Cobertura vacinal e fatores associados ao esquema incompleto de vacinação em crianças aos 12 e 24 meses de idade em cidade de médio porte na região nordeste do Brasil / Vaccination coverage and factors associated with incomplete vaccination schedule in children at 12 and 24 months of age in a medium-sized city in the northeastern region of Brazil

Introdução: A expressiva queda nas coberturas vacinais, no Brasil, a partir de 2016, que persistem até os dias atuais, constitui relevante problema de saúde pública, tornando prioridade estudos sobre seus determinantes em diferentes contextos. Objetivo: Estimar a cobertura vacinal atualizada e oportuna aos 12 e 24 meses para cada vacina e para o esquema completo e analisar os fatores associados aos esquemas incompletos, atualizado e oportuno, de vacinação em coorte de nascidos em 2018, em Arapiraca. Métodos: Estudo transversal, descritivo e analítico, em amostra representativa da coorte de nascidos vivos, em Arapiraca (AL), em 2018. As fontes de informação foram: Sistema de Informação de Nascidos Vivos; Sistema de Informação sobre Mortalidade; Prontuário Eletrônico do Cidadão; Registros de vacinação e Prontuários das Unidades Sanitárias. Foram estimadas as coberturas vacinais atualizadas e oportunas por vacina e do esquema completo em porcentagem e com intervalo de confiança de 95%, por zona rural e urbana. A associação entre o esquema incompleto de vacinação e as variáveis independentes foi investigada por meio da estimativa das razões de prevalência bruta e ajustada e os respectivos intervalos de 95% confiança, aplicando-se a regressão de Poisson. Resultados: Foram estudadas 318 crianças. A cobertura média do esquema vacinal completo e atualizado aos 12 meses foi 91,8%, respectivamente, 93,6% e 88,8%, nas áreas urbanas e rurais; aos 24 meses declinou para 75,2%, respectivamente, 76,2% e 73,3%, em zonas urbanas e rurais. A cobertura oportuna aos 12 meses, foi de 47,8%, sendo mais elevada na zona rural, 50,9% versus 46,0% (p>0,05), enquanto que aos 24 meses declina para 9,1%, sendo mais elevada em áreas rurais, 14,7% versus 5,9% (p<0,05). As vacinas com menores coberturas foram: i) esquema atualizado aos 12 meses, a segunda dose da Rotavírus Humano com 96,2% e aos 24 meses, a primeira dose de Varicela e a dose única de Hepatite A com 92,1%; ii) esquema oportuno aos 12 meses, temos a terceira dose de VIP/VOP, com 66,7%, e aos 24 meses, foi o primeiro Reforço da DTP, com 24,5%. As exposições que se mostraram independentemente associadas ao esquema incompleto atualizado e oportuno aos 12 e 24 meses foram: escolaridade da mãe inferior a oito anos ou igual/superior a 12 anos de estudo; mãe com menos de sete consultas de pré-natal; mãe residente em área rural; nascer com menos de 2.800 gramas. Contudo, mostrou-se inversamente associado ao desfecho: nascer com menos de 2.800 gramas no esquema incompleto atualizado aos 12 meses; nascer com peso entre 2.800 e 3199 gramas no esquema incompleto oportuno aos 12 meses; residir em área rural no incompleto oportuno aos 24 meses. Conclusões: Os resultados sugerem, entre as estratégias para aumentar as coberturas vacinais: políticas educativas com foco específico em segmentos mais pobres e mais ricos da população; o fortalecimento do vínculo dos serviços com a comunidade, com medidas voltadas a melhor estruturação das salas de vacinação e diminuição da rotatividade dos funcionários e o fortalecimento dos programas de saúde materno-infantil, elevando a cobertura dos programas de pré-natal e assistência à saúde dos lactentes.

Introduction: The significant decline in vaccination coverage in Brazil since 2016, persisting to the present day, constitutes a relevant public health problem, making studies on its determinants in different contexts a priority. Objective: To estimate the updated and timely vaccination coverage at 12 and 24 months for each vaccine and for the complete schedule, and to analyze the factors associated with incomplete, updated, and timely vaccination schedules in a cohort of infants born in 2018 in Arapiraca. Methods: A cross-sectional, descriptive, and analytical study was conducted on a representative sample of the cohort of live births in Arapiraca (AL), in 2018. The sources of information included: Live Birth Information System; Mortality Information System; Electronic Citizen Records; Vaccination Records; and Sanitary Unit Records. Updated and timely vaccination coverage rates were estimated for each vaccine and for the complete schedule, presented as percentages with a 95% confidence interval, stratified by rural and urban areas. The association between incomplete vaccination schedule and independent variables was investigated through estimation of crude and adjusted prevalence ratios and their respective 95% confidence intervals, using Poisson regression. Results: A total of 318 children were studied. The average coverage of the complete and updated vaccination schedule at 12 months was 91.8%, with rates of 93.6% and 88.8% in urban and rural areas, respectively. By 24 months, coverage declined to 75.2%, with rates of 76.2% and 73.3% in urban and rural areas, respectively. Timely coverage at 12 months was 47.8%, higher in rural areas at 50.9% versus 46.0% in urban areas (p>0.05). By 24 months, timely coverage decreased to 9.1%, higher in rural areas at 14.7% versus 5.9% in urban areas (p<0.05). Vaccines with lower coverage rates included: i) at 12 months, the second dose of Human Rotavirus with 96.2%, and at 24 months, the first dose of Varicella and the single dose of Hepatitis A with 92.1%; ii) for timely coverage at 12 months, the third dose of IPV/OPV had 66.7% coverage, and at 24 months, the first DTP booster had 24.5% coverage. Factors independently associated with incomplete updated and timely schedules at 12 and 24 months included: maternal education less than eight years or equal/superior to 12 years of schooling; mother with fewer than seven prenatal visits; mother residing in rural areas; and birth weight less than 2,800 grams. However, being born with less than 2,800 grams was inversely associated with incomplete updated schedules at 12 months; being born with weight between 2,800 and 3,199 grams was associated with incomplete timely schedules at 12 months; and residing in rural areas was associated with incomplete timely schedules at 24 months. Conclusions: The results suggest, among strategies to increase vaccination coverage: educational policies with specific focus on both the poorer and wealthier segments of the population; strengthening the bond between services and the community through measures aimed at better structuring vaccination rooms and reducing staff turnover; and enhancing maternal and child health programs by increasing coverage of prenatal programs and infant healthcare assistance.

