Positive epidemiology, revisited: the case for centering human rights and economic justice.

In recent years, a growing body of research in positive epidemiology has sought to expand the traditional focus of epidemiologic research beyond risk factors for disease and towards a more holistic understanding of health that includes the study of positive assets that shape well-being more broadly. While this paradigm shift holds great promise for transforming people's lives for the better, it is also critiqued for showcasing decontextualized perspectives that could cause great harm to the public's health if translated uncritically into population-based interventions. In this commentary, we argue for orienting positive epidemiology within a human rights and economic justice framework to mitigate this threat, and we discuss two examples of previously proposed health assets (religious involvement and marriage) that demonstrate the urgent need for positive epidemiologic research to center health equity. Finally, to advance the field, we provide recommendations for how future research can address shortcomings of the extant literature by moving from individual-level to societal-level applications. In doing so, we believe that positive epidemiology can be transformed into a powerful force for health equity. This article is part of a Special Collection on Mental Health.

Perfil do doente com traumatismo cranioencefálico atendido num serviço de urgência de uma ULS do norte de Portugal / Profile of patients with traumatic brain injury seen in the emergency department of a ULS in northern Portugal

Um traumatismo cranioencefálico (TCE) ocorre como consequência de uma força mecânica direta ou indireta aplicada na cabeça. É considerado um dos principais problemas de saúde pública de âmbito mundial e as suas características epidemiológicas variam de acordo com cada população, encontrando-se entre os tipos de trauma mais frequentes nos serviços de urgência. As vítimas de TCE exigem intervenções de enfermagem adequadas pelo que, o enfermeiro, enquanto membro fundamental de uma equipa multidisciplinar, necessita de constante atualização e desenvolvimento de competências, numa abordagem holística do doente neurocrítico. Objetivos: O presente trabalho tem por objetivo geral: Caracterizar o perfil do doente com traumatismo cranioencefálico atendido num serviço de urgência de uma ULS do Norte de Portugal. Definiram-se como objetivos específicos: (i) Caracterizar o perfil sociodemográfico da amostra; (ii) Caracterizar a amostra em função da presença de fatores de risco; (iii) Identificar as principais etiologias do traumatismo cranioencefálico; (iv) Determinar a gravidade do TCE, pela avaliação do nível de consciência dos doentes, através da Escala de Coma de Glasgow; (v) Identificar a principal sintomatologia pós TCE nas vítimas; (vi) Identificar o número de doentes em função dos exames complementares de diagnóstico realizados; (vii) Identificar as principais lesões cranioencefálicas associadas ao traumatismo nos doentes; (viii) Avaliar a prevalência de TCE na população atendida no SU no período de recolha de dados definido. Métodos: Para a realização do presente trabalho foi desenvolvido um estudo observacional, descritivo, de abordagem quantitativa. Utilizando um método não- probabilístico, com uma amostragem por conveniência, foi obtida uma amostra de 153 vítimas de TCE que recorreram ao SU de uma ULS do Norte de Portugal, no período compreendido entre 5 de abril a 5 de julho de 2022. Os dados foram colhidos através de um instrumento de recolha de dados elaborado para o efeito, com base na observação, complementados com o resultado de exames de diagnóstico realizados e respetivo diagnóstico médico. Resultados: Os resultados obtidos evidenciam predomínio do sexo masculino (56,9%), com uma média de idades de 63,5 anos (DP 28,79), verificando-se uma maior prevalência de TCE nos pacientes com idade superior ou igual a 85 anos (29,4%) e maioritariamente residentes em ambiente rural (55,6%). A principal etiologia foram as quedas da própria altura (56,3%), com predomínio do TCE Ligeiro (98,6%). O fator de risco predominante foi a idade superior a 65 anos (58,8%) e a principal sintomatologia associada foi a perda de consciência (22,3%). A Tomografia Computorizada cerebral foi o exame complementar de diagnóstico dominante (84,9%) e as lesões na pele/couro cabeludo foram as mais frequentes nos TCE observados (42,5%). Quanto aos traumatismos associados, os mais frequentes foram os traumatismos nos membros (31,4%). Houve predomínio da alta hospitalar após observação clínica (72,5%). A taxa de prevalência de TCE no respetivo SU no período estudado foi de 1,68 %. Conclusão: Conhecer melhor o perfil da vítima de TCE atendida num SU e tendo em consideração que a atuação do enfermeiro especialista na intervenção antecipada e prevenção de complicações na Pessoa em situação Crítica é fundamental uma vez que, no seu percurso desde a lesão até à alta clínica, esta pode sofrer inúmeras complicações. Dessa forma, o perfil encontrado sugere a importância da adoção de medidas de prevenção das principais etiologias do TCE bem como o aprimoramento no atendimento às vítimas.

