Developing a Nomogram for Prioritizing Hysteroscopy in Endometrial Cancer Diagnosis: A Case-Control Study.

(1) Background: The pandemic led to significant healthcare disruptions, resulting in postponed surgeries and extended waiting times for non-urgent treatments, including hysteroscopies essential for diagnosing endometrial cancer. This study aims to formulate a risk stratification model to enhance the prioritization of hysteroscopy procedures in Brazil; (2) Methods: A case-control study was conducted at Vila Santa Catarina Hospital in São Paulo, analyzing the medical records of 2103 women who underwent hysteroscopy between March 2019 and March 2022. We used bivariate analysis and multivariate linear regression to identify risk factors associated with endometrial cancer and formulate a nomogram; (3) Results: The findings revealed a 5.5% incidence of pre-invasive and invasive endometrial disease in the study population, with an average waiting time of 120 days for hysteroscopy procedures. The main risk factors identified were hypertension, diabetes, postmenopausal bleeding, and obesity; (4) Conclusions: This research highlights the urgent need for efficient prioritization of hysteroscopy procedures in the wake of the pandemic. The developed nomogram is an innovative tool for identifying patients at higher risk of endometrial cancer, thus facilitating timely diagnosis and treatment and improving overall patient outcomes in a strained healthcare system.

Vaginal hysterectomy for the treatment of low-risk endometrial cancer: Surgical technique, costs, and perioperative and oncologic results.

OBJECTIVES: This study aimed to describe an operative technique for vaginal hysterectomy (VH) and assess the costs, perioperative, and oncological outcomes for this procedure when used in the treatment of patients with low-risk endometrial cancer (LREC). METHODS: A retrospective analysis of medical records was conducted on patients who underwent VH to treat precursor and invasive endometrial lesions between April 2019 and November 2021 at a single center in São Paulo, Brazil. RESULTS: Thirty-four patients met the inclusion criteria. The mean patient age was 61.9 years, and the mean body mass index (BMI) was 34. Obese patients (BMI ≥ 30) accounted for 77% of the sample. Preoperative functional capacity measures were Eastern Cooperative Oncology Group (ECOG) 0-1 and ECOG-2 for 91% and 9% of the patients, respectively. The mean operative time and length of hospital stay were 109 min and 1.2 days, respectively. Four patients had a conversion of the surgical route to laparotomy. No major intraoperative complications were observed. Patients who underwent surgical conversion had a greater uterine volume (227 versus 107 mL, p = 0.006) and longer operative time (177 versus 96 min, p = 0.001). The total cost associated with VH was, on average, US$ 2058.77 (R$ 10,925.91), representing 47% of the cost associated with non-vaginal routes. Twenty-eight patients received a definitive diagnosis of endometrial carcinoma; of these, three received adjuvant radiotherapy. The mean follow-up period was 34.6 months for the patients diagnosed with cancer. One case of disease recurrence occurred 16.6 months after surgery, with one death at 28.6 months of follow-up. CONCLUSIONS: These findings suggest that VH could be a feasible and cost-effective alternative for selected patients with LREC in low-resource settings.

Does sentinel node mapping impact morbidity and quality of life in endometrial cancer?

OBJECTIVES: To evaluate the prevalence of post-operative complications and quality of life (QoL) related to sentinel lymph node (SLN) biopsy vs systematic lymphadenectomy in endometrial cancer. METHODS: A prospective cohort included women with early-stage endometrial carcinoma who underwent lymph node staging, grouped as follows: SLN group (sentinel lymph node only) and SLN+LND group (sentinel lymph node biopsy with addition of systematic lymphadenectomy). The patients had at least 12 months of follow-up, and QoL was assessed by European Organization for Research and Treatment of Cervical Cancer Quality of Life Questionnaire 30 (EORTC-QLQ-C30) and EORTC-QLQ-Cx24. Lymphedema was also assessed by clinical evaluation and perimetry. RESULTS: 152 patients were included: 113 (74.3%) in the SLN group and 39 (25.7%) in the SLN+LND group. Intra-operative surgical complications occurred in 2 (1.3%) cases, and all belonged to SLN+LND group. Patients undergoing SLN+LND had higher overall complication rates than those undergoing SLN alone (33.3% vs 14.2%; p=0.011), even after adjusting for confound factors (OR=3.45, 95% CI 1.40 to 8.47; p=0.007). The SLN+LND group had longer surgical time (p=0.001) and need for admission to the intensive care unit (p=0.001). Moreover, the incidence of lymphocele was found in eight cases in the SLN+LND group (0 vs 20.5%; p<0.001). There were no differences in lymphedema rate after clinical evaluation and perimetry. However, the lymphedema score was highest when lymphedema was reported by clinical examination at 6 months (30.1 vs 7.8; p<0.001) and at 12 months (36.3 vs 6.0; p<0.001). Regarding the overall assessment of QoL, there was no difference between groups at 12 months of follow-up. CONCLUSIONS: There was a higher overall rate of complications for the group undergoing systematic lymphadenectomy, as well as higher rates of lymphocele and lymphedema according to the symptom score. No difference was found in overall QoL between SLN and SLN+LND groups.

