Search

Objective: To systematically review the effects of caffeine on the development of cerebral palsy (CP)., Design: Systematic review., Setting: A search of five databases was performed to identify randomized controlled trials (RCT) or cohort studies published through May 2022. Studies conducted on newborns at risk of developing CP upon receiving caffeine in the first days of life were included as well. Two independent researchers assessed the screening, data extraction, and methodological quality assessment., Main Outcome Measures: Percentage of children with CP., Results: Four studies met our inclusion criteria. The only RCT found a decreased risk (approximately 40 %) of developing CP with 20 mg/kg caffeine citrate (OR 0.59, 95 % CI 0.39, 0.89). In addition, when comparing the period over which caffeine citrate was administered, one retrospective cohort study reported that infants who received caffeine up to the second day of life were also less likely to develop CP. Some methodological issues should be highlighted: in the RCT, the differences between the groups with respect to loss to follow-up were not explored. Similarly, intention-to-treat analyses were not performed. Most cohort studies have not adequately identified the primary confounding factors., Conclusions: Caffeine could be an important intervention in preventing CP. However, few studies have assessed the effects of caffeine on the risk of CP development. Due to methodological differences, no recommendation regarding its use can be safely made. The findings suggest a positive effect of caffeine citrate in the early stages of life with approximately 20 mg/kg of weight; however, well-designed RCTs with adequate sample size and power, randomization process, outcome measurement, and data analysis are still required., 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 © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The prevalence of neurological diseases is currently growing due to the combination of several factor, including poor lifestyle and environmental imbalance which enhance the contribution of genetic factors. Parkinson's disease (PD), a chronic and progressive neurological condition, is one of the most prevalent neurodegenerative human diseases. Development of models may help to understand its pathophysiology. This review focuses on studies using invertebrate models to investigate certain chemicals that generate parkinsonian-like symptoms models. Additionally, we report some preliminary results of our own research on a crustacean (the crab Ucides cordatus) and a solitary ascidian (Styela plicata), used after induction of parkinsonism with 6-hydroxydopamine and the pesticide rotenone, respectively. We also discuss the advantages, limits, and drawbacks of using invertebrate models to study PD. We suggest prospects and directions for future investigations of PD, based on invertebrate models., (© 2023 The Author(s).)

Soils enriched with biochar are recommended as a cultivation grounds, especially in case they contain significant amount of sand. However, the interactions between biochar and plants, as well as the influence of the biochar on water retention, cultivation and air properties of soils, are still not obvious. The present study aimed to determine the impact of various biochar doses on soils used for soya cultivation, in comparison to soils maintained as black fallow soil, on their water retention and productivity, for the period of two years. Sunflower husk biochar (BC1) and biochar of leafy trees (BC2), in doses of 0, 40, 60, 80 t·ha -1 , were used for field experiments. The water retention was investigated with porous boards in pressure chambers by a drying method. No differences in the hydrological properties of the soils that were differently managed (black fallow soil, crop) were observed following biochar application. Addition of BC1, in the amounts of 40, 60, and 80 t·ha -1 , caused an increase in the plant available water capacity (AWC) by 15.3%, 18.7%, and 13.3%, respectively, whereas the field capacity (FC) increased by 7.4%, 9.4%, and 8.6% for soils without biochar. Application of BC2 analogously resulted in higher AWC, by 8.97, 17.2%, and 33.1%, respectively, and higher FC by 3.75, 7.5%, and 18.3%, respectively. Increasing the doses of BC1 and BC2, both on black fallow soils and soils enriched with soya, caused a rise in total porosity (TP) and drainage porosity (DP), and a decrease in soil bulk density (SBD). Biochar with a higher total area and higher porosity (BC1) applied to soils with soya cultivation resulted in lower reductions in AW and FC than BC2 in the second year of investigation.

This study provides an overview of the literature on the cost-effectiveness of homecare services compared to in-hospital care for adults and older adults. A systematic review was performed using Medline, Embase, Scopus, Web of Science, CINAHL and CENTRAL databases from inception to April 2022. The inclusion criteria were as follows: (i) (older) adults; (ii) homecare as an intervention; (iii) hospital care as a comparison; (iv) a full economic evaluation examining both costs and consequences; and (v) economic evaluations arising from randomized controlled trials (RCTs). Two independent reviewers selected the studies, extracted data and assessed study quality. Of the 14 studies identified, homecare, when compared to hospital care, was cost-saving in seven studies, cost-effective in two and more effective in one. The evidence suggests that homecare interventions are likely to be cost-saving and as effective as hospital. However, the included studies differ regarding the methods used, the types of costs and the patient populations of interest. In addition, methodological limitations were identified in some studies. Definitive conclusions are limited and highlight the need for better standardization of economic evaluations in this area. Further economic evaluations arising from well-designed RCTs would allow healthcare decision-makers to feel more confident in considering homecare interventions.

Background: Chagas disease (CD) is still an important public health issue in Latin America. This study aims to analyse the association between socio-epidemiological factors and comorbidities with clinical manifestations of CD., Methods: We performed a cross-sectional study of 985 adult patients (65±11 y; 59.5% women) with CD. Data collection was based on questionnaires and medical records review. CD clinical forms (indeterminate, digestive, cardiac and cardiodigestive) and the stages of the cardiac form were classified according to the II Brazilian Consensus on CD. Statistical analyses were based on univariate and multivariate logistic regression., Results: Older age and Brazilian birth state (Minas Gerais and Bahia) were associated with a greater likelihood of the cardiac form of CD. A greater likelihood of the digestive form was seen in men and those of older age. Patients with arterial hypertension and diabetes were less likely to have the digestive form. Men had a greater likelihood of having a more severe cardiac presentation. Those from Minas Gerais and Bahia states had a greater likelihood of having stage B1 or B2., Conclusions: The results reinforce the aging of the CD population living in urban areas in Brazil, the high prevalence of comorbidities and that epidemiology, sex and the presence of comorbidities may be related to the clinical form of CD., (© The Author(s) 2022. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

The work analyzed the effect of Public Consultations (PC) and their contributions to the recommendations of the National Commission for the Incorporation of Technologies (CONITEC). This is a descriptive and retrospective study with a qualitative-quantitative approach using a secondary data source of public access, between 2012 and 2017. A database was developed to characterize the PC of medications and their contributions, which allowed the identification of cases of reversals between the preliminary and final recommendation of CONITEC. We analyzed the contributions in cases of reversal for characterization of argumentative axes and type of basis. Of the 307 demands for incorporation of medications, 205 went through PC, with 23,894 contributions. The reversal of the recommendations occurred in 9% of the open PC (15 medications), all in the sense of non-incorporation for incorporation. Main argumentative axes dealt with clinical benefits and minor adverse events, with prevalence of the submission of clinical experiences and opinions. Advances in the processes of incorporation of technologies in the SUS by performing PC were found and the challenge that decision makers face in institutional spaces for the improvement of social participation to strengthen the public benefit was clear.