Traumatic brain injury (TBI) occurs as a result of direct or indirect mechanical force applied to the head. It is considered one of the major public health problems worldwide, and its epidemiological characteristics vary according to each population, being among the most frequent types of trauma seen in emergency services. TBI victims require appropriate nursing interventions, and nurses, as key members of a multidisciplinary team, need constant updating and constant skill development in a holistic approach to the neurocritical patient. Aim: The main objective of this study is to characterise the profile of patients with traumatic brain injury (TBI) treated at an emergency department of Northern Portugal Local Health Unit (ULS). The following specific objectives were defined: (i) Characterize the socio-demographic profile of the sample; (ii) Characterize the sample according to the presence of risk factors; (iii) Identify the main causes of traumatic brain injury; (iv) Determine the severity of TBI by assessing patients' level of consciousness using the Glasgow Coma Scale; (v) Identify the main post-TBI symptoms in the victims; (vi) Identify the number of patients based on the complementary diagnostic tests performed; (vii) Identify the main head injury associated with trauma in the patients; (viii) Evaluate the incidence of TBI in the population attended at the Emergency Department during the defined data collection period. Methods: To carry out the present study, an observational, descriptive approach with a quantitative method was employed. Using a non-probabilistic technique, with a convenience sampling, we obtained a sample of 153 TBI victims who sought treatment at the Emergency Department of a Northern Portugal Local Health Unit (ULS), between April 5 and July 5, 2022. Data were collected using a specifically designed data collection tool based on observation, complemented with the results of diagnostic tests conducted as well as the corresponding medical diagnosis. Results: The results show a predominance of males (56.9%), with an average age of 63.5 years (SD 28.79), and a higher incidence of TBI in patients aged 85 years or older (29.4%) and mostly living in rural areas (55.6%). The main etiology was falls from standing height (56.3%), with a predominance of mild TBI (98.6%). The predominant risk factor was age over 65 years (58.8%) and the main associated symptom was loss of consciousness (22.3%). Computed tomography of the brain was the dominant diagnostic complementary exam (84.9%) and skin/scalp injuries were the most frequent in the observed TBIs (42.5%). Regarding associated traumas, limb injuries were the most common (31.4%). There was a predominance of hospital discharge after clinical observation (72.5%). The incidence rate of TBI in the respective Emergency Department during the study period was 1.68%. Conclusion: Having a better understanding of the profile of TBI victims treated at an Emergency Department and considering that the role of specialist nurses in early intervention and prevention of complications in critically ill patients is crucial, since they may experience numerous complications from the time of injury until clinical discharge. Therefore, the identified profile emphasizes the importance of adopting measures to prevent the main etiologies of TBI, as well as improving the care provided to the victims.

Caracterización de pacientes no adherentes al tratamiento de hipertensión arterial / Characterization of patients not adherent to high blood pressure treatment

Introducción. La falta del cumplimiento terapéutico es un problema en el control de la hipertensión arterial. Objetivo. Caracterizar los pacientes no adherentes al tratamiento de hipertensión arterial en pobladores de la V Región Sanitaria del Paraguay. Material y Métodos: Estudio transversal que incluyó pacientes hipertensos conocidos que se encontraban en tratamiento para la hipertensión arterial. Se utilizó la Escala de adherencia a la medicación de Morisky 8 ítems que mide comportamientos de adherencia específicos asociados a la ingesta de medicamentos. Resultados. Se incluyeron163 pacientes, todos considerados no adherentes al tratamiento según la Escala Morinsky MMAS-8. El 52,2% tenía más de 40 años, 66,3% del sexo femenino, 40,5% de nivel universitario, 57,1% casado y el 87,7% vive con la familia. El 66,9% informó trabajar hasta 8 horas por día y el 58,3% con ingresos mayores a 2 salarios mínimos. En cuanto al conocimiento el 53,9% fue alto. El 50% de los pacientes declaró utilizar plantas medicinales para su tratamiento, el 7,4% con depresión frecuentemente o casi siempre y el 22,1% ansiedad frecuentemente o casi siempre. En cuanto a las preguntas de no adherencia, el 53,4% olvidó tomar alguna vez su medicación o dejar de tomarla cuando siente que está bajo control (53,3%),el 44,2% deja de tomar su medicación porque se siente peor con ella y el 46,5% la olvida cuando viaja. Conclusión. La no adherencia en los pacientes de la V Región fue alarmante, por tanto, se deben de realizar medidas de acción respecto a las mismas. Palabras Clave: hipertensión; presión arterial; cumplimiento y adherencia al tratamiento; epidemiologia

Introduction. The lack of therapeutic compliance is a problemto control high blood pressure.Objective. To characterize patients who do not adhere to the treatment of arterial hypertension in the Vsanitary region of Paraguay. Material and Methods: A cross-sectional study was carried out in known hypertensive patients who were undergoing treatment for high blood pressure. The 8-item Morisky Medication Adherence Scale was used, which measures specific adherence behaviors associated with medication intake. Results.163 patients were included, all considered non-adherent to treatment according to the Morinsky MMAS-8 Scale. 52.2% were over 40 years old, 66.3% female, 40.5% with university level, 57.1% married, and 87.7% lived with their family. 66.9% reported working up to 8 hours per day and 58.3% with income greater than 2 minimum wages. Regarding knowledge, 53.9% was high. 50% of the patients declared using medicinal plants for their treatment, 7.4% with depression frequently or almost always and 22.1% with anxiety frequently or almost always. Regarding the non-adherence questions, 53.4% ever forgot to take their medication or stopped taking it when they feel they are under control (53.3%), 44.2% stop taking their medication because they feel worse with it and 46.5% forget it when traveling. Conclusion. The non-adherence in patients from Region V was alarming, therefore, action measures must be taken regarding them. Key words:hypertension; blood pressure; treatment adherence and compliance; epidemiology

Situação epidemiológica do Monkeypox (MPX) no Brasil, até outubro de 2022: Casos notificados, confirmados, suspeitos e mortalidade / Epidemiological situation of Monkeypox (MPX) in Brazil, until October 2022: Notified, confirmed, suspected cases and mortality / Situación epidemiológica de la Viruela del Simio (MPX) en Brasil, hasta octubre de 2022: Casos notificados, confirmados, sospechosos y mortalidade

