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Como consecuencia de la pandemia, los sistemas educativos de América Latina pasaron a funcionar de manera remota a través de internet. Surgieron nuevas necesidades que debían atenderse para garantizar la continuidad de las clases. En este contexto, marcado por gran incertidumbre, se investiga el papel de las redes personales de docentes peruanos en tanto potenciales fuentes de apoyo. Asimismo, se analiza la mediación del contexto organizacional educativo en el funcionamiento de estas redes que favoreció prácticas de apoyo mutuo. El diseño metodológico fue de carácter mixto y los resultados sugieren un apoyo multidimensional que desbordó la dimensión laboral-pedagógica, pero también tuvo efectos negativos en las vidas personales de los docentes.

The influence of the geographical location on the chemical composition of commercial Sauvignon Blanc wines was investigated. The assay was carried out on Sauvignon Blanc wines from three cold-climate valleys in Central Chile, Casablanca, Leyda, and San Antonio. The analyses revealed clear variations in some chemical parameters, especially in titratable acidity, which was higher in the geographical areas closest to the Pacific Ocean, such as the Leyda and San Antonio valleys. Regarding the composition of low-molecular-weight phenolic compounds, 17 compounds were found, and the results show that the Casablanca valley exhibits a greater abundance of monomeric flavanols, such as (+)-catechin, whereas the Leyda valley shows a higher abundance in flavonols and phenolic acids esterified with tartaric acid. Concerning the aromatic compound profile, the wines from the Casablanca valley showed a greater abundance of esters, C13 norisoprenoids, and some terpenes. The PLS-DA analysis revealed some differences, especially between wines from Casablanca and Leyda, demonstrating that the difference in the chemical composition of the wines was influenced by the geographical area.

Abstract Neutrophils rely predominantly on glycolytic metabolism for their biological functions, including reactive oxygen species (ROS) production. Although pyruvate kinase M2 (PKM2) is a glycolytic enzyme known to be involved in metabolic reprogramming and gene transcription in many immune cell types, its role in neutrophils remains poorly understood. Here, we report that PKM2 regulates ROS production and microbial killing by neutrophils. Zymosan-activated neutrophils showed increased cytoplasmic expression of PKM2. Pharmacological inhibition or genetic deficiency of PKM2 in neutrophils reduced ROS production and Staphylococcus aureus killing in vitro. In addition, this also resulted in phosphoenolpyruvate (PEP) accumulation and decreased dihydroxyacetone phosphate (DHAP) production, which is required for de novo synthesis of diacylglycerol (DAG) from glycolysis. In vivo, PKM2 deficiency in myeloid cells impaired the control of infection with Staphylococcus aureus. Our results fill the gap in the current knowledge of the importance of lower glycolysis for ROS production in neutrophils, highlighting the role of PKM2 in regulating the DHAP and DAG synthesis to promote ROS production in neutrophils.

Abstract Background The human epidermal growth factor receptor 2 (HER2) and p53 pathways may be involved in chemotherapy sensitivity and/or resistance. We explore the value of HER2 and p53 status to foretell docetaxel sensitivity in advanced breast cancer. Methods HER2 and p53 expression was analysed in 36 (median age 55 yrs; range 37-87) metastatic breast cancer patients receiving docetaxel-based first-line chemotherapy. HER2 was determined by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH), p53 was tested by IHC. We correlate the expression of study parameters with pathologic parameters, RECIST response and survival. The standard cut-off value of 2 was used to determine HER2 overexpression while p53 mean expression level was used to divide low/high expressors tumors. Results Median time to progression and overall survival were 9 (range 2 - 54) and 20 (range 3 - 101) months. Overall response rate was 41.6%. Nine cases showed HER2 overexpression. HER2 was more frequently overexpressed in less differentiated (p = 0.05) and higher stage (p = 0.003) disease. Mean FISH-HER2 values were significantly higher in responder than in non-responder pts (8.53 ± 10.21 vs 2.50 ± 4.12, p = 0.027). Moreover, HER2 overexpression correlates with treatment response at cross-tabulation analysis (p = 0.046). p53 expression was only associated with higher stage disease (p = 0.02) but lack of any significant association with HER status or docetaxel response. No significant relation with survival was observed for any parameter. Conclusion Our data seem to indicate that FISH-determined HER2 status but not p53 is associated with docetaxel sensitivity in metastatic breast cancer.

Abstract Background There is conclusive evidence that human papillomavirus (HPV) infections of the cervix are a necessary cause of cervical cancer. In Italy there are consistent data of HPV prevalence in women aged 25 - 64 years, but there is limited data for younger women. The objective of this on-going 3-year prospective cohort study is to investigate the prevalence, acquisition, clearance and persistence of HPV infections in young Tuscan women and the risk factors correlated with such events. Methods One thousand and sixty-six women aged between 18 and 24 years were enrolled and received an initial HPV test. They were asked to return to the clinic over the study period for further tests every 12 months, if their HPV HR result was negative, or every 6 months, if positive. Additionally, women with an HPV positive result were given a cytological examination and if the cytological diagnosis was ASC-US or more severe, only women with HPV HR, were referred for colposcopy. Results We present here data for the enrolment phase of the study. At baseline, within the study sample, just under 30% of women were infected by HPV and 19.3% of women were infected with oncogenic types. A relationship was highlighted between HPV infection, number of sexual partners (in particularly in the last 3 years) and the lifetime number of partner's partners. Condom use showed a slight protective effect in univariate analysis but these data were not statistically significant in multivariate analysis. The association between HPV infection and demographic and behavioural variables were tested by crude odds ratio (OR). Multivariate logistic regression was applied to compute the adjusted odds ratios. Conclusions The prevalence of oncogenic HPV types was high in young Tuscan women. The 3-year follow-up of this cohort may provide a better understanding of the processes of acquisition, clearance and persistence of infection and the correlated risk factors.

Background: Echocardiographic myocardial work is a new load-independent echocardiographic technique to quantify left ventricle (LV) systolic performance. Our aim was to establish normal values for echocardiographic myocardial work in a large population of healthy children. Methods: For all the subjects 4-, 2-, and 3-chamber-view videos were stored. The following parameters were obtained by offline analysis: the global myocardial work (GMW), the global myocardial constructive work (GCW), the global myocardial wasted work (GWW), and the global myocardial work efficiency (GWE). Age, weight, height, heart rate, and body surface area (BSA) were used as independent variables in the statistical analysis. Results: In all, 516 healthy subjects (age range, 1 day—18 years; median age, 8.2 ± 5.3 years; 55.8% male; body surface area (BSA) range, 0.16 to 2.12 m2) were included. GWI, GCW, and GWW increased with weight, height, and BSA (ρ ranging from 0.635 to 0.226, p all < 0.01); GWI and GCW positively correlated with age (ρ 0.653 and 0.507). After adjusting for BSA differences, females showed higher mean GWI (p = 0.002) and GCW values (p < 0.001), thus Z-score equations for gender have been presented. Conclusions: We provided MW values in a large population of healthy pediatric subjects including lower ages. MW values increased with age and body size and, interestingly, were higher in females than in men. These data cover a gap in current nomograms and may serve as a baseline for the evaluation of MW analysis in children with congenital and acquired heart diseases.

Background: Although coronary artery nomograms in children have been published, data on Caucasian children are lacking. The aim of this study is to provide: (i) a full dataset of coronary artery diameters in healthy children and (ii) a comparison among major previous nomograms. Materials and Methods: We prospectively evaluated 606 healthy subjects (age range, 1 days–2 scores, were logarithmic (ln[y] = a + b*ln[x]). Predicted values and Z-score boundaries by BSA are provided. Our ranges of normality are slightly lower than those, diverging from −0.22 to −0.59 Z-scores for the left main coronary artery and from −0.23 to −0.3 Z-scores for the right coronary artery. Conclusions: We report a complete dataset of normal echocardiography coronary artery diameter (including new measures of the proximal origin) values in a large population of healthy children. Our data were statistically like those of north American nomograms.

