more accurate evaluation of diaphragmatic contractility. However, the predictive utility of diaphragmatic STU for successful liberation from MV remains uncertain. This study aims to systematically review the available evidence on the predictive performance of diaphragmatic speckle-tracking ultrasound for successful weaning from MV in adult patients.MethodsThis protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and is registered in the PROSPERO database. A comprehensive search will be conducted in MEDLINE (via PubMed), Embase, Scopus, Web of Science, LILACS/BVS and CENTRAL without restrictions on language or publication date. Observational studies and clinical trials evaluating diaphragmatic speckle-tracking ultrasound during the weaning process in adults receiving invasive MV for more than 24 hours will be eligible. Two reviewers will independently select studies, extract data and assess the risk of bias using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool for diagnostic and predictive accuracy studies and the Cochrane Risk of Bias 2 tool for randomised trials. When feasible, meta-analysis will be conducted using Review Manager software. The certainty of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE)approach.Ethics and disseminationEthics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations.Prospero registration numberCRD420261338352.

Background There is evidence that fatigue and dyspnea are among the most frequently reported symptoms of post-COVID condition. Therefore, several studies have investigated respiratory muscle or global peripheral muscle training as strategies to manage those symptoms. Despite evidence of potential benefits, conflicting results persist due to the heterogeneity of rehabilitation protocols and assessment tools. Thereby, the objective of this systematic review was to evaluate the effectiveness of inspiratory muscle training and multicomponent physical training in adults with dyspnea and fatigue for at least 12 weeks after COVID-19. Method A search was conducted in September 2024, in the Cochrane Library (Cochrane Central Register of Controlled Trials), EMBASE, PubMed/MEDLINE, PEDro, Lilacs/BVS, Web of Science, Scopus, and Epistemonikos databases. The inclusion criteria were randomized clinical trials published in any language that evaluated the effectiveness of inspiratory muscle training and multicomponent physical training to improve fatigue, dyspnea, and/or physical function in adults with persistent post-COVID symptoms. The risk of bias of the included studies and the certainty of the evidence were assessed using the RoB 2 and GRADE tools, respectively. Results After the screening process, seven randomized clinical trials were included. The total number of participants included in the studies was 449. Inspiratory muscle training significantly improved inspiratory muscle strength (maximal inspiratory pressure) (MD = 22.70; 95% CI: 13.78 to 31.62), and cardiopulmonary capacity ( V ˙ O 2max ) (MD = 4.49; 95% CI: 3.35 to 5.62). Multicomponent physical training significantly improved the upper and lower body muscle strength through the handgrip strength (MD = 3.05; 95% CI: 1.68 to 4.42), sit-to-stand test (MD = 3.55; 95% CI: 1.61 to 5.49), and timed up and go test (MD = − 1.13; 95% CI: − 1.49 to − 0.77) and the physical functioning were assessed through post-COVID-19 functional scale (MD = − 0.64; 95% CI: − 1.13 to − 0.16) and physical aspects through SF-12 and SF-36 (SMD = 0.72; 95% CI: 0.29 to 1.15). No adverse events were reported among participants in the physical training group, and treatment adherence ranged from 78 to 100%. Conclusion Inspiratory muscle training improved cardiorespiratory outcomes, while multicomponent physical training improved muscle strength, physical functioning, and fatigue. Both types of training improve physical functioning. The certainty of evidence for the outcomes evaluated was low. Systematic review registration PROSPERO (CRD42023451057).

To evaluate the accuracy of neonatal 17-hydroxyprogesterone (N17OHP) levels adjusted for birth weight (BW) and time of the sample collection (TC) and propose optimized cutoff values to improve the effectiveness of newborn screening tests for congenital adrenal hyperplasia (CAHNBS) programs, utilizing a comprehensive dataset encompassing all newborn screening tests for 21-hydroxylase deficiency (21OHD) conducted over a decade in a Brazilian metropolitan region. A cross-sectional study analyzed all CAHNBS tests from newborns aged 2 to 7 days in the Federal District, Brazil, from January 2012 to September 2022. The accuracy of cutoff values based on the 99.5th percentile (99.5P) for BW and TC was compared to the CAHNBS program of São Paulo and a threshold of ≥20 mg/dL. New cutoff values were proposed to enhance screening effectiveness. Among the 340,291 newborns screened, CAH-21OHD was confirmed in 11 cases. The N17OHP cutoff in this sample reduced false positives for neonates ≤ 2500 g but increased them for those > 2500 g The proposed cutoff values based on 99.5P from the sample for neonates ≤ 2500 g, combined with a fixed cutoff ≥ 20 mg/dL for those > 2500 g, showed superior specificity (99.83 %, 95 % CI: 99.81–99.84 %), LR+ (579.16, 95 % CI: 524.23–627.87), PPV (1.84, 95 %CI: 1.70–1.99), and accuracy (99.83 %, 95 %CI: 99.81–99.84 %) than prior criteria. The proposed 17OHP cutoff strategy effectively reduced false positives, improving specificity, LR+, PPV, and accuracy Thus, it optimized CAHNBS programs while minimizing unnecessary costs and parental distress.

