Concentrations and health risk appraisal of heavy metals and volatile organic compounds in soils of automobile mechanic villages in Ogun State, Nigeria.

This report presents the findings of the concentrations, distributions and health risks assessment of heavy metals (HMs) and volatile organic compounds (VOCs) in topsoils of two typical automobile mechanic villages (MVs) situated within Ogun State, Nigeria. One of the MVs is located in basement complex terrain (Abeokuta), while the second is in the sedimentary formation (Sagamu). Ten composite samples were collected at depth of 0-30 cm with the aid of soil auger from spent oil-contaminated spots within the two MVs. The chemical parameters of interest were Pb, Cd, benzene, ethylbenzene, toluene, total petroleum hydrocarbon (TPH) as well as oil and grease (O&G). In addition, soil pH, cation exchange capacity (CEC), electrical conductivity (EC) and particle size distribution were also evaluated in order to find out their impacts on assessed soil pollutants. Results revealed that the soils in both MVs are of sandy loam texture, slight acidic to neutral pH, mean CEC < 15 cmol/kg and mean EC > 100 µS/cm. The mean concentration of each of analyzed HMs and VOCs in soils from the two MVs was < 5 mg/kg, while the mean values of TPH and O&G content were > 50 mg/kg. The mean Cd values in soils of both MVs were higher than the national soil screening level of 0.8 mg/kg, but lower than the Canadian and Italian guidelines. There is no significant correlation between each of HMs/VOCs and any of assessed soil physicochemical variables. The non-cancer risk expressed in terms of hazard index (HI) was > 1 via oral ingestion route for adults and children at the two MVs, indicating adverse non-carcinogenic health risk. The HI > 1 value was obtained for adults only through the dermal absorption pathway in Abeokuta MV. However, HI values for the two age groups at the two MVs via inhalation route were < 1, indicating no likelihood of any non-carcinogenic effects via the breathing exposure. The potential of non-cancer risk via oral ingestion route in both MVs was derived from the contributive ratios of HMs and VOCs in the order: Cd > benzene > Pb > toluene. The carcinogenic risk (CR) values due to ingested Cd, benzene and Pb for both age groups at the two MVs exceed the safe limit range of 10-6 to 10-4. Cadmium, benzene and lead made considerable contributions to the estimation of CR through dermal exposure for adults only in Abeokuta MV. The CR values via inhalation pathway for adults and children in both MVs were within the threshold range. Artisans and children should circumvent accidental ingestion of contaminated soils in addition to wearing of protective clothes during routine vehicle maintenance activities.

Atuação da psicologia em unidade neonatal no contexto da pandemia da covid-19 / The work of psychology in a neonatal unit in the covid-19 pandemic / Actuación de la psicología en una unidad neonatal en el contexto de la pandemia de la covid-19

A pandemia de covid-19 provocou intensas mudanças no contexto do cuidado neonatal, exigindo dos profissionais de saúde a reformulação de práticas e o desenvolvimento de novas estratégias para a manutenção da atenção integral e humanizada ao recém-nascido. O objetivo deste artigo é relatar a atuação da Psicologia nas Unidades Neonatais de um hospital público de Fortaleza (CE), Brasil, durante o período de distanciamento físico da pandemia de covid-19. Trata-se de estudo descritivo, do tipo relato de experiência, que ocorreu no período de março a agosto de 2020. No contexto pandêmico, o serviço de Psicologia desenvolveu novas condutas assistenciais para atender às demandas emergentes do momento, como: atendimento remoto; registro e envio on-line de imagens do recém-nascido a seus familiares; visitas virtuais; e reprodução de mensagens de áudio da família para o neonato. Apesar dos desafios encontrados, as ações contribuíram para a manutenção do cuidado centrado no recém-nascido e sua família, o que demonstra a potencialidade do fazer psicológico.(AU)

The COVID-19 pandemic brought intense changes to neonatal care and required health professionals to reformulate practices and develop new strategies to ensure comprehensive and humanized care for newborn. This study aims to report the experience of the Psychology Service in the Neonatal Units of a public hospital in Fortaleza, in the state of Ceará, Brazil, during the social distancing period of the COVID-19 pandemic. This descriptive experience report study was conducted from March to August 2020. During the pandemic, the Psychology Service developed new care practices to meet the emerging demands of that moment, such as remote care, recordings and online submission of newborns' pictures and video images for their family, virtual tours, and reproduction of family audio messages for the newborns. Despite the challenges, the actions contributed to the maintenance of a care that is centered on the newborns and their families, which shows the potential of psychological practices.(AU)

