Abstract Introduction: The increasing use of smartphones has raised concerns among health professionals, particularly regarding its effects on mental health and sedentary behavior. Objective: To investigate the association between cervical posture, average daily smartphone use, and weekly physical activity in young adults. Methods: This cross-sectional study included 13 participants (five men and eight women) with a mean age of 33.9 ± 2.6 years. Cervical posture was assessed by photogrammetry using the Brazilian-developed Postural Assessment Software to analyze horizontal (HHA) and vertical head alignment (VHA). Daily smartphone use time was obtained from device-generated reports, and weekly physical activity was self-reported. Associations between variables were examined using Spearman's correlation coefficient (rs), with statistical significance set at p < 0.05. Results: No statistically significant associations were found between smartphone use and HHA (rs = −0.058; p = 0.851) or VHA (rs = −0.215; p = 0.480). Weekly physical activity showed a moderate positive correlation with HHA (rs = 0.452; p = 0.121) and a negative correlation with VHA (rs = −0.338; p = 0.258), neither reaching statistical significance. Conclusion: Smartphone use and physical activity were not significantly associated with cervical posture alignment in this sample.
The COVID-19 pandemic disrupted chronic-care pathways and pharmaceutical logistics worldwide, significantly impacting access to biological therapies for inflammatory bowel disease (IBD) (1,2). In Brazil, vedolizumab—a selective anti-integrin agent—has progressively expanded its role in Crohn’s disease and ulcerative colitis. Understanding how pandemic-related disruptions affected its use is essential for guiding policy and ensuring equitable access. This study examined national and regional dispensing trends after the major pandemic waves. Vedolizumab dispensing data from DATASUS (3) between 2021 and 2024 were analysed nationally and by Brazil’s five macro-regions. Metrics included annual totals, year-on-year (YoY) variation, compound annual growth rate (CAGR), regional composition, and concentration indices (Herfindahl–Hirschman Index [HHI], Gini). National counts were modelled as Poisson distributions with normal-approximation 95% confidence intervals (CIs). Yearly changes were summarised as Poisson rate ratios (RRs) with log-transformed 95% CIs. Analyses were performed in Python (pandas, matplotlib) with figures standardised for publication quality (300 dpi, grayscale, labelled axes, colour heatmaps). Total dispensations rose from 1 743 in 2021 to 23 483 in 2024 (CAGR 137.9%). YoY RRs were 6.01 (95% CI 5.71–6.32) for 2022 vs 2021, 1.61 (95% CI 1.57–1.65) for 2023 vs 2022, and 1.39 (95% CI 1.37–1.42) for 2024 vs 2023. In 2024, the Southeast region accounted for 58.6% of dispensations, followed by the South (19.7%), Northeast (13.6%), Centre-West (6.8%), and North (1.4%). Regional concentration remained high (HHI 4052; Gini 0.51). The steep increase after 2021 indicates recovery from pandemic backlogs and reinstatement of elective IBD care (1,2). The 2022 surge (RR > 1) reflects catch-up initiations delayed during COVID-19 peaks, while continued growth through 2024 suggests systemic consolidation rather than temporary rebound (1). The Southeast’s dominance likely mirrors its higher specialist density and referral-centre capacity. Persistent HHI and Gini values underscore structural inequalities in biologic access across macro-regions. Limitations include the administrative nature of the dataset and absence of clinical variables such as disease activity and treatment persistence. Nevertheless, consistent effect-size estimates and concentration indices support a robust post-pandemic expansion in vedolizumab use in Brazil. Ongoing surveillance linking dispensing data to clinical outcomes is warranted to reduce regional disparities and improve care continuity (2,3). References: 1. Kennedy NA, Jones G-R, Lamb CA, Appleby R, Arnott I, Beattie RM, et al. British Society of Gastroenterology guidance for management of inflammatory bowel disease during the COVID-19 pandemic. Gastroenterology. 