Sobre ativismos e conhecimentos: a experiência de associações canábicas no Brasil / On activism and knowledge: the experience of cannabis associations in Brazil

Resumo O surgimento de associações civis em prol da cannabis se iniciou na década de 2010. Diante da inércia do Estado, essas organizações têm atuado no acolhimento, apoio, informação, capacitação e facilitação do acesso de pacientes e familiares a medicamento produzido à base de maconha, substância proibida no Brasil. Este estudo visa analisar como o ativismo canábico promovido pelas associações brasileiras se fundamenta em conhecimentos científicos ou adquiridos pela vivência dos associados. A metodologia englobou entrevistas com participantes das associações ACuCa, Ama+me e Apepi e análise de conteúdo dos perfis dessas instituições no Instagram. Verificou-se que o ativismo canábico no Instagram apresenta semelhanças com aquele praticado presencialmente, no entanto, o ativismo nas mídias sociais prioriza a divulgação do conhecimento pela informação e capacitação de seus seguidores, tendo o cuidado de tratar o conteúdo para se adequar às diretrizes da plataforma. Além disso, as principais linhas de atuação do associativismo canábico (acolhimento e distribuição de óleos medicinais) aparecem de forma velada nas publicações, sendo que em sua maioria ocorrem em conversas privadas nos meios de comunicação com as associações.

Abstract The emergence of civil associations in favor of cannabis began in the 2010s. Faced with the inertia of the State, these organizations have acted in the reception, support, information, training, and facilitation of access for patients and their families to the medicine produced from marijuana, a prohibited substance in Brazil. This study aims to analyze how cannabis activism promoted by Brazilian associations is based on scientific knowledge or knowledge acquired through the experience of members. The methodology included interviews with participants from the ACuCa, Ama+me, and Apepi associations, as well as the Content Analysis of the profiles of these institutions on Instagram. It was found that cannabis activism on Instagram is similar to that practiced in person; however, activism on social media prioritizes the dissemination of knowledge through information and training of its followers, being careful to treat the content in order to suit the guidelines of the platform. In addition, the main lines of action of cannabis associations (reception and distribution of medicinal oils) appear in a veiled way in the publications, most of which occur through private conversations in the media with the associations.

In Vitro Leishmanicidal Activity of Copaiba Oil and Kojic Acid Combination on the Protozoan Leishmania (Leishmania) amazonensis and Host Cell.

(1) Background: Leishmaniasis refers to a group of anthropozoonotic diseases caused by Leishmania. The major chemotherapeutic agent used for its treatment is Glucantime®®, but the search continues for new compounds that are economically viable and act on the protozoan without causing damage to the host cell. As an alternative approach, this study used a combination of copaiba oil (CO) and kojic acid (KA) to determine their in vitro action on host cells, on the Leishmania (Leishmania) amazonensis protozoan and its interaction with macrophages. (2) Methods: In vitro culture, analysis of cytokine release and microscopy assays were performed. Statistical analysis was performed with ANOVA (GraphPad Prism). (3) Results: The combination did not induce cytotoxic effects on macrophages after treatment but promoted morphological changes in the protozoan, such as nuclear alterations (apoptotic characteristics), alterations in the cellular body and an increase in the number of electrodense structures and acidocalcisomes, observed mainly at the concentrations of CO20KA50 and CO30KA50 µg/mL. We observed reductions in the intracellular amastigote number and in the production of proinflammatory cytokines, such as IL-6 and TNF-α, after treatment with CO30KA at 50 µg/mL. (4) Conclusions: We report here, for the first time, that the combination of CO and KA may be a promising approach against Leishmania (Leishmania) amazonensis.

Red sacaca essential oil-loaded nanostructured lipid carriers optimized by factorial design: cytotoxicity and cellular reactive oxygen species levels.

Amazonian flora includes several species with the potential to develop pharmaceutical and biotechnological products. The essential oils from Amazonian species possess some biological properties, such as antioxidant, antibacterial, and cytotoxic activities. The essential oil of red sacaca (RSO), Croton cajucara Benth., contains metabolites characterized by antioxidant and anti-inflammatory activities. Nanostructured lipid carriers (NLC) are an advantageous alternative for the effective delivery of drugs because they can solubilize lipophilic actives and reduce their cytotoxicity. This study aimed to optimize the synthesis of RSO-loaded nanostructured lipid carriers (NLC-RSO) using a 23 factorial design and investigate their antioxidant and cytotoxic effects. The red sacaca essential oil (RSO) metabolite profile was characterized using gas chromatography coupled with a mass spectrometer (GC-MS), identifying 33 metabolites, with linalool and 7-hydroxy-calamenene as the major ones, as reported in the literature. The optimized NLC-RSO formulation had a particle size less than 100 nm and a polydispersity index lower than 0.25. After characterizing NLC-RSO using Fourier-transform infrared spectroscopy, powder X-ray diffraction, zeta potential, moisture content, and wettability, in vitro cytotoxicity were performed in A549 and BEAS-2B cell lines using the resazurin metabolism assay. The data indicated a lower IC50 for RSO than for NLC-RSOs in both cell lines. Furthermore, low cytotoxicity of blank nanoparticles (blank NP) and medium chain triglycerides-loaded nanostructured lipid carriers (NLC-MCT) towards both pulmonary cell lines was noted. At a concentration of 50-100 µg/mL, free RSO exhibited higher cytotoxicity than NLC-RSO, demonstrating the protective effect of this lipid carrier in reducing cytotoxicity during metabolite delivery. Similarly, free RSO showed higher 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging than NLC-RSO, also indicating this protective effect. The 2',7'-dichlorofluorescein diacetate (DCFH-DA) intracellular reactive oxygen species (ROS) level assay did not show differences between the treatments at higher but non-cytotoxic dosages. Taken together, our results suggest that NLC-RSOs are potential RSO delivery systems for applications related to cancer treatment.

