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Este artículo identifica, con base en la teoría de Ecosistemas de Emprendimiento (EE), los factores que promueven los Ecosistemas de Emprendimiento Social (EES) en el estado de Querétaro, México. Dicha teoría explica que los EES se desarrollan en EE fortalecidos y que estos últimos prosperan en regiones con recursos. Desde una metodología cualitativa, se analizan los factores para el desarrollo de EES en Querétaro, los principales hallazgos los muestran como incipientes y con necesidad de implementar medidas holísticas para emerger adecuadamente. Este estudio es relevante porque profundiza el conocimiento de los EE regionales y los EES en México y América Latina.

Safe and effective severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have been crucial to fight against the coronavirus disease 2019 pandemic. Most vaccines are based on a mutated version of the Spike glycoprotein [K986P/V987P (S-2P)] with improved stability, yield and immunogenicity. However, S-2P is still produced at low levels. Here, we described a novel V987H mutation that increases by two-fold the production of the recombinant Spike and the exposure of the receptor binding domain (RBD). S-V987H immunogenicity was similar to S-2P in K18-hACE2 mice and golden Syrian hamsters, and superior to a monomeric RBD. Immunization with S-V987H, but not with S-2P or RBD, conferred full protection against severe disease in both animal models after SARS-CoV-2 challenge (D614G and B.1.351 variants). Furthermore, S-V987H immunized K18-hACE2 mice showed a faster tissue viral clearance than RBD- or S-2P-vaccinated animals. Thus, S-V987H protein provides an alternative to S-2P for future SARS-CoV-2 vaccines development.

Neoantigens are tumor-specific antigens that are mostly particular for each patient. Since the immune system is able to mount a specific immune response against these neoantigens, they are a promising tool for the development of therapeutic personalized cancer vaccines. Neoantigens must be presented to T cells by Antigen Presenting Cells (APC) in the context of MHC-I or MHC-II molecules. Therefore, the strategy of vaccine delivery may have a major impact on the magnitude and quality of T cell responses. Neoantigen vaccines are frequently administered as a pool of individual synthetic peptides that induce mainly CD4+ T cell responses. MHC-I-mediated presentation and the elicitation of CD8+ T cell responses may be improved using DNA or RNA sequences that code for a unique long polypeptide that concatenates the different neoantigens spaced by linker sequences. When administered this way, the selection of the spacer between neoantigens is of special interest, as it might influence the processing and presentation of the right peptides by APCs. Here, we evaluate the impact of such linker regions on the MHC-I-dependent antigen presentation using an in vitro assay that assesses the MHC-I presentation of SIINFEKL, a H-2Kb-restricted OVA peptide. Our results show that spacers used to generate epitope concatenates have a large impact on the efficiency of neoantigen processing and presentation by MHC-I molecules; in contrast, the peptide position and the flanking regions have a minimal impact. Moreover, linkers based on alanine residues promote a more efficient peptide presentation than the commonly used GGGS linker.

Feline leukemia virus (FeLV) is one of the most prevalent infectious diseases in domestic cats. Although different commercial vaccines are available, none of them provides full protection. Thus, efforts to design a more efficient vaccine are needed. Our group has successfully engineered HIV-1 Gag-based VLPs that induce a potent and functional immune response against the HIV-1 transmembrane protein gp41. Here, we propose to use this concept to generate FeLV-Gag-based VLPs as a novel vaccine strategy against this retrovirus. By analogy to our HIV-1 platform, a fragment of the FeLV transmembrane p15E protein was exposed on FeLV-Gag-based VLPs. After optimization of Gag sequences, the immunogenicity of the selected candidates was evaluated in C57BL/6 and BALB/c mice, showing strong cellular and humoral responses to Gag but failing to generate anti-p15E antibodies. Altogether, this study not only tests the versatility of the enveloped VLP-based vaccine platform but also sheds light on FeLV vaccine research.

Objective Different genetic polymorphisms of human leukocyte antigen (HLA) have been associated with the risk and prognosis of autoimmune and infectious diseases. The objectives of this study were to determine whether there is an association between HLA genetic polymorphisms and the susceptibility to and mortality of coronavirus disease 2019 (COVID-19) patients. Design Observational and prospective study. Setting Eight Intensive Care Units (ICU) from 6 hospitals of Canary Islands (Spain). Patients COVID-19 patients admitted in ICU and healthy subjects. Interventions Determination of HLA genetic polymorphisms. Main variable of interest Mortality at 30 days. Results A total of 3886 healthy controls and 72 COVID-19 patients (10 non-survivors and 62 survivor patients at 30 days) were included. We found a trend to a higher rate of the alleles HLA-A*32 (p = 0.004) in healthy controls than in COVID-19 patients, and of the alleles HLA-B*39 (p = 0.02) and HLA-C*16 (p = 0.02) in COVID-19 patients than in healthy controls; however, all these p-values were not significant after correction for multiple comparisons. Logistic regression analysis showed that the presence of certain alleles was associated with higher mortality, such as the allele HLA-A*11 after controlling for SOFA (OR = 7.693; 95% CI = 1.063–55.650; p = 0.04) or APACHE-II (OR = 11.858; 95% CI = 1.524–92.273; p = 0.02), the allele HLA-C*01 after controlling for SOFA (OR = 11.182; 95% CI = 1.053–118.700; p = 0.04) or APACHE-II (OR = 17.604; 95% CI = 1.629–190.211; p = 0.02), and the allele HLA-DQB1*04 after controlling for SOFA (OR = 9.963; 95% CI = 1.235–80.358; p = 0.03). Conclusions The new finding from our preliminary study of small sample size was that HLA genetic polymorphisms could be associated with COVID-19 mortality; however, studies with a larger sample size before definitive conclusions can be drawn.

