Diversity of kidney care referral pathways in national child health systems of 48 European countries.

Background: Primary, secondary and tertiary healthcare services in Europe create complex networks covering pediatric subspecialties, sociology, economics and politics. Two surveys of the European Society for Paediatric Nephrology (ESPN) in 1998 and 2017 revealed substantial disparities of kidney care among European countries. The purpose of the third ESPN survey is to further identify national differences in the conceptualization and organization of European pediatric kidney health care pathways during and outside normal working hours. Methods: In 2020, a questionnaire was sent to one leading pediatric nephrologist from 48 of 53 European countries as defined by the World Health Organization. In order to exemplify care pathways in pediatric primary care nephrology, urinary tract infection (UTI) was chosen. Steroid sensitive nephrotic syndrome (SSNS) was chosen for pediatric rare disease nephrology and acute kidney injury (AKI) was analyzed for pediatric emergency nephrology. Results: The care pathways for European children and young people with urinary tract infections were variable and differed during standard working hours and also during night-time and weekends. During daytime, UTI care pathways included six different types of care givers. There was a shift from primary care services outside standard working hours to general outpatient polyclinic and hospital services. Children with SNSS were followed up by pediatric nephrologists in hospitals in 69% of countries. Patients presenting with community acquired AKI were admitted during regular working hours to secondary or tertiary care hospitals. During nights and weekends, an immediate shift to University Children's Hospitals was observed where treatment was started by intensive care pediatricians and pediatric nephrologists. Conclusion: Gaps and fragmentation of pediatric health services may lead to the risk of delayed or inadequate referral of European children with kidney disease to pediatric nephrologists. The diversity of patient pathways outside of normal working hours was identified as one of the major weaknesses in the service chain.

Popular Health, Environmental and Occupational Surveillance: an integrative literature review. / Vigilância Popular da Saúde, Ambiente e Trabalho (VPSAT): uma revisão integrativa da literatura.

The objective is to identify concepts, experiences, methods, and techniques in Popular Health, Environmental and Occupational Surveillance (VPSAT). This is an integrative review that used the descriptors: Community Participation, Public Health Surveillance, Environmental Health, and Occupational Health, using five databases: Virtual Health Library, EBSCOhost, Embase, Scopus and Web of Science. The review selected 15 studies, based on the inclusion criteria: surveillance experiences with community protagonism; and exclusion criteria: research without primary data and developed only by the health service. The theoretical and methodological bases of the studies were identified as citizen science, popular education, and environmental justice; experiences such as participatory mapping and monitoring; methods such as action research, 'do-it-yourself', and community-based research; and techniques such as "Photovoice" and Community Journal. Low-income urban communities, indigenous peoples, young individuals, and workers stand out as the protagonists. The recognition of the VPSAT as an important source of data and intervention by public health systems and academia contributes to making health surveillance more dialogic and effective.

Objetiva-se identificar concepções, experiências, métodos e técnicas em Vigilância Popular da Saúde, Ambiente e Trabalho (VPSAT). Trata-se de uma revisão integrativa com os descritores: participação da comunidade, vigilância em saúde, vigilância da saúde, saúde ambiental e saúde do trabalhador, envolvendo cinco bancos de dados: Biblioteca Virtual da Saúde, EBSCOhost, Embase, Scopus e Web Of Science. A revisão selecionou 15 estudos, a partir dos critérios de inclusão: experiências de vigilância com protagonismo comunitário; e exclusão: pesquisas sem dados primários e desenvolvidas apenas pelo serviço de saúde. Identificaram-se como bases teóricas e metodológicas dos estudos a ciência cidadã, educação popular e justiça ambiental; e experiências como mapeamentos e monitoramentos participativos; métodos como pesquisa-ação, "faça você mesmo" e investigação baseada na comunidade; e técnicas como "Photovoice" e Jornal Comunitário. Destacam-se as comunidades urbanas de baixa renda, indígenas, jovens e trabalhadores como protagonistas. O reconhecimento da VPSAT como importante fonte de dados e de intervenção pelos sistemas de saúde públicos e pela academia contribui para que a vigilância em saúde seja mais dialógica e efetiva.

Empowering frail older adults: multicomponent elastic-band exercises and BCAA supplementation unleash physical health and preserve haematological biomarkers.

The effectiveness of Branched Chain Amino Acids (BCAAs) supplementation on enhancing exercise performance in both young and older adults remains a topic of debate. Recent research suggests that BCAAs combined with regular exercise might have an impact on human erythropoiesis, blood dynamics, and iron homeostasis. Given the increasing longevity of the global population, it is crucial to investigate the potential benefits of BCAA supplementation and regular exercise as non-pharmacological interventions for improving the overall health of frail older adults. To assess the influence of a 40-week multicomponent exercise intervention (MEP) combined BCCA supplementation on the haematological indicators of frail older adults (83-93 years old) residing in nursing homes. A prospective, naturalistic, controlled clinical trial employing an intervention-washout-intervention was conducted for this purpose. The study included four experimental groups: MEP plus BCAA supplementation (MEP + BCAA, n = 8), MEP only (n = 7), BCAA supplementation only (n = 7), and control group non exercising (CG, n = 13). Fried's physical frailty (PF) protocol was employed to stratify the participants. Additionally, the assessment included the evaluation of nutritional status, comorbidities, and anthropometric measurements. Among the several haematological markers examined, only mean cellular Haemoglobin Concentration (MCH) [F = 4.09; p < 0.03] and Mean Cell haemoglobin Concentration (MCHC) [F = 10, 323; p < 0,0001] showed significant effects of time group. Our findings demonstrate that a long-term intervention with BCAA plus MEP did not lead to significant alterations in the haematological profile. An 8-week withdrawal from interventions did not affect the frailty status in the MEP and MEP + BCAA groups, whereas the control group exhibited an increase in PF status. The findings, demonstrating the potential pro-immune effect and maintenance of MCH and MCHC levels, highlight the relevance of incorporating exercise and nutritional strategies to promote healthy aging. This study contributes to the achievement of the United Nations Sustainable Development Goals 3 (good health and well-being) and 10 (reduced Inequalities) for all.

