Search

Background The scale-up of parenting programmes to support early childhood development (ECD) is poorly understood. Little is known about how and when early interventions are most effective. Sustainability of ECD programming requires a better understanding of the mechanisms of real-world interventions. We examined the effects on caregiving practices of Primeira Infância Melhor (PIM), a state-wide home-visiting programme in Brazil.Methods This propensity score matched, longitudinal, quasiexperimental study uses data from the 2015 Pelotas Birth Cohort. We matched children who received PIM at any age with other cohort children on 25 key covariates. Sensitivity, guidance and responsiveness were assessed using video-recorded play tasks. Coerciveness and the parent–child relationship were assessed using the Parenting and Family Adjustment Scales. All parenting outcomes were examined at age 4 years. Separate moderation analyses were conducted for each effect modifier: family income, child age and duration of participation.Results Out of 4275 children in the cohort, 797 were enrolled in PIM up to age 4 years. 3018 children (70.6%) were included in the analytic sample, of whom 587 received PIM and 2431 were potential controls. We found a positive effect of PIM on responsiveness (β=0.08, 95% CIs 0.002 to 0.16) and sensitivity (β=0.10, 95% CIs 0.02 to 0.19). No effect was found for any secondary outcomes. Moderation analyses revealed a stronger positive effect on sensitivity for low-income parents (β=0.18, 95% CIs 0.03 to 0.34).Conclusion A state-wide, home-visiting programme in Brazil improved aspects of responsive caregiving. Effects were more pronounced for low-income families, suggesting benefits of purposeful targeting.

Objetivo: Revisar a aplicabilidade da Oxigenação por Membrana Extracorpórea (ECMO, do inglês extracorporeal membrane oxygenation) durante os períodos pré, intra e pós-operatório de pacientes submetidos ao transplante de fígado. Metodologia: Trata-se de uma revisão integrativa que buscou avaliar as indicações do uso da ECMO no transplante hepático, assim como suas complicações. Utilizou-se as bases de dados: MEDLINE, Web of Science e Scopus, com artigos publicados nos últimos 10 anos, em inglês e português. Resultados: Nesta revisão foram incluídos 24 trabalhos, dos quais 3 eram artigos originais e 21 eram relatos de caso. Os estudos foram divididos de acordo com o período da aplicação da ECMO em relação ao transplante hepático: 1 em relação ao pré-operatório, 8 ao intraoperatório e 15 no pós-operatório. Identificou-se que o uso da ECMO possui como principal indicação complicações relacionadas à síndrome hepatopulmonar. A quantidade limitada de artigos com uso na ECMO no pré-operatório reflete a importância do transplante hepático como principal medida para manejo das complicações da doença hepática. Na fase intraoperatória, a utilização da ECMO é expressiva no manejo de complicações cardiopulmonares refratárias a intervenções prévias. O uso desse mecanismo no pós-operatório identifica-se como o mais relatado, com principal indicação na hipoxemia grave secundária à síndrome hepatopulmonar em que outros tratamentos foram ineficazes. As principais complicações relacionadas ao uso do dispositivo foram sepse, falência renal e sangramento. Conclusão: A ECMO é uma modalidade terapêutica importante para o manejo de intercorrências provenientes do transplante hepático. Todavia poucos estudos na literatura possuem um número amostral adequado para avaliar sua real eficácia e seu nível de segurança.

Family-based study designs have been applied to resolve confounding by population stratification, dynastic effects and assortative mating in genetic association analyses. Here, Brumpton et al. describe theory and simulations for overcoming such biases in Mendelian randomization through within-family studies.

Gastrointestinal stromal tumors account for the majority of the mesenchymal neoplasms of the gastric antrum, but other entities should also be considered. We present the case of a 70-year-old man with an ulcerated well-circumscribed polypoid submucosal mass in the gastric antrum which was proven to be a glomus tumor. CT showed progressive contrast enhancement. Magnetic resonance imaging showed a high T2 signal intensity and heterogeneous arterial contrast enhancement which became more homogeneous in later phases. We also present the case of a 50-year-old woman with a large polypoid mass occupying half the circumference of the distal gastric antrum that was proven to be a plexiform fibromyxoma. Contrast-enhanced CT and magnetic resonance imaging revealed a pattern of progressive and heterogeneous enhancement. Although gastrointestinal stromal tumors are the most frequent gastric mesenchymal neoplasms, other rare mesenchymal tumors such as glomus tumor and plexiform fibromyxoma may arise in the gastric antrum. Keywords: Gastric antrum, Glomus tumor, Plexiform fibromyxoma

Studies leveraging gene-environment (GxE) interactions within Mendelian randomization (MR) analyses have prompted the emergence of two similar methodologies: MR-GxE and MR-GENIUS. Such methods are attractive in allowing for pleiotropic bias to be corrected when using individual instruments. Specifically, MR-GxE requires an interaction to be explicitly identified, while MR-GENIUS does not. We critically examine the assumptions of MR-GxE and MR-GENIUS in the absence of a pre-defined covariate, and propose sensitivity analyses to evaluate their performance. Finally, we explore the effect of body mass index (BMI) upon systolic blood pressure (SBP) using data from the UK Biobank, finding evidence of a positive effect of BMI on SBP. We find both approaches share similar assumptions, though differences between the approaches lend themselves to differing research settings. Where a suitable gene-by-covariate interaction is observed MR-GxE can produce unbiased causal effect estimates. MR-GENIUS can circumvent the need to identify interactions, but as a consequence relies on either the MR-GxE assumptions holding globally, or additional information with respect to the distribution of pleiotropic effects in the absence of an explicitly defined interaction covariate.

