Obesity and health service utilization in Brazil: data from the National Health Survey.

BACKGROUND: Obesity, a complex public health problem, is generally associated with other chronic diseases. The association of obesity with health service utilization has been little investigated in low- and middle-income countries. This study aimed to analyze the association between obesity and health service utilization (considering those services related to hypertension and/or diabetes). METHODS: A cross-sectional, nationally-representative, study of Brazilians aged ≥18 years was conducted. Data from the National Health Survey (2013) for 59,402 individuals were analyzed, including measured weight and height. The association between body mass index (BMI) category (under/normal weight, overweight, and obesity) and health service utilization due to hypertension and/or diabetes was investigated using Poisson regression models (crude and adjusted). To analyze the health services utilization, the following variables were considered: 1) routine visits to a general doctor or health service; 2) referrals/consultations with a specialist; 3) prescribed exams done; and 4) hospital admission due to the disease or related complication. All analyses were stratified by sex. RESULTS: Compared with under/normal-weight individuals, subjects with obesity (both male and female) made roughly double the use of all health care services assessed. Men with hypertension that had obesity had a higher risk of hospital admission (adjusted PR = 2.55; 95%CI 1.81-3.61), than those with under/normal weight. Women with diabetes that had obesity had more referrals/consultations with specialists (adjusted PR = 2.56; 95%CI 1.94-3.38), than those with under/normal weight. CONCLUSIONS: The presence of obesity was associated with increased use of health care services for hypertension and/or diabetes, indicating greater demand for human resources and materials, and a greater burden on the national health system.

A new species of Wallinia Pearse, 1920 (Digenea: Allocreadiidae), in Astyanax bimaculatus (Linnaeus, 1758) (Characidae) in Northeast Brazil, based on morphology and DNA sequences.

Wallinia caririensis n. sp. is described from the intestine of Astyanax bimaculatus (Linnaeus, 1758) (Characidae) collected in the Batateiras River in the municipality of Crato, Ceará state, Brazil. The description was based on integrative taxonomy approach using DNA sequences from the D1-D3 domains of the 28S rDNA gene. The new species was confirmed through the phylogenetic analysis of the 28S rDNA gene, which showed that Wallinia caririensis n. sp. is a sister taxon of Wallinia brasiliensis (Dias, Müller, Almeida, Silva, Azevedo, Pérez-Ponce de León, and Abdallah, 2018, and Wallinia anindoi Hernández-Mena, Pinacho-Pinacho, García-Varela, Mendonza-Garfias, and Pérez-Ponce de León, 2019), a species which parasitizes Astyanax fasciatus (Cuvier, 1819), A. lacustris (Lucena and Soares, 2016) in Brazil, and A. aeneus (Günther, 1860) in Mexico, with genetic divergences of 2% and 3%, respectively. The new species can be distinguished morphologically from its congeners by possessing large body size (length and width) and tapered extremity in the posterior end of the body, eyespots are present at the pharynx level, and vitelline follicles reach up to the half distance between the posterior testis and the extremity of the body, by having larger testes distributed in coincident zones (i.e., contiguous) and non-operculated eggs (a conspicuous characteristic in W. brasiliensis). To date, species of this genus have already been described in freshwater fishes from Mexico, Costa Rica, Venezuela, and Southeastern Brazil. The species described in this study consists of the second species parasitizing characids in Brazil, and the first record in Northeastern Brazil. This finding fills a gap and expands the biogeographic distribution of the genus Wallinia in South America.

Ecological light pollution affects anuran calling season, daily calling period, and sensitivity to light in natural Brazilian wetlands.

