Scale-free dynamics of COVID-19 in a Brazilian city.

A common basis to address the dynamics of directly transmitted infectious diseases, such as COVID-19, are compartmental (or SIR) models. SIR models typically assume homogenous population mixing, a simplification that is convenient but unrealistic. Here we validate an existing model of a scale-free fractal infection process using high-resolution data on COVID-19 spread in São Caetano, Brazil. We find that transmission can be described by a network in which each infectious individual has a small number of susceptible contacts, of the order of 2-5. This model parameter correlated tightly with physical distancing measured by mobile phone data, such that in periods of greater distancing the model recovered a lower average number of contacts, and vice versa. We show that the SIR model is a special case of our scale-free fractal process model in which the parameter that reflects population structure is set at unity, indicating homogeneous mixing. Our more general framework better explained the dynamics of COVID-19 in São Caetano, used fewer parameters than a standard SIR model and accounted for geographically localized clusters of disease. Our model requires further validation in other locations and with other directly transmitted infectious agents.

Stratifying risk outcomes among adult COVID-19 inpatients with high flow oxygen: The R4 score.

BACKGROUND: High flow oxygen therapy (HFO) is a widely used intervention for pulmonary complications. Amid the coronavirus infectious disease 2019 (COVID-19) pandemic, HFO became a popular alternative to conventional oxygen supplementation therapies. Risk stratification tools have been repurposed -and new ones developed- to estimate outcome risks among COVID-19 patients. This study aims to provide a simple risk stratification system to predict invasive mechanical ventilation (IMV) or death among COVID-19 inpatients on HFO. METHODS: Among 529 adult inpatients with COVID-19 pneumonia, we selected unadjusted clinical risk factors for developing the composite endpoint of IMV or death. The risk for the primary outcome by each category was estimated using a Cox proportional hazards model. Bootstrapping was used to validate the results. RESULTS: Age above 62, eGFR under 60 ml/min, room air SpO2 ≤89 % upon admission, history of hypertension, history of diabetes, and any comorbidity (cancer, cardiovascular disease, COPD/ asthma, hypothyroidism, or autoimmune disease) were considered for the score. Each of the six criteria scored 1 point. The score was further simplified into 4 categories: 1) 0 criteria, 2) 1 criterion, 3) 2-3 criteria, and 4) ≥4 criteria. Taking the first category as the reference, risk estimates for the primary endpoint were HR; 2.94 [1.67 - 5.26], 4.08 [2.63 - 7.05], and 6.63 [3.74 - 11.77], respectively. In ROC analysis, the AUC for the model was 0.72. CONCLUSIONS: Our score uses simple criteria to estimate the risk for IMV or death among COVID-19 inpatients with HFO. Higher category reflects consistent increases in risk for the endpoint.

Unfolding of crumpled thin sheets.

Crumpled thin sheets are complex fractal structures whose physical properties are influenced by a hierarchy of ridges. In this paper, we report experiments that measure the stress-strain relation and show the coexistence of phases in the stretching of crumpled surfaces. The pull stress showed a change from a linear Hookean regime to a sublinear scaling with an exponent of 0.65±0.03, which is identified with the Hurst exponent of the crumpled sheets. The stress fluctuations are studied. The statistical distribution of force peaks is analyzed. It is shown that the unpacking of crumpled sheets is guided by a hierarchical order of ridges.

Responses of monogenean species to variations in abiotic parameters in tilapiculture.

Fish farming is becoming an increasingly popular agricultural activity, and water quality in these environments is a major concern. Fish parasites, such as monogeneans, respond to changes in abiotic conditions, either with an increase or decrease in population. This study aimed to identify gill monogeneans and analyse their relationships with abiotic factors during the ontogenetic development of Nile tilapia over the fish culture cycle in Mato Grosso do Sul, Brazil. Fish were sampled monthly for eight months, and a total of 200 fish were collected. The physical and chemical water parameters were measured and correlated with the abundance of each monogenean species. Over the fish culture cycle, the physical and chemical parameters fluctuated, and the water quality decreased. The parasites found included Cichlidogyrus tilapiae, Cichlidogyrus thurstonae, Cichlidogyrus sclerosus, Cichlidogyrus halli and Scutogyrus longicornis. The abundances of all species showed significant differences during ontogenetic development (body size) and C. tilapiae, C. sclerosus, C. thurstonae and S. longicornis were correlated with changes in abiotic conditions. However, C. halli was not significantly correlated with any of the evaluated physical or chemical parameters. Understanding how different monogenean species respond to changes in the physical and chemical parameters of water during a production cycle can prevent peaks in abundance and subsequent sanitary problems.