La pandemia de la COVID-19 ha traído cambios intensos en el contexto de la atención neonatal, que requieren de los profesionales de la salud una reformulación de sus prácticas y el desarrollo de nuevas estrategias para asegurar una atención integral y humanizada al recién nacido. El objetivo de este artículo es reportar la experiencia del Servicio de Psicología en las Unidades Neonatales de un hospital público de Fortaleza, en Ceará, Brasil, durante el periodo de distanciamiento físico en la pandemia de la COVID-19. Se trata de un estudio descriptivo, un reporte de experiencia, que se llevó a cabo de marzo a agosto de 2020. En el contexto pandémico, el servicio de Psicología desarrolló nuevas conductas asistenciales para atender a las demandas emergentes del momento, tales como: atención remota; grabación y envío em línea de imágenes del recién nacido; visitas virtuales; y reproducción de mensajes de audio de la familia para el recién nacido. A pesar de los desafíos encontrados, las acciones contribuyeron al mantenimiento de la atención centrada en el recién nacido y su familia, lo que demuestra el potencial de la práctica psicológica.(AU)

Chaos Adaptive Particle Swarm for Physical Exercise Health Assessment.

Particle crowd algorithmic rule is a mayor examination hotspot in the authentic optimization algorithmic rule respond. Based on the PSO algorithmic rule to make optimal the RBFNN example, an amended order of nonlinear adaptable laziness power supported on the contest of population variegation is intended to extend the fixedness of population unlikeness performance and hunt capabilities to preclude the algorithmic rule from dripping into a topical extreme point prematurely, thereby further improving the prophecy correctness. Simulation experience shows that the amended PSO-RBFNN standard has open advantageous in the fixedness and sharp convergency of the prognosis proceed. In fashion to reprove the justness of reverse kinematics of robots with composite make and supercilious degrees of liberty, an amended adaptative suffix abound optimization (IAPSO) is spoken. First, the motoric equality of the 6-DOF strength-example avaricious robot design is established by the amended DH (Denavit-Hartenberg) argument course; second, on the base of the existent morsel abound algorithmic rule, the population Manhattan ceremoniousness is interested to lead the maneuver condition of the population in aqiqiy measure. And bound the adaptative lore substitute accordingly to the dissimilar maneuver possession and then adopt distinct site and hurry update modes; lastly, the fitness province with handicap substitute is present to trial the honest-prick and extended course transposition of the robot mold, and the delusion is not joint product major than 0.005 rad. The feint inference shows that the established kinematics shape is chasten, and the amended algorithmic program captures into recital the nicety, uniqueness, and velocity of the inverted resolution of the existent PSO algorithmic program, as well as higher deliverance truths. We conduct an experiment on the Brazilian jiu-jitsu. The results have clearly shown the advantage of our method.

Relação entre o perfil de adesão e as barreiras para a permanência no programa de extensão "yoga: awaken one" / Relationship between the membership profile and the barriers to stay in the "yoga: awaken one" extension program

Objetivo: Investigar a relação entre o perfil de adesão e barreiras percebidas por estudantes universitários para permanência no Programa de Extensão "Yoga: Awaken ONE". Métodos: Foram realizados dois cortes transversais com universitários da Universidade Federal do Recôncavo da Bahia. O primeiro foi composto por 16 indivíduos e investigou o perfil demográfico, socioeconômico, antropométrico, da aptidão física e da qualidade de vida dos universitários que ingressaram no Programa de Extensão. O segundo visou identificar as barreiras para permanência de 13 estudantes (dentre os 16 iniciais) que haviam se afastado do Programa após quatro meses do início. Resultados: Houve predominância de indivíduos do sexo feminino, dos cursos de graduação em Educação Física e Pedagogia e da classe socioeconômica C. A maioria dos participantes estava com indicadores adequados de gordura corporal. Observou-se grande proporção de indivíduos com indicadores baixos de flexibilidade e força muscular. Para a qualidade de vida, a menor mediana foi observada para o domínio meio ambiente e a maior para o domínio relações sociais. As principais barreiras percebidas para a prática de yoga pelos universitários foram "jornada de estudos extensa" e "jornada de trabalho extensa". Observou-se correlação do perfil sociodemográfico, indicadores de obesidade, variáveis hemodinâmicas, flexibilidade, força muscular e qualidade de vida com barreiras percebidas para permanência no Programa de Extensão universitária "Yoga: Awaken ONE". Conclusões: Estes achados sugerem que o perfil do público universitário pode ser determinante para a permanência ou evasão de programas de promoção de exercícios físicos e precisa ser considerado em propostas de programas de extensão universitária.