Aim: To determine whether blood concentrations of Bcl-2 during the 1st week of sepsis could help predict mortality. Methods: Serum Bcl-2 concentrations were determined at the 1st, 4th and 8th days of sepsis diagnosis. Results: Thirty-day surviving patients (n = 168) showed higher serum Bcl-2 levels at the 1st (p = 0.002), 4th (p

To understand the determinants of long-term immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the concurrent impact of vaccination and emerging variants, we follow a prospective cohort of 332 patients with coronavirus disease 2019 (COVID-19) over more than a year after symptom onset. We evaluate plasma-neutralizing activity using HIV-based pseudoviruses expressing the spike of different SARS-CoV-2 variants and analyze them longitudinally using mixed-effects models. Long-term neutralizing activity is stable beyond 1 year after infection in mild/asymptomatic and hospitalized participants. However, longitudinal models suggest that hospitalized individuals generate both short- and long-lived memory B cells, while the responses of non-hospitalized individuals are dominated by long-lived B cells. In both groups, vaccination boosts responses to natural infection. Long-term (>300 days from infection) responses in unvaccinated participants show a reduced efficacy against beta, but not alpha nor delta, variants. Multivariate analysis identifies the severity of primary infection as an independent determinant of higher magnitude and lower relative cross-neutralization activity of long-term neutralizing responses., Graphical abstract, Pradenas and Trinité et al. analyze the kinetics of neutralizing antibodies in response to natural SARS-CoV-2 infection and evaluate the long-term (beyond 1 year) stability and breadth of the neutralizing response before subsequent vaccination.

BackgroundUnderstanding the determinants of long-term immune responses to SARS-CoV-2 and the concurrent impact of vaccination and emerging variants of concern will guide optimal strategies to achieve global protection against the COVID-19 pandemic.MethodsA prospective cohort of 332 COVID-19 patients was followed beyond one year. Plasma neutralizing activity was evaluated using HIV-based reporter pseudoviruses expressing different SARS-CoV-2 spikes and was longitudinally analyzed using mixed-effects models.FindingsLong-term neutralizing activity was stable beyond one year after infection in mild/asymptomatic and hospitalized participants. However, longitudinal models suggest that hospitalized individuals generate both short- and long-lived memory B cells, while outpatient responses were dominated by long-lived B cells. In both groups, vaccination boosted responses to natural infection, although viral variants, mainly B.1.351, reduced the efficacy of neutralization. Importantly, despite showing higher neutralization titers, hospitalized patients showed lower cross-neutralization of B.1.351 variant compared to outpatients. Multivariate analysis identified severity of primary infection as the factor that independently determines both the magnitude and the inferior cross-neutralization activity of long-term neutralizing responses.ConclusionsNeutralizing response induced by SARS-CoV-2 is heterogeneous in magnitude but stable beyond one year after infection. Vaccination boosts these long-lasting natural neutralizing responses, counteracting the significant resistance to neutralization of new viral variants. Severity of primary infection determines higher magnitude but poorer quality of long-term neutralizing responses.

The understanding of HIV-1 pathogenesis and clinical progression is incomplete because of the variable contribution of host, immune and viral factors. The involvement of viral factors has been investigated in extreme clinical phenotypes from rapid progressors to long-term non-progressors (LTNPs). Among HIV-1 proteins, the envelope glycoprotein complex (Env) has concentrated many studies for its important role in the immune response and in the first steps of viral replication. In this study, we analyzed the contribution of 41 Envs from 24 patients with different clinical progression rates and viral loads (VLs), LTNP-Elite Controllers (LTNP-ECs); Viremic LTNPs (vLTNPs), and non-controller’s individuals contemporary to LTNPs or recent, named Old and Modern progressors. We analyzed the Env expression, the fusion and cell-to-cell transfer capacities as well as viral infectivity. The sequence and phylogenetic analysis of Envs were also performed. In every functional characteristic, the Envs from subjects with viral control (LTNP-ECs and vLTNPs) showed significant lower performance compared to those from the progressor individuals (Old and Modern). Regarding sequence analysis, the variable loops of the gp120 subunit of the Env (i.e., V2, V4 and mainly V5) of the progressor individuals showed longer and more glycosylated sequences than controller subjects. Therefore, HIV-1 Envs presenting poor viral functions and shorter sequences were associated with viremic control and the non-progressor clinical phenotype, whereas functional Envs were associated with the lack of virological control and progressor clinical phenotypes. These correlations support the central role of Env genotypic and phenotypic characteristics in the in vivo HIV-1 infection and pathogenesis.IMPORTANCEThe role of the virus in the pathogenesis of HIV-1 infection has not been investigated in isolates from individuals with different progression rates. In this work, we studied the properties of the envelope glycoprotein complex (Env) in individuals with different progression rates to elucidate its role in pathogenesis. We estimated the Env expression, the CD4 binding, the fusion and cell-to-cell viral transfer capacities that affect the infectivity of the viral Envs in recombinant viruses. The Envs from individuals which control viral replication and lack clinical progression (LTNP-ECs and vLTNPs) showed lower functional capacities than from subjects with clinical progression (Old and Modern). The functional increase of the Envs characteristics was associated with an increase in viral infectivity and in increased length of variable loops and the number of glycosylation sites of the Env (gp120/SU). These results support the concept that viral characteristics contribute to viral infection and pathogenesis.

Aims This trial aimed to evaluate the safety and efficiency of a common and simplified protocol for the surveillance of cardiac implantable electronic devices based on remote monitoring (RM) in patients with pacemakers (PMs) and implantable cardiac defibrillators (ICDs) for at least 24 months. Methods and results The RM-ALONE is a multicentre prospective trial that randomly assigned 445 patients in two groups, both followed by RM: the home monitoring-only (HMo) based on RM + remote interrogations (RIs) every 6 months and the HM + IO that adds in-office evaluations every 6 months to RM. Four hundred and forty-five patients were enrolled in the study, 294 PMs and 151 ICDs recipients. In the HMo group, 20% of patients experienced ≥1 major adverse cardiac event (MACE) vs. 19.5% in HM + IO group (P = 0.006 for non-inferiority). The proportion of patients with a PM/ICD who experienced ≥1 MACE was 15.2/29.3% in HMo group and 16.1/26.3% in HM + IO group (hazard ratio 0.95/1.15, 95% confidence interval 0.53–1.70/0.62–2.10). There were 789 in-office evaluations (136 in the HMo and 653 in the HM + IO; P Conclusion The RM-ALONE protocol common for ICD and PM surveillance, consisting of RM + RI every 6 months has proven safe and efficient in reducing hospital visits and staff workload.