Cadmium effects on the freshwater teleost Prochilodus lineatus: Accumulation and biochemical, genotoxic, and behavioural biomarkers.

In order to evaluate the effects of Cd, juveniles of the Neotropical fish Prochilodus lineatus were exposed to 1 and 10 µg L-1 Cd, for 24 and 96 h. Fish exposed to Cd showed metal accumulation in the gills, kidney, and liver, an increase in DNA damage in erythrocytes, and an increase in lipid peroxidation (LPO) in the kidney. Cd exposure also caused a reduction in catalase activity, metallothionein induction, and LPO in the liver. Cd stimulated the swimming activity of exposed fish, resulting in longer swimming times and distances travelled, especially for the shortest exposure time. Changes in acetylcholinesterase activity (AChE) in the muscle and brain are probably related to these behavioural responses. These results show that Cd affects the functioning of several organs in P. lineatus, which is indicated by the genotoxic damage and changes in the AChE and swimming pattern of the exposed fish.

Prepregnancy Obesity and Breastfeeding in the First Month of Life: A Birth Cohort.

Objective: This study aimed to investigate the association between prepregnancy obesity and disruption of exclusive breastfeeding (EBF) within the first month of life. Materials and Methods: This was a prospective cohort study conducted among Brazilian mothers and their babies born between February and December 2017. Research was conducted in all maternity hospitals in Vitória da Conquista, Brazil. Data collection started in the maternity hospitals of the city and, subsequently, an interview was conducted during a home visit on the 30th day of the child's life. Survival analysis was performed using Kaplan-Meier curves and a log rank test was applied to compare the curves. The association between independent variables and the response variable was assessed using Cox regression, following the conceptual model created for the study. Results: The study analyzed 329 pairs of mothers and babies. The prevalence of prepregnancy obesity was 12%. The prevalence of EBF disruption in the first month of life was 41.1% in nonobese mothers (confidence interval [95% CI]: 35.3-46.9) and 52.6% in obese mothers (95% CI: 36.3-68.4), with a shorter survival time among mothers with prepregnancy obesity (log rank p < 0.05). The risk of EBF disruption in the first month of life was 83% higher among mothers with prepregnancy obesity, after adjusting for confounding variables-demographic, socioeconomic, prenatal maternal data, and childbirth variables (hazard ratio = 1.84; 95% CI: 1.08-3.11). Conclusions: We observed an association between pregestational obesity and disruption of EBF in the first month of life. This finding reinforces the need for a thorough professional approach to the practice of breastfeeding in this population in the prenatal period as well as early puerperium.

Short-term outcomes after an enhanced recovery after surgery protocol in abdominal hysterectomies for leiomyomas in a teaching hospital.

OBJECTIVE: To compare the perioperative outcomes of patients undergoing abdominal hysterectomies for leiomyomas before and after the implementation of an enhanced recovery after surgery (ERAS) protocol in a teaching hospital. METHODS: This prospective cohort study compared a patient group from a historical series (pre-ERAS) with another group after ERAS implementation. Fasting time, length of hospital stay, complications, readmission rates, and procedure-related hospital costs were analyzed. RESULTS: Altogether, 187 patients were included in the analysis: 92 (49.2%) and 95 (50.8%) in the pre-ERAS and ERAS groups, respectively. Both groups had similar clinical characteristics. We observed reductions in surgical outcome findings: fasting time (13.9 to 6.7 h, P < 0.001), bladder catheter usage (21.1 to 10.9 h, P < 0.001), infection rates (20.7% to 5.3%, P = 0.002), length of stay (57.5 to 37.6 h), and 38.4% of the total estimated mean cost per procedure (USD $1570.8 to USD $967.2, P < 0.001) in the pre-ERAS and ERAS groups, respectively. Hospital readmission rates (P > 0.99) did not increase. CONCLUSION: ERAS protocol implementation for hysterectomies involving uterine leiomyomas reduced the length of hospital stay, surgical site infection rates, and hospital costs. A mean savings of USD $603.6 per procedure would allow 62.4% more hysterectomies to be performed.

Cervical Cancer-Related Knowledge, Attitudes, Practices and Self-Screening Acceptance Among Patients, Employees, and Social Media Followers of Major Brazilian Hospital.