Abstract: This study aims to assess the association between mode of delivery and human capital among young adults enrolled in the 1982 and 1993 Pelotas birth cohorts, Rio Grande do Sul State, Brasil. In 1982 and 1993, the maternity hospitals of the municipality were daily visited, the births identified, and those live births, whose family lived in the urban area of Pelotas, were examined and their mothers interviewed. Information on mode of delivery, vaginal or cesarean, was provided by the mother in the perinatal study. Performance in intelligence tests achieved schooling and income were evaluated in the 30 years visit at the 1982 cohort. At the 1993 cohort, schooling and income were assessed at the 22 years visit, whereas IQ was evaluated at 18 years. Tobacco smoking in adulthood and type of school was used as negative outcomes to strength causal inference. Initially, cesarean section was positively associated with human capital at adulthood, with the exception of income in the 1993 cohort. After controlling for confounders, the magnitude of the associations was strongly reduced, and the regression coefficients were close to the null value. The negative outcome analysis showed that, after controlling for confounding variables, the mode of delivery was not associated with tobacco smoking and type of school. Suggesting that the variables included in the regression model to control for confounding, provided an adequate adjustment and it is unlikely that the results are due to residual confounding by socioeconomic status. On the other hand, considering the short- and long-term risks and the epidemic of cesarean sections, measures should be implemented to reduce its prevalence.

ABSTRACT OBJECTIVE Describing the prevalence of chronic diseases and associated socioeconomic and demographic factors, evaluating the patterns of social distancing and the antibodies prevalence against SARS-CoV-2 and COVID-19 symptoms in carriers and non-carriers of chronic diseases. METHODS Data from 77,075 individuals aged 20 to 59 from three steps of the EPICOVID-19 Brazil (a nationwide serological survey conducted between May and June, 2021) were assessed. The presence of antibodies against SARS-CoV-2 was examined by rapid tests. Self-reported prevalence of hypertension, diabetes, asthma, cancer, chronic kidney disease and heart disease were investigated. The prevalence of mask use, adherence to isolation measures and antibodies were evaluated separately amid carriers and non-carriers of chronic diseases. The prevalence of symptoms was analyzed among carriers and non-carriers of chronic diseases with antibodies. RESULTS The prevalence of at least one chronic disease was 43%, higher in the Southeast region, among white and indigenous individuals, women, less schooled and in lower socioeconomic position. The use of masks when leaving home was similar among carriers and non-carriers of chronic diseases (98%). The proportion of participants who reported adherence to isolation measures was higher amid carriers (15.9%) than non-carriers (24.9%) of chronic diseases. The prevalence of antibodies to SARS-CoV-2 was similar amongst carriers and non-carriers (2.4% and 2.3%). The prevalence of cough, dyspnea, palpitations and myalgia was significantly higher among carriers, but the proportion of symptomatic patients was similar between groups. CONCLUSION The prevalence of chronic diseases in Brazil is high and the COVID-19 pandemic affects carriers and non-carriers of chronic diseases similarly. Carriers present more severe forms of COVID-19 and higher prevalence of symptoms. Greater adherence to social distancing measures among chronic patients is disassociated from a lower incidence of COVID-19 in this group.

Abstract Background We characterised the phenotypic consequence of genetic variation at the PCSK9 locus and compared findings with recent trials of pharmacological inhibitors of PCSK9. Methods Published and individual participant level data (300,000+ participants) were combined to construct a weighted PCSK9 gene-centric score (GS). Seventeen randomized placebo controlled PCSK9 inhibitor trials were included, providing data on 79,578 participants. Results were scaled to a one mmol/L lower LDL-C concentration. Results The PCSK9 GS (comprising 4 SNPs) associations with plasma lipid and apolipoprotein levels were consistent in direction with treatment effects. The GS odds ratio (OR) for myocardial infarction (MI) was 0.53 (95% CI 0.42; 0.68), compared to a PCSK9 inhibitor effect of 0.90 (95% CI 0.86; 0.93). For ischemic stroke ORs were 0.84 (95% CI 0.57; 1.22) for the GS, compared to 0.85 (95% CI 0.78; 0.93) in the drug trials. ORs with type 2 diabetes mellitus (T2DM) were 1.29 (95% CI 1.11; 1.50) for the GS, as compared to 1.00 (95% CI 0.96; 1.04) for incident T2DM in PCSK9 inhibitor trials. No genetic associations were observed for cancer, heart failure, atrial fibrillation, chronic obstructive pulmonary disease, or Alzheimer’s disease – outcomes for which large-scale trial data were unavailable. Conclusions Genetic variation at the PCSK9 locus recapitulates the effects of therapeutic inhibition of PCSK9 on major blood lipid fractions and MI. While indicating an increased risk of T2DM, no other possible safety concerns were shown; although precision was moderate.