To assess the potential impact of predominant circulating SARS-CoV-2 variants on neutralizing activity of infected and/or vaccinated individuals, we analyzed neutralization of pseudoviruses expressing the spike of the original Wuhan strain, the D614G and B.1.1.7 variants. Our data show that parameters of natural infection (time from infection and infecting variant) determined cross-neutralization. Importantly, upon vaccination, previously infected individuals developed equivalent B.1.1.7 and Wuhan neutralizing responses. In contrast, uninfected vaccinees showed reduced neutralization against B.1.1.7.FundingThis study was funded by Grifols, the Departament de Salut of the Generalitat de Catalunya, the Spanish Health Institute Carlos III, CERCA Programme/Generalitat de Catalunya, and the crowdfunding initiatives #joemcorono, BonPreu/Esclat and Correos.

The protective effect of neutralizing antibodies in SARS-CoV-2 infected individuals is not yet well defined. To address this issue, we have analyzed the kinetics of neutralizing antibody responses and their association with disease severity. Between March and May 2020, the prospective KING study enrolled 72 COVID-19+ participants grouped according to disease severity. SARS-CoV-2 infection was diagnosed by serological and virological tests. Plasma neutralizing responses were assessed against replicative virus and pseudoviral particles. Multiple regression and non-parametric tests were used to analyze dependence of parameters. The magnitude of neutralizing titers significantly increased with disease severity. Hospitalized individuals developed higher titers compared to mild-symptomatic and asymptomatic individuals, which together showed titers below the detection limit in 50% of cases. Longitudinal analysis confirmed the strong differences in neutralizing titers between non-hospitalized and hospitalized participants and showed rapid kinetics of appearance of neutralizing antibodies (50% and 80% of maximal activity reached after 11 and 17 days after symptoms onset, respectively) in hospitalized patients. No significant impact of age, gender or treatment on the neutralizing titers was observed in this limited cohort. These data identify a clear association of humoral immunity with disease severity and point to immune mechanisms other than antibodies as relevant players in COVID-19 protection. This work was partially funded by Grifols, the Departament de Salut of the Generalitat de Catalunya (Grant DSL0016 to JB and Grant DSL015 to JC), the Spanish Health Institute Carlos III (Grant PI17/01518 and PI18/01332 to JC) and the crowdfunding initiatives #joemcorono, BonPreu/Esclat and Correos. The funders had no role in study design, data collection and analysis, the decision to publish, or the preparation of the manuscript. EP was supported by a doctoral grant from National Agency for Research and Development (ANID)—Formation of Advanced Human Capital Program, Becas Chile: Grant 72180406. We are deeply grateful to all participant and to the technical staff of IrsiCaixa for sample processing. We also thank Daniel Pérez-Zsolt and Jordana Muñoz-Basagoiti for assistance with ACE-2 expressing 293T cell culture. Peer Reviewed "Article signat per 26 autors/es: Benjamin Trinité, Ferran Tarrés-Freixas, Jordi Rodon, Edwards Pradenas, Víctor Urrea, Silvia Marfil, María Luisa Rodríguez de la Concepción, Carlos Ávila-Nieto, Carmen Aguilar-Gurrieri, Ana Barajas, Raquel Ortiz, Roger Paredes, Lourdes Mateu, Alfonso Valencia, Víctor Guallar, Lidia Ruiz, Eulàlia Grau, Marta Massanella, Jordi Puig, Anna Chamorro, Nuria Izquierdo-Useros, Joaquim Segalés, Bonaventura Clotet, Jorge Carrillo, Júlia Vergara-Alert & Julià Blanco"

Altres ajuts: This work was partially funded by Grifols, the Departament de Salut of the Generalitat de Catalunya (grant SLD016 to J.B. and Grant SLD015 to J.C.), and the crowdfunding initiatives #joemcorono, BonPreu/Esclat and Correos. With the spread of new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there is a need to assess the protection conferred by both previous infections and current vaccination. Here we tested the neutralizing activity of infected and/or vaccinated individuals against pseudoviruses expressing the spike of the original SARS-CoV-2 isolate Wuhan-Hu-1 (WH1), the D614G mutant and the B.1.1.7 variant. Our data show that parameters of natural infection (time from infection and nature of the infecting variant) determined cross-neutralization. Uninfected vaccinees showed a small reduction in neutralization against the B.1.1.7 variant compared to both the WH1 strain and the D614G mutant. Interestingly, upon vaccination, previously infected individuals developed more robust neutralizing responses against B.1.1.7, suggesting that vaccines can boost the neutralization breadth conferred by natural infection.

