Results of a randomized, prospective clinical trial evaluating metronomic chemotherapy in nonmetastatic patients with high-grade, operable osteosarcomas of the extremities: A report from the Latin American Group of Osteosarcoma Treatment.

BACKGROUND: Metronomic chemotherapy (MC) consists of the administration of a low dose of chemotherapy on a daily or weekly basis without a long break to achieve an antitumoral effect through an antiangiogenic effect or stimulation of the immune system. The potential effect of MC with continuous oral cyclophosphamide and methotrexate in patients with high-grade operable osteosarcomas (OSTs) of the extremities was investigated. METHODS: Patients with high-grade OSTs who were 30 years old or younger were eligible for registration at diagnosis. Eligibility for randomization included 1) nonmetastatic disease and 2) complete resection of the primary tumor. The study design included a backbone of 10 weeks of preoperative therapy with methotrexate, adriamycin, and platinum (MAP). After surgery, patients were randomized between 2 arms to complete 31 weeks of MAP or receive 73 weeks of MC after MAP. The primary endpoint was event-free survival (EFS) from randomization. RESULTS: There were 422 nonmetastatic patients registered (May 2006 to July 2013) from 27 sites in 3 countries (Brazil, Argentina and Uruguay), and 296 were randomized to MAP plus MC (n = 139) or MAP alone (n = 157). At 5 years, the EFS cumulative proportions surviving in the MAP-MC group and the MAP-alone group were 61% (standard error [SE], 0.5%) and 64% (SE, 0.5%), respectively, and they were not statistically different (Wilcoxon [Gehan] statistic = 0.724; P =.395). The multivariate analysis showed that necrosis grades 1 and 2, tumor size, and amputation were associated with shorter EFS. CONCLUSIONS: According to the current follow-up, EFS with MAP plus MC is not statistically superior to EFS with MAP alone in patients with high-grade, resectable OSTs of the extremities. Cancer 2017;123:1003-10. © 2016 American Cancer Society.

Polyoxygenated steroids from the octocoral Leptogorgia punicea and in vitro evaluation of their cytotoxic activity.

Five new polyoxygenated marine steroids-punicinols A-E (1-5)-were isolated from the gorgonian Leptogorgia punicea and characterized by spectroscopic methods (IR, MS, 1H, 13C and 2-D NMR). The five compounds induced in vitro cytotoxic effects against lung cancer A549 cells, while punicinols A and B were the most active, with IC50 values of 9.7 µM and 9.6 µM, respectively. The synergistic effects of these compounds with paclitaxel, as well as their effects on cell cycle distribution and their performance in the clonogenic assay, were also evaluated. Both compounds demonstrated significant synergistic effects with paclitaxel.

Retinoblastoma treatment in a Brazilian population. Presentation and long-term results.

INTRODUCTION: Retinoblastoma is a malignant tumor with a high cure potential when proper therapy is used. The purpose of this paper is to report the clinical features and outcomes of patients with retinoblastoma who were treated with a combination of local and systemic chemotherapy-based protocols. METHOD: We retrospectively studied patients treated with systemic chemotherapy plus local treatment between 2003 and 2015 with a follow-up ≥2 years. We correlated clinical and pathological characteristics with decimal visual acuity (VA) and death. RESULTS: Among 119 patients, 60% had unilateral disease (UNI), and 52% were male. The median presentation age was 19.5 months, 10% had a positive family history, and the most frequent sign was leukocoria (68.8%). Advanced disease was more frequent in eyes with UNI (98.4%) than in eyes with bilateral retinoblastoma (BIL: 55.3%). Enucleation was performed in 97% of UNI eyes and in 55.8% of BIL eyes. The overall globe salvage was 26.6%, 44.25% of BIL eyes. Bilateral enucleation was required in 5%. High-risk pathologic features occurred in 50% and 37% of eyes enucleated without and with neoadjuvant chemotherapy, respectively. High-risk features were related to the presence of goniosynechiae in the pathologic specimen and were more frequent in children younger than 10 months or older than 40 months. Extraocular disease was present in 5% of patients, and the death rate related to metastasis of the tumor was 8%. The final VA was ≥ 0.7 in 72.8% and ≥0.1 in 91% of BIL patients. CONCLUSIONS: Treatment of retinoblastoma with conservative systemic-based chemotherapy was associated with an excellent survival rate (92%). Albeit the low overall globe salvage rate, in BIL patients, approximately half the eyes were conserved, and a satisfactory functional visual result was achieved The evaluated protocol is an important treatment option, especially in developing countries.

Maternal and paternal licit and illicit drug use, smoking and drinking and autism spectrum disorder. / Transtorno do espectro do autismo e o uso materno e paterno de medicamentos, tabaco, álcool e drogas ilícitas.

The aim of this study was to investigate the association between maternal and paternal licit and illicit drug use, smoking and drinking and autism spectrum disorder (ASD). We conducted a case-control study with children and adolescents diagnosed with ASD and neurotypical individuals. The data were collected using a semi-structured questionnaire administered during interviews with the children's mothers or guardians. The following variables were analyzed: child sex and age; maternal and parental age; use of medicines before and during pregnancy; classes of medicines used during pregnancy; maternal and paternal smoking; maternal and paternal drinking; maternal and paternal illicit drug use. The data were analyzed using logistic regression and crude and adjusted odds ratios (OR). After adjustment, the results showed an association between maternal use of antipyretics/pain killers during pregnancy (OR = 2.26; 95%CI 1.29-3.95; p < 0.040) and ASD. No association was found between maternal and paternal smoking, drinking and illicit drug use before and during pregnancy and ASD. The findings suggest that the development of ASD is influenced by environmental factors.