Objetivo: Analisar a frequência de registros de Monkeypox (MPX) no recorte histórico formado pelos meses de "janeiro a outubro de 2022" no recorte geográfico formado pelo "Brasil". Método: Pesquisa exploratória, descritiva, comparativa e quantitativa. Os dados foram adquiridos junto ao Centro de Informações Estratégicas em Vigilância em Saúde (CIEVS), do Centro de Operações em Emergências (COE) do Ministério da Saúde (MS). Resultados: Foram notificados o universo de 13.915 registros de MPX, sendo que 65% (n=9.045) eram de casos confirmados e 35% (n=4.870) eram de casos suspeitos. A região Sudeste (SE) computou a maior preponderância, tanto de casos confirmados com 65,1% (n=5.886) quanto de casos suspeitos com 33,6% (n=1.635). O estado de São Paulo (SP) obteve maior preponderância com 44,4%(n=4.012) casos confirmados e 23,2% (n=1.131) casos suspeitos. Conclusão: Foi identificado aumento na frequência de registros de casos confirmados e suspeitos no recorte geográfico e histórico analisados.

Objective: To analyze the frequency of Monkeypox (MPX) records in the historical period formed by the months from "January to October 2022" in the geographic region formed by "Brazil". Method: Exploratory, descriptive, comparative and quantitative research. Data were acquired from the Center for Strategic Information on Health Surveillance (CIEVS), from the Emergency Operations Center (COE) of the Ministry of Health (MS). Results: A total of 13,915 MPX records were reported, of which 65% (n=9,045) were confirmed cases and 35% (n=4,870) were suspected cases. The Southeast (SE) region accounted for the highest preponderance, both of confirmed cases with 65.1% (n=5,886) and of suspected cases with 33.6% (n=1,635). The state of São Paulo (SP) had the highest prevalence with 44.4% (n=4,012) confirmed cases and 23.2% (n=1,131) suspected cases. Conclusion: An increase in the frequency of records of confirmed and suspected cases was identified in the geographical and historical scope analyzed

Objetivo: Analizar la mortalidad por infarto agudo de miocardio (IAM) en Brasil de 1996 a 2017. Método: Estudio epidemiológico, exploratorio, descriptivo y cuantitativo. Los datos fueron extraídos del Servicio de Información de Mortalidad (SIM) del Ministerio de Salud (MS). Se realizó análisis estadístico descriptivo. Resultados: Se identificó un universo de 1.592.197 registros, con media y desviación estándar de (72.373±12.999,9). El año 2016 registró la mayor preponderancia con 5,9% (n=94.148) y 1996 la menor con 3,5% (n=55.900). La mayor preponderancia estuvo constituida por 59,1% (n=940.552) del sexo masculino, 25,6% (n=407.340) tenían entre 70 y 79 años, 54,7% (n=871.319) eran blancos, 45,5% (n=725.234) casados, 20,7 El % (n=328.981) tenía de 1 a 3 años de escolaridad, el 55,6% (n=885.368) tenían sus defunciones registradas en el hospital. Conclusión: Se identificó un aumento en la frecuencia de registros de defunción por IAM en el área geográfica e histórica analizada.

Levantamento epidemiológico dos casos de tuberculose no Brasil e ações alternativas para auxiliar no tratamento / Epidemiological survey of tuberculosis cases in Brazil and alternative actions to aid in treatment / Estudio epidemiológico de los casos de tuberculosis en Brasil y acciones alternativas para ayudar al tratamiento

tuberculose é uma das doenças infectocontagiosas de maior importância no Brasil e no mundo. Afeta de forma importante populações em situação de vulnerabilidade social e econômica. O objetivo deste estudo foi realizar um levantamento do número de casos notificados de tuberculose no Brasil nos últimos 10 anos (2011 a 2021), avaliar os fatores que afetam a transmissão, bem como discutir o tratamento padrão e com fitoterápicos. O levantamento epidemiológico dos casos de tuberculose no Brasil de janeiro de 2011 a dezembro de 2021 foi realizado dentre os notificados pelo Sistema de Informação de Agravos de Notificação (SINAN). Os resultados indicaram um aumento linear de casos a partir de 2017 com 90.776 casos diagnosticados, em 2018 (94.720) e 2019 (96.655). Acredita-se que o aumento linear da tuberculose neste período pode estar relacionado principalmente com o aumento da pobreza, contudo o compartilhamento de utensílios durante o uso de narguilé podem representar fatores de risco para tuberculose. Seis plantas medicinais afetam diretamente as micobactérias (Chenopodium ambrosioides, Tetradenia riparia, Physalis angulata, Origanum vulgare, Eucalyptus globulus, Mikania glomerata) e cinco plantas com atividade antibacteriana auxiliam no trato respiratório (Nasturtium officinale, Allium sativum, Schinus terebinthifolius, Adiantum capillus-veneris, Allium cepa). Contudo, a tuberculose é uma doença reemergente sendo necessária a adoção de políticas públicas que intensifiquem e implementem medidas sócio-educativas para a implantação do uso de fitoterápicos como medida complementar.