A citizen-centric view is key to channeling technological affordances into the development of future cities in which improvements are made with the quality of citizens' life in mind. This paper proposes City 5.0 as a new citizen-centric design paradigm for future cities, in which cities can be seen as markets connecting service providers with citizens as consumers. City 5.0 is dedicated to eliminating restrictions that citizens face when utilizing city services. Our design paradigm focuses on smart consumption and extends the technology-centric concept of smart city with a stronger view on citizens' roadblocks to service usage. Through a series of design workshops, we conceptualized the City 5.0 paradigm and formalized it in a semi-formal model. The applicability of the model is demonstrated using the case of a telemedical service offered by a Spanish public healthcare service provider. The usefulness of the model is validated by qualitative interviews with public organizations involved in the development of technology-based city solutions. Our contribution lies in the advancement of citizen-centric analysis and the development of city solutions for both academic and professional communities., (© The Author(s) 2023.)

This paper presents an experience report on the supervision of deinstitutionalization of the prison system through the articulation of the Psychosocial Care Network (RAPS) conducted from 2014 to 2021 within the Superintendence of Mental Health/Municipal Health Secretariat of Rio de Janeiro. This work of deinstitutionalizing people deprived of liberty with mental health problems consists of actions at the exit and entrance doors of the prison system and actions for the care of unimputable and imputable people with mental disorders. In the light of the Brazilian Psychiatric Reform, formalized by Law No. 10,216/2001, we aim to present an approach to this process counting on the possibilities of building care policies for insane offenders that are not punitive or segregating. The practical results of this work include more significant participation of the network in the construction of care for insane offenders, elaborating policies that avoid the prison career or reduce the asylum time in the penal system, and understanding that security measures must always have an outpatient nature.

A document containing a prison policy management model was examined during a study of the governmental categories established to address confinement in Brazil. Based on Bourdieu and Hertz, an attempt was made to develop an ethnography attentive to the expressions used to refer to populations and institutions so that they could reveal ongoing terminological changes and maintenance. Deprivation of liberty is traversed by public policies and vice versa, pointing to prisons as "intersectoral spaces" and prisoners as "people deprived of liberty".

Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, some systemic manifestations, mainly liver, gastrointestinal, and pancreatic are not routinely evaluated. To address these manifestations, the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology conducted a broad systematic review of the literature on studies investigating prevalence and diagnosis of these symptoms in Sjogren´s patients and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. This is the second part of this guideline, providing 6 recommendations for liver, gastrointestinal, and pancreatic care of SS patients., (© 2022. The Author(s).)

Objective: To evaluate the culinary content of key messages contained in food-based dietary guidelines (FBDG) available at the global online repository of the FAO of the UN., Design: Document analysis was conducted in August 2021 with data extraction of key messages explicitly related to cooking present in FBDG. Data were analysed inductively using thematic analysis., Setting: The FAO's global repository of FBDG., Participants: Not applicable., Results: Just over half ( n 39; 53·4 %) of the seventy-three FBDG analysed included at least one key message about cooking. The Latin American and Caribbean FBDG presented the greatest amount and variety of content about cooking in the key messages, whereas the Near East and North America placed less emphasis on cooking. We identified three themes: (i) healthy food preparation ( n 35; 61·4 % of the fifty-seven culinary key messages identified); (ii) food hygiene ( n 14; 24·6 %) and (iii) the promotion of culinary practices ( n 7; 12·3 %). Albania's key message covered two themes (food hygiene and healthy food preparation) ( n 1; 1·8 %)., Conclusion: FBDG are official documents that express recommendations for a healthy diet. As most of these recommendations throughout the world include foods that must be cooked prior to consumption, culinary content should gain more visibility and be presented more broadly in these official documents.

The IBGE has been playing a leading role in the public policy evaluation in Brazil since 2019. After the National Health Survey (PNS) evaluated primary care services in the Unified Health System (SUS) provided to adults, in 2022, the Continuous National Household Sample Survey (PNAD-C) investigated child health. To this end, it adopted one version of the Primary Care Assessment Tool (PCAT), developed and disseminated by Starfield and Shi to assess the existence and extent of the attributes of PHC services. The target audience surveyed included children under 13 years of age, and the questionnaires were answered by their guardians/caregivers. It included all the 27 federative units of the country in random probabilistic samples, also unfolding in the Brazilian metropolitan regions and capitals. This is the largest household survey on child health assessment ever conducted in Brazil. With the PNS-2019 and the PNAD-C in 2022, IBGE inaugurates its greatest legacy for Brazilian primary health care regarding the evaluation of SUS users, with all federative units recognizing and understanding how Brazilian society evaluates health services at the first level of care.

The use of misoprostol for abortifacient purposes is a phenomenon observed in Brazil since the late 1980s. The drug started to be used at that time for self-induced abortion, when it began to be commercialized for the treatment of peptic ulcer. Its access was restricted from 1998 onwards, but the drug continues to be commercialized illegally. The objective of this article is to summarize the knowledge produced by research in Brazil about induced abortion and the use of misoprostol. An integrative review of original studies carried out in Brazil and published in journals indexed in SciELO, PubMed and Lilacs databases was performed. The search found 68 titles, and 28 articles were included in the review. Most women who induced pregnancy interruption were young and did it before 15 gestational weeks. The rate of misoprostol use ranged from 89% to 36%. This drug is effective for terminating pregnancy in the first trimester and has a low rate of complications. However, the more socially vulnerable the woman is, the greater are the health risks in the abortion process. The conclusion is that the purchase of misoprostol as an abortifacient is facilitated, despite it being prohibited, and its complications are associated with the context of vulnerability of the pregnant woman.

The scope of this study was to evaluate possible differences in dietary trajectories of students according to their attendance at a University Restaurant (UR) and the basis for their admission to the university. It was an experiment conducted with undergraduate students (n=1,131) from a Brazilian public university. In 2011 and 2013, questionnaires identified and completed in person were applied assessing the regular consumption of foods that were markers of healthy or unhealthy diet, partaking of lunch, dinner and replacement of lunch and/or dinner with a snack. Changes in regular food practices were examined by the individual trajectory of each student versus the studied practices obtained by combining the responses from the questionnaires. The analysis of the association between UR attendance and trajectory was carried out using multiple logistic regression models. An association was observed (95%CI non-overlapping) with greater UR attendance and a higher chance of a positive trajectory for dinner and lunch, and consumption of beans, vegetables, raw vegetables fruit, cookies, packaged salty snacks, hamburgers and candies, and a lower chance of a negative trajectory for beans, raw vegetables, and fried snacks. The implementation of the UR promoted a significant improvement in the diet of conscientious students.