Resumo Em 2009, a Frente Nacional de Prefeitos (FNP) denominou g100 um grupo de municípios caracterizados por possuir mais de 80 mil habitantes, baixos níveis de receita pública per capita e alta vulnerabilidade socioeconômica. Este estudo buscou descrever o g100 a partir da posição comparativa segundo três medidas de vulnerabilidade socioeconômica aplicadas aos municípios com mais de 80 mil habitantes, discutindo a pertinência do uso da proposta da FNP como critério de priorização em políticas sociais. Comparou-se a listagem dos 100 primeiros municípios g100 com aquelas do Índice do Desenvolvimento Humano Municipal (IDHM), Índice de Vulnerabilidade Social (IVS) e Índice Brasileiro de Privação (IBP). Identificou-se que 25 municípios classificados como g100 não estavam entre os 100 primeiros nos demais índices; mas 46 municípios g100 encontravam-se entre os mais vulneráveis nas três medidas. Discute-se a necessidade de amplo debate e consenso sobre as medidas de vulnerabilidade socioeconômica empregadas no planejamento e execução de políticas públicas. Esta reflexão está ancorada na defesa de que as ações e políticas públicas sejam intrinsicamente planejadas para garantia de maior equidade geográfica e alocativa em face da efetividade de resposta às demandas da população.

Background: Guidelines recommend targeting decongestion in management of decompensated HF, with lower extremity edema often serving as the clinical target. LECW are seldom used in the acute setting, with a paucity of data on efficacy in HF, despite serving as a cornerstone of chronic lymphedema management. Primary objective: Study the efficacy and safety of LECW in acute decompensated HF. Methods: Open-label, randomized, parallel-group clinical trial. Primary outcomes: Days on intravenous (IV) diuretic therapy, total hospital length of stay (LOS), and 30-day all-cause readmission. Results: 32 patients were enrolled, with 29 patients completing the study. Enrollment was suspended due to the COVID-19 pandemic. Overall LOS was shorter in the intervention group (3.5 vs 6 days, p = 0.05), with no significant difference in total days on IV diuresis or 30-day readmission rate with use of LECW. Fewer patients required continuous diuretic infusion after treatment with LECW (0 vs 7 patients, p = 0.027). The intervention group scored significantly better on the MLWHF (55.5 vs 65, p = 0.021), including both the physical and emotional dimension scores. No adverse events were reported with use of LECW, including a significantly lower incidence of AKI (1 vs 13 patients, p = 0.005). Conclusion: The use of LECW resulted in reduced hospital LOS compared to standard therapy, with no difference in days of IV diuresis administration or 30-day readmission. Treatment with LECW also resulted in less continuous IV diuretic therapy, fewer incidence of AKI, and improved quality of life. Trends toward less escalation of diuresis, and greater reduction in edema were also observed.

Background: The decision to perform biventricular repair (BVR) in neonates and infants presenting with either single or multiple left ventricle outflow obstructions (LVOTOs) and a borderline left ventricle (BLV) is subject to extensive discussion, and limited information is known regarding the long-term outcomes. As a result, the objective of this study is to critically assess and summarize the available data regarding the prognosis of neonates and infants with LVOTO and BLV who underwent BVR. Methods: In February 2023, we conducted a review study with three different medical search engines (the National Library of Medicine, Science Direct, and Cochrane Library) for Medical Subject Headings and free text terms including “congenital heart disease”, “outcome”, and “borderline left ventricle”. The search was refined by adding keywords for “Shone’s complex”, “complex LVOT obstruction”, “hypoplastic left heart syndrome/complex”, and “critical aortic stenosis”. Results: Out of a total of 51 studies, 15 studies were included in the final analysis. The authors utilized heterogeneous definitions to characterize BLV, resulting in considerable variation in inclusion criteria among studies. Three distinct categories of studies were identified, encompassing those specifically designed to evaluate BLV, those focused on Shone’s complex, and finally those on aortic stenosis. Despite the challenges associated with comparing data originating from slightly different cardiac defects and from different eras, our results indicate a favorable survival rate and clinical outcome following BVR. However, the incidence of reintervention remains high, and concerns persist regarding residual pulmonary hypertension, which has been inadequately investigated. Conclusions: The available data concerning neonates and infants with LVOTO and BLV who undergo BVR are inadequate and fragmented. Consequently, large-scale studies are necessary to fully ascertain the long-term outcome of these complex defects.

Abstract Morphology‐based taxonomic research frequently applies linear morphometrics (LMM) in skulls to quantify species distinctions. The choice of which measurements to collect generally relies on the expertise of the investigators or a set of standard measurements, but this practice may ignore less obvious or common discriminatory characteristics. In addition, taxonomic analyses often ignore the potential for subgroups of an otherwise cohesive population to differ in shape purely due to size differences (or allometry). Geometric morphometrics (GMM) is more complicated as an acquisition technique but can offer a more holistic characterization of shape and provides a rigorous toolkit for accounting for allometry. In this study, we used linear discriminant analysis (LDA) to assess the discriminatory performance of four published LMM protocols and a 3D GMM dataset for three clades of antechinus known to differ subtly in shape. We assessed discrimination of raw data (which are frequently used by taxonomists); data with isometry (i.e., overall size) removed; and data after allometric correction (i.e., with nonuniform effects of size removed). When we visualized the principal component analysis (PCA) plots, we found that group discrimination among raw data was high for LMM. However, LMM datasets may inflate PC variance accounted in the first two PCs, relative to GMM. GMM discriminated groups better after isometry and allometry were removed in both PCA and LDA. Although LMM can be a powerful tool to discriminate taxonomic groups, we show that there is substantial risk that this discrimination comes from variation in size, rather than shape. This suggests that taxonomic measurement protocols might benefit from GMM‐based pilot studies, because this offers the option of differentiating allometric and nonallometric shape differences between species, which can then inform on the development of the easier‐to‐apply LMM protocols.

Abstract Background In the pharmaceutical industry, competing for few validated drug targets there is a drive to identify new ways of therapeutic intervention. Here, we attempted to define guidelines to evaluate a target’s ‘fitness’ based on its node characteristics within annotated protein functional networks to complement contingent therapeutic hypotheses. Results We observed that targets of approved, selective small molecule drugs exhibit high node centrality within protein networks relative to a broader set of investigational targets spanning various development stages. Targets of approved drugs also exhibit higher centrality than other proteins within their respective functional class. These findings expand on previous reports of drug targets’ network centrality by suggesting some centrality metrics such as low topological coefficient as inherent characteristics of a ‘good’ target, relative to other exploratory targets and regardless of its functional class. These centrality metrics could thus be indicators of an individual protein’s ‘fitness’ as potential drug target. Correlations between protein nodes’ network centrality and number of associated publications underscored the possibility of knowledge bias as an inherent limitation to such predictions. Conclusions Despite some entanglement with knowledge bias, like structure-oriented ‘druggability’ assessments of new protein targets, centrality metrics could assist early pharmaceutical discovery teams in evaluating potential targets with limited experimental proof of concept and help allocate resources for an effective drug discovery pipeline.

Abstract There is currently a need for adaptation in higher education due to the new demands of society. In this context, two factors are noteworthy: academic engagement and entrepreneurial education. This study aimed to examine whether entrepreneurship education influences academic engagement and entrepreneurial potential in college students participating and not participating in entrepreneurship education programs. It is a quantitative, exploratory, and correlational study on a 563-student sample, using the Entrepreneurial Potential Identification Scale - Escala para Identificar Potencial Empreendedor, the Utrecht Work Engagement Scale-Students, and a sociodemographic questionnaire. The results showed that students who entered an entrepreneurial training program had significantly higher rates of academic engagement and entrepreneurial potential, when compared with academics from institutions that did not have a program designed for this purpose. It is concluded that investing in entrepreneurial education can foster the generation of more engaged students with greater entrepreneurial potential.

