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Introduction: Post-COVID-19 condition, or syndrome, also known as long COVID, is an infection-associated chronic condition that can develop after a SARS-CoV-2 infection and last at least 3 months to years. Despite representing a high burden for the Unified Health System (SUS), which has affected millions of Brazilians, it has received limited attention in Brazil. Prevalence studies to date have failed to include a broad representation of the population, and there has been insufficient exploration of the impact on people's lives and the burden of and barriers to accessing health services. This article presents the research protocol for the quantitative component of a mixed methods project to produce evidence to inform SUS's provision of care for long COVID. The protocol was designed to study long COVID in SUS patients hospitalised for COVID-19 in a large city in Southeast Brazil to capture symptoms and factors associated with the syndrome, effects on quality of life and employment, health needs, use of health services and barriers to accessing necessary healthcare., Methods and Analysis: An ambidirectional cohort study to capture data retrospectively and prospectively from adults previously discharged from SUS hospitals for COVID-19. The study involves up to two telephone surveys with the patients or proxies selected from a sampling plan for population estimates. Survey questions include baseline and follow-up data on demographic, socioeconomic, comorbidities, work status, health-related quality of life, vaccination status, long COVID symptoms, healthcare needs, use and barriers to access. Descriptive and appropriate multivariable analyses will be employed., Ethics and Dissemination: The project was approved by the Research Ethics Committees of participant institutions and by the Brazilian National Research Ethics Commission. All participants provided verbal consent. We plan to publish articles in scientific journals and multimedia resources for SUS professionals and the general population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Nuts consumption is related to cardioprotective effects on primary cardiovascular prevention, but studies conducted in secondary prevention are small, scarce and controversial. The objective of this trial was to evaluate the effects of a regional and sustainable cardioprotective diet added or not with an affordable mixed nuts on cardiometabolic features in patients with previous myocardial infarction., Methods: DICA-NUTS study is a national, multi-center, and superiority-parallel randomized clinical trial. Males and females over 40 years old diagnosed with previous myocardial infarction in the last 2 to 6 months were included. Patients were allocated into two groups: the Brazilian Cardioprotective diet (DICA Br) supplemented with 30 g/day of mixed nuts (10 g of peanuts; 10 g of cashew; 10 g of Brazil nuts) (intervention group, n = 193); or only DICA Br prescription (control group, n = 195). The primary outcome was low-density lipoprotein cholesterol means (in mg/dL) after 16 weeks. Secondary outcomes were other lipid biomarkers, glycemic and anthropometric data and diet quality., Results: After adjustment for baseline values, participating study site, time since myocardial infarction and statin treatment regimen (high potency, moderate and low potency/no statins), no significant difference was found between the groups in low-density lipoprotein cholesterol concentrations (intervention-control difference: 3.48 mg/dL [-3.45 to 10.41], P = 0.32). Both groups improved their overall diet quality at the end of the study without differences between them after 16 weeks (intervention-control difference: 1.05 (-0.9 to 2.99); P = 0.29). Other lipids, glycemic profile and anthropometrics were also not different between study groups at the end of the study., Conclusion: Adding 30 g/day of mixed nuts to the DICA Br for 16 weeks did not change lipid, glycemic and anthropometric features in the post-myocardial infarction setting., Trial Registration: This study is registered on ClinicalTrials.gov website under number NCT03728127 and its World Health Organization Universal Trial Number (WHO-UTN) is U1111-1259-8105., (© 2024. The Author(s).)

The aim of this study was to develop a material capable of rapidly absorbing bodily fluids and forming a resilient, adhesive, viscoelastic hydrogel in situ to prevent post-surgical adhesions. This material was formulated using O-carboxymethyl chitosan (O-CMCS), oxidized hyaluronic acid (OHA), and a crosslinking pigment derived from genipin and glutamic acid (G/GluP). Both crosslinked (O-CMCS/OHA-G/GluP) and non-crosslinked hydrogels (O-CMCS/OHA) were evaluated using a HAAKE™ MARS™ rheometer for their potential as post-surgical barriers. A rheological analysis, including dynamic oscillatory measurements, revealed that the crosslinked hydrogels exhibited significantly higher elastic moduli ( G '), indicating superior gel formation and mechanical stability compared to non-crosslinked hydrogels. The G/GluP crosslinker enhanced gel stability by increasing the separation between G ' and G ″ and achieving a lower loss tangent (tan δ < 1.0), indicating robustness under dynamic physiological conditions. The rapid hydration and gelation properties of the hydrogels underscore their effectiveness as physical barriers. Furthermore, the O-CMCS/OHA-G/GluP hydrogel demonstrated rapid self-healing and efficient application via spraying or spreading, with tissue adherence and viscoelasticity to facilitate movement between tissues and organs, effectively preventing adhesions. Additionally, the hydrogel proved to be both cost effective and scalable, highlighting its potential for clinical applications aimed at preventing post-surgical adhesions.

Background: Achieving nutritional goals established by scientific societies is a constant challenge and not always achieved., Objective: To investigate the dietary adequacy of individuals with cardiovascular disease (CVD), participants in the Cardioprotective Brazilian Food Program residing in the Northeast region of Brazil, according to the recommendations of the Brazilian Society of Cardiology (SBC)., Methods: Cross-sectional analysis with data from the study implementing the Brazilian Cardioprotective Diet (DICA BR), which evaluated individuals with CVD treated in specialized cardiovascular health centers in eight states in the Northeast region. Food consumption was obtained by 24-hour dietary records and dietary adequacy followed SBC recommendations. Values of p < 0.05 were considered significant., Results: 647 patients were studied, with a mean (standard deviation) age of 63.1 (9.4) years, 50.2% of whom were female. When evaluating food intake, a low adequacy of carbohydrates (52.3%), proteins (70.9%), lipids (38.8%), and fiber (22.4%) was observed. It was observed that the majority of women consumed a low-protein diet (59.2%) and the elderly had a greater inadequacy in carbohydrate consumption (52.6%). Regarding sodium intake, men had a higher intake (72.9%), while the elderly showed a 13% reduction. Furthermore, it was shown that men ate more fiber (28.1%) and individuals with higher education had a high consumption of saturated fatty acids (70.5%)., Conclusions: Most individuals did not achieve the recommended dietary therapy goals for secondary cardiovascular prevention. The findings of the present study reinforce the need to implement structured strategies to encourage healthy eating habits in these individuals.

The Mediterranean dietary pattern (MPD) has shown promise in preventing low-grade systemic inflammation (LGSI). This study tested if a high adherence to the MDP by younger and older Brazilian adults is associated with lower LGSI and investigated which Mediterranean food components may contribute to these associations. We performed a secondary study on 2015 ISA-Nutrition (290 younger adults (20-59 years old) and 293 older adults (≥60 years old)), a cross-sectional population-based study in São Paulo, SP, Brazil. The adherence to the MDP was assessed using the Mediterranean Diet Score (MedDietScore), obtained from two non-consecutive 24 h dietary recalls (24HDRs). The LGSI score (from plasma CRP, TNF-α, and adiponectin) identified the inflammatory status. Linear regression models assessed the association between LGSI and the MedDietScore. In older adults only, a high adherence to the MDP signified an 11.5% lower LGSI score. Older adults, classified with high adherence to the MDP, differed by consuming lower meat intake and full-fat dairy. Between older adults, the intake of vegetables and olive oil was inversely associated with the levels of LGSI. Thus, among older adults, the intake of some specific Mediterranean food determined high adherence to the MDP and was associated with decreased LGSI.