Ecological light pollution alters an environment's light cycle, potentially affecting photoperiod-controlled behavior. Anurans, for example, generally breed nocturnally, and the influence of light pollution on their natural history may therefore be especially strong. In this study, we tested this hypothesis by measuring male calling behavior of anuran communities in natural wetlands in southern Brazil exposed or not exposed to street lights. We recorded seasonal and diel calling activity and calling response to a light pulse. The peak calling season differed between continuously lit and unlit locations with most species in illuminated wetlands shortening their calling season and calling earlier in the year. In unlit breeding sites, Boana pulchella, Pseudis minuta, and Pseudopaludicola falcipes confined their calling activity to well-defined hours of the night, but in continuously lit areas, these species called more continuously through the night. A 2-minute light pulse inhibited calling, but only in unlit wetlands. After a light pulse, frogs quickly resumed calling-suggesting acclimatization to brief artificial light exposure. Our field experiment presents a convincing example of ecological light pollution showing that artificial light alters the seasonal and diel calling time of some South American wetland anurans. It also documents their acclimatization to brief lighting when being continuously exposed to light.

A new species of Wallinia Pearse, 1920 (Digenea: Allocreadiidae) collected from Astyanax fasciatus (Cuvier, 1819) and A. lacustris Lucena and Soares, 2016 (Characiformes: Characidae) in Brazil based on morphology and DNA sequences.

Wallinia brasiliensis n. sp. is described from the intestine of two species of tetras-Astyanax fasciatus (Cuvier, 1819) and Astyanax lacustris Lucena and Soares, 2016-collected from the Batalha River in São Paulo State, Brazil. The new species can be clearly distinguished from the other three congeneric species by its vitelline follicles extending from the genital pore to the end of the caeca, eggs lacking operculum, a larger egg size with a consequently lower number relative to the other three species, and the ovary located opposite the anterior testis. The validity of the new species was confirmed through a phylogenetic analysis of the 28S rRNA gene which showed that the new species is the sister taxon to Wallinia mexicana Pérez-Ponce de León, Razo-Mendivil, Mendoza-Garfía, Rubio-Godoy and Choudhury, 2015, a species infecting Astyanax mexicanus (De Filippi, 1853) in Mexico.

Parasitic communities of Hoplosternum littorale (Hancock, 1828) as indicators of environmental impact.

The parasites are indicative of several biological aspects of their hosts, including their diet, migration, recruitment and phylogeny, but they can also be direct indicators of the environmental quality. Hoplosternum littorale is a fish that has a high commercial value in some South American countries. The fishes were collected from January to July 2012, in two locations of the Peixe River in the municipality of Anhembi, State of São Paulo, Brazil, which had different environmental and limnological characteristics (river mouth and Lagoa Cabeça de Boi). An amount of 30 fish specimens were captured in each location for the analysis of their parasitic fauna. Nine species of metazoan parasites were collected. Both Brillouin`s diversity index and Margalef`s richness index were greater in the Lagoa Cabeça de Boi. The ratio of heteroxenous and monoxenous parasite species richness (SH/SM) was higher in the Lagoa Cabeça de Boi. The results of the physicochemical analysis of the water showed that the mouth of the Peixe River can be considered an area that suffers more from anthropogenic actions than the Lagoa da Cabeça de Boi. Proteocephalus sp., Gyrodactylus sp., Scleroductus sp. and Capillaria (Neocapillaria) pterophylli are being registered for the first time in this host.

NO Exchange for a Water Molecule Favorably Changes Iontophoretic Release of Ruthenium Complexes to the Skin.

Ruthenium (Ru) complexes have been studied as promising anticancer agents. Ru nitrosyl complex (Ru-NO) is one which acts as a pro-drug for the release of nitric oxide (NO). The Ru-aqueous complex formed by the exchange of NO for a water molecule after NO release could also possess therapeutic effects. This study evaluates the influence of iontophoresis on enhancing the skin penetration of Ru-NO and Ru-aqueous and assesses its applicability as a tool in treating diverse skin diseases. Passive and iontophoretic (0.5 mA·cm-2) skin permeation of the complexes were performed for 4 h. The amount of Ru and NO in the stratum corneum (SC), viable epidermis (VE), and receptor solution was quantified while the influence of iontophoresis and irradiation on NO release from Ru-NO complex was also evaluated. Iontophoresis increased the amount of Ru-NO and Ru-aqueous recovered from the receptor solution by 15 and 400 times, respectively, as compared to passive permeation. Iontophoresis produced a higher accumulation of Ru-aqueous in the skin layers as compared to Ru-NO. At least 50% of Ru-NO penetrated the SC was stable after 4 h. The presence of Ru-NO in this skin layer suggests that further controlled release of NO can be achieved by photo-stimulation after iontophoresis.