Selective versus strategic control against Rhipicephalus microplus in cattle: A comparative analysis of efficacy, animal health, productivity, cost, and resistance management.

This study compared selective control versus strategic control against Rhipicephalus (Boophilus) microplus, under conditions of a real dairy farm. Strategic control requires that all animals be treated with acaricide at regular pre-determined intervals. Selective control only requires treatment of infested animals and only when they are at or above a pre-determined threshold. Tick counts on animals and in pasture were performed and the susceptibility of tick populations to the different treatment methods was evaluated at the beginning and end of the study using the Larval Packet Test, Larval Immersion Test, and Adult Immersion Test. Over the four years of the study strategic control was more advantageous than the selective control as the group experienced lower tick burden on animals and in pasture, absence of skin lesions and myiases, lower operating costs, treatments concentrated in fewer months of the year and lower resistance pressure.

Treatment of Winery Wastewater by Combined Almond Skin Coagulant and Sulfate Radicals: Assessment of HSO5- Activators.

The large production of wine and almonds leads to the generation of sub-products, such as winery wastewater (WW) and almond skin. WW is characterized by its high content of recalcitrant organic matter (biodegradability index < 0.30). Therefore, the aim of this work was to (1) apply the coagulation-flocculation-decantation (CFD) process with an organic coagulant based on almond skin extract (ASE), (2) treat the organic recalcitrant matter through sulfate radical advanced oxidation processes (SR-AOPs) and (3) evaluate the efficiency of combined CFD with UV-A, UV-C and ultrasound (US) reactors. The CFD process was applied with variation in the ASE concentration vs. pH, with results showing a chemical oxygen demand (COD) removal of 61.2% (0.5 g/L ASE, pH = 3.0). After CFD, the germination index (GI) of cucumber and corn seeds was ≥80%; thus, the sludge can be recycled as fertilizer. The SR-AOP initial conditions were achieved by the application of a Box-Behnken response surface methodology, which described the relationship between three independent variables (peroxymonosulfate (PMS) concentration, cobalt (Co2+) concentration and UV-A radiation intensity). Afterwards, the SR-AOPs were optimized by varying the pH, temperature, catalyst type and reagent addition manner. With the application of CFD as a pre-treatment followed by SR-AOP under optimal conditions (pH = 6.0, [PMS] = 5.88 mM, [Co2+] = 5 mM, T = 343 K, reaction time 240 min), the COD removal increased to 85.9, 82.6 and 80.2%, respectively, for UV-A, UV-C and US reactors. All treated wastewater met the Portuguese legislation for discharge in a municipal sewage network (COD ≤ 1000 mg O2/L). As a final remark, the combination of CFD with SR-AOPs is a sustainable, safe and clean strategy for WW treatment and subproduct valorization.

Contributions of the analysis of discarded cigarette packages in household waste in the Brazilian city of Rio de Janeiro, Brazil, to estimate the illegal market. / Contribuições da análise de embalagens de cigarros descartadas nos resíduos domiciliares do Município do Rio de Janeiro, Brasil, para estimativa de mercado ilegal.

The illicit trade of tobacco products, by enabling access to cheaper cigarettes, favors smoking initiation and hinders its cessation, minimizing the effects of price policy and taxes on reducing the demand for tobacco. This is especially the case among populations with lower income and schooling, where smoking is concentrated. Its confrontation requires multisectoral actions, aligned with the World Health Organization Framework Convention on Tobacco Control, supported by estimates of the illicit trade magnitude and the analysis of its characteristics. This study analyzes, based on samples of household solid waste collected in 2018 in the city of Rio de Janeiro, Brazil, the conformity of discarded cigarette packages with criteria for their regular commercialization in Brazil, classifying them as legal or illegal. The evaluation was also carried out for the 15 Planning Areas (PA) of the municipality. The Social Progress Index (SPI) was chosen to represent heterogeneities among PA. The average percentage of illegal cigarette packs found was 26.79%, ranging from 3.36% to 46.29% among PA. The PAs with high illegality presented lower Social Progress Index and lower percentages of legal cigarette packages with a price equal to or greater than BRL 7.25. Among the illegal packages, 98.07% were manufactured in Paraguay. The study contributes methodologically to measure the consumption of illegal cigarettes in the second economic capital of Brazil, supporting the National Tobacco Control Policy in the struggle against illicit trade of tobacco products and in the effective implementation of the pricing and tax policy on these products.