Background: Studies on mental disorders prevalence and comorbidity, including suicidality, are scarce in low and middle-income settings. We aimed to describe the pattern of comorbidity between mental disorders and their association with suicidality. Methods: In 1982, all hospital deliveries in Pelotas (Southern Brazil) were identified (n = 5914) and have been prospectively followed. Participants were evaluated for the presence of common mental disorders (CMD) at the ages of 18–19, 23 and 30 years. In 2012–13 (30 years of age), trained psychologists evaluated 3657 individuals for disorders using the Mini International Neuropsychiatric Interview. Results: Prevalence of suicidal wishing, suicidal planning and lifetime suicidal attempt was 4.9%, 3.8% and 6.6%, respectively. Suicidal wishing was most strongly associated with having joint major depressive episode (MD) and lifetime suicidal attempt (OR = 26.4, 95%CI:13.9–50.4) with comorbid MD with mania/hypomania (OR = 21.2, 95%CI:6.93–65.1). Suicidal planning was most strongly associated with having joint MD and lifetime suicidal attempt (OR = 44.7, 95%CI:22.6–88.4), with comorbid MD and social anxiety disorder (OR = 30.6, 95%CI:13.0–72.0), and joint social anxiety disorder with lifetime suicidal attempt (OR = 26.3, 95%CI:8.33–82.7). Independently of other disorders, prospective and cross-sectional measures of CMD were associated with higher rates of suicidality. Limitations: We do not have data on suicide deaths in follow-up and the diagnostic instrument used at 30 years of age was not used in all previous follow-up. Conclusion: MD and social anxiety have independent and combined associations with suicidality, and also with they occur with lifetime suicidal attempt and other mental disorders.

Objetivo: analisar a incidência no financiamento (FIA, em inglês), tanto estrutural como efetiva, das fontes de financiamento da saúde, encontradas na Pesquisa de Orçamentos Familiares (POF) de 2008/2009 e a distribuição dessas contribuições na população segundo seu poder de consumo. Metodologia: foram utilizados os dados da Pesquisa de Orçamentos Familiares de 2008/2009 como fonte de dados, de onde foram obtidas as fontes de financiamento (públicas e privadas) do sistema de saúde no Brasil. Essas fontes foram analisadas em referência ao poder de consumo per capita da população para avaliar a progressividade, regressividade ou proporcionalidade delas, mediante o uso de índices de concentração, Gini e Kakwani. Para isso, o estudo usou o pacote estatístico Stata 12 e o programa estatístico ADePT do Banco Mundial. Resultados: os pagamentos diretos em saúde mantiveram uma distribuição regressiva, enquanto os pagamentos com planos de saúde e impostos diretos foram progressivos e proporcionais, respetivamente. A consolidação das três fontes de financiamento foi avaliada como proporcional, por ter um índice de Kakwani de -0,0349. O índice de Gini demonstrou que os gastos feitos com saúde são ainda menos equitativos (0,609) que a distribuição geral dos recursos (0,598) dentre a população. Conclusões: o orçamento público não é suficiente para suprir todas as necessidades do SUS e as contribuições das fontes de financiamento não são progressivas, e essa é uma das possíveis causas do aumento da pobreza e das catástrofes financeiras da população brasileira.

Project portfolio management has been studied through diverse aspects. Different approaches have been used to improve project portfolio selection, but not all of them have been actually used. This study presents an artifact to improve project portfolio selection process in universities. The artifact considers strategic alignment and focuses on achieving consensus, considering university characteristics about strategic planning and decision making environment. The artifact was developed through an incremental approach using quasi-experiments in simulated situations to check and improve the accuracy of the solutions being developed. Finally, the artifact was implemented in a real situation inside a university, involving 185 projects, 15 criteria, and 12 people from different faculties and knowledge areas. Results show that the artifact is suitable to the university environment. Beyond the artifact itself and some highlights involving its development process, the multicriteria constructivist approach, the balanced scorecard, and the scoring technique, another contribution is an adapted AHP tool created to integrate traditional AHP from Saaty (1980) and a study from Bose (2015) to reduce cognitive conflict in group decision making. Other studies, in more diverse contexts, still need to be done, but the proposal seems to be promised.

Pulmonary function is influenced by environmental factors, lifestyle, and genetics. Here, in a multiethnic GWAS meta-analysis for pulmonary function traits, the authors identify over 50 additional genetic loci, a subset of which are specific for European, African, Asian, or Hispanic/Latino ancestry.

O presente artigo busca verificar a instrumentalidade do tema da saúde para a participação ativa e propositiva do Brasil na política internacional entre 1995 e 2010. O tema provocava discussões complexas, constantes e marcantes em diversos fóruns globais nesse período, quando os governos de Fernando Henrique Cardoso e Luiz Inácio Lula da Silva buscavam uma atuação internacional relevante e influente. Seus governos divergiam sobre as responsabilidades e oportunidades do Brasil no sistema internacional, mas compartilhavam o objetivo de assumir posição de influência na política internacional. Na busca estratégica por credibilidade, no período FHC, e por autonomia, no período Lula da Silva, o país assumia uma espécie de dever global, que seria realizado por meio de diversas parcerias internacionais e pela participação em instituições globais de relevo. Nesse esforço, parecia necessário formalizar o tratamento do tema da saúde na agenda da política externa brasileira, o que ocorreria em um processo de institucionalização que implicou, entre 1995 e 2010, a adoção de mudanças no nível político-administrativo dos ministérios das Relações Exteriores e da Saúde e em menções crescentes ao tema da saúde nos discursos das autoridades brasileiras nos fóruns internacionais.

Background: Breastfeeding is associated with short and long-term health benefits. Long-term effects might be mediated by epigenetic mechanisms, yet the literature on this topic is scarce. We performed the first epigenome-wide association study of infant feeding, comparing breastfed vs non-breastfed children. We measured DNA methylation in children from peripheral blood collected in childhood (age 7 years, N = 640) and adolescence (age 15–17 years, N = 709) within the Accessible Resource for Integrated Epigenomic Studies (ARIES) project, part of the larger Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Cord blood methylation (N = 702) was used as a negative control for potential pre-natal residual confounding. Results: Two differentially-methylated sites presented directionally-consistent associations with breastfeeding at ages 7 and 15–17 years, but not at birth. Twelve differentially-methylated regions in relation to breastfeeding were identified, and for three of them there was evidence of directional concordance between ages 7 and 15–17 years, but not between birth and age 7 years. Conclusions: Our findings indicate that DNA methylation in childhood and adolescence may be predicted by breastfeeding, but further studies with sufficiently large samples for replication are required to identify robust associations.