OBJECTIVE To estimate the trends of fall-related hospitalization, mortality, and lethality among older adults in Brazil and regions. METHODS This is a descriptive study based on data from the Hospital Information System of the Brazilian Unified Health System. We included records of every older adult, aged 60 years or older, hospitalized for accidental fall from January, 1998 to November, 2015 in all Brazilian regions. We selected the codes E885, E886, E880, E884, E884 from the International Classification of Diseases, 9th revision, and W01, W03, W10, W17, W18 from the 10th revision, and calculated fall-related hospitalization and mortality rates per 100,000 inhabitants, as well as lethality. To estimate trends, we applied the Prais-Winsten regression for time series analysis. RESULTS During the period, 1,192,829 fall-related hospitalizations occurred, among which 54,673 had a fatal outcome; lethality was 4.5%. Hospitalization rates showed upward trends, with seasonality, in Brazil (11%), and in the Northeast (44%), Midwest (13%), and South regions (14%). The North showed a decreasing hospitalization rate (48%), and the Southeast a stationary one (3%). CONCLUSIONS In Brazil, fall-related hospitalizations, mortality, and lethality among older adults showed an upward trend from 1998 to 2015, with seasonal peaks in the second and third quarters. Considering we are in plain demographic transition, to improve hospital healthcare and encourage falls prevention programs among older adults is essential. RESUMO OBJETIVO Estimar as tendências de internação, mortalidade e letalidade por quedas em idosos no Brasil e regiões. MÉTODOS Estudo descritivo realizado a partir de dados do Sistema de Informações Hospitalares do Sistema Único de Saúde. Foram incluídos os registros de todos os idosos, a partir de 60 anos, internados por quedas acidentais entre janeiro de 1998 e novembro de 2015 em todas regiões do Brasil. Foram selecionados os códigos E885, E886, E880, E884, E888 e W01, W03, W10, W17, W18 da Classificação Internacional de Doenças (CID), 9ª e 10ª revisão respectivamente, e calculadas as taxas de internação e mortalidade por quedas por 100.000 habitantes, além da letalidade. Para cálculo de tendências, usou-se o procedimento de Prais-Winsten de autorregressão para análise de séries temporais. RESULTADOS Foram realizadas 1.192.829 internações por quedas no período, ocorreram 54.673 desfechos fatais, e a letalidade foi de 4,5%. As taxas de internação apresentaram tendências crescentes, com sazonalidade, no Brasil e nas regiões Nordeste, Centro-Oeste e Sul (taxas de crescimento de 11%, 44%, 13% e 14%, respectivamente). No Norte, a taxa de internação foi decrescente, e no Sudeste foi estacionária (taxas de crescimento: 48% e 3%). CONCLUSÕES Houve tendência crescente de internações, mortalidade e letalidade por quedas em idosos entre 1998 e 2015 no Brasil, com picos sazonais no segundo e terceiro trimestres. É necessário aprimorar tanto a assistência hospitalar quanto incentivar programas de prevenção de quedas em idosos, visto que estamos em plena transição demográfica.

OBJECTIVE To estimate the prevalence of accidental falls in women and to identify possible associations of sociodemographic, clinical and lifestyle variables with falls, in 2007 and 2014. METHODS Two cross-sectional studies were performed, in 2007 and 2014, within the Projeto de Saúde de Pindamonhangaba (PROSAPIN – Pindamonhangaba Health Project), with women aged between 35 to 75 years. Probabilistic samples were selected among women living in the municipality and participating in the Health Family Strategy. Data collection included: face-to-face interview, anthropometric examination and blood test. The outcome variable “have you fallen in the last six months?” was raised during the interview. The prevalence of falls in 2007 and 2014 were estimated by score with a 95% confidence interval (95%CI). Multiple logistic regression models were constructed to identify the association of independent variables with the occurrence of falls for each year based on the odds ratio (OR). We used the Stata 14.0 software for statistical analysis. RESULTS The prevalence of accidental falls were: 17.6% (95%CI 14.9–20.5) in 2007 and 17.2% (95%CI 14.8–19.8) in 2014. In 2007, factors associated with falls were: aged 50–64 years (OR = 1.81; 95%CI 1.17–2.80), high school (OR = 1.76; 95%CI 1.06–2.93), hyperuricemia (OR = 3.74; 95%CI 2.17–6.44), depression (OR = 2.07; 95%CI 1.31–3.27), poor sleep (OR = 1.78; 95%CI 1.12–2.82) and daytime sleepiness (OR = 1.86; 95%CI 1.16–2.99). In 2014, they were: aged 50–64 years (OR = 1.64; 95%CI 1.04–2.58), hyperuricemia (OR = 1.91; 95%CI 1.07–3.43) and depression (OR = 1.56; 95%CI 1.02–2.38), plus metabolic syndrome (OR = 1.60; 95%CI 1.03–2.47) and musculoskeletal pain (OR = 1.81; 95%CI 1.03–3.18). CONCLUSIONS Falls occur significantly in women aged 50 years or over, indicating that they are not restricted to older adults and that there is a need to initiate preventive measures earlier. Both studies showed similar magnitudes of occurrence of accidental falls and reinforced their multifactorial nature. In addition, hyperuricemia may be a potential new factor associated with falls. RESUMO OBJETIVO Estimar a prevalência de quedas acidentais em mulheres e identificar possíveis associações de variáveis sociodemográficas, clínicas e de hábitos de vida com as quedas, em 2007 e 2014. MÉTODOS Foram realizados dois estudos transversais, em 2007 e 2014, dentro do Projeto de Saúde de Pindamonhangaba (PROSAPIN), com mulheres com idades variando de 35 a 75 anos. As amostras probabilísticas foram selecionadas dentre as mulheres residentes no município e participantes da Estratégia Saúde da Família. A coleta de dados incluiu: entrevista face a face, exame antropométrico e exame sanguíneo. A variável de desfecho “Sofreu queda nos últimos seis meses?” foi levantada durante a entrevista. Foram estimadas as prevalências de quedas em 2007 e 2014 por ponto e intervalo de confiança de 95% (IC95%). Modelos de regressão logística múltipla foram construídos para identificar a associação das variáveis independentes e a ocorrência de quedas para cada ano a partir da odds ratio (OR). Utilizou-se o software Stata 14.0 para análise estatística. RESULTADOS As prevalências de quedas acidentais foram: 17,6% (IC95% 14,9–20,5) em 2007 e 17,2% (IC95% 14,8–19,8) em 2014. Em 2007 os fatores associados a quedas foram: idade de 50–64 anos (OR = 1,81; IC95% 1,17–2,80), ensino médio (OR = 1,76; IC95% 1,06–2,93), hiperuricemia (OR = 3,74; IC95% 2,17–6,44), depressão (OR = 2,07; IC95% 1,31–3,27), sono ruim (OR = 1,78; IC95% 1,12–2,82) e sonolência diurna (OR = 1,86; IC95% 1,16–2,99). Em 2014 permaneceram: idade de 50–64 anos (OR = 1,64; IC95% 1,04–2,58), hiperuricemia (OR = 1,91; IC95% 1,07–3,43) e depressão (OR = 1,56; IC95% 1,02–2,38), acrescidos da síndrome metabólica (OR = 1,60; IC95% 1,03–2,47) e da dor musculoesquelética (OR = 1,81; IC95% 1,03–3,18). CONCLUSÕES As quedas ocorrem de maneira importante em mulheres a partir dos 50 anos, indicando que não são restritas a idosos e que há necessidade de iniciar medidas preventivas mais precocemente. Os dois estudos mostraram magnitudes semelhantes de ocorrência de quedas acidentais e reforçaram sua multifatorialidade. Além disso, a hiperuricemia pode ser um potencial novo fator associado a quedas.