Ter alguém com quem contar: A percepção de adolescentes acerca do amor e do suporte do(a) parceiro(a) amoroso(a) / Have somebody to count on: Adolescents' perception about love and support from a romantic partner

Embora interações com amigos e parceiros amorosos ganhem importância na adolescência, ainda há controvérsias acerca da profundidade e da qualidade da vinculação amorosa. Buscou-se avaliar a percepção de setenta adolescentes gaúchos (12 a 18 anos), de escolas públicas e privadas de Porto Alegre e Canoas/RS, acerca do amor e do suporte do(a) parceiro(a) amoroso(a), e verificar suas associações com características sociodemográficas. Aplicou-se individualmente, em sala de aula, um questionário de dados sociodemográficos, o Inventário de Qualidade dos Relacionamentos Interpessoais e a Escala Triangular do Amor ­ Versão Reduzida. Os dados obtidos foram digitados em planilha no SPSS e analisados por meio de estatística descritiva e correlacional (Correlação de Spearman e comparação entre grupos via teste de Mann-Whitney, considerando as variáveis gênero, faixa etária, renda familiar, religião, escolaridade e presença ou não de relação sexual). Os adolescentes perceberam seus relacionamentos como importantes, considerando-os boa fonte de suporte, apresentando altos índices de intimidade, paixão e comprometimento e baixo nível de conflito. Encontrou-se associação positiva entre comprometimento e profundidade e intimidade e suporte, assim como entre maior idade e maior comprometimento. Ter relacionamento sexual associou-se a maior percepção de conflito e paixão. Os relacionamentos amorosos mostraram ser fonte de suporte para o desenvolvimento saudável desses adolescentes.

Although interactions with friends and romantic relationships become important during adolescence, there is still controversy about the depth and quality of adolescents' attachment to their romantic partners. The present study aimed to evaluate the adolescents' perception of love and their romantic partner's support, as well as to verify its possible associations with sociodemographic characteristics. Seventy adolescents (12 to 18 years old) from South Brazil, enrolled in public and private schools of Porto Alegre and Canoas/RS, fulfilled individually, at school, a sociodemographic data questionnaire, the Quality of Relationships Inventory and the Triangular Love Scale ­ Reduced Version. The collected data were entered into a spreadsheet in SPSS. Descriptive and correlational statistics analysis were performed (Spearman correlation and comparison between groups via Mann-Whitney test, considering the variables gender, age group, family income, religion, education level, and the presence or absence of sexual intercourse). The adolescents perceived their romantic relationships as important, as a good source of support, showing high levels of intimacy, passion and commitment, and low levels of conflict. A positive association was found between commitment and depth, and intimacy and support, as well as higher age and more advanced levels of commitment. Having a sexual relationship was associated with a higher perception of conflict and passion. Romantic relationships proved to be a source of support for the healthy development of these adolescents.

Molecular characterization of Brazilian FeLV strains in São Luis, Maranhão Brazil.

The feline leukemia virus (FeLV) belongs to the Retroviridae family and Gammaretrovirus genus, and causes a variety of neoplastic and non-neoplastic diseases in domestic cats (Felis catus), such as thymic and multicentric lymphomas, myelodysplastic syndromes, acute myeloid leukemia, aplastic anemia, and immunodeficiency. The aim of the present study was to carry out the molecular characterization of FeLV-positive samples and determine the circulating viral subtype in the city of São Luís, Maranhão, Brazil, as well as identify its phylogenetic relationship and genetic diversity. The FIV Ac/FeLV Ag Test Kit (Alere™) and the commercial immunoenzymatic assay kit (Alere™) were used to detect the positive samples, which were subsequently confirmed by ELISA (ELISA - SNAP® Combo FeLV/FIV). To confirm the presence of proviral DNA, a polymerase chain reaction (PCR) was performed to amplify the target fragments of 450, 235, and 166 bp of the FeLV gag gene. For the detection of FeLV subtypes, nested PCR was performed for FeLV-A, B, and C, with amplification of 2350-, 1072-, 866-, and 1755-bp fragments for the FeLV env gene. The results obtained by nested PCR showed that the four positive samples amplified the A and B subtypes. The C subtype was not amplified. There was an AB combination but no ABC combination. Phylogenetic analysis revealed similarities (78% bootstrap) between the subtype circulating in Brazil and FeLV-AB and with the subtypes of Eastern Asia (Japan) and Southeast Asia (Malaysia), demonstrating that this subtype possesses high genetic variability and a differentiated genotype.

Fila única de leitos e a pandemia de COVID-19: atuação do Poder Legislativo Federal no ano de 2020 / Single waiting list for hospital beds during the COVID-19 pandemic: performance of the Federal Legislative Branch in 2020

Resumo A pesquisa investigou proposições legislativas sobre fila única de internações e leitos de UTI no âmbito do Poder Legislativo Federal no primeiro ano da pandemia. Tratou-se de estudo exploratório, qualitativo e de base documental que analisou projetos de leis sobre o tema. Os resultados foram organizados conforme o perfil dos autores e o conteúdo qualitativo dos projetos. Preponderaram parlamentares do sexo masculino, filiados a partidos de esquerda e com formação profissional em áreas que não a da saúde. A maioria das proposições tratou de fila única geral, especificando leitos hospitalares, gestão mista e indenização mediante tabela SUS. A Câmara dos Deputados apresentou mais projetos, porém pouco tem avançado em suas tramitações. Entre os projetos analisados, apenas um foi priorizado na Comissão Externa de Enfrentamento à COVID-19. Concluiu-se que o Poder Legislativo Federal perdeu, uma vez mais, oportunidade valiosa de legislar para o futuro e preparar o país com um arcabouço normativo capaz de enfrentar emergências sanitárias ainda desconhecidas, mas que exigirão muito dos gestores e do SUS.

Abstract This study investigated legislative proposals on the single waiting list for hospitalizations and ICU beds within the scope of the Federal Legislative Branch in the first year of the pandemic (2020). This was an exploratory, qualitative, and document- based study, which analyzed bills analyzed in the Brazilian National Congress on the subject. The results were organized according to the authors' profile and qualitative content of the bills. There was a predominance of male parliamentarians, affiliated with left-wing parties and professional training in areas other than health. Most bills dealt with a general single waiting list, specifying hospital beds, the mixed management of hospital beds, and indemnity through the Brazilian Unified Health System's (SUS, in Portuguese) price table. The House of Representatives presented more bills, but no progress was made in their processing. Among the analyzed bills, only one was prioritized in the External Commission to Combat COVID-19. It was concluded that the Federal Legislative Branch once again missed the chance to legislate for the future and prepare the country with a normative framework capable of confronting health emergencies, which will demand much from health managers and SUS itself.

