Photobiomodulation therapy for chronic knee pain in obese patients in pre-rehabilitation for bariatric surgery: randomised, placebo-controlled, double-blinded, clinical trial protocol.

INTRODUCTION: Obesity has become a worldwide public health problem and is directly linked to loss of quality of life, complications and comorbidities. One of them is chronic pain, especially in the knees, which increases significantly and proportionally with weight gain. In patients with severe obesity, with indication for bariatric surgery, the presence of chronic pain disables and often prevents their participation in a pre-surgical rehabilitation programme. As an analgesic therapy, photobiomodulation (PBM) has been studied with safety, efficacy, well-tolerated used and low costs. Thus, this study aims to evaluate the use of PBM for the treatment of chronic knee pain in obese patients undergoing a pre-surgical rehabilitation programme for bariatric surgery. METHODS AND ANALYSES: This is a double-blinded, randomised, placebo-controlled clinical, superiority, trial protocol. The PBM will be applied in bilateral knees and lumbar paraspinal points levels referring to the roots of innervation of the knee. The outcomes evaluated will be pain intensity, functionality, quality of life and clinical signs of neurological sensitization of chronic knee pain pathways. ETHICS AND DISSEMINATION: This protocol has already been approved by the Comitê de Ética em Pesquisa do Hospital das Clínicas da Universidade Federal de Goiás/EBSERH-Ethics Committee and it is following SPIRIT guidelines. The results will be statistically analysed and subsequently published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: Clinical Trials Platform (https://clinicaltrials.gov/) with the number NCT05816798.

Household structure is independently associated with malaria risk in rural Sussundenga, Mozambique.

Introduction: Mozambique has the fourth highest malaria cases and malaria mortality globally. Locally, malaria incidence increases from low in the southern region to high in the central and northern regions. Manica Province in central Mozambique has the fourth highest prevalence of malaria out of the 11 provinces, and the highest in the central region of the country. In this area where coverage of interventions has been limited, household level risk factors can be important for understanding the natural history of infection, as well as the implementation of current and future interventions. There has been indication that the relationship between household structure and malaria risk is actually a mediating one between the true relationship between household income and education and Plasmodium falciparum infection. The objective of this study was to determine and quantify these complex relationships. Methods: We conducted a community-based cross-sectional study in Sussundenga village. Sussundenga is a rural village, located in Sussundenga District, Manica Province, Mozambique. We enrolled 303 participants from 83 randomly selected households. We collected information on demographics, household construction, and administered a P. falciparum rapid diagnostic test (RDT). We constructed several generalized estimating equations logistic regression models to determine the independent effects of housing construction on malaria risk. We also constructed models separate from generalized estimating equations logistic mediation models to determine the proportion of effects mediated by household construction material in the relationship between head of household occupation and education and malaria risk. Results: The overall malaria prevalence among the study population by RDT was 30.8%. In the multivariable model adjusting for all individual and household factors as potential confounders, rudimentary roof structure was the only household structural variable that was statistically significantly associated with increased malaria risk [OR 2.41 (1.03-5.63)]. We found no evidence that household structure mediated the relationship between head of household education or employment and malaria risk in our study population. Discussion: Household structure was a significant risk factor for malaria infection in our study population. These findings are consistent with malaria being a disease of poverty and an area that could be targeted for future interventions that could have long-term impacts.

Association of anthelmintic treatment with malaria prevalence in Rural Sussundenga, Mozambique.

Background: Mozambique has the 4 th highest malaria incidence and mortality globally. Despite the existing malaria control strategies, malaria prevalence remains stagnant. These challenges have increased calls for innovative strategies in areas with the highest disease burden. Community mass treatment with anthelmintic agents have been used as an effective tool for the control of major helminth infections and has emerged as a potential tool for vector control in the fight against malaria. Methods: This was an analysis of data from a cross-sectional community-based survey designed to study malaria risk, prevention, and health seeking behaviors in Sussundenga, Mozambique. Using logistic regression models, we quantified the association between ever receiving anthelmintic treatment and P. falciparum infection. We also fit models to determine the association between recent anthelmintic treatment and malaria infection. Results: Two-hundred, seventy-seven (277) participants from 83 households were included in this analysis. The prevalence of P. falciparum infection measured by rapid diagnostic test (RDT) was 30%. 77% of participants reported having ever received anthelmintics. The prevalence of malaria was slightly higher among participants who reported ever taking anthelmintics. There was no statistically significant association between prior receipt of anthelmintic and P. falciparum malaria infection after adjusting for age, ITN use and head of household full-time employment (OR = 1.37, 95% CI, 0.70-2.70, p = 0.36). However, recent intake of anthelmintics was associated with lower odds of testing positive for in the adjusted models (OR = 0.35, 95% CI, 0.07-1.80, p = 0.21), but this was not statistically significant. Conclusions: Our findings show that the benefit of anthelmintics treatment as a control tool for P. falciparum malaria infection is likely tied to when it is administered rather than if it was ever administered. These findings offer evidence for making decisions in planning mass community deworming in sub-Saharan Africa.