Calidad de la educación sexual recibida en el contexto escolar y su asociación a conductas sexuales en adolescentes chilenos, según datos VIII Encuesta Nacional de la Juventud / Quality of sexual education received in the school context and its association with sexual behaviors in Chilean adolescents, according to data from the VIII National Youth Survey

OBJETIVO: Evaluar la calidad de la educación sexual recibida en el contexto escolar y su asociación a conductas sexuales en adolescentes chilenos. MÉTODOS: Estudio transversal y analítico. La muestra correspondió a adolescentes de ambos sexos de 15 a 19 años, se obtuvo de una base de datos con representación nacional. Se evaluó la calidad de la educación sexual recibida en el contexto escolar como buena, regular y mala. Se realizó análisis descriptivo y de asociación entre las variables. Se calculó OR (Odds ratio) y RRR (Relative-risk ratios) ajustado por sexo, edad en años cumplidos, grupo socioeconómico y zona. RESULTADOS: La muestra correspondió a 1.049 adolescentes sexualmente activos, de estos el 21,83% correspondió al grupo con evaluación mala, 44,16% con evaluación regular y 34,01% con evaluación buena. La razón entre adolescentes que no usaron condón en la última relación sexual versus usaron condón, es 1,64 veces mayor en los adolescentes con evaluación mala de la educación sexual recibida (OR: 1,64; IC95%: 1,01 - 2,68). La razón entre adolescentes que tuvieron dos o más parejas sexuales en el último año versus ninguna o una, es 2,15 veces mayor en los adolescentes con evaluación mala de la educación sexual recibida (OR: 2,15; IC95%: 1,30 - 3,56). CONCLUSIÓN: Los participantes de este estudio evalúan la educación sexual recibida mayoritariamente como regular, existiendo una asociación con las conductas sexuales. Es importante realizar estudios en profundidad que permitan conocer por qué los adolescentes evalúan sólo como regular la educación sexual recibida en el sistema escolar.

OBJECTIVE: To evaluate the quality of the sexual education received in the school context and its association with sexual behaviors in Chilean adolescents. METHODS: Cross-sectional and analytical study. The sample corresponded to adolescents of both sexes from 15 to 19 years old, it was obtained from a database with national representation. The quality of the sexual education received in the school context was evaluated as good, regular and bad. Descriptive and association analysis were performed between the variables. OR (Odds ratio) and RRR (Relative-risk ratios) adjusted for sex, age in completed years, socioeconomic group and area were calculated. RESULTS: The sample corresponded to 1,049 sexually active adolescents, of these, 21.83% corresponded to the group with bad "Evaluation", 44.16% with regular "Evaluation" and 34.01% with good "Evaluation". The ratio among adolescents who did not use a condom in the last sexual relationship versus those who used a condom is 1.64 times higher in adolescents with a poor evaluation of sexual education received (OR: 1.64; 95% CI: 1.01 - 2.68). The ratio among adolescents who had two or more sexual partners in the last year versus those who had neither or one, is 2.15 times higher in adolescents with poor evaluation of sexual education received (OR: 2.15; 95% CI: 1.30 - 3.56). CONCLUSION: The participants of this study evaluate the sexual education received mostly as regular, with an association with sexual behaviors. It is important to conduct in-depth studies that allow us to know why adolescents evaluate the sexual education received in the school system as regular only.

Salud sexual y salud reproductiva en mujeres jóvenes con consumo de sustancias en Chile según datos VIII encuesta nacional de la juventud / Sexual health and reproductive health in young women with substance consumption in Chile according to data VIII national youth survey