O comércio ilícito de produtos de tabaco, ao possibilitar acesso a cigarros mais baratos, favorece a iniciação do tabagismo e dificulta sua cessação, minimizando os efeitos da política de preços e impostos sobre a redução da demanda por tabaco, sobretudo entre populações de menor renda e escolaridade, onde se concentra o tabagismo. Seu enfrentamento requer ações multissetoriais, alinhadas à Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde e seus protocolos, e respaldadas em estimativas de sua magnitude e na análise de suas características. O estudo pretende analisar, por meio de amostras de resíduos sólidos domiciliares coletados em 2018 no Município do Rio de Janeiro, Brasil, a conformidade das embalagens de cigarros descartadas com critérios para a sua comercialização regular no país, classificando-as como legais ou ilegais. A avaliação foi feita também para as 15 Áreas de Planejamento (AP) do município. Escolheu-se o Índice de Desenvolvimento Social (IDS) para representar as heterogeneidades entre as AP. O percentual médio de embalagens de cigarros ilegais encontrado foi de 26,79%, variando de 3,36% a 46,29% entre as AP. As AP com alta ilegalidade apresentavam menores IDS e menores percentuais de embalagens de cigarros legais com preço igual ou superior a R$ 7,25. Dentre as embalagens ilegais, 98,07% apresentavam o Paraguai como país fabricante. O estudo contribui metodologicamente para dimensionar o consumo de cigarros ilegais na segunda capital econômica do Brasil, subsidiando a Política Nacional de Controle do Tabaco no combate ao comércio ilícito de produtos de tabaco e na efetiva implementação da política de preços e impostos sobre estes produtos.

El comercio ilícito de productos del tabaco, al posibilitar el acceso a cigarrillos más baratos, favorece la iniciación del tabaquismo y dificulta la interrupción de su consumo, minimizando los efectos de la política de precios e impuestos sobre la reducción de la demanda de tabaco, sobre todo entre poblaciones de menor renta y escolaridad, donde se concentra el tabaquismo. Su combate requiere acciones multisectoriales, alineadas con la Convención-Marco para el Control del Tabaco de la Organización Mundia de la Salud, y sus protocolos, y respaldadas en estimaciones de su magnitud y en el análisis de sus características. El estudio pretende analizar, mediante muestras de residuos sólidos domiciliarios, recogidos en 2018 en el Municipio de Rio de Janeiro, Brasil, la conformidad de los paquetes de cigarrillos tirados a la basura con criterios para su comercialización regular en el país, clasificándolos como legales o ilegales. La evaluación se realizó también para las 15 Áreas de Planificación (AP) del municipio. Se escogió el Índice de Desarrollo Social (IDS) para representar heterogeneidades entre las AP. El porcentaje medio de paquetes de cigarrillos ilegales encontrado fue de un 26,79%, variando de 3,36% a 46,29% entre las AP. Las AP con alta ilegalidad presentaban menores IDS y menores porcentajes de paquetes de cigarrillos legales con un precio igual o superior a BRL 7,25. Entre los embalajes ilegales, un 98,07% presentaban Paraguay como el país fabricante. El estudio contribuye metodológicamente para dimensionar el consumo de cigarrillos ilegales en la segunda capital económica de Brasil, apoyando la Política Nacional de Control del Tabaco en el combate al comercio ilícito de productos del tabaco y en la efectiva implementación de la política de precios e impuestos sobre estos productos.

Avaliação de usuários sobre atributos da atenção primária à saúde bucal na Estratégia Saúde da Família / User evaluation on the attributes of primary care for oral health in the Family Health Strategy

Avaliação em saúde é uma importante ferramenta no processo de transformação e melhoria de um serviço de saúde. O PCATool (Instrumento de Avaliação da Atenção Primária) é um dos principais instrumentos usados para avaliar o primeiro nível de atenção à saúde. O objetivo do trabalho foi avaliar a Atenção Primária à Saúde Bucal em um Centro de Saúde da Família na perspectiva de usuários adultos. Trata-se de uma pesquisa transversal realizada em 2016 no Centro de Saúde da Família Francisco Moura Vieira em Sobral, Ceará. Para coleta dos dados foi usado o Instrumento de Avaliação da Atenção Primária - Saúde Bucal (PCATool-SB), versão usuário. Participaram do estudo 172 usuários. As análises dos resultados mostraram uma alta orientação à Atenção Primária à Saúde nos atributos de Primeiro Contato (Utilização) e Coordenação (Sistema de Informações), enquanto os demais atributos essenciais e derivados indicaram baixa orientação. Não houve associação entre os escores e as variáveis sociodemográficas. Conclui-se que há necessidade de restruturação da atenção prestada na unidade, principalmente na adequação da relação número de profissionais e demanda, a fim de melhorar o serviço de saúde ofertado aos usuários.

Health assessment is an important tool in the process of transformation and improvement of a health service. The PCATool (Primary Care Assessment Tool) is one of the main tools used to evaluate the first level of health care. The aim of the present paper is to evaluate the Primary Oral Health Care in a Family Health Center from the perspective of adult users. This is a cross-sectional study carried out in 2016 at the Francisco Moura Vieira Family Health Center in Sobral, Ceará. To collect the data, the Primary Care Assessment Tool - Oral Health (PCATool-SB), user version, was used. 172 users participated in the study. The analysis of the results showed a high orientation to Primary Health Care in the attributes of First Contact (Use) and Coordination (Information System), while the other essential and derivatives attributes indicated low orientation. There was no association between scores and sociodemographic variables. It is concluded that there is a need to restructure the care provided at the unit, mainly in the adequacy of the relationship between the number of professionals and demand, in order to improve the health service offered to users.

Assessment of pesticides in water using time-weighted average calibration of passive sampling device manufactured with carbon nanomaterial coating on stainless steel wire.