2021;161(3):e1–e6. 2. Rubin DT, Feuerstein JD, Wang AY, Cohen RD. AGA Clinical Practice Update on management of inflammatory bowel disease during the COVID-19 pandemic: Expert commentary. Inflamm Bowel Dis. 2020;26(8):1141–1145. 3. DATASUS. Sistema de Informações do SUS: Banco de dados de medicamentos especializados. Brasília: Ministério da Saúde; 2025. Available from: https://datasus.saude.gov.br/ 4. Sands BE, Feagan BG, Rutgeerts P, Colombel JF, Sandborn WJ, Sy R, et al. Vedolizumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2013;369(8):699–710. 5. Sandborn WJ, Feagan BG, Rutgeerts P, Hanauer S, Colombel JF, Sands BE, et al. Vedolizumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med. 2013;369(8):711–721. 6. Magro F, Doherty G, Peyrin-Biroulet L, et al. ECCO position paper on biological treatment cycles in inflammatory bowel disease. J Crohns Colitis. 2020;14(12):1609–1623. 7. Fiorino G, Allocca M, Danese S. COVID-19 in patients with inflammatory bowel disease: Management and clinical outcomes. Nat Rev Gastroenterol Hepatol. 2020;17(10):577–579. 8. Ungaro RC, Brenner EJ, Gearry RB, Kaplan GG, Kissous-Hunt M, Lewis JD, et al. Effect of IBD medications on COVID-19 outcomes: Results from an international registry. Gastroenterology. 2022;162(2):316–319. 9. Bezzio C, Saibeni S, Variola A, Allocca M, Massari A, Gerardi V, et al. Outcomes of COVID-19 in patients with inflammatory bowel disease treated with biologics. Aliment Pharmacol Ther. 2020;52(11–12):1410–1418. 10. D’Amico F, Peyrin-Biroulet L, Danese S. Inflammatory bowel disease management during the COVID-19 outbreak: A survey among gastroenterologists. United European Gastroenterol J. 2020;8(7):775–781. 11. Agrawal M, Brenner EJ, Zhang X, Colombel JF, Kappelman MD. Characteristics and outcomes of IBD patients with COVID-19 on biologics: Insights from SECURE-IBD registry. Gut. 2021;70(4):725–732. 12. Macaluso FS, Orlando A, Cottone M. The role of vedolizumab in ulcerative colitis treatment: Current evidence and future perspectives. Ther Adv Gastroenterol. 2020;13:1–15. 13. Baumgart DC, Misery L, Naegeli AN, Ferrante M, Hanauer S, Peyrin-Biroulet L. Biological therapy for Crohn’s disease and ulcerative colitis: Results, risks and perspectives. Nat Rev Gastroenterol Hepatol. 2021;18(10):601–612. 14. Feagan BG, Panaccione R, Sandborn WJ, D’Haens GR, et al. Clinical trial endpoints for therapeutic studies in IBD: Recommendations from the IOIBD. Gastroenterology. 2020;159(2):422–429. 15. D’Amico F, Danese S, Peyrin-Biroulet L. Systematic review on COVID-19 and inflammatory bowel disease: Lessons for future preparedness. J Crohns Colitis. 2022;16(7):1019–1032. 16. World Health Organization. The impact of COVID-19 on health systems: Policy brief. Geneva: WHO; 2021. 17. Brazilian Ministry of Health. Política Nacional de Assistência Farmacêutica: Componentes e diretrizes. Brasília: Ministério da Saúde; 2023. 18. Peyrin-Biroulet L, Oussalah A, Williet N, Roblin X. Impact of immunosuppressants and biologics on COVID-19 outcomes in IBD: A systematic review. Gut. 2021;70(4):725–732. 19. Ungaro R, Colombel JF. Vedolizumab: A gut-selective integrin blocker for the treatment of IBD. Clin Gastroenterol Hepatol. 2017;15(4):584–594. 20. Panaccione R, Danese S. Targeted therapies in inflammatory bowel disease: Future perspectives beyond anti-TNF agents. Gastroenterology. 2022;163(5):1275–1290. Conflict of interest: Da Silva Cornelio, Thiago: No conflict of interest Caroline de Almeida, Erica: No conflict of interest Fernandes Notaro, Daniela: No conflict of interest