O presente estudo objetivou investigar a associação entre o TEA e o uso materno e paterno de medicamentos, tabaco, álcool e drogas ilícitas. Trata-se de um estudo caso-controle realizado com crianças e adolescentes diagnosticados com TEA e indivíduos neurotípicos. Os dados foram colhidos por meio de entrevista com as mães ou responsáveis. Foram analisadas as variáveis sexo e idade das crianças/adolescentes; idade dos pais; uso de medicamentos antes e durante a gestação; classes de medicamentos usados na gestação; tabagismo materno e paterno; etilismo materno e paterno; uso de drogas ilícitas pelos pais. Para a análise das informações, utilizou-se o modelo de regressão logística, além da razão de chances (OR) bruta e ajustada. Os resultados mostraram que, após os ajustes, foi encontrada associação entre o uso materno na gestação de antitérmicos/analgésicos (OR = 2,26; IC95% 1,29-3,95; p < 0,040) com o TEA. Já o uso de tabaco, álcool e drogas ilícitas materno e paterno, antes e durante a gestação, não apontou relação com o TEA. Os dados encontrados sugerem que existe influência de fatores ambientais no desenvolvimento do TEA.

Anti HSV-1 activity of halistanol sulfate and halistanol sulfate C isolated from Brazilian marine sponge Petromica citrina (Demospongiae).

The n-butanol fraction (BF) obtained from the crude extract of the marine sponge Petromica citrina, the halistanol-enriched fraction (TSH fraction), and the isolated compounds halistanol sulfate (1) and halistanol sulfate C (2), were evaluated for their inhibitory effects on the replication of the Herpes Simplex Virus type 1 (HSV-1, KOS strain) by the viral plaque number reduction assay. The TSH fraction was the most effective against HSV-1 replication (SI = 15.33), whereas compounds 1 (SI = 2.46) and 2 (SI = 1.95) were less active. The most active fraction and these compounds were also assayed to determine the viral multiplication step(s) upon which they act as well as their potential synergistic effects. The anti-HSV-1 activity detected was mediated by the inhibition of virus attachment and by the penetration into Vero cells, the virucidal effect on virus particles, and by the impairment in levels of ICP27 and gD proteins of HSV-1. In summary, these results suggest that the anti-HSV-1 activity of TSH fraction detected is possibly related to the synergic effects of compounds 1 and 2.

Anti-infective potential of marine invertebrates and seaweeds from the Brazilian coast.

This manuscript describes the evaluation of anti-infective potential in vitro of organic extracts from nine sponges, one ascidian, two octocorals, one bryozoan, and 27 seaweed species collected along the Brazilian coast. Antimicrobial activity was tested against Staphylococcus aureus (ATCC 25923), Enterococcus faecalis (ATCC 29212), Pseudomonas aeruginosa (ATCC 27853), Escherichia coli (ATCC 25922) and Candida albicans (ATCC 10231) by the disk diffusion method. Antiprotozoal activity was evaluated against Leishmania braziliensis (MHOM/BR/96/LSC96-H3) promastigotes and Trypanosoma cruzi (MHOM/BR/00/Y) epimastigotes by MTT assay. Activity against intracellular amastigotes of T. cruzi and L. brasiliensis in murine macrophages was also evaluated. Antiviral activity was tested against Herpes Simplex Virus type 1 (HSV-1, KOS strain) by the plaque number reduction assay (IC50). Cytotoxicity on VERO cells was evaluated by the MTT assay (CC50). The results were expressed as SI = CC50/IC50. The most promising antimicrobial results were obtained against S. aureus and C. albicans with Dragmacidon reticulatum. Among the seaweeds, only Osmundaria obtusiloba showed moderate activity against P. aeruginosa. Concerning antiprotozoal activity, Bugula neritina, Carijoa riseii, Dragmaxia anomala and Haliclona (Halichoclona) sp. showed the most interesting results, mainly against extracellular promastigote forms of L. braziliensis (66, 35.9, 97.2, and 43.6% inhibition, respectively). Moreover, six species of seaweeds Anadyomene saldanhae, Caulerpa cupressoides, Canistrocarpus cervicornis, Dictyota sp., Ochtodes secundiramea, and Padina sp. showed promising results against L. braziliensis (87.9, 51.7, 85.9, 93.3, 99.7, and 80.9% inhibition, respectively), and only Dictyota sp. was effective against T. cruzi (60.4% inhibition). Finally, the antiherpes activity was also evaluated, with Haliclona (Halichoclona) sp. and Petromica citrina showing the best results (SI = 11.9 and SI > 5, respectively). All the active extracts deserve special attention in further studies to chemically characterize the bioactive compounds, and to perform more refined biological assays.

Acute promyelocytic leukemia in childhood and adolescence: treatment results of a modified AIDA protocol at a Brazilian center.