The continued contamination of water sources by pesticides is a problem that involves the life of aquatic organisms and human health, especially in countries whose economy is based on agriculture. The need to know the quality of drinking water under these circumstances is a priority for the public health of any community. Passive sampling methods allow the determination of long-term environmental pollutants through a single sample collection, reducing time and cost of analyses. One advantage of passive sampling is that it is possible to calculate a time-weighted average (TWA) concentration value or an equilibrium concentration value, depending on the type of device used and the exposure time. Passive sampling techniques using carbon nanomaterials (CNMs) have a high potential for pesticide sampling in aquatic systems. A device for passive sampling manufactured with CNMs in a microextraction system and recyclable materials was calibrated in laboratory exposure conditions over 15 days. The calibration results showed linear accumulation periods between 5 and 10 days. Sampling rates were between 0.014 and 0.146 mL day-1. The sampler was field-tested in the San Francisco river basin in the state of Minas Gerais in Brazil for 7 days. This research allowed for the detection and calculation of TWA concentrations for organochlorine pesticides such as α-HCH, 4,4-DDE, and 4,4-DD in water sources. The manufactured device demonstrated greater sensitivity than the grab sampling processes for the detection of pesticides. The performed passive sampling system using gas chromatography/mass spectrometry (GC/MS) technique allowed for the collection, detection, identification, and quantification of 26 pesticides.

ceRNA Network of lncRNA/miRNA as Circulating Prognostic Biomarkers in Non-Hodgkin Lymphomas: Bioinformatic Analysis and Assessment of Their Prognostic Value in an NHL Cohort.

Research has been focusing on identifying novel biomarkers to better stratify non-Hodgkin lymphoma patients based on prognosis. Studies have demonstrated that lncRNAs act as miRNA sponges, creating ceRNA networks to regulate mRNA expression, and its deregulation is associated with lymphoma development. This study aimed to identify novel circulating prognostic biomarkers based on miRNA/lncRNA-associated ceRNA network for NHL. Herein, bioinformatic analysis was performed to construct ceRNA networks for hsa-miR-150-5p and hsa-miR335-5p. Then, the prognostic value of the miRNA-lncRNA pairs' plasma levels was assessed in a cohort of 113 NHL patients. Bioinformatic analysis identified MALAT1 and NEAT1 as hsa-miR-150-5p and has-miR-335-5p sponges, respectively. Plasma hsa-miR-150-5p/MALAT1 and hsa-miR335-5p/NEAT1 levels were significantly associated with more aggressive and advanced disease. The overall survival and progression-free survival analysis indicated that hsa-miR-150-5p/MALAT1 and hsa-miR335-5p/NEAT1 pairs' plasma levels were remarkably associated with NHL patients' prognosis, being independent prognostic factors in a multivariate Cox analysis. Low levels of hsa-miR-150-5p and hsa-miR-335-5p combined with high levels of the respective lncRNA pair were associated with poor prognosis of NHL patients. Overall, the analysis of ceRNA network expression levels may be a useful prognostic biomarker for NHL patients and could identify patients who could benefit from more intensive treatments.

Contribuições da análise de embalagens de cigarros descartadas nos resíduos domiciliares do Município do Rio de Janeiro, Brasil, para estimativa de mercado ilegal / Contribuciones del análisis de paquetes de cigarrillos desechados como residuos domiciliarios en el Municipio de Rio de Janeiro, Brasil, para estimar mercado ilegal / Contributions of the analysis of discarded cigarette packages in household waste in the Brazilian city of Rio de Janeiro, Brazil, to estimate the illegal market

Resumo: O comércio ilícito de produtos de tabaco, ao possibilitar acesso a cigarros mais baratos, favorece a iniciação do tabagismo e dificulta sua cessação, minimizando os efeitos da política de preços e impostos sobre a redução da demanda por tabaco, sobretudo entre populações de menor renda e escolaridade, onde se concentra o tabagismo. Seu enfrentamento requer ações multissetoriais, alinhadas à Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde e seus protocolos, e respaldadas em estimativas de sua magnitude e na análise de suas características. O estudo pretende analisar, por meio de amostras de resíduos sólidos domiciliares coletados em 2018 no Município do Rio de Janeiro, Brasil, a conformidade das embalagens de cigarros descartadas com critérios para a sua comercialização regular no país, classificando-as como legais ou ilegais. A avaliação foi feita também para as 15 Áreas de Planejamento (AP) do município. Escolheu-se o Índice de Desenvolvimento Social (IDS) para representar as heterogeneidades entre as AP. O percentual médio de embalagens de cigarros ilegais encontrado foi de 26,79%, variando de 3,36% a 46,29% entre as AP. As AP com alta ilegalidade apresentavam menores IDS e menores percentuais de embalagens de cigarros legais com preço igual ou superior a R$ 7,25. Dentre as embalagens ilegais, 98,07% apresentavam o Paraguai como país fabricante. O estudo contribui metodologicamente para dimensionar o consumo de cigarros ilegais na segunda capital econômica do Brasil, subsidiando a Política Nacional de Controle do Tabaco no combate ao comércio ilícito de produtos de tabaco e na efetiva implementação da política de preços e impostos sobre estes produtos.