Purpose – This research aims to investigate the different impacts of easy (fluency) and difficult (disfluency) business relationship evaluations on future purchase intentions. In addition, it seeks to investigate the mediating role of confidence in these evaluations and present a new form of fluency manipulation performed directly by satisfaction evaluations. Design/methodology/approach – This research includes a first experiment with a 3 (fluency: easy vs difficult vs control) x 2 (hypothetical scenario of satisfaction vs dissatisfaction) factorial design, using 180 undergraduate students, and a second single factor experiment (fluency: easy vs difficult vs control) with 326 consumers evaluating their financial services provider. Both used a between-subject design with the individuals being randomly distributed between the scenarios. Findings – Dissatisfied consumers who perceived ease in evaluating commercial relationships have increased confidence in these evaluations, negatively influencing their purchase intentions. Meanwhile, satisfied consumers are generally overconfident, being equally affected by perceived difficulty or ease due to a direct bias from the evaluation, which increases purchase intentions. Originality/value – The results demonstrate that fluency (perceived ease or difficulty) depends on the valence of the evaluations, directly affecting (positive valence) or indirectly affecting (negative valence) subsequent decisions. We also present a new, faster, and more practical way to manipulate fluency. Furthermore, we raise some ethical questions as these effects result in biased decisions.

Abstract The biogeographic distribution of diversity among populations of threatened mammalian species is generally investigated using population genetics. However, intraspecific phenotypic diversity is rarely assessed beyond taxonomy‐focused linear measurements or qualitative descriptions. Here, we use a technique widely used in the evolutionary sciences—geometric morphometrics—to characterize shape diversity in the skull of an endangered marsupial, the northern quoll, across its 5,000 km distribution range along Northern Australia. Skull shape is a proxy for feeding, behavior, and phenotypic differentiation, allowing us to ask whether populations can be distinguished and whether patterns of variation indicate adaptability to changing environmental conditions. We analyzed skull shape in 101 individuals across four mainland populations and several islands. We assessed the contribution of population, size, sex, rainfall, temperature, and geography to skull shape variation using principal component analysis, Procrustes ANOVA, and variation partitioning analyses. The populations harbor similar amounts of broadly overlapping skull shape variation, with relatively low geographic effects. Size predicted skull shape best, coinciding with braincase size variation and differences in zygomatic arches. Size‐adjusted differences in populations explained less variation with far smaller effect sizes, relating to changes in the insertion areas of masticatory muscles, as well as the upper muzzle and incisor region. Climatic and geographic variables contributed little. Strikingly, the vast majority of shape variation—76%—remained unexplained. Our results suggest a uniform intraspecific scope for shape variation, possibly due to allometric constraints or phenotypic plasticity beyond the relatively strong allometric effect. The lack of local adaptation indicates that cross‐breeding between populations will not reduce local morphological skull (and probably general musculoskeletal) adaptation because none exists. However, the potential for heritable morphological variation (e.g., specialization to local diets) seems exceedingly limited. We conclude that 3D geometric morphometrics can provide a comprehensive, statistically rigorous phenomic contribution to genetic‐based conservation studies.

O objetivo do presente artigo é avaliar a estabilidade temporal do UWES, instrumento de avaliação do engajamento no trabalho, construto caracterizado por elevado vigor, dedicação e absorção no trabalho. A amostra foi composta por 423 trabalhadores de teleatendimento e utilizou-se a metodologia de teste/reteste mediante intervalo de tempo de um mês, com emprego de análises descritivas e de confiabilidade. Como resultado, o instrumento manteve qualidade psicométrica adequada (alfa de Cronbach > 0,8; CFI > 0,95; RMSEA < 0,07) além de bons resultados que atestam a sua invariância de medida entre as coletas longitudinais (configural, métrica e escalar), dados alinhados com o manual do instrumento. Com relação à estabilidade temporal, houve acréscimo dos valores do alfa de Cronbach e correlações significativas e positivas. Sugere-se que os resultados obtidos denotam adequada qualidade psicométrica com estabilidade temporal, contudo ressalta-se a necessidade de novos estudos, em especial pela aplicação ter ocorrido em apenas uma categoria profissional, empresa e região.

Background: Echocardiographic screening of anomalous coronary artery origin is of increasing interest for children participating in sport activities. However, criteria to define normal coronary artery origins in children are poorly defined. Thus, the aim of the present investigation is to define the normal origin and angle of emergence of coronary arteries by echocardiography in healthy children. Materials and methods: The distances of the left main and right coronary artery (LMCA, RCA) origins from the aortic annulus were measured in the parasternal long-axis view (LAX). The angle of coronary artery emergence was measured in the parasternal short-axis view (SAX). Results: A total of 700 healthy subjects (mean age: 9.53 ± 5.95 years; range: 1 day–17.98 years) were prospectively enrolled. The distance of the RCA and LMCA from the aortic annulus correlated with body surface area, and nomograms (Z-scores) were generated. The RCA origin was below the sinotubular junction (STJ) in 605 patients (86.43%), at the STJ in 66 patients (9.43%), and above the STJ in 29 patients (4.14%). The LMCA origin was below the STJ in 671 patients (95.86%), at the STJ in 12 patients (1.71%), and above the STJ in 17 patients (2.43%). With respect to the RCA, an emergence angle < 18.5° in the SAX predicted a high take-off. with a sensitivity of 98.3% and a specificity of 93.1% (AUC 0.998). With respect to the LMCA, an emergence angle > 119.5° in the SAX predicted a high take-off, with a sensitivity of 70.6% and a specificity of 82.4% (AUC 0.799). Conclusion: This study establishes nomograms for LMCA and RCA origin in standard echocardiographic projections in healthy children.

A very rare variant of MPD is the Pigmented Mammary Paget Disease (PMPD), first described by Culberson et al. in 1956. It is very difficult to distinguish this variant from melanoma both clinically and dermoscopically. The diagnosis is confirmed by histopathology and immunohistochemistry. Correct diagnosis is crucial for surgical treatment, which is different for these two diseases. We report the case of a 92-year-old woman, who presented an asymptomatic pigmented lesion of the right nipple and areola. The lesion was arisen for about 6 months and was suspected for melanoma because of clinical and dersmoscopic characteristics. Incisional biopsy revealed tumor cells, that proliferate in the major mammary ducts, and tumor cells in the overlying epidermis of the nipple, thus diagnosing pigmented mammary Paget disease (PMPD). The patient underwent radical mastectomy.

Studies highlight that although the spiritual/religious dimension is commonly used as a resource for coping with stress and suffering, sometimes this dimension can also be a locus of struggles. The Religious and Spiritual Struggles (RSS) Scale, composed of 26 items (extended version), is an instrument that assesses the presence of six types of spiritual struggles, categorized into three major categories: Intrapersonal, Interpersonal, and Supernatural. More recently, studies have presented a leaner version, with 14 items (short version), also suitable for evaluating religious/spiritual struggles. This study aimed to validate the RSS Scale, in its two versions, in the Brazilian cultural context and was able to attest to its quality and reliability, albeit with small variations. The Brazilian extended version presented six components (similar to the original version) explaining 68.48% of variance and 0.907 of KMO. Two items were withdrawn due to low loadings, but the psychometric qualities of both versions in two different samples (one wide sample and one with LGBTQIA+ individuals) were maintained. The reliability (Cronbach’s alpha) for each one of the six components ranged from 0.78 to 0.88 (24 items) and from 0.73 to 0.83 (14 items). The TLI and CFI were, respectively, 0.934 and 0.945 (24 items) and 0.982 and 0.988 for the short version (14 items). Furthermore, convergent validity tests indicated correlations with the Satisfaction with Life Scale. The RSS Scale (the Brazilian versions with 24 and 14 items), demonstrated reliability in the studied sample and can be applied in clinical and research contexts.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common forms of liver disease, which is associated with several etiological factors, including stress and dysfunction in oxidative metabolism. However, studies showed that aerobic exercise training (AET) can combat the oxidative stress (OS) and improves mitochondrial functionality in the NAFLD. To test the hypothesis that AET improves oxidative metabolism and antioxidant defense in the liver of ob/ob mice. Male ob/ob mice with eight weeks old were separated into two groups: the sedentary group (S), n=7, and the trained group (T), n=7. The T mice were submitted to an 8-week protocol of AET at 60% of the maximum velocity achieved in the running capacity test. Before AET, no difference was observed in running test between the groups (S=10.4 ± 0.7 min vs. T= 13 ± 0.47 min). However, after AET, the running capacity was increased in the T group (12.8 ± 0.87 min) compared to the S group (7.2 ± 0.63 min). In skeletal muscle, the T group (26.91 ± 1.12 U/mg of protein) showed higher citrate synthase activity compared with the S group (19.28 ± 0.88 U/mg of protein) (p =0.006). In the analysis of BW evolution, significant reductions were seen in the T group as of the fourth week when compared to the S group. In addition, food intake was not significant different between the groups. Significant increases were observed in the activity of enzymes citrate synthase (p=0.004) and β-HAD (p=0.01) as well as in PGC-1α gene expression (p=0.002) in the liver of T group. The levels of TBARs and carbonyls, as well as SOD, CAT and GST were not different between the groups. However, in the nonenzymatic antioxidant system, we found that the T group had higher sulfhydryl (p = 0.02), GSH (p=0.001) and GSH/GSSG (p=0.02) activity. In conclusion, the AET improved body weight evolution and the aerobic capacity, increased the response of oxidative metabolism markers in the liver such as PGC-1α gene expression and citrate synthase and β-HAD enzyme activities in ob/ob mice. In addition, AET improved the non-enzymatic antioxidant defense and did not change the enzymatic defense.