INTRODUCTION: Acute promyelocytic leukemia currently presents an excellent chance of cure with protocols based on all-trans-retinoic acid (ATRA) and anthracycline or only differentiation agents. However, high early mortality rates continue to be reported METHODS: Between 2000 and 2018, patients were enrolled and retrospectively analyzed by medical records. A modified AIDA protocol, with a 1-year shortening of the treatment duration, reduction in the number of drugs and a strategy to reduce early mortality by the postponement of the initiation of anthracyclines were employed. Overall and event-free survival rates and toxicity were analyzed RESULTS: Thirty-two patients were enrolled, of whom 56% were female, with a median age of 12 years and 34% belonged to the high-risk group. Two patients had the hypogranular variant and three had another cytogenetic alteration, in addition to the t(15;17). The median start of the first anthracycline dose was 7 days. There were two early deaths (6%) due to central nervous system (CNS) bleeding. All patients achieved molecular remission after the consolidation phase. Two children relapsed and were rescued by arsenic trioxide and hematopoietic stem cell transplantation. The presence of disseminated intravascular coagulation (DIC) at diagnosis (p = 0.03) was the only factor with survival impact. The five-year event-free survival (EFS) was 84% and 5-year overall survival (OS) was 90% CONCLUSION: The survival results were comparable to those found in the AIDA protocol, with a low rate of early mortality in relation to the Brazilian reality.

[Alcohol use, family conflicts and parental supervision among high school students]. / Uso de álcool, conflitos familiares e supervisão parental entre estudantes do ensino médio.

The association between alcohol consumption by students with family conflicts, parental supervision and quality of relationships was investigated. A cross-sectional study was conducted with 1,265 adolescents from 21 schools. The Brazilian version of the Drug Use Screening Inventory/DUSI was used, and absolute and relative prevalence for categorical variables was estimated, while bivariate analyses and Pearson's Chi Square test were conducted. For the magnitude of the association between the dependent and independent variables, prevalence ratios were estimated using Poisson multivariate regression. There was an association between alcohol consumption and drug use by family members, frequent discussions and parental lack of awareness about adolescents' activities. Family supervision, a good relationship with parents/guardians, establishing an affective family bond and parents' knowledge about teenagers' whereabouts, were protective factors for alcohol use. The conclusion was that the high rate of schoolchildren who consume alcohol is worrying, liable to health complications in general, and a harmonized family relationship is fundamental. The implementation of measures of intervention between school and the Family Health Strategy, can contribute to the establishment of a protective bond.

Investigou-se a associação entre o consumo de álcool pelos escolares com os conflitos familiares, supervisão dos pais e qualidade dos relacionamentos. Estudo transversal realizado com 1.265 adolescentes de 21 escolas. Foi utilizada a versão brasileira do Inventário de Triagem do Uso de Drogas/DUSI e estimadas prevalências absolutas e relativas para variáveis categóricas, e conduzidas análises bivariadas: teste Qui Quadrado de Pearson. Para magnitude da associação entre a variável dependente e independentes foram estimadas razões de prevalências por meio deregressão multivariável de Poisson. Houve associação do consumo de álcool com uso de drogas por familiares, discussões frequentes e desconhecimento dos pais sobre o que os adolescentes fazem. Supervisão familiar, bom relacionamento com pais/responsáveis, estabelecimento de vínculo familiar afetivo e ciência dos pais acerca do que os adolescentes fazem e onde estão, foram fatores de proteção para uso de álcool. Concluiu-se que a alta taxa de escolares que consomem álcool é preocupante, passível de complicações da saúde na sua integralidade, sendo fundamental relação familiar harmonizada. A implementação de práticas interventivas entre escola e Estratégia de Saúde da Família, podem contribuir no estabelecimento de vínculo protetivo.

Dolabellane Diterpenoids from the South Atlantic Gorgonian Convexella magelhaenica.

Two new dolabellane diterpenoids (1 and 2) were isolated from a small sample of the deep water gorgonian octocoral Convexella magelhaenica collected as a nontarget by-catch by dredging (-93 m) in commercial Patagonian scallop fishing grounds in the South Atlantic. The structures of the new compounds, which are major metabolites in the extract, were established by spectroscopic techniques and chemical transformations. Both compounds were cytotoxic against a human pancreatic adenocarcinoma cell line at micromolar concentrations.

Involvement of the central nervous system in neuroblastomas: A potential direct pathway.

Although frequently disseminated to other anatomical sites, neuroblastoma (NB) is rarely reported as involving the central nervous system (CNS), which may reflect insufficient research in poorly controlled systemic disease. Here we demonstrate the involvement of the CNS in patients with NB over 18 months of age at diagnosis of extensive systemic disease. Meningeal metastases were observed even in the presence of complete systemic control. Although no improvement in patient's survival was observed, radiotherapy was effective in preventing CNS recurrence after observation of actual or previous dural disease. In conclusion, this study uncovered the uncommon pathologic involvement of the CNS in children with advanced NB and underscores the meningeal surface as a potential pathway for this to occur.

Transtorno do espectro do autismo e o uso materno e paterno de medicamentos, tabaco, álcool e drogas ilícitas / Maternal and paternal licit and illicit drug use, smoking and drinking and autism spectrum disorder

Resumo O presente estudo objetivou investigar a associação entre o TEA e o uso materno e paterno de medicamentos, tabaco, álcool e drogas ilícitas. Trata-se de um estudo caso-controle realizado com crianças e adolescentes diagnosticados com TEA e indivíduos neurotípicos. Os dados foram colhidos por meio de entrevista com as mães ou responsáveis. Foram analisadas as variáveis sexo e idade das crianças/adolescentes; idade dos pais; uso de medicamentos antes e durante a gestação; classes de medicamentos usados na gestação; tabagismo materno e paterno; etilismo materno e paterno; uso de drogas ilícitas pelos pais. Para a análise das informações, utilizou-se o modelo de regressão logística, além da razão de chances (OR) bruta e ajustada. Os resultados mostraram que, após os ajustes, foi encontrada associação entre o uso materno na gestação de antitérmicos/analgésicos (OR = 2,26; IC95% 1,29-3,95; p < 0,040) com o TEA. Já o uso de tabaco, álcool e drogas ilícitas materno e paterno, antes e durante a gestação, não apontou relação com o TEA. Os dados encontrados sugerem que existe influência de fatores ambientais no desenvolvimento do TEA.