Bearing in mind that universal access to sanitation services is one of the objectives of the Brazilian Plan for Basic Sanitation and one of the sustainable development goals (SDG), this research sought to evaluate the coverage of supply and of the quality of water distributed in Brazil in 2019. Data from the National Sanitation Information System (SNIS) and Water Quality for Human Consumption Surveillance Information System (Sisagua) databases were evaluated. It was found that 82% of the population has access to Water Supply Systems (WSS), this percentage only being lower in the North (58%) and Northeast (74%) regions. Most of the population is served by WSS; however, in the North region, 6.6% of the population is served by WSS and 7.2% by Collective Alternative Solution (CAS) without treatment. For the Total Coliforms parameter, 21.9% of CAS samples from the North region were outside the potability standard, while for the residual disinfectant agent, 40.6% of WSS from the Northeast region was outside this standard (with 19% of the samples having a concentration of the disinfectant agent above 5.0 mg/L, and 81% of the samples presenting concentration lower than 0.2 mg/L. The conclusion drawn is that part of the population may be vulnerable to water quality-related risks.

Sjogren's Syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, these systemic manifestations are not routinely evaluated and there is no homogenous approach to their diagnosis or evaluation. To close this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of these manifestations and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. The first part of this guideline summarizes the most important topics, and 11 recommendations are provided for the articular, pulmonary, and renal care of SS patients., (© 2022. The Author(s).)

Background: Animal pollination is an important ecosystem function and service, ensuring both the integrity of natural systems and human well-being. Although many knowledge shortfalls remain, some high-quality data sets on biological interactions are now available. The development and adoption of standards for biodiversity data and metadata has promoted great advances in biological data sharing and aggregation, supporting large-scale studies and science-based public policies. However, these standards are currently not suitable to fully support interaction data sharing., Results: Here we present a vocabulary of terms and a data model for sharing plant-pollinator interactions data based on the Darwin Core standard. The vocabulary introduces 48 new terms targeting several aspects of plant-pollinator interactions and can be used to capture information from different approaches and scales. Additionally, we provide solutions for data serialization using RDF, XML, and DwC-Archives and recommendations of existing controlled vocabularies for some of the terms. Our contribution supports open access to standardized data on plant-pollinator interactions., Conclusions: The adoption of the vocabulary would facilitate data sharing to support studies ranging from the spatial and temporal distribution of interactions to the taxonomic, phenological, functional, and phylogenetic aspects of plant-pollinator interactions. We expect to fill data and knowledge gaps, thus further enabling scientific research on the ecology and evolution of plant-pollinator communities, biodiversity conservation, ecosystem services, and the development of public policies. The proposed data model is flexible and can be adapted for sharing other types of interactions data by developing discipline-specific vocabularies of terms., (© The Author(s) 2022. Published by Oxford University Press GigaScience.)

Ethnopharmacological Relevance: Euphorbia tirucalli L., a tropical and subtropical plant, also known by the popular name avelós, has been used in folk medicine against many diseases as rheumatism, asthma, toothache, and cancer. Studies have shown that natural compounds contained in this plant species may be associated with these functions. However, little is known about its potential toxicity., Aim of the Study: Several proteins conduct biological functions, in particular, proteinases, play a crucial role in many mechanisms of living beings, including plants, animals and microorganisms. However, when poorly regulated, they can generate consequences, such as the non-production of certain substances, or even the abnormal multiplication of cells, which leads to tumors. On the other hand, by regulating these enzymes, proteinase inhibitors act by reducing the activity of proteinases, thus preventing their malfunction. The objective of this work was to evaluate the toxicity of the protein extract of E. tirucalli and to purify a protease inhibitor that may be associated with the biological medicinal functions of the plant., Materials and Methods: The cytotoxic and mutagenic properties of the protein extract produced from the stem of avelós was investigated using the Ames test. The protein extract was also submitted to a protease inhibitor purification process using the gel filtration chromatography technique and the purified protein was biochemically characterized., Results: A protease inhibitor, called tirustatin, was isolated 1.84-fold by Biogel P100. The calculated molecular mass of the isolated protein is 25.97 kDa. The inhibitor was stable at pH 3-10, with pronounced activity at pH 6. Thermostability was observed even at elevated temperature (100 °C) with inhibitory activity increased by 1.14-fold compared to inhibitor activity at room temperature. Incubation at basic pH values for up to 60 min caused little reduction (0.25-fold) in the papain inhibitory activity of tirustatin. The stoichiometry of the papain-tirustatin interaction was 1.5: 1 and 28.8 pM of the inhibitor effected 50% inhibition. With an equilibrium dissociation constant of 8.74 x 10-8M for the papain enzyme, it is possible to evaluate the isolated protein as a non-competitive inhibitor. In addition, the protein extract of E. tirucalli even at the maximum concentration used (20 μg/mL), did not show a cytotoxic and mutagenic profile in a bacterial model., Conclusion: The results presented in this work provide data that reinforce the idea of the potential use of proteins produced in E. tirucalli as pharmacological and biotechnological agents that can be exploited for the development of efficient drugs., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Physical exercise is considered an adjuvant treatment to Parkinson's disease (PD) patients, possibly reducing inflammatory responses in the brain. Studies have stated that physical exercise protects dopaminergic neurons in PD models produced by neurotoxins. However, few studies focused on immunohistochemically reacted astrocytes and morphometric analyses of these cells in a PD mouse model submitted to physical exercise. We investigated the effects of treadmill training on striatal astrocytes of a PD mouse model combining immunohistochemistry and western-blotting for glial fibrillary acidic protein (GFAP) with morphometric analyses. Male Swiss mice were divided into 4 groups: sedentary control (SEDCONT), exercise control (EXERCONT), sedentary Parkinson (SEDPD), and exercise Parkinson (EXERPD). Stereotaxic bilateral injections of 6-hydroxydopamine into the striatum were adopted for PD groups. Striatal astrocytes showed increased GFAP in EXERPD, and we observed a higher level of GFAP in EXERPD than SEDPD. The number of primary and secondary processes was similar in striatal astrocytes of control groups and EXERPD. The astrocyte primary processes of SEDPD were larger than those of EXERPD, EXERCONT and SEDCONT. Cell body diameters and areas showed no difference between groups. We concluded that physical exercise influences striatal astrocytes in exercised parkinsonian mice., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Studies on disrespect and abuse/mistreatment/obstetric violence during pregnancy, childbirth and puerperium have increased in recent decades. However, researchers interested in the subject face many theoretical and methodological difficulties. In this sense, this study aims to discuss and reflect on how issues related to definition and terminology, measurement, and public policies in Brazil have hindered research on this topic and the mitigation of these acts. The first problem addressed was the lack of consensus regarding the terminology and definition of this construct. This situation causes a cascading effect, impacting the use of non-validated measurement instruments and, consequently, a lack of accuracy and comparability between studies. Another issue mentioned is the lack of studies exploring the consequences of these acts on women's and newborn's health, which is one of the main gaps on the subject today. The absence of causal studies affects health decision-making, impairing the elaboration of specific public policies.