Resumen: El comercio ilícito de productos del tabaco, al posibilitar el acceso a cigarrillos más baratos, favorece la iniciación del tabaquismo y dificulta la interrupción de su consumo, minimizando los efectos de la política de precios e impuestos sobre la reducción de la demanda de tabaco, sobre todo entre poblaciones de menor renta y escolaridad, donde se concentra el tabaquismo. Su combate requiere acciones multisectoriales, alineadas con la Convención-Marco para el Control del Tabaco de la Organización Mundia de la Salud, y sus protocolos, y respaldadas en estimaciones de su magnitud y en el análisis de sus características. El estudio pretende analizar, mediante muestras de residuos sólidos domiciliarios, recogidos en 2018 en el Municipio de Rio de Janeiro, Brasil, la conformidad de los paquetes de cigarrillos tirados a la basura con criterios para su comercialización regular en el país, clasificándolos como legales o ilegales. La evaluación se realizó también para las 15 Áreas de Planificación (AP) del municipio. Se escogió el Índice de Desarrollo Social (IDS) para representar heterogeneidades entre las AP. El porcentaje medio de paquetes de cigarrillos ilegales encontrado fue de un 26,79%, variando de 3,36% a 46,29% entre las AP. Las AP con alta ilegalidad presentaban menores IDS y menores porcentajes de paquetes de cigarrillos legales con un precio igual o superior a BRL 7,25. Entre los embalajes ilegales, un 98,07% presentaban Paraguay como el país fabricante. El estudio contribuye metodológicamente para dimensionar el consumo de cigarrillos ilegales en la segunda capital económica de Brasil, apoyando la Política Nacional de Control del Tabaco en el combate al comercio ilícito de productos del tabaco y en la efectiva implementación de la política de precios e impuestos sobre estos productos.

Abstract: The illicit trade of tobacco products, by enabling access to cheaper cigarettes, favors smoking initiation and hinders its cessation, minimizing the effects of price policy and taxes on reducing the demand for tobacco. This is especially the case among populations with lower income and schooling, where smoking is concentrated. Its confrontation requires multisectoral actions, aligned with the World Health Organization Framework Convention on Tobacco Control, supported by estimates of the illicit trade magnitude and the analysis of its characteristics. This study analyzes, based on samples of household solid waste collected in 2018 in the city of Rio de Janeiro, Brazil, the conformity of discarded cigarette packages with criteria for their regular commercialization in Brazil, classifying them as legal or illegal. The evaluation was also carried out for the 15 Planning Areas (PA) of the municipality. The Social Progress Index (SPI) was chosen to represent heterogeneities among PA. The average percentage of illegal cigarette packs found was 26.79%, ranging from 3.36% to 46.29% among PA. The PAs with high illegality presented lower Social Progress Index and lower percentages of legal cigarette packages with a price equal to or greater than BRL 7.25. Among the illegal packages, 98.07% were manufactured in Paraguay. The study contributes methodologically to measure the consumption of illegal cigarettes in the second economic capital of Brazil, supporting the National Tobacco Control Policy in the struggle against illicit trade of tobacco products and in the effective implementation of the pricing and tax policy on these products.

Pediatric transplantation in Europe during the COVID-19 pandemic: Early impact on activity and healthcare.

The current pandemic SARS-CoV-2 has required an unusual allocation of resources that can negatively impact chronically ill patients and high-complexity procedures. Across the European Reference Network on Pediatric Transplantation (ERN TransplantChild), we conducted a survey to investigate the impact of the COVID-19 outbreak on pediatric transplant activity and healthcare practices in both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT). The replies of 30 professionals from 18 centers in Europe were collected. Twelve of 18 centers (67%) showed a reduction in their usual transplant activity. Additionally, outpatient visits have been modified and restricted to selected ones, and the use of telemedicine tools has increased. Additionally, a total of 14 COVID-19 pediatric transplanted patients were identified at the time of the survey, including eight transplant recipients and six candidates for transplantation. Only two moderate-severe cases were reported, both in HSCT setting. These survey results demonstrate the limitations in healthcare resources for pediatric transplantation patients during early stages of this pandemic. COVID-19 disease is a major worldwide challenge for the field of pediatric transplantation, where there will be a need for systematic data collection, encouraging regular discussions to address the long-term consequences for pediatric transplantation candidates, recipients, and their families.

Ochratoxin A in Beers Marketed in Portugal: Occurrence and Human Risk Assessment.

Ochratoxin A (OTA) is produced by fungi present in several agricultural products with much relevance to food safety. Since this mycotoxin is widely found in cereals, beer has a potential contamination risk. Therefore, it was deemed essential to quantify, for the first time, the levels of OTA in beer, a cereal-based product that is marketed in Portugal, as well as to calculate the human estimated weekly intake (EWI) and risk assessment. A total of 85 samples were analyzed through immunoaffinity clean-up, followed by liquid chromatography-fluorescence detection (LC-FD). This analytical methodology allowed a limit of quantification (LOQ) of 0.43 µg/L. The results showed that 10.6% were contaminated at levels ranging between

Development of a Healthy Lifestyle Assessment Toolkit for the General Public.