The use of reverse logistics for waste management in a Brazilian grocery retailer.

Retail growth is a result of the diversification of departments with the intention to look to consumer's needs and level of demand. Pressed by consumers and by the law, the adoption of environmental preservation practices is becoming stronger among grocery retailers. The objective of this research was to analyse the practices of reverse logistics performed by a retailer and measure the amount of waste generated by each department. To reach the proposed goal, a field research study was conducted to directly observe a grocery retailer in the state of Sao Paulo, Brazil, for a period of 6 months and monitor the amounts of cardboard and plastic discarded by each department. Using the Wuppertal method, the first result observed was that the retailer stopped its monthly production of approximately 20 tonne of biotic and abiotic material, which influence global warming and degradation of the ozone layer. Another result observed with the implementation of reverse logistics, was that the general grocery department mostly used cardboard and plastic. This sector includes products such as food cupboard, drinks, household, health and beauty, and pet articles. The fresh fruit and vegetable department and the meat, chicken and frozen department were increasingly using less plastic and cardboard packaging, increasing the use of returnable and durable packaging and thus promoting sustainability.

Effect of coronaviruses on blood vessel permeability: potential therapeutic targets.

Coronavirus-induced diseases have afflicted humanity for several decades. This scenario was aggravated by the emergence of the coronavirus disease 2019 (named COVID-19) in Wuhan, China, in December 2019. Since then, COVID-19 has killed millions of people worldwide, probably the most devastating pandemic since HIV/AIDS. This review aimed to bring together important updated aspects related to coronavirus-induced diseases and the enhanced vascular permeability observed mainly in the lungs of affected people. The dysregulated vascular permeability in the lungs is of fundamental importance for coronaviruses-caused morbidity and mortality. Thus, as described in this review, it is a target of new and old drugs.

Weight Gain and Change in Body Mass Index after Age 20 in the Brazilian Population and Associated Sociodemographic Factors: Data from the National Health Survey.

Obesity is considered one of the main contemporary public health problems. We aim to assess changes in body weight and nutritional status in adulthood and the associated sociodemographic variables. We use data from the 2013 National Health Survey (n = 21,743). Changes in weight and body mass index (BMI) were calculated based on mean difference between measurements at age 20 and data collected at the interview, stratified by sex. The association was analyzed using linear regression. Mean weight gain was greater among women than men. The largest gain was verified among the younger adults for both sexes. Age was found to be associated with weight and BMI change in men and women where, for every additional year of age, there was an increase in weight and BMI of 0.10 kg and 0.04 kg/m2 in men and of 0.22 kg and 0.09 kg/m2 in women, respectively. For education, a direct association was found for men and an inverse for women. Association with area of residence was significant among males only, where rural men gained less than their urban counterparts. Weight gain was progressive, being more marked in the younger group, and was associated with education differently according to sex.

Medication use and obesity in Brazil: results from the National Health Survey.

Noncommunicable diseases (NCDs) associated with obesity generally require drug treatment. The use of medications in individuals with obesity has not been extensively investigated. The objective of this study was to analyze the relation between obesity and medication use. Data from the Brazilian National Health Survey 2013 was used, including 59,402 individuals. Weight and height measures were used to calculate body mass index (BMI) and categorized individuals according to BMI classification (exposure). The number of medications used for treating nine obesity-related NCDs was the outcome variable. Multinomial regression analyses were performed. The risk of use of medications to treat at least one NCD increased progressively with rising BMI, where this risk was even higher for treating two or more diseases. The risk of having to treat two or more NCDs with medications was approximately 70% greater among individuals with overweight (adjusted RR = 1.66; 95%CI 1.46-1.89), 170% greater in those with class I obesity (adjusted RR = 2.68; 95%CI 2.29-3.12), 340% greater for class II obesity (adjusted RR = 4.44; 95%CI 3.54-5.56) and 450% greater among individuals with class III obesity (adjusted RR = 5.53; 95%CI 3.81-8.02), compared with normal-weight subjects. Obesity was directly associated with drug utilization and the number of medications used to treat obesity-related NCDs.