This review evaluated the knowledge of health professionals (HP) about breastfeeding and factors that leading the weaning. A search was performed in four electronics databases and the grey literature. The search strategy included Mesh terms and synonyms. No language or date restrictions were adopted. Studies that evaluated the knowledge of HP about breastfeeding and weaning were considered eligible. The studies retrieved by the searches were evaluated by two independently examiners. From 1,417 studies retrieved, 35 were included. Many countries and professionals from different health areas were analyzed. No studies evaluated the dentists' knowledge. Although the included HP know the benefits of breastfeeding for health, the length of breastfeeding recommended by the World Health Organization, exclusive or not, was not aligned with all professionals' endorsement. Information about weaning is scarce; however, HP are mindful of the main potential causes of early weaning. The knowledge of HP is conflicting about breastfeeding and unusual about weaning. Furthermore, no studies were found that presented data on the knowledge of dentists on the subject. Thus, assessments of dentists' knowledge and education measures for HP are necessary since they are frequently questioned about these issues.

Flowering plant species and their nectar-feeding vertebrates exemplify some of the most remarkable biotic interactions in the Neotropics. In the Brazilian Atlantic Forest, several species of birds (especially hummingbirds), bats, and non-flying mammals, as well as one lizard feed on nectar, often act as pollinators and contribute to seed output of flowering plants. We present a dataset containing information on flowering plants visited by nectar-feeding vertebrates and sampled at 166 localities in the Brazilian Atlantic Forest. This dataset provides information on 1902 unique interactions among 515 species of flowering plants and 129 species of potential vertebrate pollinators and the patterns of species diversity across latitudes. All plant-vertebrate interactions compiled were recorded through direct observations of visits, and no inferences of pollinators based on floral syndromes were included. We also provide information on the most common plant traits used to understand the interactions between flowers and nectar-feeding vertebrates: plant growth form, corolla length, rate of nectar production per hour in bagged flowers, nectar concentration, flower color and shape, time of anthesis, presence or absence of perceptible fragrance by human, and flowering phenology as well as the plant's threat status by International Union for Conservation of Nature (IUCN) classification. For the vertebrates, status of threat by IUCN classification, body mass, bill or rostrum size are provided. Information on the frequency of visits and pollen deposition on the vertebrate's body is provided from the original source when available. The highest number of unique interactions is recorded for birds (1771) followed by bats (110). For plants, Bromeliaceae contains the highest number of unique interactions (606), followed by Fabaceae (242) and Gesneriaceae (104). It is evident that there was geographical bias of the studies throughout the southeast of the Brazilian Atlantic Forest and that most effort was directed to flower-hummingbird interactions. However, it reflects a worldwide tendency of more plants interacting with birds compared with other vertebrate species. The lack of similar protocols among studies to collect basic data limits the comparisons among areas and generalizations. Nevertheless, this dataset represents a notable effort to organize and highlight the importance of vertebrate pollinators in this hotspot of biodiversity on Earth and represents the data currently available. No copyright or proprietary restrictions are associated with the use of this data set. Please cite this data paper when the data are used in publications or scientific events., (© 2022 The Ecological Society of America.)

Background: Liver segmentation is a fundamental step in the treatment planning and diagnosis of liver cancer. However, manual segmentation of liver is time-consuming because of the large slice quantity and subjectiveness associated with the specialist's experience, which can lead to segmentation errors. Thus, the segmentation process can be automated using computational methods for better time efficiency and accuracy. However, automatic liver segmentation is a challenging task, as the liver can vary in shape, ill-defined borders, and lesions, which affect its appearance. We aim to propose an automatic method for liver segmentation using computed tomography (CT) images., Methods: The proposed method, based on deep convolutional neural network models and image processing techniques, comprise of four main steps: (1) image preprocessing, (2) initial segmentation, (3) reconstruction, and (4) final segmentation., Results: We evaluated the proposed method using 131 CT images from the LiTS image base. An average sensitivity of 95.45%, an average specificity of 99.86%, an average Dice coefficient of 95.64%, an average volumetric overlap error (VOE) of 8.28%, an average relative volume difference (RVD) of -0.41%, and an average Hausdorff distance (HD) of 26.60 mm were achieved., Conclusions: This study demonstrates that liver segmentation, even when lesions are present in CT images, can be efficiently performed using a cascade approach and including a reconstruction step based on deep convolutional neural networks., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

This work proposes a way to detect the wandering movement of Alzheimer's patients from path data collected from non-intrusive indoor sensors around the house. Due to the lack of adequate data, we have manually generated a dataset of 220 paths using our developed application. Wandering patterns in the literature are normally identified by visual features (such as loops or random movement), thus our dataset was transformed into images and augmented. Convolutional layers were used on the neural network model since they tend to have good results in finding patterns mainly on images. The Convolutional Neural Network model was trained with the generated data representing the hourly analysis and achieved an F1 score (relation between precision and recall) of 75%, recall of 60%, and precision of 100% on the validation slice. For comparative purposes, we have also trained the model with a 30-min interval of analysis and achieved an F1 score of 57.14%, a recall of 80% and a precision of 44.44%., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd 2022.)