Background Previous data have reported that the growth of established tumors may be facilitated by postsepsis disorder through changes in the microenvironment and immune dysfunction. However, the influence of postsepsis disorder in initial carcinogenesis remains elusive.Methods In the present work, the effect of postsepsis on inflammation-induced early carcinogenesis was evaluated in an experimental model of colitis-associated colorectal cancer (CAC). We also analyzed the frequency and role of intestinal T regulatory cells (Treg) in CAC carcinogenesis.Results The colitis grade and the tumor development rate were evaluated postmortem or in vivo through serial colonoscopies. Sepsis-surviving mice (SSM) presented with a lower colonic DNA damage, polyp incidence, reduced tumor load, and milder colitis than their sham-operated counterparts. Ablating Treg led to restoration of the ability to develop colitis and tumor polyps in the SSM, in a similar fashion to that in the sham-operated mice. On the other hand, the growth of subcutaneously inoculated MC38luc colorectal cancer cells or previously established chemical CAC tumors was increased in SSM.Conclusion Our results provide evidence that postsepsis disorder has a dual effect in cancer development, inhibiting inflammation-induced early carcinogenesis in a Treg-dependent manner, while increasing the growth of previously established tumors.

Overweight and obesity are a worldwide pandemic with geographic differences. Possible explanations include variable access to food and its quality, dietary habits of the populations, behavioral patterns, and characteristics of the food markets. This study aimed to examine the acquisition of food in the different regions of Brazil and to relate it with the geography of Brazilian obesity. We used data provided by a Brazilian official organ, which gathers periodic data on the household food acquisition. Descriptive statistics and multidimensional scaling techniques were used to ascertain the similarity of food acquisition among populations in the Brazilian states. High levels of overweight and obesity occur in all states (>44%), especially in the southern half of the country (>54%). We found differences in the food acquisition patterns throughout the country. Furthermore, we identify that states with similar dietary patterns have similar population levels of overweight and obesity, demonstrating a possible relationship between the food supply models and these food insecurity manifestations as expressed in the individual health. However, the occurrence of regional singularities suggests that the food supply model constitutes only one of the multiple variables that compete for diversity in the Brazilian regional distribution of obesity and overweight. We found that socioeconomic conditions influence nutritional misalignment in the geography of Brazil. Our results show that overweight and obesity have a higher occurrence in middle age (35–79 years), and it is more present in females. Moreover, women with lower education and lower incomes have higher levels of overweight and obesity, an association of unhealthy food intake with poverty. In men, obesity is more frequent in those with more schooling and higher incomes. Based on the widely variable geographical characteristics of the distant states of Brazil, we conclude that overweight and obesity go beyond an individual lifestyle and access to quality food, and is more related to a complex framing of factors, like schooling, age, sex, income, feeding patterns, food markets, and anthropological circumstances.

BackgroundEfficacy and safety of treatments for hospitalized COVID-19 are uncertain. We systematically reviewed efficacy and safety of remdesivir for the treatment of COVID-19.MethodsStudies evaluating remdesivir in adults with hospitalized COVID-19 were searched in several engines until August 21, 2020. Primary outcomes included all-cause mortality, clinical improvement or recovery, need for invasive ventilation, and serious adverse events (SAEs). Inverse variance random effects meta-analyses were performed.ResultsWe included four randomized controlled trials (RCTs) (n = 2296) [two vs. placebo (n = 1299) and two comparing 5-day vs. 10-day regimens (n = 997)], and two case series (n = 88). Studies used intravenous remdesivir 200mg the first day and 100mg for four or nine more days. One RCT (n = 236) was stopped early due to AEs; the other three RCTs reported outcomes between 11 and 15 days. Time to recovery was decreased by 4 days with remdesivir vs. placebo in one RCT (n = 1063), and by 0.8 days with 5-days vs. 10-days of therapy in another RCT (n = 397). Clinical improvement was better for 5-days regimen vs. standard of care in one RCT (n = 600). Remdesivir did not decrease all-cause mortality (RR 0.71, 95%CI 0.39 to 1.28, I2 = 43%) and need for invasive ventilation (RR 0.57, 95%CI 0.23 to 1.42, I2 = 60%) vs. placebo at 14 days but had fewer SAEs; 5-day decreased need for invasive ventilation and SAEs vs. 10-day in one RCT (n = 397). No differences in all-cause mortality or SAEs were seen among 5-day, 10-day and standard of care. There were some concerns of bias to high risk of bias in RCTs. Heterogeneity between studies could be due to different severities of disease, days of therapy before outcome determination, and how ordinal data was analyzed.ConclusionsThere is paucity of adequately powered and fully reported RCTs evaluating effects of remdesivir in hospitalized COVID-19 patients. Until stronger evidence emerges, we cannot conclude that remdesivir is efficacious for treating COVID-19.

Mass-vaccination against COVID-19 is still a distant goal for most low-to-middle income countries. The experience gained through decades producing polyclonal immunotherapeutics (such as antivenoms) in many of those countries is being redirected to develop similar products able to neutralize SARS-CoV-2 infection. In this study we analyzed the biological activity (viral neutralization or NtAb) and immunochemical properties of hyperimmune horses’ sera (HHS) obtained during initial immunization (I) and posterior re-immunization (R) cycles using the RBD domain of the SARS-CoV-2 spike protein as antigen. HHS at the end of the R cycle showed higher NtAb titers when compared to those after the I cycle (35,585 vs. 7000 mean NtAb, respectively). Moreover, this increase paralleled an increase in avidity (95.2% to 65.2% mean avidity units, respectively). The results presented herein are relevant for manufacturers of these therapeutic tools against COVID-19.

Background: Speckle-tracking echocardiography (STE) has gained increasing value in the evaluation of congenital heart diseases (CHD); however, its use in pediatric cardiac surgery is limited. Aim: To evaluate left ventricular (LV) systolic impairment after biventricular pediatric cardiac surgery by STE strain (ε) analysis. Methods: We prospectively enrolled 117 children undergoing cardiac surgery for CHD. Echocardiography was performed at four different times: pre-operatively, 12–36 h (Time 1), 3–5 days (Time 2), and 6–8 days (Time 3). Images were obtained in the 4-2-and 3 apical chamber’s views to derive LV global and regional (basal/mid/apical) ε values. Results: At different postoperative times, we performed 320 examinations in 117 children (mean age: 2.4 ± 3.9, range: 0–16 years); 117 age-matched healthy children served as controls. All global, basal, and mid LVε values decreased after surgery; the lowest values being at Time 1 (p < 0.0001), which increased thereafter. At discharge, all global, basal, and mid LVε values remained lower than in pre-operative and healthy children (p < 0.05). Instead, apical segments (lowest at baseline) increased after surgery (p < 0.0001) but remained lower compared to controls. LV ejection fraction (LVEF) decreased at Time 1 (p = 0.0004) but promptly recovered to Time 2 and normalized at Time 3. Conclusions: STE ε analysis revealed a significant LV systolic impairment after surgery with amelioration thereafter but incomplete normalization at discharge. Base-apex differences emerged with apical segments that, contrary to all the other regions, showed relative hypercontractility after surgery. The slower recovery of LVε values compared to LVEF suggests that STE ε analysis may be more accurate for the follow-up of mild LV post-surgical impairment.