Tuberculosis is one of the most important infectious diseases in Brazil and worldwide. It significantly affects populations in situations of social and economic vulnerability. This study aimed to survey the number of reported tuberculosis cases in Brazil in the last 10 years (2011 to 2021) to assess the factors that affect the transmission and discuss standard and herbal treatments. The epidemiological survey of tuberculosis cases in Brazil from January 2011 to December 2021 was carried out among those notified by the Notifiable Diseases Information System (SINAN). The results indicated a linear increase in cases from 2017, with 90,776 diagnosed cases, in 2018 (94,720) and 2019 (96,655). It is believed that the linear increase in tuberculosis in this period may be mainly related to the increase in poverty. However, the sharing of utensils during the use of hookah may represent risk factors for tuberculosis. Six medicinal plants directly affect mycobacteria (Chenopodium ambrosioides, Tetradenia riparia, Physalis angulata, Origanum vulgare, Eucalyptus globulus, Mikania glomerata), and five plants with antibacterial activity help in the respiratory tract (Nasturtium officinale, Allium sativum, Schinus terebinthifolius, Adiantum capillus-veneris, Allium cepa). However, tuberculosis is a re-emerging disease, and it is necessary to adopt public policies that intensify and implement socio-educational measures for using herbal medicines as a complementary measure.

La tuberculosis es una de las enfermedades infecciosas más importantes en Brasil y en el mundo. Afecta significativamente a las poblaciones en situación de vulnerabilidad social y económica. El objetivo de este estudio fue realizar una encuesta sobre el número de casos notificados de tuberculosis en Brasil en los últimos 10 años (2011 a 2021), para evaluar los factores que afectan a la transmisión, así como para discutir el tratamiento estándar y con fitoterapias. La encuesta epidemiológica de los casos de tuberculosis en Brasil desde enero de 2011 hasta diciembre de 2021 se realizó entre los notificados por el Sistema de Informação de Agravos de Notificação (SINAN). Los resultados indicaron un aumento lineal de casos desde 2017 con 90.776 casos diagnosticados, en 2018 (94.720) y 2019 (96.655). Se cree que el aumento lineal de la tuberculosis en este periodo puede estar relacionado principalmente con el aumento de la pobreza, aunque el hecho de compartir los utensilios durante el uso de la shisha puede representar factores de riesgo para la tuberculosis. Seis plantas medicinales afectan directamente a las micobacterias (Chenopodium ambrosioides, Tetradenia riparia, Physalis angulata, Origanum vulgare, Eucalyptus globulus, Mikania glomerata) y cinco plantas con actividad antibacteriana ayudan a las vías respiratorias (Nasturtium officinale, Allium sativum, Schinus terebinthifolius, Adiantum capillus-veneris, Allium cepa). Sin embargo, la tuberculosis es una enfermedad reemergente siendo necesaria la adopción de políticas públicas que intensifiquen e implementen medidas socioeducativas para la implementación del uso de fitoterápicos como medida complementaria.

Boletín Epidemiológico Semana 14 (Informe de Salud de Vacaciones de Semana Santa 2022) / Epidemiological Bulletin Week 14 (Easter Holidays Health Report 2022)

Informe que presenta la situación epidemiológica El Salvador al 18 de abril de 2022 (Datos preliminares) Principales causas de consulta, acumuladas desde el 11 de abril a la fecha, años 2021 ­ 2022 Total consultas, emergencias y referencias, Semana Santa El Salvador 2020 ­ 2021 Informe de COVID-19 I. Contexto mundial de COVID -19 II. Contexto Centroamérica y República Dominicana III. Situación Nacional, Programación semanal de tamizajes comunitarios, semana santa 2022 Recursos Humanos a disposición para este periodo del sistema integrado de salud

Report presenting the epidemiological situation of El Salvador as of April 18, 2022 (Preliminary data) Main causes of consultation, accumulated from April 11 to date, years 2021 - 2022 Total queries, emergencies and referrals, Easter El Salvador 2020 ­ 2021 COVID-19 Report I. Global Context of COVID -19 II. Context Central America and the Dominican Republic III. National Situation, Weekly programming of community screening, Holy Week 2022 Human resources available for this period of the integrated health system

Directrices para el diagnóstico clínico y el tratamiento del dengue, el chikunguña y el zika. Versión corregida / Guidelines for the clinical diagnosis and treatment of dengue, chikungunya and Zika. Corrected version

La presente publicación describe las intervenciones formuladas con sólidas pruebas de eficacia, evitar riesgos innecesarios, utilizar los recursos de forma eficiente, disminuir la variabilidad clínica y, en esencia, mejorar la salud y garantizar una atención de calidad, razón de ser de los sistemas y servicios de salud. Las presentes directrices se elaboraron siguiendo la metodología GRADE con el apoyo de un panel de expertos clínicos de distintos países, todos ellos convocados por la Organización Panamericana de la Salud. Por medio de la respuesta a doce preguntas clave sobre el diagnóstico clínico y el tratamiento del dengue, el chikunguña y el zika, se formulan recomendaciones basadas en evidencia para pacientes pediátricos, jóvenes, adultos, personas mayores y embarazadas expuestos a estas enfermedades o con sospecha o diagnóstico confirmado de infección.

