Evaluation of self-care with feet among patients with diabetes mellitus.

BACKGROUND: The diabetic foot is a complication of diabetes mellitus (DM) and is the most common cause of lower limb amputation. OBJECTIVES: To assess foot self-care practices by sex and educational level in DM patients from the Northeast of Brazil, state of Bahia. METHODS: This was a quantitative, cross-sectional, observational, analytical study with 88 DM patients seen at routine consultations from February to March of 2020. Data were collected using questionnaires on socioeconomic data and self-care of feet (knowledge about the diabetic foot, habits related to care/inspection of feet, and visits to the Healthcare Center when changes to foot health are detected). RESULTS: 58% of the sample did not know the term "diabetic foot", but a majority did perform minimum adequate foot care practices, such as inspecting feet (60.2%), moisturizing feet (65.9%), avoiding walking barefoot (81.8%), and trimming toenails (92%), although 90.9% did not wear footwear considered appropriate. There was a relationship between lower educational level and worse performance in questions relating to walking barefoot, moisturizing feet, trimming toenails, wearing appropriate footwear, and identifying mycoses (p < 0.05), but there was no association between performing self-care activities and sex. CONCLUSIONS: Interviewed patients with DM did not perform all foot self-care activities and did not know what the term "diabetic foot" means. There was an association between lower educational level and reduced capacity to perform these activities, which suggests that health literacy is important to improve self-care of feet, contributing to reduce complications and foot amputations.

Supplementation with vitamin D and its analogs for treatment of endothelial dysfunction and cardiovascular disease.

Vitamin D (1,25-dihydroxycolecalciferol) is a prohormone that has attracted the interest of researchers since studies have shown that its effects are not restricted to bone metabolism. Thus, the present review summarizes the most recent findings and discusses the usefulness of prescribing vitamin D and its analogues for treatment and prevention of cardiovascular disorders and endothelial dysfunction. The paper constitutes a narrative review of the literature, selecting articles published from 2012 to 2019. Studies have shown that vitamin D3 and its analogues have beneficial effects on endothelial function, but these results are controversial, since research with larger samples and of longer duration found no reduction in morbidity and mortality or cardiovascular risk factors after use of these substances. Given the current state of the art, there is no clear scientific basis for supplementation with vitamin D or its analogues for treatment of endothelial dysfunction or cardiovascular disease.

Up-regulation of SPINT2/HAI-2 by Azacytidine in bone marrow mesenchymal stromal cells affects leukemic stem cell survival and adhesion.

The role of tumour microenvironment in neoplasm initiation and malignant evolution has been increasingly recognized. However, the bone marrow mesenchymal stromal cell (BMMSC) contribution to disease progression remains poorly explored. We previously reported that the expression of serine protease inhibitor kunitz-type2 (SPINT2/HAI-2), an inhibitor of hepatocyte growth factor (HGF) activation, is significantly lower in BMMSC from myelodysplastic syndromes (MDS) patients compared to healthy donors (HD). Thus, to investigate whether this loss of expression was due to SPINT2/HAI-2 methylation, BMMSC from MDS and de novo acute myeloid leukaemia (de novo AML) patients were treated with 5-Azacitidine (Aza), a DNA methyltransferase inhibitor. In MDS- and de novo AML-BMMSC, Aza treatment resulted in a pronounced SPINT2/HAI-2 levels up-regulation. Moreover, Aza treatment of HD-BMMSC did not improve SPINT2/HAI-2 levels. To understand the role of SPINT2/HAI-2 down-regulation in BMMSC physiology, SPINT2/HAI-2 expression was inhibited by lentivirus. SPINT2 underexpression resulted in an increased production of HGF by HS-5 stromal cells and improved survival of CD34+ de novo AML cells. We also observed an increased adhesion of de novo AML hematopoietic cells to SPINT2/HAI-2 silenced cells. Interestingly, BMMSC isolated from MDS and de novo AML patients had increased expression of the integrins CD49b, CD49d, and CD49e. Thus, SPINT2/HAI-2 may contribute to functional and morphological abnormalities of the microenvironment niche and to stem/progenitor cancer cell progression. Hence, down-regulation in SPINT2/HAI-2 gene expression, due to methylation in MDS-BMMSC and de novo AML-BMMSC, provides novel insights into the pathogenic role of the leukemic bone marrow microenvironment.