Solvent influence on molecular interactions in the bulk of fluorene copolymer films.

The effect of intermolecular interactions between the chains of the amorphous PFO-MEH-PPV films built from toluene and tetrahydrofuran (THF) were studied by atomistic molecular dynamics simulations, applying a successive solvent removal procedure. In the good solvent toluene, the incidence of topological entanglements is more significant. While in the poor solvent, coplanar interactions between neighbouring segments of the chains were also found, which is characteristics of cohesional entanglements. Structure factor curves of the films showed three peaks associated with the microstructure of the film, as previously reported by WAX diffractogram measurements. Moreover, the good solvent promotes more flexibility in dihedral angles, and the chains become nearer to each other.

Relationships between nursing diagnoses and the level of dependence in activities of daily living of elderly residents.

OBJECTIVE: To identify and validate nursing diagnoses of elderly residents, and determine their relationship with the level of dependence in activities of daily living. METHODS: One hundred thirty-five older adults were assessed using medical history and physical examination. Twelve validated gerontological instruments were administered to assess delirium, nutritional status, risk for falls, risk for pressure injury, dementia, cognitive losses, depression, and level of dependence in daily living and instrumental activities of daily living. Nursing diagnoses were identified and validated by experienced, doctorally-prepared nurses. The association between the presence of a nursing diagnosis and the level of dependence was assessed by a test for trend in proportions. The Kruskal-Wallis hypothesis test was used to investigate the association between the number of nursing diagnoses and the level of dependence of the elderly. RESULTS: Most older adults were at risk for malnutrition, at high risk for falls, cognitively impaired, totally dependent for daily living and activities of daily living. In addition, they had very mild dementia and most did not have risk for pressure injuries. Depression was noted among those with dementia, but was absent in those without dementia. A total of 52 nursing diagnoses were validated. Of these, 11 were associated with the level of dependence in daily living. CONCLUSION: These results can be reproduced in other skilled nursing facilities for older adults, and these may allow the planning of interventions to alleviate etiologies and signs/symptoms of nursing diagnoses, rather than simply directing care toward a general category of dependence. Therefore, guaranteeing individualized nursing care to meet the specific needs of each resident.

Synthesis and spectral investigation of Al(III) catechin/beta-cyclodextrin and Al(III) quercetin/beta-cyclodextrin inclusion compounds.

Al-catechin/beta-cyclodextrin and Al-quercetin/beta-cyclodextrin (beta-CD) inclusion compounds were synthesized and characterized by IR, UV-vis, 1H and 13C NMR and TG and DTA analyses. Because quercetin is sparingly soluble in water, the stability constants of the Al-quercetin/beta-CD and Al-catechin/beta-CD compounds were determined by phase solubility studies. The AL-type diagrams indicated the formation of 1:1 inclusion compounds and allowed calculation of the stability constants. The thermodynamic parameters were obtained from the dependence of the stability constants on temperature and results indicated that the formation of the inclusion compounds is an enthalpically driven process. The thermal decomposition of the solid Al-quercetin/beta-CD and Al-catechin/beta-CD inclusion compounds took place at different stages, compared with the respective precursors, proving that an inclusion complexation process really occurred.

Iontophoresis-stimulated silk fibroin films as a peptide delivery system for wound healing.

Silk fibroin (SF) films containing a peptide, neurotensin (NT), stimulated by iontophoresis were developed aiming to modulate the inflammatory process and prevent the growth of microorganisms typical of wounds. NT-loaded SF films composition shows predominance of ß-sheet structures that conferred adequate mechanical properties, transparency, moderate roughness and low swelling index to fibroin films. Infrared spectroscopy and thermal analysis suggested the presence of non-covalent interactions between NT and fibroin. Using the MALDI imaging technique, it was possible to visualize the homogeneous NT distribution throughout the film surface, in addition to its prolonged release for up to 72 h. In vitro studies in E. coli liposaccharide-stimulated macrophages showed a significant reduction of interleukins production after NT-loaded film application, whereas NT solution did not reduce them. Bi-laminated NT-loaded fibroin films containing silver electrodes provided a burst release of NT when anodic iontophoresis was applied, enabling a rapid onset of drug action. In addition, anodic iontophoresis presented a bacteriostatic effect against gram-positive microorganisms. Different iontophoresis densities, from 0.2 to 0.6 mA/cm2, did not significantly reduce fibroblast viability after 30 min of application. In conclusion, iontophoretic-stimulated peptide-loaded fibroin films could be a promising platform for the treatment of wounds.

