The effect of conditional cash transfers on tuberculosis incidence and mortality is determined by ethnoracial and socioeconomic factors: a cohort study of 54 million individuals in Brazil.

Background: Conditional Cash Transfers (CCT) are the world's most widely implemented interventions for poverty alleviation. Still, there is no solid evidence of the CCT effects on the reduction of the burden of Tuberculosis (TB) in marginalized and extremely vulnerable populations. We estimated the effect of the Bolsa Família Program (BFP), the largest CCT in the world, on TB incidence, mortality, and case-fatality rate using a nationwide cohort of 54.5 million individuals during a 12-year period in Brazil. Methods: We selected low-income individuals who entered in the 100 Million Brazilians Cohort and were linked to nationwide TB registries between 2004 to 2015, and compared BFP beneficiaries and non-beneficiaries using a quasi-experimental impact evaluation design. We employed inverse probability of treatment weighting (IPTW) multivariable Poisson regressions, adjusted for all relevant socioeconomic, demographic, and healthcare confounding variables - at individual and municipal level. Subsequently, we evaluated BFP effects for different subpopulations according to ethnoracial factors, wealth levels, sex, and age. We also performed several sensitivity and triangulation analyses to verify the robustness of the estimates. Findings: Exposure to BFP was associated with a large reduction in TB incidence in the low-income individuals under study (adjusted rate ratio [aRR]:0.59;95%CI:0.58-0.60) and mortality (aRR:0.69;95%CI:0.65-0.73). The strongest BFP effect was observed in Indigenous people both for TB incidence (aRR:0.37;95%CI:0.32-0.42), and mortality-aRR:0.35;95%CI:0.20-0.62), and in Black and Pardo people (Incidence-aRR:0.58;95%CI:0.57-0.59; Mortality -aRR:0.69;95%CI:0,64-0,73). BFP effects showed a clear gradient according to wealth levels and were considerably stronger among the extremely poor individuals for TB incidence (aRR:0.49, 95%CI:0.49-0.50) and mortality (aRR:0.60;95%CI:0.55-0.65). The BFP effects on case-fatality rates were also positive, however without statistical significance. Interpretation: CCT can strongly reduce TB incidence and mortality in extremely poor, Indigenous, Black and Pardo populations, and could significantly contribute to achieving the End TB Strategy targets and the TB-related Sustainable Development Goals.

The intersecting effects of race, wealth, and education on AIDS incidence, mortality, and case-fatality rate: a Brazilian cohort study of 28.3 million individuals.

The relationships between race, education, wealth, their intersections and AIDS morbidity/mortality were analyzed in retrospective cohort of 28.3 million individuals followed for 9 years (2007-2015). Together with several sensitivity analyses, a wide range of interactions on additive and multiplicative scales were estimated. Race, education, and wealth were each strongly associated with all of the AIDS-related outcomes, and the magnitude of the associations increased as intersections were included. A significantly higher risk of illness (aRR: 3.07, 95%CI:2.67-3.53) and death (aRR: 4.96, 95%CI:3.99-6.16) from AIDS was observed at the intersection of Black race, lower educational attainment, and less wealth. A higher case-fatality rate (aRR: 1.62, 95%CI:1.18-2.21) was also seen for the same intersectional group. Historically oppressed groups lying at the intersections of race, education, and wealth, had a considerably higher risk of illness and death from AIDS. AIDS-related interventions will require the implementation of comprehensive intersectoral policies that follow an intersectionality perspective.

Income determines the impact of cash transfers on HIV/AIDS: cohort study of 22.7 million Brazilians.

Living with extremely low-income is an important risk factor for HIV/AIDS and can be mitigated by conditional cash transfers. Using a cohort of 22.7 million low-income individuals during 9 years, we evaluated the effects of the world's largest conditional cash transfer, the Programa Bolsa Família, on HIV/AIDS-related outcomes. Exposure to Programa Bolsa Família was associated with reduced AIDS incidence by 41% (RR:0.59; 95%CI:0.57-0.61), mortality by 39% (RR:0.61; 95%CI:0.57-0.64), and case fatality rates by 25% (RR:0.75; 95%CI:0.66-0.85) in the cohort, and Programa Bolsa Família effects were considerably stronger among individuals of extremely low-income [reduction of 55% for incidence (RR:0.45, 95% CI:0.42-0.47), 54% mortality (RR:0.46, 95% CI:0.42-0.49), and 37% case-fatality (RR:0.63, 95% CI:0.51 -0.76)], decreasing gradually until having no effect in individuals with higher incomes. Similar effects were observed on HIV notification. Programa Bolsa Família impact was also stronger among women and adolescents. Several sensitivity and triangulation analyses demonstrated the robustness of the results. Conditional cash transfers can significantly reduce AIDS morbidity and mortality in extremely vulnerable populations and should be considered an essential intervention to achieve AIDS-related sustainable development goals by 2030.