Sleep apnea and sudden death in the non-cardiac population: A systematic review.

INTRODUCTION: Obstructive sleep apnea (OSA) is one of the main risk factors for cardiovascular diseases and is associated with both morbidity and mortality. OSA has also been linked to arrhythmias and sudden death. OBJECTIVE: To assess whether OSA increases the risk of sudden death in the non-cardiac population. METHODS: This is a systematic review of the literature. The descriptors "sudden death" and "sleep apnea" and "tachyarrhythmias" and "sleep apnea" were searched in the PubMed/Medline and SciELO databases. RESULTS: Thirteen articles that addressed the relationship between OSA and the development of tachyarrhythmias and/or sudden death with prevalence data, electrocardiographic findings, and a relationship with other comorbidities were selected. The airway obstruction observed in OSA triggers several systemic repercussions, e.g., changes in intrathoracic pressure, intermittent hypoxia, activation of the sympathetic nervous system and chemoreceptors, and release of catecholamines. These mechanisms would be implicated in the appearance of arrhythmogenic factors, which could result in sudden death. CONCLUSION: There was a cause-effect relationship between OSA and cardiac arrhythmias. In view of the pathophysiology of OSA and its arrhythmogenic role, studies have shown a higher risk of sudden death in individuals who previously had heart disease. On the other hand, there is little evidence about the occurrence of sudden death in individuals with OSA and no heart disease, and OSA is not a risk factor for sudden death in this population.

Effects of primary health care and socioeconomic aspects on the dispersion of COVID-19 in the Brazilian Northeast: Ecological study of the first pandemic wave.

BACKGROUND: The COVID-19 pandemic has had a negative impact on socioeconomic and public health conditions of the population. AIM: To measure the temporal evolution of COVID-19 cases in cities near the countryside outside metropolitan areas of northeastern Brazil and the impact of the primary care organization in its containment. METHODS: This is a time-series study, based on the first three months of COVID-19 incidence in northeastern Brazil. Secondary data were used, the outcome was number of COVID-19 cases. Independent variables were time, coverage and quality score of basic health services, and demographic, socioeconomic and social isolation variables. Generalizable Linear Models with first order autoregression were applied. RESULTS: COVID-19 spreads heterogeneously in cities near the countryside of Northeastern Brazilian cities, showing associations with the city size, socioeconomic and organizational indicators of services. The Family Health Strategy seems to mitigate the speed of progression and burden of the disease, in addition to measures such as social isolation and closure of commercial activities. CONCLUSION: The spread of COVID-19 reveals multiple related factors, which require coordinated intersectoral actions in order to mitigate its problems, especially in biologically and socially vulnerable populations.

Lower expression of NOTCH components in peripheral blood mononuclear cells of allogeneic hematopoietic cell transplant patients.

INTRODUCTION: Chronic graft-versus-host disease (cGvHD) not only remains the main cause of late mortality after allogeneic hematopoietic cell transplant, but also has the capacity of causing severe organ impairment in those who survive. The Notch, a highly conserved ligand-receptor pathway, is involved in many immunological processes, including inflammatory and regulatory responses. Recently, mouse models have shown that the blockage of canonical Notch signaling prevents GvHD. OBJECTIVE AND METHOD: Due to the lack of data on the Notch pathway in human chronic GvHD, we sought to study the expression of NOTCH components in primary samples of patients who received allo-HCT and presented active cGvHD or a long-term clinical tolerance to cGvHD. RESULTS: Our results showed a significantly lower expression of NOTCH components in both groups that received allo-HCT, independently of their cGvHD status, when compared to healthy controls. CONCLUSION: Moreover, there were no differences in gene expression levels between the active cGvHD and clinically tolerant groups. To our knowledge, this is one of the first studies performed in human primary samples and our data indicate that much remains to be learned regarding NOTCH signaling as a new regulator of GvHD.