Abstract The aim of this study was to investigate the association between maternal and paternal licit and illicit drug use, smoking and drinking and autism spectrum disorder (ASD). We conducted a case-control study with children and adolescents diagnosed with ASD and neurotypical individuals. The data were collected using a semi-structured questionnaire administered during interviews with the children's mothers or guardians. The following variables were analyzed: child sex and age; maternal and parental age; use of medicines before and during pregnancy; classes of medicines used during pregnancy; maternal and paternal smoking; maternal and paternal drinking; maternal and paternal illicit drug use. The data were analyzed using logistic regression and crude and adjusted odds ratios (OR). After adjustment, the results showed an association between maternal use of antipyretics/pain killers during pregnancy (OR = 2.26; 95%CI 1.29-3.95; p < 0.040) and ASD. No association was found between maternal and paternal smoking, drinking and illicit drug use before and during pregnancy and ASD. The findings suggest that the development of ASD is influenced by environmental factors.

AUTISM SPECTRUM DISORDER AND POSTNATAL FACTORS: A CASE-CONTROL STUDY IN BRAZIL.

OBJECTIVE: To estimate the magnitude of the association between Autism Spectrum Disorder (ASD) and postnatal factors in a Brazilian population. METHODS: A case-control study was performed with 253 individuals diagnosed with ASD and 886 individuals without signs of the disorder. A semi-structured questionnaire and the multiple logistic regression model were adopted in the data analysis. To estimate the magnitude of associations, the crude and adjusted Odds Ratio (OR) was used. RESULTS: An association with the following factors was found: having been born with congenital malformation (OR 4.24; confidence interval of 95% - 95%CI 1.92-9.34), neonatal jaundice (OR 1.43; 95%CI 1.01-2.02), absence of crying at birth and seizure episode in childhood (OR 5.75; 95%CI 3.37-9.81). The magnitude of the association was higher in the children/adolescents who had two or more postnatal complications (OR 6.39; 95%CI 4.10-10.00). CONCLUSIONS: The findings of the present study suggest that malformation, neonatal jaundice, absence of crying at birth and seizure episodes in childhood are important factors to be considered when studying the etiology of ASD.

[Autism spectrum disorder and parents' age: a case-control study in Brazil]. / Transtorno do espectro do autismo e idade dos genitores: estudo de caso-controle no Brasil.

Autism spectrum disorder (ASD) has become a public health problem with major family, social, and economic impacts. This study aimed to estimate the association between ASD and parents' age at the time of their child's birth. A case-control study was performed, consisting of 243 individuals with ASD (cases) and 886 neurotypical controls. A semi-structured questionnaire was applied, following by multiple logistic regression. Associations between ASD and paternal age (in years) from 25 to 34 (OR = 1.65; 95%CI: 1.01-2.71), 35 to 44 (OR = 1.62; 95%CI: 0.96-2.73), and ≥ 45 (OR = 2.44; 95%CI: 1.14-5.00); and maternal age from 25 to 34 (OR = 2.38; 95%CI: 1.54-3.37) and ≥ 35 (OR = 2.09; 95%CI: 1.29-3.39) were significant when assessed in independent models. However, when included in a single model, only maternal age from 25 to 34 (OR = 2.27; 95%CI: 1.45-3.55) and ≥ 35 years (OR = 2.15; 95%CI: 1.21-3.83) remained associated with ASD. The association was stronger when both parents were older (OR = 4.87; 95%CI: 1.71-13.80). The results have important implications for clinical psychiatry and public health, since parents' age at childbirth has increased. Emphasis is needed on the prevention of late childbearing and screening and follow-up of children born to these couples.

O transtorno do espectro do autismo (TEA) tem se tornado um problema de saúde pública, com grande impacto familiar, social e econômico. O objetivo deste trabalho foi estimar a associação entre o TEA e a idade dos genitores no momento do parto. Realizou-se um estudo de caso-controle constituído por 243 indivíduos com o TEA (casos) e 886 neurotípicos (controles). Foi aplicado um questionário semiestruturado e realizada a regressão logística múltipla. Associações entre o TEA e as idades paterna (em anos) entre 25 e 34 (OR = 1,65; IC95%: 1,01-2,71), 35 e 44 (OR = 1,62; IC95%: 0,96-2,73) e ≥ 45 (OR = 2,44; IC95%: 1,14-5,00); e materna entre 25 e 34 (OR = 2,38; IC95%: 1,54-3,37) e ≥ 35 (OR = 2,09; IC95%: 1,29-3,39) foram significativas quando avaliadas em modelos independentes. Porém, quando incluídas em um mesmo modelo apenas as idades maternas entre 25 e 34 (OR = 2,27; IC95%: 1,45-3,55) e ≥ 35 (OR = 2,15; IC95%: 1,21-3,83) se mantiveram associadas. A magnitude da associação foi maior quando ambos os genitores apresentavam idades avançadas (OR = 4,87; IC95%: 1,71-13,80). Os resultados encontrados podem ter importantes implicações para a psiquiatria clínica e a saúde pública, pois a idade dos genitores, no momento do parto, tem aumentado. Deve-se enfatizar a prevenção da idade reprodutiva tardia e o rastreamento e o acompanhamento das crianças geradas por estes casais.