Prospective Randomized Phase 2 Trial of Hypofractionated Stereotactic Radiation Therapy of 25 Gy in 5 Fractions Compared With 35 Gy in 5 Fractions in the Reirradiation of Recurrent Glioblastoma.

PURPOSE: The aim of this work was to investigate whether reirradiation of recurrent glioblastoma with hypofractionated stereotactic radiation therapy (HSRT) consisting of 35 Gy in 5 fractions (35 Gy/5 fx) compared with 25 Gy in 5 fractions (25 Gy/5 fx) improves outcomes while maintaining acceptable toxicity. METHODS AND MATERIALS: We conducted a prospective randomized phase 2 trial involving patients with recurrent glioblastoma (per the 2007 and 2016 World Health Organization classification). A minimum interval from first radiation therapy of 5 months and gross tumor volume of 150 cc were required. Patients were randomized 1:1 to receive HSRT alone in 25 Gy/5 fx or 35 Gy/5 fx. The primary endpoint was progression-free survival (PFS). We used a randomized phase 2 screening design with a 2-sided α of 0.15 for the primary endpoint. RESULTS: From 2011 to 2019, 40 patients were randomized and received HSRT, with 20 patients in each group. The median age was 50 years (range, 27-71); a new resection before HSRT was performed in 75% of patients. The median PFS was 4.9 months in the 25 Gy/5 fx group and 5.2 months in the 35 Gy/5 fx group (P = .23). Six-month PFS was similar at 40% (85% CI, 24%-55%) for both groups. The median overall survival (OS) was 9.2 months in the 25 Gy/5 fx group and 10 months in the 35 Gy/5 fx group (P = .201). Grade ≥3 necrosis was numerically higher in the 35 Gy/5 fx group (3 [16%] vs 1 [5%]), but the difference was not statistically significant (P = .267). In an exploratory analysis, median OS of patients who developed treatment-related necrosis was 14.1 months, and that of patients who did not was 8.7 months (P = .003). CONCLUSIONS: HSRT alone with 35 Gy/5 fx was not superior to 25 Gy/5 fx in terms of PFS or OS. Due to a potential increase in the rate of clinically meaningful treatment-related necrosis, we suggest 25 Gy/5 fx as the standard dose in HSRT alone. During follow-up, attention should be given to differentiating tumor progression from potentially manageable complications.

The effect of primary health care on AIDS incidence and mortality: a cohort study of 3.4 million Brazilians.

Background: Primary Health Care (PHC) is essential for the health and wellbeing of people living with HIV/AIDS. This study evaluated the effects of one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. Methods: A retrospective cohort study carried out in Brazil, from January 1 2007 to December 31 2015. We conducted a quasi-experimental effect evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the effect of FHS on AIDS incidence and mortality and comparing outcomes between residents of municipalities with no FHS coverage with those in municipalities with full FHS coverage. We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated FHS effect by sex and age, and performed a wide range of sensitivity and triangulation analyses. Findings: FHS coverage was associated with lower AIDS incidence (rate ratio [RR]:0.76, 95%CI:0.68-0.84) and mortality (RR:0.68,95%CI:0.56-0.82). FHS effect was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR 0.62, 95%CI:0.53-0.72) and mortality (RR 0.56, 95%CI:0.43-0.72). Conclusions: AIDS should be an avoidable outcome for most people living with HIV today, and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.

The effect of primary health care on tuberculosis in a nationwide cohort of 7·3 million Brazilian people: a quasi-experimental study.

BACKGROUND: Universal health coverage is one of the WHO End TB Strategy priority interventions and could be achieved-particularly in low-income and middle-income countries-through the expansion of primary health care. We evaluated the effects of one of the largest primary health-care programmes in the world, the Brazilian Family Health Strategy (FHS), on tuberculosis morbidity and mortality using a nationwide cohort of 7·3 million individuals over a 10-year study period. METHODS: We analysed individuals who entered the 100 Million Brazilians Cohort during the period Jan 1, 2004, to Dec 31, 2013, and compared residents in municipalities with no FHS coverage with residents in municipalities with full FHS coverage. We used a cohort design with multivariable Poisson regressions, adjusted for all relevant demographic and socioeconomic variables and weighted with inverse probability of treatment weighting, to estimate the effect of FHS on tuberculosis incidence, mortality, cure, and case fatality. We also performed a range of stratifications and sensitivity analyses. FINDINGS: FHS exposure was associated with lower tuberculosis incidence (rate ratio [RR] 0·78, 95% CI 0·72-0·84) and mortality (0·72, 0·55-0·94), and was positively associated with tuberculosis cure rates (1·04, 1·00-1·08). FHS was also associated with a decrease in tuberculosis case-fatality rates, although this was not statistically significant (RR 0·84, 95% CI 0·55-1·30). FHS associations were stronger among the poorest individuals for all the tuberculosis indicators. INTERPRETATION: Community-based primary health care could strongly reduce tuberculosis morbidity and mortality and decrease the unequal distribution of the tuberculosis burden in the most vulnerable populations. During the current marked rise in global poverty due to the COVID-19 pandemic, investments in primary health care could help protect against the expected increases in tuberculosis incidence worldwide and contribute to the attainment of the End TB Strategy goals. FUNDING: TB Modelling and Analysis Consortium (Bill & Melinda Gates Foundation), Wellcome Trust, and Brazilian Ministry of Health. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.