INTRODUÇÃO: Esta pesquisa constitui um estudo de prevalência, cujo título não pôde ser adequado para \"Quedas acidentais e suas recorrências em mulheres de meia-idade: prevalência e fatores associados\" em virtude da Resolução/USP/CoPGR 6018/11. OBJETIVOS: Analisar as prevalências de quedas acidentais e de suas recorrências em mulheres adultas em 2007 e 2014, bem como as associações dos fatores sociodemográficos, clínicos e de hábitos de vida nos dois momentos. MÉTODOS: Foram realizados dois estudos transversais em 2007 e 2014 dentro do Projeto de Saúde de Pindamonhangaba, PROSAPIN, com amostra aleatória estimada final de 875 mulheres em 2007 e de 1.200 em 2014, com idade de 35 a 75 anos. As coletas das variáveis independentes foram realizadas em 3 etapas: 1) Entrevista face-a-face, 2) Exame antropométrico; 3) Exame sanguíneo. As variáveis de desfecho foram investigadas durante a entrevista: \"sofreu queda nos últimos 6 meses?\" e em caso positivo: \"quantas\"? Estimou-se as prevalências de quedas acidentais e das recorrentes em 2007 e 2014 por ponto e intervalo de confiança de 95% (IC95%). Foram construídos modelos de regressão múltipla para identificar as associações das variáveis independentes com as quedas acidentais e com as recorrências em 2007 e 2014, a partir da Odds Ratio, OR (IC:95%). Utilizou-se o software Stata 14.0 para os cálculos estatísticos considerando-se significante p < 0,05. RESULTADOS: As prevalências de quedas acidentais/2007 foram semelhantes, com valores de 17,6%(IC95%: 14,9-20,5) e 17,1%(IC95%: 14,8-19,8) em 2014, assim como as das recorrências/2007: 5,6%(IC95%: 4,1-7,5) e, 4,7%(IC95%: 3,4-6,3) em 2014. Os modelos de regressão multivariados foram distintos para cada ano, com os seguintes fatores associados às quedas/2007: idade de 50-64 anos, OR 1,81(1,17-2,80), hiperuricemia: OR 3,74(2,17-6,44), depressão: OR 2,07(1,31-3,27), sono ruim: OR 1,78(1,12-2,82), sonolência diurna: OR 1,86(1,16-2,99) e escolaridade: OR 1,76(1,06-2,93). Em 2014, foram mantidas as associações das quedas acidentais com: idade de 50-64 anos, OR 1,64 (1,04-2,58); hiperuricemia, OR 1,91 (1,07-3,43) e depressão, OR 1,56 (1,02- 2,38); acrescidos da síndrome metabólica: OR 1,60(1,03-2,47) e dor musculoesquelética: OR 1,81(1,03-3,18). As quedas recorrentes/2007 foram associadas no modelo de regressão multivariado ao \"quase cair\": OR 2,49(1,08- 5,76); cor não branca: OR 2,23 (1,07-4,67); depressão: OR 4,51(2,11-9,65); diabetes: OR 2,84(1,25-6,45) e hiperuricemia: OR 3,82(1,74-8,37) e em 2014 mantiveram-se associadas ao \"quase cair\", OR 17,11(5,15-56,83) além do sono ruim OR 2,47(1,26-4,84); e escolaridade: OR 0,21(0,05-0,92). CONCLUSÕES: As quedas iniciam de maneira significante em mulheres de 50-64 anos, e a hiperuricemia pode ser um novo fator associado às quedas acidentais e recorrentes. As quedas acidentais foram associadas às variáveis clínicas (hiperuricemia, depressão, síndrome metabólica e dor musculoesquelética) sociodemográficas (idade de 50-64 anos e escolaridade) e dos hábitos de vida (sono ruim e sonolência diurna). Assim como as quedas recorrentes, associadas principalmente com variáveis clínicas (depressão, diabetes, hiperuricemia e quase cair), seguidos pelas sociodemográficas (cor não branca e escolaridade) e pelo sono ruim, representando os hábitos de vida. Com exceção da cor não branca e da escolaridade, os demais fatores associados às quedas acidentais ou às quedas recorrentes interferem direta ou indiretamente na funcionalidade, prejudicando equilíbrio e marcha, aumentando a predisposição às quedas e suas recorrências INTRODUCTION: This research is a prevalence study, whose title could not be adequate for \"Accidental falls and their recurrences in middle-aged women: prevalence and associated factors\" due to Resolution / USP / CoPGR 6018/11. OBJECTIVES: To analyze the accidental falls prevalence and their recurrences in adult women in 2007 and 2014, as well as the associations of sociodemographic, clinical and lifestyle factors at both times. METHODS: Two cross-sectional studies were conducted in 2007 and 2014 inside Projeto de Saúde de Pindamonhangaba, PROSAPIN, with a final estimated random sample of 875 women in 2007 and 1,200 in 2014, aged 35-75 years. Independent variables were collected in 3 stages: 1) Face-to-face interview, 2) Anthropometric examination; 3) Blood test. The outcome variables were investigated during the interview: \"have you fallen in the last 6 months?\" And if so, \"how many\"? The prevalence of accidental and recurrent falls in 2007 and 2014 was estimated by point and 95% confidence interval (95% CI). Multiple regression models were built to identify the associations of independent variables with accidental falls and recurrences in 2007 and 2014, based on the Odds Ratio, OR (CI: 95%). Stata 14.0 software was used for statistical calculations considering significant p < 0.05. RESULTS: The prevalence of accidental falls / 2007 were similar, with values of 17.6% (95% CI: 14.9-20.5) and 17.1% (95% CI: 14.8-19.8) in 2014, as well as those of recurrences / 2007: 5.6% (95% CI: 4.1-7.5) and 4.7% (95% CI: 3.4-6.3) in 2014. Multivariate regression models were distinct for each year, with the following factors associated with falls / 2007: age 50-64 years, OR 1.81 (1.17- 2.80), hyperuricemia: OR 3.74 (2.17-6 , 44), depression: OR 2.07 (1.31-3.27), bad sleep: OR 1.78 (1.12-2.82), daytime sleepiness: OR 1.86 (1.16-2 , 99) and educational level: OR 1.76 (1.06-2.93). In 2014, the associations of accidental falls were maintained with: age 50-64 years, OR 1.64 (1.04-2.58); hyperuricemia, OR 1.91 (1.07-3.43) and depression, OR 1.56 (1.02-2.38); plus metabolic syndrome: OR 1.60 (1.03-2.47) and musculoskeletal pain: OR 1.81 (1.03-3.18). Recurrent falls / 2007 were associated in the \"near fall\" multivariate regression model: OR 2.49 (1.08-5.76); non-white color: OR 2.23 (1.07-4.67); depression: OR 4.51 (2.11-9.65); diabetes: OR 2.84 (1.25-6.45) and hyperuricemia: OR 3.82 (1.74-8.37) and in 2014 remained associated with near-fall, OR 17.11 (5 , 15- 56.83) in addition to bad sleep OR 2.47 (1.26-4.84); and educational level: OR 0.21 (0.05-0.92). CONCLUSIONS: Falls begin significantly in women aged 50-64 years, and hyperuricemia may be a new factor associated with accidental and recurrent falls. Accidental falls were associated with clinical variables (hyperuricemia, depression, metabolic syndrome, and musculoskeletal pain) sociodemographic (age 50-64 years and education) and lifestyle habits (poor sleep and daytime sleepiness). As well as recurrent falls, mainly associated with clinical variables (depression, diabetes, hyperuricemia and fall tendency), followed by sociodemographic (non-white color and education) and poor sleep, representing life habits. With the exception of non-white color and education, the other factors associated with accidental falls or recurrent falls directly or indirectly interfere with functionality, impairing balance and gait, increasing predisposition to falls and their recurrences

