Lung transplantation: Current insights and outcomes.

Until now, the ability to predict or retard immune-mediated rejection events after lung transplantation is still limited due to the lack of specific biomarkers. The pressing need remains to early diagnose or predict the onset of chronic lung allograft dysfunction (CLAD) and its differential phenotypes that is the leading cause of death. Omics technologies (mainly genomics, epigenomics, and transcriptomics) combined with advanced bioinformatic platforms are clarifying the key immune-related molecular routes that trigger early and late events of lung allograft rejection supporting the biomarker discovery. The most promising biomarkers came from genomics. Both unregistered and NIH-registered clinical trials demonstrated that the increased percentage of donor-derived cell-free DNA in both plasma and bronchoalveolar lavage fluid showed a good diagnostic performance for clinically silent acute rejection events and CLAD differential phenotypes. A further success arose from transcriptomics that led to development of Molecular Microscope® Diagnostic System (MMDx) to interpret the relationship between molecular signatures of lung biopsies and rejection events. Other immune-related biomarkers of rejection events may be exosomes, telomer length, DNA methylation, and histone-mediated neutrophil extracellular traps (NETs) but none of them entered in registered clinical trials. Here, we discuss novel and existing technologies for revealing new immune-mediated mechanisms underlying acute and chronic rejection events, with a particular focus on emerging biomarkers for improving precision medicine of lung transplantation field.

Role of HLA matching and donor specific antibody development in long-term survival, acute rejection and cardiac allograft vasculopathy.

Although there are different data supporting benefits of HLA matching in kidney transplantation, its role in heart transplantation is still unclear. HLA mismatch (MM) between donor and recipient can lead to the development of donor-specific antibodies (DSA) which produces negative events on the outcome of heart transplantation. Moreover, DSAs are involved in the development of antibody-mediated rejection (AMR) and are associated with an increase in cardiac allograft vasculopathy (CAV). In this study it is analyzed retrospectively the influence of HLA matching and anti-HLA antibodies on overall survival, AMR and CAV in heart transplantation. For this retrospective study are recruited heart transplanted patients at the Cardiac Transplantation Centre of Naples between 2000 and 2019. Among the 155 heart transplant patients, the mean number of HLA-A, B, -DR MM (0 to 6) between donor and recipient was 4.5 ± 1.1. The results show a negative association between MM HLA-DR and survival (p = 0.01). Comparison of patients with 0-1 MM at each locus to all others with 2 MM, for both HLA class I and class II, has not showed significant differences in the development of CAV. Our analysis detected DSA in 38.1% of patients. The production of de novo DSA reveals that there is not an influence on survival (p = 0.72) and/or AMR (p = 0.39). Instead, there is an association between the production of DSA class II and the probability of CAV development (p = 0.03). Mean fluorescence intensity (MFI) values were significantly higher in CAV-positive patients that CAV-negative patients (p = 0.02). Prospective studies are needed to evaluate HLA class II matching as an additional parameter for heart allocation, especially considering the increment of waiting list time.

Which physical and social characteristics of Brazilian cities contribute to physical activity of adolescents?

This study aimed to analyze the association between adolescents' physical activity and the Brazilian capitals' built and social environment. The units of analysis of this ecological study were the 26 capitals and the Federal District, with data from the National Adolescent Health Survey (2012). The outcome variable was the reported regular physical activity (PA) of ninth graders in Brazilian schools. Exposure variables included characteristics of the natural environment, socioeconomic and educational indicators, urban infrastructure, urban violence, and sociocultural factors retrieved from several secondary sources of Brazilian databases. We adopted multiple linear regression to verify the association between PA and exposure variables. The percentage of active adolescents was 33.0% (95%CI: 32.1; 33.9). In the final model, higher PA was associated with lower temperature, higher Primary Education Development Index, the higher percentage of ramps for wheelchair users, and a higher percentage of leisure-time active adults. The data show that climatic and educational factors, the infrastructure, and the social environment of the capitals can contribute to Brazilian adolescents complying with the recommended weekly PA levels.

Which physical and social characteristics of Brazilian cities contribute to physical activity of adolescents? / Quais características físicas e sociais das cidades brasileiras contribuem para atividade física de adolescentes?

Abstract This study aimed to analyze the association between adolescents' physical activity and the Brazilian capitals' built and social environment. The units of analysis of this ecological study were the 26 capitals and the Federal District, with data from the National Adolescent Health Survey (2012). The outcome variable was the reported regular physical activity (PA) of ninth graders in Brazilian schools. Exposure variables included characteristics of the natural environment, socioeconomic and educational indicators, urban infrastructure, urban violence, and sociocultural factors retrieved from several secondary sources of Brazilian databases. We adopted multiple linear regression to verify the association between PA and exposure variables. The percentage of active adolescents was 33.0% (95%CI: 32.1; 33.9). In the final model, higher PA was associated with lower temperature, higher Primary Education Development Index, the higher percentage of ramps for wheelchair users, and a higher percentage of leisure-time active adults. The data show that climatic and educational factors, the infrastructure, and the social environment of the capitals can contribute to Brazilian adolescents complying with the recommended weekly PA levels.