Síndrome de burnout em docentes universitários dos cursos de saúde / Burnout syndrome in university professors in health courses / Síndrome de burnout en profesores universitarios de cursos de salud

RESUMO Objetivo A síndrome de burnout é definida como um fenômeno psicossocial em resposta crônica aos estressores interpessoais no ambiente de trabalho. Avaliar a síndrome de burnout em docentes dos cursos da área de saúde. Método Estudo descritivo, transversal, com abordagem quantitativa. Para coleta de dados foi utilizado o Maslach Burnout Inventory, além de um questionário socioeconô-mico. Utilizou-se do teste exato de Fisher para verificar se existe associação entre as variáveis sociodemográficas e a presença de burnout. Resultados Participaram do estudo 57 docentes, a maior parte do sexo feminino (n=39; 68,4%) e com tempo de atuação profissional acima de 10 anos (n=30; 52,6%). A maioria possui outro vinculo (n=43; 75,4%) e dedica mais de 40 horas semanais ao trabalho (n=35; 61,4%). A variável lazer apresentou-se estatisticamente significante em relação a ter ou não burnout evidenciando maior proporção de adoecimento entre os que referiram não sair a lazer. Observou-se percentuais elevados de exaustão emocional, despersonalização e baixa realização profissional revelando uma alta prevalência da síndrome de burnout entre os docentes. Conclusão Esses achados merecem atenção para o acompanhamento dos fatores psicossociais e organizacionais do processo laboral que possam intervir na qualidade de vida e nas condições de saúde desse trabalhador.

ABSTRACT Objective To analyze the burnout syndrome in professors of health courses. Method It is a descriptive, cross-sectional study with a quantitative approach. For data collection were used the Maslach Burnout Inventory, in addition, a socioecono-mic questionnaire. That was used Fisher's exact test to verify the association between sociodemographic variables and the presence of Burnout. Results 57 college professors participated in the study, most of them female (n=39; 68.4%) and with professional experience over 10 years (n=30; 52.6%). Most have ano-ther job (n=43; 75.4%) and devote more than 40 hours a week to work (n=35; 61.4%). The leisure variable is shown to be statistically significant in relation to have burnout or not, showing the highest proportion of problems among those who refer to not leaving leisure. High percentages of emotional exhaustion, depersonalization, and low professional achievement were observed, revealing a high prevalence of burnout syndrome between the professors. Conclusion These findings deserve attention for monitoring psychosocial and organizational factors in the work process that may interfere with the quality of life and the health conditions of this worker.

RESUMEN Objetivo El síndrome de burnout se define como un fenómeno psicosocial en respuesta crónica a estresores interpersonales en el lugar de trabajo. Valorar el síndrome de burnout en profesores de cursos del área de la salud. Método Estudio descriptivo, transversal con enfoque cuantitativo. Para la recolección de datos se utilizó el Inventario de Burnout de Maslach, además de un cuestionario socioeconómico. Se utilizó la prueba exacta de Fisher para verificar si existe asociación entre las variables sociodemográficas y la presencia de burnout. Resultados Participaron 57 profesores, la mayoría mujeres (n=39; 68,4%) y con más de 10 años de experiencia profesional (n=30; 52,6%). La mayoría tenía otro vínculo (n=43; 75,4%) y dedicaba más de 40 horas semanales al trabajo (n=35; 61,4%). La variable ocio resultó estadísticamente significativa en relación con tener burnout o no tenerlo, mostrando una mayor proporción de enfermedad entre quienes informaron no salir por ocio. Se observaron altos porcentajes de agotamiento emocional, despersonalización y baja realización profesional, revelando una alta prevalencia del síndrome de burnout entre los docentes. Conclusión Estos hallazgos merecen atención para monitorear los factores psicosociales y organizacionales del proceso de trabajo que pueden afectar la calidad de vida y las condiciones de salud de estos trabajadores.