Expression of transforming growth factor ß pathway components in chronic graft-versus-host disease after allogeneic hematopoietic cell transplantation.

Chronic graft-versus-host disease (cGvHD), an immunological complication of allogeneic cell transplantation, is the principal cause of non-relapse mortality and morbidity. Even though advances have been made in understanding the pathophysiology of this disorder, many questions remain. We sought to evaluate gene expression of transforming growth factor ß (TGF-ß) pathway components, through quantitative RT-PCR and PCR array, in patients with cGvHD with different disease activity. We observed an upregulation of SMAD3, BMP2, CDKN1A, IL6, and TGF-ß2 genes in the clinical tolerance group, which had never developed cGvHD, or which had been withdrawn from all immunosuppressive treatments (IST) for at least 1 year. In addition, SMAD5 gene upregulation was observed in cGvHD patients undergoing IST, and ordinal regression showed a correlation between SMAD5 expression and disease severity. Our data support the evidence of the important role of TGF-ß effects in the pathological process of cGvHD.

Low health literacy and quality of life in patients with systemic arterial hypertension.

Purpose: Evaluate the level of health literacy and quality of life of patients with hypertension. Methods: A cross-sectional, observational study was carried out in the Northeast region of Brazil with 105 patients with hypertension through the SAHLPA-18, S-TOFHLA and MINICHAL tests. Results: For both literacy tests applied, it can be observed that about 60% of the interviewed patients did not present adequate health literacy. It was found that factors such as increasing age, lower economic class and lower education were associated with a lower level of health literacy. In the evaluation of the quality of life by the MINICHAL, 46.7% of the patients reported that hypertension interferes with quality of life. It was also possible to show that the time of diagnosis (p = 0.04) and the economic class (p = 0.008) influence the quality of life. Conclusion: Hypertension is a chronic condition that requires continuous treatment and has potential risks of evolving with fatal and non-fatal complications that can affect the patients' quality of life. The data presented reflect the difficulty in understanding and processing health information, which may directly impact on the therapeutic management of hypertension.

Arhgap21 Deficiency Results in Increase of Osteoblastic Lineage Cells in the Murine Bone Marrow Microenvironment.

ARHGAP21 is a member of the RhoGAP family of proteins involved in cell growth, differentiation, and adhesion. We have previously shown that the heterozygous Arhgap21 knockout mouse model (Arhgap21+/-) presents several alterations in the hematopoietic compartment, including increased frequency of hematopoietic stem and progenitor cells (HSPC) with impaired adhesion in vitro, increased mobilization to peripheral blood, and decreased engraftment after bone marrow transplantation. Although these HSPC functions strongly depend on their interactions with the components of the bone marrow (BM) niche, the role of ARHGAP21 in the marrow microenvironment has not yet been explored. In this study, we investigated the composition and function of the BM microenvironment in Arhgap21+/- mice. The BM of Arhgap21+/- mice presented a significant increase in the frequency of phenotypic osteoblastic lineage cells, with no differences in the frequencies of multipotent stromal cells or endothelial cells when compared to the BM of wild type mice. Arhgap21+/- BM cells had increased capacity of generating osteogenic colony-forming units (CFU-OB) in vitro and higher levels of osteocalcin were detected in the Arhgap21+/- BM supernatant. Increased expression of Col1a1, Ocn and decreased expression of Trap1 were observed after osteogenic differentiation of Arhgap21+/- BM cells. In addition, Arhgap21+/- mice recipients of normal BM cells showed decreased leucocyte numbers during transplantation recovery. Our data suggest participation of ARHGAP21 in the balanced composition of the BM microenvironment through the regulation of osteogenic differentiation.

