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Background: Communicable diseases represent a huge economic burden for healthcare systems and for society. Sexually transmitted infections (STIs) are a concerning issue, especially in developing and underdeveloped countries, in which environmental factors and other determinants of health play a role in contributing to its fast spread. In light of this situation, machine learning techniques have been explored to assess the incidence of syphilis and contribute to the epidemiological surveillance in this scenario., Objective: The main goal of this work is to evaluate the performance of different machine learning models on predicting undesirable outcomes of congenital syphilis in order to assist resources allocation and optimize the healthcare actions, especially in a constrained health environment., Method: We use clinical and sociodemographic data from pregnant women that were assisted by a social program in Pernambuco, Brazil, named Mãe Coruja Pernambucana Program (PMCP). Based on a rigorous methodology, we propose six experiments using three feature selection techniques to select the most relevant attributes, pre-process and clean the data, apply hyperparameter optimization to tune the machine learning models, and train and test models to have a fair evaluation and discussion., Results: The AdaBoost-BODS-Expert model, an Adaptive Boosting (AdaBoost) model that used attributes selected by health experts, presented the best results in terms of evaluation metrics and acceptance by health experts from PMCP. By using this model, the results are more reliable and allows adoption on a daily usage to classify possible outcomes of congenital syphilis using clinical and sociodemographic data., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Teixeira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: to identify the sociodemographic profile and the characteristics of interpersonal violence against older adults during the first year of the COVID-19 pandemic in a capital city from the Brazilian Southeast region., Method: a descriptive and exploratory research study with a cross-sectional design based on the notifications of suspected or confirmed cases of violence against older adults between March 2020 and March 2021. A univariate statistical analysis and Fisher's exact test (p<0.05) were performed., Results: a total of 2,681 notifications were recorded during the period. The main victims were individuals aged between 60 and 64 years old, female, white-skinned and with low schooling levels. The instances of violence were more frequent in the victims' homes. Physical and psychological violence predominated, through physical force/beatings and threats, respectively. Most of the aggressors were male, younger than the victims and generally their children or intimate partners. The aggressions were perpetrated more than once and were driven by generational conflicts. There was low referral to entities for the protection of older adults., Conclusion: the sociodemographic profile found evidences vulnerable victims, subjected to many types of violence, and at a potential risk against their overall health.

Background: The Brazilian healthcare system is a large and complex system, specially considering its mixed public and private funding. The incidence of syphilis has increased in the last four years, in spite of the presence of an effective and available treatment. Furthermore, syphilis takes part in a group of disorders of compulsory notification to the public health surveillance. The epidemiological implications are especially important during pregnancy since it can lead to complications, related to prematurity stillbirth and miscarriage, in addition to congenital syphilis, characterized by multisystem involved in the newborn., Methods: The Action Research methodology was applied to address the complexity of the syphilis surveillance scenario in Pernambuco, Brazil. Iterative learning cycles were used, resulting in six cycles, followed by a formal validation of an operational version of the syphilis Trigram visualisation at the end of the process. The original data source was analyzed and prepared to be used without any new data or change in the ordinary procedure of the current system., Results: The main result of this work is the production of a Syphilis Trigram: a domain-specific infographic for presenting gestational data and birth data. The second contribution of this work is the Average Trigram, an organized pie chart which synthesizes the Syphilis Trigram relationship in an aggregated way. The visualization of both graphics is presented in an Infographic User Interface, a tool that gathers an infographic broad visualization aspect to data visualization. These interfaces also gather selections and filters tools to assist and refine the presented information. The user can experience a specific case-by-case view, in addition to an aggregated perspective according to the cities monitored by the system., Conclusions: The proposed domain-specific visualization amplifies the understanding of each syphilis case and the overall characteristics of cases of a chosen city. This new information produced by the Trigram can help clarify the reinfection/relapse cases, optimize resource allocation and enhance the syphilis healthcare policies without the need of new data. Thus, this enables the health surveillance professionals to see the broad tendency, understand the key patterns through visualization, and take action in a feasible time., (© 2022. The Author(s).)