Purpose To report long-term results of the Argus T adjustable system for treatment of post-prostatectomy urinary incontinence (PPI). Materials and Methods From October 2007 to August 2008, 37 patients with PPI were included in a prospective, single-arm, multicenter trial of treatment with the Argus T adjustable system (Promedon, Argentina). Preoperative evaluation included urine culture, urethrocystoscopy, urodynamic testing, 24-h pad weight test (PWT) and quality of life questionnaires. Patients were stratified according to baseline degree of incontinence (mild–moderate or severe). Postoperative evaluation included immediate PWT, quality of life questionnaires and daily use of pads at 1, 12 and 30 months. Results and Conclusions One patient was lost to follow-up. At the 30-month follow-up, 24/31 patients (77%) were dry, 3/31 (10%) improved and 4/31 (13%) were failures. In particular, in the mild-moderate group, 8/8 (100%) patients were dry. In the severe group, 20/28 patients (71%) were dry, 3/28 (11%) improved and 5/28 (18%) were failures. Median visual analogue scale (VAS) scores dropped from 9 (4-10) to 0.5 (0-10) and International Consultation on Incontinence Questionnaire Short Form scores from (ICIQ-SF) 19 (12–21) to 1 (0–10). Retrograde leak point pressure increased from 18 (5–29) to 35 (22–45) cm H2O after intraoperative adjustment. Complications included immediate postoperative infection in 2/36 patients (6%) and transient inguinal and/or perineal pain in 22/36 patients (61%). Argus T has a long-term high success rate (86% cure + improvement at the 30-month follow-up). Good outcomes were achieved even in severe incontinence cases and maintained for over 30 months.

[This corrects the article DOI: 10.1371/journal.pone.0173070.].

BACKGROUND:Breastfeeding benefits both infants and mothers. Recent research shows long-term health and human capital benefits among individuals who were breastfed. Epigenetic mechanisms have been suggested as potential mediators of the effects of early-life exposures on later health outcomes. We reviewed the literature on the potential effects of breastfeeding on DNA methylation. METHODS:Studies reporting original results and evaluating DNA methylation differences according to breastfeeding/breast milk groups (e.g., ever vs. never comparisons, different categories of breastfeeding duration, etc) were eligible. Six databases were searched simultaneously using Ovid, and the resulting studies were evaluated independently by two reviewers. RESULTS:Seven eligible studies were identified. Five were conducted in humans. Studies were heterogeneous regarding sample selection, age, target methylation regions, methylation measurement and breastfeeding categorisation. Collectively, the studies suggest that breastfeeding might be negatively associated with promoter methylation of LEP (which encodes an anorexigenic hormone), CDKN2A (involved in tumour suppression) and Slc2a4 genes (which encodes an insulin-related glucose transporter) and positively with promoter methylation of the Nyp (which encodes an orexigenic neuropeptide) gene, as well as influence global methylation patterns and modulate epigenetic effects of some genetic variants. CONCLUSIONS:The findings from our systematic review are far from conclusive due to the small number of studies and their inherent limitations. Further studies are required to understand the actual potential role of epigenetics in the associations of breastfeeding with later health outcomes. Suggestions for future investigations, focusing on epigenome-wide association studies, are provided.

With the development of synchronized phasor measurement technology in recent years, it gains great interest the use of PMU measurements to improve state estimation performances due to their synchronized characteristics and high data transmission speed. The ability of the Phasor Measurement Units (PMU) to directly measure the system state is a key over SCADA measurement system. PMU measurements are superior to the conventional SCADA measurements in terms of resolution and accuracy. Since the majority of measurements in existing estimators are from conventional SCADA measurement system, it is hard to be fully replaced by PMUs in the near future so state estimators including both phasor and conventional SCADA measurements are being considered. In this paper, a mixed measurement (SCADA and PMU measurements) state estimator is proposed. Several useful measures for evaluating various aspects of the performance of the mixed measurement state estimator are proposed and explained. State Estimator validity, performance and characteristics of the results on IEEE 14 bus test system and IEEE 30 bus test system are presented.

As propriedades hidráulicas apresentam uma grande variabilidade espacial devido à heterogeneidade do solo, sendo a textura um dos factores determinantes dessa heterogeneidade. Neste trabalho estudou-se a variabilidade da curva de retenção de água, θ(h), e da curva da condutividade hidráulica, K(h), determinadas em solos de texturas diferentes e correspondentes a 11 das 12 classes texturais do diagrama triangular de Gomes e Silva (1962). Com base em 558 curvas θ(h) e em 245 curvas K(h), obtidas a partir de amostras não perturbadas e incluídas na base de dados PROPSOLO da Estação Agronómica Nacional, indicam-se, para cada classe, os valores médios, o desvio padrão, os valores máximos e mínimos de cada parâmetro do modelo de Mualem-van Genuchten. Indica-se ainda uma função θ(h) e K(h) média para cada classe textural.Soil texture influences significantly soil hydraulic properties, which due to soil heterogeneity normally present large spatial variability. The variability of soil retention θ(h), and hydraulic conductivity K(h) curves, in 11 of the 12 texture classes of the diagram of Gomes e Silva (1962) was studied. For each textural class, average, maximum, minimum, and the standard deviation values for the Mualem van Genuchten parameters are presented based on 558 θ(h) and 245 K(h) curves determined in undisturbed soil samples which are included in the PROPSOLO database of Estação Agronómica Nacional. An average function describing θ(h) and K(h) in each textural class is also presented.