Background: Short-course, rifamycin-based regimens could facilitate scale-up of tuberculosis preventive therapy (TPT), but it is unclear how stringently tuberculosis (TB) disease should be ruled out before TPT use., Methods: We developed a state-transition model of a TPT intervention among two TPT-eligible cohorts: adults newly diagnosed with HIV in South Africa (PWH) and TB household contacts in Pakistan (HHCs). We modeled two TPT regimens-4 months of rifampicin [4R] or 6 months of isoniazid [6H]-comparing each to a reference of no intervention. Before initiating TPT, TB disease was excluded either through symptom-only screening or with additional radiographic screening that could detect subclinical TB but might limit access to the TPT intervention. TPT's potential curative effects on both latent and subclinical TB were modeled, as were both acquisitions of resistance and prevention of drug-resistant disease. Although all eligible individuals received the screening and/or TPT interventions, the modeled TB outcomes comprised only those with latent or subclinical TB that would have progressed to symptomatic disease if untreated., Results: When prescribed after only symptom-based TB screening (such that individuals with subclinical TB were included among TPT recipients), 4R averted 45 active (i.e., symptomatic) TB cases (95% uncertainty range 24-79 cases or 40-89% of progressions to active TB) per 1000 PWH [17 (9-29, 43-94%) per 1000 HHCs]; 6H averted 37 (19-66, 52-73%) active TB cases among PWH [13 (7-23, 53-75%) among HHCs]. With this symptom-only screening, for each net rifampicin resistance case added by 4R, 12 (3-102) active TB cases were averted among PWH (37 [9-580] among HHCs); isoniazid-resistant TB was also reduced. Similarly, 6H after symptom-only screening increased isoniazid resistance while reducing overall and rifampicin-resistant active TB. Screening for subclinical TB before TPT eliminated this net increase in resistance to the TPT drug; however, if the screening requirement reduced TPT access by more than 10% (the estimated threshold for 4R among HHCs) to 30% (for 6H among PWH), it was likely to reduce the intervention's overall TB prevention impact., Conclusions: All modeled TPT strategies prevent TB relative to no intervention, and differences between TPT regimens or between screening approaches are small relative to uncertainty in the outcomes of any given strategy. If most TPT-eligible individuals can be screened for subclinical TB, then pairing such screening with rifamycin-based TPT maximizes active TB prevention and does not increase rifampicin resistance. Where subclinical TB cannot be routinely excluded without substantially reducing TPT access, the choice of TPT regimen requires weighing 4R's efficacy advantages (as well as its greater safety and shorter duration that we did not directly model) against the consequences of rifampicin resistance in a small fraction of recipients., (© 2021. The Author(s).)

For the purpose of analyzing topics linking the health-disease-work process to medical evaluation practices under the scope of the federal public service and their interaction with Worker's Health, this article investigates the issue of determining the duration of the sick leave period that a worker is granted for caring for their own health, within the Subsistema Integrado de Atenção à Saúde do Servidor (SIASS). To that end, the parameters for granting time off work, as provided by the Manual de Perícia Oficial, and the speeches on this topic by the interviewees were analyzed. The importance given to the topic 'days off work' arises from the fact that it is related to the time it takes the worker to recover, which implies fewer days dedicated to being productive. Interviews were conducted with 32 professionals from 5 educational institutions, and this article highlights some analytical categories: days off work; Manual da Perícia and disagreement between medical evaluators and attending physicians. The results point to the usefulness of revising the Manual taking into account Worker's Health, identifying contradictions; the need for shaping an effectively interdisciplinary evaluation, so that the worker's health-related complaints can be handled from the perspective of the worker's care, and not simply concerning control and surveillance.

The COVID-19 pandemic, which originated in December 2019 in the city of Wuhan, China, continues to have a devastating effect on the health and well-being of the global population. Currently, approximately 8.8 million people have already been infected and more than 465,740 people have died worldwide. An important step in combating COVID-19 is the screening of infected patients using chest X-ray (CXR) images. However, this task is extremely time-consuming and prone to variability among specialists owing to its heterogeneity. Therefore, the present study aims to assist specialists in identifying COVID-19 patients from their chest radiographs, using automated computational techniques. The proposed method has four main steps: (1) the acquisition of the dataset, from two public databases; (2) the standardization of images through preprocessing; (3) the extraction of features using a deep features-based approach implemented through the networks VGG19, Inception-v3, and ResNet50; (4) the classifying of images into COVID-19 groups, using eXtreme Gradient Boosting (XGBoost) optimized by particle swarm optimization (PSO). In the best-case scenario, the proposed method achieved an accuracy of 98.71%, a precision of 98.89%, a recall of 99.63%, and an F1-score of 99.25%. In our study, we demonstrated that the problem of classifying CXR images of patients under COVID-19 and non-COVID-19 conditions can be solved efficiently by combining a deep features-based approach with a robust classifier (XGBoost) optimized by an evolutionary algorithm (PSO). The proposed method offers considerable advantages for clinicians seeking to tackle the current COVID-19 pandemic., Competing Interests: 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., (© 2021 Elsevier Ltd. All rights reserved.)

The objective was to understand and analyze the experiences of Afro-Brazilian women regarding pregnancy, delivery and postpartum care. It involves empirical research, with a qualitative approach. Women were interviewed who declared themselves black or colored and were attended in the public health services in the municipalities of the State of Pernambuco. The narratives were collected through semi-structured interviews. The Content Analysis technique was used. The narratives addressed the issues of obstetric violence and institutional racism. The intersection of levels of oppression such as race, class and gender are determinant in interventions and abusive practices in the helathcare that involves childbirth. The conclusion drawn is that structural racism hinders and denies access to black women to their reproductive rights.

Background: Despite mainly benign, exophytic subcutaneous cranial masses present with a myriad of differential diagnosis possibilities, ranging from simple, superficial lesions to complex lesions involving the central nervous system. Although the gold standard imaging modality for the diagnosis of these lesions is magnetic resonance imaging, Doppler Ultrasonography can be a useful, inexpensive, and available tool for evaluation of lesions that could potentially be safely treated in the primary care setting, and lesions that would demand advanced neurosurgical care., Case Description: This patient presented with a complex exophytic plasmocytoma that was first diagnosed and erroneously approached as a subcutaneous lipoma with surgical resection in an outpatient surgical setting. This interpretive approach resulted in the failure of the procedure due to significant hemorrhage. The patient was immediately referred to neurosurgical care and transferred to our center. Admission doppler ultrasound imaging revealed absence of the frontal bone, the enriched and profuse vascularization, allowing further and proper diagnostic approach and treatment., Conclusion: Ultrasound could be a reliable, fast, and simple imaging method aiding practitioners to perform a better workup for patients with exophytic subcutaneous cranial masses., Competing Interests: There are no Conflict of Interest., (Copyright: © 2021 Surgical Neurology International.)

Mental health problems have great international health relevance. From a multifactorial nature, the health conditions considered here as suffering are influenced by social elements such as the construction of masculinity, notwithstanding the evident increasing criticisms and struggles against male sexism. Given this setting, the paper addresses male mental distress and its care, based on a literature review, according to BVS research, and considering the 2010-2020 period. Twenty-two papers were selected from the research. The results of the study were organized into these categories: Characteristics/Particularities of men's mental distress; Access/Way of seeking help by men in distress and approach/Care of men in mental distress. We can conclude that there is a need for more visibility for the relationship between masculinity and suffering and their care specificities, considering the existence of an apparent silent crisis, the right of men (as people) to care, and the possible contribution, albeit indirect and modest, of addressing men's distress to the fight against machismo.

Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs. Women with SS often experience gynecological symptoms due to the disease and need extra care regarding their sexual activity, reproductive health and during pregnancy, conditions that are not properly conducted in the clinical practice. To cover this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of symptoms, diagnosis, monitoring, prognosis, and treatment of these manifestations. A Focus Group meeting was held and included experts in the field and methodologists, based on a previously developed script, with themes related to the objective of the study. The most important topics were summarized and 11 recommendations were provided., (© 2021. The Author(s).)