Objective: To determine the frequency of drug therapy problems among older adults in Primary Health Care, and to analyze the factors associated with their identification in the initial patient assessment, carried out by pharmacists offering medication therapy management services., Methods: A cross-sectional study conducted with data from 758 older adults followed up in medication therapy management services in Primary Health Care in the cities of Belo Horizonte, Betim, and Lagoa Santa (MG, Brazil). Univariate and multivariate analyses were performed to evaluate the factors associated with identification of four or more drug therapy problems in the initial clinical assessment., Results: A total of 1,683 drug therapy problems were identified, 73.6% of older patients had at least one problem. The most frequent problems were nonadherence (23.0%) and the need for additional drug therapy (18.0%). Polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and aged 75 years or older remained positively and statistically associated with identification of four or more drug therapy problems (p<0.05)., Conclusion: There is a high frequency of problems related to medication use among older users of Primary Health Care, and the medication therapy management services should be prioritized to the older patients, who present with polypharmacy, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, heart failure, and age ≥ 75 years, since they are more likely to have more drug therapy problems.

Background: Garcinia brasiliensis is a species native to the Amazon forest. The white mucilaginous pulp is used in folk medicine as a wound healing agent and for peptic ulcer, urinary, and tumor disease treatments. The activity of the proprotein convertases (PCs) Subtilisin/Kex is associated with the development of viral, bacterial and fungal infections, osteoporosis, hyperglycemia, atherosclerosis, cardiovascular, neurodegenerative and neoplastic diseases., Methods: Morelloflavone (BF1) and semisynthetic biflavonoid (BF2, 3 and 4) from Garcinia brasiliensis were tested as inhibitor of PCs Kex2, PC1/3 and Furin, and determined IC 50 , K i , human proinflammatory cytokines secretion in Caco-2 cells, mechanism of inhibition, and performed molecular docking studies., Results: Biflavonoids were more effective in the inhibition of neuroendocrine PC1/3 than mammalian Furin and fungal Kex2. BF1 presented a mixed inhibition mechanism for Kex2 and PC1, and competitive inhibition for Furin. BF4 has no good interaction with Kex2 and Furin since carboxypropyl groups results in steric hindrance to ligand-protein interactions. Carboxypropyl groups of BF4 promote steric hindrance with Kex2 and Furin, but effective in the affinity of PC1/3. BF4 was more efficient at inhibiting PCl/3 (IC 50  = 1.13 μM and K i  = 0,59 μM, simple linear competitive mechanism of inhibition) than Kex2, Furin. Also, our results strongly suggested that BF4 also inhibits the endogenous cellular PC1/3 activity in Caco-2 cells, since PC1/3 inhibition by BF4 causes a large increase in IL-8 and IL-1β secretion in Caco-2 cells., Conclusions: BF4 is a potent and selective inhibitor of PC1/3., General Significance: BF4 is the best candidate for further clinical studies on inhibition of PC1/3., (Copyright © 2021. Published by Elsevier B.V.)

Background: Although considerable success in reducing the incidence of malaria has been achieved in Brazil in recent years, an increase in the proportion of cases caused by the harder-to-eliminate Plasmodium vivax parasite can be noted. Recurrences in P. vivax malaria cases are due to new mosquito-bite infections, drug resistance or especially from relapses arising from hypnozoites. As such, new innovative surveillance strategies are needed. The aim of this study was to develop an infographic visualization tool to improve individual-level malaria surveillance focused on malaria elimination in the Brazilian Amazon., Methods: Action Research methodology was employed to deal with the complex malaria surveillance problem in the Amazon region. Iterative cycles were used, totalling four cycles with a formal validation of an operational version of the Malaria Trigram tool at the end of the process. Further probabilistic data linkage was carried out so that information on the same patients could be linked, allowing for follow-up analysis since the official system was not planned in such way that includes this purpose., Results: An infographic user interface was developed for the Malaria Trigram that incorporates all the visual and descriptive power of the Trigram concept. It is a multidimensional and interactive historical representation of malaria cases per patient over time and provides visual input to decision-makers on recurrences of malaria., Conclusions: The Malaria Trigram is aimed to help public health professionals and policy makers to recognise and analyse different types of patterns in malaria events, including recurrences and reinfections, based on the current Brazilian health surveillance system, the SIVEP-Malária system, with no additional primary data collection or change in the current process. By using the Malaria Trigram, it is possible to plan and coordinate interventions for malaria elimination that are integrated with other parallel actions in the Brazilian Amazon region, such as vector control management, effective drug and vaccine deployment strategies., (© 2021. The Author(s).)