Background: Adhering to a diet adequate in macronutrients is crucial for the secondary prevention of cardiovascular diseases., Objective: To assess the prevalence of adherence to recommendations for the consumption of dietary fatty acids for the prevention and treatment of cardiovascular diseases and to estimate whether the presence of certain cardiovascular risk factors would be associated with adherence., Methods: Cross-sectional study using baseline data from 2,358 participants included in the "Brazilian Cardioprotective Nutritional Program Trial". Dietary intake and cardiovascular risk factors were assessed. Adequate intake of polyunsaturated fatty acids (PUFA) was considered as ≥10% of total daily energy intake; for monounsaturated fatty acids (MUFA), 20%; and for saturated fatty acids (SFA), <7% according to the Brazilian Society of Cardiology. A significance level of 5% was considered in the statistical analysis., Results: No participant adhered to all recommendations simultaneously, and more than half (1,482 [62.9%]) did not adhere to any recommendation. Adherence exclusively to the SFA recommendation was the most prevalent, fulfilled by 659 (28%) participants, followed by adherence exclusively to the PUFA (178 [7.6%]) and MUFA (5 [0.2%]) recommendations. There was no association between the number of comorbidities and adherence to nutritional recommendations (p = 0.269). Participants from the Brazilian Northeast region showed a higher proportion of adherence to SFA consumption recommendations (38.42%) and lower adherence to PUFA intake (3.52%) (p <0.001) compared to other regions., Conclusions: Among the evaluated sample, there was low adherence to nutritional recommendations for dietary fatty acid consumption.

The objective of the present study was to describe the dietary inflammatory profile and its correlations with sleep parameters of obese individuals with obstructive sleep apnea (OSA). Forty individuals underwent nocturnal polysomnography, anthropometric measurements, body composition by plethysmography, assessment of food consumption by three-day food records, and blood collection for the lipid, glycemic and hormonal profile. Food consumption data were evaluated semiquantitatively, quantitalively assessment, and calculation of the dietary inflammatory index (DII) was perfomed. The results demonstrated a predominantly proinflammatory dietary profile. The participants showed a low intake of fruit and vegetables. Additionally, a low consumption of fiber, magnesium, vitamin D, and vitamin E was observed, although there was an adequate distribution of macronutrients. In conclusion, although the inflammatory profile did not correlate with OSA, the study showed a directly proportional relationship between adequate dietary patterns and better sleep quality., Competing Interests: Conflict of Interests The authors have no conflict of interests to declare., (Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective: To assess the effect of SARS-CoV-2 infection on the health conditions and functional capacity of older adults living in long-term care units in Maceió City - Alagoas State., Methods: A prospective cohort was conducted with institutionalized older adults of both sexes. Older adults were assessed for clinical conditions (diagnosis of chronic diseases and biochemical tests), functional capacity, and nutritional status. All assessments were repeated on two occasions, maintaining a 6-month interval between them., Results: The sample was composed of 289 older adults. Of the total, 98 (33.9%) were positive for COVID-19 and eight died (2.8%). Men were more likely to have COVID-19 (OR = 3.50; p < 0.01). It was observed that the disease contributed to increasing the frequency of dependent older adults after six months (OR = 1.38; p-interaction < 0.01). It was also observed that after six months of positive diagnosis for COVID-19, there was greater weight loss (p < 0.01), reduced BMI (p < 0.01), increased mean SBP (p = 0.04), and DBP (p = 0.03)., Conclusion: Effects of COVID-19 in institutionalized older adults go beyond acute complications and compromise blood pressure control, functional capacity, and favor weight loss.

Background: In Brazil, the COVID-19 pandemic found the universal and public Unified Health System (SUS) with problems accumulated over time, due, among other reasons, to low investments, and disparities in resource distribution. The preparedness and response of the healthcare system, involving the SUS and a private sector, was affected by large socioeconomic and healthcare access inequities. This work was aimed at offering an overview of COVID-19 inpatient mortality during the pandemic in Brazil, exploring factors associated with its variations and, specifically, differences across public, private (for-profit) and philanthropic (private non-profit) inpatient healthcare units, providers, and non-providers of services to the SUS., Methods: This cross-sectional study used public secondary data. The main data source was the SIVEP-Gripe, which comprises data on severe acute respiratory illness records prospectively collected. We also employed the National Record of Health Establishments, the SUS' Hospitalization Information System and municipalities' data from IBGE. We considered adult COVID-19 hospitalizations registered in SIVEP-Gripe from February 2020 to December 2022 in inpatient healthcare units with a minimum of 100 cases in the period. Data analyses explored the occurrence of inpatient mortality, employing general linear mixed models to identify the effects of patients', health care processes', healthcare units' and municipalities' characteristics on it., Results: About 70% of the COVID-19 hospitalizations in Brazil were covered by the SUS, which attended the more vulnerable population groups and had worse inpatient mortality. In general, non-SUS private and philanthropic hospitals, mostly reimbursed by healthcare insurance plans accessible for more privileged socioeconomic classes, presented the best outcomes. Southern Brazil had the best performance among the macro-regions. Black and indigenous individuals, residents of lower HDI municipalities, and those hospitalized out of their residence city presented higher odds of inpatient mortality. Moreover, adjusted inpatient mortality rates were higher in the pandemic peak moments and were significantly reduced after COVID-19 vaccination reaching a reasonable coverage, from July 2021., Conclusions: COVID-19 exposed socioeconomic and healthcare inequalities and the importance and weaknesses of SUS in Brazil. This work indicates the need to revert the disinvestment in the universal public system, a fundamental policy for reduction of inequities in the country., (© 2023. The Author(s).)

Background: An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors., Methods: This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant., Results: In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence., Conclusions: A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country., (© 2023 The British Dietetic Association Ltd.)

Objectives: The aim of this study was to evaluate the association of the dietary inflammatory index (DII) with the nutritional status and metabolic control of children and adolescents with type 1 diabetes mellitus., Methods: This was a cross-sectional study that examined data of children and adolescents ages 7 to 16 y diagnosed with type 1 diabetes mellitus. Dietary intake was assessed using a 24-h dietary recall, from which the DII was calculated. The outcomes were body mass index, lipid profiles (low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol), and glycated hemoglobin. The DII was evaluated in tertiles and in a continuous way. Multiple linear regression was adopted in the analysis, with P < 0.05 considered significant., Results: Overall, 120 children and adolescents with a mean age of 11.7 (± 2.8) y were included, 53.3% (n = 64) of whom were girls. Excess weight was present in 31.7% participants (n = 38). The average DII was +0.25, ranging from -1.11 to +2.67. Higher values of selenium (P = 0.011), zinc (P = 0.001), fiber (P < 0.001), and other micronutrients were observed in the first tertile of the DII (diet with more antiinflammatory potential). The DII appeared as a predictor of body mass index (P = 0.002; β = 0.23; 95% confidence interval [CI], 0.39-1.75) and non-high-density lipoprotein cholesterol (P = 0.034; β = 0.19; 95% CI, -13.5 to 0.55). There was a tendency for DII to be associated with glycemic control (P = 0.09; β = 0.19; 95% CI, -0.04 to 0.51)., Conclusions: The inflammatory potential of the diet was associated with increased body mass index and aspects related to metabolic control in children and adolescents with type 1 diabetes mellitus., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Delirium is a common, serious, and often preventable neuropsychiatric emergency mostly characterized by a disturbance in attention and awareness. Systemic insult and inflammation causing blood-brain-barrier (BBB) damage and glial and neuronal activation leading to more inflammation and cell death is the most accepted theory behind delirium's pathophysiology. This study aims to evaluate the relationship between brain injury biomarkers on admission and delirium in acutely ill older patients. We performed a prospective cohort study which analyzed plasma S100B levels at admission in elderly patients. Our primary outcome was delirium diagnosis. Secondary outcomes were association between S100B, NSE and Tau protein and delirium diagnosis and patients' outcomes (admissions to intensive care, length of hospital stay, and in-hospital mortality). We analyzed 194 patients, and 46 (24%) developed delirium, 25 on admission and 21 during hospital stay. Median of S100B at admission in patients who developed delirium was 0.16 and median was 0.16 in patients who didn't develop delirium (p: 0.69). Levels S100B on admission did not predict delirium in acutely ill elderly patients.Trial registration: The study was approved by the local institutional review board (CAPPESq, no. 77169716.2.0000.0068, October 11, 2017) and registered in Brazilian Clinical Trials Registry (ReBEC, no. RBR-233bct)., (© 2023. The Author(s).)