Evolução temporal de indicadores de consumo alimentar e estado nutricional relacionados às doenças crônicas entre adultos na cidade do Rio de Janeiro e nas demais capitais brasileiras, 2006-2019 / Temporal trend of indicators of food consumption and nutritional status related to noncommunicable diseases in adults from the city of Rio de Janeiro and other Brazilian capitals, 2006 to 2019

Resumo Introdução: Alimentação e estado nutricional inadequados são importantes fatores de risco para doenças crônicas não transmissíveis (DCNT). No Brasil, a cidade do Rio de Janeiro (RJ) tem se destacado pela elevada prevalência de obesidade. Objetivo: Avaliar a evolução temporal de indicadores de consumo alimentar e de estado nutricional, relacionados às DCNT, em adultos da cidade do Rio de Janeiro e das demais capitais brasileiras. Método: Utilizou-se dados do Vigitel de 2006 a 2019. Modelos de regressão de Prais-Winsten foram empregados para avaliar a variação na prevalência dos indicadores de interesse. Esses foram definidos com base nas metas do Plano Nacional de Segurança Alimentar e Nutricional (2016-19) e do Plano de Ações Estratégicas para o Enfrentamento das DCNT no Brasil (2011-22). Resultados: Não houve variação significativa no consumo regular e recomendado de frutas e hortaliças, assim como no consumo regular de doces. O consumo regular de refrigerantes diminuiu no RJ e nas demais capitais no período. A prevalência de excesso de peso e de obesidade aumentou significativamente no RJ e nas demais capitais do país. Conclusões: A evolução dos indicadores revela um cenário desfavorável para a saúde da população e para o alcance das metas dos planos nacionais.

Abstract Background: Inadequate diet and nutritional status are important risk factors for noncommunicable diseases (NCDs). In Brazil, the city of Rio de Janeiro (RJ) has stood out for its high prevalence of obesity. Objective: To evaluate the temporal trend of indicators of food consumption and nutritional status related to NCDs in the adult population of the city of RJ and other Brazilian capitals. Method: Vigitel data between 2006 and 2019 were used. Prais-Winsten regression was used to evaluate the variation in the prevalence of interest indicators. These were defined based on the goals of the National Plan for Food and Nutritional Security (Plano Nacional de Segurança Alimentar e Nutricional - 2016-19) and the Strategic Action Plan to Tackle NCDs in Brazil (Plano de Ações Estratégicas para o Enfrentamento das DCNT no Brasil - 2011-22). Results: Regular and recommended consumption of fruits and vegetables and regular consumption of sweets did not present significant variation, while the regular consumption of soft drinks decreased in RJ and other capitals during the period. The prevalence of excess weight and obesity increased significantly in RJ and in other capitals. Conclusions: The trend of the indicators reveals an unfavorable scenario for the health's population and to achieve the goals proposed in the national plans.

Structural dependence of MEH-PPV chromism in solution.

The chromism observed in the MEH-PPV polymer in tetrahydrofuran (THF) solution is discussed as a function of the structural morphology of the backbone chains. To evaluate this phenomenon, we carried out simulations employing a hybrid methodology using molecular dynamics and quantum mechanical approaches. Our results support the hypothesis that the morphological order-disorder transition is related to the change from red to blue phase observed experimentally. The morphological disorder is associated with total or partial twisted arrangements in the polymer backbone, which induces an electronic conjugation length more confined to shorter segments. In addition, the main band of the MEH-PPV UV-Vis spectrum at the lower wavelength is related to the blue phase, in contrast to the red phase found for the more planar backbone chains.