Resumo Este estudo teve como objetivo analisar a associação entre atividade física em adolescentes e ambientes construído e social das capitais brasileiras. Trata-se de um estudo ecológico cujas unidades de análise foram as 26 capitais e o Distrito Federal, com dados da Pesquisa Nacional de Saúde do Adolescentes (2012). A variável de desfecho foi a prática regular de atividade física (AF) relatada pelos escolares do 9º ano de escolas brasileiras. As variáveis de exposição incluíram características do ambiente natural, indicadores socioeconômicos e educacionais, de infraestrutura, violência urbana e fatores socioculturais, obtidas de diferentes bases de dados de fontes secundárias brasileiras. Adotou-se a regressão linear múltipla para verificar a associação entre AF e variáveis de exposição. O percentual de adolescentes ativos foi de 33,0% (IC95%: 32,1; 33,9). No modelo final, foram associados à maior prática de AF: menor temperatura, maior Índice de Desenvolvimento da Educação Básica, maior percentual de rampa para cadeirante e maior percentual de adultos ativos no lazer. Os dados mostram que fatores climáticos e educacionais, a infraestrutura e o ambiente social das capitais podem contribuir para que os adolescentes brasileiros cumpram os níveis semanais recomendados de AF.

Distribuição e qualidade de espaços públicos para atividade física de lazer em uma capital do Brasil / Distribution and quality of public spaces for physical leisure activity in a brazilian capital

As características físicas do ambiente podem contribuir na promoção da saúde, principalmente a disponibilidade e qualidade dos espaços públicos de lazer. O presente estudo tem como objetivo analisar a distribuição e a qualidade dos equipamentos para atividade física de lazer em uma capital brasileira. Foram avaliados 27 espaços públicos, incluindo parques, praças e canteiros habitáveis disponíveis no raio de 1.000 metros de três polos do Programa Academia da Saúde (PAS) no município de Belo Horizonte. Em 2019, os equipamentos foram auditados por meio da aplicação da versão adaptada do Physical Activity Resource Assessment (PARA), que avalia a existência, qualidade, segurança, limpeza e estética dos equipamentos. Frequências absolutas e relativas foram calculadas. Dos 27 locais avaliados, 22,2% eram parques (n = 6), 70,4% praças (n = 19) e 7,4% canteiros habitáveis (n = 2). Quadras de vôlei e campos de futebol foram os equipamentos mais identificados nos parques, presentes em todos os locais analisados, enquanto academias e estações de exercício ao ar livre foram os mais comuns nas praças (89,5%; 52,9%, respectivamente). Quanto aos canteiros habitáveis, apresentaram apenas quadras de vôlei/campos de futebol. Com relação à limpeza e estética, as maiores proporções foram pichações (74,1%), lixo espalhado/sujeira (74,1%), grama alta (44,4%) e sinais de vandalismo e sujeira de animais (37,0%). A pequena diversidade e qualidade ruim dos equipamentos, e as características inadequadas de limpeza e estética dos espaços de lazer no qual se encontram, podem impedir ou dificultar o uso dos mesmos para a prática de atividade física, demonstrando assim, a necessidade de investimentos mais expressivos nesses locais

The physical characteristics of the environment can contribute to health promotion, especially the availa-bility and quality of public leisure spaces. The present study aims to analyze the distribution and quality of equipment for leisure physical activity in a Brazilian capital. Twenty-seven public spaces, including parks, squares and boulevards available within a radius of 1,000 meters of three centers of the Health Academy Program (PAS) in the city of Belo Horizonte were evaluated. In 2019, the equipment was audited through the application of the adapted version of the Physical Activity Resource Assessment (PARA), which evaluates the existence, quality, safety, cleanliness, and aesthetics of the equipment. Absolute and relative frequencies were calculated. Of the 27 sites evaluated, 22.2% were parks (n=6), 70.4% were squares (n = 19), and 7.4% were boulevards (n = 2). Volleyball courts and soccer fields were the most identified equipment in parks, present in all analyzed places, while outdoor gyms and exercise stations were the most common in squares (89.5%; 52.9%, respectively). As for boulevards, they only had volleyball courts/soccer fields. Regarding cleanliness and aesthetics, the highest proportions were graffiti (74.1%), scattered garbage/dirt (74.1%), tall grass (44.4%), and signs of vandalism and animal dirt (37.0%). The small diversity and poor quality of equipment, and the inadequate characteristics of cleanliness and aesthetics of the leisure spaces in which they are located, can prevent or hinder their use for the practice of physical activity, thus demonstrating the need for more expressive investments in these places

Oral skills and breastfeeding performance of premature newborns hospitalized in a neonatal unit / Habilidades orais e desempenho na mamada de recém-nascidos prematuros internados em unidade neonatal