Nutritional and food education as a complementary treatment approach in severe obese individuals.

Background: The treatment for obesity, specifically severe obesity, is a challenge for health professionals and services. It requires a multidisciplinary and holistic approach covering the complexity and difficulties of incorporating healthy habits to prevent associated diseases and mortality. Individual intervention's methods are not enough to change eating habits. Objective: To describe and investigate the contribution of nutritional and food education as a complementary therapeutic approach in the treatment of individuals with severe obesity and their family members. Methods: A multidisciplinary team adopted a group approach. A different topic was addressed at each therapeutic meeting to assist in the nutritional treatment of obesity, such as diet and healthy habits i.e. barriers to lifestyle changes. The topics were developed based on different methodological and teaching approaches to facilitate adherence to non-drug treatment. Results: Overall, there was a greater understanding towards the adoption of healthy eating habits of the whole family, greater motivation to adhere to dietary changes and adoption of a more physical active lifestyle. This interventional educational support methodology had been accepted in such a positive way for patients and their relatives. Family member participation expands the possibilities of establishing necessary and lasting changes in the lifestyle of not only the patients, but their whole families. Conclusion: Health education actions constitute an important complementary therapeutic approach in promoting health and preventing complications in individuals with severe obesity. This article can be useful to enlarge the debate on the subject and face the challenges related to the effective treatment of obesity, notably severe obesity.

Evaluation of childhood cataract characteristics at a tertiary referral center / Características de catarata na infância em um centro de referência terciário

ABSTRACT Purpose: To examine the epidemiological characteristics of children undergoing cataract surgery at a referral center in Sao Paulo State, Brazil, as well as the facts surrounding treatment delays. Methods: In this transversal observational study, 240 operated eyes from 178 children undergoing cataract surgery were reviewed. The following aspects were analyzed: epidemiological and clinical characteristics, parental observations, red reflex test, operated eye, and age at cataract diagnosis and surgery. Results: The mean ages at the first visit and cataract surgery were 48.9 months (SD=50.0 months) and 64.5 months (SD= 55.4 months), respectively. The most critical sign adverted by parents was leukocoria. The red reflex test was performed on two-thirds of the children, with abnormal results in 28.0%. A family history of cataracts was evident in 30 (20,9%) children (n=144). Previous ocular surgery was found in 37 (16,6%) of the eyes (n=223), anterior segment disorders in 20 (9,0%) eyes (n=221), strabismus in 21 (9,5%) of the eyes (n=220), and nystagmus in 38 (24,4%) of the children (n=156). Conclusions: One of the causes for the delay in admission may have been the failure to complete the red reflex. In terms of etiology, heredity was the most crucial component. The presence of strabismus and nystagmus in many of these children points to late diagnosis. The most significant impediments to adequate cataract treatment in children were the lack of referral programs and children's specialized ophthalmologic centers, in addition to the restricted number of support professionals trained in the field and pediatric ophthalmology specialists.

RESUMO Objetivos: Rever características epidemiológicas de crianças submetidas a cirurgia de catarata, em centro de referência no estado de São Paulo, Brasil, e fatos associados a atrasos no tratamento. Métodos: Um total de 240 olhos submetidos a cirurgia de catarata, em 178 crianças, foram revisados neste estudo transversal observacional. Os seguintes aspectos foram analisados: características clínicas e epidemiológicas, sinais apontados pelos pais, teste do reflexo vermelho, olho operado e idade no diagnóstico e na cirurgia. Resultados: A média de idades na primeira visita e cirurgia de catarata foi de 48.9 meses (DP=50,0 meses) e 64.5 meses (DP=55.4 meses), respectivamente. O sinal mais importante apontado pelos pais foi a leucocoria. O teste do reflexo vermelho foi realizado em dois terços das crianças com resultados anormais em 28%. Histórico familiar de catarata foi evidente em 30 (20,9%) crianças (n=144). Os achados mais prevalentes em termos de histórico de problemas oculares foram: cirurgias oculares prévias em 37 (16,6%) olhos (n= 223), alterações do segmento anterior em 20 (9,0%) olhos (n=221), estrabismo em 21 (9,5%) olhos (n=220) e nistagmo em 38 (24,4%) crianças (n=156). Conclusões: Uma das causas para o atraso na admissão pode ter sido a falha em realizar o teste do reflexo vermelho, apesar de não ter sido possível verificar se todas as crianças foram submetidas ao exame. A hereditariedade foi o fator mais importante quanto à causa da catarata nessas crianças. A presença de estrabismo e nistagmo mais uma vez aponta para o diagnóstico tardio. Ausência de programas de referência e centros oftalmológicos especializados em crianças, além do número restrito de profissionais de apoio treinados na área e especialistas em oftalmologia pediátrica, foram as barreiras mais importantes para o tratamento adequado da catarata em crianças.

Avaliação muscular do joelho e funcional de membros inferiores de jovens atletas de voleibol do sexo feminino / Knee muscle evaluation and lower limbs' functional evaluation of young female volleyball athletes

Os desequilíbrios musculares e funcionais são analisados na tentativa de prevenir lesões e melhorar os desempenhos de atletas. Objetivo: Analisar o desempenho muscular de extensores e flexores de joelho e o desempenho funcional dos membros inferiores de atletas de voleibol. Métodos: Quinze atletas da categoria sub-16 de voleibol feminino da Universidade de Caxias do Sul foram avaliadas. Para análise do desempenho muscular, as variáveis pico de torque de extensores e flexores de joelho, e razão convencional de extensores/flexores, foi utilizado o dinamômetro isocinético. Já para a análise funcional dos membros inferiores, foram utilizados os testes Hop tests e Y balance test (YBT). Resultados: Na comparação entre membro dominante (MD) e não dominante (MND), não houve diferenças estatisticamente significativas na análise do pico de torque; já na razão flexores/extensores foi encontrada diferença significativa apenas à 240°/s. Entretanto, os valores médios da razão flexores/extensores encontrarem-se abaixo dos valores sugeridos pela literatura. As avaliações funcionais também não mostraram assimetrias entre os membros; no entanto, a pontuação composta do YBT apresentou-se abaixo dos valores normativos. Conclusão: A excelente simetria entre os membros pode ser justificada pela especificidade do esporte, pois os gestos esportivos do voleibol apresentam carácter simétrico durante as exigências físicas dos membros inferiores. No entanto, os baixos valores da razão flexores/extensores e da pontuação composta do YBT talvez não estejam diretamente relacionados a um risco maior de lesões já que os valores de referência utilizados são de atletas adultos.