Patients with COVID-19 may develop symptoms that interfere with food intake. Systemic inflammatory response associated with physical inactivity and/or immobilization during hospital stay can induce weight and muscle loss leading to sarcopenia and worsening the clinical condition of these patients. The present study identifies the frequency and factors associated with sarcopenia prediction in adult and elderly patients hospitalized for COVID-19. It is a cohort-nested cross-sectional study on adult and elderly patients admitted to wards and intensive care units (ICUs) of 8 hospitals in a northeastern Brazilian state. The study was conducted from June 2020 to June 2021. Sociodemographic, economic, lifestyle, and current and past clinical history variables were collected. Sarcopenia prediction was determined by the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire compiled in the Remote-Malnutrition APP (R-MAPP). Patients were diagnosed with sarcopenia when the final score ≥ 4 points. The study included 214 patients with a mean age of 61.76 ± 16.91 years, of which 52.3 % were female and 57.5 % elderly. Sarcopenia prevailed in 40.7 % of the sample. Univariate analysis showed greater probability of sarcopenia in elderly individuals, nonpractitioners of physical activities, hypertensive patients, diabetic patients, and those hospitalized in the ICU. In the multivariate model, the type of hospital admission remained associated with sarcopenia prediction, where patients admitted to the ICU were 1.43 (95 % CI: 1.04; 1.97) more likely to have sarcopenia than those undergoing clinical treatment. Sarcopenia prediction was not associated with patient outcome (discharge, transfer, or death) (p = 0.332). The study highlighted an important percentage of sarcopenia prediction in patients with COVID-19, especially those admitted to the ICU. Additional investigations should be carried out to better understand and develop early diagnostic strategies to assist in the management of sarcopenic patients with COVID-19., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: The present study aimed to identify associations between extremes in body weight status (underweight and excess body weight) before a COVID-19 diagnosis and clinical outcomes in patients infected with SARS coronavirus type 2., Methods: A multicenter cohort study was conducted in eight different states in northeastern Brazil. Demographic, clinical (previous diagnosis of comorbidities), and anthropometric (self-reported weight and height) data about individuals who tested positive for COVID-19 were collected. Outcomes included hospitalization, mechanical ventilation, and death. Multivariable logistic regression models, adjusted based on age, sex and previous comorbidities, were used to assess the effects of extremes in body weight status on clinical outcomes., Results: A total of 1308 individuals were assessed (33.6% were elderly individuals). The univariable analyses showed that only hospitalization was more often observed among underweight (3.2% versus 1.2%) and overweight (68.1% versus 63.3%) individuals. In turn, cardiovascular diseases were more often observed in all clinical outcomes (hospitalization: 19.7% versus 4.8%; mechanical ventilation: 19.9% versus 13.5%; death: 21.8% versus 14.1%). Based on the multivariable analysis, body weight status was not associated with risk of hospitalization (underweight: odds ratio [OR]: 1.10; 95% confidence interval [CI] 95%, 0.50-2.41 and excess body weight: OR: 0.81; 95 CI, 0.57-1.14), mechanical ventilation (underweight: OR: 0.92; 95% CI, 0.52-1.62 and excess weight: OR: 0.90; 95% CI, 0.67-1.19), and death (underweight: OR: 0.61; 95% CI, 0.31-1.20 and excess body weight: OR 0.88; 95% CI, 0.63-1.23)., Conclusions: Being underweight and excess body weight were not independently associated with clinical outcomes in patients with COVID-19 in the herein analyzed cohort. This finding indicates that the association between these variables may be confounded by both age and comorbidities., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Frailty, a multifactorial ageing-related syndrome characterised by reduced resistance to stressors and possibly associated with low-grade systemic inflammation, results in negative health outcomes and compromises healthy ageing. There is a growing body of evidence on the relationship between dietary habits, low-grade systemic inflammation and the risk of frailty. Consumption of dietary ultra-processed products (UPP) could negatively contribute to these conditions. In this article, we intend to (i) discuss the role that UPP might have on the development of frailty considering the inflammatory potential of this type of food and (ii) to raise awareness on deleterious effects of excess UPP intake in the development of adverse health outcomes, in particular, frailty and compromised healthy ageing. UPP are industrial formulations whose nutrient profile has been associated with inflammation and altered gut microbiota. Besides, diets with a greater presence of unprocessed foods and antioxidants have been linked to the reduction of oxidative stress and the expression of inflammatory biomarkers. Because inflammation is believed to be a contributing factor in the development of frailty, it is possible that UPP would contribute to the onset or increase of this condition. Importantly, the increasing consumption of UPP in younger populations might pose a greater risk to the development of compromised healthy ageing in the long term.

Background: We hypothesized that factors related to malnutrition, namely low muscle mass, appetite loss, and adiposity, are associated with frailty and pre-frailty in community-dwelling older adults., Aims: To identify the prevalence of frailty and pre-frailty in a Brazilian convenience sample and test the association between these conditions and malnutrition-related factors., Methods: This is a cross-sectional analysis of an ongoing community project. We studied 106 older adults (≥60 years old). Frailty (dependent variable) was screened using the FRAIL-BR scale. The independent variables were appetite loss (AL), screened from the SNAQ questionnaire; sarcopenia risk, investigated by SARC-F; body adiposity, estimated by the body mass index (BMI); visceral adiposity, estimated by waist circumference (WC) and the combination of these two indicators. The associations were investigated using multinomial logistic regression models., Main Results: We found, from our sample, 30.2 % pre-frail and 31.1 % frail participants. The frail and pre-frail were older than the non-frail; the frail ones presented a higher proportion of sarcopenia risk and a higher proportion of AL. From the multiple regression models, frailty conditions showed significant association with the AL (OR = 0.68; p = 0.012 and OR = 0.64; p = 0.009 for pre-frail and frail, respectively) and with sarcopenia risk (OR = 3.24; p = 0.001 and OR = 5.34; p < 0.011 for pre-frail and frail respectively). The adiposity indicated by waist circumference, and age, remained in the final model only as adjusting variables but without statistical significance., Conclusions: in our convenience sample of older adults, frailty and pre-frailty showed significant association with appetite loss and sarcopenia risk, but not with adiposity indicators. Future studies are needed to better understand our findings., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: The objective of this study was to identify an association between serum levels of 25(OH) D, inflammation and cardiovascular disease risk in older adults., Methods: This was a cross-sectional study, with older adults of both sexes, investigating variables on lifestyle, anthropometric assessments (weight, height, waist circumference, BMI), and systemic arterial hypertension (systolic blood pressure, SBP, and diastolic blood pressure DBP), serum levels of 25(OH)D, serum high-sensitive C-reactive protein (hs-CRP), serum lipid profile and fasting blood glucose. Cardiovascular disease risk was assessed using the global risk score for cardiovascular events, the Framingham criteria., Results: The sample consisted of 124 participants, 50.8% of whom were at high risk for cardiovascular events. Older adults with 25(OH)D insufficiency presented higher levels of blood sugar (p < 0.01), LDL-c (p = 0.03) SBP (p < 0.01) and hs-CRP (p < 0.01). When grouped by serum concentrations hs-CRP, it was observed that higher hs-CRP levels were associated with higher blood glucose (p = 0.02), SBP (p = 0.04) and lower HDL-c concentrations (p = 0.02). It was also observed that 25(OH)D insufficiency increased the chance of a high risk for cardiovascular events by 2.8 times (OR = 2.80; p = 0.01), which with high hs-CRP concentrations increased to 4.75 times (OR = 4.75; p < 0.01)., Conclusion: Low concentrations of 25(OH)D and the presence of inflammation in older adults are associated with a high risk for cardiovascular diseases., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Java vulnerabilities correspond to 91% of all exploits observed on the worldwide web. The present work aims to create antivirus software with machine learning and artificial intelligence and master in Java malware detection. Within the proposed methodology, the suspected JAR sample is executed to intentionally infect the Windows OS monitored in a controlled environment. In all, our antivirus monitors and considers, statistically, 6824 actions that the suspected JAR file can perform when executed. Our antivirus achieved an average performance of 91.58% in the distinction between benign and malware JAR files. Different initial conditions, learning functions and architectures of our antivirus are investigated. The limitations of commercial antiviruses can be supplied by intelligent antiviruses. Instead of blacklist-based models, our antivirus allows JAR malware detection preventively and not reactively as Oracle's Java and traditional antivirus modus operandi., (© 2022. The Author(s).)