Resumo: O objetivo foi analisar as barreiras de acesso aos serviços de saúde existentes em cinco Regiões de Saúde do Brasil. Foram analisadas as respostas obtidas a partir da aplicação de questionários semiestruturados a gestores, prestadores e, em número mais restrito, a profissionais de saúde do Sistema Único de Saúde, tendo como referência as dimensões: Acessibilidade Geográfica, Disponibilidade e Aceitabilidade. Foram verificadas as especificidades em relação às barreiras de acesso nas regiões consideradas, já outras como a localização e tempo gasto no trajeto foram barreiras em quase todas elas quando foi considerado o cuidado ao acidente vascular cerebral. Quando à Disponibilidade, foram observadas questões relacionadas à insuficiência de médicos, tempo de espera prolongado e problemas relativos à integração, em todas as regiões. Quanto à Aceitabilidade, destacou-se a crença dos usuários de não possuir problemas de saúde. As Regiões de Saúde situadas no Sul e Sudeste do país registraram menor quantidade e diversidade de barreiras, revelando a persistência de desigualdades regionais. Embora os resultados não representem o conjunto do Brasil, permitem apontar questões relevantes sobre o processo de regionalização do sistema de saúde no país.

BackgroundBladder cancer (BC) is the 9th most common cancer diagnosis worldwide. Low grade (LG) represents 70% of all BCs, characterized by recurrence and rare ability (10-15%) to progress to high grade (HG) and invade. The remaining 30% is high grade (HG), fast invasive BC, which is resistant to therapy. Identifying biomarkers for predicting those tumors able to progress is a key goal for patient outcome improvement. This study focuses on the most promising prognostic markers.Materials and methodsTP53 and FGFR3 mutational status, Survivin, CK19, CK20, E-cadherin and CD44 gene expression analysis were performed on 66 BCs.ResultsSurvivin was found associated to tumor grade (pConclusionWe suggest Survivin, both as a biomarker associated to G3 BCs but negatively related to TP53 mutational status, and as a potential novel therapeutic target.

In this study, the effects of static and multi-pulsed mild-intensity high hydrostatic pressure (HHP) treatments (60 or 100 MPa, ~23 °C) on the extractability and accumulation of phenolics and carotenoids in whole carrots were evaluated. HHP treatments were applied for the time needed to reach the desired pressure (come-up-time, CUT) either as a single pulse or multi-pulse (2P, 3P, and 4P). Likewise, a single sustained treatment (5 min) applied at 60 or 100 MPa was evaluated. Individual carotenoids, free and bound phenolics were quantified after HHP treatment and subsequent storage (48 h, 15 °C). As an immediate HHP response, phenolic extractability increased by 66.65% and 80.77% in carrots treated with 3P 100 MPa and 4P 60 MPa, respectively. After storage, CUT 60 MPa treatment accumulated free (163.05%) and bound (36.95%) phenolics. Regarding carotenoids, total xanthophylls increased by 27.16% after CUT 60 MPa treatment, whereas no changes were observed after storage. Results indicate that HHP processing of whole carrots at mild conditions is a feasible innovative tool to enhance the nutraceutical properties of whole carrots by increasing their free and bound phenolic content while maintaining carotenoid levels. HHP treated carrots can be used as a new functional food or as raw material for the production of food and beverages with enhanced levels of nutraceuticals.

Introduction: Attentional bias, the tendency that a person has to drive or maintain attention to a specific class of stimuli, may play an important role in the etiology and persistence of mental disorders. Attentional bias modification has been studied as a form of additional treatment related to automatic processing. Objectives: This systematic literature review compared and discussed methods, evidence of success and potential clinical applications of studies about attentional bias modification (ABM) using a visual probe task. Methods: The Web of Knowledge, PubMed and PsycInfo were searched using the keywords attentional bias modification, attentional bias manipulation and attentional bias training. We selected empirical studies about ABM training using a visual probe task written in English and published between 2002 and 2014. Results: Fifty-seven studies met inclusion criteria. Most (78%) succeeded in training attention in the predicted direction, and in 71% results were generalized to other measures correlated with the symptoms. Conclusions: ABM has potential clinical utility, but to standardize methods and maximize applicability, future studies should include clinical samples and be based on findings of studies about its effectiveness.

Fibre-reinforced concrete (FRC) has been used in numerous types of precast elements around the world, as has been shown that reductions in production costs and time can be obtained; however, there is little experience of this material in Uruguay. Therefore, our study analysed the feasibility of its utilisation in this country. This paper reports on the development of a simple analysis model that is useful for the design of FRC precast elements. The model efficiency was evaluated through its application to a practical case study—vertical precast concrete sandwich panel systems tested by bending. Three different types of reinforcement were analysed: synthetic fibres, metal fibres, and steel mesh. With the developed model, the cost-efficiency of different panel geometries and amounts of reinforcement were evaluated. The model allowed consideration of the contribution of the fibres to withstand internal tensile forces of the panels and therefore be able to substitute for the steel mesh in the panel wythes. It was found that it was possible to optimise panel reinforcement and geometry, thereby reducing wythe thickness. Besides the reduction in production time, it was possible to achieve cost savings of up to 10% by replacing steel mesh with fibres and of more than 20% if the geometry was also modified.

Objetivo: avaliar a adequação do cuidado no desempenho dos serviços de saúde na atenção básica, de média e alta complexidade nas regiões e unidades federadas brasileiras no período de 1998 a 2010. Métodos: dados dos sistemas nacionais de informação em saúde de nascidos vivos, doenças de notificação compulsória, atendimento ambulatorial e hospitalar e dados demográficos do Instituto Brasileiro de Geografia e Estatística foram utilizados para o cálculo de taxas padronizadas, médias, razões e proporções para o Brasil, regiões e unidades federativas no período de 1998 a 2010. Resultados: melhor adequação dos serviços de saúde foi observada na área básica e na alta complexidade identificadas pela evolução positiva do número de consultas de pré-natal em todas as regiões e do percentual de tomografias realizadas em pacientes com acidente vascular cerebral que usaram tomografia computadorizada que alcançam, respectivamente, valores em torno de 61% e 33% em 2010. Conclusão: uma melhor avaliação da adequação depende tanto da implementação de políticas e práticas de saúde mais equitativas quanto de mudanças nos registros administrativos.

Resumen INTRODUCCIÓN La incidencia de insuficiencia renal aguda a nivel mundial es 18% y la mortalidad intrahospitalaria puede alcanzar más del 50%. En Perú, existen escasos estudios acerca de la mortalidad en pacientes con insuficiencia renal aguda en hemodiálisis. OBJETIVOS Identificar los factores de riesgo asociados a mortalidad intrahospitalaria en pacientes con insuficiencia renal aguda en hemodiálisis. MÉTODOS Es una cohorte retrospectiva, en la cual se estudió a los pacientes con insuficiencia renal aguda en hemodiálisis en el Hospital Nacional Edgardo Rebagliati Martins entre enero de 2013 y diciembre de 2015. Se halló un tamaño de muestra de 154 pacientes con una potencia de 80%, y un intervalo de confianza de 95%. Se utilizaron los códigos de la Clasificación Internacional de Enfermedades-10 para identificar las historias clínicas de pacientes con insuficiencia renal aguda (N.17) y hemodiálisis (Z.49). La variable independiente fue oliguria y la variable dependiente fue mortalidad intrahospitalaria. Para el análisis multivariado, se utilizó regresión de Poisson. RESULTADOS El universo fue de 285 pacientes. Se revisaron 212 historias clínicas y se excluyeron 44. De las 168 historias clínicas estudiadas, 129 pertenecían a pacientes vivos y 39 a fallecidos. La incidencia de mortalidad fue de 17,2%. Las principales causas de insuficiencia renal aguda en hemodiálisis fueron sepsis (39,2%) y deshidratación severa (10,8%). En el modelo ajustado, los factores de riesgo asociados a mortalidad intrahospitalaria de insuficiencia renal aguda en hemodiálisis fueron lactato (riesgo relativo 1,09), potasio (riesgo relativo 0,93), y presión arterial media (riesgo relativo 0,97). CONCLUSIONES El lactato es un parámetro objetivo que permite predecir el pronóstico y contribuye a un mejor manejo de los pacientes con insuficiencia renal aguda en hemodiálisis.