OBJETIVOS: Determinar la asociación entre el consumo de sustancias y características de salud sexual y reproductiva de mujeres jóvenes en Chile. MÉTODOS: Estudio transversal analítico en mujeres entre 15 a 24 años. Se formaron 3 grupos: Sin consumo de sustancias (SCS), Consumo no problemático de sustancias (CNPS) y Consumo problemático de sustancias (CPS). Se realizó análisis descriptivo y de asociación entre las variables. Se ajustaron modelos de regresión logística múltiple y ordinal múltiple. RESULTADOS: Muestra de 2.589 jóvenes, el 37,8% correspondió al grupo SCS, 46,3% al grupo CSNP y 15,9% al grupo CPS. En promedio la edad de inicio de actividad sexual fue menor en el grupo CPS (15,9 años p = 0,001) mostrando mayor porcentajes de sexo oral, anal, no uno de condón, relaciones sexuales con parejas menos estables, mayor número de parejas sexuales y violencia en la pareja, (p =0,001). En este grupo se incrementa 5,84 el riesgo de tener la última relación sexual con pareja menos estable (IC95%: 3,90 - 12,01) y 8,35 veces el riesgo de tener 2 o más parejas sexuales (últimos 12 meses) (IC95%: 5,35 - 16,34). En el grupo CNPS se incrementa 1,11 veces el riesgo de tener la última relación sexual con pareja menos estable (IC95%: 1,43 - 3,12), 1,01 veces tener 2 y más parejas sexuales (últimos 12 meses) (IC95%: 1,20 - 3,36). CONCLUSIONES: Reconociéndose que la sexualidad es multifactorial, las mujeres con consumo de sustancias viven situaciones que facilitan riesgos para su salud sexual. El consumo en mujeres jóvenes es un problema de salud pública que presenta desafíos para su abordaje.

OBJECTIVES: To determine the association between substance use and characteristics of sexual and reproductive health of young women in Chile. METHODS: Analytical cross-sectional study in women between 15 and 24 years. Three groups were formed: No substance use (SCS), Non-problematic substance use (CNPS) and Problem substance use (CPS). Descriptive and association analysis was performed between the variables. Multiple logistic regression and multiple ordinal models were adjusted. RESULTS: Sample of 2,589 young people, 37.8% corresponded to the SCS group, 46.3% to the CSNP group and 15.9% to the CPS group. On average the age of onset of sexual activity was lower in the CPS group (15.9 years p = 0.001) showing higher percentages of oral, anal sex, not a condom, sex with less stable partners, greater number of sexual partners and violence in the couple, (p = 0.001). In this group the risk of having the last sexual relationship with a less stable partner is increased 5.84 (95% CI: 3.90 - 12.01) and 8.35 times the risk of having 2 or more sexual partners (last 12 months) (95% CI: 5.35-16.34). In the CNPS group the risk of having the last sexual relationship with a less stable partner is increased 1.11 times (95% CI: 1.43 - 3.12), 1.01 times having 2 and more sexual partners (last 12 months) (95% CI: 1.20-3.36). CONCLUSIONS: Recognizing that sexuality is multifactorial, women with substance use experience situations that facilitate risks to their sexual health. Consumption in young women is a public health problem that presents challenges for its approach.

Edad de inicio sexual y asociación a variables de salud sexual y violencia en la relación de pareja en adolescentes chilenos / Age of sexual initiation and association with variables of sexual health and violence in the couple relationship in Chilean adolescents

RESUMEN Objetivo Analizar la edad de inicio sexual y su asociación a variables de salud sexual y violencia en la relación de pareja (VRP) en adolescentes chilenos. Métodos Estudio transversal y analítico. La muestra se obtuvo de base de datos con representación nacional. Se realizó análisis de regresión logística múltiple controlando por edad y grupo socioeconómico y estratificando por sexo para determinar asociación entre las variables. Resultados En mujeres, el inicio sexual temprano (antes de los 15 años) aumenta en 0,85 veces el riesgo de embarazo no planificado (OR: 1,85; IC95%: 1,08 - 3,15). En hombres el inicio sexual temprano aumenta en 2.33 veces el riego de no usar anticonceptivo en la primera relación sexual (OR: 3,33; IC95%: 1,85 - 6,01) y 4.33 veces de tener 2 y más parejas sexuales durante los últimos 12 meses (OR: 5,33; IC95%: 3,25 - 8,75). La prevalencia de VRP fue 10%, siendo la violencia psicológica la más frecuente en hombres y en mujeres. En las mujeres, la edad de inicio sexual temprano aumenta 5,72 veces el riesgo de violencia física (OR: 6,72; IC95%: 2,52 - 17,87) y 7,82 veces violencia psicológica (OR: 8,82; IC95%: 4,10 - 19,0). Las adolescentes que presentan un inicio temprano de actividad sexual, muestran más frecuencia de prácticas de control y abuso hacia su pareja, en comparación con los hombres. Conclusiones El inicio sexual temprano y la VRP existen con una frecuencia preocupante, existiendo asociación entre ambas, en especial en mujeres, lo que aumenta el riesgo para la salud en general. Es necesaria la capacitación de los equipos de salud y educación e implementación de estrategias integrales que contribuyan a promover la salud y bienestar de los adolescentes.

