Instituto de Saúde

Este artigo analisa a neurodiversidade no contexto escolar e discute estratégias pedagógicas viáveis para o trabalho docente em classes heterogêneas. Parte-se da compreensão de que diferenças no neurodesenvolvimento, como as observadas em estudantes autistas, com transtorno do déficit de atenção/hiperatividade, dislexia, dispraxia e outras condições, não podem ser reduzidas a déficits homogêneos. A escola que opera apenas com um aluno padrão tende a converter diferenças de processamento, comunicação, autorregulação e aprendizagem em fracasso escolar, indisciplina ou invisibilidade pedagógica. O estudo adota abordagem bibliográfica e documental, mobilizando literatura científica recente, marcos legais brasileiros e documentos internacionais sobre educação inclusiva. Argumenta-se que a prática do professor ganha consistência quando articula desenho universal para a aprendizagem, previsibilidade da rotina, mediação da linguagem, avaliação flexível, organização sensorial do ambiente e colaboração com a família e a equipe escolar. Em vez de propor intervenções idealizadas ou dependentes de alta especialização clínica, o texto descreve adaptações de baixo custo e alta aplicabilidade que podem ampliar participação, permanência e aprendizagem. A análise sustenta que a inclusão efetiva não decorre de boa vontade genérica, mas de decisões didáticas concretas, monitoradas e ajustadas ao perfil funcional do estudante.

As doenças crônicas não transmissíveis (DCNTs) representam um dos principais desafios para os sistemas de saúde, especialmente na Atenção Primária à Saúde (APS), devido à elevada carga de morbimortalidade, necessidade de cuidado longitudinal e dificuldades de adesão farmacoterapêutica. Tais dificuldades são frequentemente associadas à polifarmácia, ao baixo letramento em saúde e a falhas na comunicação clínica. Nesse contexto, estratégias de qualificação da comunicação terapêutica tornam-se centrais para a segurança do paciente e a equidade no cuidado. Objetivo: relatar a incorporação institucional da “Receita Simples” na Secretaria de Saúde do Distrito Federal (SES-DF), descrevendo sua trajetória desde o desenvolvimento e validação na APS até sua formalização como produto oficial da rede, bem como caracterizar o modelo institucional final e seu potencial de integração a sistemas digitais, como o e-SUS APS. Trata-se de estudo descritivo baseado em análise documental e reconstrução da trajetória institucional da Receita Simples. A validação prévia pelo método Delphi, com painel multiprofissional, alcançou Índice de Validade de Conteúdo superior a 0,8 e consistência interna elevada (alfa de Cronbach até 0,9876), sustentando a adequação técnica do modelo. Em 2025, a institucionalização pela SES-DF consolidou a ferramenta como instrumento complementar à prescrição formal, estruturado por tabela de horários, pictogramas, fontes ampliadas e identificação por cores, com diretrizes de acessibilidade. A Receita Simples configura tecnologia leve/leve-dura com potencial para promover equidade comunicacional e segurança terapêutica, embora persistam desafios para integração digital e monitoramento da implementação.

Oropouche virus (OROV) is an arbovirus endemic to the Amazon region since the 1950s that re-emerged in late 2023, causing a major epidemic across Central and South America. Here we investigated the transmission dynamics of the 2023-2024 epidemic in Manaus City (Amazonas state, Brazil), a major metropolitan hub in the Amazon, and estimated OROV infections across Latin America and the Caribbean. OROV re-emergence in Manaus resulted in an increase of IgG seroprevalence from 11.4% in November 2023 to 25.7% in November 2024. The neutralizing capacity of OROV-specific IgG antibodies from individuals collected before and after the re-emergence demonstrated a median plaque reduction neutralization test 50% titer of 640 against both the historical and contemporary OROV isolates. A historical reconstruction of OROV circulation in Manaus indicated a continuous low-level transmission with two major outbreaks of comparable seasonality and magnitude in 1980-1981 and 2023-2024. We estimate approximately 336,000 OROV infections in the Amazon region under a scenario of continuous endemic transmission without major outbreaks and over 9.4 million OROV infections during major outbreaks from 1960 to 2025. Collectively, our findings provide a comprehensive assessment of OROV transmission in Manaus and contribute to a better understanding of the OROV burden.