El trastorno del espectro del autismo (TEA) se ha convertido en un problema de salud pública, con un gran impacto familiar, social y económico. El objetivo de este trabajo fue estimar la asociación entre el TEA y la edad de los progenitores en el momento del parto. Se realizó un estudio de caso-control constituido por 243 individuos con TEA (casos) y 886 neurotípicos (controles). Se aplicó un cuestionario semiestructurado y se realizó una regresión logística múltiple. Las asociaciones entre el TEA y las edades paterna (en años) entre 25 y 34 (OR = 1,65; IC95%: 1,01-2,71), 35 y 44 (OR = 1,62; IC95%: 0,96-2,73) y ≥ 45 (OR = 2,44; IC95%: 1,14-5,00); y materna entre 25 y 34 (OR = 2,38; IC95%: 1,54-3,37) y ≥ 35 (OR = 2,09; IC95%: 1,29-3,39) fueron significativas cuando se evaluaron en modelos independientes. No obstante, cuando se incluían en un mismo modelo, sólo las edades maternas entre 25 y 34 (OR = 2,27; IC95%: 1,45-3,55) y ≥ 35 (OR = 2,15; IC95%: 1,21-3,83) se mantuvieron asociadas. La magnitud de la asociación fue mayor cuando ambos progenitores presentaban edades avanzadas (OR = 4,87; IC95%: 1,71-13,80). Los resultados encontrados pueden tener importantes implicaciones para la psiquiatría clínica y la salud pública, puesto que la edad de los progenitores, en el momento del parto, ha aumentado. Se debe enfatizar la prevención de la edad reproductiva tardía y el rastreo, así como el seguimiento, de los niños generados por estas parejas.

Acute promyelocytic leukemia in childhood and adolescence: treatment results of a modified AIDA protocol at a Brazilian center

ABSTRACT Introduction: Acute promyelocytic leukemia currently presents an excellent chance of cure with protocols based on all-trans-retinoic acid (ATRA) and anthracycline or only differentiation agents. However, high early mortality rates continue to be reported Methods: Between 2000 and 2018, patients were enrolled and retrospectively analyzed by medical records. A modified AIDA protocol, with a 1-year shortening of the treatment duration, reduction in the number of drugs and a strategy to reduce early mortality by the postponement of the initiation of anthracyclines were employed. Overall and event-free survival rates and toxicity were analyzed Results: Thirty-two patients were enrolled, of whom 56% were female, with a median age of 12 years and 34% belonged to the high-risk group. Two patients had the hypogranular variant and three had another cytogenetic alteration, in addition to the t(15;17). The median start of the first anthracycline dose was 7 days. There were two early deaths (6%) due to central nervous system (CNS) bleeding. All patients achieved molecular remission after the consolidation phase. Two children relapsed and were rescued by arsenic trioxide and hematopoietic stem cell transplantation. The presence of disseminated intravascular coagulation (DIC) at diagnosis (p = 0.03) was the only factor with survival impact. The five-year event-free survival (EFS) was 84% and 5-year overall survival (OS) was 90% Conclusion: The survival results were comparable to those found in the AIDA protocol, with a low rate of early mortality in relation to the Brazilian reality.

Pandemia da Covid-19: um evento traumático para estudantes de Ciências Biológicas e da Saúde? / The Covid-19 pandemic: a traumatic event for health and biological science students?

Resumo: Introdução: Os universitários de Ciências da Saúde se tornaram especialmente afetados pela pandemia do vírus Sars-CoV-2. As angústias intrinsicamente relacionadas à Covid-19 foram somadas aos impactos referentes às mudanças acontecidas nas instituições acadêmicas, particularmente a mudança para o ensino on-line, uma metodologia que pode gerar desconforto aos estudantes, além de vários obstáculos relacionados ao ensino e à aprendizagem, o que pode ter repercussões traumáticas importantes na saúde mental dessa população. Objetivo: Este estudo teve como objetivo verificar a carga mental provocada pela pandemia da Covid-19, como um evento traumático ao ponto de desencadear transtornos psiquiátricos, como o transtorno do estresse pós-traumático (Tept), em universitários. Método: Trata-se de um estudo transversal e quantitativo, com orientação analítico-descritiva, mediante preenchimento de formulário digital anônimo, iniciado após prévia aprovação do Comitê de Ética em Pesquisa. Os sujeitos foram estudantes de Ciências Biológicas e da Saúde de uma universidade estadual localizada na Região Sudeste do Brasil. A amostra foi constituída por 618 estudantes. Resultado: Foram respondidos 618 formulários pelos estudantes que pertenciam aos cursos de Educação Física (28,8%), Medicina (25,4%), Odontologia (18,1%), Ciências Biológicas (15,2%) e Enfermagem (12,5%). A presença de sintomas de estresse pós-traumático verificados pela Escala de Impacto do Evento-Revisada (IES-R) obteve prevalência de 32,7% (n = 202) entre os estudantes universitários das Ciências Biológicas e da Saúde. Conclusão: Houve impacto significativo na saúde mental dos universitários com presença de sintomas depressivos, ansiedade e estresse acima dos encontrados na literatura científica, e, consequentemente, constatou-se alta na prevalência do Tept.