Objectives: To compare balance, foot function and mobility in patients with rheumatoid arthritis with and without foot orthoses., Design: Randomized controlled trial., Setting: Outpatient rheumatology clinic., Subjects: A total of 94 subjects with rheumatoid arthritis were randomized; of these, 81 were included in the analyses (Intervention group: 40; Control group: 41)., Intervention: The Intervention Group received custom-made foot orthoses while the Control Group received none intervention., Main Measure: The "Foot Function Index," the "Berg Balance Scale," and the "Timed-up-and-go Test" were assessed at baseline an after four weeks. The chosen level of significance was P  < 0.05., Results: Average (standard deviation) participant age was 56.7 (±10.6) years old and average disease duration (standard deviation) was 11.4 (± 7.2) years. Groups were similar at baseline, except for comorbidity index and race. After four weeks, significant interaction group versus time was observed for Foot Function Index (change: Intervention group: -1.23 ± 1.58; Control group: -0.12 ± 1.16 - P  = 0.0012) and for Berg Balance Scale (change: Intervention group: 2 ± 3; Control group: 0 ± 3 - P  = 0.0110), but not for the Timed-up-and-go Test (change: Intervention group: -1.34 ± 1.99; Control group: -0.84 ± 2.29 - P  = 0.0799)., Conclusion: Foot orthoses improved foot function and balance in patients with rheumatoid arthritis.

Objective: To evaluate the clinical impact of a comprehensive medication management (CMM) service in a Brazilian primary health-care setting., Methods: A quasi-experimental study has been carried out between July 2014 and November 2016 with patients who received the service in the primary care setting of a Brazilian city (n = 1057). Factors associated with drug therapy problems (DTP) detection in the initial assessment were evaluated by performing univariate and multivariate analyzes. To evaluate the impact of the CMM service, a linear regression model was constructed from the difference between the initial and final values of the clinical and laboratory parameters adjusted by multiple variables., Results: A total of 1642 DTPs was identified, the most prevalent one being "nonadherence" (31.9%) and the "need for additional drug therapy" (22.9%). The use of 5 or more medications and the presence of 3 or more diseases were positively associated with the identification of 3 or more DTPs during the initial assessment. Even after multiple adjustments, a statistically significant reduction has been observed in the values of glycated hemoglobin, systolic blood pressure, low-density cholesterol, and total cholesterol., Conclusion: The CMM service contributed to the resolution of DTP and showed positive clinical impact in primary health care in the studied setting.

We report a case of severe congenital toxoplasmosis that involved an atypical T. gondii genotype in a newborn baby from Alagoas state in Northeastern Brazil. A pregnant woman presented IgM and IgG anti-T. gondii antibodies, as detected by the chemiluminescence immunoassay on the second trimester of pregnancy. A mouse bioassay was performed using umbilical cord blood and one isolate was obtained. The isolate was designated TgCTBrAL1 and genetic characterization revealed genotype ToxoDB #162. Genotype results of the rhoptry genes, ROP5 and ROP18, could predict the high virulence of the isolate in mice, which was confirmed by an in vivo virulence assay. This is the first report of generating a T. gondii isolate from a newborn baby with congenital toxoplasmosis in Northeastern Brazil.