The prevalence of age-related non-communicable chronic diseases has increased worldwide, being the leading causes of morbidity and death in many world regions, including in Europe. Innovative models and strategies focused on preventive care, including early identification of risk factors underlying disease onset and progression, and proper modification of lifestyle habits and behaviors, might contribute to promote quality of life, healthy living and active aging. Healthy Lifestyle Innovative Quarters for Cities and Citizens (HeaLIQs4cities) is an EIT Health-funded project aiming to engage, empower and educate citizens toward healthy lifestyles. One of the major objectives of this project was to develop a toolkit for a rapid and informal assessment of healthy lifestyles, to be used at different levels of care pathways, including in informal public environments. In this paper, we describe the methodology underlying the development of the toolkit, which resulted from the collaboration of an interdisciplinary focus group of academic experts, from medicine, sport sciences, psychology, health economics, and innovative technologies applied to health. The following eight components were included in the toolkit: (1) anthropometric assessment and cardiometabolic parameters; (2) physical activity and exercise; (3) well-being, social cohesion, and functional independence; (4) nutrition; (5) mental health; (6) smoking, drinking, and use of illicit substances; (7) sleep habits and quality; and (8) health and disease. A traffic light rating system indicating the risk score was used (low: green; moderate: yellow; and relevant: orange) for each of the 8 components, together with recommendations for the toolkit users. After completing the reduced version of the toolkit, individuals showing moderate or relevant risk in one or more of the 8 dimensions, were invited to participate in a more detailed assessment (toolkit long version), based on deeper and scientifically validated tools. The toolkit was incorporated in eVida, a web-based platform that focuses on delivering services to personalized health and well-being. The validation of the current toolkit has been applied in wide-ranging public events in three different European Regions. Large scale deployment of the toolkit is expected to profit from the Reference Site Collaborative Network of the European Innovation Partnership on Active and Healthy Aging (EIP on AHA).

Development of a low-cost electrochemical sensor based on babassu mesocarp (Orbignya phalerata) immobilized on a flexible gold electrode for applications in sensors for 5-fluorouracil chemotherapeutics.

There are increasing concerns regarding the risks arising from the contamination of manipulators of antineoplastic drugs promoted by occupational exposure or even in the dosage of drugs. The present work proposes the use of an electrochemical sensor based on a biopolymer extracted from the babassu coconut (Orbignya phalerata) for the determination of an antineoplastic 5-fluorouracil (5-FU) drug as an alternative for the monitoring of these drugs. In order to reduce the cost of this sensor, a flexible gold electrode (FEAu) is proposed. The surface modification of FEAu was performed with the deposition of a casting film of the biopolymer extracted from the babassu mesocarp (BM) and modified with phthalic anhydride (BMPA). The electrochemical activity of the modified electrode was characterized by cyclic voltammetry (CV), and its morphology was observed by atomic force microscopy (AFM). The FEAu/BMPA showed a high sensitivity (8.8 µA/µmol/L) and low limit of detection (0.34 µmol/L) for the 5-FU drug in an acid medium. Electrochemical sensors developed from the babassu mesocarp may be a viable alternative for the monitoring of the 5-FU antineoplastic in pharmaceutical formulations, because in addition to being sensitive to this drug, they are constructed of a natural polymer, renewable, and abundant in nature. Graphical abstract ᅟ.

Daily hematologic assessment during a 230-km multistage ultramarathon / Avaliação hematológica diária durante uma ultramaratona de múltiplos estágios de 230 km / Evaluación hematológica diaria durante una ultramaratón de múltiples etapas de 230 km

ABSTRACT Introduction: The popularity of ultra-endurance events is increasing worldwide. However, information about hematological parameters during repeated bouts of long-duration running, such as stages during a multi-stage ultramarathon (MSUM) is scarce. Objective: The purpose of the study was to monitor daily hematologic assessment in a 230-km multistage ultramarathon (MSUM) in hot environmental conditions. Methods: Eleven male and three female (n = 14) ultra-endurance runners entered this MSUM, which was conducted over five stages, covering a total distance of 230 km in hot ambient conditions. Peripheral blood samples were collected before and after each stage to determine leukocyte and erythrocytes parameters. Results: Multilevel modelling considering all measurement points showed an increase for whole blood leukocyte and granulocyte counts at five stages of the MSUM and for monocytes until Stage 3 of the race. For erythrocyte parameters, decreases across stages were observed in hemoglobin concentration and hematocrit responses when computing/considering all measurement points. Conclusions: The results indicate that MSUM in a hot environment leads to a greater impact on leukocyte population responses and platelet variation in the initial stages of the race. We suggest that athletes may have a decrease in immune function in the early stages of the MSUM, probably with some transient risk of infectious. Nevertheless, a physiological adaptation to physical exertion and heat mitigates these changes in the subsequent stages of MSUM. Level of Evidence III; Case-control study.

RESUMO Introdução: A popularidade dos eventos de ultra-resistência está aumentando em todo o mundo. Entretanto, faltam informações sobre os parâmetros hematológicos durante episódios repetidos de corridas de longa duração, como, por exemplo, os estágios durante uma ultramaratona de múltiplos estágios (MSUM). Objetivo: O objetivo do estudo foi monitorar a avaliação hematológica diária em uma ultramaratona de múltiplos estágios (MSUM) de 230 km sob condições climáticas quentes. Métodos: Onze corredores e três corredoras de -ultra-resistência (n = 14) participaram dessa MSUM, em cinco estágios, totalizando uma distância de 230 km sob condições climáticas quentes. As amostras de sangue periférico foram coletadas antes e após cada estágio para determinação dos parâmetros de leucócitos e eritrócitos. Resultados: O modelo multinível considerando todos os pontos de medição apresentou um aumento na contagem de leucócitos e granulócitos do sangue total nos cinco estágios da MSUM e para os monócitos até o estágio três da competição. Para os parâmetros dos eritrócitos, foram observadas reduções através dos estágios na concentração de hemoglobina e nas respostas do hematócrito ao se contabilizar/considerar todos os pontos de medição. Conclusões: Os resultados indicam que a MSUM em condições climáticas quentes exerce um maior impacto nas respostas da população de leucócitos e na variação plaquetária nos estágios iniciais da competição. Sugerimos que os atletas podem ter uma diminuição na função imune nos estágios iniciais da MSUM, provavelmente, com algum risco transitório de infecção. No entanto, uma adaptação fisiológica para o esforço físico e calor minimiza essas alterações nos estágios seguintes da MSUM. Nível de Evidência III; Estudo caso-controle.