ABSTRACT Purpose: to compare oral skills and functional breastfeeding performance at the time of speech-language-hearing assessment and tube removal in premature newborns admitted to a neonatal unit. Methods: a cross-sectional observational study in premature newborns without serious pathologies, admitted to the neonatal unit of a hospital of the Public Health System, from May to August 2022. Data were collected from the medical records, and premature newborns were assessed regarding the readiness for oral feeding, breastfeeding performance, and oral skill level at the time of assessment and tube removal. The Wilcoxon test was used to compare these measures at both moments, setting the significance level at 5%. Results: the study sample had 126 premature newborns with a mean weight of 1,937.2 g and a mean gestational age of 33.1 weeks. Both the breastfeeding performance score (from 6.5 to 8.2) and the oral skill level improved between the two moments, with more premature babies in level IV (the most mature), with a statistically significant relationship (p < 0.001). Conclusion: the breastfeeding performance and oral skill levels improved between the speech-language-hearing assessment and tube removal in hospitalized premature infants, indicating development in skills during this process.

RESUMO Objetivo: comparar as habilidades orais e o desempenho funcional na mamada no momento da avaliação fonoaudiológica e na ocasião da retirada de sonda em prematuros internados em Unidade Neonatal. Métodos: estudo observacional transversal, realizado com prematuros sem patologias graves, internados em Unidade Neonatal de hospital do Sistema Único de Saúde, no período de maio a agosto de 2022. Foram coletados dados no prontuário e realizada avaliação da prontidão para via oral, do desempenho na mamada e do nível de habilidade oral do prematuro no momento da avaliação e na retirada de sonda. Foi utilizado o teste de Wilcoxon para comparar essas medidas nos dois momentos, considerando nível de significância de 5%. Resultados: participaram do estudo 126 prematuros com peso e idade gestacional médios de 1.937,2 g e 33,1 semanas, respectivamente. Houve melhora no escore de desempenho da mamada entre os dois momentos (de 6,5 para 8,2) e no nível de habilidade oral, com mais prematuros no nível IV, o mais maduro, com relação estatisticamente significante (p<0,001). Conclusão: houve melhora no desempenho da mamada e nível de habilidade oral ao comparar os momentos da avaliação fonoaudiológica e retirada de sonda em prematuros internados, indicando evolução nas habilidades no decorrer desse processo.

Lethality among individuals infected with visceral leishmaniasis in Brazil: a retrospective study (2007-2018).

Visceral leishmaniasis (VL) is a public health problem with a high prevalence and lethality in Brazil. This study aims to estimate the lethality and associated factors in individuals with VL and assess survival time, emphasizing VL/HIV coinfection. This retrospective study has 37,583 individuals notified and confirmed with VL in the Sistema de Informação de Agravos de Notificação (SINAN) between 2007 and 2018 (Brazil). Lethality was evaluated considering VL deaths, deaths from other causes (OC), and non-deaths. We performed a multinomial logistic regression, with non-death as the benchmark category. We conducted a survival analysis (Kaplan-Meier method), emphasizing VL/HIV coinfection. Most individuals were young, male, mixed race, low schooling level, and urban dwellers. The lethality rate was 10.2% (VL and OC deaths) and 7.8% (VL deaths). The prevalence of HIV infection was 8.81%. A higher likelihood of VL and OC deaths was observed in older age groups, females, and with a higher number of symptoms. A higher likelihood of OC deaths was identified in individuals with HIV. A lower likelihood of VL and OC deaths was observed for individuals on VL therapy. The mean survival time was longer for VL/HIV individuals, who had a lower survival rate than those with VL. The data point to the need for attention to the timely diagnosis of VL and HIV and adequate pharmacological treatment in this population.

Noise annoyance, sociodemographic and health patterns, and neighborhood perceptions in a Brazilian metropolis: BH Health Study.

OBJECTIVE: The present study aims to analyze the association of noise annoyance with individual and sociodemographic factors and self-perception of the neighborhood in an urban center. METHODS: Data were collected through a population-based cross-sectional study held in two of the nine health districts in the city of Belo Horizonte, Minas Gerais, Brazil, from 2008 to 2009. The study included 3,934 individuals of both genders, aged 18 years and older. The response variable was the self-perception of noise, investigated by the question: "In your neighborhood, does the noise bother you?" The explanatory variables were grouped into the following domains: sociodemographic, social determinants, self-rated health, and self-reported diseases. RESULTS: The prevalence of noise annoyance was 47% for women and 39.8% for men. For both genders, noise annoyance was independently associated with bad traffic and the presence of loud music, discussions, and late-night parties. CONCLUSION: Gender differences were identified in the association of noise annoyance with sociodemographic characteristics and self-reported morbidity. Traffic and social customs were the main sources of noise in the regions under study.

[Cooccurrence of obesogenic risk factors in Brazilian adolescents: the role of sociodemographic characteristics and parental presence]. / Coocorrência de fatores de risco obesogênicos em adolescentes brasileiros: o papel das características sociodemográficas e da presença parental.