Impacto de la transformación digital en la salud tropical / Impact of digital transformation on tropical health

La Transformación Digital (TD) es todo un proceso que busca optimizar la relación usuario­organización, mejorando así los procesos y el desempeño. Con la llegada de la pandemia COVID-19 a principios del año 2020, cuando fue necesario acelerar la inclusión de las Tecnologías de Información y Comunicación (TIC) para continuar ofreciendo los servicios sanitarios, se constituye el sistema peruano de TD como un sistema funcional; con normas, principios y procedimientos; y con técnicas e instrumentos para ordenar las actividades del sector público y con miras a su optimización. Se planteó una investigación de carácter descriptivo para conocer el impacto de la transformación digital en la salud tropical del Perú. Para ello se determinaron el impacto en la gestión de datos, gobernanza, e intercambio de conocimiento e innovación digital de 4 enfermedades metaxénicas y 3 zoonóticas seleccionadas a partir del análisis de los distintos componentes de la sala virtual de situación de salud del Centro Nacional de Epidemiología, Prevención y Control de Enfermedades del Perú. Los datos fueron analizados bajo el Sistema de Información para la Salud (IS4H) de la OPS que permitió valorar la interoperabilidad de los procesos relacionados con la categorización de estas nosologías. Para todos los factores evaluados: gestión de datos, innovación, gestión y gobernanza y gestión e intercambio de conocimiento, los resultados, en general, estuvieron alrededor de la media (3 puntos, en una escala del 1 al 5), siendo el valor más alto (3,3 puntos) para la gestión y gobernanza, y el valor más bajo (2,7 puntos) para la innovación. Se necesita un enfoque más holístico en la salud pública para asegurarse de que se proporcione una respuesta eficaz frente a las enfermedades tropicales. Si los sistemas de salud se colocan en el medio de la acción, esto permitiría tener mayores posibilidades de hacer frente a estas enfermedades mediante el uso adecuado de las herramientas modernas que logren complementar el enfoque tradiciona(AU)

Digital Transformation (TD) is a whole process that seeks to optimize the user-organization relationship, thus improving processes and performance. With the arrival of the COVID-19 pandemic at the beginning of 2020, when it was necessary to accelerate the inclusion of Information and Communication Technologies (ICT) to continue offering health services, the Peruvian DT system was established as a functional system; with norms, principles and procedures; and with techniques and instruments to order the activities of the public sector and with a view to their optimization. A descriptive investigation was proposed to know the impact of digital transformation on tropical health in Peru. For this, the impact on data management, governance, and exchange of knowledge and digital innovation of 4 metaxenic and 3 zoonotic diseases selected from the analysis of the different components of the virtual health situation room of Centro Nacional de Epidemiología, Prevención y Control de Enfermedades of Peru. The data were analyzed under PAHO's Information System for Health (IS4H), which made it possible to assess the interoperability of the processes related to the categorization of these nosologies. For all the factors evaluated: data management, innovation, management and governance, and knowledge management and exchange, the results, in general, were around the average (3 points, on a scale from 1 to 5), with the highest value being highest (3.3 points) for management and governance, and the lowest value (2.7 points) for innovation. A more holistic approach to public health is needed to ensure that an effective response to tropical diseases is provided. If health systems are placed in the middle of the action, this would allow them to have greater possibilities of dealing with these diseases through the appropriate use of modern tools that manage to complement the traditional approach(AU)

Epidemiology and reporting characteristics of preclinical systematic reviews.

In an effort to better utilize published evidence obtained from animal experiments, systematic reviews of preclinical studies are increasingly more common-along with the methods and tools to appraise them (e.g., SYstematic Review Center for Laboratory animal Experimentation [SYRCLE's] risk of bias tool). We performed a cross-sectional study of a sample of recent preclinical systematic reviews (2015-2018) and examined a range of epidemiological characteristics and used a 46-item checklist to assess reporting details. We identified 442 reviews published across 43 countries in 23 different disease domains that used 26 animal species. Reporting of key details to ensure transparency and reproducibility was inconsistent across reviews and within article sections. Items were most completely reported in the title, introduction, and results sections of the reviews, while least reported in the methods and discussion sections. Less than half of reviews reported that a risk of bias assessment for internal and external validity was undertaken, and none reported methods for evaluating construct validity. Our results demonstrate that a considerable number of preclinical systematic reviews investigating diverse topics have been conducted; however, their quality of reporting is inconsistent. Our study provides the justification and evidence to inform the development of guidelines for conducting and reporting preclinical systematic reviews.

Análise da percepção de acadêmicos de medicina de São José do Rio Preto, São Paulo, Brasil sobre a doença de Chagas e seus vetores / Perception analysis of medical students from São José do Rio Preto, São Paulo, Brazil about Chagas disease and its vectors