Muscle and functional imbalances are analyzed in order to try prevent injuries and improve athletes' performance. Objective: To analyze knee's muscular performance of the knee extensors and flexors and lower limbs' functional performance of volleyball athletes. Methods: Fifteen female volleyball, athletes under the age of 16 from the University of Caxias do Sul, were analyzed. For analysis of muscle performance, the variables peak torque of knee extensors and flexors, and conventional flexor/extensor ratio, the isokinetic dynamometer was used. For the functional analysis of the lower limbs, the Hop tests and Y balance test (YBT) were used. Results: In the comparison between dominant (MD) and non-dominant (MND) limbs, there were no statistically significant differences in the analysis of peak torque; and in the flexor/extensor ratio analyzes, just one significant difference was found at 240°/s. However, the mean values of flexor/extensor ratio are below to the values suggested by the literature. Functional assessments also did not show asymmetries between members; however, the YBT composite score was below to the normative values. Conclusion: The excellent symmetry between the members can be justified by the sport's specificity, as the volleyball's gestures have a symmetrical character during the physical demands of the lower limbs. However, the low values of the flexor/extensor ratio and the YBT composite score may not be directly related to an increased risk of injuries since the reference values used are for adult athletes.

The Effect of Ketogenic Diet on Shared Risk Factors of Cardiovascular Disease and Cancer.

Cardiovascular disease (CVD) and cancer are the first and second leading causes of death worldwide, respectively. Epidemiological evidence has demonstrated that the incidence of cancer is elevated in patients with CVD and vice versa. However, these conditions are usually regarded as separate events despite the presence of shared risk factors between both conditions, such as metabolic abnormalities and lifestyle. Cohort studies suggested that controlling for CVD risk factors may have an impact on cancer incidence. Therefore, it could be concluded that interventions that improve CVD and cancer shared risk factors may potentially be effective in preventing and treating both diseases. The ketogenic diet (KD), a low-carbohydrate and high-fat diet, has been widely prescribed in weight loss programs for metabolic abnormalities. Furthermore, recent research has investigated the effects of KD on the treatment of numerous diseases, including CVD and cancer, due to its role in promoting ketolysis, ketogenesis, and modifying many other metabolic pathways with potential favorable health effects. However, there is still great debate regarding prescribing KD in patients either with CVD or cancer. Considering the number of studies on this topic, there is a clear need to summarize potential mechanisms through which KD can improve cardiovascular health and control cell proliferation. In this review, we explained the history of KD, its types, and physiological effects and discussed how it could play a role in CVD and cancer treatment and prevention.

Dyslipidemia induced by lipid diet in late gestation donor impact on growth kinetics and in vitro potential differentiation of umbilical cord Wharton's Jelly mesenchymal stem cells in goats.

Mesenchymal stem cells (MSC) from the umbilical cord (UC) have several attractive properties for clinical use. This study aimed to verify the impact of a lipid-rich diet during late gestation of donor goats on the growth and differentiation of MSCs from UC. From the 100th day of pregnancy to delivery, 22 goats were grouped based on their diet into the donor-lipid (DLD; n = 11) and donor-baseline (DBD; n = 11) diet groups. Diets were isonitrogenous and isoenergetic, differing in fat content (2.8% vs. 6.3% on a dry matter basis). Wharton's jelly (WJ) fragments were cultured. After primary culture, samples of WJ-MSCs were characterized by the expression of CD90, CD73, CD34, CD45, CD105, and Fas genes, mitochondrial activity using MitoTracker (MT) fluorescence probe, and growth kinetics. Population doubling time (PDT) was also determined. WJ-MSCs were differentiated into chondrocytes, adipocytes and osteocytes, and the mineralized area and adipocytes were determined. The lipid diet significantly increased triglyceride and cholesterol levels during pregnancy. The DLD group showed sub-expression of the CD90 gene, a high MT intensity, and a low proliferation rate at the end of the subculture. The mean PDT was 83.9 ± 1.3 h. Mineralized area and lipid droplet stain intensity from osteogenic and adipogenic differentiations, respectively, were greater in DLD. We conclude that in donor goats, dietary dyslipidemia during late pregnancy affects the ability of UC-derived MSCs to express their developmental potential in vitro, thus limiting their possible use for therapeutic purposes.

Evaluation of childhood cataract characteristics at a tertiary referral center.

PURPOSE: To examine the epidemiological characteristics of children undergoing cataract surgery at a referral center in Sao Paulo State, Brazil, as well as the facts surrounding treatment delays. METHODS: In this transversal observational study, 240 operated eyes from 178 children undergoing cataract surgery were reviewed. The following aspects were analyzed: epidemiological and clinical characteristics, parental observations, red reflex test, operated eye, and age at cataract diagnosis and surgery. RESULTS: The mean ages at the first visit and cataract surgery were 48.9 months (SD=50.0 months) and 64.5 months (SD= 55.4 months), respectively. The most critical sign adverted by parents was leukocoria. The red reflex test was performed on two-thirds of the children, with abnormal results in 28.0%. A family history of cataracts was evident in 30 (20,9%) children (n=144). Previous ocular surgery was found in 37 (16,6%) of the eyes (n=223), anterior segment disorders in 20 (9,0%) eyes (n=221), strabismus in 21 (9,5%) of the eyes (n=220), and nystagmus in 38 (24,4%) of the children (n=156). CONCLUSIONS: One of the causes for the delay in admission may have been the failure to complete the red reflex. In terms of etiology, heredity was the most crucial component. The presence of strabismus and nystagmus in many of these children points to late diagnosis. The most significant impediments to adequate cataract treatment in children were the lack of referral programs and children's specialized ophthalmologic centers, in addition to the restricted number of support professionals trained in the field and pediatric ophthalmology specialists.