Estado antropométrico de pacientes pediátricos com doença inflamatória intestinal / Anthropometric status of pediatric patients with inflammatory bowel disease

Introdução: a Doença Inflamatória Intestinal (DII) é decorrente de vários fatores que provocam alteração na homeostase do microbioma na resposta imune e no aumento da permeabilidade intestinal. O estado nutricional inadequado, principalmente em pacientes pediátricos com DII, representa prognóstico ruim e pode influenciar na resposta ao tratamento, à morbidade e à mortalidade. Objetivo: esse estudo teve objetivo de caracterizar o estado antropométrico de pacientes pediátricos atendidos em um ambulatório referência para DII. Metodologia: a amostra foi constituída por pacientes atendidos em primeira consulta no ambulatório, de junho de 2020 até fevereiro de 2021. Foram incluídos pacientes com diagnóstico clínico de Doença de Cronh e Colite Ulcerativa, de ambos sexos, com idade entre 2 a 19 anos. Resultados: dos pacientes com CU, 54,7% apresentaram adequado estado nutricional e 45,3% dos pacientes com DC. O percentual de déficit de massa muscular foi de 47,6% dos pacientes com CU e 52,4% dos pacientes com DC. A baixa estatura foi de 37,5% nos pacientes com CU e 62,5% com DC. Conclusão: a avaliação nutricional de crianças e adolescentes portadores de doenças inflamatórias intestinais deve fazer parte da rotina de atendimento, para que sejam promovidas práticas alimentares saudáveis que favoreçam o crescimento, recuperação ponderal e manutenção de massa muscular.

Background: Inflammatory Bowel Disease (IBD) is due to several factors that cause changes in microbiome homeostasis, immune response and increased intestinal permeability. Inadequate nutritional status, especially in pediatric patients with IBD, represents a poor prognosis and can influence treatment response, morbidity and mortality. Objective: the aim of this study was to characterize the anthropometric status of pediatric patients seen at the reference outpatient clinic for IBD. Methods: the sample consisted of patients seen in the first consultation at the clinic, from June 2020 to February 2021. Patients with a clinical diagnosis of Cronh's Disease and Ulcerative Colitis, of both genders, aged between 2 and 19 years were included. Results: of patients with UC 54.7% had an adequate nutritional status and 45.3% of patients with CD. The percentage of muscle mass deficit was 47.6% of patients with UC and 52.4% of patients with CD. Short stature was 37.5% in patients with UC and 62.5% with CD. Conclusion: nutritional assessment of children and adolescents with inflammatory bowel diseases should be part of the routine of care, so that healthy eating practices that favor growth, weight recovery and maintenance of muscle mass are promoted.

Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data.

BACKGROUND: Reducing poverty and improving access to health care are two of the most effective actions to decrease maternal mortality, and conditional cash transfer (CCT) programmes act on both. The aim of this study was to evaluate the effects of one of the world's largest CCT (the Brazilian Bolsa Familia Programme (BFP)) on maternal mortality during a period of 11 years. METHODS: The study had an ecological longitudinal design and used all 2548 Brazilian municipalities with vital statistics of adequate quality during 2004-2014. BFP municipal coverage was classified into four levels, from low to consolidated, and its duration effects were measured using the average municipal coverage of previous years. We used negative binomial multivariable regression models with fixed-effects specifications, adjusted for all relevant demographic, socioeconomic, and healthcare variables. RESULTS: BFP was significantly associated with reductions of maternal mortality proportionally to its levels of coverage and years of implementation, with a rate ratio (RR) reaching 0.88 (95%CI 0.81-0.95), 0.84 (0.75-0.96) and 0.83 (0.71-0.99) for intermediate, high and consolidated BFP coverage over the previous 11 years. The BFP duration effect was stronger among young mothers (RR 0.77; 95%CI 0.67-0.96). BFP was also associated with reductions in the proportion of pregnant women with no prenatal visits (RR 0.73; 95%CI 0.69-0.77), reductions in hospital case-fatality rate for delivery (RR 0.78; 95%CI 0.66-0.94) and increases in the proportion of deliveries in hospital (RR 1.05; 95%CI 1.04-1.07). CONCLUSION: Our findings show that a consolidated and durable CCT coverage could decrease maternal mortality, and these long-term effects are stronger among poor mothers exposed to CCT during their childhood and adolescence, suggesting a CCT inter-generational effect. Sustained CCT coverage could reduce health inequalities and contribute to the achievement of the Sustainable Development Goal 3.1, and should be preserved during the current global economic crisis due to the COVID-19 pandemic.

Acute myocardial infarction on Nongated chest computed tomography.