Objective: Investigate the relationship between the member adherence profile and barriers perceived by university students to remain in the "Yoga: Awaken ONE" Extension Program. Methods: Two cross-sections were carried out with university students from the Federal University of Recôncavo da Bahia. The first was composed of 16 individuals and investigated the demographic, socioeconomic, anthropometric, physical fitness, and quality of life profile of university students joining the Extension Program. The second aimed at identifying the barriers to remain in the program faced by 13 students (out of the initial 16) who had withdrawn from the Program four months after the beginning. Results: There was a predominance of female individuals, from undergraduate courses in Physical Education and Pedagogy, and from the C socioeconomic class. Most participants had adequate body fat indexes. There was a large proportion of individuals with low flexibility and muscle strength. For quality of life, the lowest median was observed for the environment domain, while the highest could be noted for the social relationship domain. The main barriers perceived for the practice of yoga by university students were "long study hours" and "long work hours". There was a correlation between sociodemographic profile, obesity indicators, hemodynamic variables, flexibility, muscle strength, and QOL with the perceived barriers to stay in the "Yoga: Awaken ONE" university extension program. Conclusions: These findings suggest that the profile of the university audience can be a determinant for the permanence or dropout of programs that promote physical exercise and therefore, it should be taken into consideration in proposals for university extension programs.

Estudio de la actividad antimicrobiana de Xenophyllum poposum sobre microorganismos de la cavidad bucal por el método de difusión radial / Study of the antimicrobial activity of Xenophyllum poposum on microorganisms of the oral cavity by the radial diffusion method

Resumen En este estudio se evaluó la actividad antimicrobiana in vitro de extractos de Xenophyllum poposum sobre microorganismos bucales como Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Actinomyces naeslundii, Actinomyces odontolyticus, Candida albicans y Veillonella sp. Se empleó el método de difusión radial en agar y como controles negativo y positivo de inhibición se emplearon etanol y clorhexidina al 0,12% (Plac out NF®) respectivamente. Los extractos con mayor actividad antimicrobiana fueron el etanólico y el clorofórmico. La diferencia entre ambos no fue estadísticamente significativa (p≥0,05). Tampoco se observó diferencia significativa con respecto a la clorhexidina, excepto sobre Veillonella sp., ya que el extracto etanólico presentó halos de inhibición significativamente menores sobre este microorganismo. Esto es importante ya que Veillonella se considera indicador de salud en relación a la caries dental. En base a esto, el extracto etanólico de Xenophyllum poposum podría ser usado como control químico de la biopelícula dental.

Abstract In this study, the in vitro antimicrobial activity of Xenophyllum poposum extracts on oral microorganisms such as Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Actinomyces naeslundii, Actinomyces odontolyticus, Candida albicans, Veillonella sp. was evaluated. The radial diffusion method in agar was used and 0.12% ethanol and chlorhexidine (Plac out NF®) were used as negative and positive inhibition controls, respectively. The extracts with the highest antimicrobial activity were the ethanolic and chloroform extracts. The difference between the two was not statistically significant (p≥0.05). No significant difference was observed with respect to chlorhexidine, except on Veillonella sp., since the ethanolic extract presented significantly lower inhibition halos on this microorganism. This is important as Veillonella is considered an indicator of health in relation to dental caries. Based on this, the ethanolic extract of Xenophyllum poposum could be used as chemical control of dental biofilm.

Resumo Neste estudo, a atividade antimicrobiana de extratos de Xenophyllum poposum sobre microrganismos orais como Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, Actinomyces naeslundii, Actinomyces odontolyticus, Candida albicans e Veillonella sp. Foi utilizado o método de difusão radial em ágar e etanol 0,12% e clorexidina (Plac out NF®) como controles de inibição negativa e positiva, respectivamente. Os extratos com maior atividade antimicrobiana foram os extratos etanólico e clorofórmio. A diferença entre os dois não foi estatisticamente significativa (p≥0,05). Não foi observada diferença significativa em relação à clorexidina 0,12%, exceto em Veillonella sp., uma vez que o extrato etanólico apresentou halos de inibição significativamente menores neste microrganismo. Isso é importante, pois a Veillonella é considerada um indicador de saúde em relação à cárie dentária. Com base nisso, o extrato etanólico de Xenophyllum poposum pode ser utilizado como controle químico do biofilme dental.

Transition to universal primary health care coverage in Brazil: analysis of uptake and expansion patterns of Brazil’s Family Health Strategy (1998-2012)

Family Health Strategy, the primary health care program in Brazil, has been scaled up throughout the country, but its expansion has been heterogeneous across municipalities. We investigate if there are unique municipal characteristics that can explain the timing of uptake and the pattern of expansion of the Family Health Strategy from years 1998 to 2012. We categorized municipalities in six groups based on the relative speed of the Family Health Strategy uptake and the pattern of Family Health Strategy coverage expansion. We assembled data for 11 indicators for years 2000 and 2010, for 5,507 municipalities, and assessed differences in indicators across the six groups, which we mapped to examine spatial heterogeneities. Important factors differentiating early and late adopters of the Family Health Strategy were supply of doctors and population density. Sustained coverage expansion was related mainly to population size, marginal benefits of the program and doctors’ supply. The uptake was widespread nationwide with no distinct patterns among regions, but highly heterogeneous at the state and municipal level. The Brazilian experience of expanding primary health care offers three lessons in relation to factors influencing diffusion of primary health care. First, the funding mechanism is critical for program implementation, and must be accompanied by ways to support the supply of primary care physicians in low density areas. Second, in more developed and bigger areas the main challenge is lack of incentives to pursue universal coverage, especially due to the availability of private insurance. Third, population size is a crucial element to guarantee coverage sustainability over time.