Telesimulation integrates clinical simulation and technology-mediated education, expanding access to supervised training and skill-based teaching, especially when deliberate practice and structured feedback are required. When we direct this approach to the training of psychologists, especially in Cognitive Behavioral Therapy (CBT), in which Socratic questioning (SQ) depends on micro-skills and qualified feedback, telesimulation seems promising. This methodological study aimed to develop and validate the content of a telesimulation instructional program to develop SQ in therapists in continuing education. The program included a systematization guide, knowledge assessment, synchronous scenarios with a standardized patient, and structured debriefing, which was evaluated by judges in two rounds for clarity, relevance, and applicability. After revisions, the re-evaluated items achieved full agreement (RVC/CVR=1.0). Limitations include evidence restricted to content validity, so a pilot study and research on effectiveness, transfer to practice, and implementation in different contexts is recommended. https://doi.org/10.21723/riaee.v21i00.1921202

COVID-19 has caused substantial impacts on health, the economy, education, and quality of life worldwide, and pandemic control measures are directly associated with the quality of the pandemic response, which is essential for developing more assertive interventions for health promotion, treatment, and control of COVID-19. To evaluate epidemiological and operational indicators of COVID-19 surveillance in hospitalized patients in the state of Pará in 2021 by health mesoregion. A cross-sectional, analytical, and ecological epidemiological study. Data were obtained from the Epidemiological Surveillance of Severe Acute Respiratory Syndrome through the Influenza Epidemiological Surveillance System (SIVEP-Gripe). A total of 18,007 severe acute respiratory syndrome surveillance reports were included. In terms of incidence, there was a significant difference in the Lower Amazon, Southwest Pará, and Southeast Pará (p < 0.001). In terms of lethality, the highest rates were in the Lower Amazon and Metropolitan Region of Belém (p < 0.001). In terms of mortality, significance was observed in the Lower Amazon, the Metropolitan Region of Belém, and Southwest Pará (p < 0.001). For timely notification (80%), sample collection (80%), completion of the collection date (100%), recording of the molecular test date (100%), and Intensive Care Unit (ICU) admission (100%), none of the mesoregions reached the target. The criterion of confirmation, evolution, and date of evolution did not reach the target (100%) in any mesoregion. For timely case closure (80%), five mesoregions reached the goal: Lower Amazon, Marajó, Metropolitan Region of Belém, Northeast Pará, and Southeast Pará. Differences were observed between health mesoregions in both epidemiological and operational indicators. The most affected mesoregions were the Lower Amazon, Southwest Pará, and Southeast Pará, which have high social vulnerability and are farther from the metropolitan area of Belém, where health services with better hospital and laboratory structures are concentrated.

Visceral leishmaniasis (VL), once considered a rural disease in Brazil, has progressively urbanised, particularly in the state of São Paulo (SSP), where the first urban cases emerged after the detection of the vector Lutzomyia longipalpis in 1997. This study explores the environmental, climatic, socioeconomic, and infrastructural factors associated with the expansion and establishment of VL in urban areas of SSP. For the statistical analysis, two types of models were developed. First, for all municipalities (with or without VL), the logistic regression model was used. Second, for the municipalities in which VL occurred between 1999 and 2012, a multilevel logistic regression model was used, accounting for repeated measurements (VL occurrence or non-occurrence in each municipality) over time. For both models, the associations between exposure variables and the outcome are expressed as odds ratios (OR) and their respective 95% CIs. We found that the presence of railways, highways, and sugarcane cultivation areas, as well as high annual temperatures and evapotranspiration rates, were associated with VL occurrence. Conversely, lower VL rates were associated with higher rainfall, higher altitude, and more rainy days. We conclude that unplanned urbanisation, poverty, population mobility, and climate change have facilitated the spread of the disease in São Paulo. The results highlight the need for integrated surveillance and control strategies that consider the socioenvironmental determinants to prevent further expansion of VL to other vulnerable urban areas of São Paulo State and bordering states.