Introduction: Few data on the COVID-19 epidemiological characteristics among the pediatric population in Africa exists. This paper examines the age and sex distribution of the morbidity and mortality rate in children with COVID-19 and compares it to the adult population in 15 Sub-Saharan African countries., Methods: A merge line listing dataset shared by countries within the Regional Office for Africa was analyzed. Patients diagnosed within 1 March and 1 September 2020 with a confirmed positive RT-PCR test for SARS-CoV-2 were analyzed. Children's data were stratified into three age groups: 0-4 years, 5-11 years, and 12-17 years, while adults were combined. The cumulative incidence of cases, its medians, and 95% confidence intervals were calculated., Results: 9% of the total confirmed cases and 2.4% of the reported deaths were pediatric cases. The 12-17 age group in all 15 countries showed the highest cumulative incidence proportion in children. Adults had a higher case incidence per 100,000 people than children., Conclusion: The cases and deaths within the children's population were smaller than the adult population. These differences may reflect biases in COVID-19 testing protocols and reporting implemented by countries, highlighting the need for more extensive investigation and focus on the effects of COVID-19 in children., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

To analyze the effect of a sugarcane cystatin (CaneCPI-5) on the microbial profile and viability, as well as on the prevention of dentin demineralization using a microcosm biofilm model. Ninety bovine dentine specimens were divided into five experimental groups according with the solution they were treated for 60 s: (1) PBS (negative control), (2) 0.12% chlorhexidine (positive control), (3) Fluoride (500 ppm F, as NaF), (4) 0.025 mg/ml CaneCPI-5, and (5) 0.05 mg/ml CaneCPI-5. Specimens were incubated with inoculum (McBain's saliva plus human saliva) in the first 8 h, and from then on, they were exposed to McBain saliva containing sucrose and daily treated (60 s) with the solutions for 5 days. Resazurin and colony-forming unit counting assays were performed. Dentin demineralization was measured by transverse micro-radiography (TMR). 0.12% chlorhexidine significantly reduced the metabolic activity of the microcosm biofilm in relation to the negative control and treated groups (p < 0.01). CHX and F significantly reduced the counts of total microorganisms, mutans group streptococci, and lactobacilli when compared with the negative control. None of the treatments was able to significantly reduce dentin demineralization in comparison with the negative control. In the model evaluated, CaneCPI-5 neither altered the microcosm biofilm profile and viability nor protected dentin against demineralization., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Household surveys are one of the primary methodologies used in population-based studies. This narrative review of the literature aims to gather and describe the leading national and international household surveys of relevance. In Brazil, the historical role played by the Brazilian Institute of Geography and Statistics (IBGE) in conducting the most relevant research in the production of social data stands out. The Medical-Health Care Survey (AMS) and the National Household Sample Survey (PNAD), with the serial publication of Health Supplements, are the country's primary sources of health information. In 2013, in partnership with the Ministry of Health, IBGE launched the National Health Survey (PNS), the most significant household health survey ever conducted in Brazil. The PNS-2019 received a major thematic and sampling expansion and, for the first time, applied the Primary Care Assessment Tool to assess PHC services in all 27 Brazilian states.

Jaboticaba, a popular Brazilian berry, has been studied due to its relevant polyphenol composition, health benefits and potential use for the development of derived food products. Considering that around 200 articles have been published in recent years, this review aims to provide comprehensive and updated information, as well as a critical discussion on: (i) jaboticaba polyphenolic composition and extraction methods for their accurate determination; (ii) jaboticaba polyphenol's metabolism; (iii) biological effects of the fruit and the relationship with its polyphenols and their metabolites; (iv) challenges in the development of jaboticaba derived products. The determination of jaboticaba polyphenols should employ hydrolysis procedures during extraction, followed by liquid chromatographic analysis. Jaboticaba polyphenols, mainly anthocyanins and ellagitannins, are extensively metabolized, and their metabolites are probably the most important contributors to the relevant health effects associated with the fruit, such as antioxidant, anti-inflammatory, antidiabetic, hepatoprotective and hypolipidemic. Most of the technological processing of jaboticaba fruit and its residues is related to their application as a colorant, antioxidant, antimicrobial and source of polyphenols. The scientific literature still lacks studies on the metabolism and bioactivity of polyphenols from jaboticaba in humans, as well as the effect of technological processes on these issues., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The scope of this paper was to describe the health promotion practices developed in a community school in the municipality of Rio de Janeiro in the light of public policies and the school culture. It sought to analyze the significance attributed by the students to these practices and discuss the model of care and health promotion practices developed at school, based on the meanings attributed to such practices by the subjects under study. The qualitative and ethnographic approach supported by Geertz facilitated an understanding of the significance emerging around the health issue. The results demonstrated the incorporation of health promotion actions in daily school life, their interface with sectorial policies, and the central importance of these actions in normative aspects. The significance reproduced medical-sanitary clichés portraying the social spaces, the material resources, the procedures involved and the social actors in these actions. The influence of local culture, habits and lifestyles in the construction of the concept of health in the community studied is highlighted.