The self-rated health status and key influencing factors in middle-aged and elderly: Evidence from the CHARLS.

ABSTRACT: To evaluate the self-rate health (SRH) status and explore influence factors of middle-aged and elderly in China.China Health and Retirement Longitudinal Survey was conducted in 2011, 2013, 2015 and 2018. Data of the China Health and Retirement Longitudinal Survey in 2018 was used in our study and a total of 17898 participants were included. SRH status was graded as "very good, good, average, bad, very bad." Participants who answered "very good" and "good" were regarded as self-rated good health and who answered "average," "bad" and "very bad" were regarded as self-rated poor health. Odds ratio and 95% confidence interval of Logistics regression were calculated to evaluate the correlation between SRH and chronic diseases, demographic characteristics and lifestyle of middle-aged and elderly participants.A total of 4476 (25.01%) participants reported they had good health, and 13422 (74.99%) reported they had poor health. 9975 participants self-rated they had no chronic disease (55.73%), and 7923 (44.27%) participants self-rated they suffered from one and above chronic diseases. The prevalence of chronic diseases showed significant odds ratio and trend with SRH poor rate of participants. The more kinds of chronic diseases they suffered from, the poorer SRH was reported in middle-aged and elderly participants. Except for the chronic diseases, participants with higher age, living in rural, with high Center for Epidemiological Survey-Depression Scale score of depression and fewer time of physical activities also correlated with higher SRH (poor) rate.The SRH (good) rate was very low in middle-aged and elderly, participants who accompanied with more kinds of chronic diseases, fewer physical activities, higher age and living in the rural had a worse health status. A more comprehensive and integrated health framework should be strengthened to improve the health of middle-aged and elderly in China.

Worldwide evidence about infant stunting from a public health perspective: A systematic review / Evidencia mundial sobre el retraso del crecimiento infantil desde una perspectiva de salud pública: revisión sistemática

Abstract Introduction: According to the World Health Organization (WHO) global estimates for 2017, 9.6% of children under 5 years old are stunted. Worldwide evidence shows that actions for preventing stunting and catching-up growth are relevant if addressed by all the sectors involved. Therefore, there is a need to identify 'intersectoral actions' to address the risk of stunting during pregnancy and the first 2 years of life. Objective: To identify and describe worldwide evidence for prevention, nutritional interventions, and 'intersectoral collaboration' efforts against stunting in infants. Materials and methods: We conducted a systematic review in 2019 (PROSPERO CRD42019134431). The search included PubMed, OVID, and Web of Science, as well as WHO and the Food and Agriculture Organization of the United Nations (FAO) official documents and expert recommendations. Results: We selected 231 studies: 86.1% described prevention-related factors, 30.7%, nutritional interventions, and 52.8% intersectoral collaboration efforts; 36.4% of the studies were conducted in multiple regions; 61% of the studies described the importance of interventions during pregnancy, 71.9% from birth up to 6 months old, and 84.8% from 6 months up to 2 years old. The most frequent variables described were antenatal care, nutritional counseling for the mother and the newborn, and counseling on micronutrient supplementation. Conclusions: Evidence-based understanding of actions geared towards monitoring the risk of stunting-associated factors from pregnancy up to 2 years old is critical.

Resumen Introducción. Según estimaciones mundiales de la Organización Mundial de la Salud (OMS) para el 2017, el 9,6 % de los niños menores de cinco años padecen retraso del crecimiento. La evidencia mundial ha demostrado que las acciones para prevenir el retardo del crecimiento o para tratarlo adquieren relevancia si las abordan todos los sectores involucrados. Por lo tanto, es necesario determinar las acciones intersectoriales para atender el riesgo de retraso del crecimiento durante el embarazo y los dos primeros años de vida. Objetivo. Rastrear y describir la evidencia mundial para la prevención, las intervenciones nutricionales y los esfuerzos de colaboración intersectorial contra el retraso del crecimiento en los lactantes. Materiales y métodos: Se hizo una revisión sistemática en el 2019 (PROSPERO CRD42019134431). La búsqueda incluyó PubMed, OVID y Web of Science, así como documentos oficiales de la OMS y la Organización para la Agricultura y la Alimentación de Naciones Unidas (FAO) y recomendaciones de expertos. Resultados. Se seleccionó un total de 231 estudios: 86,1 % describían factores relacionados con la prevención, 30,7 %, intervenciones nutricionales, y 52,8 %, esfuerzos de colaboración intersectorial; 36,4 % de ellos se llevaron a cabo en múltiples regiones. Del total, el 61 % de los estudios se enfocaba en la importancia de las intervenciones durante el embarazo, el 71,9 % desde el nacimiento hasta los seis meses y el 84,8 % desde los seis meses hasta los dos años. Las variables descritas con mayor frecuencia fueron la atención prenatal, el asesoramiento nutricional para la madre y el recién nacido, y el asesoramiento sobre la suplementación con micronutrientes. Conclusiones. La comprensión basada en la evidencia de las acciones orientadas a monitorear el riesgo de factores asociados al retraso del crecimiento desde el embarazo hasta los dos años, es fundamental.