ABSTRACT Objective To analyze the age of sexual debut, its association with variables of sexual health and intimate partner violence (PV) in Chilean adolescents. Methods Cross-sectional and analytical study. The sample was obtained from a database with national representation. Multiple logistic regression analysis was carried out controlling by age and socioeconomic group and stratifying by sex to determine association between the variables. Results In women, the age of early sexual initiation increases in 0.85 times the risk of unplanned pregnancy (OR: 1.85, 95% CI: 1.08 - 3.15). In men, the age of early sexual debut increases by 2.33 times the risk of not using contraception in the first sexual relationship (OR: 3.33, 95% CI: 1.85 - 6.01) and 4.33 times of having 2 and more sexual partners during the last 12 months (OR: 5.33, 95% CI: 3.25 - 8.75). The prevalence of PV was 10%, psychological violence was the most frequent in men and women. In women, the age of early sexual initiation increases 5.72 times the risk of physical violence (OR: 6.72, 95% CI: 2.52 17.87) and 7.82 times psychological violence (OR: 8.82; 95% CI: 4.10 - 19.0) Adolescents who have an early onset of sexual activity show more evidence of control practices and abuse toward their partner, compared to men. Conclusions Intimate partner violence exists with a worrisome frequency, having an association with early sexual initiation, especially in women, increasing the risk to health in general. It is necessary to train health and education teams and implement comprehensive strategies that contribute to promoting the health and well-being of adolescents.

Thyroid Function in Human Obesity: Underlying Mechanisms.

Obesity is associated with several metabolic and endocrine disorders; and changes in plasma concentrations, secretion patterns, and clearance of various hormones are observed in obese patients. In this context, recent research has shown that overweight can influence the function of the thyroid gland, usually leading to increased thyrotropin concentrations and changes in the ratio between the hormones triiodothyronine and thyroxine, though within the normal range. The etiology of these changes is still unclear; however, several mechanisms have been proposed including the adaptive process to increase energy expenditure, hyperleptinemia, changes in the activity of deiodinases, the presence of thyroid hormones resistance, chronic low-grade inflammation, and insulin resistance. Although the clinical implications have not been clarified, studies suggest that these changes in the thyroid function of obese individuals may contribute to the worsening of metabolic complications and the development of diseases in the thyroid gland.

Patrón de sangrado uterino en adolescentes usuarias de implante anticonceptivo subdérmico de etonogestrel / Uterine bleeding patterns of adolescents using the long term etonogestrel contraceptive implant

Objetivo: Describir las características del patrón sangrado uterino de las adolescentes que usan el implante anticonceptivo sudérmico de etonogestrel (IASE) que concurren a un centro especializado en salud sexual y reproductiva de adolescentes en Santiago, Chile, y su asociación con variables biopsicosocial. Método: Estudio de cohorte retrospectiva de las usuarias de IASE. Los datos fueron analizados utilizando la ecuación de estimación generalizada, análisis de sobrevida de Kaplan Meier y test de log-rank. Resultados: La cohorte incluyó a 62 adolescentes. La media de edad fue de 16,2 años. Las participantes recibieron asesoramiento anticonceptivo antes de la inserción del IASE, y fueron seguidas durante tres años. Los patrones de sangrado más frecuentes durante el primer año fue el de amenorrea (40,5%) y el sangrado aceptable (27,1%), mientras que el menos frecuente fue prolongado y/o sangrado frecuente (15,8%). De acuerdo con el análisis de sobrevida, la única variable biopsicosocial asociado con patrón prolongado y/o sangrado frecuente fue condición médica previa. Cinco adolescentes (8%) se retiraron el IASE. Conclusiones: El IASE es una opción anticonceptiva segura y altamente eficaz para las adolescentes, independientemente de la paridad. La consejería es de gran importancia para fomentar la tolerancia y la adhesión al implante.

Objectives: To describe uterine bleeding patterns of adolescents using the long term etonogestrel contraceptive implant (ENG implant) attending a specialized adolescent sexual and reproductive health centre in Santiago, Chile, and test their association with bio-psychosocial variables. Methods: A retrospective cohort study of ENG implant users was conducted and data were analysed using the Generalized Estimating Equation, Kaplan Meier Survival Analysis and Log-Rank Test. Results: The cohort included 62 adolescents with and average age at inclusion of 16.2 years. Participants received contraceptive counselling prior to insertion of an ENG implant, and were followed up for three years. The most frequent bleeding patterns during the first year were amenorrhea (40.5%) and acceptable bleeding (27.1%), whilst the least frequent was prolonged and/or frequent bleeding (15.8%). According to the survival analysis, the only bio-psychosocial variable associated with prolonged and/or frequent bleeding was prior medical condition. Five adolescents (8%) withdrew from the treatment. Conclusions: The ENG implant is a safe and highly effective contraceptive option for adolescents, regardless of parity. Counselling is of great importance to foster tolerance and adherence to the ENG implant.