BACKGROUND: Brazil has a high burden of cervical cancer, even though it is preventable, traceable and treatable. Hence, this study evaluated levels of knowledge, attitudes and practices (KAP) related to cervical cancer screening and diagnosis and acceptance of self-screening techniques among women aged 24 and greater. METHODS: A cross-sectional KAP survey was administered to n = 4206 women and spanned questions relating to cervical cancer, HPV, speculum, Pap test and colposcopy. Questionnaire was disseminated through a major hospital's social media platforms, intranet and gynecologic-oncology clinics. Logistic regressions evaluated associations between sociodemographic characteristics and knowledge, attitudes, and preventative behaviors against cervical cancer. Participants indicated willingness to try DNA-HPV self-sampling and cervix self-visualization (self-colposcopy). FINDINGS: Participants were mostly white individuals (70.5%) with higher education and from social classes A and B. They demonstrated superior levels of KAP than described in the literature, with over 57.8% having answered 80+% of questions correctly. KAP scores were predicted by social class, educational attainment, race, history of premalignant cervical lesions and geographic location. About 80% and 63% would be willing to try DNA-HPV self-sampling and cervix self-visualization, respectively. Interest in self-screening was associated with adequate attitude (OR = 1.85) and inadequate practice (OR = .83). INTERPRETATION: Adequate KAP are fundamental for the successful implementation of a self-screening program. Participants were interested in methods that provide them with greater autonomy, control and practicality. Self-screening could address barriers for under-screened women such as shame, discomfort, distance from clinics and competing commitments, enabling Brazil to reach the WHO's cervical cancer elimination goals. It could also decrease excess medical intervention in over-screened populations by promoting shared decision-making.

Time trends of physical activity for leisure and transportation in the Brazilian adult population: results from Vigitel, 2010-2019.

This time-series study examined a 10-year historical series of the physical activity prevalence for leisure and transportation in the Brazilian adult population. Information from 512,969 adults interviewed from the Vigitel between 2010 and 2019 was analyzed. Individuals who reported practicing at least 150 minutes/week of moderate-intensity physical activity or at least 75 minutes/week of vigorous-intensity physical activity were considered active during leisure time. Individuals who reported walking or cycling to/from work, course, or school at least 30 minutes/day, equivalent to at least 150 minutes/week of moderate-intensity physical activity, were considered active during transportation. The prevalence of physical activity for leisure and transportation was calculated annually and stratified by sex, age group, schooling, and race/skin color. The segmented regression model was applied to analyze the time series. Annual percent change and average annual percent change were calculated. Over time, the prevalence of physical activity for leisure increased, and the prevalence of physical activity for transportation decreased. The highest prevalence of physical activity for leisure was observed among males, young individuals, and those with high education. Older adults, those with high education, and white people presented the lowest prevalence of active transport. Policymakers should propose strategies that encourage and facilitate physical activity for leisure in women, individuals aged ≥ 35 years, and those with less education (< 12 years), and physical activity for transportation among older adults (≥ 60 years), those with high education (≥ 12 years), and white people.

[Introduction of ultra-processed foods and associated factors among children under six months of age in the Southwest of the state of Bahia, Brazil]. / Introdução de alimentos ultraprocessados e fatores associados em crianças menores de seis meses no sudoeste da Bahia, Brasil.

The scope of this study was to assess the prevalence and associated factors with the introduction of ultra-processed food (UPF) among children under six months of age living in the southwest of Bahia state. This is an excerpt from a prospective cohort study conducted with pairs of mothers/babies. The introduction of UPF was defined by the intake of at least one UPF before the age of six months. Socioeconomic, maternal, paternal, gestational, and child-related information was gathered by the application of questionnaires. To analyze the factors associated with the outcome, Poisson regression was performed according to a hierarchical model. P-value<0.05 and 95% confidence interval are considered. A total of 300 mother/baby pairs were evaluated. Before 6 months, 31.3% of children have already received UPF. With greater introduction of cookies/biscuits (23.3%) and yogurt (14.3%). The introduction of UPF before six months of age was higher among families with lower income (p=0.038), lower maternal education (p=0.031), lower maternal (p=0.017) and paternal (p=0.013) age, among children who had cow's milk <6 months (p<0.001) and tea <30 days (p=0.005). The results demonstrate the need for interventions aimed at reducing the introduction of UPF, especially for low-income families, with less education and among younger parents.