The study aimed to estimate the prevalence of cooccurrence of obesogenic risk factors in Brazilian adolescents and associated sociodemographic and family characteristics. This is a cross-sectional study of data from the Brazilian National School Health Survey, 2009 (n = 53,274). The outcome variable (cooccurrence of obesogenic risk factors) varied from zero to five and was obtained as the sum of the risk behaviors: daily consumption of soft drinks; daily consumption of candy; insufficient consumption of fruits; insufficient consumption of vegetables; and insufficient physical activity. The explanatory variables were sex, age, skin color, region of Brazil, household goods and services score, maternal schooling, type of school, family composition, parental monitoring, and main meals shared with parents or guardians. A Venn diagram was used for exploratory analysis, plus ordinal logistic regression with partial proportional odds model for multivariate analysis. The results showed higher odds of simultaneous occurrence of the factors in adolescent girls, in teens with less parental supervision, and teens who shared fewer meals with their parents or guardians. Meanwhile, adolescents living in more developed regions of the country and those whose mothers had more schooling showed lower odds of cooccurrence of obesogenic risk factors. Actions that encourage greater family involvement and supervision in dietary behavior can have a positive impact on the prevention of obesity in Brazilian adolescents, especially in less developed regions and in homes where the mothers have less schooling.

O objetivo do estudo foi estimar a prevalência da coocorrência de fatores de risco obesogênicos em adolescentes brasileiros e características sociodemográficas e familiares associadas. É um estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar, 2009 (n = 53.274). A variável resposta (coocorrência de fatores de risco obesogênicos) variou de zero a cinco e foi obtida com base no somatório dos comportamentos de risco: consumo diário de refrigerantes; consumo diário de guloseimas; consumo insuficiente de frutas; consumo insuficiente de hortaliças e atividade física insuficiente. As variáveis explicativas foram sexo, idade, cor da pele, região brasileira, escore de bens e serviços do domicílio, escolaridade materna, tipo de escola, composição familiar, monitoramento parental e realização de refeições principais com os responsáveis. Utilizou-se o diagrama de Venn para a análise exploratória e a regressão logística ordinal com modelo de odds proporcionais parciais para análise multivariada. Verificou-se maior chance de ocorrência simultânea dos fatores nos adolescentes do sexo feminino, naqueles que tinham menor monitoramento parental e que realizavam menor número de refeições com os responsáveis. Em contraste, adolescentes que residiam em regiões mais desenvolvidas do país e aqueles cujas mães possuíam maior escolaridade apresentaram menor chance de coocorrência de fatores de risco obesogênicos. Ações que estimulem mais envolvimento e supervisão familiar no comportamento alimentar podem promover impacto positivo na prevenção da obesidade em adolescentes brasileiros, principalmente em regiões menos desenvolvidas e em lares com mães de menor escolaridade.

El objetivo del estudio fue estimar la prevalencia de la coocurrencia de factores de riesgo obesogénicos en adolescentes brasileños, así como las características sociodemográficas y familiares asociadas. Se trata de un estudio transversal, con datos de la Encuesta Nacional de Salud del Escolar, 2009 (n = 53.274). La variable respuesta (coocurrencia de factores de riesgo obesogénicos) varió de cero a cinco, y se obtuvo a partir del sumatorio de los comportamientos de riesgo: consumo diario de refrescos; consumo diario de golosinas; consumo insuficiente de frutas; consumo insuficiente de hortalizas y actividad física insuficiente. Las variables explicativas fueron: sexo, edad, color de piel, región brasileña, marcador de bienes y servicios del domicilio, escolaridad materna, tipo de escuela, composición familiar, monitoreo parental y realización de comidas principales con los responsables. Se utilizó el diagrama de Venn para un análisis exploratorio y regresión logística ordinal con un modelo de odds proporcionales parciales para el análisis multivariado. Se verificó una mayor oportunidad de ocurrencia simultánea de los factores en adolescentes del sexo femenino, en aquellos que tenían un menor monitoreo parental y que realizaban un menor número de comidas con los responsables. En contraste, adolescentes que residían en regiones más desarrolladas del país, y aquellos cuyas madres poseían una mayor escolaridad, presentaron una menor oportunidad de coocurrencia de factores de riesgo obesogénicos. Acciones que estimulen más implicación y supervisión familiar en el comportamiento alimentario pueden promover un impacto positivo en la prevención de la obesidad en adolescentes brasileños, principalmente en regiones menos desarrolladas y en hogares con madres de menor escolaridad.

Soft drinks and sweeteners intake: Possible contribution to the development of metabolic syndrome and cardiovascular diseases. Beneficial or detrimental action of alternative sweeteners?