Letramento digital em saúde de estudantes de enfermagem ou medicina: fatores relacionados / Alfabetización digital en salud de estudiantes de enfermería o medicina: factores relacionados / Digital health literacy of nursing or medical students: related factors

Resumo Objetivo Identificar fatores relacionados ao letramento digital em saúde de estudantes de medicina ou enfermagem. Métodos O nível de letramento digital em saúde de graduandos de enfermagem ou medicina de três instituições foi avaliado pela eHealth Literacy Scale (eHEALS), versão brasileira, cujo escore varia de 8 a 40; quanto maior a pontuação, maior o nível de letramento autorreferido. Relações entre o escore do eHEALS e variáveis sociodemográficas e acadêmicas foram verificadas por meio dos testes de Mann Whitney ou Kruskal Wallis, com significância de 5%. Quando havia significância do teste de Kruskal Wallis, foi utilizado teste de Dunn para comparações dois a dois. Resultados Participaram 346 estudantes, com idade média de 23,0±5,0 anos, 71,5% do sexo feminino, 51,6% do curso de Enfermagem. A pontuação média do eHEALS foi de 31,6±4,4. Maiores escores do eHEALS se associaram a: sexo masculino, instituição pública, curso integral, maior tempo desde o início da graduação, ter pessoas próximas que buscam informações sobre saúde online, dominar outro idioma, se sentir bem/muito bem sobre a saúde atual. O nível de letramento se correlacionou positivamente com idade, utilidade da internet e seu conteúdo de saúde. O item "Sinto-me confiante em usar informações da Internet para tomar decisões de saúde" teve pontuação mais baixa. Conclusão Características sociodemográficas e acadêmicas se relacionam ao letramento digital em saúde de estudantes universitários. Esses resultados podem subsidiar e direcionar esforços curriculares nas universidades, engajando futuros profissionais da saúde na disseminação de informações confiáveis dentro e fora do contexto acadêmico, bem como na assistência assistida por tecnologias.essionals in the dissemination of reliable information inside and outside the academic context, and in technology-assisted care.

Resumen Objetivo Identificar factores relacionados a la alfabetización digital en salud de estudiantes de medicina o enfermería. Métodos El nivel de alfabetización digital en salud de estudiantes universitarios de enfermería o medicina de tres instituciones fue evaluado por la eHealth Literacy Scale (eHEALS), versión brasileña, cuya puntuación varía de 8 a 40; cuanto más alta la puntuación, más alto el nivel de alfabetización autorreferido. La relación entre la puntuación de eHEALS y variables sociodemográficas y académicas se verificó a través de las pruebas de Mann Whitney o de Kruskal Wallis, con una significancia del 5 %. Cuando había significancia en la prueba de Kruskal Wallis, se utilizó la prueba de Dunn para comparaciones de a dos. Resultados Participaron 346 estudiantes, de edad promedio de 23,0±5,0 años, 71,5 % del sexo femenino, 51,6 % del curso de Enfermería. El puntaje promedio del eHEALS fue de 31,6±4,4. Las puntuaciones más altas de eHEALS se asociaron con: sexo masculino, institución pública, curso integral, más tiempo desde el inicio del curso universitario, tener a personas próximas que buscan información sobre salud online, dominar otro idioma, sentirse bien/muy bien sobre la salud actual. El nivel de alfabetización se correlacionó positivamente con la edad, utilidad de internet y su contenido de salud. El ítem "Me siento seguro al usar información de internet para tomar decisiones de salud" obtuvo un puntaje más bajo. Conclusión Características sociodemográficas y académicas se relacionan con la alfabetización digital en salud de estudiantes universitarios. Esos resultados pueden respaldar y orientar iniciativas curriculares en las universidades, y así involucrar a futuros profesionales de salud en la diseminación de información confiable dentro y fuera del contexto académico, así como a la atención auxiliada por tecnologías.