Contrast-enhanced chest computed tomography (CT) is not considered part of the evaluation of myocardial infarction. However, acute myocardial infarction has been detected on contrast-enhanced chest CT as areas of decreased myocardial enhancement in patients evaluated for other indications, such as pulmonary embolism and aortic dissection. We present a case of acute myocardial infarction on a nongated chest CT in a 67-year-old male who presented with atypical chest pain and initial nondiagnostic electrocardiogram. This case highlights that acute myocardial infarction may be detectable on contrast-enhanced CT. When evaluating contrast-enhanced chest CT's for other etiologies of chest pain, radiologists should look for potential myocardial perfusion abnormalities that can provide clues to the presence of myocardial infarction.

Adiposidade Corporal e Apolipoproteínas em Crianças e Adolescentes: Metanálise de Estudos Prospectivos / Body Adiposity and Apolipoproteins in Children and Adolescents: A Meta-Analysis of Prospective Studies

Resumo Fundamento Excesso de adiposidade corporal e doenças cardiovasculares são problemas mundiais com crescente prevalência em crianças e adolescentes, sendo necessário investigar a relação destes, afim de construir estratégias de enfrentamento. Objetivo Investigar influência do excesso de adiposidade corporal sobre os níveis séricos de apolipoproteínas B e A1 (ApoB e ApoA1) em crianças e adolescentes. Métodos Busca sistemática nas bases de dados Medline/PubMed, Embase, Lilacs, Web of Science, Ovid e Science Direct de coortes consideradas elegíveis, avaliando-se qualidade metodológica e risco de viés; estudos combináveis, com boa qualidade e baixo risco de viés foram analisados com metanálise; a medida sumária utilizada foi a diferença de média ponderada e seu respectivo intervalo de confiança a 95%. Resultados 8 artigos preencheram os critérios de elegibilidade, incluindo indivíduos com média de idade variando de 9 a 15,7 anos. Para a metanálise, incluíram-se 4 artigos, com total de 7.974 crianças e adolescentes. Observou-se aumento médio de 4,94 mg/dL (IC 95%: 4,22 a 5,67 mg/dL) nos níveis de ApoB naqueles com excesso de adiposidade. Para a ApoA1, identificou-se redução média de -8,13 mg/dL (IC 95%: - 9,09 a -7,17 mg/dL) nos níveis séricos desse marcador em indivíduos com maior adiposidade corporal. Além disso, a influência do excesso de adiposidade corporal sobre os níveis de ApoA1 e ApoB foi maior entre adolescentes do que entre crianças. Conclusões O excesso de adiposidade corporal influenciou tanto na redução dos valores de ApoA1 quanto no aumento dos níveis de ApoB em crianças e adolescentes, e tais alterações foram mais relevantes entre adolescentes.(Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Excess Weight and Cardiovascular Diseases are health problems with increasing prevalence among children and adolescents, hence the need to investigate the issues related to them to better deal with the problem. Objective To investigate the influence of excess adiposity on the levels of apolipoprotein B and A1 in children and adolescents. Methods A systematic search was conducted in the PubMed, Embase, Lilacs, Web of Science, Ovid and Science direct databases, searching for cohort eligible studies and evaluating their results, methodological quality and risk of bias; combinable studies with good quality and low risk of bias were evaluated by meta-analysis. The summary measure used was the weighted mean difference (WMD) with its respective 95% confidence interval. Results 8 articles attended the eligibility criteria including individuals with age mean varying from 9 to 15.7 years of age. The meta-analysis included 4 articles with a total of 7,974 children and adolescents. It was observed a mean increase of 4,94mg/dL (95%CI: 4,22 to 5,67) in the ApoB levels in individuals with excess of body adiposity. For the ApoA1, we identified a mean reduction of -8,13mg/dL (95%CI: -9,09 to -7,17 mg/dL) in its levels in children and adolescents with higher body adiposity. Beside this, the influence of excess adiposity on the ApoB and ApoA1 levels was higher between adolescents than children. Conclusions The excess of body adiposity influenced both the reduction of ApoA1 values and the increase of ApoB levels, being these changes more relevant among adolescents. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Body Adiposity and Apolipoproteins in Children and Adolescents: A Meta-Analysis of Prospective Studies. / Adiposidade Corporal e Apolipoproteínas em Crianças e Adolescentes: Metanálise de Estudos Prospectivos.