Background & Aims: Acutely ill older adults are at higher risk of malnutrition. This study aimed to explore the applicability and accuracy of the GLIM criteria to diagnose malnutrition in acutely ill older adults in the emergency ward (EW)., Methods: We performed a retrospective secondary analysis, of an ongoing cohort study, in 165 participants over 65 years of age admitted to the EW of a Brazilian university hospital. Nutrition assessment included anthropometry, the Simplified Nutritional Assessment Questionnaire (SNAQ), the Malnutrition Screening Tool (MST), and the Mini-Nutritional Assessment (MNA). We diagnosed malnutrition using GLIM criteria, defined by the parallel presence of at least one phenotypic [nonvolitional weight loss (WL), low BMI, low muscle mass (MM)] and one etiologic criterion [reduced food intake or assimilation (RFI), disease burden/inflammation]. We used the receiver operating characteristic (ROC) curves and Cox and logistic regression for data analyses., Results: GLIM criteria, following the MNA-SF screening, classified 50.3% of participants as malnourished, 29.1% of them in a severe stage. Validation of the diagnosis using MNA-FF as a reference showed good accuracy (AUC = 0.84), and moderate sensitivity (76%) and specificity (75.1%). All phenotypic criteria combined with RFI showed the best metrics. Malnutrition showed a trend for an increased risk of transference to intensive care unit (OR = 2.08, 95% CI 0.99, 4.35), and severe malnutrition for in-hospital mortality (HR = 4.23, 95% CI 1.2, 14.9)., Conclusion: GLIM criteria, following MNA-SF screening, appear to be a feasible approach to diagnose malnutrition in acutely ill older adults in the EW. Nonvolitional WL combined with RFI or acute inflammation were the best components identified and are easily accessible, allowing their potential use in clinical practice., Competing Interests: Conflict of interest The authors have no competing interests to disclose., (Copyright © 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: To analyze the geographical variation in the provision of health services, namely in demand, patterns of utilization, and effectiveness in the Brazilian Health Regions in four different periods of the COVID-19 pandemic, from February 2020 to March 2021., Methods: Descriptive serial cross-sectional study based on secondary data on COVID-19 hospitalizations from SIVEP-Gripe, a public and open-access database of Severe Acute Respiratory Illness records collected by the Brazilian Ministry of Health, and COVID-19 case notification data from Brasil.io, a repository of public data. Fifty-six epidemiological weeks were split into four periods. The following variables were considered for each Brazilian Health Region, per period: number of hospitalizations, hospitalizations per 100,000 inhabitants, hospitalizations per 100 new cases notified in the Health Region, percentage of hospitalizations with ICU use, percentages of hospitalizations with invasive and non-invasive ventilatory support, percentage of hospitalizations resulting in death and percentage of hospitalizations with ICU use resulting in death. Descriptive statistics of the variables were obtained across all 450 Health Regions in Brazil over the four defined pandemic periods. Maps were generated to capture the spatiotemporal variation and trends during the first year of the COVID-19 pandemic in Brazil., Results: There was great variation in how COVID-19 hospitalizations grew and spread among Health Regions, with higher numbers between June and August 2020, and, especially, from mid-December 2020 to March 2021. The variation pattern in the proportion of ICU use in the hospitalizations across the Health Regions was broad, with no intensive care provision in large areas in the North, Northeast, and Midwest. The proportions of hospitalizations and hospitalizations with ICU use resulting in deaths were remarkably high, reaching medians of 34.0% and 62.0% across Health Regions, respectively., Conclusion: The Heath Regions in Brazil are highly diverse, showing broad disparities in the capacity to respond to the demands imposed by COVID-19, services provided, use and outcomes., Competing Interests: The authors have declared that no competing interests exist.

Objective: To analyze the temporal evolution of the pattern of hospital use in the context of the COVID-19 pandemic in Brazil., Methods: This retrospective observational study compared hospital use and mortality in the Brazilian Unified Health System (SUS) in the first six months of the COVID-19 pandemic with the year before the onset of the pandemic in six Brazilian capitals (São Paulo, Rio de Janeiro, Manaus, Fortaleza, Recife, and Brasilia). It was based on secondary administrative data from the SUS Hospital Information System (SIH), focusing on the number of hospitalizations per fortnight, age, and gender of patients, hospital length of stay, and the proportions of surgical, elective, with the use of ICU, and resulting in death hospitalizations. It also compared the number of hospitalizations and mortality related to frequent diagnostic groups., Results: A significant drop was identified in the number of hospitalizations as of March 2020, with the first peak of COVID-19 hospitalizations in five capitals recorded in May 2020. In the six capitals, we observed significant reductions in the mean number of hospitalizations per fortnight from the beginning of the pandemic. We also identified an increase in the mean age of the patients and the proportion of male patients. The proportion of surgical and elective hospitalizations dropped significantly in all capitals, while the proportion of hospitalizations with ICU use increased significantly. Significant increases in-hospital mortality were also recorded in the six capitals with the pandemic, including or excluding COVID-19 hospitalizations from the comparison., Conclusion: The pandemic caused changes in the pattern of use and hospital indicators in the first six months in the cities considered, evidencing the need for attention to diseases with a hospital production altered by the COVID-19 course and health system performance problems in the face of challenges., (© 2021. The Author(s).)