O objetivo do estudo foi avaliar a frequência e os fatores de risco para a introdução de alimentos ultraprocessados (AUP) em crianças menores de seis meses residentes em um município do sudoeste da Bahia. Trata-se de um recorte de um estudo coorte prospectiva realizado com duplas de mães/bebês. A introdução de AUP foi definida pela ingestão de pelo menos um AUP antes dos seis meses de vida. As informações socioeconômicas, maternas, paternas, gestacionais e relacionadas a criança foram obtidas por meio da aplicação de questionários. Para análise dos fatores associados ao desfecho foi realizada regressão de Poisson de acordo com um modelo hierárquico. Foram avaliadas 300 duplas de mães/bebês. Antes dos 6 meses, 31,3% das crianças já haviam recebido AUP. Houve maior frequência de introdução de bolacha/biscoito (23,3%) e petit suísse (14,3%). A introdução de AUP antes dos seis meses de vida foi maior entre famílias com menor renda (p=0,038), menor escolaridade materna (p=0,031), menor idade materna (p=0,017) e paterna (p=0,013), em criança que receberam leite de vaca antes dos 6 meses (p<0,001) e chá antes dos 30 dias (p=0,005). Os resultados demonstram a necessidade de intervenções voltadas para redução da introdução de AUP, principalmente para famílias de baixa renda, com menor grau de instrução e entre pais mais jovens.

Physicians' and nurses' perspective on chronic disease care practices in Primary Health Care in Brazil: a qualitative study.

BACKGROUND: Primary health care-oriented systems provide better healthcare, especially for chronic diseases. This study analyzed the perspectives of physicians and nurses performing care for patients with chronic diseases in Primary Health Care in a Brazilian city. METHODS: A qualitative study was conducted in Vitória da Conquista, Bahia, Brazil, using semi-structured interviews with five physicians and 18 nurses. The interview included questions from an analytical matrix based on three dimensions of healthcare practices: organizational, technical care, and biopsychosocial, following a deductive approach. The interviews were fully transcribed and analyzed using a thematic categorical approach. RESULTS: The results indicated that the provision of chronic care occurs in a comprehensive way. Potentialities were identified in the diversification of access, offer of care actions and technologies, integration of teamwork, and bringing together social networks to foster autonomy and self-care. Weaknesses were mostly related to the high number of people in the teams, follow-up of several cases, high turnover of support teams, low integration of Primary Health Care with other levels, difficulties in intersectoral articulation and family participation in care. CONCLUSION: The multidimensional assessment of health care practices aimed at individuals with chronic noncommunicable diseases was useful to portray the strengths and weaknesses of the services. It also ratifies the need to consider the importance of and investment in primary health care by offering the necessary technical, political, logistical and financial support to the units, to ensure the sustainability of the actions by nurses, doctors and entire team.

Introdução de alimentos ultraprocessados e fatores associados em crianças menores de seis meses no sudoeste da Bahia, Brasil / Introduction of ultra-processed foods and associated factors among children under six months of age in the Southwest of the state of Bahia, Brazil

Resumo O objetivo do estudo foi avaliar a frequência e os fatores de risco para a introdução de alimentos ultraprocessados (AUP) em crianças menores de seis meses residentes em um município do sudoeste da Bahia. Trata-se de um recorte de um estudo coorte prospectiva realizado com duplas de mães/bebês. A introdução de AUP foi definida pela ingestão de pelo menos um AUP antes dos seis meses de vida. As informações socioeconômicas, maternas, paternas, gestacionais e relacionadas a criança foram obtidas por meio da aplicação de questionários. Para análise dos fatores associados ao desfecho foi realizada regressão de Poisson de acordo com um modelo hierárquico. Foram avaliadas 300 duplas de mães/bebês. Antes dos 6 meses, 31,3% das crianças já haviam recebido AUP. Houve maior frequência de introdução de bolacha/biscoito (23,3%) e petit suísse (14,3%). A introdução de AUP antes dos seis meses de vida foi maior entre famílias com menor renda (p=0,038), menor escolaridade materna (p=0,031), menor idade materna (p=0,017) e paterna (p=0,013), em criança que receberam leite de vaca antes dos 6 meses (p<0,001) e chá antes dos 30 dias (p=0,005). Os resultados demonstram a necessidade de intervenções voltadas para redução da introdução de AUP, principalmente para famílias de baixa renda, com menor grau de instrução e entre pais mais jovens.