BACKGROUND: Excess Weight and Cardiovascular Diseases are health problems with increasing prevalence among children and adolescents, hence the need to investigate the issues related to them to better deal with the problem. OBJECTIVE: To investigate the influence of excess adiposity on the levels of apolipoprotein B and A1 in children and adolescents. METHODS: A systematic search was conducted in the PubMed, Embase, Lilacs, Web of Science, Ovid and Science direct databases, searching for cohort eligible studies and evaluating their results, methodological quality and risk of bias; combinable studies with good quality and low risk of bias were evaluated by meta-analysis. The summary measure used was the weighted mean difference (WMD) with its respective 95% confidence interval. RESULTS: 8 articles attended the eligibility criteria including individuals with age mean varying from 9 to 15.7 years of age. The meta-analysis included 4 articles with a total of 7,974 children and adolescents. It was observed a mean increase of 4,94mg/dL (95%CI: 4,22 to 5,67) in the ApoB levels in individuals with excess of body adiposity. For the ApoA1, we identified a mean reduction of -8,13mg/dL (95%CI: -9,09 to -7,17 mg/dL) in its levels in children and adolescents with higher body adiposity. Beside this, the influence of excess adiposity on the ApoB and ApoA1 levels was higher between adolescents than children. CONCLUSIONS: The excess of body adiposity influenced both the reduction of ApoA1 values and the increase of ApoB levels, being these changes more relevant among adolescents. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

FUNDAMENTO: Excesso de adiposidade corporal e doenças cardiovasculares são problemas mundiais com crescente prevalência em crianças e adolescentes, sendo necessário investigar a relação destes, afim de construir estratégias de enfrentamento. OBJETIVO: Investigar influência do excesso de adiposidade corporal sobre os níveis séricos de apolipoproteínas B e A1 (ApoB e ApoA1) em crianças e adolescentes. MÉTODOS: Busca sistemática nas bases de dados Medline/PubMed, Embase, Lilacs, Web of Science, Ovid e Science Direct de coortes consideradas elegíveis, avaliando-se qualidade metodológica e risco de viés; estudos combináveis, com boa qualidade e baixo risco de viés foram analisados com metanálise; a medida sumária utilizada foi a diferença de média ponderada e seu respectivo intervalo de confiança a 95%. RESULTADOS: 8 artigos preencheram os critérios de elegibilidade, incluindo indivíduos com média de idade variando de 9 a 15,7 anos. Para a metanálise, incluíram-se 4 artigos, com total de 7.974 crianças e adolescentes. Observou-se aumento médio de 4,94 mg/dL (IC 95%: 4,22 a 5,67 mg/dL) nos níveis de ApoB naqueles com excesso de adiposidade. Para a ApoA1, identificou-se redução média de -8,13 mg/dL (IC 95%: - 9,09 a -7,17 mg/dL) nos níveis séricos desse marcador em indivíduos com maior adiposidade corporal. Além disso, a influência do excesso de adiposidade corporal sobre os níveis de ApoA1 e ApoB foi maior entre adolescentes do que entre crianças. CONCLUSÕES: O excesso de adiposidade corporal influenciou tanto na redução dos valores de ApoA1 quanto no aumento dos níveis de ApoB em crianças e adolescentes, e tais alterações foram mais relevantes entre adolescentes.(Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).

Hypertriglyceridemic Waist Phenotype and Changes in the Fasting Glycemia and Blood Pressure in Children and Adolescents Over One-Year Follow-Up Period / Fenótipo Cintura Hipertrigliceridêmica e mudanças na glicemia de jejum e pressão arterial de crianças e adolescentes após um ano de seguimento

Abstract Background: The hypertriglyceridemic waist (HTW) phenotype is defined as the simultaneous presence of increased waist circumference (WC) and serum triglycerides (TG) levels and it has been associated with cardiometabolic risk in children and adolescents. Objective: The objective was to evaluate the influence of HTW phenotype in the fasting glycemia and blood pressure in children and adolescents over one-year follow-up period. Methods: It is a cohort study involving 492 children and adolescents from 7 to 15 years old, both genders, who were submitted to anthropometric, biochemical and clinical evaluation at the baseline, and also after 6 and 12 months of follow-up. Generalized Estimating Equation (GEE) models were calculated to evaluate the longitudinal influence of the HTW phenotype in the glycemia and blood pressure over one-year. Results: It was observed a prevalence of 10.6% (n = 52) of HTW phenotype in the students. The GEE models identified that students with HTW phenotype had an increase of 3.87 mg/dl in the fasting glycemia mean (CI: 1.68-6.05) and of 3.67mmHg in the systolic blood pressure (SBP) mean (CI: 1.55-6.08) over one-year follow-up, after adjusting for confounding variables. Conclusions: The results of this study suggest that HTW phenotype is a risk factor for longitudinal changes in glycemia and SBP in children and adolescents over one-year follow-up period.