Prevalence and factors associated with metabolic syndrome in a vulnerable population in northern Brazil: a cross-sectional study / Prevalência e fatores associados à síndrome metabólica em população vulnerável do norte do Brasil: um estudo transversal

INTRODUCTION: metabolic syndrome (SM) is a set of metabolic imbalances that are associated with the development of cardiovascular diseases, type 2 diabetes mellitus, in addition to other chronic non-communicable diseases. SM has been gaining prominence in the scientific community mainly due to link with the increase of the obesity epidemic in the worldOBJECTIVE: To analyze the factors associated with metabolic syndrome and its prevalence in a vulnerable population in the Northern Region of BrazilMETHODS: This is a cross-sectional study with artisanal fishers from the state of Tocantins, and data collected between 2016 and 2017 were used. The outcome variable for MS was defined according to the criteria of the International Diabetes Federation. The following variables were assessed: socioeconomic and demographic information, fish consumption, and smoking. For statistical and data analysis, the Shapiro-Wilk test, Poisson regression, Student's t-test, and interquartile regression were evaluatedRESULTS: The general prevalence rate (PR) of MS was 31.9% higher in women than in men. The factors associated with MS were economic class and smoking, and there was an association between socioeconomic class and smoking (p=0.015). The most prevalent component was abdominal obesity with a rate of 62.5% (95% confidence interval [CI]: 54.5, 70.5). The prevalence of MS in terms of sex (PR=2.27, 95% 1.04 CI, 4.92, p=0.037), smoking (PR=2.40, 95% CI, 30, p=0.003) and years of professional experience (>10 PR=2.07, 95% CI 1.06, 4.05, p=0.033) was also assessedCONCLUSION: In the present study, the prevalence of SM was associated with smoking and socioeconomic status, which is considered high when compared to the worldwide prevalence. These findings highlight the importance of looking at public policies so that health services can develop actions that generate greater adherence to good health practices by the population

INTRODUÇÃO: A síndrome metabólica (SM) é um conjunto de desequilíbrios metabólicos que estão associados ao desenvolvimento de doenças cardiovasculares, diabetes mellitus tipo 2 além de outras doenças crônicas não transmissíveis. A SM vem ganhando destaque na comunidade científica principalmente por sua ligação com o aumento da epidemia de obesidade no mundoOBJETIVO: Analisar os fatores associados à síndrome metabólica e sua prevalência em população vulnerável da Região Norte do BrasilMÉTODO: Trata-se de um estudo transversal com pescadores artesanais do estado do Tocantins, e foram utilizados dados coletados entre 2016 e 2017. A variável desfecho para SM foi definida de acordo com os critérios da International Diabetes Federation. As seguintes variáveis foram avaliadas: informações socioeconômicas e demográficas, consumo de peixe e tabagismo. Para análise estatística e de dados, foram avaliados o teste de Shapiro - Wilk, regressão de Poisson, teste t de Student e regressão interquartilRESULTADOS: A taxa geral de prevalência (RP) da SM foi 31,9% maior em mulheres do que em homens. Os fatores associados à SM foram classe econômica e tabagismo e houve associação entre classe socioeconômica e tabagismo (p = 0,015). O componente mais prevalente foi obesidade abdominal com uma taxa de 62,5% (intervalo de confiança de 95% [IC]: 54,5, 70,5). A prevalência de SM em termos de sexo (RP = 2,27, IC 95% 1,04, 4,92, p = 0,037), tabagismo (RP = 2,40, IC 95%, 30, p = 0,003) e anos de experiência profissional (> 10 RP = 2,07, IC 95% 1,06, 4,05, p = 0,033) também foi avaliadoCONCLUSÃO: No presente estudo, a prevalência de SM esteve associada ao tabagismo e ao nível socioeconômico, sendo considerada elevada quando comparada a prevalência mundial. Esses achados assinalam a importância de um olhar das políticas públicas para que os serviços de saúde possam desenvolver ações que geram maior adesão as boas práticas de saúde pela população

A look at vulnerability: analysis of the lack of access to health care for quilombolas in Brazil / Um olhar para a vulnerabilidade: análise da ausência de acesso à saúde pelos quilombolas no Brasil