Abstract Objective To identify factors related to the digital health literacy of medical or nursing students. Methods The level of digital health literacy of undergraduate nursing or medical students from three institutions was assessed using the Brazilian version of the eHealth Literacy Scale (eHEALS), whose score ranges from 8 to 40; the higher the score, the higher the self-reported literacy level. Relationships between the eHEALS score and sociodemographic and academic variables were assessed using the Mann Whitney or Kruskal Wallis tests, with a significance level of 5%. When the Kruskal Wallis test was significant, the Dunn's test was used for two by two comparisons. Results 346 students participated in the study, with a mean age of 23.0±5.0 years, 71.5% female, 51.6% from the Nursing course. The mean eHEALS score was 31.6±4.4. Higher eHEALS scores were associated with the male gender, attending a public institution, full-time course, longer time since enrollment in the course, having close people who seek health information online, mastering another language, and feeling good/very good about their current health. The literacy level was positively correlated with age, and the usefulness of the internet and its health content. Lower scores were reached in the item "I feel confident in using information from the internet to make health decisions". Conclusion Sociodemographic and academic characteristics are related to the digital health literacy of university students. These results can support and direct curricular efforts in universities, engaging future health professionals in the dissemination of reliable information inside and outside the academic context, and in technology-assisted care.

Transcorneal iontophoresis of dendrimers: PAMAM corneal penetration and dexamethasone delivery.

Iontophoresis of nanocarriers in the eye has been proposed to sustain drug delivery and maintain therapeutic concentrations. Fourth generation polyamidoamine (PAMAM) dendrimers are semi-rigid nanoparticles with surface groups that are easily modified. These dendrimers are known to modulate tight junctions, increase paracellular transport of small molecules and be translocated across epithelial barriers, exhibiting high uptake by different cell lines. The first aim of this study was to investigate the effect of iontophoresis on PAMAM penetration and distribution into the cornea. The second aim was to evaluate, ex vivo and in vivo, the effect of these dendrimers in dexamethasone (Dex) transcorneal iontophoresis. Anionic (PAMAM G3.5) and cationic (PAMAM G4) dendrimers were labeled with fluorescein isothiocyanate (FITC), and their distribution in the cornea was investigated using confocal microscopy after ex vivo anodal and cathodal iontophoresis for various application times. The particle size distribution and zeta potential of the dendrimers in an isosmotic solution were determined using dynamic light scattering and Nanoparticle Tracking Analysis (NTA), where the movement of small particles and the formation of large aggregates, from 5 to 100 nm, could be observed. Transcorneal iontophoresis increased the intensity and depth of PAMAM-FITC fluorescence in the cornea, suggesting improved transport of the dendrimers across the epithelium toward the stroma. PAMAM complexes with Dex were characterized by (13)C-NMR, (1)H-NMR and DOSY. PAMAM G3.5 and PAMAM G4 increased the aqueous solubility of Dex by 10.3 and 3.9-fold, respectively; however, the particle size distribution and zeta potential remained unchanged. PAMAM G3.5 decreased the Dex diffusion coefficient 48-fold compared with PAMAM G4. The ex vivo studies showed that iontophoresis increased the amount of Dex that penetrated into the cornea by 2.9, 5.6 and 3.0-fold for Dex, Dex-PAMAM G4 and Dex-PAMAM G3.5, respectively. In vivo experiments, however, revealed that iontophoresis of Dex-PAMAM-G3.5 increased Dex concentration in the aqueous humor by 6.6-fold, while iontophoresis of Dex-PAMAM G4 and Dex increased it 2.5 and 2-fold, respectively. Therefore, iontophoresis targeted PAMAM to the cornea but it is the sustained delivery of the Dex from PAMAM that prevents its rapid elimination from the aqueous humor. In conclusion, iontophoresis of PAMAM complexes represents a promising strategy for targeted and sustained topical drug delivery to the eye.