Background: Nut consumption has been related to improvements on cardiometabolic parameters and reduction in the severity of atherosclerosis mainly in primary cardiovascular prevention. The objective of this trial is to evaluate the effects of the Brazilian Cardioprotective Diet (DIeta CArdioprotetora Brasileira, DICA Br) based on consumption of inexpensive locally accessible foods supplemented or not with mixed nuts on cardiometabolic features in patients with previous myocardial infarction (MI)., Methods: DICA-NUTS study is a national, multicenter, randomized 16-week follow-up clinical trial. Patients over 40 years old with diagnosis of previous MI in the last 2 to 6 months will be recruited (n = 388). A standardized questionnaire will be applied to data collection and blood samples will be obtained. Patients will be allocated in two groups: Group 1: DICA Br supplemented with 30 g/day of mixed nuts (10 g of peanuts, 10 g of cashew, 10 g of Brazil nuts); and Group 2: only DICA Br. The primary outcome will consist of LDL cholesterol means (in mg/dL) after 16 weeks of intervention. Secondary outcomes will consist of other markers of lipid profile, glycemic profile, and anthropometric data., Discussion: It is expected that DICA Br supplemented with mixed nuts have superior beneficial effects on cardiometabolic parameters in patients after a MI, when compared to DICA Br., Trial Registration: ClinicalTrials.gov Identifier NCT03728127 . First register: November 1, 2018; Last update: June 16, 2021. World Health Organization Universal Trial Number (WHO-UTN): U1111-1259-8105., (© 2021. The Author(s).)

Objectives: To investigate the association between joint diseases (JD) and common mental disorders (CMD) in women at ages related to menopause., Study Design: Cross-sectional, population-based study (São Paulo City Health Survey, SP, Brazil). The sample was composed of 1191 women, 40 years and older., Main Parameters Investigated: Dependent variable (outcome): Presence of CMD, investigated by the Self Reporting Questionnaire-20 (SRQ-20)., Independent Variables: Presence of JD; other self-reported chronic conditions different from JD (OCC); age categories (40-45, 46-50, 51-55, 56-60, 61+ years old); Adjusting variables: years of formal education and ethnicity (skin color), used as proxies of socioeconomic status. The associations were investigated using simple and multiple logistic regression models., Main Results: The prevalence of CMD was 30.4%, and JD was 21.4%. Considering only the women presenting CMD, the prevalence of JD was 31.6%. The final regression model showed an independent association between JD and CMD (OR = 1.998; p < 0.001), age between 56 and 60 years (OR = 0.542; p = 0.018), and having three OCC (OR = 2.696; p = 0.027)., Conclusions: Our data showed that JD in women of the ages related to menopause was significantly and independently associated with CMD. Interestingly, the 56 to 60 years' age interval showed a very particular feature, with opposite association's direction, which demands further investigations., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Anorexia of aging (AA) is classically associated with depression. However, robust evidence is lacking regarding general clinic populations. Our aim was to evaluate the association between AA and major depressive disorder (MDD) in geriatric outpatients from a middle-income country., Methods: We conducted a cross-sectional analysis of a cohort study. MDD diagnosis was assessed with a psychiatric interview (SCID-5-CV) according to DSM-5 criteria. Depressive symptomatology was assessed by a 15-items Geriatric Depression Scale (GDS) and the PHQ-9 questionnaire. Appetite was measured with the Simple Nutrition Appetite Questionnaire (SNAQ), whereas AA was defined as a SNAQ score ≤13 points). Linear and logistic regression analysis adjusted for potential confounders were applied to assess the association between depressive symptomatology, MDD and AA., Results: Of the total 339 participants, MDD was present in 65. AA was more frequent in patients with MDD compared to non-depressed patients (30.7 versus 7.7%; p<0.001). The SNAQ score was lower in depressed patients (14.5 vs. 16.6, p<0.001). Adjusted for confounding, linear and logistic regression showed a significant association between the GDS score, PHQ-9 score and MDD with the SNAQ score (p<0.001) and cut-off representing AA (p<0.001), respectively. Moreover, MDD and AA interacted significantly with their association with weight loss (p<0.001)., Conclusions: Depression scales (even without somatic complaints) and MDD were associated with AA in geriatric outpatients. AA is associated with weight loss in MDD. Prospective studies should expand these findings., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Managing HIV infection as a chronic condition includes encouraging adoption of healthy behaviors and promotion of physical activity (PA). However, people living with HIV (PLH) are often under social and programmatic vulnerability that may compromise behavior change. Understanding such barriers is crucial for successful incorporation of PA in their comprehensive care., Methods and Findings: In this study, we describe PA, energy intake from diet, and anthropometry of a cohort of PLH starting antiretroviral therapy (ART) at a Brazilian reference clinic, report how PA was addressed in routine care and investigate association between PA, energy intake and psychosocial constructs that may facilitate PA (social support and self-efficacy for PA). Among 61 PLH (86.9% males, mean age = 32.5 years) anthropometry was normal, but 47.5% reported PA below recommendations. Despite presenting high social support scores, family encouragement for PA was low, and self-efficacy classified as medium. Chart reviews yielded infrequent reports concerning PA. After adjusting for gender and age, we found a negative association between energy intake from diet and self-efficacy, but none between PA and energy intake or between PA and psychosocial constructs., Conclusions: We conclude that patients in our cohort were insufficiently active when starting ART, and that PA was poorly addressed by caretakers in routine HIV care. Nevertheless, social support and self-efficacy scores suggest potential for behavioral change. Caregivers should therefore start considering patients' vulnerabilities and establishing strategies to help them overcome barriers to incorporate PA in their comprehensive care effectively., Competing Interests: The authors have declared that no competing interests exist.

Background: Diabetes mellitus (DM) is associated with a higher prevalence of metabolic syndrome (MS) and cardiovascular mortality. However, few Brazilian studies evaluated MS in diabetic individuals with cardiovascular disease (CVD). Nevertheless, the objective of this study was to compare the prevalence of MS in cardiac patients with and without DM. Methods: Cross-sectional study of BALANCE Program Trial with patients with CVD, ≥45 years old, who had been attending specialized ambulatories on cardiovascular health, in eight states in the Northeast of Brazil. The components of MS were evaluated by following the criteria of National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP III) and Joint Interim Statement (JIS). In addition, there were investigated different indexes of abdominal obesity, variables related to lifestyle, and food intake. The statistical analysis included descriptive statistics and the Student's t -test, Mann-Whitney, and chi-squared tests for the comparison of groups. There were significant values of P  < 0.05. Results: Six hundred forty-seven individuals were evaluated with average (standard deviation) age of 63.1 (9.3) years, being 50.5% females and 40.3% diabetic patients. When the groups of patients who were diabetic and the nondiabetic ones, the first showed higher percentage of obesity (38.5% vs. 23.2%, P  < 0.001), of high waist circumference (84.8% vs. 71.9%; P  < 0.001), higher waist-height ratio [0.6 (0.6-0.7) vs. 0.6 (0.5-0.6); P  < 0.001], conicity index [1.35 (1.29-1.39) vs. 1.32 (1.27-1.38); P  = 0.004], and prevalence of MS, because of the criteria of NCEP ATP III (98.8% vs. 80.4%; P  < 0.001), as well as the criteria of JIS (99.2% vs. 89.3%; P  < 0.001). The component of higher frequency was high blood pressure and/or hypertension (95.0%), followed by hypertriglyceridemia (93.0%). There were no differences regarding age, lifestyle, and food intake. Conclusions: Diabetic individuals with CVD showed more prevalence of MS and more abdominal obesity than nondiabetic individuals. ClinicalTrials.gov ID: NCT01620398.