Implicancias del marco legal chileno en la prevención del embarazo adolescente: conflicto e inseguridad en los profesionales de la salud / Implications of chilean legal framework in teen pregnancy prevention: conflict and insecurity in health professionals

Background: Teenage pregnancy is a psychosocial and multifactorial problem described as a lack of exercise of rights in sexual and reproductive health. There are important aspects in the doctor-patient relationship and confidentiality that directly affect the continuity and quality of care. There are controversies in the laws relating to the provision of contraception and confidentiality, and those that protect the sexual indemnity, especially in adolescents under 14 years. Aim: To describe the implications of the legal framework for professional midwives in the care of adolescents younger than 14 years in sexual and reproductive health. Material and Methods: In-depth interviews were conducted to 13 female and 2 male midwives working at Primary Health Care Centers in the Metropolitan Region. Results: The attention of adolescents younger than 14 years in sexual and reproductive health involves medical-legal issues for health professionals. All professionals recognize that mandatory reporting sexual activity is a complex situation. All professionals notify pregnancies. In relation to the delivery of contraception, clinical care is problematic since professionals should take shelter from a legal standpoint. Conclusions: The medical-legal context of pregnant women under 14 years of age care generates a context of uncertainty and fear for professionals and becomes a source of conflict and insecurity in the exercise of the profession.

[Implications of chilean legal framework in teen pregnancy prevention: conflict and insecurity in health professionals]. / Implicancias del marco legal chileno en la prevención del embarazo adolescente: conflicto e inseguridad en los profesionales de la salud.

BACKGROUND: Teenage pregnancy is a psychosocial and multifactorial problem described as a lack of exercise of rights in sexual and reproductive health. There are important aspects in the doctor-patient relationship and confidentiality that directly affect the continuity and quality of care. There are controversies in the laws relating to the provision of contraception and confidentiality, and those that protect the sexual indemnity, especially in adolescents under 14 years. AIM: To describe the implications of the legal framework for professional midwives in the care of adolescents younger than 14 years in sexual and reproductive health. MATERIAL AND METHODS: In-depth interviews were conducted to 13 female and 2 male midwives working at Primary Health Care Centers in the Metropolitan Region. RESULTS: The attention of adolescents younger than 14 years in sexual and reproductive health involves medical-legal issues for health professionals. All professionals recognize that mandatory reporting sexual activity is a complex situation. All professionals notify pregnancies. In relation to the delivery of contraception, clinical care is problematic since professionals should take shelter from a legal standpoint. CONCLUSIONS: The medical-legal context of pregnant women under 14 years of age care generates a context of uncertainty and fear for professionals and becomes a source of conflict and insecurity in the exercise of the profession.

Consejería y seguimiento en la elección de un método anticonceptivo en adolescentes que consultan por prevención de embarazo / Contraception counseling and follow up in teens that ask for pregnancy prevention

La Consejería para la anticoncepción, es un proceso interactivo entre un consejero y la adolescente, don- de el primero actúa como facilitador ayudando a la joven en la elección de un método anticonceptivo (MACs), educando sobre el uso correcto y consistente del método elegido. OBJETIVO: Caracterizar los componentes de una consejería efectiva para la elección y continuidad de MACs en adolescentes que solicitan atención, para prevenir un embarazo. Método: Se realizó una búsqueda bibliográfica de artículos científicos, guía clínicas y re- comendaciones, sobre tres momentos de la prestación de consejería de anticoncepción: elección del anticonceptivo, continuidad de uso y cambio de MAC. CONCLUSIÓN: La consejería es parte fundamental tanto para la elección como apoyo en la continuidad y uso de un anticonceptivo, así como para la asesoría frente a un cambio de MAC. Profesionales especialistas en atención de adolescentes cuentan con más habilidades para reconocer las necesidades de la consultante como técnicas de comunicación, que favorecen el uso consistente de un MAC, mejorando el bienestar reproductivo y sexual de la adolescente.

INTRODUCTION: The contraception counseling is an interactive process between a counselor and an adolescent, where the counselor acts as a facilitator, thus helping the teenager to choose a birth control method, as well as teaching how its proper and consistent use. AIM: Characterize the components of an effective birth control counseling: for choosing the method and monitoring contraception in adolescents seeking care for pregnancy prevention. Method: A literature search on the topic was performed. Comprising: scientific articles, clinical guidelines and recommendations on three instances of contraceptive counseling: contraceptive choice, continuity of use and change of MAC. CONCLUSION: Counseling is a central part for: the birth control method selection, the method in use continuation, and also when a change is in need. An adolescent’s Health Professional has more skills to recognize the needs of an in adolescent and able to develop communication skills, helping and promoting a consistent use of contraceptives and improve the reproductive and sexual well-being of adolescents.