Previous research advocates that exercise is a non-pharmacological therapy for Parkinson's disease (PD). However, few studies have investigated the effects of exercise on central nervous system structures other than the nigrostriatal pathway by using PD animal models. This study investigated the effects of exercise on tyrosine hydroxylase (TH)- and cerebral dopamine neurotrophic factor (CDNF)-containing spinal-cord neurons. Male Swiss mice were divided into 4 groups: sedentary control (SEDCONT), exercise control (EXERCONT), sedentary Parkinson (SEDPD), and exercise Parkinson (EXERPD). The PD groups were submitted to a surgical procedure for stereotaxic bilateral injection of 6-hydroxydopamine into the striatum. TH- and CDNF-containing spinal-cord neurons were evaluated in all groups, using immunohistochemistry and western-blotting. TH content in the ventral horn differed notably between the SEDPD and EXERPD groups. CDNF content was highest in the EXERPD group. SEDPD and EXERPD groups differed the most, as shown by immunohistochemistry and western-blotting. The EXERPD group showed the most intense labeling in immunohistochemistry compared to the SEDCONT and EXERCONT groups. Therefore, we showed here that exercise increased the content of both TH and CDNF in the spinal-cord neurons of a bilateral PD mouse model. We may assume that the spinal cord is affected in a PD model, and therefore this central nervous system region deserves more attention from researchers dealing with PD., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Ethnopharmacological Relevance: Sapindus saponaria, also popularly known as soapberry, has been used in folk medicinal values because of its therapeutic properties and several compounds in its composition, which represent a target in potential for drug discovery. However, few data about its potential toxicity has been reported., Aim of the Study: Plant proteins can perform essential roles in survival, acting as defense mechanism, as well functioning as important molecular reserves for its natural metabolism. The aim of the current study was to investigate the in vitro toxicity profile of protein extract of S. saponaria and detect protein potentially involved in biological effects such as collagen hydrolysis and inhibition of viral proteases., Materials and Methods: Protein extract of soapberry seeds was investigated for its cytotoxic and genotoxic action using the Ames test. The protein extract was also subjected to a partial purification process of a protease and a protease inhibitor by gel chromatography filtration techniques and the partially isolated proteins were characterized biochemically., Results: Seed proteins extract of S. saponaria was evaluated until 100 μg/mL concentration, presenting cytotoxicity and mutagenicity in bacterial model mostly when exposed to exogenous metabolic system and causing cytotoxic and genotoxic effects in HepG2 cells. The purification and partial characterization of a serine protease (43 kDa) and a cysteine protease inhibitor (32.8 kDa) from protein extract of S. Saponaria, corroborate the idea of ​​the biological use of the plant as an insecticide and larvicide. Although it shows cytotoxic, mutagenic and genotoxic effects., Conclusion: The overall results of the present study provide supportive data on the potential use of proteins produced in S. saponaria seeds as pharmacological and biotechnological agents that can be further explored for the development of new drugs., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Breast cancer is the second most common cancer in the world. Early diagnosis and treatment increase the patient's chances of healing. The temperature of cancerous tissues is generally different from that of healthy neighboring tissues, making thermography an option to be considered in the fight against cancer because it does not use ionizing radiation, venous access, or any other invasive process, presenting no damage or risk to the patient. In this paper, we propose a hybrid computational method using the Dynamic Infrared Thermography (DIT) and Static Infrared Thermography (SIT) for abnormality screening and diagnosis of malignant tumor (cancer), applying supervised and unsupervised machine learning techniques. We use the area under receiver operating characteristic curve, sensitivity, specificity, and accuracy as performance measures to compare the hybrid methodology with previous work in the literature. The K-Star classifier achieved accuracy of 99% in the screening phase using DIT images. The Support Vector Machines (SVM) classifier applied on SIT images yielded accuracy of 95% in the diagnosis of cancer. The results confirm the potential of the proposed approaches for screening and diagnosis of breast cancer., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Breast cancer is one of the leading causes of mortality globally, but early diagnosis and treatment can increase the cancer survival rate. In this context, thermography is a suitable approach to help early diagnosis due to the temperature difference between cancerous tissues and healthy neighboring tissues. This work proposes an ensemble method for selecting models and features by combining a Genetic Algorithm (GA) and the Support Vector Machine (SVM) classifier to diagnose breast cancer. Our evaluation demonstrates that the approach presents a significant contribution to the early diagnosis of breast cancer, presenting results with 94.79% Area Under the Receiver Operating Characteristic Curve and 97.18% of Accuracy.

This work is the result of a master's thesis that aimed to understand students' perceptions of violence within affective-sexual relationships between adolescents in a public school in the Costa Verde, Rio de Janeiro. The study corpus was derived from participant observation in the school and in-depth interviews with three girls and three boys aged between 18 and 24 years. The core areas of analysis were affective-sexual trajectories, experiences involving violence within relationships, and agency in the face of conflict. The findings reveal that violence is part of the everyday lives of adolescents and reinforce the victim/aggressor dichotomy. The adolescents' interpretations of violence were divided into two categories: "suffering" and "serious acts of violence". These understandings influence the recognition of violence and agency. The reproduction of gender norms contributes to sustaining gender hierarchy and inequalities, which affect girls and boys differently. Silence on this issue contributes to the invisibility of violence within relationships and the consequent failure to seek support from relevant organizations and services. Further research is needed to gain a deeper understanding of violence within affective-sexual relationships between adolescents.

The scope of this article was to analyze the access of children with complex chronic health conditions to specialized care, identifying their strengths and weaknesses from the perspective of speech therapists. The selection of research subjects was made considering the participation in a virtual group whose dynamics signaled the difficulty of members, municipal civil servants, in the conduct of referring patients to health services. Face-to-face interviews were conducted with 14 speech therapists from this group who work with children. The study of the difficulties faced by the interviewees made it possible to identify that care via the Regulation System is an aggravating factor in difficulties of access. In this respect, the problems mentioned were grouped into three topics: (1) Waiting time for making appointments; (2) Distance from the care centers; and (3) Misconceptions in the referral process. In addition, the work of the Expanded Family Health and Primary Care Service was identified as a relevant factor in facilitating children's access to specialized care services in partnership with regulation. The conclusion drawn is that the presence of mediators in health care benefits the population with difficulty of access to services, including children with complex chronic health conditions.

Data management tools, called Business Intelligence (BI), can be important to provide complete and customizable information for the demands of health management. The objective of the article is to present the evaluation of the applicability and potential of a BI tool in the planning of management actions of Primary Health Care. Exploratory study, with a quantitative approach, using the dimensions of efficiency and optimization as attributes of quality. A Family Clinic was selected in the city of Rio de Janeiro. Data from the territory, from the Bolsa Família Program register and some "Care Lines" were inserted in the BI, in order to explore the possibilities of combining and generating indicators. In this article, we present the use of Form A and the pregnant woman's Care Line. As a result, greater range of detailed indicators compared to a common tab, and optimization in obtaining lists and perform monitoring tasks by the teams and the manager. Regarding efficiency, its low cost and easy handling reduces the costs of creation and necessary professionals. As a conclusion, the BI tool enables greater organization and planning, facilitating the Family Health Clinic management, mainly for the monitoring of indicators and evaluation processes.

In this study we evaluated whether single nucleotide polymorphisms (SNPs) in the genes encoding PTH, VDR, CYP24A1, and CYP27B1 were associated with mandibular retrognathism (MR). Samples from biologically-unrelated Brazilian patients receiving orthodontic treatment were included in this study. Pre-orthodontic lateral cephalograms were used to determine the phenotype. Patients with a retrognathic mandible were selected as cases and those with an orthognathic mandible were selected as controls. Genomic DNA was used for genotyping analysis of SNPs in PTH (rs694, rs6256, and rs307247), VDR (rs7975232), CYP24A1 (rs464653), and CYP27B1 (rs927650). Chi-squared or Fisher's tests were used to compare genotype and allele distribution among groups. Haplotype analysis was performed for the SNPs in PTH . The established alpha was p < 0.05. Multifactor dimensionality reduction (MDR) was used to identify SNP-SNP interactions. A total of 48 (22 males and 26 females) MR and 43 (17 males and 26 females) controls were included. The linear mandibular and the angular measurements were statistically different between MR and controls ( p < 0.05). In the genotype and allele distribution analysis, the SNPs rs694, rs307247, and rs464653 were associated with MR ( p < 0.05). MDR analyses predicted the best interaction model for MR was rs694-rs927650, followed by rs307247-rs464653-rs927650. Some haplotypes in the PTH gene presented statistical significance. Our results suggest that SNPs in PTH , VDR , CYP24A1 , and CYP27B1 genes are associated with the presence of mandibular retrognathism.