Abstract: Introduction: Health Sciences university students were especially affected by the Sars-CoV-2 virus pandemic. The anxieties intrinsically related to Covid-19 were added to the impacts related to the changes that have taken place in academic institutions, particularly the change to online teaching, a methodology that can generate discomfort for students, in addition to several obstacles related to teaching and learning, which can have important traumatic effects on the mental health of this population. Objective: To assess the mental health burden caused by the COVID-19 pandemic, as a traumatic event capable of triggering psychiatric disorders, such as Post-Traumatic Stress Disorder (PTSD), in university students. Methods: This is a cross-sectional and quantitative study, of analytical-descriptive nature, carried out by filling out an anonymous digital form, initiated after prior approval by the Research Ethics Committee. The subjects were students of Biological and Health Sciences at a State University located in the southeastern region of Brazil. The sample consisted of 618 students. Results: 618 forms were answered by students attending the courses of Physical Education (28.8%), Medicine (25.4%), Dentistry (18.1%), Biological Sciences (15.2%) and Nursing (12.5%). The presence of post-traumatic stress symptoms assessed by the Impact of Event Scale - Revised (IES-R) obtained a prevalence of 32.7% (n = 202) among university students from Biological and Health Sciences courses. Conclusions: There was a significant impact on the mental health of university students, with the presence of depressive symptoms, anxiety and stress above those found in the scientific literature and, consequently, a high prevalence of PTSD.

Importância do agente comunitário de saúde nas ações da Estratégia Saúde da Família: revisão integrativa / Role of the community health agent in Family Health Strategy actions: an integrative review / Importancia del agente comunitario de salud en las acciones de la Estrategia de Salud Familiar: revisión integradora

Esta revisão integrativa analisa o papel do agente comunitário de saúde (ACS) e os fatores associados ao trabalho desenvolvido na Estratégia Saúde da Família (ESF). A busca de estudos foi realizada no portal da Biblioteca Virtual em Saúde (BVS), incluindo as bases de dados Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Base de Dados em Enfermagem (Bdenf). Incluíram-se estudos primários publicados entre 2016 e 2021, com textos completos, nos idiomas português, inglês e espanhol. Excluíram-se protocolos, normas técnicas e outras revisões. Os estudos elegíveis foram avaliados na íntegra para a sumarização de dados e classificação dos níveis de evidências A busca inicial obteve 578 estudos. Destes, excluíram-se 44 duplicados, restando 534 para leitura de títulos e resumos. Foram selecionados 29 para leitura na íntegra, excluindo-se dez por não responderem à questão de pesquisa. A amostra foi constituída por 19 estudos. O trabalho do ACS baseia-se principalmente em ações de visita domiciliar, cadastramento e acompanhamento da população adstrita em seu território de atuação. Tal profissional contribui de forma significativa para a melhoria das condições de saúde da população, pois serve de elo entre a equipe de saúde e a comunidade, possibilitando maior acesso da população aos serviços ofertados pelo Sistema Único de Saúde (SUS).

This integrative review analyzes the role of community health agents (CHA) and factors associated with the work developed by the Family Health Strategy (FHS). Bibliographic search was conducted on the Virtual Health Library (VHL), including the Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Health Sciences Literature (LILACS) and Base de Dados em Enfermagem (BDENF) databases. Primary studies published in Portuguese, English and Spanish between 2016 and 2021, and available in full were included. Protocols, technical standards, and other reviews were excluded. Eligible studies were assessed in full for data summarization and classification of the levels of evidence Initial search identified 578 studies, of which 44 duplicates were excluded. A total of 534 papers had their title and abstract read. Of these 29 were selected for full reading and 10 were excluded for not answering the research question, resulting in a final sample with 19 studies. CHA work consists mainly in home visits, registration, and monitoring of the population in their territory, contributing significantly to improve people's health conditions, since they serve as a link between the health team and the community, providing greater user access to Unified Health System (SUS) services.

Esta revisión integradora analiza el papel del agente comunitario de salud (ACS) y los factores asociados al trabajo desarrollado en la Estrategia de Salud Familiar (ESF). La búsqueda de estudios se realizó en el portal de Biblioteca Virtual en Salud (BVS), incluyendo las bases de datos Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) y Base de Datos en Enfermería (BDENF). Se incluyeron estudios primarios publicados entre 2016 y 2021, con textos completos en los idiomas portugués, inglés y español. Se excluyeron los protocolos, las normas técnicas y otras revisiones. Los estudios elegibles se evaluaron en su totalidad para sintetizar los datos y clasificar los niveles de evidencia La búsqueda inicial obtuvo 578 estudios. De estos, se excluyeron 44 duplicados, quedando 534 para la lectura de títulos y resúmenes. Se seleccionaron 29 para su lectura íntegra, excluyendo diez por no responder a la pregunta de investigación. La muestra estaba formada por 19 estudios. El trabajo de las ACS se basa principalmente en acciones de visita domiciliaria, registro y seguimiento de la población en su territorio de actuación. Ese profesional contribuye significativamente para la mejoría de las condiciones de salud de la población, pues sirve de enlace entre el equipo de salud y la comunidad, posibilitando un mayor acceso de la población a los servicios de salud ofrecidos por el Sistema Único de Salud (SUS).