Purpose: Obstructive Sleep Apnea (OSA) is closely associated with obesity. Weight loss ameliorates OSA and its associated metabolic disorders. A high protein intake may improve weight loss through increased energy expenditure, and fat-free mass maintenance during weight loss., Objectives: To evaluate the effects of a low-energy, high-protein diet on OSA severity and metabolic parameters in obese men., Methods: Forty-five OSA obese (BMI ≥ 30 kg/m 2 ) males were included in this randomized study and submitted to nocturnal polysomnography, body composition measured by plethysmography, biochemical analyses of blood glucose, insulin and lipids, and food intake evaluations before and after one month of a low-energy diet. Diets were designed to create a 30% deficit in total energy expenditure with 1.6 g of protein/kg/day (High Protein group - HP) or 0.8 g of protein/kg/day (Low Protein group - LP)., Results: Only a time effect of the intervention was observed in body mass (-3.7 ± 2.0% for the LP group and -4.0 ± 1.5% for the HP group; p < 0.001), Body Mass Index (p < 0.001), fat mass in kg (p < 0.01) and fat-free mass in kg (p < 0.01). Significant improvements in Apnea Hypopnea Index were observed in both groups (54.0 ± 25.0 to 33.7 ± 31.7 in LP group; 39.7 ± 24.3 to 21.4 ± 25.9 in HP group; p = 0.06). Improvements of 38% and 46% in the Apnea-Hypopnea Index were observed in the LP and HP groups, respectively. Both interventions provided equivalent metabolic benefits as reductions in glucose (p < 0.001), insulin (p < 0.001), HOMA-IR (p = 0.005), triglycerides (p = 0.002), and in total cholesterol (p = 0.004)., Conclusion: One month of a low-energy diet resulted in significant improvements in OSA severity in obese men. Increased protein intake during a short period of low-energy diet had no further beneficial effects on OSA severity or biochemical parameters than a standard protein diet. Registered under ClinicalTrials.gov Identifier no. NCT01985035., Competing Interests: Declaration of competing interest None of the authors have conflicts of interest to disclose and do not have any financial relationship with a commercial entity that has an interest in the subject of this manuscript., (Copyright © 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Objective: To study the profile of hospitalizations due to COVID-19 in the Unified Health System (SUS) in Brazil and to identify factors associated with in-hospital mortality related to the disease., Methods: Cross-sectional study, based on secondary data on COVID-19 hospitalizations that occurred in the SUS between late February through June. Patients aged 18 years or older with primary or secondary diagnoses indicative of COVID-19 were included. Bivariate analyses were performed and generalized linear mixed models (GLMM) were estimated with random effects intercept. The modeling followed three steps, including: attributes of the patients; elements of the care process; and characteristics of the hospital and place of hospitalization., Results: 89,405 hospitalizations were observed, of which 24.4% resulted in death. COVID-19 patients hospitalized in the SUS were predominantly male (56.5%) with a mean age of 58.9 years. The length of stay ranged from less than 24 hours to 114 days, with a mean of 6.9 (±6.5) days. Of the total number of hospitalizations, 22.6% reported ICU use. The odds on in-hospital death were 16.8% higher among men than among women and increased with age. Black individuals had a higher likelihood of death. The behavior of the Charlson and Elixhauser indices was consistent with the hypothesis of a higher risk of death among patients with comorbidities, and obesity had an independent effect on increasing this risk. Some states, such as Amazonas and Rio de Janeiro, had a higher risk of in-hospital death from COVID-19. The odds on in-hospital death were 72.1% higher in municipalities with at least 100,000 inhabitants, though being hospitalized in the municipality of residence was a protective factor., Conclusion: There was broad variation in COVID-19 in-hospital mortality in the SUS, associated with demographic and clinical factors, social inequality, and differences in the structure of services and quality of health care., Competing Interests: The authors have declared that no competing interests exist.

The area of Policy, Planning and Health Management (PPG) express the intersection between research, intervention and political action. The article analyzes the dynamics of knowledge production about PPG in the Journal Ciência & Saúde Coletiva (C&SC) from 1996 to 2019. The study articulates a bibliometric and qualitative approach to explore the profile of articles in three dimensions: thematic, methodological and authorship/institutional partnerships. 1680 PPG manuscripts were identified, corresponding to 28.3% of the total publications. Thematic analysis showed a strong influence of the context and the implementation of Unified Health System (SUS). Qualitative empirical studies predominated, followed by quantitative and quanti-qualitative studies. The combination of methodological procedures was frequent, with bibliographic review and interviews being the most cited. The average number of authors per article and national institutional partnerships increased. As most articles were published in Portuguese, the challenge of internationalization persists. The PPG area stands out in the Journal C&SC and in the production of scientific knowledge relevant to SUS.

Diabetes mellitus is a chronic disease that is considered a worldwide epidemic, and its control is a constant challenge for health systems. Since insulin had its first successful use, scientists have researched to improve the desired effects and reduce side-effects. Over the years, the challenge has been to increase adherence to treatment and improve the quality of life for diabetics by developing an insulin delivery system. This systematic review (SR) analyses experimental articles from 1998 to 2018 related to the development of the chitosan/insulin delivery system (CIDS). Automated support: Start tool was used to perform part of these activities. The search terms "insulin", "delivery or release system", and "chitosan" were used to retrieve articles in PubMed, Science Direct, Engineering Village, and HubMed. A total of 55 articles were selected. The overview, phase, model, way of administration, and the efficiency of CIDS were analyzed. According to SR results, most of the articles were published from 2010 onwards, representing 72.7% of the selected papers, and research groups from China publicized 23.6% of the selected articles. According to the SR, 51% of the studies were carried out in vivo and 45% in vitro. Most of the systems were nanoparticle based (54.8%), and oral administration was proposed by 60.0% of the selected articles. Only 36.4% performed loaded capacity and encapsulation efficiency assays, and 24 h (16.4%), 12 h (12.7%), and 6 h (11.0%) were the most frequent insulin release times. Chitosan's intrinsic characteristics, which include biodegradability, biocompatibility, adhesiveness, the ability to open epithelial tight junctions to allow an increase in the paracellular transport of macromolecular drugs, such as insulin, and the fact that it does not result in allergic reactions in the human body after implantation, injection, topical application or ingestion, have contributed to the increase in research of CIDS over the years. However, the number of studies is still limited and the use of an alternative form of insulin administration is not yet possible. Thus, more studies in this area, aiming for the development of an insulin delivery system that can promote more adherence to the treatment and patient comfort, are required.

Background: Poor appetite is common through the aging process and increases the risk of weight loss, protein-energy malnutrition, immunossupression, sarcopenia and frailty. The Simplified Nutritional Appetite Questionnaire (SNAQ) has the aim to monitor appetite and identify older adults at risk of weight loss., Objective: To describe the process of translation and cultural adaptation to Brazilian Portuguese of the SNAQ., Methods: The translation and cultural adaptation was developed in five steps: translation (by three of the authors of the manuscript and assembled by consensus), backtranslation (by an English native speaker), semantic evaluation (by one verontologist and one nutritionist), comprehension of content (by nutrition specialists and by a group of older persons), pre-test and the SNAQ final version development., Results: The SNAQ Portuguese version maintained the original version meaning and referral. To achieve this feature, the process required some modifications to improve the understanding of older persons, such as inclusion of other options to the answers of some questions, rewritten of one question and inclusion of a meal definition., Conclusion: SNAQ questionnaire has been successfully translated and adapted to Portuguese. As our next step, we are validating this tool in different clinical settings in Brazil.