Objetivo: Descrever as percepções e expectativas de gestantes sobre as práticas da Atenção Primária à Saúde no pré-natal. Método: Estudo descritivo, qualitativo, realizado em Unidades Básicas de Saúde de um município do Pernambuco, com 12 gestantes acompanhadas pela Estratégia Saúde da Família. A coleta ocorreu por meio de entrevistas semiestruturadas e a análise seguiu a técnica de análise de conteúdo de Bardin. Resultados: As gestantes eram majoritariamente adultas jovens, com baixa renda e inserção laboral fora do domicílio. Destacou-se o papel da enfermagem na escuta e orientação, e do Agente Comunitário de Saúde na adesão ao cuidado, além de fragilidades estruturais. Conclusão: As gestantes valorizam acolhimento e escuta ativa, reforçando a necessidade de cuidado humanizado.

Nearly 300 million people globally require humanitarian assistance, primarily due to conflicts and complex emergencies (CE). Modern conflicts are increasingly prolonged, deadly and frequent, severely disrupting health systems and hindering the provision of quality tuberculosis (TB) care. Managing drug-resistant TB (DR-TB) in these settings is particularly challenging. War and post-war conditions could potentially amplify resistance. However, evidence on DR-TB in CE-affected countries remains scarce. A scoping review, including grey literature and consultation with implementing agencies, was conducted to analyse published experiences worldwide in delivering DR-TB care in CE. The review included 16 peer-reviewed articles and 11 reports. Countries affected by war exhibit multiple risk factors for amplifying TB resistance. DR-TB management in CE is ongoing, yet diagnostic access is limited, with notification rates below 20% of estimated cases. Treatment success rates among those diagnosed are comparable to global averages. Innovative approaches, such as molecular tests, shorter regimens and patient-centred approaches, have achieved higher success rates. Information on vulnerable populations, including internally displaced persons, prisoners and children, remains minimal. Only one country had reliable information on DR-TB in prisoners (Iraq), accounting for one-third of the national resistant cohort. Most CE countries rely on external funding for DR-TB programmes. Like in other infectious diseases, war significantly alters DR-TB dynamics in affected countries and bordering or refugee-hosting countries, threatening progress towards TB elimination and exacerbating the global antimicrobial resistance crisis. While innovations have improved the feasibility of DR-TB care in CE, access remains severely constrained. Identified risk factors, challenges and priorities underscore the need for expanded TB support and targeted research, particularly for vulnerable populations in CE scenarios.

25-hydroxyvitamin D is the best biomarker of vitamin D biological activity, and its serum level has been used in studies assessing vitamin D sufficiency. However, the definitions of vitamin D deficiency and insufficiency remain non-consensual. The cutoff point for serum 25-hydroxyvitamin D levels used to define vitamin D sufficiency typically ranges between 50 and 75 nmol/L. Serum levels below 30 nmol/L, indicative of severe vitamin D deficiency, may have potentially adverse effects on skeletal and overall health. Hypovitaminosis D is highly prevalent worldwide, including across Europe. Several cross-sectional studies using random or convenience sampling, conducted at national or local levels, have documented a high prevalence of hypovitaminosis D, including severe cases, in Portugal. These studies were summarized in a narrative review, confirming the magnitude of this public health problem. The causes of hypovitaminosis D include low dietary intake or malabsorption of vitamin D, as well as inadequate sun exposure and insufficient endogenous synthesis, which are influenced by multiple factors. Several strategies have been proposed to address this significant public health issue, including adopting a healthier lifestyle with increased outdoor physical activity, controlling excess weight and obesity, and consuming foods naturally rich in vitamin D. However, given the high prevalence of sedentary lifestyles and obesity in Portugal, combined with inadequate dietary intake of vitamin D, these measures alone may be insufficient. Vitamin D supplementation and food fortification are two additional strategies for correcting hypovitaminosis D. Supplementation targeted at individuals at risk or with confirmed deficiency has not proven effective in significantly reducing the prevalence of severe deficiency in the Portuguese population. Food fortification, whether mandatory or voluntary, may represent a complementary and potentially more effective approach than individualized supplementation in populations with a high prevalence of severe hypovitaminosis D, as is the case in Portugal.