The centrality of religiosity scale (CRS), available in three versions (with 5, 10 and 15 items), is a measuring instrument that identifies the central importance of religiosity in the psychological construction and in the behavior of an individual. According to the literature, five components together express the centrality of religion in life: Public practice, private practice, ideological, intellectual, and religious experience. These components are the ground on which religious constructs are formed and activated. For the validation of the scale in the Brazilian cultural context, two versions were tested (CRS-10BR and CRS-5BR) with data collected from a general population (N = 687). Exploratory Factor Analysis (N = 334) resulted in a five-factor solution congruent to CRS-10BR. Confirmatory Factor Analysis (N = 353) demonstrated that a five-factor solution (Intellect, Ideology, Private Practice, Public Practice and Religious Experience) indicated better fit indexes than the single-factor solution of five items (CRS-5BR). Thus, CRS-10BR is recommended to capture CRS full construct. However, the CRS-5BR version can be considered suitable for use in the Brazilian population when the context is demanding simpler and faster data collection.

Los recursos humanos en salud, hasta el momento habían permanecido al margen de la consideración en la mayoría de las reformas, por lo que la Organización Panamericana de la Salud lanzó una iniciativa de una mejor elaboración de políticas para este sector. Asimismo, Uruguay con la reforma del sistema de salud también implementa herramientas de gestión para decidir políticas con respecto a este tema. Con el objetivo de conocer los cambios en cuanto a la distribución, situación laboral y algunas de las condiciones de trabajo de los Licenciados en Enfermería en Uruguay en estos últimos veinte años, en este trabajo se recurrió al estudio de los censos existentes en el país de los años 1993 y 2013. Realizamos un estudio descriptivoretrospectivo parcial-comparativo, realizado en Montevideo, Uruguay. Se tomaron como sujeto de estudio a los Licenciados en Enfermería censados en los años 1993 y 2013. Los resultados fueron que la profesión Enfermera continúa siendo de elección mayoritariamente femenina, aunque se ha observado un leve aumento de electores masculinos. Se podría afirmar que hubo un incremento de Licenciados en Enfermería trabajando en el interior del país y un aumento también en la cantidad de los mismos trabajando en el sector público. En cuanto a la carga horaria se acrecentó el número de dichos profesionales trabajando en dos empleos. Aún no se ha logrado en el Uruguay alcanzar la Meta 1 de la OPS. Se concluyó que existe aún falta de datos actuales que permitan una comparación más exacta, dado que no se ha lanzado todavía la segunda parte del censo de 2013, donde se profundizaría en las Condiciones laborales. Sería recomendable investigar acerca de las causales de multiempleo y la decisión de trabajar en Montevideo, para poder así desarrollar políticas de Estado acordes a las necesidades y problemas detectados en todo el país.

Resumo: Fundamento: A mensuração de indicadores de qualidade contribui para monitoramento do desempenho do tratamento do Infarto Agudo do Miocárdio com supradesnivelamento do segmento ST (IAMCSST). Objetivo: Desenvolver uma ferramenta virtual para calcular indicadores de desempenho através de informações enviadas via WEB. Métodos: Identificação de pontos críticos no processo terapêutico e formulação de indicadores avaliados em retrospetivo estudo piloto. Desenvolvimento de ferramenta virtual para coleta prospetiva dos dados relacionados com o atendimento inicial ao IAMCSST. Seleção e convocação dos hospitais para cadastro no sistema e exposição do projeto. Utilização do sítio www.qualiiam.cict.fiocruz.br/indicadores.php para acesso aos relatórios dos indicadores em tempo real. Resultados: Houve variação no número de pacientes cadastrados por cada hospital (A = 7; B = 14; C = 16; D = 44; E = 43). AAS foi administrado em 94,6% dos casos. A administração do IECA/BRA ocorreu em 76,1% dos pacientes. A administração de betabloqueadores ocorreu em 82,5%. 68,4% dos pacientes sem contra-indicação a fibrinolítico recebeu o fármaco. Em nenhum caso o tempo porta agulha foi inferior a 30 min. A média obtida foi 122 min. Todos os pacientes admitidos nos hospitais com hemodinâmica foram submetidos à angioplastia primária. A média obtida para tempo porta-balão foi 161 min. Em apenas 28% destes pacientes o tempo porta balão foi menor do que 90 min. Conclusão: O sistema pode ser usado como ferramenta de gestão para monitoramento dos indicadores de performance no atendimento inicial ao IAM. Análises futuras destes indicadores poderão contribuir para avaliar o impacto destes relatórios sobre a incorporação de melhores práticas assistenciais. Abstract: Background: Measurement of quality indicators contributes to monitoring the performance of initial treatment of ST-elevated myocardial infarction (STEMI). Objective: To develop a virtual tool to calculate performance indicators of initial treatment of STEMI online via the internet. Methods: We identified critical elements of the therapeutic process and formulated indicators in a retrospective pilot study, and developed a virtual tool for prospective data collection on initial treatment of STEMI. Rio de Janeiro hospitals with emergency care units were selected and invited to participate in the project. Online reports were developed to be accessed at www.qualiiam.icict.fiocruz.br/indicadores.php and analyzed. Results: Five hospitals agreed to participate in the project and monitored treatment of different numbers of patients with a diagnosis of STEMI (A=7, B=14, C=16, D=44 and E=43). Aspirin was administered in 94.6% of cases, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in 76.1% and beta-blockers in 82.5%; 68.4% of patients with no contraindication received fibrinolysis. In no case was door-to-needle time less than 30 min, and mean time was 122 min. All patients admitted to hospitals with catheterization facilities underwent primary angioplasty; mean door-to-balloon time in these patients was 161 min; in only 28% was it less than 90 min. Conclusion: The system can be used as a tool to monitor the performance of initial treatment of patients with STEMI. Analysis of these indicators in the future may help to evaluate the contribution of online reporting to the development of better treatment practices. Palavras-chave: Indicadores de qualidade em assistência à saúde, Infarto do miocárdio, Medicina de emergência, Diretrizes, Gestão em saúde, Keywords: Quality indicators in health care, Myocardial infarction, Emergency medicine, Guidelines, Health management