Background: Some questions regarding the benefits of the Mediterranean Dietary Pattern (MDP) are still unanswered, especially in non-Mediterranean areas. As such, this study intends to evaluate the association between the adherence to the MDP with the presence of Common Mental Disorders (CMD) in Brazilian older adults, adopting two different concepts of MDP., Methods: The sample included 545 elders from 2015 Health Survey of São Paulo City (cross-sectional population-based study). CMD were identified through the Self Reporting Questionnaire-20 (SRQ-20). Data from two 24-hour dietary recall were used to construct two concepts of MDP according to the Mediterranean-diet score (MDS): Traditional MDP (included only foods with characteristics of the original MDP) and Brazilian-MDP (included foods with non-Mediterranean characteristics). The analyses included two different models (crude model and adjusted model for potential confounders) of logistic regression., Results: Moderate and high adherence to Traditional MDP were associated with a lower prevalence of CMD (OR: 0.59; 95% CI: 0.35-0.98 and OR: 0.42, 95% CI: 0.18-0.96, respectively), after adjustment for sociodemographic, lifestyle and health status variables. In turn, the presence of CMD was not significantly associated with any level of adherence to the Brazilian-MDP., Limitations: due to the cross-sectional feature of the study, we cannot determine a cause-effect relationship; some covariates were self-reported; the results cannot apply to the elderly from other regions., Conclusion: Moderate and high adherence to the traditional MDP was found to reduce the risk of mental disorders in Brazilian elderly. Nevertheless, an increased intake of non-Mediterranean food components can limit this effect., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2020. Published by Elsevier B.V.)

Objectives: We aimed to investigate the effect of a symbiotic substance on symptoms of brain disorders and inflammation in the elderly. Methods: Forty-nine elders, both genders, assigned into two groups: S-group (synbiotic) and P-group (placebo). Evaluations at the beginning and at the end of the experiment: geriatric depressive symptoms scale-15 (GDS-15); mini-mental status examination (MMSE); % of body fat (%fat); serum IL-6, TNF-α and IL-10; serum diamine-oxidase (DAO), intestinal fatty-acid binding protein (IFABP), and lipopolysaccharide (LPS). Results: Both groups had reduced their %Fat, TNF-α, and DAO. The IL-6, GDS-15, and MMSE were increased in both groups. IL-10 was significantly increased only in the S-group, and LPS was significantly reduced only in the P-group. The GDS-15final was negatively explained by DAO, IL-10, TNF-α, %Fat, being woman, and being allocated in the P-group. The variables that positively explained the GDS-15final were the IL-6, the IFABP, and the LPS. MMSEfinal was positively associated with the IL-10, DAO, being woman, and being allocated in the P-group; and negatively associated with IL-6, TNF-α, %Fat, IFABP, and LPS. Conclusions: We found weak effects of symbiotic on depressive symptoms and more optimistic effects on cognition in apparently healthy elderly. Other studies, with individuals diagnosed with depressive morbidity or cognitive decline, are needed.Registration of Clinical Studies - REBEC (RBR-6qr9xx)].

Product Development Partnerships (PDP) are one of the measures used by the Brazilian government to incentivize innovation policy, to expand the population's access to strategic medicines, and to reduce the country's technological dependence by strengthening the national pharmaceutical manufacturing base. The study aimed to identify the Critical Success Factors (FCS in Portuguese) for the implementation of these partnerships, using as the reference one of the largest Brazilian government pharmaceutical laboratories. FCS are seen as key areas in which the results must be satisfactory in order to ensure successful performance in the organization or project. The methodological strategies included literature review, analysis of internal documents, and semi-structured interviews with key actors. We analyzed the partnerships approved for this public laboratory from 2009 to May 2018. The study enabled a critical view of the phases in a PDP and identification of specific critical factors for this type of project. The findings reveal persistent organizational challenges for increasing the executability of partnerships, which can serve as a reference for other government laboratories that have PDP agreements under way or that intend to submit proposals for them.

Background: Aging is a complex process marked by alterations on gut functioning and physiology, accompanied by an increase on the inflammatory status, leading to a scenario called "inflammaging"., Objective: To evaluate the effects of a synbiotic substance on systemic inflammation, gut functioning of community-dwelling elders., Methods: This is a secondary analysis from a randomized clinical trial, lasting 24 weeks, including 49 elders, distributed into two groups: SYN (n=25), which received a synbiotic substance (Frutooligossacaride 6g, Lactobacillus paracasei LPC-31 109 to 108 UFC, Lactobacillus rhamnosus HN001 109 to 108 UFC, Lactobacillus acidophilus NCFM 109 to 108 UFC e Bifidobacterium lactis HN019 109 to 108 UFC), or PLA (n=24), receiving placebo. The evaluations consisted of serum IL-10 e TNF-α (after overnight fasting), evaluation of chronic constipation (by Rome III Criteria) and faeces types (by Bristol Stool Form Scale). Data were compared before and after the supplementation time, and between groups., Results: No significant differences were found between baseline and final values of serum inflammatory markers. Some subtle beneficial changes were observed in SYN, concerning both gut functioning and faeces types., Conclusion: From our data, synbiotic supplementation showed a subtle benefit in gut functioning in apparently healthy community-dwelling elders. Our findings can suggest that the benefits in healthy individuals were less expressive than the ones presented in studies with individuals previously diagnosed as dysbiosis. Future studies, comparing elders with and without gut dysbiosis can confirm our findings.

In the context of crisis and resource constraints, it is reasonable to assume the deteriorated weaknesses of the Unified Health System (SUS), such as regional inequalities, underfinancing, and care quality issues. This study explored the application of easily comprehensible and calculated access and effectiveness indicators that could reflect the hospital network crisis. Five indicators extracted from the Hospital Information System, related to Brazil and states of the Southeastern region, were analyzed in the 2009-2018 period: hospitalizations resulting in death; surgical hospitalizations resulting in death; elective surgeries in the total of surgical hospitalizations; hip prostheses in the senior population; and angioplasties in the population aged 20 years and over. Statistical control charts were used to compare indicators between states, before and from 2014. In Brazil, overall hospital deaths had a slight increase while surgical deaths declined; elective surgeries and hipprosthesis also decreased. In Southeastern Brazil, Rio de Janeiro was the worst performer, especially the decrease of the elective surgeries. The results illustrate the potential of indicators to monitor crisis effects on hospital care.

The present article aimed to evaluate the consumption of protective foods and predictors of cardiovascular (CV) risk and its relationship with cardiovascular risk factors (CVRF) by hypertensive individuals in the state of Alagoas. A population-based cross-sectional study was carried out from 2013 to 2016 with 655 hypertensive adults of both sexes. Food consumption was assessed by a validated food frequency questionnaire with measurements converted to scores and the foods were divided into three groups: I - processed foods/CV risk predictors; II - ultraprocessed foods/higher CV risk predictors; III - in natura or minimally processed foods/ CV risk protectors. Socioeconomic, demographic, biochemical, clinical and anthropometric variables were also analyzed. The consumption scores of food groups I, II and III were, respectively, 0.11; 0.13 and 0.24 (p = 0.001). The consumption of processed foods was correlated positively with high blood cholesterol (p = 0.045) and negatively with age (p = 0.001); while that of ultraprocessed foods was correlated with the sedentary lifestyle (p = 0.01). Thus, it was observed a relationship between the consumption of CV risk predictors foods with high blood cholesterol and sedentary lifestyle, reflecting the need for nutricional education actions.

Chronic hyperglycemia is the key point of macro- and microvascular complications associated with diabetes mellitus. Excess glucose is responsible for inducing redox imbalance and both systemic and intrarenal inflammation, playing a critical role in the pathogenesis of diabetic kidney disease, which is currently the leading cause of dialysis in the world. The pathogenesis of the disease is complex, multifactorial and not fully elucidated; many factors and mechanisms are involved in the development, progression and clinical outcomes of the disease. Despite the disparate mechanisms involved in renal damage related to diabetes mellitus, the metabolic mechanisms involving oxidative/inflammatory pathways are widely accepted. The is clear evidence that a chronic hyperglycemic state triggers oxidative stress and inflammation mediated by altered metabolic pathways in a self-perpetuating cycle, promoting progression of cell injury and of end-stage renal disease. The present study presents an update on metabolic pathways that involve redox imbalance and inflammation induced by chronic exposure to hyperglycemia in the pathogenesis of diabetic kidney disease.