Estudo de propriedades psicométricas do M-chat no Brasil / Study of M-chat psychometric proprieties in Brazil / Estudio de las propiedades psicométricas de M-chat en Brasil

O objetivo deste estudo foi avaliar as propriedades psicométricas do Modified Checklist for Autism in Toddlers (M-Chat) em crianças de 24 a 36 meses de idade com (Grupo 1/n = 88) e sem (Grupo 2/n = 1116) o transtorno do espectro do autismo (TEA). Avaliou-se a consistência interna e estimou-se a sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN). Além disso, construiu-se a curva Receiver Operating Characteristic (ROC). Para avaliar a validade discriminante, comparou-se a proporção de falhas entre as crianças com e sem o TEA, utilizando o teste qui-quadrado ou teste Exato de Fisher. Comparou-se ainda o número de falhas segundo sexo, faixa etária e grupo do participante por meio do teste de Mann-Whitney. O M-Chat apresentou consistência interna elevada (0,78 e 0,86), reprodutibilidade satisfatória (Kappa de 0,6 a 0,79 e CCI = 0,87 e 0,89), alta sensibilidade (0,807 e 0,932), especificidade (0,927 e 0,706) e VPN (0,984 e 0,992), porém as estimativas do VPP (0,467 e 0,250) não foram satisfatórias. Quanto à validade discriminante, observou-se que a proporção de falhas foi significativamente maior no grupo de crianças com TEA. Observou-se também que o número de falhas foi maior entre as crianças do sexo masculino, com faixa etária de 25-36 meses e no grupo com TEA. A versão brasileira do M-Chat tem propriedades psicométricas adequadas no que se refere à confiabilidade, sensibilidade, especificidade, VPN e validade discriminante, o que torna recomendável sua aplicação para rastrear crianças com sinais do TEA.(AU)

This study aims to assess the psychometric properties of the instrument Modified Checklist for Autism in Toddlers (M-CHAT) in children from 24 to 36 months old with (Group 1/n = 88) and without (Group 2/n = 1116) Autism Spectrum Disorder (ASD). Internal consistency was evaluated and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were estimated. Also, the Receiver Operating Characteristic (ROC) curve was generated. To evaluate the discriminant validity, the proportion of flaws among children with and without ASD was assessed by applying the Chi-square test or by the Exact Fisher test. The number of flaws based on sex, age group, and participant's group was also compared with the Mann-Whitney Test. The M-CHAT showed high internal consistency (0.78 and 0.86), satisfactory reproductivity (Kappa 0.60 and 0.79 and ICC = 0.87 and 0.89), high sensibility (0.807 and 0.932), specificity (0.927 and 0.706), and NPV (0.984 and 0.992); however, PPV estimates (0.467 and 0.250) were not satisfactory. Regarding the discriminant validity, the proportion of flaws was significantly higher in the group of children with ASD. Moreover, the number of flaws was larger among boys, in the age group 25-36 months, and in the group with ASD. The Brazilian version of M-CHAT has adequate psychometric properties concerning reliability, sensitivity, specificity, NPV and discriminant validity, which makes its application recommendable to track children with ASD signs.(AU)

Ese estudio tuvo como objetivo evaluar las propiedades psicométricas del Modified Checklist for Autism in Toddlers (M-CHAT) en niños de 24 a los 36 meses de edad con (grupo 1/n=88) y sin (grupo 2/n=1116) el trastorno del espectro autista (TEA). Fueron evaluadas la consistencia interna y estimadas la sensibilidad, especificidad, valor predictivo positivo (VPP), valor predictivo negativo (VPN). Además, se construyó la curva Receiver Operating Characteristic (ROC). Para evaluar la validad discriminante se comparó la proporción de los fracasos entre los niños con y sin TEA, utilizando el examen chi-cuadrado o la prueba exacta de Fisher. Se compararon también el número de fracasos según el sexo, edad y grupo de participantes por medio del teste Mann-Whitney. El M-CHAT presentó consistencia interna elevada (0,78 y 0,86), reproductividad satisfactoria (Kappa de 0,60 a 0,79 e CCI = 0,87 e 0,89), alta sensibilidad (0,807 e 0,932), especificidad (0,927 e 0,706) y VPN (0,984 e 0,992), pero las estimativas del VPP (0,467 e 0,250) no fueron satisfactorias. Acerca de la validad discriminante, se observó que la proporción de fallas fue significativamente mayor en el grupo de niños con TEA. El número de fracasos fue mayor entre los niños varones, de 25 a 36 meses de edad y no en el grupo con TEA. La versión brasileña del M-CHAT tiene propiedades psicométricas adecuadas en lo que concierne a la confiabilidad, sensibilidad, especificidad, VPN y validad discriminante, lo que hace que su aplicación sea recomendada para rastrear los niños con señales de TEA.(AU)

Influence of breastfeeding duration on the incidence of dental caries in preschoolers: a cohort study / Influência da duração da amamentação na incidência de cárie dentária em pré-escolares: um estudo de coorte

Abstract Objectives: investigate the association between breastfeeding duration and the incidence of severe caries in preschoolers. Methods: a cohort study was conducted with 132 pairs of mothers and children in the city of Diamantina, Brazil. Data collection was performed in 2 moments: when the children were between two and three years of age (baseline- 2013/2014) and after three years (T1-2016/2017). In both moments, children were evaluated for dental caries (International Caries Detection and Assessment System - ICDAS) and a questionnaire was administered to the mothers addressing socioeconomic aspects and thee habits of children. The outcome evaluated was the incidence of severe caries (Dentin caries - ICDAS Codes 5 and 6). Data analysis involved descriptive statistics, chi-squared test and Poisson hierarchical regression with robust variance. Results: children who breastfed for more than 24 months (RR = 2.24 CI95%= 1.23-4.08), those whose parents were separated (RR = 1.73 CI95%= 1.11-2.69), and those with estab-lished/severe caries (RR = 2.74 CI95%= 1.37-5.49) at baseline were at greater risk of incidence of severe caries after three years. Conclusion: breastfeeding for more than 24 months is a risk factor for incidence of severe caries. In addition, family structure and established or severe baseline caries were associated.