RESUMEN Introducción: La popularidad de los eventos de ultra resistencia está aumentando en todo el mundo. Entretanto, faltan informaciones sobre los parámetros hematológicos durante episodios repetidos de carreras de larga duración, como por ejemplo, las etapas de una ultramaratón de múltiples etapas (MSUM). Objetivo: El objetivo del estudio fue monitorizar la evaluación hematológica diaria en una ultramaratón de múltiples etapas (MSUM) de 230 km bajo condiciones climáticas cálidas. Métodos: Once corredores y tres corredoras de ultra resistencia (n = 14) participaron en esa MSUM, en cinco etapas, totalizando una distancia de 230 km bajo condiciones climáticas cálidas. Las muestras de sangre periférica fueron colectadas antes y después de cada etapa para determinación de los parámetros de leucocitos y eritrocitos. Resultados: El modelo multinivel considerando todos los puntos de medición presentó un aumento en el conteo de leucocitos y granulocitos de la sangre total en las cinco etapas de la MSUM y para los monocitos hasta la etapa 3 de la competencia. Para los parámetros de eritrocitos, fueron observadas reducciones a través de las etapas en la concentración de hemoglobina y en las respuestas de hematocrito al contabilizar/considerar todos los puntos de medición. Conclusiones: Los resultados indican que la MSUM en condiciones climáticas cálidas ejerce un mayor impacto en las respuestas de la población de leucocitos y en la variación plaquetaria en las etapas iniciales de la competencia. Sugerimos que los atletas pueden tener una disminución en la función inmune en las etapas iniciales de la MSUM probablemente con algún riesgo transitorio de infección. Sin embargo, una adaptación fisiológica para el esfuerzo físico y el calor, minimiza esas alteraciones en las etapas siguientes de la MSUM. Nivel de Evidencia III; Estudio de caso-control.

Iniquidades na assistência odontológica ao longo do curso de vida de jovens: um estudo de coorte / Inequalities in dental care during the life course of young people: a cohort study

Resumo O objetivo deste estudo foi investigar a assistência odontológica sob a perspectiva do "life course", bem como seus fatores determinantes, em jovens no município de Sobral, Ceará, Brasil. Realizou-se um estudo de coorte com ondas em 2000, 2006 e 2012 com 482 jovens atualmente entre 17 e 21 anos. Foram investigados dois desfechos: a assistência odontológica imediata e a ausência de assistência odontológica, baseados na trajetória dentária em relação ao tratamento restaurador. E como variáveis independentes, utilizaram-se as condições socioeconômicas e utilização de serviços e ações de saúde bucal nas três ondas investigadas. Observou-se que piores condições socioeconômicas ao longo da vida apresentaram-se como fator de risco para ausência da assistência odontológica e o efeito inverso foi observado com a imediata. A participação em grupos de adolescentes também apresentou relação com a maior assistência odontológica, bem como receber informação sobre saúde bucal. Este estudo revelou a presença de iniquidades na assistência odontológica ao longo da vida da população estudada.

Abstract The scope of this study was to investigate dental care from the life course perspective and its determinant factors among young people in the city of Sobral, State of Ceará, Brazil. A cohort study was conducted with waves in 2000, 2006 and 2012 with 482 young people aged between 17 and 21 years. Two outcomes were investigated: immediate dental care and the lack of dental care, based on the dental trajectory in relation to restorative treatment. Socioeconomic conditions and recourse to oral health services and actions in the three waves investigated were used as independent variables. It was found that low socioeconomic status throughout life presented itself as a risk factor for lack of dental care and the inverse effect was observed with immediate dental care. Participation in groups of teenagers was also related to dental care, as well as receiving information on oral health. This study revealed the presence of inequalities in dental care throughout the life course of the population assessed.

Trends in the scientific production on aquatic microhabitats phytotelmata: a scientometric study / Tendências na produção científica sobre microhabitats fitotelmata: um estudocienciométrico

We performed a scientometry to validate trends in the scientific production on phytotelmata and the importance of these microenvironments in the maintenance of biodiversity. We searched for articles in the Web of Science and looked at publications from 1987 to 2016. We collected years of publication, surveyed organisms, countries where the surveys took place, plants that accumulate phytotelmata, scientific journals that publish more about the topic and their respective IFs (Impact Factor) and the keywords of each article. We built a heatmap using the most frequent keywords in the studies, to investigate the topics studied over the years. We have found 293 publications, increasing over the years. Insects, anurans and crustaceans were the most studied organisms. The most studied plant families were Bromeliaceae, Poaceae and Apiaceae. The published studies analized were carried out mainly in Brazil, Argentina and Peru. The most published journals on the subject are: Zootaxa, Hydrobiologia, Biotropica and Journal of Natural History. Some main global concerns such as climate change, habitat fragmentation has gained the attention of the phytotelmata studies in the recent years. The results contribute to the knowledge about phytotelmata accumulated biodiversity and research trends.