Caracterização dos processos éticos de enfermagem no estado de alagoas / Characterization of the ethical nursing processes in the state of alagoas / Caracterización de los procesos éticos de enfermería en el estado de alagoas

RESUMO Objetivo: analisar as infrações relacionadas à abertura de processos éticos disciplinares contra os profissionais de enfermagem no estado de Alagoas, Brasil. Método: trata-se de um estudo documental, exploratório, retrospectivo com análise quantitativa, realizado no Conselho Regional de Enfermagem de Alagoas, de novembro de 2020 a janeiro de 2021. Através da consulta ao processo físico, com auxílio de roteiro de coleta, os dados foram analisados por estatística descritiva. Resultados: foram analisados 68 processos éticos de 2009 a 2020. Destacam-se as infrações referente a relações interprofissionais (37,03%) e negligências (20,99%), a penalidade mais aplicada foi a advertência verbal (42,22%) e o denunciante principal foi o Conselho Regional de Enfermagem de Alagoas (27,94%). Conclusão: é necessário enfatizar as questões pertinentes às infrações pelos núcleos de educação permanente, para fortalecer a comunicação entre os profissionais. A pesquisa contribui para dar visibilidade aos processos éticos enfrentados pelos profissionais de enfermagem.

ABSTRACT Objective: to analyze the infringements related to the opening of disciplinary ethical processes against Nursing professionals in the state of Alagoas, Brazil. Method: this is a documentary, exploratory and retrospective study with quantitative analysis, carried out at the Regional Nursing Council of Alagoas, from November 2020 to January 2021. By consulting the physical process, with the aid of a collection script, the data were analyzed using descriptive statistics. Results: 68 ethical processes were analyzed from 2009 to 2020. The infringements referring to interprofessional relationships (37.03%) and negligence (20.99%) stand out; the most applied penalty was verbal warning (42.22%) and the main complainant was the Regional Nursing Council of Alagoas (27.94%). Conclusion: it is necessary to emphasize the issues related to the infringements by the permanent education centers, to strengthen communication between the professionals. The research contributes to giving visibility to the ethical processes faced by Nursing professionals.

RESUMEN Objetivo: analizar las infracciones relacionadas con la iniciación de procesos éticos disciplinarios contra profesionales de enfermería en el estado de Alagoas, Brasil. Método: se trata de un estudio documental, exploratorio, retrospectivo con análisis cuantitativo, realizado en el Consejo Regional de Enfermería de Alagoas, de noviembre de 2020 a enero de 2021. Mediante consulta del proceso físico, con la ayuda de una guía de recolección, los datos fueron analizados por estadística descriptiva. Resultados: Se analizaron 68 procesos éticos desde 2009 hasta 2020. Se destacan las infracciones vinculadas a las relaciones interprofesionales (37,03%) y la negligencia (20,99%), la sanción más aplicada fue la advertencia verbal (42,22%) y el principal denunciante fue el Consejo Regional de Enfermería de Alagoas (27,94%). Conclusión: es necesario enfatizar las cuestiones relacionadas con las infracciones de los centros de educación permanente, para fortalecer la comunicación entre los profesionales. La investigación contribuye a dar visibilidad a los procesos éticos que enfrentan los profesionales de enfermería.

Positive Effects of Extra-Virgin Olive Oil Supplementation and DietBra on Inflammation and Glycemic Profiles in Adults With Type 2 Diabetes and Class II/III Obesity: A Randomized Clinical Trial.

Background: Evidence on the effects of dietary interventions on inflammatory markers in individuals with obesity and type 2 diabetes mellitus (T2DM) is scarce. Our study evaluated the effects of extra-virgin olive oil alone and in combination with a traditional Brazilian diet on inflammatory markers and glycemic profiles in adults with both T2DM and class II/III obesity. Methods: Adults aged 18-64 years with T2DM and class II/III obesity were randomized into two intervention groups: 1) extra-virgin olive oil only and 2) extra-virgin olive oil + a traditional Brazilian diet (OliveOil+DietBra). Data on sociodemographic characteristics, lifestyle, anthropometry, biochemical markers and inflammatory markers were collected. The primary outcomes were glycemic parameters and inflammatory markers. The body mass index (BMI) and weight were the secondary outcomes. Results: Forty individuals with T2DM and class II/III obesity were enrolled, and 34 (85%) completed the intervention course. The intake of olive oil was 37.88 ± 12.50 mL/day in the olive oil group and 37.71 ± 12.23 mL/day in the OliveOil+DietBra group, with no significant difference between groups (p = 0.484). Compared to the olive oil only group, the OliveOil+DietBra group had significantly lower levels of fasting insulin (p = 0.047) at the end of the intervention, whereas the other glycemic parameters were not altered. In the OliveOil+DietBra group, serum levels of inflammatory cytokines, IL-1α (p = 0.006) and adiponectin (p = 0.049) were lower and those of TNFα were higher (p = 0.037). There was a significant reduction in BMI and weight compared to the baseline values in the OliveOil+DietBra group (p = 0.015). Conclusions: The intervention with OliveOil+DietBra effectively decreased the levels of fasting insulin, IL-1α and adiponectin, suggesting its beneficial role in improving the inflammatory profiles and fasting insulin levels in adults with class II/III obesity and T2DM. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT02463435.

Challenges for maintaining surgical care practices in the COVID-19 pandemic: an integrative review / Desafíos para mantener las prácticas de cuidado quirúrgico durante la pandemia de COVID-19: una revisión integrativa / Desafios para a manutenção das práticas de cuidados cirúrgicos na pandemia por COVID-19: uma revisão integrativa

Objective: to present the knowledge produced on challenges of health services for maintaining surgical care practices in times of the COVID-19 pandemic. Methods: this is an integrative literature review, performed with descriptors 'Surgical Centers' and 'Coronavirus Infections' in the MEDLINE/PubMed Central, IBECS, LILACS, BDENF, Coleta SUS, BIGG, BINACIS, SciELO, PubMed, Science Direct, and Cochrane Library databases. Results: of the 405 studies analyzed, 27 met the inclusion criteria. The main challenges for surgical services during the pandemic were: (i) rearrangement of the general practice in surgical units; (ii) management and administration of resources and elective surgeries; (iii) follow-up and control of preoperative patients to medium term; (iv) maintenance of autonomy and mental health of patients and health professionals in this context; and (v) teaching health residents in the operating room. Conclusion: for surgical care services, the challenges caused by managing the high demand of patients in need of care resulted in the transfer of own resources to other units and the consequent hiring of professionals to meet the demand for these services due to the damming of postponed elective surgeries. This knowledge will allow us to propose strategies in decision making in this scenario, considering the new waves that may arise from this disease.