OBJETIVO: Inquéritos populacionais constituem ferramenta fundamental para monitorar a cobertura de mamografia e os fatores associados à sua realização. Em inquéritos baseados na população residente em domicílios com telefone as estimativas tendem a ser superestimadas. O estudo teve por objetivo estimar a cobertura de mamografia com base em pesquisas de base populacional. MÉTODOS: A partir das coberturas por mamografia em mulheres de 50 a 69 anos, com e sem telefone fixo, observadas na Pesquisa Nacional por Amostra de Domicílios (PNAD) 2003, calcularam-se as razões entre elas e o respectivo coeficiente de variação. A razão de cobertura foi multiplicada pela cobertura estimada pelo sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL), permitindo estimar a cobertura entre mulheres sem telefone em 2007. Essas estimativas foram aplicadas à população de mulheres, com e sem telefone, obtidas a partir da PNAD 2006, obtendo-se assim as estimativas finais para as capitais. RESULTADOS: Em 2007, para o conjunto das capitais, estimou-se a cobertura de mamografia em aproximadamente 70%, variando de 41,2% em Porto Velho (RO) a 82,2% em Florianópolis (SC). Em 17 municípios a cobertura foi maior que 60%; em oito, de 50%-60%; e em dois, a cobertura foi inferior a 50%. Em termos absolutos, a diferença entre as coberturas do VIGITEL e as estimadas foi de 6,5% para o conjunto dos municípios, variando de 3,4% em São Paulo (SP) a 24,2% em João Pessoa (PB). CONCLUSÕES: As diferenças nas magnitudes das estimativas da cobertura de mamografia por inquéritos populacionais são em grande parte reflexo dos desenhos dos estudos. No caso específico da mamografia, seria mais apropriado estimar sua cobertura combinando dados do VIGITEL com aqueles de outros inquéritos, que incluam informações sobre mulheres com e sem telefone fixo, especialmente em municípios de baixa cobertura de telefonia fixa.OBJETIVO: Encuestas poblacionales constituyen herramienta fundamental para monitorear la cobertura de mamografía y los factores asociados a su realización. En pesquisas basadas en la población residente en domicilios con teléfono las estimaciones tienden a ser superestimadas. El estudio tuvo por objetivo estimar la cobertura de mamografía con base en pesquisas de base poblacional. MÉTODOS: A partir de las coberturas por mamografía en mujeres de 50 a 69 años, con y sin teléfono fijo, observadas en la Pesquisa Nacional por Muestra de Domicilios (PNAD) 2003, se calcularon las razones entre ellas y el respectivo coeficiente de variación. La razón de cobertura fue multiplicada por la cobertura estimada por el Sistema de Vigilancia de Factores de Riesgo y Protección para Enfermedades Crónicas por Pesquisa Telefónica (VIGITEL), permitiendo estimar la cobertura entre mujeres sin teléfono en 2007. Estas estimaciones fueron aplicadas a la población de mujeres, con y sin teléfono, obtenidas a partir de la PNAD 2006, obteniéndose así las estimaciones finales para las capitales. RESULTADOS: En 2007, para el conjunto de las capitales, se estimó la cobertura de mamografía en aproximadamente 70%, variando de 41,2% en Porto Velho (Norte de Brasil) a 82,2% en Florianópolis (Sur). En 17 municipios la cobertura fue mayor que 60%; en ocho, de 50%-60%; y en dos, la cobertura fue inferior a 50%. En términos absolutos, la diferencia entre las coberturas del VIGITEL y las estimadas fue de 6,5% para el conjunto de los municipios, variando de 3,4% en Sao Paulo (Sureste) a 24,2% en Joao Pessoa (Noreste). CONCLUSIONES: Las diferencias en las magnitudes de las estimativas de la cobertura de mamografía por pesquisas poblacionales son en gran parte reflejo de los diseños de los estudios. En el caso específico de la mamografía, seria más apropiado estimar su cobertura combinando datos del VIGITEL con aquellos de otras pesquisas, que incluyan informaciones sobre mujeres con y sin teléfono fijo, especialmente en municipios de baja cobertura de telefonía fija.OBJECTIVE: Population surveys constitute an essential tool to monitor mammography coverage and factors associated with its performance. Estimates tend to be overestimated in surveys based on the population living in households with a telephone. The study aimed to estimate mammography coverage from population-based surveys. METHODS: Based on mammography coverage levels in women aged between 50 and 69 years, with and without a fixed telephone line, from the Pesquisa Nacional por Amostra de Domicílios 2003 (PNAD - 2003 National Household Survey), ratios between these coverage levels and their respective variation coefficient were calculated. The coverage ratio was multiplied by the coverage estimated by the Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL - Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases), enabling coverage in women without telephones in 2007 to be estimated. These estimates were applied to the female population, with and without a telephone, obtained from the PNAD 2006, thus achieving the final estimates for the capitals. RESULTS: In 2007, mammography coverage was estimated at about 70% for the group of capitals, varying from 41.2% in Porto Velho (Northern Brazil) to 82.2% in Florianópolis (Southern Brazil). In 17 cities, coverage was higher than 60%; in eight, between 50% and 60%; and in two, below 50%. In absolute terms, the difference between VIGITEL coverage levels and those estimated was 6.5%, varying from 3.4% in São Paulo (Southeastern Brazil) to 24.2% in João Pessoa (Northeastern Brazil). CONCLUSIONS: Differences in magnitudes of mammography coverage estimates for population surveys are mostly a reflection of study designs. In the specific case of mammography, it would be more appropriate to estimate its coverage by combining VIGITEL data with those from other surveys that include information about women with and without a fixed telephone line, especially in cities with low fixed telephone line coverage.

Analisou-se o acesso aos serviços de saúde e sua utilização por idosos residentes em áreas rurais no Brasil em 2003, comparando os padrões observados com idosos residentes em área urbana e com o padrão existente em 1998, a partir dos dados dos suplementos sobre Acesso e Utilização de Serviços de Saúde da Pesquisa Nacional por Amostra de Domicílios. Observou-se que as barreiras de acesso eram maiores na área rural em comparação à urbana. A utilização de serviços de saúde era menor do que nos idosos urbanos, mesmo para aqueles que referiram problema de saúde. Não se observou diferença nas taxas de internação entre idosos rurais e urbanos. A análise do tipo de serviço utilizado mostrou que há acesso limitado a serviços de complexidade intermediária. Os resultados sugerem que os mais idosos apresentam barreiras de acesso ainda maiores. O diferencial de gênero na utilização favorável à mulher foi mais marcado nos idosos rurais. Barreiras financeiras também são mais marcadas. Houve indicativo de alguma melhora no desempenho dos serviços do Sistema Único de Saúde (SUS). Recomendou-se ampliação da oferta e adaptação dos serviços às especificidades territoriais, culturais e sociais dos idosos rurais.We analyzed access to health services and the utilization of such services by elderly rural residents in Brazil in 2003, comparing the patterns to those of the urban elderly and the equivalent rural pattern in 1998, using data from the National Household Sample Survey. Access barriers were greater in rural as compared to urban areas. Health services utilization was less than in the urban elderly, even for rural elders who reported health problems. There was no difference in hospitalization rates among rural and urban elderly. Analysis of the health services that were used showed that there was limited access to services with intermediate complexity. The results suggest that access barriers increase even further with advancing age. Gender differences in utilization, generally favoring women, are more marked in the rural elderly. Financial barriers are also more evident. The health services supply should be expanded and adapted to the territorial, cultural, and social characteristics of the rural elderly.

No início da década de 1990, foi desenvolvida na Inglaterra uma nova metodologia para alocação de recursos financeiros aos serviços de saúde baseada nas necessidades de saúde da população. Essa metodologia caracteriza-se por adotar o modelo teórico de demanda aos serviços de saúde e por empregar dados de utilização dos serviços para estimar o uso com base na necessidade de saúde. Este artigo objetivou avaliar a aplicabilidade dessa metodologia para alocação de recursos federais no Brasil. Empregaram-se dados do Sistema de Informações Hospitalares do Sistema Único de Saúde sobre as internações de curta permanência ocorridas no Brasil em 1999. Foram analisadas 134 áreas geográficas, que cobrem o país como um todo. Os modelos estatísticos para estimar o uso testaram as seguintes variáveis de necessidades: mortalidade infantil; mortalidade geral padronizada; percentual de analfabetos; percentual de domicílios permanentes chefiados por mulheres e média de pessoas por domicílio. Todos os modelos de estimativa do uso de testados apresentaram coeficientes de regressão com sinal negativo, o que indica que a metodologia estudada apresenta restrições em contextos com grandes desigualdades sociais no uso de serviços de saúde, como o do Brasil.In the early 1990s, a group of British researchers developed a new methodology for healthcare resource allocation based on need. The methodology's main characteristics are to draw on the theoretical model for healthcare services demand and apply data on health services utilization to estimate needs-based use. The objective of the current study was to assess the applicability of this methodology for allocating Federal resources at the local level in Brazil. Data from all acute hospital admissions in 1999 came from the Inpatient Information System of the Unified National Health System (SUS). The country was divided into 134 geographic areas. The statistical models tested to estimate needs-based use applied the following need variables: infant mortality rate; standardized mortality rate; illiteracy rate; proportion of households headed by women; and mean number of household members. All tested models showed negative regression coefficients, indicating that the methodology is inadequate for resource allocation based on need in places like Brazil with large social inequalities in healthcare utilization.