Realizamos uma cienciometria para demonstrar tendências na produção científica sobre fitotelmata e a importância desses microambientes na manutenção da biodiversidade. Buscamos artigos no Web of Science e analisamos publicações de 1987 até 2016. Coletamos os anos de publicação, organismos estudados, países onde ocorreram as pesquisas, plantas que acumulam fitotelmata, revistas científicas que mais publicam sobre o tema e seus respectivos FIs (Fator de Impacto) e as palavras-chave de cada artigo. Fizemos um heatmap, utilizando as palavras-chave mais frequentes nos estudos, para investigar os tópicos estudados ao longo dos anos. Encontramos 293 publicações, com aumento ao longo dos anos. Os insetos, anuros e crustáceos foram os organismos mais estudados. As famílias de plantas mais estudadas foram Bromeliaceae, Poaceae e Apiaceae. As pesquisas foram realizadas, principalmente, no Brasil, na Argentina e no Peru. Os periódicos que mais publicam sobre o tema são: Zootaxa, Hydrobiologia, Biotropica e Journal of Natural History. Os resultados contribuem para o conhecimento sobre a biodiversidade acumulada em fitotelmata e tendências nas pesquisas.

Labor market integration, immigration experience, and psychological distress in a multi-ethnic sample of immigrants residing in Portugal.

OBJECTIVES: This study aims at examining how factors relating to immigrants' experience in the host country affect psychological distress (PD). Specifically, we analyzed the association among socio-economic status (SES), integration in the labor market, specific immigration experience characteristics, and PD in a multi-ethnic sample of immigrant individuals residing in Lisbon, Portugal. DESIGN: Using a sample (n = 1375) consisting of all main immigrant groups residing in Portugal's metropolitan area of Lisbon, we estimated multivariable linear regression models of PD regressed on selected sets of socio-economic independent variables. A psychological distress scale was constructed based on five items (feeling physically tired, feeling psychologically tired, feeling happy, feeling full of energy, and feeling lonely). RESULTS: Variables associated with a decrease in PD are being a male (demographic), being satisfied with their income level (SES), living with the core family and having higher number of children (social isolation), planning to remain for longer periods of time in Portugal (migration project), and whether respondents considered themselves to be in good health condition (subjective health status). Study variables negatively associated with immigrants' PD were job insecurity (labor market), and the perception that health professionals were not willing to understand immigrants during a clinical interaction. CONCLUSION: The study findings emphasized the importance of labor market integration and access to good quality jobs for immigrants' psychological well-being, as well as the existence of family ties in the host country, intention to reside long term in the host country, and high subjective (physical) health. Our research suggests the need to foster cross-national studies of immigrant populations in order to understand the social mechanisms that transverse all migrant groups and contribute to lower psychological well-being.

[Inequalities in dental care during the life course of young people: a cohort study]. / Iniquidades na assistência odontológica ao longo do curso de vida de jovens: um estudo de coorte.

The scope of this study was to investigate dental care from the life course perspective and its determinant factors among young people in the city of Sobral, State of Ceará, Brazil. A cohort study was conducted with waves in 2000, 2006 and 2012 with 482 young people aged between 17 and 21 years. Two outcomes were investigated: immediate dental care and the lack of dental care, based on the dental trajectory in relation to restorative treatment. Socioeconomic conditions and recourse to oral health services and actions in the three waves investigated were used as independent variables. It was found that low socioeconomic status throughout life presented itself as a risk factor for lack of dental care and the inverse effect was observed with immediate dental care. Participation in groups of teenagers was also related to dental care, as well as receiving information on oral health. This study revealed the presence of inequalities in dental care throughout the life course of the population assessed.

O objetivo deste estudo foi investigar a assistência odontológica sob a perspectiva do "life course", bem como seus fatores determinantes, em jovens no município de Sobral, Ceará, Brasil. Realizou-se um estudo de coorte com ondas em 2000, 2006 e 2012 com 482 jovens atualmente entre 17 e 21 anos. Foram investigados dois desfechos: a assistência odontológica imediata e a ausência de assistência odontológica, baseados na trajetória dentária em relação ao tratamento restaurador. E como variáveis independentes, utilizaram-se as condições socioeconômicas e utilização de serviços e ações de saúde bucal nas três ondas investigadas. Observou-se que piores condições socioeconômicas ao longo da vida apresentaram-se como fator de risco para ausência da assistência odontológica e o efeito inverso foi observado com a imediata. A participação em grupos de adolescentes também apresentou relação com a maior assistência odontológica, bem como receber informação sobre saúde bucal. Este estudo revelou a presença de iniquidades na assistência odontológica ao longo da vida da população estudada.

Brazil: balance of the National Tobacco Control Policy in the last decade and dilemmas. / Brasil: balanço da Política Nacional de Controle do Tabaco na última década e dilemas.

Since 2005, Brazil has been a Party of the World Health Organization Framework Convention on Tobacco Control, an international treaty whose measures are the foundation of the National Tobacco-Control Policy (NTCP), of Brazil. The results evidence a significant decrease in the prevalence of smokers and in tobacco-related morbidity and mortality. These results, however, could have been even better if there wasn't the interference of the tobacco supply chain (TSC), controlled by transnational corporations, which has become more intense over the last 10 years. These companies made Brazil not only a repository for tobacco, but also for economic and political power capable of threatening NTCP achievements. This Essay recounts the development of NTCP and the tobacco supply chain modus operandi to hamper it, and discusses how the strengthening of policies to promote alternative crops for tobacco could shield NTCP from such interference.