"Assessing Today for a Better Tomorrow": An observational cohort study about quality of care, mortality and morbidity among newborn infants admitted to neonatal intensive care in Guinea.

BACKGROUND: Neonatal mortality in Guinea accounts for about 30% of all fatalities in children younger than five years. Countrywide, specialized neonatal intensive care is provided in one single clinic with markedly limited resources. To implement targeted measures, prospective data on patient characteristics and factors of neonatal death are needed. OBJECTIVE: To determine the rates of morbidity and mortality, to describe clinical characteristics of admitted newborns requiring intensive care, to assess the quality of disease management, and to identify factors contributing to neonatal mortality. METHODS: Prospective observational cohort study of newborns admitted to the hospital between mid-February and mid-March 2019 after birth in other institutions. Data were collected on maternal/prenatal history, delivery, and in-hospital care via convenience sampling. Associations of patient characteristics with in-hospital death were assessed using cause-specific Cox proportional-hazards models. RESULTS: Half of the 168 admitted newborns underwent postnatal cardiopulmonary resuscitation. Reasons for admission included respiratory distress (49.4%), poor postnatal adaptation (45.8%), prematurity (46.2%), and infections (37.1%). 101 newborns (61.2%) arrived in serious/critical general condition; 90 children (53.9%) showed clinical signs of neurological damage. Quality of care was poor: Only 59.4% of the 64 newborns admitted with hypothermia were externally heated; likewise, 57.1% of 45 jaundiced infants did not receive phototherapy. Death occurred in 56 children (33.3%) due to birth asphyxia (42.9%), prematurity (33.9%), and sepsis (12.5%). Newborns in serious/critical general condition at admission had about a fivefold higher hazard to die than those admitted in good condition (HR 5.21 95%-CI 2.42-11.25, p = <0.0001). Hypothermia at admission was also associated with a higher hazard of death (HR 2.00, 95%-CI 1.10-3.65, p = 0.023). CONCLUSION: Neonatal mortality was strikingly high. Birth asphyxia, prematurity, and infection accounted for 89.3% of death, aggravated by poor quality of in-hospital care. Children with serious general condition at admission had poor chances of survival. The whole concept of perinatal care in Guinea requires reconsideration.

The Unfolding Method to Explore Health-Related Quality of Life Constructs in a Chinese General Population.

OBJECTIVES: Health-related quality of life (HRQOL) is a complicated concept that can be measured using multiple health items. Although HRQOL is closely associated with people's subjective assessment of their own health, a limited number of studies have investigated which health items are considered most important and relevant by the general population. Even fewer empirical studies have investigated how HRQOL is understood in non-Western populations. This study used multidimensional unfolding analysis in a Chinese general population to explore the constructs of HRQOL. METHODS: A scoping review of Chinese generic HRQOL measures and a series of qualitative interviews produced a list of 42 potentially important health items in a Chinese cultural setting; 110 Chinese participants in face-to-face interviews ranked the health items from most important to least important. Responses were coded into a rectangular 110 × 42 matrix, and multidimensional unfolding was conducted to analyze participants' preferences for health items. RESULTS: It was found that demographic characteristics and one's health condition affected views of HRQOL. Meanwhile, 3 health items were considered to be most important across the whole sample: sleep quality, body constitution, and spiritual appearance. CONCLUSION: This study used a novel approach to explore how people coming from a Chinese cultural setting may perceive HRQOL and which aspects of HRQOL are most important to them. The study shows that multidimensional unfolding is a feasible approach to assess preferences in a general population. Future studies using this approach are recommended to further explore the constructs of HRQOL in other general populations.

Development of integration indexes to determine the extent of family planning and child immunization services integration in health facilities in urban areas of Nigeria.

BACKGROUND: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. METHODS: This study utilizes cross-sectional health facility (N = 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N = 1479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). RESULTS: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. CONCLUSION: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.