The rapid increase in obesity, metabolic syndrome, and cardiovascular diseases (CVDs) has been related to the rise in sugar-added foods and sweetened beverages consumption. An interesting approach has been to replace sugar with alternative sweeteners (AS), due to their impact on public health. Preclinical and clinical studies, which analyze the safety of AS intake, are still limited. Major pathogenic mechanisms of these substances include ROS and AGEs formation. Indeed, endothelial dysfunction involving in the pathogenesis of micro- and macro-vascular diseases is mitochondrial dysfunction dependent. Hyperglycemia and endoplasmic reticulum stress together produce ROS, contributing to the development and progression of cardiovascular complications during type 2 diabetes (T2D), thus causing oxidative changes and direct damage of lipids, proteins, and DNA. Epidemiological studies in healthy subjects have suggested that the consumption of artificial AS can promote CV complications, such as glucose intolerance and predisposition to the onset of T2D, whereas natural AS could reduce hyperglycemia, improve lipid metabolism and have antioxidant effects. Long-term prospective clinical randomized studies are needed to evaluate precisely whether exposure to alternative sugars can have clinical implications on natural history and clinical outcomes, especially in children or during the gestational period through breast milk.

Novel Insights Regarding Nitric Oxide and Cardiovascular Diseases.

Nitric oxide (NO) is a powerful mediator with biological activities such as vasodilation and prevention of vascular smooth muscle cell proliferation as well as functional regulation of cardiac cells. Thus, impaired production or reduced bioavailability of NO predisposes to the onset of different cardiovascular (CV) diseases. Alterations in the redox balance associated with excitation-contraction coupling have been identified in heart failure (HF), thus contributing to contractile abnormalities and arrhythmias. For its ability to influence cell proliferation and angiogenesis, NO may be considered a therapeutic option for the management of several CV diseases. Several clinical studies and trials investigated therapeutic NO strategies for systemic hypertension, atherosclerosis, and/or prevention of in stent restenosis, coronary heart disease (CHD), pulmonary arterial hypertension (PAH), and HF, although with mixed results in long-term treatment and effective dose administered in selected groups of patients. Tadalafil, sildenafil, and cinaguat were evaluated for the treatment of PAH, whereas vericiguat was investigated in the treatment of HF patients with reduced ejection fraction. Furthermore, supplementation with hydrogen sulfide, tetrahydrobiopterin, and nitrite/nitrate has shown beneficial effects at the vascular level.

Network Medicine Approach in Prevention and Personalized Treatment of Dyslipidemias.

Dyslipidemias can affect molecular networks underlying the metabolic homeostasis and vascular function leading to atherogenesis at early stages of development. Since disease-related proteins often interact with each other in functional modules, many advanced network-oriented algorithms were applied to patient-derived big data to identify the complex gene-environment interactions underlying the early pathophysiology of dyslipidemias and atherosclerosis. Both the proprotein convertase subtilisin/kexin type 7 (PCSK7) and collagen type 1 alpha 1 chain (COL1A1) genes arose from the application of TFfit and WGCNA algorithms, respectively, as potential useful therapeutic targets in prevention of dyslipidemias. Moreover, the Seed Connector algorithm (SCA) algorithm suggested a putative role of the neuropilin-1 (NRP1) protein as drug target, whereas a regression network analysis reported that niacin may provide benefits in mixed dyslipidemias. Dyslipidemias are highly heterogeneous at the clinical level; thus, it would be helpful to overcome traditional evidence-based paradigm toward a personalized risk assessment and therapy. Network Medicine uses omics data, artificial intelligence (AI), imaging tools, and clinical information to design personalized therapy of dyslipidemias and atherosclerosis. Recently, a novel non-invasive AI-derived biomarker, named Fat Attenuation Index (FAI™) has been established to early detect clinical signs of atherosclerosis. Moreover, an integrated AI-radiomics approach can detect fibrosis and microvascular remodeling improving the customized risk assessment. Here, we offer a network-based roadmap ranging from novel molecular pathways to digital therapeutics which can improve personalized therapy of dyslipidemias.

Noise annoyance, sociodemographic and health patterns, and neighborhood perceptions in a Brazilian metropolis: BH Health Study / Percepção do ruído como incômodo, características sociodemográficas, de saúde e percepção da vizinhança em uma metrópole brasileira: Estudo Saúde em Beagá

ABSTRACT Objective: The present study aims to analyze the association of noise annoyance with individual and sociodemographic factors and self-perception of the neighborhood in an urban center. Methods: Data were collected through a population-based cross-sectional study held in two of the nine health districts in the city of Belo Horizonte, Minas Gerais, Brazil, from 2008 to 2009. The study included 3,934 individuals of both genders, aged 18 years and older. The response variable was the self-perception of noise, investigated by the question: "In your neighborhood, does the noise bother you?" The explanatory variables were grouped into the following domains: sociodemographic, social determinants, self-rated health, and self-reported diseases. Results: The prevalence of noise annoyance was 47% for women and 39.8% for men. For both genders, noise annoyance was independently associated with bad traffic and the presence of loud music, discussions, and late-night parties. Conclusion: Gender differences were identified in the association of noise annoyance with sociodemographic characteristics and self-reported morbidity. Traffic and social customs were the main sources of noise in the regions under study.