Resumo Fundamento: O fenótipo de cintura hipertrigliceridêmica (CHT) é definido como a presença simultânea de circunferência de cintura (CC) e níveis séricos de triglicérides (TG) aumentados e tem sido associado com risco cardiometabólico em crianças e adolescentes. Objetivo: Avaliar a influência do fenótipo CHT na glicemia de jejum e na pressão arterial em crianças e adolescentes em um período de acompanhamento de um ano. Métodos: Trata-se de um estudo de coorte envolvendo 492 crianças e adolescentes de 7 a 15 anos de ambos os sexos, que foram submetidos à avaliação antropométrica, bioquímica e clínica no início e também após 6 e 12 meses de seguimento. Os modelos de Equação de Estimulação Generalizada (GEE) foram calculados para avaliar a influência longitudinal do fenótipo CHT na glicemia e na pressão arterial ao longo de um ano. Resultados: Foi observada uma prevalência de 10,6% (n = 52) do fenótipo CHT nos estudantes. Os modelos GEE identificaram que os estudantes com fenótipo CHT apresentaram aumento de 3,87 mg/dl na média de glicemia em jejum (IC: 1,68-6,05) e de 3,67 mmHg na pressão arterial sistólica media (PAS) (IC: 1,55-6,08) depois de um ano de acompanhamento, após ajuste para variáveis de confusão. Conclusões: Os resultados deste estudo sugerem que o fenótipo CHT é um fator de risco para alterações longitudinais da glicemia e da PAS em crianças e adolescentes em um período de um ano de seguimento.

Hypertriglyceridemic Waist Phenotype and Changes in the Fasting Glycemia and Blood Pressure in Children and Adolescents Over One-Year Follow-Up Period.

BACKGROUND:: The hypertriglyceridemic waist (HTW) phenotype is defined as the simultaneous presence of increased waist circumference (WC) and serum triglycerides (TG) levels and it has been associated with cardiometabolic risk in children and adolescents. OBJECTIVE:: The objective was to evaluate the influence of HTW phenotype in the fasting glycemia and blood pressure in children and adolescents over one-year follow-up period. METHODS:: It is a cohort study involving 492 children and adolescents from 7 to 15 years old, both genders, who were submitted to anthropometric, biochemical and clinical evaluation at the baseline, and also after 6 and 12 months of follow-up. Generalized Estimating Equation (GEE) models were calculated to evaluate the longitudinal influence of the HTW phenotype in the glycemia and blood pressure over one-year. RESULTS:: It was observed a prevalence of 10.6% (n = 52) of HTW phenotype in the students. The GEE models identified that students with HTW phenotype had an increase of 3.87 mg/dl in the fasting glycemia mean (CI: 1.68-6.05) and of 3.67mmHg in the systolic blood pressure (SBP) mean (CI: 1.55-6.08) over one-year follow-up, after adjusting for confounding variables. CONCLUSIONS:: The results of this study suggest that HTW phenotype is a risk factor for longitudinal changes in glycemia and SBP in children and adolescents over one-year follow-up period. FUNDAMENTO:: O fenótipo de cintura hipertrigliceridêmica (CHT) é definido como a presença simultânea de circunferência de cintura (CC) e níveis séricos de triglicérides (TG) aumentados e tem sido associado com risco cardiometabólico em crianças e adolescentes. OBJETIVO:: Avaliar a influência do fenótipo CHT na glicemia de jejum e na pressão arterial em crianças e adolescentes em um período de acompanhamento de um ano. MÉTODOS:: Trata-se de um estudo de coorte envolvendo 492 crianças e adolescentes de 7 a 15 anos de ambos os sexos, que foram submetidos à avaliação antropométrica, bioquímica e clínica no início e também após 6 e 12 meses de seguimento. Os modelos de Equação de Estimulação Generalizada (GEE) foram calculados para avaliar a influência longitudinal do fenótipo CHT na glicemia e na pressão arterial ao longo de um ano. RESULTADOS:: Foi observada uma prevalência de 10,6% (n = 52) do fenótipo CHT nos estudantes. Os modelos GEE identificaram que os estudantes com fenótipo CHT apresentaram aumento de 3,87 mg/dl na média de glicemia em jejum (IC: 1,68-6,05) e de 3,67 mmHg na pressão arterial sistólica media (PAS) (IC: 1,55-6,08) depois de um ano de acompanhamento, após ajuste para variáveis de confusão. CONCLUSÕES:: Os resultados deste estudo sugerem que o fenótipo CHT é um fator de risco para alterações longitudinais da glicemia e da PAS em crianças e adolescentes em um período de um ano de seguimento.