Nuances between sedentary behavior and physical inactivity: cardiometabolic effects and cardiovascular risk.

OBJECTIVE: The aim of this study was to highlight the differences between the cardiometabolic effects and the cardiovascular risk of physical inactivity and sedentary behavior. METHODS: A narrative bibliographic review was conducted. In the research, national and international articles were selected from the PubMed, SciELO, and LILACS databases using the descriptors "sedentary lifestyle, cardiovascular risk, physical inactivity, sedentary behavior, and cardiovascular risks." DISCUSSION: Both physical inactivity and sedentary behavior are related to metabolic and organic changes, promoting a chronic proinflammatory state, cardiac remodeling, increased body adiposity, and skeletal muscle dysfunction. It is possibly stated that both of them result in a higher risk of developing chronic diseases, resulting in higher global and cardiovascular morbidity and mortality, with nuances in their intrinsic effects. CONCLUSIONS: It is inferred that both physical inactivity and sedentary behavior are cardiovascular risk factors that can be modified with the correct clinical approach. It is necessary to differentiate physically inactive individuals from those with a high number of sedentary behaviors. These concepts need better clinical applicability to improve the prevention of primary and secondary cardiovascular risks.

Concordance between two instruments for health literacy assessment. / Concordância entre dois instrumentos para avaliação do letramento em saúde.

OBJETIVO: To determine agreement between the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18) measurement instruments as a strategy for estimating concurrent validity. METHODS: This was a cross-sectional study conducted with users of the Brazilian National Health System. An agreement approach using a weighted Kappa test for qualitative data was applied in order to test for concurrent validity. RESULTS: 372 individuals participated. It was found that 66% and 62% of them did not have an adequate level of literacy according to SAHLPA-18 and S-TOFHLA, respectively. There was strong correlation between the instruments (p<0.001; r=0.60), although the 65.3% agreement of correct answers found was considered weak (Kappa=0.35; p<0.001). CONCLUSION: The SAHLPA-18 and S-TOFHLA instruments have different constructs and poor agreement. Use of different instruments is indicated in research intended to measure level of literacy, as is the development of instruments specific to health conditions that allow results close to the real context of individuals to be obtained.

COVID-19 and health literacy: the yell of a silent epidemic amidst the pandemic.

The emergence of a new form of Coronavirus (SARS-CoV-2) exposed weaknesses of health services in several countries, with overcrowding of hospitals, and lack of supplies and professionals in combating the disease, which sometimes contributed to the installation of social, political, and economic chaos. The critical situation experienced made the subject widely publicized so that the current pandemic also deals with an information epidemic. However, the data received and transmitted require prior critical analysis of its content, although not everyone is able to make the necessary judgment before using or sharing information, partly due to the lack of adequate health knowledge. Health literacy is a broad and important topic in public health but still globally underestimated, thus considered a silent epidemic. The exponential increase in the number of confirmed cases shows the world population's inadequacy and difficulty in understanding basic prevention guidelines. The COVID-19 pandemic warns of gaps in the health literacy levels of the world population and exposes the need for a comprehensive mapping to identify the overall health literacy status in more countries.

The importance of the early diagnosis of aorta coarctation.