RESUMO Objetivo: Analisar a associação entre o incômodo provocado pelo ruído com fatores individuais e sociodemográficos e a autopercepção de vizinhança em um centro urbano. Métodos: Os dados foram coletados por meio de um estudo transversal de base populacional, desenvolvido em dois dos nove distritos sanitários do município de Belo Horizonte, Minas Gerais, no período de 2008 a 2009. Participaram do estudo 3.934 indivíduos, de ambos os sexos, com 18 anos ou mais. A variável resposta foi a autopercepção do ruído, investigada pela pergunta: "Pensando na sua vizinhança o ruído/barulho incomoda você?". As variáveis explicativas foram agrupadas nos seguintes domínios: sociodemográfico, determinantes sociais, autoavaliação de saúde e autorrelato de doenças. Resultados: Para as mulheres, a prevalência do incômodo ao ruído foi de 47%, e para os homens, foi de 39,8%. Para ambos os sexos, o incômodo ao ruído foi independentemente associado ao trânsito ruim e presença de música alta, discussões e festas até tarde. Conclusões: Diferenças entre os sexos foram observadas para associação entre o incômodo ao ruído, características sociodemográficas e morbidade autorreferida. O trânsito e os costumes sociais se configuraram como a principal fonte geradora de ruído nas regiões estudadas.

Coocorrência de fatores de risco obesogênicos em adolescentes brasileiros: o papel das características sociodemográficas e da presença parental / Cooccurrence of obesogenic risk factors in Brazilian adolescents: the role of sociodemographic characteristics and parental presence / Coocurrencia de factores de riesgo obesogénicos en adolescentes brasileños: el papel de las características sociodemográficas y presencia parental

Resumo: O objetivo do estudo foi estimar a prevalência da coocorrência de fatores de risco obesogênicos em adolescentes brasileiros e características sociodemográficas e familiares associadas. É um estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar, 2009 (n = 53.274). A variável resposta (coocorrência de fatores de risco obesogênicos) variou de zero a cinco e foi obtida com base no somatório dos comportamentos de risco: consumo diário de refrigerantes; consumo diário de guloseimas; consumo insuficiente de frutas; consumo insuficiente de hortaliças e atividade física insuficiente. As variáveis explicativas foram sexo, idade, cor da pele, região brasileira, escore de bens e serviços do domicílio, escolaridade materna, tipo de escola, composição familiar, monitoramento parental e realização de refeições principais com os responsáveis. Utilizou-se o diagrama de Venn para a análise exploratória e a regressão logística ordinal com modelo de odds proporcionais parciais para análise multivariada. Verificou-se maior chance de ocorrência simultânea dos fatores nos adolescentes do sexo feminino, naqueles que tinham menor monitoramento parental e que realizavam menor número de refeições com os responsáveis. Em contraste, adolescentes que residiam em regiões mais desenvolvidas do país e aqueles cujas mães possuíam maior escolaridade apresentaram menor chance de coocorrência de fatores de risco obesogênicos. Ações que estimulem mais envolvimento e supervisão familiar no comportamento alimentar podem promover impacto positivo na prevenção da obesidade em adolescentes brasileiros, principalmente em regiões menos desenvolvidas e em lares com mães de menor escolaridade.

Abstract: The study aimed to estimate the prevalence of cooccurrence of obesogenic risk factors in Brazilian adolescents and associated sociodemographic and family characteristics. This is a cross-sectional study of data from the Brazilian National School Health Survey, 2009 (n = 53,274). The outcome variable (cooccurrence of obesogenic risk factors) varied from zero to five and was obtained as the sum of the risk behaviors: daily consumption of soft drinks; daily consumption of candy; insufficient consumption of fruits; insufficient consumption of vegetables; and insufficient physical activity. The explanatory variables were sex, age, skin color, region of Brazil, household goods and services score, maternal schooling, type of school, family composition, parental monitoring, and main meals shared with parents or guardians. A Venn diagram was used for exploratory analysis, plus ordinal logistic regression with partial proportional odds model for multivariate analysis. The results showed higher odds of simultaneous occurrence of the factors in adolescent girls, in teens with less parental supervision, and teens who shared fewer meals with their parents or guardians. Meanwhile, adolescents living in more developed regions of the country and those whose mothers had more schooling showed lower odds of cooccurrence of obesogenic risk factors. Actions that encourage greater family involvement and supervision in dietary behavior can have a positive impact on the prevention of obesity in Brazilian adolescents, especially in less developed regions and in homes where the mothers have less schooling.