Avaliou-se o efeito das combinações de quatro níveis diferenciados de N com três níveis de NaCl, veiculados ao solo pela água de rega, nas concentrações foliares de N, P, K, Ca, Mg e Na em sorgo sacarino (Sorghum bicolor ssp. saccharatum), em dois anos consecutivos de um ensaio instalado num Fluvissolo Êutrico, em Alvalade-Sado, provido de um sistema de rega gota-a-gota ("Fonte tripla linear"). Pesquisaram-se relações entre os teores foliares dos nutrientes e a produção de matéria seca (caules, folhas + panículas e total) e entre níveis de N e de NaCl e teores foliares médios de nutrientes. Foi a disponibilidade do azoto no solo que, mais do que a salinidade, afetou a absorção de nutrientes, com reflexo nos teores foliares e na produção. O teor foliar de N foi o melhor indicador na previsão da produção de caules do sorgo sacarino.We evaluated the influence of the combinations of four N levels with three NaCl levels, applied through irrigation, on leaf N, P, K, Ca, Mg, and Na concentrations of sweet sorghum (Sorghum bicolor ssp. saccharatum), in two consecutive years of an experiment established on a Eutric Fluvisol in Alvalade-Sado region, equipped with a drip irrigation system ("Triple Linear Source"). The relationships between leaf nutrient concentrations and dry matter production (stems, leaves, and aerial biomass), and between N and NaCl levels and the leaf nutrient concentrations were also searched. It was nitrogen availability in soil that, more than salinity, affected nutrient uptake, with reflexes on the leaf concentrations and the yields. Leaf N concentration was the best indicator for predicting the stems production of sweet sorghum.

To investigate the associations of TP53 R72P and MDM2 T309G SNPs with HPV infection status, HPV oncogenic risk and HIV infection status.Cross-sectional study combining two groups (150 HIV-negative and 100 HIV-positive) of women.Data was collected using a closed questionnaire. DNA was extracted from cervical samples. HPV infection status was determined by nested-PCR, and HPV oncogenic risk group by Sanger sequencing. Both SNPS were genotyped by PCR-RFLP. Crude and adjusted associations involving each exposure (R72P and T309G SNPs, as well as 13 models of epistasis) and each outcome (HPV status, HPV oncogenic risk group and HIV infection) were assessed using logistic regression.R72P SNP was protectively associated with HPV status (overdominant model), as well as T309G SNP with HPV oncogenic risk (strongest in the overdominant model). No epistatic model was associated with HPV status, but a dominant (R72P over T309G) protective epistatic effect was observed for HPV oncogenic risk. HIV status was strongly associated (risk factor) with different epistatic models, especially in models based on a visual inspection of the results. Moreover, HIV status was evidenced to be an effect mediator of the associations involving HPV oncogenic risk.We found evidence for a role of R72P and T309G SNPs in HPV status and HPV oncogenic risk (respectively), and strong associations were found for an epistatic effect in HIV status. Prospective studies in larger samples are warranted to validate our findings, which point to a novel role of these SNPs in HIV infection.

OBJETIVO: A cirurgia de sling pubovaginal é utilizada no tratamento da incontinência urinária de esforço (IUE) do tipo III e como resgate na falha de procedimentos anteriores. Tem índice de sucesso variando de 73 a 89%. Podem ser utilizados diversos materiais autólogos e sintéticos com semelhantes resultados. Nosso objetivo foi comparar o sling de parede vaginal com o de fáscia do reto abdominal quanto à eficácia e às complicações. MÉTODO: Foram estudadas 27 pacientes no período de 04/98 a 09/00, divididas em dois grupos: grupo I com nove pacientes submetidas a sling de parede vaginal; grupo II com 18 pacientes submetidas a sling de fáscia do reto abdominal. Todas foram submetidas a um estudo urodinâmico completo, classificadas quanto ao tipo de IUE, e seguidas no ambulatório de urologia. RESULTADOS: grupo I com média de idade de 51,4 anos, tempo de seguimento médio de 14,3 meses. Pressão de Perda aos Esforços (PPE) variando de 50 a 100cmH2O com média de 81,1cmH2O. Houve 66% de complicações. Taxa de sucesso de 88,8% e índice de satisfação 85 pontos. Grupo II com média de idade de 54,2 anos, seguimento médio de 19,3 meses. PPE variando de 45 a 92cmH2O, média de 65,5cmH2O. Houve 72% de complicações e sucesso de 88,8%. Índice de satisfação de 74 pontos. CONCLUSÕES: Os dados encontrados estão de acordo com a literatura, sendo os dois grupos comparáveis quanto à eficácia em período curto de seguimento. O grupo II apresentou maior número de complicações, assim como maior tempo de cateter vesical e menor índice de satisfação geral.

Resumo A entrevista aborda os percursos que ligam as ciências sociais à saúde a partir da trajetória do sociólogo Luiz Antonio de Castro Santos. Participante ativo do processo de integração desses campos, Castro Santos contempla alguns dos desafios enfrentados em sua trajetória profissional como forma de abordar aproximações que nem sempre se revelaram desprovidas de tensões. Conversa rica em fatos e processos, Castro Santos situa alguns dos principais personagens e marcos de uma trajetória que trouxe contribuições tanto para as ciências sociais e a história como, principalmente, para as ciências da saúde.