Abstract The scope of this study was to assess the prevalence and associated factors with the introduction of ultra-processed food (UPF) among children under six months of age living in the southwest of Bahia state. This is an excerpt from a prospective cohort study conducted with pairs of mothers/babies. The introduction of UPF was defined by the intake of at least one UPF before the age of six months. Socioeconomic, maternal, paternal, gestational, and child-related information was gathered by the application of questionnaires. To analyze the factors associated with the outcome, Poisson regression was performed according to a hierarchical model. P-value<0.05 and 95% confidence interval are considered. A total of 300 mother/baby pairs were evaluated. Before 6 months, 31.3% of children have already received UPF. With greater introduction of cookies/biscuits (23.3%) and yogurt (14.3%). The introduction of UPF before six months of age was higher among families with lower income (p=0.038), lower maternal education (p=0.031), lower maternal (p=0.017) and paternal (p=0.013) age, among children who had cow's milk <6 months (p<0.001) and tea <30 days (p=0.005). The results demonstrate the need for interventions aimed at reducing the introduction of UPF, especially for low-income families, with less education and among younger parents.

Can Lemna minor mitigate the effects of cadmium and nickel exposure in a Neotropical fish?

We aimed to evaluate if Lemna minor can mitigate the observed effects of cadmium (Cd) and nickel (Ni) exposure in Prochilodus lineatus. Fish were exposed for 96 h to 20 µg L-1 of Cd, 1.5 mg L-1 of Ni, or to a mixture of these two metals. In all tests, one group was exposed to the metals with duckweed on the water surface, and other group was exposed only to the metals, without plants. After each exposure, samples of P. lineatus tissues were collected to evaluate multiple biomarkers. Duckweed prevented bioaccumulation in some fish tissues and attenuated changes in acetylcholinesterase activity, increases in erythrocytic nuclear abnormality frequency, and hyperglycemia. However, the changes in plasma ion concentrations, reduction in activity of ion transport enzymes, and histological damage were not mitigated. Therefore, we concluded that L. minor partially attenuates the effects caused by Cd and Ni exposure.

Sentinel lymph node mapping versus sentinel lymph node mapping with systematic lymphadenectomy in endometrial cancer: an open-label, non-inferiority, randomized trial (ALICE trial).

BACKGROUND: Growing evidence suggest that sentinel lymph node (SLN) biopsy in endometrial cancer accurately detects lymph node metastasis. However, prospective randomized trials addressing the oncological outcomes of SLN biopsy in endometrial cancer without lymphadenectomy are lacking. PRIMARY OBJECTIVES: The present study aims to confirm that SLN biopsy without systematic node dissection does not negatively impact oncological outcomes. STUDY HYPOTHESIS: We hypothesized that there is no survival benefit in adding systematic lymphadenectomy to sentinel node mapping for endometrial cancer staging. Additionally, we aim to evaluate morbidity and impact in quality of life (QoL) after forgoing systematic lymphadenectomy. TRIAL DESIGN: This is a collaborative, multicenter, open-label, non-inferiority, randomized trial. After total hysterectomy, bilateral salpingo-oophorectomy and SLN biopsy, patients will be randomized (1:1) into: (a) no further lymph node dissection or (b) systematic pelvic and para-aortic lymphadenectomy. MAJOR INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria are patients with high-grade histologies (endometrioid G3, serous, clear cell, and carcinosarcoma), endometrioid G1 or G2 with imaging concerning for myometrial invasion of ≥50% or cervical invasion, clinically suitable to undergo systematic lymphadenectomy. PRIMARY ENDPOINTS: The primary objective is to compare 3-year disease-free survival and the secondary objectives are 5-year overall survival, morbidity, incidence of lower limb lymphedema, and QoL after SLN mapping ± systematic lymphadenectomy in high-intermediate and high-risk endometrial cancer. SAMPLE SIZE: 178 participants will be randomized in this study with an estimated date for completing accrual of December 2024 and presenting results in 2027. TRIAL REGISTRATION NUMBER: NCT03366051.

Assessment of stress and associated factors in employees of a public higher education institution.

Introduction: Occupational stress is considered as the negative imbalance between work demands and resources, and it can generate consequences to an individual's health and interfere with his or her quality of life. Objectives: To investigate stress and its associated factors among employees of a higher education institution through a cross-sectional study (at the baseline of a longitudinal study) including 176 individuals aged 18 years or older. Sociodemographic characteristics related to physical surroundings, lifestyle, working conditions, and health and illness were tested as explanatory variables. Methods: Stress was estimated using prevalence rate, prevalence ratio (PR), and a 95% confidence interval. For a multivariate analysis, we employed a Poisson regression model with robust variance, where a p-value ≤ 0.05 was considered significant. Results: The prevalence of stress was 22.7% (16.48-28.98). This study noticed that depressive individuals, professors, and those who self-assessed their health as poor or very poor had a positive association with stress within the studied population. Conclusions: Studies of this type are important for identifying characteristics in this population that could contribute to the planning of public policies in order to improve the quality of life of employees of public institutions.