As doenças negligenciadas (DN) são um grupo diversificado de enfermidades que prevalecem em condições tropicais e subtropicais de 149 países e afetam mais de um bilhão de pessoas que vivem em situação de pobreza em todo o mundo. Atualmente, estima-se que oito milhões de pessoas estejam infectadas com a doença de Chagas (DC). Embora São José do Rio Preto, São Paulo, Brasil seja uma região do estado de São Paulo conhecida pelo alto grau de incidência de dengue, existem, pelo menos, 700 pacientes chagásicos registrados no Hospital de Base de São José do Rio Preto e alta incidência do vetor, sendo que mais de 14 mil triatomíneos foram coletados no noroeste paulista entre 2004 e 2011. Assim, levando em consideração que a DC é clinicamente curável se o tratamento for realizado no estágio inicial de contaminação com o Trypanosoma cruzi e que a ação dos profissionais da saúde é fundamental para o diagnóstico laboratorial dessa doença na fase aguda da infecção (período em quem os fármacos anti-tripanosomatídeos são efetivos), avaliou-se a percepção de acadêmicos de Medicina de São José do Rio Preto, São Paulo, Brasil sobre questões gerais relacionadas com essa enfermidade, por meio de uma pesquisa transversal, descritiva, prospectiva e quantitativa. A maioria dos alunos demonstrou conhecer o agente etiológico da DC. Além disso, os alunos de medicina demonstraram conhecimento da principal forma de transmissão do parasita, embora uma parcela deles não associou a transmissão da DC às fezes de triatomíneos. Outra dificuldade observada por esses discentes foi em relação ao tratamento da DC, pois mais da metade dos alunos respondeu erroneamente que a DC não tem cura ou tem cura na fase crônica. Levando-se em consideração que a DC foi descrita por um médico que caracterizou todos os aspectos da doença, há necessidade dos cursos de graduação de medicina abordarem as DNs de forma holística, pois as Diretrizes Curriculares Nacionais exigem a formação de profissionais de saúde competentes e capazes de integrarem dimensões biológicas, psicológicas, sociais e ambientais.

Neglected Diseases (ND) are a diverse group of diseases that are prevalent in tropical and subtropical conditions in 149 countries and affect more than one billion people living in poverty worldwide. Currently, it is estimated that eight million people are infected with Chagas disease (CD). Although São José do Rio Preto, São Paulo, Brazil is a region of the state of São Paulo known for its high incidence of dengue, there are at least 700 patients with CD registered at the Base Hospital of São José do Rio Preto and high incidence of the vector, as more than 14 thousand triatomines were collected in the northwest of São Paulo between 2004 and 2011. Thus, taking into account that CD is clinically curable if the treatment is carried out at the initial stage of contamination with Trypanosoma cruzi and that the action of health professionals is essential for the clinical diagnosis of this disease in the acute phase of the infection (period in which anti-trypanosomatids are effective), was evaluated the perception of medical students from São José do Rio Preto, São Paulo, Brazil about general questions related to this disease, through a cross-sectional, descriptive, prospective and quantitative research. Most students demonstrated knowledge of the etiological agent of CD. In addition, medical students demonstrated knowledge of the main form of transmission of the parasite, although a portion of them did not associate CD transmission with triatomine feces. Another difficulty observed by these students was related to the treatment of CD, as more than half of the students answered erroneously that CD has no cure or can be cured in the chronic phase. Taking into account that CD was described by a doctor who characterized all aspects of the disease, there is a need for undergraduate medical courses to address NDs in a holistic way, as the National Curriculum Guidelines require the training of competent health professionals capable of integrating biological, psychological, social and environmental dimensions.

Religion, Spirituality, and Health: New Considerations for Epidemiology.

Religion and spirituality are important social determinants that drive public health practice. The field of epidemiology has played a vital role in answering long-standing questions about whether religion is causally associated with health and mortality. As epidemiologists spark new conversations (e.g., see Kawachi (Am J Epidemiol. (https://doi.org/10.1093/aje/kwz204)) and Chen and VanderWeele (Am J Epidemiol. 2018;187(11):2355-2364)) about methods (e.g., outcomes-wide analysis) used to establish causal inference between religion and health, epidemiologists need to engage with other aspects of the issue, such as emerging trends and historical predictors. Epidemiologists will need to address 2 key aspects. The first is changing patterns in religious and spiritual identification. Specifically, how do traditional mechanisms (e.g., social support) hold up as explanations for religion-health associations now that more people identify as spiritual but not religious and more people are not attending religious services in physical buildings? The second is incorporation of place into causal inference designs. Specifically, how do we establish causal inference for associations between area-level constructs of the religious environment (e.g., denomination-specific church membership/adherence rates) and individual- and population-level health outcomes?

Management of COVID-19: the Zhejiang experience / 浙江大学学报·医学版

The current epidemic situation of coronavirus disease 2019 (COVID-19) still remained severe. As the National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital of Zhejiang University School of Medicine is the primary medical care center for COVID-19 in Zhejiang province. Based on the present expert consensus carried out by National Health Commission and National Administration of Traditional Chinese Medicine, our team summarized and established an effective treatment strategy centered on "Four-Anti and Two-Balance" for clinical practice. The "Four-Anti and Two-Balance" strategy included antivirus, anti-shock, anti-hyoxemia, anti-secondary infection, and maintaining of water, electrolyte and acid base balance and microecological balance. Meanwhile, integrated multidisciplinary personalized treatment was recommended to improve therapeutic effect. The importance of early viralogical detection, dynamic monitoring of inflammatory indexes and chest radiograph was emphasized in clinical decision-making. Sputum was observed with the highest positive rate of RT-PCR results. Viral nucleic acids could be detected in 10%patients' blood samples at acute period and 50%of patients had positive RT-PCR results in their feces. We also isolated alive viral strains from feces, indicating potential infectiousness of feces.Dynamic cytokine detection was necessary to timely identifying cytokine storms and application of artificial liver blood purification system. The "Four-Anti and Two-Balance" strategy effectively increased cure rate and reduced mortality. Early antiviral treatment could alleviate disease severity and prevent illness progression, and we found lopinavir/ritonavir combined with abidol showed antiviral effects in COVID-19. Shock and hypoxemia were usually caused by cytokine storms. The artificial liver blood purification system could rapidly remove inflammatory mediators and block cytokine storm.Moreover, it also favored the balance of fluid, electrolyte and acid-base and thus improved treatment efficacy in critical illness. For cases of severe illness, early and also short period of moderate glucocorticoid was supported. Patients with oxygenation index below 200 mmHg should be transferred to intensive medical center. Conservative oxygen therapy was preferred and noninvasive ventilation was not recommended. Patients with mechanical ventilation should be strictly supervised with cluster ventilator-associated pneumonia prevention strategies. Antimicrobial prophylaxis was not recommended except for patients with long course of disease, repeated fever and elevated procalcitonin (PCT), meanwhile secondary fungal infection should be concerned.Some patients with COVID-19 showed intestinal microbial dysbiosis with decreased probiotics such as and , so nutritional and gastrointestinal function should be assessed for all patients.Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation. Anxiety and fear were common in patients with COVID-19. Therefore,we established dynamic assessment and warning for psychological crisis. We also integrated Chinese medicine in treatment to promote disease rehabilitation through classification methods of traditional Chinese medicine. We optimized nursing process for severe patients to promote their rehabilitation. It remained unclear about viral clearance pattern after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Therefore, two weeks' quarantine for discharged patients was required and a regular following up was also needed.The Zhejiang experience and suggestions have been implemented in our center and achieved good results. However, since COVID-19 was a newly emerging disease, more work was warranted to improve strategies of prevention, diagnosis and treatment for COVID-19.