ABSTRACT OBJECTIVE To evaluate the prevalence of reports of symptoms of COVID-19 among individuals with and without antibodies and identify those with greater capability to predict the presence of antibodies against SARS-CoV-2. METHODS The study uses data collected in phases 5 to 8 of Epicovid-19-RS. The presence of antibodies against SARS-CoV-2 was evaluated by a rapid test. The occurrence of cough, fever, palpitations, sore throat, difficulty breathing, changes in taste and smell, vomiting, diarrhea, body pain, shaking, and headache since March 2020 was also evaluated. Then, the capability to predict the evaluated symptoms concerning the presence of antibodies was calculated. RESULTS A total of 18,000 individuals were interviewed and 181 had antibodies against COVID-19 in phases 5 to 8. The proportion of asymptomatic individuals was 19.9% among participants with antibodies and 49.7% among those without antibodies. All symptoms were reported more frequently by individuals with antibodies. The division of the prevalence of symptoms among individuals with antibodies by the prevalence among individuals without antibodies showed the following prevalence ratios: for changes in smell or taste (9.1), fever (4.2), tremors (3.9), breathing difficulty (3.2) and cough (2.8 times). Anosmia and fever were the symptoms with a greater capability to predict the presence of antibodies. CONCLUSION The prevalence of symptoms was higher among individuals with antibodies against SARS-CoV-2. The proportion of asymptomatic individuals was low. Altered smell or taste and fever were the symptoms that most predict the presence of antibodies. These results can help to identify probable cases, contributing to the clinical diagnosis and screening of patients for testing and isolation guidance in positive cases, especially in scenarios of the scarcity of diagnostic COVID-19 tests.

Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01–1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated. [ABSTRACT FROM AUTHOR]

Background: Instrumental variables (IVs) can be used to provide evidence as to whether a treatment X has a causal effect on an outcome Y. Even if the instrument Z satisfies the three core IV assumptions of relevance, independence, and exclusion restriction, further assumptions are required to identify the average causal effect (ACE) of X on Y. Sufficient assumptions for this include homogeneity in the causal effect of X on Y ; homogeneity in the association of Z with X ; and no effect modification. Methods: We describe the no simultaneous heterogeneity assumption, which requires the heterogeneity in the X - Y causal effect to be mean independent of (i.e., uncorrelated with) both Z and heterogeneity in the Z - X association. This happens, for example, if there are no common modifiers of the X - Y effect and the Z - X association, and the X - Y effect is additive linear. We illustrate the assumption of no simultaneous heterogeneity using simulations and by re-examining selected published studies. Results: Under no simultaneous heterogeneity, the Wald estimand equals the ACE even if both homogeneity assumptions and no effect modification (which we demonstrate to be special cases of—and therefore stronger than—no simultaneous heterogeneity) are violated. Conclusions: The assumption of no simultaneous heterogeneity is sufficient for identifying the ACE using IVs. Since this assumption is weaker than existing assumptions for ACE identification, doing so may be more plausible than previously anticipated. [ABSTRACT FROM AUTHOR]

The article discusses the use of instrumental variable (IV) analysis in research design, which allows for valid causal conclusions even in the presence of confounding or reverse causation. The analysis requires that the IV satisfies three conditions: relevance, independence or exchangeability, and exclusion restriction. The authors argue that empirical evidence should be provided to support the assumptions of IV analysis, and they critique a recent study that used distance to a cycle path as the IV for the relationship between cycle commuting and mental ill-health. They highlight the lack of theoretical justification and limited evidence for the independence assumption in the study. The authors recommend additional analyses and a comprehensive assessment of the plausibility of the assumptions. The article was written by Fernando Pires Hartwig and George Davey Smith and is supported by the Medical Research Council and the University of Bristol. [Extracted from the article]

Copyright of Brazilian Journal of Transplantation is the property of Brazilian Journal of Transplantation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Interpreting instrumental variable results often requires further assumptions in addition to the core assumptions of relevance, independence, and the exclusion restriction.Methods: We assess whether instrument-exposure additive homogeneity renders the Wald estimand equal to the average derivative effect (ADE) in the case of a binary instrument and a continuous exposure.Results: Instrument-exposure additive homogeneity is insufficient for ADE identification when the instrument is binary, the exposure is continuous, and the effect of the exposure on the outcome is nonlinear on the additive scale. For a binary exposure, the exposure-outcome effect is necessarily additive linear, so the homogeneity condition is sufficient.Conclusions: For binary instruments, instrument-exposure additive homogeneity identifies the ADE if the exposure is also binary. Otherwise, additional assumptions (such as additive linearity of the exposure-outcome effect) are required. [ABSTRACT FROM AUTHOR]

Since their discovery in the 1970s, purinergic receptors have been shown to play key roles in a wide variety of biologic systems and cell types. In the immune system, purinergic receptors participate in innate immunity and in the modulation of the adaptive immune response. In particular, P2 receptors, which respond to extracellular nucleotides, are widely expressed on leukocytes, causing the release of cytokines and chemokines and the formation of inflammatory mediators, and inducing phagocytosis, degranulation, and cell death. The activity of these receptors is regulated by ectonucleotidases—expressed in these same cell types—which regulate the availability of nucleotides in the extracellular environment. In this article, we review the characteristics of the main purinergic receptor subtypes present in the immune system, focusing on the P2 family. In addition, we describe the physiologic roles of the P2 receptors already identified in leukocytes and how they can positively or negatively modulate the development of infectious diseases, inflammation, and pain. [ABSTRACT FROM AUTHOR]