INTRODUCTION: In Brazil, access to health care is a constitutional right guaranteed by the Unified Health System that provides, in its guiding principles, universality, and equity of access to health servicesOBJECTIVE: To analyze the factors associated with the quilombola population's access to health servicesMETHODS: Cross-sectional study with 91,085 quilombolas. To measure the absence of access to health, the variables sex, ethnicity, work, disability, age group, illiteracy, place of residence, and average family income were used. The lack of access to health services was due to the identification of health care establishments by quilombola families in the Cadastro Único database. The association between socioeconomic characteristics and the lack of access to health services were assessed using the chi-square test and the measures of magnitude of the association and respective confidence intervals were estimated by Poisson Regression with robust varianceRESULTS: Among the factors associated with access to health services for the quilombola population, it is observed that the group with the highest risk is the elderly quilombolas, who declare themselves indigenous and who reside in the central west region It is noted that in 2004 there was a reduction in the lack of access to health by quilombolas to health services, however, between 2005 and 2015, there is an increase in the lack of access to health by quilombolas, after that period there is an ascendancy of access to health by this populationCONCLUSION: Several factors are associated with access to health by quilombola populations, which, related to the inequalities experienced by this population, directly impact government actions

INTRODUÇÃO: No Brasil, o acesso à saúde é um direito constitucional garantido a partir do Sistema Único de Saúde que prevê, em seus princípios norteadores, a universalidade e a equidade de acesso aos serviços de saúdeOBJETIVO: Analisar os fatores associados ao acesso da população quilombolas aos serviços de saúdeMÉTODO: Estudo transversal com 91.085 quilombolas. Para mensurar a ausência do acesso à saúde utilizou-se as variáveis sexo, etnia, trabalho, deficiência, faixa etária, analfabetismo, local de domicílio e a renda média familiar. A ausência do acesso aos serviços de saúde se deu a partir da identificação dos estabelecimentos de assistência à saúde pelas famílias quilombolas na base de dados do Cadastro Único. A associação entre as características socioeconômicas e a ausência do acesso aos serviços de saúde foram avaliadas pelo teste qui-quadrado e as medidas de magnitude da associação e respectivos intervalos de confiança foram estimados por Regressão de Poisson com variância robustaRESULTADOS: Dentre os fatores associados ao acesso aos serviços de saúde da população quilombolas, observa-se que o grupo com maior risco é os quilombolas idosos, que se autodeclaram indígenas e que residem na região centro oeste. Nota-se que no ano de 2004 houve uma redução na ausência do no acesso à saúde dos quilombolas aos serviços de saúde, entretanto entre 2005 a 2015 iniciou-se um aumento na ausência do acesso à saúde, a partir desse período uma ascendência do acesso à saúde por parte dessa populaçãoCONCLUSÃO: Diversos fatores estão associados ao acesso à saúde pelas populações quilombolas, os quais, relacionado às desigualdades vivenciadas por essa população, impactam diretamente nas ações governamentais

Estudo anatômico das artérias perfurantes do músculo gastrocnêmio medial / Anatomical study of perforator arteries of the medial gastrocnemius muscle

OBJETIVOS: Os autores apresentam os resultados da dissecção do feixe vascular do músculo gastrocnêmio medial (MGM) e de suas artérias perfurantes, com o objetivo de contribuir anatomicamente para seu estudo. MÉTODOS: Foram dissecadas 13 peças englobando o joelho e perna (oito à direita e cinco à esquerda), de 13 cadáveres adultos (oito masculinos e cinco femininos), todos frescos. Foi realizado estudo anatômico e radiológico detalhado avaliando o padrão de distribuição, trajeto, número e comprimento da irrigação do MGM e de suas artérias perfurantes. RESULTADO: Foi observado que a artéria sural medial (ASM) divide-se em dois troncos intramusculares principais (medial e lateral) e que em 90 por cento dos casos as perfurantes provêm do tronco lateral. Em 38,5 por cento dos casos, foi identificada uma perfurante, ao passo que duas perfurantes são observadas em 46,1 por cento dos casos. Todas as artérias perfurantes estavam entre 5,7cm e 14,0cm da prega poplítea e entre 16,5cm e 34,0cm do maléolo medial. CONCLUSÃO: A irrigação do MGM pela ASM e suas artérias perfurantes faz-se adequada para sua utilização como retalho miocutâneo no membro inferior.

OBJECTIVES: The authors present the results of dissecting the vascular bundle of the medial gastrocnemius muscle (MGM) and its perforating arteries with the purpose of giving their contribution to anatomical studies. METHODS: 13 pieces of knee and leg (eight right and five left) of 13 fresh adult cadavers (eight male and five female) to evaluate the distribution, path, number and length of irrigation of the MGM and its perforating arteries. RESULTS: They observed that the medial sural artery (ASM) is divided into two main intramuscular branches (medial and lateral), and in 90 percent of the cases, the perforating arteries come from the lateral branch. In 38.5 percent of the cases, they identified one perforating artery, and two perforating arteries were seen in 46.1 percent of the cases. All of the perforating arteries were at a distance of 14.0 cm from the popliteal fold and between 16.5 cm and 34.0 cm from the medial malleolus. CONCLUSION: MGM irrigation by ASM and its perforating arteries is adequate for the use of the muscle as a myocutaneous flap of in the lower limb.