Menarquia temprana y su asociación con conductas de riesgo en adolescentes / Early menarche and its association with risk behaviors in adolescents

ANTECEDENTES: La pubertad no está necesariamente asociada a un desarrollo psicosocial equivalente. La falta de madurez y las características de la adolescencia podrían favorecer la aparición de conductas de riesgo. OBJETIVO: Determinar la asociación entre la edad de la menarquia y presencia de conductas de riesgo en adolescentes. MÉTODO: Diseño de corte transversal. La muestra incluyó adolescentes postmenárquicas. El instrumento fue una encuesta semiestructurada. Se realizó análisis descriptivo bivariado y multivariado. RESULTADOS: La muestra correspondió a 1844 adolescentes, la mediana de edad fue de 16 años y 12 años para la menarquia. El 57% provino de nivel socioeconómico medio, el 98% estaba escolarizada y 52% vivía con ambos padres. El 35,1% presentó menarquia temprana. El abuso sexual se presentó en 26,0% en el grupo de menarquia temprana y en 21,4% en el de menarquia no temprana. El inicio de actividad sexual antes de los 15 años se presentó en un 39,4% y en 22,3% de adolescentes con menarquia temprana y no temprana respectivamente (OR: 1,88; IC95%: 1,46-2,43), asociándose con disfuncionalidad familiar (OR: 2,08; IC95%: 1,45-2,99) y ausencia de los padres (OR: 1,74; IC95%: 1,09-2,76). La frecuencia de consumo de alcohol se asoció a disfuncionalidad familiar severa (OR: 2,00; IC95%: 1,34-3,00). CONCLUSIÓN: La menarquia temprana se asoció al inicio precoz de actividad sexual. Es importante promover comportamientos seguros desde edades tempranas y acompañar a las niñas en su proceso de maduración.

BACKGROUND: Puberty is not necessarily associated with an equivalent psychosocial development. The lack of maturity and characteristics of adolescence may promote the emergence of risk behaviors. OBJECTIVE: To determine the association between age at menarche and presence of risk behaviors in adolescents. METHOD: Cross-sectional design study. The sample included postmenarchal adolescents. The instrument was a semistructured survey. Bivariate and multivariate descriptive analysis. RESULTS: The sample consisted of 1844 adolescents, the median age was 16 years and 12 years for menarche. 57% came from middle socioeconomic level, 98% attended school and 52% lived with both parents. 35.1% had early menarche. Sexual abuse occurred in 26.0% in the group of early menarche and 21.4% for no early menarche. The onset of sexual activity before age 15 occurred in 39.4% and 22.3% of adolescents with early and no early menarche respectively (OR: 1.88; 95%CI: 1.46-2.43), associated with family dysfunction (OR: 2.08; 95%CI: 1.45-2.99) and absence of parents (OR: 1.74; 95%CI: 1.09-2.76). The frequency of alcohol consumption was associated with severe family dysfunction (OR: 2.00; 95%CI: 1.34-3.00). CONCLUSION: Early menarche was associated with early onset of sexual activity. It is important to promote safe behavior from an early age and escort girls in their maturation process.

Chronic glucocorticoid treatment enhances lipogenic activity in visceral adipocytes of male Wistar rats.

AIM: Glucocorticoid (GC) in excess promotes the redistribution of adipose tissue from peripheral to central sites of the body. In this study, we characterized an experimental condition of prolonged GC excess and investigated its effect on the lipogenic metabolism in white adipose tissue. METHODS: Twenty male Wistar rats were divided into control (CON) and dexamethasone-treated (DEX) groups. DEX group received dexamethasone (0.25 mg kg(-1) day(-1) ) during 4 weeks, while CON group received saline. Animals were killed and subcutaneous (SC), retroperitoneal (RP) and mesenteric (MS) fat pads were excised, weighed and processed for adipocyte isolation, morphometric cell analysis and incorporation of glucose into lipids. RESULTS: The treatment effectively blocked hypothalamic-pituitary-adrenal axis, as verified by a 58% decrease in plasma corticosterone levels and 19% atrophy in adrenal glands in DEX group. Animals from DEX group presented insulin resistance, glucose intolerance, dyslipidaemia and increased insulin and leptin plasma levels and hypertrophied adipocytes. They showed increased lipogenesis in RP and MS depots, with increased incorporation of glucose into fatty acids of triacylglycerol. Increased activity of lipogenic enzymes ATP-citrate lyase, fatty acid synthase, glucose-6-phosphate dehydrogenase and malic was only seen in the MS depot in DEX group, while gene expression of these enzymes was enhanced in SC and MS fat depots. CONCLUSION: The adaptations promoted by GC treatment in adipose metabolism seemed to be mainly due to the increased activity of enzymes that supply the NADPH required for lipogenesis than to the increase in enzymes that more directly deal with fatty acid synthesis itself.