INTRODUCTION: Coarctation of the aorta is a congenital heart disease characterized by a narrowing that occurs in the aortic artery. This constriction can occur anywhere along its entire length; however, it is more common between the origin of the left subclavian artery and the ductus arteriosus. Its incidence corresponds to 3 cases per 10,000 births. Thus, it is a common cardiopathy, but with high mortality and morbidity rates, which are related to a failure in the early diagnosis. METHOD: In the research, articles of the national and international literature in Pubmed, Scielo and Lilacs databases were selected using the following descriptors: coarctation, aorta, diagnosis, heart diseases, congenital abnormalities. RESULTS: The pathophysiology of CoA and its systemic implications in the life of newborn and adults are well elucidated. However, due to the lack of habit to palpate pulses and to check the blood pressure in both upper and lower limbs during the physical examination, it is still a pathology little diagnosed in childhood. There are several techniques used in the repair of coarctation, each with their specifics, although, when not treated, aneurysms, heart failure, coronary diseases, and stroke are the main complications arising from the evolution of this pathology, which explains the low survival rate of these patients. CONCLUSION: Coarctation of the aorta is, therefore, a cardiac malformation of significant importance due to its incidence and its significant mortality risk. In this sense, the early diagnosis stands out as an essential piece for better prognosis of the patient.

Lower expression of NOTCH components in peripheral blood mononuclear cells of allogeneic hematopoietic cell transplant patients

ABSTRACT Introduction: Chronic graft-versus-host disease (cGvHD) not only remains the main cause of late mortality after allogeneic hematopoietic cell transplant, but also has the capacity of causing severe organ impairment in those who survive. The Notch, a highly conserved ligand-receptor pathway, is involved in many immunological processes, including inflammatory and regulatory responses. Recently, mouse models have shown that the blockage of canonical Notch signaling prevents GvHD. Objective and Method: Due to the lack of data on the Notch pathway in human chronic GvHD, we sought to study the expression of NOTCH components in primary samples of patients who received allo-HCT and presented active cGvHD or a long-term clinical tolerance to cGvHD. Results: Our results showed a significantly lower expression of NOTCH components in both groups that received allo-HCT, independently of their cGvHD status, when compared to healthy controls. Conclusion: Moreover, there were no differences in gene expression levels between the active cGvHD and clinically tolerant groups. To our knowledge, this is one of the first studies performed in human primary samples and our data indicate that much remains to be learned regarding NOTCH signaling as a new regulator of GvHD.

Ischemic Stroke and Acute Myocardial Infarction: Trends in in-Hospital Mortality in Brazil from 1998 to 2018

Abstract Background Ischemic stroke and acute myocardial infarction (AMI) are cardiovascular diseases with high morbidity and mortality rates in Brazil and worldwide. Their outcomes are influenced by public policies aimed at mitigating risk factors and by investments in infrastructure of emergency support and quality of hospital care. Objective To analyze the trend in the proportion of in-hospital deaths from ischemic stroke and AMI in Brazil as a way of evaluating the effectiveness of urgency and emergency services. Methods Ecological time series study using data from the Hospital Information System. The outcome was the proportion of in-hospital deaths from ischemic stroke and AMI with stratification by sex and state. Prais-Winsten regression was used to analyze the trend between 1998-2018 with α≤0,05. Results The proportion of deaths from AMI and ischemic stroke declined in the time series (p<0.001), decreasing annually by 0.17% and 0.25%, respectively. In 20 years, it reduced 43.76% (ischemic stroke) and 32.39% (AMI) in both sexes. However, the decline was more evident in the South and Southeast regions. Conclusion The reduction in hospital deaths from AMI and ischemic stroke was heterogeneous among Brazilian regions, which may be related to inequality in emergency services and hospital support.

Avaliação do autocuidado com os pés entre pacientes portadores de diabetes melito / Evaluation of self-care with feet among patients with diabetes mellitus