The high prevalence of chronic diseases and use of multiple medications identified in Primary Health Care (PHC) suggest the need for the implementation of Comprehensive Medication Management (CMM) services. This study aimed to evaluate the clinical results of CMM services in a Brazilian PHC setting. A quasi-experimental study was performed with patients followed-up for two years ( n = 90). Factors associated with the detection of four drug therapy problems (DTP) or more in the initial assessment were evaluated (univariate and multivariate analyses), as well as the clinical impact observed in laboratory parameters (HbA1c, Blood Pressure, LDL- and HDL-covariance analysis). A predominance of women (61.1%), a mean age of 65.5 years, and a prevalence of polypharmacy (87.8%)-use of five or more drugs-were observed. A total of 441 DTP was identified, 252 required interventions with the prescriber, 67.9% of which were accepted and 59.6% were solved. The main DTP were 'non-adherence' (28.1%), 'need for additional drug therapy' (21.8%), and 'low dose' (19.5%). Hypertension was positively associated with the identification of four DTP or more. A statistically significant reduction was detected in all assessed laboratory parameters ( p < 0.05). CMM services contributed to the resolution of DTP and improved clinical outcomes.

To assess the risk posed by meat consumption to the Fiji and Pacific populace, the present study reports nitrate and nitrite in meat. Twelve commercially available meat products, with a total of 210 fresh and processed meat samples, were analysed for nitrate and nitrite by an optimised RP-HPLC technique with isocratic elution using n-octylamine in 20.0% methanol at pH 6.60. The nitrate content in the meat samples ranged from 0.00 to 124 mg kg -1 whereas the nitrite ranged from 0.00 to 164 mg kg -1 . The study shows that the nitrate and nitrite contents of meat samples in Fiji were below the maximum level proposed by European Union legislation but above the limit set by Food Standards Australia and New Zealand (FSANZ). The estimated dietary intake of nitrate and nitrite was calculated from a 24-h diet recall study as well as from Fiji's food balance sheets., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Despite great progress made in methods to prevent mother-to-child transmission of HIV (MTCT), delivery and uptake of these measures remains a challenge in many countries. Although the Brazilian Ministry of Health aimed to eliminate MTCT by 2015, infection still occured in 15-24% of infants born to HIV-infected mothers. We sought to identify remaining factors that constrain MTCT elimination., Methods: We conducted a retrospective, matched case-control study by reviewing hospital charts of infants born to HIV-infected mothers between 1997 and 2014 at three MTCT reference hospitals in the Rio de Janeiro metropolitan area. Cases were defined as HIV-exposed children with two positive HIV tests before 18 months of age; controls were defined as HIV-exposed children with two negative HIV tests before 18 months of age. We performed bivariate and MTCT cascade analyses to identify risk factors for MTCT and gaps in prevention services., Results: We included 435 infants and their mothers (145 cases, 290 controls). Bivariate analyses of MTCT preventative care (PMTCT) indicated that cases were less likely to complete all individual measures in the antenatal, delivery, and postnatal period (p < 0.05). Assessing completion of the PMTCT cascade, the sequential steps of PMTCT interventions, we found inadequate retention in care among both cases and controls, and cases were significantly less likely than controls to continue receiving care throughout the cascade (p < 0.05). Motives for incompletion of PMTCT measures included infrastructural issues, such as HIV test results not being returned, but were most often due to lack of care-seeking. Over the course of the study period, PMTCT completion improved, although it remained below the 95% target for antenatal care, HIV testing, and antenatal ART set by the WHO. Adding concern, evaluation of co-infections indicated that case infants were also more likely to have congenital syphilis (OR: 4.29; 95% CI: 1.66 to 11.11)., Conclusions: While PMTCT coverage has improved over the years, completion of services remains insufficient. Along with interventions to promote care-seeking behaviour, increased infrastructural support for PMTCT services is needed to meet the HIV MTCT elimination goal in Brazil as well as address rising national rates of congenital syphilis.