Fenômeno lúcio. Relato de um caso exuberante com excelente resposta ao tratamento com poliquimioterapia multibacilar

O Fenômeno de Lúcio (FL) representa uma reação cutânea necrosante grave, que pode ocorrer na Hanseníase de Lúcio e em outras formas de Hanseníase Virchowiana. Manifesta-se 3-4 anos após o início da doença e é mais comum em pacientes não tratados ou recebendo dose inadequada de tratamento. Caracteriza-se por surtos de máculas eritematosas, ligeiramente infiltradas, que evoluem com necrose central e posterior ulceração. Sua fisiopatogenia é ainda desconhecida, porém é consenso que se trata fundamentalmente de um processo trombótico-oclusivo. Na histologia observa-se trombose de pequenos vasos da derme superior e média, resultando em ulceração da epiderme, infiltrado inflamatório com histiócitos espumosos, e numerosos bacilos, inclusive na parede dos vasos.

Patrón intergeneracional del embarazo adolescente en las hijas de una cohorte de mujeres que controlaron su primer embarazo en un centro integral para adolescentes embarazadas / Intergenerational pattern of adolescent pregnancy in daughters of a cohort of women who were teenage mothers

Antecedentes: Las circunstancia desventajosas de las madres adolescentes tienden a repetirse, con consecuencias aún más graves en la vida de sus hijas, que suelen tener dificultades escolares y se embarazan a una edad incluso más temprana que sus propias madres. Objetivo: Examinar el patrón intergeneracional del embarazo adolescente en las hijas de una cohorte de mujeres que fueron madres adolescentes. Método: Estudio transversal medido en dos momentos, de una cohorte histórica de mujeres que controlaron su primer embarazo en un centro especializado en la atención de adolescentes embarazadas. La información de las madres se obtuvo en la primera entrevista que se aplicó al ingreso prenatal y la de las hijas fue obtenida cuando éstas eran adolescentes. Se analizaron las características de las madres y de las hijas que se embarazaron. Posteriormente se compararon las características entre las hijas que se embarazaron y aquellas que no. Resultados: En el 21 por ciento las hijas se embarazaron, aunque menor a lo que reporta la literatura, es igualmente preocupante porque un embarazo en la adolescencia altera en general la trayectoria estudiantil y el proyecto de vida de la adolescente. Las hijas repitieron consecuencias adversas, pero lograron tener éxito en la permanencia escolar y sus madres tuvieron menos hijos que las abuelas, como resultado positivo del programa. Conclusión: Programas de atención integral con profesionales entrenados en la atención de adolescentes embarazadas pueden tener un impacto positivo importante en la reducción de los patrones reproductivos intergeneracionales del embarazo adolescente...

Background: Disadvantaged circumstances of adolescent mothers tend to repeat, with even worse consequences in the lives of their daughters, who often have schooling difficulties and become pregnant at an even earlier age than their own mothers. Objective: To examine the intergenerational pattern of adolescent pregnancy in daughters of a cohort of women who were teenage mothers. Method: Cross-sectional study measured at two points in a historical cohort of women who attended their first pregnancy in a specialized center of pregnant adolescents. Mothers information was obtained in the first interview that was applied to the prenatal admission and daughters information was obtained when they were teenagers. The characteristics of the mothers and daughters who got pregnant are analyzed. We then compared the characteristics of the daughters who became pregnant and those not. Results: In 21 percent the daughters became pregnant, though lower then reported by literature, is also worrisome because a teenage pregnancy alters the overall student experience and life projects teenager. The daughters repeated adverse consequences, but managed to succeed in school retention and mothers had fewer children than their grandmothers, as a positive result of the program. Conclusion: Comprehensive care programs with trained professionals in the care of pregnant adolescents can have significant positive impact on reducing intergenerational reproductive patterns of teenage pregnancy...