La educación médica en el diagnóstico educativo-terapéutico de pacientes hipertensos con rigidez arterial alterada / Medical education in the educational-therapeutic diagnosis of hypertensive patients with altered arterial stiffness

RESUMEN Fundamento: el carácter preventivo del sistema de salud cubano, como principio para su desarrollo, orienta la formación de un médico que responda consecuentemente a los problemas de salud de la población; de ahí que la educación médica los prepara para aplicar los últimos descubrimientos científicos en la prevención y tratamiento de enfermedades. Objetivo: valorar la contribución de una estrategia de diagnóstico educativo-terapéutico dirigido a la prevención de complicaciones vasculares que produce la hipertensión arterial. Métodos: se realizó una investigación pedagógica en el Policlínico Universitario "José Martí Pérez" de Santiago de Cuba durante 2019. Se emplearon métodos teóricos: análisis-síntesis, sistémico-estructural, holístico-dialéctico, hermenéutico-dialéctico e inductivo-deductivo; empíricos: encuestas, análisis documental, taller de socialización con especialistas, y técnicas educativas; estadísticos: técnicas descriptivas y análisis porcentual. Resultados: se aplicó una estrategia constituida por acciones de intervención educativo-terapéutica concretada en un proyecto de diagnóstico educativo de salud, la cual permitió incrementar el nivel de conocimientos de los pacientes hipertensos sobre su enfermedad; finalizada su aplicación se comprobó que no desarrollaron complicaciones vasculares lo que generó mayor compromiso con su salud. Conclusiones: los especialistas valoraron como adecuados el carácter científico profesional de la estrategia y su pertinencia. Su implementación contribuyó a la educación de los pacientes como un aporte de la educación médica en el nivel de atención primaria de salud.

ABSTRACT Background: the preventive nature of the Cuban health system, as a principle for its development, guides the training of a doctor who consistently responds to the health problems of the population; hence medical education prepares them to apply the latest scientific findings in disease prevention and treatment. Objective: to assess the contribution of an educational-therapeutic diagnostic strategy aimed at preventing vascular complications caused by hypertension. Methods: a pedagogical research was carried out at "José Martí Pérez" University Polyclinic in Santiago de Cuba during 2019. Theoretical methods were used: analysis-synthesis, systemic-structural, holistic-dialectical, hermeneutical-dialectical and inductive-deductive; empirical ones: surveys, documentary analysis, socialization workshop with specialists, and educational techniques; statistics: descriptive techniques and percentage analysis. Results: a strategy consisting of educational-therapeutic intervention actions was applied, it was concretized in a health educational diagnosis project, which allowed to increase the level of knowledge of hypertensive patients about their disease; after its implementation, it was found that they did not develop vascular complications, which generated a greater commitment to their health. Conclusions: the specialists valued the professional scientific nature of the strategy and its relevance as adequate. Its implementation contributed to the education of patients as a contribution to medical education at the primary health care level.

Factors associated with COVID-19 infections and mortality in Africa: a cross-sectional study using publicly available data.

INTRODUCTION: The current COVID-19 pandemic is a global threat. This elicits questions on the level of preparedness and capacity of health systems to respond to emergencies relative to other parts of the world. METHODS: This cross-sectional study uses publicly available core health data for 53 African countries to determine risk factors for cumulative COVID-19 deaths and cases per million in all countries in the continent. Descriptive statistics were determined for the indicators, and a negative binomial regression was used for modelling the risk factors. RESULTS: In sub-Saharan Africa, an increase in the number of nursing and midwifery personnel decreased the risk of COVID-19 deaths (p=0.0178), while a unit increase in universal healthcare (UHC) index of service coverage and prevalence of insufficient physical activity among adults increased the risk of COVID-19 deaths (p=0.0432 and p=0.0127). An increase in the proportion of infants initiating breast feeding reduced the number of cases per million (p<0.0001), while an increase in higher healthy life expectancy at birth increased the number of cases per million (p=0.0340). CONCLUSION: Despite its limited resources, Africa's preparedness and response to the COVID-19 pandemic can be improved by identifying and addressing specific gaps in the funding of health services delivery. These gaps impact negatively on service delivery in Africa, which requires more nursing personnel and increased UHC coverage to mitigate the effects of COVID-19.

Predictive Accuracy of Heart Failure-Specific Risk Equations in an Electronic Health Record-Based Cohort.

BACKGROUND: Guidelines recommend identification of individuals at risk for heart failure (HF). However, implementation of risk-based prevention strategies requires validation of HF-specific risk scores in diverse, real-world cohorts. Therefore, our objective was to assess the predictive accuracy of the Pooled Cohort Equations to Prevent HF within a primary prevention cohort derived from the electronic health record. METHODS: We retrospectively identified patients between the ages of 30 to 79 years in a multi-center integrated healthcare system, free of cardiovascular disease, with available data on HF risk factors, and at least 5 years of follow-up. We applied the Pooled Cohort Equations to Prevent HF tool to calculate sex and race-specific 5-year HF risk estimates. Incident HF was defined by the International Classification of Diseases codes. We assessed model discrimination and calibration, comparing predicted and observed rates for incident HF. RESULTS: Among 31 256 eligible adults, mean age was 51.4 years, 57% were women and 11% Black. Incident HF occurred in 568 patients (1.8%) over 5-year follow-up. The modified Pooled Cohort Equations to Prevent HF model for 5-year risk prediction of HF had excellent discrimination in White men (C-statistic 0.82 [95% CI, 0.79-0.86]) and women (0.82 [0.78-0.87]) and adequate discrimination in Black men (0.69 [0.60-0.78]) and women (0.69 [0.52-0.76]). Calibration was fair in all race-sex subgroups (χ2<20). CONCLUSIONS: A novel sex- and race-specific risk score predicts incident HF in a real-world, electronic health record-based cohort. Integration of HF risk into the electronic health record may allow for risk-based discussion, enhanced surveillance, and targeted preventive interventions to reduce the public health burden of HF.