Highlights • Non-surviving showed higher RDW than surviving patients. • There is an association between RDW and mortality. • RDW could be used as mortality biomarker., Purpose We have previously reported an association between high red blood cell distribution width (RDW) and mortality in septic and brain infarction patients. However, no association between RDW and mortality in coronavirus disease 2019 (COVID-19) patients has been reported so far; thus, the objective of this study was to determine if that association exists. Methods Prospective and observational study carried out in 8 Intensive Care Units from 6 hospitals of Canary Islands (Spain) including COVID-19 patients. We recorded RDW at ICU admission and 30-day survival. Results We found that patients who did not survive (n = 25) compared to surviving patients (n = 118) were older (p = 0.004), showed higher RDW (p = 0.001), urea (p

OBJETIVO: Estimar a prevalência de quedas acidentais em mulheres e identificar possíveis associações de variáveis sociodemográficas, clínicas e de hábitos de vida com as quedas, em 2007 e 2014. MÉTODOS: Foram realizados dois estudos transversais, em 2007 e 2014, dentro do Projeto de Saúde de Pindamonhangaba (PROSAPIN), com mulheres com idades variando de 35 a 75 anos. As amostras probabilísticas foram selecionadas dentre as mulheres residentes no município e participantes da Estratégia Saúde da Família. A coleta de dados incluiu: entrevista face a face, exame antropométrico e exame sanguíneo. A variável de desfecho “Sofreu queda nos últimos seis meses?” foi levantada durante a entrevista. Foram estimadas as prevalências de quedas em 2007 e 2014 por ponto e intervalo de confiança de 95% (IC95%). Modelos de regressão logística múltipla foram construídos para identificar a associação das variáveis independentes e a ocorrência de quedas para cada ano a partir da odds ratio (OR). Utilizou-se o software Stata 14.0 para análise estatística. RESULTADOS: A s p revalências d e q uedas a cidentais f oram: 17,6% ( IC95% 14,9–20,5) e m 2007 e 17,2% (IC95% 14,8–19,8) em 2014. Em 2007 os fatores associados a quedas foram: idade de 50–64 anos (OR = 1,81; IC95% 1,17–2,80), ensino médio (OR = 1,76; IC95% 1,06–2,93), hiperuricemia (OR = 3,74; IC95% 2,17–6,44), depressão (OR = 2,07; IC95% 1,31–3,27), sono ruim (OR = 1,78; IC95% 1,12–2,82) e sonolência diurna (OR = 1,86; IC95% 1,16–2,99). Em 2014 permaneceram: idade de 50–64 anos (OR = 1,64; IC95% 1,04–2,58), hiperuricemia (OR = 1,91; IC95% 1,07–3,43) e depressão (OR = 1,56; IC95% 1,02–2,38), acrescidos da síndrome metabólica (OR = 1,60; IC95% 1,03–2,47) e da dor musculoesquelética (OR = 1,81; IC95% 1,03–3,18). CONCLUSÕES: As quedas ocorrem de maneira importante em mulheres a partir dos 50 anos, indicando que não são restritas a idosos e que há necessidade de iniciar medidas preventivas mais precocemente. Os dois estudos mostraram magnitudes semelhantes de ocorrência de quedas acidentais e reforçaram sua multifatorialidade. Além disso, a hiperuricemia pode ser um potencial novo fator associado a quedas.