Relationships between nursing diagnoses and the level of dependence in activities of daily living of elderly residents / Relações entre diagnósticos de enfermagem e nível de dependência para atividades da vida diária de idosos

ABSTRACT Objective: To identify and validate nursing diagnoses of elderly residents, and determine their relationship with the level of dependence in activities of daily living. Methods: One hundred thirty-five older adults were assessed using medical history and physical examination. Twelve validated gerontological instruments were administered to assess delirium, nutritional status, risk for falls, risk for pressure injury, dementia, cognitive losses, depression, and level of dependence in daily living and instrumental activities of daily living. Nursing diagnoses were identified and validated by experienced, doctorally-prepared nurses. The association between the presence of a nursing diagnosis and the level of dependence was assessed by a test for trend in proportions. The Kruskal-Wallis hypothesis test was used to investigate the association between the number of nursing diagnoses and the level of dependence of the elderly. Results: Most older adults were at risk for malnutrition, at high risk for falls, cognitively impaired, totally dependent for daily living and activities of daily living. In addition, they had very mild dementia and most did not have risk for pressure injuries. Depression was noted among those with dementia, but was absent in those without dementia. A total of 52 nursing diagnoses were validated. Of these, 11 were associated with the level of dependence in daily living. Conclusion: These results can be reproduced in other skilled nursing facilities for older adults, and these may allow the planning of interventions to alleviate etiologies and signs/symptoms of nursing diagnoses, rather than simply directing care toward a general category of dependence. Therefore, guaranteeing individualized nursing care to meet the specific needs of each resident.

RESUMO Objetivo: Identificar e validar diagnósticos de enfermagem em idosos de uma instituição de longa permanência e determinar sua relação com o nível de dependência para atividades da vida diária. Métodos: Foram avaliados 135 idosos por meio de histórico clínico e exame físico. Utilizaram-se 12 instrumentos gerontológicos validados para avaliar delirium, estado nutricional, risco de quedas, risco de lesão por pressão, demência, declínio cognitivo, depressão e nível de dependência para atividades da vida diária e atividades instrumentais da vida diária. Os diagnósticos de enfermagem foram identificados e validados por enfermeiros doutores com expertise clínica. A associação entre a presença de diagnóstico de enfermagem e o nível de dependência foi avaliada por teste de tendência de proporções. A associação entre o número de diagnósticos de enfermagem e o nível de dependência dos idosos foi verificada pelo teste de hipótese de Kruskal-Wallis. Resultados: A maioria dos idosos apresentou risco de desnutrição, alto risco de quedas, declínio cognitivo, dependência total para atividades da vida diária e atividades instrumentais da vida diária e demência muito leve. A maior parte não apresentou risco de lesões por pressão. A depressão foi verificada entre aqueles com demência, mas estava ausente naqueles sem demência. Foram validados 52 diagnósticos de enfermagem. Destes, 11 foram associados ao nível de dependência para atividades da vida diária. Conclusão: Estes resultados podem ser reproduzidos em outras instalações qualificadas para idosos e permitir o planejamento de intervenções para aliviar etiologias e sinais/sintomas dos diagnósticos de enfermagem, em vez de simplesmente direcionar os cuidados para uma categoria geral de dependência e, assim, garantir cuidados de enfermagem individualizados para atender às necessidades específicas de cada residente.

Topical delivery of ocular therapeutics: carrier systems and physical methods.

OBJECTIVE: The basic concepts, major mechanisms, technological developments and advantages of the topical application of lipid-based systems (microemulsions, nanoemulsions, liposomes and solid lipid nanoparticles), polymeric systems (hydrogels, contact lenses, polymeric nanoparticles and dendrimers) and physical methods (iontophoresis and sonophoresis) will be reviewed. KEY FINDINGS: Although very convenient for patients, topical administration of conventional drug formulations for the treatment of eye diseases requires high drug doses, frequent administration and rarely provides high drug bioavailability. Thus, strategies to improve the efficacy of topical treatments have been extensively investigated. In general, the majority of the successful delivery systems are present on the ocular surface over an extended period of time, and these systems typically improve drug bioavailability in the anterior chamber whereas the physical methods facilitate drug penetration over a very short period of time through ocular barriers, such as the cornea and sclera. SUMMARY: Although in the early stages, the combination of these delivery systems with physical methods would appear to be a promising tool to decrease the dose and frequency of administration; thereby, patient compliance and treatment efficacy will be improved.