Resumo Contexto O pé diabético é uma complicação do diabetes melito (DM), sendo a maior causa de amputação dos membros inferiores. Objetivos Avaliar a prática de medidas de autocuidado com os pés, segundo sexo e escolaridade, em pacientes portadores de DM na região nordeste no estado da Bahia. Métodos Estudo quantitativo, observacional, analítico, transversal, realizado com 88 pacientes portadores de DM, em consulta de rotina, de fevereiro a março de 2020. A coleta de dados foi executada através da aplicação de questionários socioeconômico e do autocuidado com os pés (conhecimento sobre pé diabético, hábitos de cuidado/inspeção dos pés e procura pela Unidade de Saúde na presença de alterações com a saúde dos pés). Resultados Do total, 58% dos indivíduos desconhecia o termo "pé diabético", porém possuíam cuidados mínimos adequados com os pés, como inspecioná-los (60,2%), hidratá-los (65,9%), não andar descalço (81,8%) e cortar as unhas (92%), apesar de 90,9% não utilizar sapatos considerados adequados. Houve relação entre menor nível de escolaridade e pior desempenho nas questões referentes a andar descalço, hidratar os pés, cortar as unhas, usar calçados adequados e identificar micoses (p < 0,05), porém não houve associação da realização das medidas de autocuidado e sexo. Conclusão Os portadores de DM entrevistados não realizaram todas as medidas de autocuidado com os pés e desconheciam o termo "pé diabético". Houve associação entre menor escolaridade e menor capacidade de realização dessas medidas, o que sugere que o letramento em saúde seria importante para melhoria desse autocuidado, contribuindo para diminuição de complicações e amputações dos pés.

Abstract Background The diabetic foot is a complication of diabetes mellitus (DM) and is the most common cause of lower limb amputation. Objectives To assess foot self-care practices by sex and educational level in DM patients from the Northeast of Brazil, state of Bahia. Methods This was a quantitative, cross-sectional, observational, analytical study with 88 DM patients seen at routine consultations from February to March of 2020. Data were collected using questionnaires on socioeconomic data and self-care of feet (knowledge about the diabetic foot, habits related to care/inspection of feet, and visits to the Healthcare Center when changes to foot health are detected). Results 58% of the sample did not know the term "diabetic foot", but a majority did perform minimum adequate foot care practices, such as inspecting feet (60.2%), moisturizing feet (65.9%), avoiding walking barefoot (81.8%), and trimming toenails (92%), although 90.9% did not wear footwear considered appropriate. There was a relationship between lower educational level and worse performance in questions relating to walking barefoot, moisturizing feet, trimming toenails, wearing appropriate footwear, and identifying mycoses (p < 0.05), but there was no association between performing self-care activities and sex. Conclusions Interviewed patientswith DM did not perform all foot self-care activities and did not know what the term "diabetic foot" means. There was an association between lower educational level and reduced capacity to perform these activities, which suggests that health literacy is important to improve self-care of feet, contributing to reduce complications and foot amputations.

De novo AML exhibits greater microenvironment dysregulation compared to AML with myelodysplasia-related changes.

The interaction between the bone marrow microenvironment and malignant hematopoietic cells can result in the protection of leukemia cells from chemotherapy in both myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). We, herein, characterized the changes in cytokine expression and the function of mesenchymal stromal cells (MSC) in patients with MDS, AML with myelodysplasia-related changes (MRC), a well-recognized clinical subtype of secondary AML, and de novo AML. We observed a significant inhibitory effect of MDS-MSC on T lymphocyte proliferation and no significant differences in any of the cytokines tested. AML-MSC inhibited T-cell proliferation only at a very low MSC/T cell ratio. When compared to the control, AML-MRCderived MSC presented a significant increase in IL6 expression, whereas de novo AML MSC presented a significant increase in the expression levels of VEGFA, CXCL12, RPGE2, IDO, IL1ß, IL6 and IL32, followed by a decrease in IL10 expression. Furthermore, data indicate that IL-32 regulates stromal cell proliferation, has a chemotactic potential and participates in stromal cell crosstalk with leukemia cells, which could result in chemoresistance. Our results suggest that the differences between AML-MRC and de novo AML also extend into the leukemic stem cell niche and that IL-32 can participate in the regulation of the bone marrow cytokine milieu.