Studies leveraging gene-environment (GxE) interactions within Mendelian randomization (MR) analyses have prompted the emergence of two similar methodologies: MR-GxE and MR-GENIUS. Such methods are attractive in allowing for pleiotropic bias to be corrected when using individual instruments. Specifically, MR-GxE requires an interaction to be explicitly identified, while MR-GENIUS does not. We critically examine the assumptions of MR-GxE and MR-GENIUS in the absence of a pre-defined covariate, and propose sensitivity analyses to evaluate their performance. Finally, we explore the effect of body mass index (BMI) upon systolic blood pressure (SBP) using data from the UK Biobank, finding evidence of a positive effect of BMI on SBP. We find both approaches share similar assumptions, though differences between the approaches lend themselves to differing research settings. Where a suitable gene-by-covariate interaction is observed MR-GxE can produce unbiased causal effect estimates. MR-GENIUS can circumvent the need to identify interactions, but as a consequence relies on either the MR-GxE assumptions holding globally, or additional information with respect to the distribution of pleiotropic effects in the absence of an explicitly defined interaction covariate. [ABSTRACT FROM AUTHOR]

Background: Two-sample Mendelian randomization (MR) allows the use of freely accessible summary association results from genome-wide association studies (GWAS) to estimate causal effects of modifiable exposures on outcomes. Some GWAS adjust for heritable covariables in an attempt to estimate direct effects of genetic variants on the trait of interest. One, both or neither of the exposure GWAS and outcome GWAS may have been adjusted for covariables.Methods: We performed a simulation study comprising different scenarios that could motivate covariable adjustment in a GWAS and analysed real data to assess the influence of using covariable-adjusted summary association results in two-sample MR.Results: In the absence of residual confounding between exposure and covariable, between exposure and outcome, and between covariable and outcome, using covariable-adjusted summary associations for two-sample MR eliminated bias due to horizontal pleiotropy. However, covariable adjustment led to bias in the presence of residual confounding (especially between the covariable and the outcome), even in the absence of horizontal pleiotropy (when the genetic variants would be valid instruments without covariable adjustment). In an analysis using real data from the Genetic Investigation of ANthropometric Traits (GIANT) consortium and UK Biobank, the causal effect estimate of waist circumference on blood pressure changed direction upon adjustment of waist circumference for body mass index.Conclusions: Our findings indicate that using covariable-adjusted summary associations in MR should generally be avoided. When that is not possible, careful consideration of the causal relationships underlying the data (including potentially unmeasured confounders) is required to direct sensitivity analyses and interpret results with appropriate caution. [ABSTRACT FROM AUTHOR]

Objective: We aimed at evaluating the association of maternal pre-pregnancy nutritional status with offspring anthropometry and body composition. We also evaluated whether these associations were modified by gender, diet and physical activity and mediated by birth weight.Design: Birth cohort study.Setting: Waist circumference was measured with an inextensible tape, and fat and lean mass were measured using dual-energy X-ray absorptiometry. Multiple linear regression was used to adjust for possible confounders and allele score of BMI. We carried out mediation analysis using G-formula.Participants: In 1982, 1993 and 2004, all maternity hospitals in Pelotas (South Brazil) were visited daily and all live births whose families lived in the urban area of the city were evaluated. These subjects have been followed up at different ages.Results: Offspring of obese mothers had on average higher BMI, waist circumference and fat mass index than those of normal weight mothers, and these differences were higher among daughters. The magnitudes of the association were similar in the cohorts, except for height, where the association pattern was not clear. In the 1982 cohort, further adjustment for a BMI allele score had no material influence on the magnitude of the associations. Mediation analyses showed that birth weight captured part of this association.Conclusions: Our findings suggest that maternal pre-pregnancy nutritional status is positively associated with offspring BMI and adiposity in offspring. And this association is higher among daughters whose mother was overweight or obese and, birth weight explains part of this association. [ABSTRACT FROM AUTHOR]

Estimates from Mendelian randomization studies of unrelated individuals can be biased due to uncontrolled confounding from familial effects. Here we describe methods for within-family Mendelian randomization analyses and use simulation studies to show that family-based analyses can reduce such biases. We illustrate empirically how familial effects can affect estimates using data from 61,008 siblings from the Nord-Trøndelag Health Study and UK Biobank and replicated our findings using 222,368 siblings from 23andMe. Both Mendelian randomization estimates using unrelated individuals and within family methods reproduced established effects of lower BMI reducing risk of diabetes and high blood pressure. However, while Mendelian randomization estimates from samples of unrelated individuals suggested that taller height and lower BMI increase educational attainment, these effects were strongly attenuated in within-family Mendelian randomization analyses. Our findings indicate the necessity of controlling for population structure and familial effects in Mendelian randomization studies. Family-based study designs have been applied to resolve confounding by population stratification, dynastic effects and assortative mating in genetic association analyses. Here, Brumpton et al. describe theory and simulations for overcoming such biases in Mendelian randomization through within-family studies. [ABSTRACT FROM AUTHOR]