Objective: To investigate the prevalence of depressive symptoms and its association with clinical and psychological factors in patients with rheumatoid arthritis (RA) in Germany and in Brazil., Method: A convenience sample of 267 RA patients, 176 from Germany (age 62.4 ± 12.3 years) and 91 from Brazil (age 56.3 ± 12.6 years), was used in this cross-sectional study. The following questionnaires were used: Beck Depression Inventory (BDI), painDETECT test, Perceived Stress Questionnaire, fatigue questionnaire (FACIT), Health Assessment Questionnaire Disability Index (HAQ-DI), and the SF-36 questionnaires (Short-Form 36 Health Survey). Disease activity score (DAS 28-CRP) and visual analogue scale (VAS) for pain were also evaluated. Statistical analysis is based on comparison of means and proportions. Statistical significance for non-normal data was evaluated by non-parametrical tests., Results: Depressive symptoms were more prevalent in the Brazilian sample (44% vs 22.9%, p = 0.025). Compared to German patients, the Brazilian ones also experienced more pain (current pain status on VAS: 4.67 ± 3.4 vs 3.67 ± 2.31 respectively, p < 0.01), were physically more limited (1.89 ± 1.85 vs 1.01 ± 0.75, p = 0.012), and had higher C-reactive protein levels (7.78 ± 18.3 vs 5.82 ± 10.45, p = 0.028). Despite receiving a more intensive treatment, German patients presented similar disease activity when compared to Brazilian patients (DAS28-CRP: Brazil 3.4 ± 1.5 vs Germany 3.3 ± 1.3, p = 0.307)., Conclusion: Depressive symptoms are frequent in RA patients from different countries and interact with psychological disorders and the experience of pain. They contribute negatively to their well-being suggesting the need for psychoeducational strategies. Key Points • New psychoeducational strategies for RA management.• Higher inflammation marker in rheumatoid arthritis patients is associated with depression.• Medical treatment in RA influences depressive symptoms.• Depressive symptoms are dependent on population group.• High disease activity is related to depression.

The text presents and discusses the main aspects related to the current dynamics of the vaccine industry in the world and in Brazil, focusing on the demand created by the pandemic of COVID-19. At the global level, it briefly exposes the place currently occupied by Brazil within the scope of the BRICS and sets out and analyzes the options - identities and differences - of industrial policy in Brazil, China and India in the field of vaccines. Next, it analyzes the displacement of the vaccine industry, from a situation of exclusive production of immunizers to a majority control by the large pharmaceutical industry. Further on, it recovers recent fundamental aspects of the vaccine industry in Brazil, with an emphasis on Biomanguinhos / Fiocruz and the Butantan Institute. Finally, it discusses the successes and limitations of the technology transfer mechanism used by the two institutions, as well as the relevance of their historically assumed commitment to public health policies.

Background: Effectively bridging the knowledge-policy gap to support the development of evidence-based policies that promote health and well-being remains a challenge for both the research and policy communities. Community-based system dynamics (CBSD) is a participatory modelling approach that aims to build stakeholders' capacity to learn and address complex problems collaboratively. However, limited evidence is available about the contributions of CBSD to knowledge-generating and policy processes across sectors and policy spheres. In the context of a multi-country research project focused on creating an evidence base to inform urban health policies across Latin America, a series of CBSD workshops convened stakeholders from research, policy-making, and other backgrounds working in food and transportation systems. Diverse participants were selected aiming to incorporate multiple perspectives relevant to understanding complex urban systems linked to food and transportation. This study focuses on one of these workshops, whose avenue was São Paulo, Brazil, assembling country-based participants representing local, regional, national, and international institutions with multidisciplinary backgrounds linked to food and transportation systems., Objective: The aim of this case study is to explore the perceived influence of one of these workshops on attendees' understandings of food and transportation systems and their relationship to healthy urban environments, with attention to the role of the workshop in supporting knowledge to policy translation for urban health., Methods: We conducted 18 semi-structured qualitative interviews with attendees one year after their participation in a CBSD workshop held in São Paulo, Brazil. A framework method approach was used to code participants' responses and identify emerging themes., Results: Participants reported that the workshop's group model-building activities influenced their understanding of the knowledge-policy process as it relates to food and transport systems. Workshop contributed to participants' (1) abilities to engage with multisectoral stakeholders, (2) construct a shared language and understanding of urban challenges, (3) improve understanding of the interconnectedness across food and transportation systems, (4) facilitate dialogue across sectors, and (5) apply a systems thinking approach within their sector and professional context. Participants continued to draw on the tools developed during the workshop, and to apply systems thinking to their research and policy-making activities., Conclusions: CBSD may offer valuable opportunities to connect the research sector to the policy-making process. This possibility may contribute to knowledge to policy translation in the interconnection between the urban context, food and transportation systems, and health.

This work aims to propose new standards to assess the degree of sediment contamination in saline and brackish environments, since the legislation currently used in Brazil is based on Canadian/American regulations, which do not comply with the conditions in Brazil. This study is based on geochemical analyses of 340 surface sediment samples collected in the Green Coast region (Rio de Janeiro, Brazil), including Mangaratiba, Angra dos Reis and Ribeira coves and Ilha Grande and Sepetiba bays. This region is influenced by industrial, harbor, urban and tourist activities and was affected by a dam rupture episode that released contaminated material. The results show heterogeneity in the distribution and range of metal concentrations in the study area depending on the supply of metals from natural and anthropogenic sources. Environmental characteristics such as coastal and tidal currents, water temperature and salinity, local depth, sediment grain size, sedimentary dynamics and biogeochemical processes influence the dispersion or retention of metals. The pollution load index (PLI) suggests that Sepetiba Bay is the region with the most environmental degradation due to anthropogenic contamination. In this context, we propose the establishment of new levels of contamination according to the Cd, Cr, Cu, Mn, Ni, Pb, V and Zn concentrations in sediments of salt and brackish waters, considering I) background level; II) level 1 - with anthropogenic influence; and III) level 2 - contaminated. The results of this work also suggest that, except for zinc, the range of metal concentrations admitted by Brazilian legislation are quite permissive and not adequate for Brazilian coastal environments., (Copyright © 2021 Elsevier Ltd. All rights reserved.)