Resumen: El objetivo del estudio fue estimar la prevalencia de la coocurrencia de factores de riesgo obesogénicos en adolescentes brasileños, así como las características sociodemográficas y familiares asociadas. Se trata de un estudio transversal, con datos de la Encuesta Nacional de Salud del Escolar, 2009 (n = 53.274). La variable respuesta (coocurrencia de factores de riesgo obesogénicos) varió de cero a cinco, y se obtuvo a partir del sumatorio de los comportamientos de riesgo: consumo diario de refrescos; consumo diario de golosinas; consumo insuficiente de frutas; consumo insuficiente de hortalizas y actividad física insuficiente. Las variables explicativas fueron: sexo, edad, color de piel, región brasileña, marcador de bienes y servicios del domicilio, escolaridad materna, tipo de escuela, composición familiar, monitoreo parental y realización de comidas principales con los responsables. Se utilizó el diagrama de Venn para un análisis exploratorio y regresión logística ordinal con un modelo de odds proporcionales parciales para el análisis multivariado. Se verificó una mayor oportunidad de ocurrencia simultánea de los factores en adolescentes del sexo femenino, en aquellos que tenían un menor monitoreo parental y que realizaban un menor número de comidas con los responsables. En contraste, adolescentes que residían en regiones más desarrolladas del país, y aquellos cuyas madres poseían una mayor escolaridad, presentaron una menor oportunidad de coocurrencia de factores de riesgo obesogénicos. Acciones que estimulen más implicación y supervisión familiar en el comportamiento alimentario pueden promover un impacto positivo en la prevención de la obesidad en adolescentes brasileños, principalmente en regiones menos desarrolladas y en hogares con madres de menor escolaridad.

Flow Cytometry Characterization of Pluripotent Transmembrane Glycoproteins on Resident Cervix Uteri Cells in Patients Screened for Cervical Cancer.

The aim of this study was to characterize both by flow cytometry analysis and immunohistochemistry cervix uteri cells of nulliparous women screened for cervical intraepithelial neoplasia (CIN) in comparison to a group without CIN by using mesenchymal stem cell-like and hematopoietic lineage markers. A significant expression for CD29, CD38, HLA-I, and HLA-II was correlated positively to the CIN degree and it was more relevant in patients positive for human papilloma virus (HPV). Thus, identification and detailed characterization of pluripotent resident in uteri cells could be a promising therapeutic target.

Association of mammography with sociodemographic and care factors in residents of Belo Horizonte, MG, Brazil

Objective: This study aimed to investigate screening mammography in the last two years, sociodemographic factors, and healthcare service use among women aged 40­69 years living in a Brazilian urban center. Methods: The data are part of a household survey called "MOVE-SE Academias" (2014/2015) carried out in Belo Horizonte (MG). The sample was selected using a stratified threestage cluster sampling: Health Academy Program units distributed in the city, census tracts, and households. Pearson's chi-square test was used in the analysis. Results: Of the 371 women included in this study with a mean age of 52.5 years, 66.2% among those aged 40­49 years (n = 157) and 75.7% among those aged 50­69 years (n = 214) reported being submitted to mammography within two years before the interview. When it comes to women aged 40­49 and 50­69 years, a higher proportion was found among those with higher schooling (p = 0.011 and p = 0.001), who had been to medical appointments in less than one year (p = 0.024 and p < 0.001), who had performed the Pap smear test in less than two years (p < 0.001 for both groups) and who reported having a private health insurance (p = 0.007 and p = 0.008). Higher family income was associated only with the performance of the screening exam among women aged 40­49 years (p = 0.006). Conclusion: Our results suggest inequalities in access to health services for breast cancer screening, modulated by socioeconomic factors, including private health insurance. Prioritizing more vulnerable groups in cancer screening as a public policy can contribute to reducing health inequalities.

The dating of thrombus organization in cases of pulmonary embolism: an autopsy study.

BACKGROUND: Pulmonary embolism (PE) is associated to high mortality rate worldwide. However, the diagnosis of PE often results inaccurate. Many cases of PE are incorrectly diagnosed or missed and they are often associated to sudden unexpected death (SUD). In forensic practice, it is important to establish the time of thrombus formation in order to determine the precise moment of death. The autopsy remains the gold standard method for the identification of death cause allowing the determination of discrepancies between clinical and autopsy diagnoses. The aim of our study was to verify the morphological and histological criteria of fatal cases of PE and evaluate the dating of thrombus formation considering 5 ranges of time. METHODS: Pulmonary vessels sections were collected from January 2010 to December 2017. Sections of thrombus sampling were stained with hematoxylin and eosin. The content of infiltrated cells, fibroblasts and collagen fibers were scored using a semi-quantitative three-point scale of range values. RESULTS: The 30 autopsies included 19 males (63.3%) and 11 females (36.7%) with an average age of 64.5 ± 12.3 years. The time intervals were as follows: early (≤1 h), recent (> 1 h to 24 h), recent-medium (> 24 h to 48 h), medium (> 48 h to 72 h) and old (> 72 h). In the first hour, we histologically observed the presence of platelet aggregation by immunofluorescence method for factor VIII and fibrinogen. The presence of lymphocytes has been identified from recent thrombus (> 1 h to 24 h) and the fibroblast cells were peripherally located in vascular tissue between 48 and 72 h, whereas they resulted central and copious after 72 h. CONCLUSIONS: After a macroscopic observation and a good sampling traditional histology, it is important to identify the time of thrombus formation. We identified histologically a range of time in the physiopathology of the thrombus (early, recent, recent-medium, medium, old), allowing to determine the dating of thrombus formation and the exact time of death. CLINICAL TRIAL NUMBER: NCT03887819. TRIAL REGISTRATION: The trial registry is Cliniclatrials.gov, with the unique identifying number NCT03887819. The date of registration was 03/23/2019 and it was "Retrospectively registered".