A avaliação no ensino superior constitui um elemento central dos processos formativos, estando diretamente relacionada à qualidade do ensino, à permanência estudantil e à construção do conhecimento acadêmico. Historicamente, entretanto, as práticas avaliativas nesse nível de ensino têm sido marcadas por concepções classificatórias, seletivas e centradas na mensuração do desempenho discente. Em contraposição a essa lógica, abordagens contemporâneas defendem a avaliação como processo formativo, articulado ao ensino e à aprendizagem, orientado pelo acompanhamento contínuo e pela reflexão pedagógica. Fundamentado em autores como Freire (1996), Luckesi (2011), Hoffmann (2014) e Perrenoud (1999), o presente artigo discute a avaliação no ensino superior a partir de uma perspectiva formativa e humanizadora, analisando seus desafios institucionais e suas implicações para a aprendizagem acadêmica. Conclui-se que práticas avaliativas dialógicas e processuais contribuem para a construção de percursos formativos mais significativos e para o fortalecimento da relação pedagógica no contexto universitário.
Objective: To identify demographic, clinical, healthcare, and virological factors associated with in-hospital death among patients with severe acute respiratory syndrome (SARS) and respiratory viral codetection in Brazil. Methods: We conducted a retrospective cohort study using 2022–2023 records from the Brazilian Influenza Epidemiological Surveillance Information System. Hospitalised SARS cases with two or more viruses detected by RT-PCR and known outcomes were included. Crude and adjusted odds ratios (ORs) were estimated using logistic regression, with assessment of discrimination, calibration, multicollinearity, and sensitivity to unmeasured confounding using E-values. Results: Among 12,581 hospitalisations, 84.1% occurred in children aged 0–4 years, and 466 patients died (case fatality: 3.7%). After adjustment, age (aOR per year: 1.045; 95%CI: 1.039–1.051), liver disease (aOR: 4.658; 95%CI: 1.868–11.614), immunosuppression (aOR: 2.181; 95%CI: 1.338–3.555), invasive ventilation (aOR: 10.264; 95%CI: 7.202–14.628), and detection of three or more viruses (aOR: 1.665; 95%CI: 1.147–2.418) were associated with higher odds of death. The model had an AUC of 0.901. Conclusion: Death was associated with age, clinical vulnerability, markers of acute severity, and greater codetection complexity. Findings may support risk stratification but do not establish causality and require consideration of selection, measurement, and residual-confounding biases.
A classificação de risco configura-se como uma estratégia fundamental para a sistematização dos serviços de urgência e emergência, possibilitando a priorização dos atendimentos conforme a gravidade clínica dos pacientes. Objetivo: Realizar uma meta-síntese dos artigos selecionados acerca das atribuições do enfermeiro na classificação de risco como estratégia de segurança do paciente. Método: Trata-se de uma pesquisa de natureza exploratória e descritiva, desenvolvida por meio de revisão integrativa da literatura, com abordagem qualitativa dos dados, na qual foi realizada a meta-síntese das produções científicas relacionadas ao desempenho do enfermeiro nesse contexto. Resultados: Demonstram que a atuação do enfermeiro na classificação de risco é fundamental para a organização dos serviços de urgência e emergência e para a promoção da segurança do paciente. Discussão: Os estudos analisados comprovam que o enfermeiro é o profissional legalmente habilitado para realizar a avaliação clínica inicial, identificar sinais de gravidade e definir a prioridade de atendimento, contribuindo para a redução de agravos, complicações e eventos adversos. Conclusão: A classificação de risco realizada pelo enfermeiro constitui em um processo essencial para a promoção da segurança do paciente, sendo necessários investimentos em capacitação profissional e na melhoria das condições de trabalho para qualificar a assistência nos serviços de urgência e emergência.