Introdução: O estresse ocupacional é considerado como o desequilíbrio negativo entre demandas de emprego e recursos de trabalho, podendo gerar consequências à saúde e interferir na qualidade de vida dos indivíduos. Objetivos: Investigar o estresse e os fatores associados em funcionários de uma instituição de ensino superior, através de um estudo transversal (linha de base de um estudo longitudinal) composto por 176 indivíduos de 18 anos ou mais. Variáveis sociodemográficas relacionadas ao entorno físico, estilo de vida, condições de trabalho e saúde e doença foram testadas como explicativas. Métodos: Foi realizada uma estimativa do estresse através da prevalência, razão de prevalência e intervalo de confiança de 95%. Para a análise multivariada, foi adotada a regressão de Poisson com variância robusta, sendo o valor de p ≤ 0,05 adotado como significativo. Resultados: A prevalência de estresse foi de 22,7% (16,48-28,98). O trabalho constatou que indivíduos depressivos, do grupo de docentes e aqueles que autoavaliaram sua saúde como ruim ou muito ruim apresentaram associação positiva com o estresse na população estudada. Conclusões: Pesquisas como esta são importantes para identificar características nessa população que podem contribuir com o planejamento de políticas públicas para melhorar a qualidade de vida dos funcionários da instituição pública.

Acute Exposure to Biogenic Nanosilver Produced from Fusarium oxysporum in a Neotropical Fish.

Biogenic nanosilver (bNAg) has emerged as a potentially less toxic alternative to synthetic nanosilver. However, no studies have evaluated its effects on a fish species from the Neotropical region. Thus, our aim was to evaluate the effects of a bNAg on the Neotropical fish Prochilodus lineatus. For this purpose, after 24 h of exposure to 100 µg L-1 of bNAg, blood samples were collected to evaluate hematological, genotoxic, and plasma parameters. Gills and liver were sampled to evaluate biomarkers of oxidative stress and brain samples were used to assess neurotoxicity. The fish presented hyperglycemia, an increased number of erythrocytes, a reduction in antioxidant enzyme activity in both tissues evaluated, and a decrease in lipid peroxidation in the gills. We concluded that P. lineatus is a sensitive species to this nanoparticle, since it presented alterations in several biomarkers after an acute exposure.

Acute Response to Capsiate Supplementation at Rest and during Exercise on Energy Intake, Appetite, Metabolism, and Autonomic Function: A Randomized Trial.

OBJECTIVE: The purpose of the present study was to examine the effect of capsiate supplementation on energy intake, self-reported appetite-related sensations, energy expenditure, fat oxidation, and autonomic parameters with and without an exercise intervention. METHODS: Thirteen healthy men completed four randomized trials: two trials for the control condition (without exercise), one with capsiate supplementation (CTRLcap) and one with a placebo (CTRLpla), and two trials for the exercise condition, one with capsiate supplementation (EXcap) and one with placebo (EXpla). Exercise sessions were performed 150 min after the consumption of a standardized breakfast, and supplementation 115 min after consumption of breakfast. An ad libitum buffet was offered 200 min following the completion of the standardized breakfast, and energy intake (EI) and relative energy intake (REI) (relative energy intake = energy intake - energy expenditure related to exercise) were evaluated. RESULTS: There were no significant effects on EI, self-reported appetite sensations, fat oxidation, and energy expenditure. REI was reduced in conditions involving EX when compared to CTRL. A low-frequency to high-frequency ratio for heart rate variability was higher in CTRLcap (1.6 ± 1.1) vs. CTRLpla (1.2 ± 0.9) (p = 0.025; d = 0.39). CONCLUSION: Acute capsiate supplementation combined with aerobic exercise has limited effects on the examined variables (EI, REI, fat oxidation, energy expenditure, and autonomic parameters), while changes in the autonomic nervous system function in the absence of exercise may have occurred without influencing other variables. CLINICAL TRIAL REGISTRATION: ensaiosclinicos.gov.br number, RBR-5pckyr https://ensaiosclinicos.gov.br/rg/RBR-5pckyr.

Industry workers with hypertension and diabetes mellitus, the prevalence of self-reported adherence, and disease control

Abstract To evaluate the prevalence of self-reported drug adherence and factors associated, as well as clinical health outcomes, for industry workers with hypertension (HTN) and diabetes mellitus (DM). This was a cross-sectional study of 137 Brazilian industry workers with HTN and/ or DM. Self-reported adherence was assessed, and the disease control was defined through blood pressure and capillary glycemia values. Data were descriptively analyzed and the factors associated with adherence were evaluated using the Poisson model with robust variance to calculate prevalence ratios. The prevalence of self-reported drug adherence was 79.6% and the prevalence of disease control was 53.8%. There was no statistically significant association between the two variables. In the controlled disease group, non-adherence was associated with being under 40 years of age, not having a partner, and having a risky alcohol consumption habit. In the uncontrolled disease group, adherence was highest for participants aged 40 years and older. The prevalence of self-reported drug adherence was high, but the prevalence of disease control was low and not associated with adherence, indicating that the self-reported adherence measure may be inaccurate. Our findings identify some factors that explain non-adherent behavior in the workforce.