Homicídios em Belo Horizonte, MG: um retrato das iniquidades nas cidades / Homicides in Belo Horizonte, MG, Brazil: a portrait of urban inequality

Resumo Os homicídios no Brasil são um dos indicadores mais sensíveis da desigualdade social nas cidades. Assim, políticas de proteção social integradas nos territórios podem impactar esse evento em saúde. Este artigo objetiva descrever os homicídios em Belo Horizonte à luz de um modelo conceitual, parte de um processo avaliativo de um projeto de reurbanização na cidade. A partir da revisão da literatura, construiu-se um modelo conceitual para a compreensão dos homicídios e sua vinculação com o viver nas cidades. Realizou-se um estudo descritivo dos homicídios a partir de dados do Sistema de Informação sobre Mortalidade (SIM) relativos ao período de 2002 a 2012. O modelo conceitual reforça que os homicídios encontram nas cidades seus mais expressivos determinantes vinculados à desigualdade e à exclusão, junto a valores de uma cultura de força e preconceitos. Os homicídios em Belo Horizonte apresentam taxas elevadas na cidade formal, sendo de três a seis vezes maiores nas favelas. Morrem mais negros, jovens homens, de baixa escolaridade, nas vias públicas e nos territórios vulneráveis. Os homicídios são a síntese das desvantagens urbanas, especialmente em tais áreas. Retrata-se em Belo Horizonte o que se vê no Brasil, denunciando a desigualdade e sua perversidade no viver e morrer nas cidades.

Abstract In Brazil, homicides are one of the most sensitive indicators of urban social inequalities. Integrated social protection policies can have a definite impact over this health event. The objective of this article is to describe homicides in Belo Horizonte in the light of a conceptual model, part of the evaluation process of a redevelopment project in the city. Based on a review of the literature, this conceptual model was constructed to assess the relationship between homicides and urban living in Brazil. A descriptive study of homicides was carried out using data on the period from 2002 to 2012, extracted from the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM). The conceptual model reinforces that the most expressive determinants of homicides are found in the cities, and are linked to inequality and exclusion, together with the values of a culture based on prejudice and the use of force. The prevalence of homicides in Belo Horizonte was high even in the formally urbanized part of the city, but reached numbers three to six times higher in its favelas. Most deaths pertain black young men of low schooling. These deaths usually take place in public roads and in vulnerable territories. Homicides are the synthesis of urban disadvantages, especially in vulnerable areas. The situation in Belo Horizonte is similar throughout the rest of Brazil. Pointing to the reality of living and dying in cities, these data testify against social inequality and its perversity.

Built and Social Environment by Systematic Social Observation and Leisure-Time Physical Activity Report among Brazilian Adults: a Population-Based Study.

The aim of this study was to investigate the relationship between built and social environment and leisure-time physical activity (LTPA) among adults living in an urban center. The individual data was from the household survey and the environmental data was assessed through systematic social observation by trained observers on street segments of respondents' residences. The relationship between environmental factors and LTPA was examined using multilevel logistic regression. The prevalence of LTPA was 30.2% (95% CI 27.4-32.9%). Individuals living in census tracts with higher walking environment indicators (OR = 1.20; 95% CI 1.02 to 1.40) and safety (OR = 1.18; 95% CI 1.01 to 1.38) were more likely to be active during leisure time, even after adjusting for individual variables. Improving the built and social environment is an important step for achieving higher levels of LTPA in the population in a middle-income country.

Genetic background, epigenetic factors and dietary interventions which influence human longevity.

Longevity is mainly conditioned by genetic, epigenetic and environmental factors. Different genetic modifications seem to be positively associated to longevity, including SNPs in SIRT1, APOE, FOXO3A, ACE, ATM, NOS1 and NOS2 gene. Epigenetic changes as DNA hyper- and hypo-methylation influence significantly human longevity by activating/deactivating different genes involved in physiological mechanisms. Several studies have confirmed that centenarians have a lower DNA methylation content compared to young subjects, which showed more homogeneously methylated DNA region. Also the up-regulation of miR-21 seems to be more associated with longevity in different populations of long-lived subjects, suggesting its role as potential epigenetic biomarkers. A non-pharmacological treatment that seems to contrast age-related diseases and promote longevity is represented by dietary intervention. It has been evaluated the effects of dietary restriction of both single nutrients or total calories to extend lifespan. However, in daily practice it is very difficult to guarantee adherence/compliance of the subjects to dietary restriction and at the same time avoid dangerous nutritional deficiencies. As consequence, the attention has focused on a variety of substances both drugs and natural compounds able to mime the beneficial effects of caloric restriction, including resveratrol, quercetin, rapamycin, metformin and 2-deoxy-D-glucose.