Abusive head trauma (AHT) is an extreme form of physical abuse that is produced by abruptly shaking an infant or toddler.To describe the direct economic cost of care during hospitalization of 14 children with confirmed diagnosis of AHT in a pediatric hospital.Analysis of the cost of disease in patients with AHT attended to between 2001 and 2010. Partial direct economic cost of medical care (days of hospital stay, laboratory tests and imaging studies, surgical procedures and subspecialist consultations) was calculated adjusting for inflation, with year 2001 taken as base year. Patients were classified in three groups (moderate, severe and fatal AHT). Descriptive and sensitivity analysis was carried out.Patients with severe AHT generated higher medical care costs ($105,794.88 ± 33,201.91) in comparison with the group of moderate ($37,012.95, ± 7,154.87) and fatal AHT ($18,595.04 ± 6424.47) (p0.05). Total cost was $665,467.98 Mexican pesos ($71,249.25 international dollars).Total cost for the 14 patients was an elevated figure, as in other parts of the world. The direct economic cost is closely related to the severity of the clinical presentation.El trauma craneal no accidental (TCNA) es una forma extrema de abuso físico que se produce por la sacudida brusca de un lactante o preescolar.Describir el costo económico directo de la atención durante la hospitalización de 14 niños con diagnóstico confirmado de TCNA en un hospital pediátrico.Análisis del costo de la enfermedad en pacientes con TCNA, atendidos entre 2001 y 2010. Se realizó análisis descriptivo y de sensibilidad. Se calculó costo económico directo parcial de la atención médica (días de estancia hospitalaria, exámenes de laboratorio y gabinete, procedimientos quirúrgicos y consultas por subespecialista), ajustado por la inflación, se tomó como año base 2001. Los pacientes se clasificaron en tres grupos: TCNA moderado, severo y fatal.Los pacientes con TCNA severo generaron mayor costo en la atención médica ($105 794.88 ± 33 201.91), en comparación con el grupo con TCNA moderado ($37 012.95 ± 7154.87) y fatal ($18 595.04 ± 6424.47) (p0.05). El costo total fue de 665 467.98 pesos mexicanos (71 249.25 dólares internacionales).El costo total de los 14 pacientes fue una cifra elevada como en otras partes del mundo. El costo económico directo se relaciona estrechamente con la gravedad del cuadro clínico.

Objective: To analyze the influence of a kinesiotherapeutic program for the prevention of falls on the cardiovascular function in the elderly. Materials and Methods: The sample consisted of 18 community-living elderly with a mean age of 73.5 ± 8.8 years (14 women; 4 men) who participated in an exercise program for flexibility, strength, balance and proprioception. We measured systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR) and double product (DP) before and after exercise. The coefficient of variation (CV) of the measures was used, as well as paired t test and Wilcoxon test for comparison between baseline and endpoint after exercise. Results: In 10 sessions, there was an average CV lower than 10% for SBP, DBP and HR. As an acute effect of exercise, there was a significant increase in SBP and DBP and a significant decrease in HR. Comparing the data of the 1st session of exercise to those of the 10th session, we observed that the values of the variables tended to be reduced (except the initial DBP), but with significance only for the final DP. There was a greater reduction in SBP, HR and DP over 20 sessions compared to 10 sessions. Conclusion: The program for the prevention of falls provided chronic effects that are beneficial to cardiovascular function in the elderly, which may also be indicated for the management of cardiovascular diseases. DESCRIPTORS: Aged. Exercises. Arterial Pressure. Heart Rate.

Objetivo: Relatar a experiencia vivenciada por estudantes do Programa de Educacao pelo Trabalho para Saude, Rede de Cuidados a Pessoa com Deficiencia (PET Rede PCD), numa unidade de saude da familia, na construcao e execucao de um Projeto Terapeutico Singular (PTS). Configurando-se como uma proposta interdisciplinar e multiprofissional potencializadora dos diferentes saberes do cuidado. Relato da Experiencia: a ideia de se construir um PTS, uma iniciativa dos estudantes do PET junto a equipe de saude, surgiu diante da necessidade de atender a um maior numero de pessoas da comunidade com deficiencia fisica e que vivem num contexto biopsicossocial de extrema vulnerabilidade. Apos a realizacao de visitas domiciliares e a de identificacao dos criterios de elegibilidade - possibilidades de melhoria da qualidade de vida, complexo contexto familiar, identificacao de necessidades e, principalmente, a necessidade particular de superar dificuldades - o sujeito eleito possui 15 anos de idade, tendo como diagnostico Diplegia Espastica. Comentarios: a realizacao desse PTS junto a equipe de Saude da Familia foi uma experiencia desafiadora e muito proveitosa, possibilitando a troca de saberes entre diversas areas e profissionais, se constituindo como instrumento para a formacao academica dos graduandos envolvidos, alem de estimular a equipe para a educacao permanente. Nao podemos esquecer que a natureza do PTS e ser um processo continuo de planejamento, acompanhamento e avaliacao. Varias metas foram alcancadas, porem ha muito por ser feito. Acreditamos que devemos ser multiplicadores de propostas como essa, valorizando-as para que ocorram mudancas na realidade e no cenario de pratica onde estao sendo formados os profissionais de saude. DESCRITORES Paralisia Cerebral. Espastica. Infantil. Saude Publica.