Vitamin D Receptor Polymorphisms in Sex-Frailty Paradox.

The "male-female health-survival paradox" evidences that the survival advantage observed in women is linked to higher rates of disability and poor health status compared to men, a phenomenon also called the "sex-frailty paradox". The depletion of vitamin D seems to play a role in the fragilization of old persons, and genetic polymorphisms of the vitamin D receptor (VDR) gene seem to be involved in regulating the vitamin D pathway. This study correlated the VDR gene polymorphisms (FokI, ApaI, BsmiI, and TaqI) with frailty, computed by frailty index (FI), in 202 persons (127 women and 75 men, aged from 60 to 116 years), aiming to capture the involvement of vitamin D in the sex-frailty paradox. The results showed slightly higher FI (p = 0.05), lower levels of 25(OH)D (p = 0.04), and higher levels of parathyroid hormone PTH (p = 0.002) and phosphorus (p < 0.001) in women than in men. Interestingly, the ApaI minor allele (Aa + aa) showed a significant positive association with FI (p = 0.03) and a negative association with inorganic phosphorus values (p = 0.04) compared to AA genotype only in women, regardless of age. The exact mechanism and the causal role that, in old women, links ApaI polymorphism with frailty are still unclear. However, we could speculate that a specific genetic profiling, other than 25(OH)D levels, play a role in the sex-frailty paradox.

Development and validation of the specific instrument for assistance complexity of puerperal and newborns: Fantinelli Scale / Desenvolvimento e validação do instrumento específico para complexidade assistencial de puérperas e recém-nascidos: Escala Fantinelli

Abstract Objectives: to develop and validate a care complexity assessment system adapted for mothers and newborns, based on two pre-existing scales. Methods: this is a cross-sectional study of psychometric validation of instruments, applied in a roomming-in, in 2016. The instrument has 13 indicators, submitted to the evaluation of a panel of judges for validation. For the psychometric analysis of the instrument, five criteria were adopted: a) internal consistency through Cronbach's alpha (αC); (b) intraclass correlation coefficient (ICC); c) correlation between categorical items, mediating Kendall correlation; d) ceiling and floor effect; e) Kaiser-Meyer-Olkin test. Results: after evaluating the judges on the categories, the agreement was satisfactory, being equal to or greater than 80%. The mean total score of the 13 items was 22.5 ± 4.2, with an intermediate level score of 52.9%. For psychometric validation purposes, the instrument presented αC scores of 0.73 points, between minimum items of 0.70 and maximum of 0.74 points. In the correlation of αC by items and the total score, the instrument showed high relationships (r2: 0.84). In the ICC assessment of 0.73 points (CI95%= 0.71-0.75; p<0.001). Conclusion: the questionnaire presented psychometric indicators of acceptable content validity, with statistical evidence of reliability, obtained by satisfactory inter-rateragreement.

Resumo Objetivos: desenvolver e validar um sistema de avaliação de complexidade assistencial adaptado para puérperas e recém-nascidos, com base em duas escalas preexistentes. Métodos: trata-se de um estudo transversal, de validação psicométrica de instrumentos, aplicado em um alojamento conjunto, no período 2016. O instrumento possui 13 indicadores, submetidos à avaliação de um painel de juízes para validação. Para análise psicométrica do instrumento foram adotados cinco critérios: a) consistência interna por meio do Alfa de Cronbach (αC); b) Coeficiente de correlação intraclasse (CCI); c) correlação entre itens categóricos, mediando a correlação de Kendall; d) efeito teto e piso; e) teste de Kaiser-Meyer-Olkin. Resultados: feita a avaliação dos juízes sobre as categorias, a concordância foi satisfatória, sendo igual ou maior a 80%.A média do escore total dos 13 itens foi de 22,5±4,2, com classificação do nível intermediário em 52,9%. Para fins de validação psicométrica, o instrumento apresentou escores de αC de 0,73 pontos, entre itens mínimos de 0,70 e máximo de 0,74 pontos. Na correlação do αC por itens e o escore total, o instrumento demonstrou relações elevadas (r2: 0,84). Na avaliação do CCI de 0,73 pontos (IC95%= 0,71-0,75; p<0,001). Conclusão: o questionário apresentou indicadores psicométricos de validade de conteúdos aceitáveis, com evidência estatística de confiabilidade obtida pela satisfatória concordância interavaliadores.

The TechSAge Minimum Battery: A multidimensional and holistic assessment of individuals aging with long-term disabilities.