Dor neuropática na prática clínica: ênfase nos instrumentos diagnósticos / Neuropathic pain in clinical practice: emphasis on diagnostic tools

A dor neuropática é causada por uma lesão ou doença do sistema nervoso somatossensitivo. Trata-se de uma manifestação sindrômica que envolve mecanismos inflamatórios e imunes com fisiopatologia ainda pouco esclarecida. O espectro de apresentação da dor neuropática é amplo e, assim, constitui um desafio na prática clínica. Este problema de saúde pública necessita de ampla capacidade técnica dos clínicos generalistas. Torna-se relevante identificar o potencial de cronificação do sintoma e adotar abordagens mitigantes do processo lesivo, estrutural e emocional. Nesse sentido, o diagnóstico adequado da dor neuropática é o primeiro passo na abordagem ao paciente. Diante disso, essa revisão objetiva facilitar a melhor escolha dos métodos diagnósticos no manejo clínico do paciente. Dentre estes, é possível citar a imagem por ressonância magnética funcional, eletroneuromiografia, tomografia por emissão de pósitrons, microneurografia, teste quantitativo sensorial, biópsias de pele, estudos de condução nervosa e de potencial somatossensorial evocado. A dor, por ser um processo sensorial subjetivo, apresenta amplo espectro de manifestações clínicas. Por essa razão, é possível fazer uso de técnicas como métodos de triagem e exames complementares para um diagnóstico mais específico.

Neuropathic pain is caused by an injury or illness of the somatosensory nervous system. It is a syndromic manifestation that involves inflammatory and immune mechanisms, whose pathophysiology is still poorly understood. The spectrum of presentation of neuropathic pain is wide and, therefore, it is a challenge in clinical practice. This public health problem requires the broad technical capacity of general practitioners. It is relevant to identify the potential for chronicity of the symptom and adopt mitigating approaches to the harmful, structural, and emotional process. In this sense, the proper diagnosis of neuropathic pain is the first step in approaching the patient. Therefore, this review aims to facilitate the best choice of diagnostic methods in the clinical management of the patient. Among these, functional magnetic resonance imaging, electroneuromyography, positron emission tomography, microneurography, quantitative sensory testing, skin biopsies, nerve conduction and evoked somatosensory potential studies are possible. Pain, being a subjective sensory process, has a wide spectrum of clinical manifestations. For this reason, it is possible to make use of techniques such as screening methods and complementary exams for a more specific diagnosis.

Atherosclerosis Complications in the Brazilian Population: An Ecological Time Series Study

Abstract Background: Atherosclerosis is a serious health problem, and several factors contribute to its occurrence. Longitudinal and qualified monitoring of primary health care (PHC) may contribute to the management of atherosclerosis and reduction of avoidable hospital admissions. Objectives: To estimate the trend in hospitalizations for atherosclerosis and the impact of PHC coverage on its evolution from 2008 to 2018 in Brazil. Methods: An ecological time series analytical study based on the outcomes of hospital admissions for atherosclerosis in Brazil. Time in years, PHC coverage, and Family Health Strategy (FHS) services were considered independent variables. A Prais-Winsten model was used to estimate the outcome trend, and α < 0.05 was adopted. Results: We observed a mean increase of 1.81 hospitalizations for atherosclerosis per 100 000 inhabitants annually (p = 0.002) in Brazil. This growth was evidenced in the Northeast (p < 0.001), Southeast (p = 0.003), and South (p < 0.001) regions, being stable in the North (p = 0.057) and Midwest (p = 0.62) regions. Men presented twice the growth in hospitalizations from the fifth decade of life on (p < 0.01). An inversely proportional relationship was observed for PHC coverage (B = -0.71; p < 0.001) and the proportion of FHS services (B = -0.59; p < 0.001) with the rate of admissions due to atherosclerosis in Brazil. Conclusions: Although hospitalizations for atherosclerotic complications are increasing in Brazil, they present regional and individual gender and age discrepancies, as well as a mitigating effect exerted by PHC coverage.