Encuesta sobre prácticas de medicina preventiva / Survey on practics of preventive medicine

El objetivo del presente trabajo fue evaluar las acciones de medicina preventiva que toman estudiantes avanzados de ciencias de la salud para si mismo. Se revisan las principales prácticas preventivas (medidas de seguridad en tránsito, consumo de tóxicos, prevención de enfermedades transmisibles, dieta y actividad física, controles médicos y odontológicos periódicos) para ello: Se realizó una encuesta anónima entre estudiantes de último año de las carreras de medicina y enfermeria universitaria. Se detectaron prevalencias promedio de medidas de seguridad en tránsito 21 por ciento, sobrepeso 40 por ciento, tabaquismo 45 por ciento, inmunización contra hepatítis "B" 75 por ciento, contra tétanos 63,5 por ciento, contra sarampión, rubeola, paperas y varicela 47 por ciento, controles odontológicos 18 por ciento, controles ginecológicos 71,5 por ciento, colesterolemia 51 por ciento, dieta saludable 41 por ciento, actividad física 40 por ciento, sexo seguro 80 por ciento, conductas apropiadas... (AU)

Encuesta sobre prácticas de medicina preventiva / Survey on practics of preventive medicine

El objetivo del presente trabajo fue evaluar las acciones de medicina preventiva que toman estudiantes avanzados de ciencias de la salud para si mismo. Se revisan las principales prácticas preventivas (medidas de seguridad en tránsito, consumo de tóxicos, prevención de enfermedades transmisibles, dieta y actividad física, controles médicos y odontológicos periódicos) para ello: Se realizó una encuesta anónima entre estudiantes de último año de las carreras de medicina y enfermeria universitaria. Se detectaron prevalencias promedio de medidas de seguridad en tránsito 21 por ciento, sobrepeso 40 por ciento, tabaquismo 45 por ciento, inmunización contra hepatítis "B" 75 por ciento, contra tétanos 63,5 por ciento, contra sarampión, rubeola, paperas y varicela 47 por ciento, controles odontológicos 18 por ciento, controles ginecológicos 71,5 por ciento, colesterolemia 51 por ciento, dieta saludable 41 por ciento, actividad física 40 por ciento, sexo seguro 80 por ciento, conductas apropiadas...

Cardiopatias congénitas en geriatría / Heart defects congenita in geriatric

Las cardiopatías congénitas ocurren en casi 10 (de cada 1000 nacidos vivos. Los defectos del tabique auricular (CIA) son mas frecuentes en mujeres y son una de las anomalías cardíacas congénitas mas frecuentes en adultos.Aunque la expectativa de vida no es normal la sobreviva es buena, la insuficiencia cardíaca congestiva es la causa de muerte mas frecuente.Se realiza análisis retrospectivo de la historia clínica de una paciente atendida en los Consultorios Externos del Hospital de Quilmes de 66 años que consulta en Febrero de 1998 por disnea de esfuerzo, soplo mesosistólico eyectivo en foco pulmonar. Telerradiografía de tórax: Cardiomegalia grado I/11, arco medio prominente. Electrocardiograma: crecimiento biauricular Bloqueo Completo de Rama Derecha. Serología positiva para Chagas. Ecocardiograma 2D-M y Doppler cardíaco: dilatación de ambas aurículas y ventrículo derecho, solución de continuidad en septum interauricular compatible con C.I.A Resonancia nuclear magnética.Se visualiza cortocircuito de dirección de izquierda a derecha. Se solicita cateterismo cardíaco derecho e izquierdo y cinecoronariografía, procedimiento no aceptado por la paciente.El tema CIA es revisado a propósito de un caso atendido en nuestra institución. Es de destacar la importancia de ser sistemáticos en el estudio de los cuadros de disnea en gerontes. (AU)

Cardiopatias congénitas en geriatría / Heart defects congenita in geriatric

Las cardiopatías congénitas ocurren en casi 10 (de cada 1000 nacidos vivos. Los defectos del tabique auricular (CIA) son mas frecuentes en mujeres y son una de las anomalías cardíacas congénitas mas frecuentes en adultos.Aunque la expectativa de vida no es normal la sobreviva es buena, la insuficiencia cardíaca congestiva es la causa de muerte mas frecuente.Se realiza análisis retrospectivo de la historia clínica de una paciente atendida en los Consultorios Externos del Hospital de Quilmes de 66 años que consulta en Febrero de 1998 por disnea de esfuerzo, soplo mesosistólico eyectivo en foco pulmonar. Telerradiografía de tórax: Cardiomegalia grado I/11, arco medio prominente. Electrocardiograma: crecimiento biauricular Bloqueo Completo de Rama Derecha. Serología positiva para Chagas. Ecocardiograma 2D-M y Doppler cardíaco: dilatación de ambas aurículas y ventrículo derecho, solución de continuidad en septum interauricular compatible con C.I.A Resonancia nuclear magnética.Se visualiza cortocircuito de dirección de izquierda a derecha. Se solicita cateterismo cardíaco derecho e izquierdo y cinecoronariografía, procedimiento no aceptado por la paciente.El tema CIA es revisado a propósito de un caso atendido en nuestra institución. Es de destacar la importancia de ser sistemáticos en el estudio de los cuadros de disnea en gerontes.