BACKGROUND: People with disabilities acquired in early to mid-life are living longer, contributing to growing numbers of older adults who are aging with disability, an understudied population likely to be underserved. OBJECTIVES: This paper demonstrates the usefulness of the TechSAge Minimum Battery as a holistic assessment of health for people aging with disabilities. METHODS: Survey data of socio-demographic and health characteristics were collected from 176 older adults with long-term vision, hearing, and/or mobility disabilities. A series of descriptive and bivariate analyses were conducted to illustrate the heterogeneity of the sample. An in-depth analysis of the subsample with vision difficulty was conducted to highlight the tool's value in assessing detailed contextual information for a specific disability. RESULTS: Prevalence of health conditions (M = 4.1; SD = 2.5), prescription medications (M = 4.1; SD = 3.9), and serious functional difficulties (M = 1.6; SD = 0.85) indicated a fair degree of comorbidity, but with considerable variation in number and type among individuals. Subjective health ratings were high overall, but lower scores were correlated with additional comorbidities (r = -0.31-0.40, p =<.001). Analyses of the subsample with vision difficulty demonstrated heterogeneity in functional capacity, degree of impairment, duration, and use of supportive aids. CONCLUSIONS: Findings highlighted the heterogeneity among people aging with disability and demonstrated the importance of capturing multi-dimensional factors inclusive of an individual's capacity, context, and personal factors, which the Minimum Battery provides in an integrated assessment. Potential healthcare applications of the tool are discussed with implications for bridging aging and disability services.

Implications of the Hemoglobin Glycation Index on the Diagnosis of Prediabetes and Diabetes.

OBJECTIVE: Fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG) from a 75-g oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) can lead to different results when diagnosing prediabetes and diabetes. The Hemoglobin Glycation Index (HGI) quantifies the interindividual variation in glycation resulting in discrepancies between FPG and HbA1c. We used data from the Vitamin D and Type 2 Diabetes (D2d) study to calculate HGI, to identify HGI-associated variables, and to determine how HGI affects prediabetes and diabetes diagnosis. MEASUREMENTS: A linear regression equation [HbA1c (%) = 0.0164 × FPG (mg/dL) + 4.2] was derived using the screening cohort (n = 6829) and applied to calculate predicted HbA1c. This was subtracted from the observed HbA1c to determine HGI in the baseline cohort with 2hPG data (n = 3945). Baseline variables plus prediabetes and diabetes diagnosis by FPG, HbA1c, and 2hPG were compared among low, moderate, and high HGI subgroups. RESULTS: The proportion of women and Black/African American individuals increased from low to high HGI subgroups. Mean FPG decreased and mean HbA1c increased from low to high HGI subgroups, consistent with the HGI calculation; however, mean 2hPG was not significantly different among HGI subgroups. CONCLUSIONS: High HGI was associated with Black race and female sex as reported previously. The observation that 2hPG was not different across HGI subgroups suggests that variation in postprandial glucose is not a significant source of population variation in HGI. Exclusive use of HbA1c for diagnosis will classify more Black individuals and women as having prediabetes compared with using FPG or 2hPG.

Relationship Between Modified Body Adiposity Index and A Body Shape Index with Biochemical Parameters in Bariatric Surgery Candidates.

BACKGROUND: Body mass index, an estimate of body fat percentage, has been previously shown to be associated with metabolic disorders. However, there is little data on the associations between a body shape index (ABSI) or modified body adiposity index (MBAI), which provide valuable definitions of body fat, with serum biochemical parameter levels. Therefore, this study was conducted to find either ABSI or MBAI associations with serum biochemical parameter levels in bariatric surgery candidates. METHODS: This cross-sectional study was conducted on 776 bariatric surgery candidates (age range 18-69 years) between November 2010 and September 2017. Demographic data, anthropometric indices, biochemical parameters, and body composition analysis data were drawn from the National Obesity Surgery Database, Iran. ABSI and MBAI were calculated using related equations. A stepwise multivariate linear regression was used to evaluate whether ABSI or MBAI was associated with each serum biochemical parameter. RESULTS: ABSI, age, and multivitamin/mineral supplementation (MVMS) were independently associated with serum vitamin D (ß = 24.374, SE 10.756, P value 0.026; ß = 0.022, SE 0.007, P value 0.002; ß = 0.639, SE 0.235, P value 0.008). However, a negative association was observed between MBAI and vitamin D (ß = - 0.037, SE 0.016, P value 0.025) in a model adjusted for age and MVMS. Additionally, MBAI and age showed a significant positive association with serum HDL-c (ß = 0.185, SE 0.085, P value 0.028; ß = 0.171, SE 0.033, P value < 0.001), although there was a negative association between male sex and HDL-c (ß = - 4.004, SE 0.891, P value < 0.001). CONCLUSION: ABSI and MBAI may be appropriate indices in predicting serum vitamin D and HDL-c levels.