Objetivo. Presentar el conocimiento producido sobre los desafíos de los servicios de salud para el mantenimiento de las prácticas de atención quirúrgica en tiempos de pandemia por COVID-19. Métodos. Revisión integradora de la literatura, realizada con los descriptores 'Centros quirúrgicos' e 'Infecciones por Coronavirus' en las bases de datos Medline/PubMed Central, IBECS, LILACS, BDENF, Collects SUS, BIGG, BINACIS, SCIELO, PUBMED, SCIENCE DIRECT y Cochrane Library. Resultados. De 405 estudios analizados 27 cumplieron los criterios de inclusión. Los principales desafíos para los servicios de cirugía durante la pandemia fueron: (i) la reorganización de la práctica del cuidado general en las unidades quirúrgicas, (ii) la gestión y administración de recursos y de las cirugías electivas, (iii) el seguimiento y control de los pacientes preoperatorios a medio plazo, (iv) el mantener la autonomía y la salud mental del paciente y de los profesionales sanitarios en este contexto, y (v) la enseñanza de los residentes sanitarios en el quirófano. Conclusión. Para los servicios de atención quirúrgica el reto ocasionado por el manejo de la alta demanda de pacientes con necesidad del cuidado tuvo como consecuencia la transferencia de recursos propios a otras unidades y la contratación posterior de profesionales para suplir la demanda de estos servicios ante el represamiento de cirugías electivas. Este conocimiento permitirá plantear estrategias en la toma de decisiones frente a este escenario, si se consideran las nuevas olas de esta enfermedad que se pueden presentar.

Objetivo. Apresentar o conhecimento produzido sobre os desafios dos serviços de saúde para a manutenção das práticas de cuidados cirúrgicos em tempos de pandemia por COVID-19. Métodos. Revisão integrativa da literatura, realizada com os descritores 'Centros Cirúrgicos' e 'Infecções por Coronavírus' nas bases de dados Medline/PubMed Central, IBECS, LILACS, BDENF, Coleta SUS, BIGG, BINACIS, SCIELO, PUBMED, SCIENCE DIRECT e Cochrane Library. Resultados. Dos 405 estudos analisados, 27 preencheram os critérios de inclusão. Os principais desafios para os serviços cirúrgicos durante a pandemia foram: (i) a reorganização da clínica geral nas unidades cirúrgicas, (ii) a gestão e administração de recursos e cirurgias eletivas, (iii) o acompanhamento e controle de pacientes pré-operatórios a médio prazo, (iv) manutenção da autonomia e saúde mental do paciente e dos profissionais de saúde nesse contexto, e (v) ensino dos residentes de saúde no centro cirúrgico. Conclusão. Para os serviços de atendimento cirúrgico, os desafios causados pelo gerenciamento da alta demanda de pacientes com necessidade de atendimento resultaram no repasse de recursos próprios para outras unidades e consequente contratação de profissionais para atender a demanda desses serviços devido ao represamento de cirurgias eletivas adiadas. Este conhecimento permitirá propor estratégias na tomada de decisão diante desse cenário, considerando as novas ondas que podem surgir dessa doença.

Encapsulation of safflower oil in nanostructured lipid carriers for food application.

Safflower oil (SO) is mainly rich in linoleic acid (ω-6), oleic acid (ω-9), and other bioactives with potential antioxidant, antidiabetic, thermogenic, anti-inflammatory, cardioprotective and anticancer activities. The reduced aqueous solubility and high susceptibility to oxidative degradation are undesirable for food applications and can be overcome by incorporation in lipid nanoparticles. Thus, the main goal was to develop and characterize SO-loaded nanostructured lipid carriers (NLC-SO) and to evaluate their potential for protection of the antioxidant activity of the bioactive. NLC-SO showed average size of 222 ± 2.0 nm, zeta potential of  43 ± 3.5 mV and the encapsulation efficiency was 49.0 ± 2.8%, combined with high thermal compatibility (up to 228 °C) and physical stability for up to 60 days in aqueous dispersion. Besides, the NLC-SO showed threefold reduction in the DPPH radical scavenge activity after encapsulation, indicating protection of the antioxidant components of the SO and preservation of the bioactives. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13197-021-05078-5.

Impact of donor nutritional balance on the growth and development of mesenchymal stem cells from caprine umbilical cord Wharton´s jelly.

Mesenchymal stem cells (MSCs) from the umbilical cord (UC) have aroused considerable interest. However, little is known about the maternal effect on these cells. The aim of this study was to verify the impact of the nutritional status of donor goats on the growth and differentiation of MSCs from the UC. At parturition, 19 goats were grouped based on their low or high body mass index (low BMI, LBMI, n = 9; and high BMI, HBMI, n = 10). UCs were collected during delivery and Wharton's jelly (WJ) fragments cultured. WJ-MSCs were differentiated into osteocytes, adipocytes, chondrocytes, and the population doubling time (PDT) was determined. Samples of WJ-MSCs were also used to verify the expression of the CD90, CD73, CD34, CD45, and CD105 genes. Media used for WJ-MSC primary cultures were analyzed using near-infrared spectroscopy. The lag phase was 7.5 ± 0.6 days and the entire culture took 26.7 ± 1.3 days, with a cell proliferation rate of 8.500 cells/day. The mean PDT from subculture was 30.0 ± 0.7 h. The CD105 gene was sub-expressed in LBMI, and the spectra of the spent media from the second to fourth day of WJ-MSC primary culture were segregated into negative scores by multivariate analysis. We conclude that, in goats, the nutritional balance of the donor did not affect the in vitro growth of MSCs derived from the UC. However, the molecular profile observed in the low BMI group suggests that the use of MSCs for therapeutic purposes should be considered more carefully.