Background: Subjective aspects of dental prosthesis need in middle-aged adults are poorly explored, especially when the population presents chronic diseases. Objectives: To investigate if the use and necessity of dental prosthesis influence the self-perceptions of health and dental treatment need in middle-aged adults with chronic diseases., Material and Methods: A cross-sectional study was performed in 210 middle-aged adults. Socio-demographic aspects, dental services use, oral and general perceptions of health, dental treatment need and OIDP were assessed using a standardized questionnaire. One trained dentist evaluated the use and necessity of dental prosthesis. Data were analyzed using Chi-square and multivariate logistic regression ( p <0.05)., Results: The use of dental prosthesis showed a proportion of 2.2:1 for upper to lower arch. Dental prosthesis need was largely prevalent (90 and 95% in upper and lower arch, respectively). The self-perceptions of dental treatment need and oral health were associated with the use and necessity of dental prosthesis ( p <0.05), which could not be observed in relation to the general self-perception. The adjusted model demonstrated that the subjective necessity of dental treatment was 16.04 (1.92-133.7) fold higher in individuals with necessity of rehabilitation in the lower arch. Besides, a positive self-perception of oral health (satisfied) was 2.59 (1.38-4.85) more expressive in individuals that used a dental prosthesis in upper arch., Conclusions: The self-perception of oral health was influenced by the use of maxillary dental prosthesis in individuals with chronic disease. Moreover, individuals were more likely able to perceive treatment need when the lower jaw was affected by tooth loss. Key words: Tooth loss, epidemiology, personal satisfaction, aged, chronic disease., Competing Interests: Conflict of interest statement: The authors declare no potential conflict of interest with respect to the authorship and/or publication of this article.

Background Direct-acting antivirals (DAA) are currently used for the treatment of chronic hepatitis C (HCV). However, few studies describe the adverse effects (AE) associated with DAA therapy in "real-word" cohorts. Aim To evaluate AE in Brazilian chronic HCV patients after DAA-therapy. Setting A reference center for hepatitis treatment in Rio de Janeiro, Brazil. Methods An observational "real-world" study was conducted with 102 chronic HCV patients undergoing DAA therapy for 12 or 24 weeks. The self-reported AE were correlated with cirrhosis status, genotype, age, current therapeutic schemes and comorbidities. Serious AE were also investigated. Main outcome measure Frequency of AE during DAA therapy. Results Overall, mean ± SD age was 60.9 ± 9.4 years, 67% were females, HCV-genotype 1 was the most prevalent (81%) and 74% were cirrhotic. Moreover, all patients reached sustained virological response. About 90% of patients reported at least one AE associated with current treatment, with a mean of 2.7 symptoms per patient. The most frequently reported AE were fatigue (43%), headache (42%), neuropsychiatric symptoms (30%) and nausea (26%). Furthermore, hemoglobin < 12 mg/dL was the most frequent (38%) laboratory abnormality observed. Neuropsychiatric symptoms were the only AE significantly different in treatment-experienced group when compared to naïve patients (41.7 vs. 12.5, P = 0.002). The higher frequency of AE did not correlate with the presence of previous treatment, cirrhosis, genotype, age, current therapeutic schemes with DAA or comorbidities. Conclusion DAA-based therapeutic regimens demonstrated safety in a Brazilian "real-world" cohort of chronic hepatitis C patients.

Background: Temporal trends in dietary patterns reveal associations between food consumption and increased prevalence of non-communicable chronic disease., Objectives: This study characterized dietary patterns in adolescents in urban area located in northeast of Brazil, relating it to the markers of a healthy diet., Methods: A cross-sectional study used two 24-hour recalls to assess dietary intake in 430 public school students from Natal-RN, Brazil. Principal component analysis was used to derive dietary patterns according to consumption of food based on weight (grams), energy (Kcal), or fiber (grams). The analysis results yielded 3 distinct principal components: 7, 8, and 4 (cumulative variance >70%; factor loadings >0.4). The association between independent variables and the factor scores of all components obtained was determined by the Prevalence Ratio (CI 95%)., Results: The dietary patterns derived were: (1) Pure Traditional Food System, the highly representative pattern in young adolescents and the first component of the analytical models, (2) Combined and Risk Food System; extraction of total food weight and energy revealed markers of unhealthy diets based on high sugar, saturated fat, and salt consumption, and (3) Modified Traditional Food System represented by fiber; pattern 1 was observed within this model too. The associations observed, predominantly from the TFSm pattern, distinguished by sex, age and nutritional status., Conclusions: Patterns 1 and 3 are characterized by preserved regional food practices that prevent chronic disease, whereas pattern 2 is characterized by health risks. These inter-sectorial findings should be considered in the development of health care policies for children and adolescents., (Copyright AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)