Time trends of physical activity for leisure and transportation in the Brazilian adult population: results from Vigitel, 2010-2019 / Tendências temporais da atividade física para lazer e transporte na população adulta brasileira: resultados do Vigitel, 2010-2019 / Tendencias temporales de la actividad física para el ocio y el transporte en la población adulta brasileña: resultados del Vigitel, 2010-2019

This time-series study examined a 10-year historical series of the physical activity prevalence for leisure and transportation in the Brazilian adult population. Information from 512,969 adults interviewed from the Vigitel between 2010 and 2019 was analyzed. Individuals who reported practicing at least 150 minutes/week of moderate-intensity physical activity or at least 75 minutes/week of vigorous-intensity physical activity were considered active during leisure time. Individuals who reported walking or cycling to/from work, course, or school at least 30 minutes/day, equivalent to at least 150 minutes/week of moderate-intensity physical activity, were considered active during transportation. The prevalence of physical activity for leisure and transportation was calculated annually and stratified by sex, age group, schooling, and race/skin color. The segmented regression model was applied to analyze the time series. Annual percent change and average annual percent change were calculated. Over time, the prevalence of physical activity for leisure increased, and the prevalence of physical activity for transportation decreased. The highest prevalence of physical activity for leisure was observed among males, young individuals, and those with high education. Older adults, those with high education, and white people presented the lowest prevalence of active transport. Policymakers should propose strategies that encourage and facilitate physical activity for leisure in women, individuals aged ≥ 35 years, and those with less education (< 12 years), and physical activity for transportation among older adults (≥ 60 years), those with high education (≥ 12 years), and white people.

Este estudo de série temporal analisou a prevalência de atividade física para lazer e transporte na população adulta brasileira em uma série histórica de uma década. Foram analisadas informações de 512.969 adultos entrevistados pelo Vigitel entre 2010 e 2019. Os indivíduos que relataram praticar pelo menos 150 minutos/semana de atividade física moderada ou pelo menos 75 minutos/semana de atividade física vigorosa foram considerados ativos durante seu lazer. Os indivíduos que relataram caminhar ou andar de bicicleta para/do trabalho, curso ou escola por pelo menos 30 minutos/dia (equivalente a pelo menos 150 minutos/semana de atividade física moderada) foram considerados ativos durante seu transporte. A prevalência de atividade física para lazer e transporte foi calculada anualmente e estratificada por sexo, faixa etária, escolaridade e cor da pele/raça. Modelo de regressão segmentada foi aplicado para analisar a série temporal. Foram calculadas as mudanças percentuais anuais e as mudanças médias anuais. Com o tempo, a prevalência de atividade física para o lazer aumentou e a prevalência de atividade física para o transporte diminuiu. A maior prevalência de atividade física para lazer foi observada entre homens, jovens e pessoas com Ensino Médio completo. Idosos, pessoas com Ensino Médio e brancos apresentaram a menor prevalência de transporte ativo. Formuladores de políticas devem propor estratégias que incentivem e facilitem a atividade física para o lazer em mulheres, indivíduos com idade ≥ 35 anos e pessoas com baixa escolaridade (< 12 anos), e atividade física para transporte entre idosos (≥ 60 anos), aqueles com Ensino Médio completo (≥ 12 anos) e pessoas brancas.

Este estudio de serie temporal analizó la prevalencia de la actividad física para el ocio y el transporte en la población adulta brasileña en una serie histórica de una década. Se analizaron las informaciones de 512.969 adultos, entrevistados por Vigitel entre 2010 y 2019. Las personas que informaron practicar al menos 150 minutos/semana de actividad física moderada o al menos 75 minutos/semana de actividad física vigorosa se consideraron activas durante su tiempo libre. Las personas que informaron caminar o andar en bicicleta al/desde el trabajo, curso o escuela por al menos 30 minutos/día (equivalente al menos a 150 minutos/semana de actividad física moderada) se consideraron activas durante su transporte. La prevalencia de la actividad física para el ocio y el transporte se calculó anualmente y se estratificó por sexo, grupo de edad, escolaridad y color de piel/raza. Se aplicó un modelo de regresión segmentada para analizar la serie temporal. Se calcularon las variaciones porcentuales anuales y las variaciones porcentuales medias anuales. Con el paso del tiempo, la prevalencia de la actividad física para el ocio tuvo un aumento y una reducción para el transporte. La mayor prevalencia de actividad física para el ocio se observó entre hombres, jóvenes y personas con educación secundaria. Los ancianos, las personas con educación secundaria y los blancos tuvieron una prevalencia más baja en el transporte activo. Los formuladores de políticas deben proponer estrategias de fomento a la actividad física para el ocio en mujeres, personas ≥ 35 años y personas con baja escolaridad (< 12 años), y la actividad física para el transporte entre los ancianos (≥ 60 años), aquellos con educación secundaria (≥ 12 años) y personas blancas.