Association between Selenium in Soil and Diabetes in Chinese Residents Aged 35-74 Years: Results from the 2010 National Survey of Chronic Diseases and Behavioral Risk Factors Surveillance / 生物医学与环境科学（英文）

Objective@#To explore the association between soil selenium levels and the risk of diabetes in Chinese adults aged 35-74 years.@*Methods@#Data for this study were derived from the China Chronic Diseases and Behavioral Risk Factors Surveillance 2010 survey. Selenium concentrations in soil were obtained from the Atlas of Soil Environmental Background Values in China. A two-level binary logistic regression model was used to determine the association between soil selenium concentrations and the risk of diabetes, with participants nested within districts/counties.@*Results@#A total of 69,332 participants aged 35-74 years, from 158 districts/counties were included in the analysis. Concentrations of selenium in soil varied greatly across the 158 districts/counties, with a median concentration of 0.219 mg/kg ( : 0.185-0.248). The results showed that both Quartile 1 (0.119-0.185 mg/kg) and Quartile 4 (0.249-0.344 mg/kg) groups were positively associated with diabetes compared to a soil selenium concentration of 0.186-0.219 mg/kg (Quartile 2), crude odds ratios ( s) (95% ) were 1.227 (1.003-1.502) and 1.280 (1.048-1.563). The values were 0.045 and 0.013, for Quartile 1 and Quartile 4 groups, respectively. After adjusting for all confounding factors of interest, the Quartile 1 group became non-significant, and the Quartile 4 group had an adjusted (95% ) of 1.203 (1.018-1.421) relative to the reference group (Quartile 2), the values was 0.030. No significant results were seen for the Quartile 3 group (0.220-0.248 mg/kg) compared to the reference group.@*Conclusion@#Excessive selenium concentrations in soil could increase the risk of diabetes among Chinese adults aged 35-74 years.

An overview of COVID-19 / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection emerged in Wuhan City, Hubei Province, China in December 2019. By Feb. 11, 2020, the World Health Organization (WHO) officially named the disease resulting from infection with SARS-CoV-2 as coronavirus disease 2019 (COVID-19). COVID-19 represents a spectrum of clinical manifestations that typically include fever, dry cough, and fatigue, often with pulmonary involvement. SARS-CoV-2 is highly contagious and most individuals within the population at large are susceptible to infection. Wild animal hosts and infected patients are currently the main sources of disease which is transmitted via respiratory droplets and direct contact. Since the outbreak, the Chinese government and scientific community have acted rapidly to identify the causative agent and promptly shared the viral gene sequence, and have carried out measures to contain the epidemic. Meanwhile, recent research has revealed critical aspects of SARS-CoV-2 biology and disease pathogenesis; other studies have focused on epidemiology, clinical features, diagnosis, management, as well as drug and vaccine development. This review aims to summarize the latest research findings and to provide expert consensus. We will also share ongoing efforts and experience in China, which may provide insight on how to contain the epidemic and improve our understanding of this emerging infectious disease, together with updated guidance for prevention, control, and critical management of this pandemic.

Linear mixed model for weight analysis in mice infected by Trypanosoma cruzi

The use of linear mixed models for nested structure longitudinal data is called hierarchical linear modeling. Thismodeling takes into account the dependence of existing data within each level and between hierarchical levels. The process of modeling, estimating and analyzing diagnoses was illustrated through data on the weights of mice experimentally infected by Trypanosoma cruzi, divided into different treatment groups, with the purpose of verifying the evolution of their body weight as a result of usingdifferent types of biotherapeutics produced from Gallus gallus domesticus(chicken) serum to treat Trypanosoma cruzi. Through the model selection criteria AIC and BIC and the likelihood ratio test, a model was chosen to describe the data correctly. Model diagnoses were then performed by means of residual analysis for both levels and an analysis of influential observations to verify if any observations were signaled as influencing the fixed effects, the components of variance and the adjusted values. After the analysis, it was possible to notice that the observations that were signaled as influential had little impact on the Model chosen initially, so it was maintained, with no differences being evidenced between the treatments with the biotherapeutics tested; only the Time variable and the Random intercept were necessary to describe the weight of the mice.