Background: We characterised the phenotypic consequence of genetic variation at the PCSK9 locus and compared findings with recent trials of pharmacological inhibitors of PCSK9.Methods: Published and individual participant level data (300,000+ participants) were combined to construct a weighted PCSK9 gene-centric score (GS). Seventeen randomized placebo controlled PCSK9 inhibitor trials were included, providing data on 79,578 participants. Results were scaled to a one mmol/L lower LDL-C concentration.Results: The PCSK9 GS (comprising 4 SNPs) associations with plasma lipid and apolipoprotein levels were consistent in direction with treatment effects. The GS odds ratio (OR) for myocardial infarction (MI) was 0.53 (95% CI 0.42; 0.68), compared to a PCSK9 inhibitor effect of 0.90 (95% CI 0.86; 0.93). For ischemic stroke ORs were 0.84 (95% CI 0.57; 1.22) for the GS, compared to 0.85 (95% CI 0.78; 0.93) in the drug trials. ORs with type 2 diabetes mellitus (T2DM) were 1.29 (95% CI 1.11; 1.50) for the GS, as compared to 1.00 (95% CI 0.96; 1.04) for incident T2DM in PCSK9 inhibitor trials. No genetic associations were observed for cancer, heart failure, atrial fibrillation, chronic obstructive pulmonary disease, or Alzheimer's disease - outcomes for which large-scale trial data were unavailable.Conclusions: Genetic variation at the PCSK9 locus recapitulates the effects of therapeutic inhibition of PCSK9 on major blood lipid fractions and MI. While indicating an increased risk of T2DM, no other possible safety concerns were shown; although precision was moderate. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Salud Pública is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Accumulating evidence suggests that breastfeeding benefits children's intelligence, possibly due to long-chain polyunsaturated fatty acids (LC-PUFAs) present in breast milk. Under a nutritional adequacy hypothesis, an interaction between breastfeeding and genetic variants associated with endogenous LC-PUFAs synthesis might be expected. However, the literature on this topic is controversial.Methods: We investigated this gene × environment interaction through a collaborative effort. The primary analysis involved >12 000 individuals and used ever breastfeeding, FADS2 polymorphisms rs174575 and rs1535 coded assuming a recessive effect of the G allele, and intelligence quotient (IQ) in Z scores.Results: There was no strong evidence of interaction, with pooled covariate-adjusted interaction coefficients (i.e. difference between genetic groups of the difference in IQ Z scores comparing ever with never breastfed individuals) of 0.12[(95% confidence interval (CI): -0.19; 0.43] and 0.06 (95% CI: -0.16; 0.27) for the rs174575 and rs1535 variants, respectively. Secondary analyses corroborated these results. In studies with ≥5.85 and <5.85 months of breastfeeding duration, pooled estimates for the rs174575 variant were 0.50 (95% CI: -0.06; 1.06) and 0.14 (95% CI: -0.10; 0.38), respectively, and 0.27 (95% CI: -0.28; 0.82) and -0.01 (95% CI: -0.19; 0.16) for the rs1535 variant.Conclusions: Our findings did not support an interaction between ever breastfeeding and FADS2 polymorphisms. However, subgroup analysis suggested that breastfeeding may supply LC-PUFAs requirements for cognitive development if breastfeeding lasts for some (currently unknown) time. Future studies in large individual-level datasets would allow properly powered subgroup analyses and further improve our understanding on the breastfeeding × FADS2 interaction. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the lethal potential of macrophages infected with Staphylococcus aureus after PACT (Photochemical Antimicrobial Chemotherapy) using phenothiazine derivatives (a solution containing 1:1 methylene blue and O toluidine blue) and laser (660 nm, 40 mW, 60 s, 12 J/cm 2 ) or LED (632 ± 2 nm, 145 mW, 40 s, 12 J/cm 2 ). Six experimental groups were evaluated: Control Group (untreated); Photosensitizer group (phenothiazines – 12.5 μg/mL); Laser Group; LED Group; Laser PACT Group; and LED PACT Group. The pre-irradiation time used in this study was 5 min. Macrophages and bacteria were cultured in specific culture media and/or allowed interaction between the cell types. Subsequently, tests were carried out to evaluate microbial proliferation, ROS production by macrophages and survival capacity of S. aureus after phagocytosis. Fluorescence microscopy assays were performed with the H 2 DCFDA probe, after PACT, at the initial time (0 h), 4-h and 12-h. The tests were performed in triplicate and the statistical test used was ANOVA with Tukey post-test. After PACT, a statistically significant difference (p > 0.0001) was observed between the microbial growth of the control group and the PACTs groups. Laser PACT and LED PACT groups presented, respectively, reductions of 84.2% and 81.5% when compared to control and 53.3% and 46% when compared to the photosensitizer group. It is concluded that the therapeutic protocols presented in this study increased the phagocytic capacity, the response rate of the phagocytes and the consequent reduction of the numbers of S. aureus for both PACT protocols, however the increase in ROS production was only observed in the group irradiated with Laser light. [ABSTRACT FROM AUTHOR]

GeoGebra software has an interface that enables the simultaneous operation of two types of representation of function records, algebraic and graphic. This possibility of exploring two types of records matches the idea of the Theory of Semiotics Representation Registers (TRRS), handling and coordination of at least two representations of the same mathematical object, defended by Raymond Duval. Thus, this article aims to understand how the use of GeoGebra software can help high school students in learning exponential function through mobilization, manipulation and coordination of semiotic representations during an interventional activity. Therefore, an intervention instrument composed of seven activities which included the study of the exponential function based on TRRS. The instrument was administered to a group of students first year of high school from public school located in the extreme south of Bahia. The analysis of this instrument was qualitative and revealed that the GeoGebra software can assist students in learning exponential function, since the answers given by the students in the activities indicated that most of the students responded assertively, building knowledge about the mathematical object under study through mobilization, manipulation and coordination of representations and exploitation properties of studied function. [ABSTRACT FROM AUTHOR]