Caracterização dos processos éticos de enfermagem no estado de alagoas / Characterization of the ethical nursing processes in the state of alagoas / Caracterización de los procesos éticos de enfermería en el estado de alagoas

RESUMO Objetivo: analisar as infrações relacionadas à abertura de processos éticos disciplinares contra os profissionais de enfermagem no estado de Alagoas, Brasil. Método: trata-se de um estudo documental, exploratório, retrospectivo com análise quantitativa, realizado no Conselho Regional de Enfermagem de Alagoas, de novembro de 2020 a janeiro de 2021. Através da consulta ao processo físico, com auxílio de roteiro de coleta, os dados foram analisados por estatística descritiva. Resultados: foram analisados 68 processos éticos de 2009 a 2020. Destacam-se as infrações referente a relações interprofissionais (37,03%) e negligências (20,99%), a penalidade mais aplicada foi a advertência verbal (42,22%) e o denunciante principal foi o Conselho Regional de Enfermagem de Alagoas (27,94%). Conclusão: é necessário enfatizar as questões pertinentes às infrações pelos núcleos de educação permanente, para fortalecer a comunicação entre os profissionais. A pesquisa contribui para dar visibilidade aos processos éticos enfrentados pelos profissionais de enfermagem.

ABSTRACT Objective: to analyze the infringements related to the opening of disciplinary ethical processes against Nursing professionals in the state of Alagoas, Brazil. Method: this is a documentary, exploratory and retrospective study with quantitative analysis, carried out at the Regional Nursing Council of Alagoas, from November 2020 to January 2021. By consulting the physical process, with the aid of a collection script, the data were analyzed using descriptive statistics. Results: 68 ethical processes were analyzed from 2009 to 2020. The infringements referring to interprofessional relationships (37.03%) and negligence (20.99%) stand out; the most applied penalty was verbal warning (42.22%) and the main complainant was the Regional Nursing Council of Alagoas (27.94%). Conclusion: it is necessary to emphasize the issues related to the infringements by the permanent education centers, to strengthen communication between the professionals. The research contributes to giving visibility to the ethical processes faced by Nursing professionals.

RESUMEN Objetivo: analizar las infracciones relacionadas con la iniciación de procesos éticos disciplinarios contra profesionales de enfermería en el estado de Alagoas, Brasil. Método: se trata de un estudio documental, exploratorio, retrospectivo con análisis cuantitativo, realizado en el Consejo Regional de Enfermería de Alagoas, de noviembre de 2020 a enero de 2021. Mediante consulta del proceso físico, con la ayuda de una guía de recolección, los datos fueron analizados por estadística descriptiva. Resultados: Se analizaron 68 procesos éticos desde 2009 hasta 2020. Se destacan las infracciones vinculadas a las relaciones interprofesionales (37,03%) y la negligencia (20,99%), la sanción más aplicada fue la advertencia verbal (42,22%) y el principal denunciante fue el Consejo Regional de Enfermería de Alagoas (27,94%). Conclusión: es necesario enfatizar las cuestiones relacionadas con las infracciones de los centros de educación permanente, para fortalecer la comunicación entre los profesionales. La investigación contribuye a dar visibilidad a los procesos éticos que enfrentan los profesionales de enfermería.

Limites e possibilidades de agentes comunitários de saúde na identificação de sintomas depressivos / Límites y posibilidades de los agentes comunitarios de salud en la identificación de síntomas depresivos / Limitations and possibilities of community health workers in identifying depressive symptoms

RESUMO Objetivo: avaliar o conhecimento de agentes comunitários de saúde sobre identificação de sintomas depressivos na comunidade. Método: trata-se de pesquisa qualitativa, realizada em Unidade Básica de Saúde, em Teresina, Piauí, Brasil, com 15 agentes comunitários de saúde. Utilizou-se o método da Pesquisa-Ação. A produção dos dados aconteceu em janeiro e fevereiro de 2019, por meio de dois seminários temáticos, pautados no Método Criativo Sensível. Os discursos foram submetidos à análise temática. Resultados: agentes comunitários de saúde reconhecem os sintomas depressivos por tristeza, choro, isolamento, anedonia e solidão, manifestados pelos indivíduos. Os limites para essa identificação, relatados pelos profissionais, foram dificuldade de acesso aos usuários e às famílias e estigma e preconceito com a depressão. Quanto às possibilidades, destacaram-se acesso à informação sobre a temática pela mídia, diálogo/conversa estabelecido entre usuário e profissional e acesso à rede de apoio. Considerações finais: conclui-se que o reconhecimento, as limitações e as possibilidades de identificação de sintomas depressivos por esses profissionais refletem no diagnóstico, planejamento e implementação de ações no cuidado em saúde mental de forma precoce e segura.

RESUMEN Objetivo: evaluar el conocimiento de agentes comunitarios de salud sobre identificación de síntomas depresivos en la comunidad. Método: se trata de investigación cualitativa, realizada en Unidad Básica de Salud, en Teresina, Piauí, Brasil, con 15 agentes comunitarios de salud. Se utilizó el método de Investigación-acción. La producción de los datos tuvo lugar en enero y febrero de 2019, a través de dos seminarios temáticos, de acuerdo con el Método Creativo-sensible. Los discursos fueron sometidos al análisis temático. Resultados: Los agentes comunitarios de salud reconocen los síntomas depresivos por tristeza, llanto, aislamiento, anhedonia y soledad, manifestados por los individuos. Los límites para esa identificación, relatados por los profesionales, fueron dificultad de acceso a los usuarios y a las familias y estigma y prejuicio con la depresión. En cuanto a las posibilidades, se destacaron acceso a la información sobre la temática por los medios, diálogo/conversación establecido entre usuario y profesional y acceso a la red de apoyo. Consideraciones finales: se concluye que el reconocimiento, las limitaciones y las posibilidades de identificación de síntomas depresivos por parte de estos profesionales reflejan en el diagnóstico, la planificación e implementación de acciones en el cuidado en salud mental de forma precoz y segura.

ABSTRACT Objective: to evaluate the knowledge of community health workers about the identification of depressive symptoms in the community. Method: this is a qualitative research, conducted in a Primary Health Care Unit in Teresina, Piauí, Brazil, with 15 community health workers. We used the Action-Research method. Data production took place in January and February 2019, through two thematic seminars, guided by the Creative Sensitive Method.The speeches were submitted to thematic analysis. Results: community health workers recognize the depressive symptoms by means of sadness, crying, isolation, anhedonia and loneliness, manifested by individuals. The limitations to this identification, reported by professionals, were difficulty of access to users and families, as well as stigma and prejudice against depression. As for the possibilities, access to information about the theme through the media, dialogue/conversation established between users and professionals, besides access to a support network, were highlighted. Final considerations: we conclude that the recognition, limitations and possibilities of identification of depressive symptoms by these professionals are reflected in the diagnosis, planning and implementation of actions in mental health care in an early and safe way.