This study explores the relationship between socioeconomic and geographic variables of Brazilian municipalities and deaths caused by thermal (TB) and electrical burns (EB). Using data from the Mortality Information System and municipal indicators from IBGE, the impact of several factors on burn mortality was investigated. The analysis revealed a significant association between mortality and HDI (EB: 2000-2009 - RR=1.4·10−³ (95%CI: 3.4·10−4-5.9·10−3), 2010-2019 - RR=1.53·10−3 (95%CI: 2.46·10−4-9.57·10−3); TB: 2000-2009 - RR=2.95·10−6 (95%CI: 7.63·10−7-1.14·10−5), 2010-2019 - RR=1.24·10−7 (95%CI: 1.79·10−8-8.68·10−7)), Gini index (EB: 2000-2009 - RR=33.02) (95%CI: 18.43-59.03), 2010-2019 - RR=197.52 (95%CI: 111.2-350.14); TB: 2000-2009 - RR=25.77 (95%CI: 14.68-45.13), 2010-2019 - RR=431.24 (95%CI: 237.24-781.89)), and percentage of the population living in urban areas (EB: 2000-2009 - RR=1.644) (95%CI: 1.253-2.1689), 2010-2019 - RR=1.55 (95%CI: 1.17-2.07); TB: 2000-2009 - RR=2.42 (95%CI: 1.8-3.26), 2010-2019 - RR=2.794 (95%CI: 1.98-3.96)). The results suggest that lower socioeconomic conditions are correlated with higher risks of death by burns, indicating that it is a public health issue linked to social inequalities.

Background Burn treatments are complex, and for this reason, a specialised multidisciplinary approach is recommended. Evaluating the quality of care provided to acute burn patients through quality indicators makes it possible to develop and implement measures aiming at better results. There is a lack of information on which indicators to evaluate care in burn patients. The purpose of this scoping review was to identify a list of quality indicators used to evaluate the quality of hospital care provided to acute burn patients and indicate possible aspects of care that do not have specific indicators in the literature. Method A comprehensive scoping review (PRISMA-ScR) was conducted in four databases (PubMed, Cochrane Library, Embase, and Lilacs/VHL) between July 25 and 30, 2022 and redone on October 6, 2022. Potentially relevant articles were evaluated for eligibility. General data and the identified quality indicators were collected for each included article. Each indicator was classified as a structure, process, or outcome indicator. Results A total of 1548 studies were identified, 82 were included, and their reference lists were searched, adding 19 more publications. Thus, data were collected from 101 studies. This review identified eight structure quality indicators, 72 process indicators, and 19 outcome indicators listed and subdivided according to their objectives. Conclusion This study obtained a list of quality indicators already used to monitor and evaluate the hospital care of acute burn patients. These indicators may be useful for further research or implementation in quality improvement programs. Trial Registration Protocol was registered on the Open Science Framework platform on June 27, 2022 ( https://doi.org/10.17605/OSF.IO/NAW85 ).

Affirmative action providing higher education access for socially vulnerable students has been implemented in several countries. However, these policies remain controversial. This study compares the performance of students admitted through the regular path and social quota systems, during and after completion of nursing education, in a public nursing school in Brazil. This retrospective cohort study included all students admitted to nursing school at the School of Health Sciences (ESCS), Brazil, between 2009 and 2014, who were followed until May 2020. The first phase involved document analysis from the ESCS academic management system and Brazilian government agencies. In the second phase, a survey was conducted among the alumni. The social quota system criterion was public school attendance across all primary and secondary education levels. Of the 448 students included in the study, 178 (39.7%) were from the affirmative action and 270 (60.3%) from the regular path systems. Affirmative action students were older at the time of nursing school admission (p < 0.001) and took longer to be admitted to the nursing school (p < 0.001) after completing high school. There were no significant differences in the dropout rates and years to complete nursing school. In the second phase, 108 alumni answered the survey. No significant differences were found in their participation in the undergraduate scientific research program and university extension projects, attending residency programs, getting a master's degree and doctoral degree, monthly income, teaching activity, joining public service through a government job competition process, participation in management activities in the private and public health sector, and degree of job satisfaction. Our results revealed that affirmative action is a policy that contributes to the reduction of inequalities and guarantees the training of nursing professionals with a similar professional qualification received through affirmative action and regular path systems.