Fenômeno lúcio. Relato de um caso exuberante com excelente resposta ao tratamento com poliquimioterapia multibacilar

O Fenômeno de Lúcio (FL) representa uma reação cutânea necrosante grave, que pode ocorrer na Hanseníase de Lúcio e em outras formas de Hanseníase Virchowiana. Manifesta-se 3-4 anos após o início da doença e é mais comum em pacientes não tratados ou recebendo dose inadequada de tratamento. Caracteriza-se por surtos de máculas eritematosas, ligeiramente infiltradas, que evoluem com necrose central e posterior ulceração. Sua fisiopatogenia é ainda desconhecida, porém é consenso que se trata fundamentalmente de um processo trombótico-oclusivo. Na histologia observa-se trombose de pequenos vasos da derme superior e média, resultando em ulceração da epiderme, infiltrado inflamatório com histiócitos espumosos, e numerosos bacilos, inclusive na parede dos vasos.

Evaluation of anaerobic biodegradability of wastewater from tebuconazole manufacturing.

This study aimed to verify the biological anaerobic treatability of tebuconazole effluent manufacturing. For this purpose, two preliminary batch tests were performed using an 'anaerobic respirometer' adjusting the initial pH of the effluent at 7.0 and 8.0, respectively (first phase). In addition, two tests (second phase) were run using sequential batch anaerobic fermenters, the first operated at different hydraulic detention times (10 and 16.7 days) and the second with different initial dilutions of the effluent (5 and 20%). The chemical oxygen demand (COD) removal observed on the anaerobic respirometer tests was in the range of 66-81%. According to the preliminary batch tests an optimal value of initial COD concentration and amount of biomass was identified, which was considered for the fermenters start up. However, it was observed that the optimal relation provided by the respirometer test was not a good parameter of operational control for the fermenters due to the accumulation of inhibitory substances, which affected the microbial activity and took the system to collapse. The initial dilution of the effluent (5 and 20%) was essential for the stability of the anaerobic system, allowing COD removals above 74% during this study.

Lack of correlation between sealer penetration into dentinal tubules and sealability in nonbonded root fillings.

AIM: To determine the correlation between leakage and sealer penetration into dentinal tubule. METHODOLOGY: The root canal of 60 mandibular central incisor teeth were prepared and filled under standardized conditions. Teeth were placed into a device to assess glucose penetration using 15 psi pressure application. After 1 h, glucose concentrations in the lower chamber were measured using an enzymatic reaction. Each specimen was then sectioned horizontally at 3, 6 and 8 mm from the apex, and a standard metallographic preparation was performed. The coronally facing surface of each slice was examined in a high-resolution stereomicroscope and under Confocal Laser Scanning Microscope. For each slice, the external outline of the root canal, the internal circumference of the root canal walls and the areas along the canal walls where the sealer had penetrated into the dentinal tubules (sealer tags) were outlined and measured. Afterwards, the percentage of the sealer penetration in each section was calculated. The Spearman correlation test was used to verify the correlation between the variables studied (glucose leakage and sealer penetration into dentinal tubules). RESULTS: The means and standard deviations of glucose leakage were 0.744 g L(-1) (±0.5), and the percentage of the dentinal tubule sealer penetration varied between teeth from 5.6% to 42.21%, with an average of 13.7 ± 17.2%. The Spearman correlation test revealed no significant correlation between the two factors analysed (P = 0.082). The r(2) value was equal to 0.12. CONCLUSIONS: There was no significant correlation between sealability sealer penetration into dentinal tubules. The lack of correlation reported is of relevance as sealer penetration into dentinal tubules has been used as an advantageous property during the launch of new root filling materials and techniques.

Modelling of epitaxial film growth with an Ehrlich-Schwoebel barrier dependent on the step height.

The formation of mounded surfaces in epitaxial growth is attributed to the presence of barriers against interlayer diffusion in the terrace edges, known as Ehrlich-Schwoebel (ES) barriers. We investigate a model for epitaxial growth using an ES barrier explicitly dependent on the step height. Our model has an intrinsic topological step barrier even in the absence of an explicit ES barrier. We show that mounded morphologies can be obtained even for a small barrier while a self-affine growth, consistent with the Villain-Lai-Das Sarma equation, is observed in the absence of an explicit step barrier. The mounded surfaces are described by a super-roughness dynamical scaling characterized by locally smooth (facetted) surfaces and a global roughness exponent α > 1. The thin film limit is featured by surfaces with self-assembled three-dimensional structures having an aspect ratio (height/width) that may increase or decrease with temperature depending on the strength of the step barrier.