Physiological aspects were evaluated to determine optimal conditions for the decolorization of a synthetic dye, Poly R-478, by white-rot fungus Trametes versicolor # 52J. The decolorization experiments were carried out in semicontinuous operation during three cycles to improve the process efficiency. The best decolorization efficiencies (65% to 80%) were obtained in fungal cultures performed in nitrogen limited conditions under aerobic conditions.Efluentes industriais altamente coloridos são difíceis de degradar utilizando as tecnologias fisico-químicas e bacterianas existentes atualmente. O sistema enzimático extracelular secretado pelo fungo de podridão branca apresenta um grande potencial oxidativo, capaz de dar início a decomposição das estruturas residuais dos compostos responsáveis pela cor destes efluentes. Aspectos fisiológicos foram avaliados para optimizar as condições de descoloramento de um corante sintético, Poly R-478, pelo fungo de podridão branca Trametes versicolor # 52J. Os experimentos de descoloramento foram realizados em operação semi-contínua durante três ciclos para melhorar a eficiência do processo. As melhores eficiências de descoloramento (65 % a 80%) foram obtidas em culturas de fungos tratadas em condições limitadas de nitrogênio em atmosfera de ar.

The article analyzes the World Health Organization Report for 2000, with emphasis placed on the methodology used to analyze the indicators utilized to compare and classify the performance of the health systems of the 191 member countries. The Report's contribution was the compromise of monitoring the performance of the health systems of member countries, but because of the inconsistent way it was elaborated, and the utilization of questionable scientific evaluation methodologies, the Report fails to give a clear picture. A criterion-based methodology revision is imposed. The main problems in evidence are the choice of individual indicators of disparity in health that discount the population profile, the inadequate control of the impact of social disparities over the performance of the systems, the evaluation of the responsibility of systems that are only partially articulated to the right of the citizens, the lack of data for a great number of countries, consequently having inconsistent estimations, and the lack of transparency in the methodological procedures in the calculation of some indicators. The article suggests a wide methodological revision of the Report.O artigo discute o Relatório da Organização Mundial de Saúde para 2000, com ênfase na análise metodológica dos indicadores utilizados para comparar e classificar o desempenho dos sistemas de saúde dos 191 países membros. O Relatório contribui ao colocar na agenda o compromisso de monitorar o desempenho dos sistemas de saúde dos países membros porém, a forma inconsistente de sua elaboração e a utilização de metodologias de avaliação questionáveis cientificamente, impõem uma criteriosa revisão metodológica. Os principais problemas destacados são a escolha de indicadores individuais de desigualdade em saúde que desconsideram o perfil populacional; o controle inadequado do impacto das desigualdades sociais sobre o desempenho dos sistemas; a avaliação da responsabilidade dos sistemas, apenas parcialmente articulada aos direitos dos cidadãos; a ausência de dados para um grande número de países levando a diversas estimativas pouco consistentes; a falta de transparência nos procedimentos metodológicos para o cálculo de alguns dos indicadores. O artigo sugere uma ampla revisão de caráter metodológico do Relatório.

Introdução: A artrite reumatoide (AR) é uma doença autoimune inflamatória sistêmica de etiologia desconhecida. Modelos animais de artrite são extremamente úteis para o estudo da fisiopatologia da doença e de novas terapias. Objetivo: Considerando a predominância da AR em mulheres e escassez de estudos sobre influência do sexo no desenvolvimento da artrite experimental, o objetivo deste trabalho foi avaliar o impacto do sexo no desenvolvimento clínico da artrite experimental induzida por colágeno do tipo II (CIA). Métodos: Camundongos DBA1J foram divididos em machos e fêmeas, ambos n=6. CIA foi induzida por duas injeções intradérmicas com colágeno no dia zero e 18. Escore clínico da artrite e do edema articular foram avaliados diariamente por 10 dias após o desenvolvimento da doença. Resultados: A evolução do escore clínico não demonstrou diferença entre os machos e fêmeas. O escore clínico avaliado separadamente - patas dianteiras e traseiras, apresentou diferença significativa (p

This study analyzes data from the World Health Survey (WHS) conducted in 2003, with a sample of 5,000 individuals 18 years and older. Some 24.0% of the interviewees had private health insurance, and the main variables associated with private coverage were number of household assets, age, level of education, formal employment, living in municipalities with more than 50,000 inhabitants, and good self-rated health. The socioeconomic profiles of needs for and use of health services in the population covered by private health plans are different, confirming the findings of other studies reporting that this population segment as a whole presents better health conditions and greater use of services as compared to the population without private coverage, even after adjusting for socio-demographic variables and self-rated health. The WHS data also suggest that individuals with private health plans do not always use their insurance to pay for services, except in the case of mammograms.Esse estudo analisa os dados da Pesquisa Mundial de Saúde (PMS), realizada em 2003, em uma amostra de 5 mil indivíduos com 18 anos ou mais. Cerca de 24,0% dos indivíduos entrevistados têm seguro privado de saúde, sendo que os fatores associados à posse do plano são o número de bens, idade, escolaridade, ter emprego formal, residir em municípios com menos de 50 mil habitantes e referir boa auto-avaliação do estado de saúde. Os perfis sócio-demográficos de necessidades e uso de serviços de saúde da população coberta por plano de saúde são distintos, confirmando os achados de outros trabalhos que referem que esse segmento populacional como um todo apresenta melhores condições de saúde e um maior uso de serviços em relação à população não coberta por seguro de saúde, mesmo após o controle por variáveis sócio-demográficas e a auto-avaliação do estado de saúde. Os dados da PMS também sugerem que pessoas cobertas por plano de saúde nem sempre utilizam o plano para pagamento de serviços, excetuando-se o caso da mamografia.

Self-rated health has been used extensively in epidemiologic studies, not only due to its importance per se but also due to the validity established by its association with clinical conditions and with greater risk of subsequent morbidity and mortality. In this study, the socio-demographic determinants of good self-rated health are analyzed using data from the World Health Survey, adapted and carried out in Brazil in 2003. Logistic regression models were used, with age and sex as covariables, and educational level, a household assets index, and work-related indicators as measures of socioeconomic status. Besides the effects of sex and age, with consistently worst health perception among females and among the eldest, the results showed pronounced socioeconomic inequalities. After adjusting for age, among females the factors that contributed most to deterioration of health perception were incomplete education and material hardship; among males, besides material hardship, work related indicators (manual work, unemployment, work retirement or incapable to work) were also important determining factors. Among individuals with long-term illness or disability, the socioeconomic gradient persisted, although of smaller magnitude.A auto-avaliação da saúde vem sendo amplamente utilizada nos estudos epidemiológicos, não só por ser importante por si, mas também pela sua validade, estabelecida por suas relações com as condições clínicas e com o maior risco de morbi-mortalidade subseqüente. Neste trabalho, são analisados os determinantes sócio-demográficos da auto-avaliação de saúde boa, utilizando os dados da Pesquisa Mundial de Saúde, inquérito domiciliar realizado no Brasil, em 2003. Foram utilizados modelos de regressão logística, considerando idade e sexo como co-variáveis, e o grau de instrução, a posse de bens no domicílio e a situação de trabalho como indicadores do nível sócio-econômico. Além das diferenças por sexo e idade, com auto-avaliações consistentemente piores entre as mulheres e entre os mais idosos, os resultados indicaram acentuadas desigualdades sócio-econômicas. Ajustando-se por idade, entre as mulheres, a instrução incompleta e a privação material foram os fatores que mais contribuíram para a pior percepção da saúde; entre os homens, além da privação material, os indicadores relacionados ao trabalho tiveram efeitos importantes. Entre os indivíduos com doença de longa duração ou incapacidade, o gradiente social persistiu, embora em menor magnitude.

RESUMO O rastreamento por intermédio da mamografia é o principal meio de detecção da neoplasia maligna da mama. Considera-se relevante compreender como este tem se dado nas Regiões de Saúde brasileiras, unidade espacial fundamental na atual política de saúde. A análise de indicadores relacionados à cobertura de mamografia das mulheres de 40 a 69 anos, número, distribuição e grau de utilização dos mamógrafos demonstra grandes problemas, que não podem ser simplesmente atribuídos à falta de equipamentos. Destaca-se também a diversidade de situações das Regiões de Saúde e das unidades da federação, caracterizada especialmente pelas melhores condições no Sul e Sudeste e piores nas outras regiões.