This article describes a systematic review of the literature on studies that have used the scores method proposed by Fornés et al. (2002) to evaluate food consumption and discuss the method from the perspective of food pattern assessment. The search of the Medline, Lilacs and Scielo databases was limited to the English, Portuguese and Spanish languages and to articles published from 2002 to 2016. The inclusion criterion was studies that used the scores method proposed by Fornés et al. to evaluate food consumption. The original search found 8300 items. After reading titles and abstracts and applying the exclusion criteria, 14 articles were selected. The articles evaluating food pattern used different groupings and examined associations with anthropometric, socioeconomic and biochemical variables. It was concluded that the scores method is able to evaluate food patterns and enables associations to be established between anthropometric, biochemical, socioeconomic and clinical variables and the components of the study diet/food grouping to which the individual was exposed.

Background: People suffering from spinal cord injury (SCI) undergo metabolic and physical disturbances that target the skeletal muscle, causing a progressive loss of muscle mass., Objective: To estimate the appendicular lean mass index (ALMI) in athletes with traumatic (T-group) and non-traumatic (NT-group) SCI, and its association with metabolic and demographic parameters., Methods: Wheelchair athletes with SCI aged 18 to 52 years old were included (n = 62). From DEXA assessment, we estimated the ALM index (ALMI = appendicular lean mass/height2) and classified participants according to the degree of muscle loss (ALMI < 2 SD from the reference populations). Fasting blood was assayed for glycaemia, insulin, cortisol, and IGF-1 serum levels. Data were compared by T-test and Fisher's Exact Test; predictors of ALMI were investigated by linear regression models., Results: The frequency of low ALMI was 63% in overall sample, 55% T-group and 71% NT-group. Low ALMI had no significant association with the origin of injury (X2 = 1.1, p = 0.29). Linear regression analyses showed significant association, in the whole sample, between ALMI and serum levels of IGF-1 (Beta = 0.69; p < 0.001), age (Beta=-5.8; p < 0.001), percentage fat mass (Beta=-0.26; p = 0.001), and energy intake (Beta = 0.32; p = 0.02). These significances were not maintained in the NT-group sub-analyses., Conclusions: Low ALMI was very frequent in our SCI participants, despite exercising and independently of the type of injury. Metabolic and demographic variables associated with low ALMI were different according to the origin of injury, which possibly relies on physiopathology particularities. More studies are necessary to clarify our findings.

Background: Maternal morbidity and mortality are still serious public health concerns in Brazil, and access to quality obstetric care is one critical point of this problem. Despite efforts, obstetric care quality problems and sub-optimal/poor outcomes persist. The study aimed to identify contextual elements that would potentially affect the implementation of an obstetric care quality improvement intervention., Methods: A qualitative study was conducted in three public maternity hospitals of a large Brazilian city, with high annual volume of births and buy-in from high-level managers. Individual interviews with doctors and nurses were conducted from July to October 2015. Semi-structured interviews sought to explore teamwork, coordination and communication, and leadership, being open to capture other contextual elements that could emerge. Interviews were recorded and transcribed, and the categories of analysis were identified and updated based on the constant comparative method., Results: Twenty-seven interviews were carried out. Extra-organizational context concerning the dependence of the maternity hospitals on primary care units, responsible for antenatal care, and on other healthcare organizations' services emerged from interviews, but the main findings of the study centered on intra-organizational context with potential to affect healthcare quality and actions for its improvement, including material resources, work organization design, teamwork, coordination and communication, professional responsibility vis-à-vis the patient, and leadership. A major issue was the divergence of physicians' and nurses' perspectives on care quality, which in turn negatively affected their capacity to work together., Conclusion: Overall, the findings suggest that care on the maternity hospitals was fragmented and lacked continuity, putting at risk the quality. Redesigning work organization, promoting conditions for multi-professional teamwork, better communication and coordination, improving more systemic accountability/lines of authority, and investing in team members' technical competence, and fitness of organizational structures and processes are all imbricated actions that may contribute to obstetric care quality improvement.

Restricted sodium intake has been recommended for more than 1 century for the treatment of hypertension. However, restriction seems to increase blood cholesterol. In women with excess weight, blood cholesterol may increase even more because of insulin resistance and the high lipolytic activity of adipose tissue.The aim of this study was to assess the association between blood cholesterol and sodium intake in hypertensive women with and without excess weight.This was a cross-sectional study with hypertensive and nondiabetic women aged 20 to 59 years, recruited at the primary healthcare units of Maceio, Alagoas, Brazilian Northeast. Excess weight was defined as body mass index (BMI) ≥25.0 kg/m. Sodium intake was estimated by the 24-hour urinary excretion of sodium. Blood cholesterol was the primary outcome investigated by this study, and its relationship with sodium intake and other variables was assessed by Pearson correlation and multivariate linear regression using a significance level of 5%.This study included 165 hypertensive women. Of these, 135 (81.8%) were with excess weight. The mean sodium intake was 3.7 g (±1.9) and 3.4 g (±2.4) in hypertensive women with and without excess weight, respectively. The multiple normal linear regression models fitted to the "blood cholesterol" in the 2 groups reveal that for the group of hypertensive women without excess weight only 1 independent variable "age" is statistically significant to explain the variability of the blood cholesterol levels. However, for the group of hypertensive women with excess weight, 2 independent variables, age and sodium intake, can statistically explain variations of the blood cholesterol levels.Blood cholesterol is statistically inversely related to sodium intake for hypertensive women with excess weight, but it is not statistically related to sodium intake for hypertensive women without excess weight.

Organotin compounds, such as tributyltin (TBT), are environment contaminants that induce bioaccumulation and have potential toxic effects on marine species and mammals. TBT have been banned by the International Maritime Organization in 2003. However, the assessment of butyltin and metal contents in marine sediments has demonstrated high residual levels of TBT in some cases exceeding 7000 ng Sn g -1 . The acceptable daily intake (ADI) level for TBT established by the World Health Organization is 0.5 μg/kg bw/day is based on genotoxicity, reproduction, teratogenicity, immunotoxicity, and mainly neurotoxicity. However, their effect on the cardiovascular system is not well understood. In this study, female rats were exposed to 0.5 μg/kg/day of TBT for 15 days with the goal of understanding the effect of TBT on vascular function. Female Wistar rats were treated daily by gavage and divided into control (n = 10) and TBT (n = 10) groups. The aortic rings were incubated with phenylephrine in both the presence and absence of endothelium. The phenylephrine concentration-response curves were generated by exposing endothelium-intact samples to N G -nitro-L-arginine methyl ester (L-NAME), apocynin, superoxide dismutase (SOD), catalase, tiron, and allopurinol. Acetylcholine (ACh) and sodium nitroprusside (SNP) were used to evaluate the relaxation response. Exposure to TBT reduced serum 17β-estradiol E 2 levels and increased vascular reactivity. After incubation with L-NAME, the vascular reactivity to phenylephrine was significantly higher. Apocynin, SOD, catalase, and tiron decreased the vascular reactivity to phenylephrine to a significantly greater extent in TBT-treated rats than in the control rat. The relaxation induced by ACh and SNP was significantly reduced in TBT rats. Exposure to TBT induced aortic wall atrophy and increased superoxide anion production and collagen deposition. These results provide evidence that exposing rats to the current ADI for TBT (0.5 μg/kg) for 15 days induced vascular dysfunction due to oxidative stress and morphological damage and should be considered an important cardiovascular risk factor.