Terapia floral de Bach y orientación psicológica en mujeres víctimas de violencia psicológica

Introducción: la violencia psicológica afecta a niveles crecientes la salud física, psico-emocional y social de quienes la padecen.Resulta de vital importancia la elección de un recurso terapéutico integral, que contribuya a disminuir los síntomas identificados en mujeres víctimas de violencia psicológica.Objetivo: evaluar los resultados del tratamiento con terapia floral de Edward Bach y orientación psicológica en mujeres víctimas de violencia psicológica.Métodos: se realizó una investigación descriptiva y transversal en el consultorio No. 22 del policlínico Idalberto Revuelta de Sagua la Grande, provincia Villa Clara.Resultados: se identificaron estados emocionales en las mujeres tales como: miedo, ansiedad, culpa, depresión, tristeza, baja autoestima, presencia de traumas psicológicos en etapas anteriores de su desarrollo ontogenético, soledad, desesperanza, entre otras. Entre las esencias florales aplicadas se encontraron: Star of Bethlehem, Mímulus, Gorse, Gentian, Impatiens, Centaury.Conclusiones: se evaluó el resultado del tratamiento con terapia floral y orientación psicológica, aplicados de manera individual, y se determinó la efectividad de la terapia floral de Bach, para disminuir los síntomas identificados en mujeres víctima de violencia psicológica, como parte del tratamiento integral.[AU]

Health Challenges and Assets of Forest-Dependent Populations in Cameroon.

Indigenous populations often have poorer health outcomes than the general population. Marginalization, colonization, and migration from traditional lands have all affected traditional medicine usage, health access, and indigenous health equity. An in-depth understanding of health for specific populations is essential to develop actionable insights into contributing factors to poor indigenous health. To develop a more complete, nuanced understanding of indigenous health status, we conducted first-person interviews with both the indigenous Baka and neighboring Bantu villagers (the reference population in the region), as well as local clinicians in Southern Cameroon. These interviews elucidated perspectives on the most pressing challenges to health and assets to health for both groups, including access to health services, causes of illness, the uses and values of traditional versus modern medicine, and community resilience during severe health events. Baka interviewees, in particular, reported facing health challenges due to affordability and discrimination in public health centers, health effects due to migration from their traditional lands, and a lack of culturally appropriate public health services.

A systematic review of the role of vitamin D and calcium in premenstrual syndrome

Premenstrual syndrome (PMS) is a common disorder that affects millions of women of reproductive age worldwide. In recent years, there has been a focus on finding accessible, acceptable, and cost-effective therapeutic approaches with minimal side effects to treat the symptoms of PMS. This systematic review aimed to investigate the role of calcium and vitamin D in Premenstrual syndrome. The PubMed, EMBASE, Web of Science, Scopus, Science Direct, and Google Scholar databases were systematically searched for relevant articles from clinical trial, case-control, and cross-sectional studies. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to assess the quality of the selected papers. A total of 28 eligible high-quality papers were reviewed. Low serum levels of calcium and vitamin D during the luteal phase of the menstrual cycle were found to cause or exacerbate the symptoms of PMS. Therefore, the administration of calcium and vitamin D supplements or the use of a diet rich in these two substances can restore serum levels and eliminate or reduce the symptoms of PMS. Calcium and vitamin D supplementation are recommended as an inexpensive, low-risk, acceptable, and accessible approach to eliminate or reduce the symptoms of PMS.

The association between dietary pattern and depression in middle-aged Korean adults

BACKGROUND/OBJECTIVES: The association between dietary patterns and depression has been reported but the results have been inconsistent. This study was conducted to investigate the association between dietary patterns and depression in middle-aged Korean adults. SUBJECTS/METHODS: The participants were selected from a community-based cohort, a subset of the Korean Genome and Epidemiology Study. Depression was assessed using the Korean version of the Beck Depression Inventory (BDI) and those with a BDI score ≥ 16 were defined as having depression. The subjects' food intakes over the year preceding the survey were estimated by using a validated semi-quantitative food frequency questionnaire. Dietary patterns were identified by using factor analysis. Multiple logistic regression was used to assess the association of dietary pattern with depression. RESULTS: Among 3,388 participants, 448 (13.2%) were identified as having depression. We identified two major dietary patterns: ‘Healthy’ dietary pattern was characterized by high intakes of vegetables, soybeans, mushroom, seaweeds, white fish, shellfish and fruits and a low intake of white rice. ‘Unhealthy’ dietary pattern was characterized by high intakes of white rice, meats, ramen, noodles, bread and coffee and a low intake of rice with other grains. Compared with subjects in the lowest quartiles, those in the highest quartiles of the healthy dietary pattern had a significantly lower odds ratio (OR = 0.59, 95% CI: 0.42–0.82, P for trend = 0.0037) after adjusting for potential confounders. In contrast, the unhealthy dietary pattern was negatively associated with depression (OR = 1.65, 95% CI: 1.19–2.28, P for trend = 0.0021). CONCLUSION: This results suggest that a healthy dietary pattern (rich in vegetables, soybeans, mushroom, seaweeds, white fish, shellfish, and fruits) is associated with low risk of depression. Whereas an unhealthy dietary pattern (rich in white rice, meats, ramen, noodles, bread, and coffee) is associated with a high risk of depression in middle-aged Korean adults.