Resumo Objetivos: investigar a associação entre a duração da amamentação e a incidência de cárie grave em pré-escolares. Métodos: foi realizado um estudo de coorte com 132 pares de mães e crianças de Diamantina, Minas Gerais, Brasil. As crianças foram avaliadas em dois momentos: dois e três anos de idade (baseline-2013/2014) e após três anos (T1- 2016/2017). Dados socioeconómicos e relativos aos hábitos das criançasforam obtidos por meio de entrevistas com as mães e a presença de cárie dentária foi diagnosticada segundo o protocolo "International Caries Detection and Assessment System - ICDAS". O desfecho foi a incidência de cárie grave (cárie em dentina - códigos ICDAS 5 e 6). Para análise dos dados empregou-se regressão hierárquica de Poisson com variância robusta. Resultados: crianças que amamentaram por mais de 24 meses (RR = 2,24 IC95%= 1,234,08), cujos pais viviam separados no baseline (RR = 1,73 IC95%= 1,11-2,69) e aquelas com cárie estabelecida ou grave no baseline (RR = 2, 74 IC950%= 1,37-5,49) estavam em maior risco de incidência de cárie grave após 3 anos. Conclusão: a amamentação por mais de 24 meses foi um fator de risco para a incidência de cárie dentária grave em pré-escolares. Além disso, estrutura familiar e cárie estabelecida ou grave no baseline estiveram associados.

Uso de álcool, conflitos familiares e supervisão parental entre estudantes do ensino médio / Alcohol use, family conflicts and parental supervision among high school students

Resumo Investigou-se a associação entre o consumo de álcool pelos escolares com os conflitos familiares, supervisão dos pais e qualidade dos relacionamentos. Estudo transversal realizado com 1.265 adolescentes de 21 escolas. Foi utilizada a versão brasileira do Inventário de Triagem do Uso de Drogas/DUSI e estimadas prevalências absolutas e relativas para variáveis categóricas, e conduzidas análises bivariadas: teste Qui Quadrado de Pearson. Para magnitude da associação entre a variável dependente e independentes foram estimadas razões de prevalências por meio deregressão multivariável de Poisson. Houve associação do consumo de álcool com uso de drogas por familiares, discussões frequentes e desconhecimento dos pais sobre o que os adolescentes fazem. Supervisão familiar, bom relacionamento com pais/responsáveis, estabelecimento de vínculo familiar afetivo e ciência dos pais acerca do que os adolescentes fazem e onde estão, foram fatores de proteção para uso de álcool. Concluiu-se que a alta taxa de escolares que consomem álcool é preocupante, passível de complicações da saúde na sua integralidade, sendo fundamental relação familiar harmonizada. A implementação de práticas interventivas entre escola e Estratégia de Saúde da Família, podem contribuir no estabelecimento de vínculo protetivo.

Abstract The association between alcohol consumption by students with family conflicts, parental supervision and quality of relationships was investigated. A cross-sectional study was conducted with 1,265 adolescents from 21 schools. The Brazilian version of the Drug Use Screening Inventory/DUSI was used, and absolute and relative prevalence for categorical variables was estimated, while bivariate analyses and Pearson's Chi Square test were conducted. For the magnitude of the association between the dependent and independent variables, prevalence ratios were estimated using Poisson multivariate regression. There was an association between alcohol consumption and drug use by family members, frequent discussions and parental lack of awareness about adolescents' activities. Family supervision, a good relationship with parents/guardians, establishing an affective family bond and parents' knowledge about teenagers' whereabouts, were protective factors for alcohol use. The conclusion was that the high rate of schoolchildren who consume alcohol is worrying, liable to health complications in general, and a harmonized family relationship is fundamental. The implementation of measures of intervention between school and the Family Health Strategy, can contribute to the establishment of a protective bond.

[Demographic and mortality trends in Niterói, Rio de Janeiro, Brazil, 1979 to 1997]. / Evolução da população e da mortalidade em Niterói, Rio de Janeiro, Brasil, 1979 a 1997.

An analysis of the 1979-1997 historical series points to demographic and mortality trends in Niterói, Rio de Janeiro State, over the course of those two decades. There was a drop in the rate of population increase, with a significant change in the age structure. In the time series, there was a decline in mortality from cardiovascular diseases and an overall downward trend in mortality from infectious and parasitic diseases, albeit with a sharp increase beginning in 1996 resulting in a change in disease classification (ICD-9 to ICD-10). As for infant mortality, there was a predominance of deaths in the neonatal group. An analysis of major groups of diseases and injuries highlights the importance of ischemic heart disease and cerebrovascular diseases, homicides, traffic accidents, and AIDS.