Objetivo: Relatar experiencias vividas por dois estudantes inseridos na Rede de Servicos a Pessoa com Deficiencia, atraves do Programa de Educacao pelo Trabalho para a Saude (PET SAUDE). Relato de Experiencia: Suas acoes foram desenvolvidas em um centro de media complexidade, referencia em atencao a saude das pessoas com deficiencia no estado da Paraiba, a FUNAD. As acoes visaram primeiramente diagnosticar as necessidades do servico e consequentemente sugerir acoes que favorecam o dialogo entre os usuarios e o servico, bem como a melhoria na qualidade dos servicos prestados. Assim, realizou-se um diagnostico situacional da FUNAD, onde se constatou pontos positivos e fragilidades. Para tal, foi tomado como base o instrutivo CER IV que estabelece Normas Gerais de Funcionamento dos Servicos Especializados em Reabilitacao, entao ao compara-lo com a realidade apresentada pelo servico se identificou a necessidade de desenvolver um projeto de pesquisa que avaliasse a qualidade do servico prestado. Tal necessidade foi discutida com parte da gestao e dos proprios profissionais que se posicionaram de acordo, como tambem se demonstraram estimulados para colaborarem, uma vez que consideraram tal acao uma oportunidade real de mudanca positiva na qualidade das condicoes de trabalho como tambem dos servicos prestados. Conclusao: E de suma importância, para aquisicao de resultados fidedignos, considerar tambem a opiniao dos usuarios, uma vez que sao eles que recebem os servicos prestados e assim sabem as suas reais necessidades. De tal modo, apos a avaliacao da qualidade, serao propostas acoes de melhoria na qualidade dos servicos prestados pela FUNAD. DESCRITORES Deficiencia. Avaliacao em Saude. Servicos de Saude.

Objetivo: O presente artigo tem como proposta realizar um relato de experiencia das atividades vivenciadas no Projeto Pet – Redes de Cuidados a Pessoa com Deficiencia, com enfoque nas acoes desenvolvidas no cenario de praticas da Secretaria Estadual da Saude da Paraiba – Area Tecnica de Saude da Pessoa com Deficiencia, produzindo uma reflexao critica sob a otica dos alunos bolsistas inseridos neste campo de pratica. Material e Metodos: Trata-se de um relato de experiencia que toma como procedimento a analise feita a partir das vivencias pautadas no tripe: Ensino, Pesquisa e Extensao do Programa de Educacao pelo Trabalho em Saude (PET). Resultados: Com isto, pudemos observar a dinâmica de construcao do Plano Estadual da Pessoa com Deficiencia e participar de experiencias para a nossa formacao profissional tais como: Encontro Regional da Economia da Saude do Nordeste 2014: “Avancos e Eficiencias nas Politicas de Saude para o SUS”, Reunioes com o Grupo Condutor Estadual da Paraiba, Oficina PET, dentre outros. Conclusao: Por fim, concluimos que o PET desenvolve e proporciona experiencias impares para a nossa formacao, fazendo com que se obtenha um olhar diferenciado sobre a realidade e o processo de construcao de projetos dentro da gestao. DESCRITORES Gestao em Saude. Pessoas com Deficiencia. Educacao Superior.

INTRODUÇÃO: A população idosa apresenta-se em um acelerado processo de crescimento associado ao aumento da expectativa de vida. As alterações no envelhecimento podem comprometer o padrão de marcha e equilíbrio dos idosos, predispondo-os a quedas. Como estratégia de prevenção, indica-se a atividade física regular direcionada para ganho de força, equilíbrio, propriocepção e melhoria da marcha. OBJETIVO: Verificar os efeitos de um programa de exercícios físicos na marcha e na mobilidade funcional de idosos. MATERIAIS E MÉTODOS: Participaram do estudo oito idosos com mais de 60 anos (três homens e cinco mulheres). Os participantes realizaram duas avaliações antes e após a intervenção de seis meses: (1) marcha, pelo método de marcação de passarelas e (2) equilíbrio, por meio do Time Up and Go Test (TUGT). Para análise dos dados utilizou-se o software R (2.9.0). Para comparação dos dados, foi utilizado o teste t de Student pareado e o teste de correlação de Pearson, com p < 0,05. RESULTADOS: Verificou-se aumento no comprimento dos passos E (de 0,71 ± 0,19 para 0,80 ± 0,19 cm) e D (de 0,73 ± 0,17 para 0,81 ± 0,17 cm), e das passadas E (de 1,44 ± 0,36 para 1,59 ± 0,32 cm). Para o TUGT, além de forte correlação entre idade e velocidade da marcha e base de suporte, observou-se diminuição no tempo de realização do teste (de 13,92 ± 3,84 para 9,46 ± 1,68 segundos). CONCLUSÃO: O programa de exercícios físicos direcionados para a prevenção de quedas melhorou o desempenho funcional de idosos e alterou positivamente as variáveis da marcha. INTRODUCTION: The elderly population is presented in an accelerated growth associated with increased life expectancy. The changes in aging can affect the pattern of gait and balance in the elderly may predispose them to falls. As prevention strategy, regular physical activity is indicated to gain strength, balance, proprioception and gait improvement. OBJECTIVE: To investigate the effects of an exercise program on gait and mobility of elderly. MATERIALS ANS METHODS: Eight subjects (three men and five women) over 60 years old participated in the study. They underwent two assessments: 1) march, by the method of marking walkways, and balance through the Time Up and Go Test (TUGT) before and after the six months intervention. For data analysis, we used R software (2.9.0). To compare the data we used the Student's "t" test paired and Pearson correlation, p < 0.05. RESULTS: An increase in stride length and (0.71 ± 0.19 to 0.80 ± 0.19 cm) and D (0.73 ± 0.17 to 0.81 ± 0.17 cm), and stride E (1.44 ± 0.36 to 1.59 ± 0.32 cm). For TUGT observed reduction in the time of the test (of 13.92 ± 3.84 to 9.46 ± 1.68 seconds), and a strong correlation between age and gait speed and support base. CONCLUSION: The exercise program targeted to prevention of falls improved the performance of elderly and positively affected the gait variables.