[Periodic occupational examination: an opportunity for diagnosis and monitoring of chronic noncommunicable diseases in men]. / Exame ocupacional periódico: oportunidade de diagnóstico e monitoramento de doença crônica não transmissível em homens.

The study aimed to estimate the prevalence of arterial hypertension as the principal marker of chronic noncommunicable diseases (NCDs) and to identify associated modifiable factors in male workers. Baseline data were used from a longitudinal study with a sample of 1,024 male workers 18 years or older in a municipality in Northeast Brazil. The marker for NCDs was arterial hypertension, defined as systolic pressure ≥ 140mmHg and/or diastolic pressure ≥ 90mmHg and/or prior diagnosis of arterial hypertension and/or use of antihypertensive medication. Poisson regression with robust variance was used, adopting hierarchical entry of variables. Population attributable fractions (PAFs) were calculated for the lifestyle variables to measure the impact of modifiable factors on workers' health. Prevalence of hypertension was 28.6% (95%CI: 25.9-31.5). Distal factors associated with hypertension were age > 40 years, black skin color, and family income ≥ 3 times the monthly minimum wage. Intermediate factors were alcohol abuse, smoking, high self-rated salt intake, and physical inactivity. Proximal factors were overweight and obesity. Calculation of PAFs showed that a reduction or elimination of unhealthy lifestyle habits and behaviors in this population group would reduce the prevalence of the target NCD, hypertension, by 56.1%. The identification of modifiable factors and the ways they can negatively impact male workers' health allows planning interventions in the workplace itself to reach the largest number of individuals, aimed at reducing the harmful effects of NCDs.

Objetivou-se estimar a prevalência de hipertensão arterial, como principal marcador de doença crônica não transmissível (DCNT), e identificar os fatores modificáveis associados, em trabalhadores homens. Foram utilizados dados da linha de base de um estudo longitudinal com uma amostra de 1.024 trabalhadores homens com 18 anos ou mais de um município do Nordeste do Brasil. O marcador de DCNT foi a hipertensão arterial, definida por pressão arterial sistólica ≥ 140mmHg e/ou pressão arterial diastólica ≥ 90mmHg e/ou diagnóstico prévio de hipertensão arterial e/ou uso de medicamentos anti-hipertensivos. Empregou-se a regressão de Poisson com variância robusta, adotando a entrada hierárquica de variáveis. Foram calculadas frações atribuíveis populacionais (FAP) para as variáveis de estilo de vida, a fim de dimensionar o impacto dos fatores modificáveis na saúde dos trabalhadores. A prevalência da hipertensão arterial nesta população foi de 28,6% (IC95%: 25,9-31,5), os fatores distais: idade > 40 anos, cor da pele preta e renda familiar ≥ 3 salários mínimos; fatores intermediários: consumo abusivo de álcool, consumo de tabaco, percepção de um consumo elevado de sal e inatividade física e o fator proximal: sobrepeso e obesidade associaram-se positivamente com a hipertensão arterial. O cálculo da FAP permitiu observar que se ocorresse a redução ou eliminação de hábitos e comportamentos relacionados ao estilo de vida deste público, reduziria em 56,1% a prevalência da DCNT estudada. A identificação de fatores modificáveis e como estes podem interferir negativamente na saúde de trabalhadores homens possibilita o planejamento de intervenções no próprio local de trabalho, a fim de alcançar o maior número de indivíduos, visando reduzir os efeitos deletérios das DCNT.

El objetivo fue estimar la prevalencia de hipertensão arterial, como principal marcador de enfermedad crónica no transmisible (ECNT), así como identificar factores modificables asociados, en hombres trabajadores. Se utilizaron datos de la línea de base, procedentes de un estudio longitudinal, con una muestra de 1.024 hombres trabajadores con 18 años o más de un municipio del Nordeste de Brasil. El marcador de ECNT fue la hipertensão arterial, definida por presión arterial sistólica ≥ 140mmHg y/o presión arterial diastólica ≥ 90mmHg y/o diagnóstico previo de hipertensão arterial y/o uso de medicamentos antihipertensivos. Se empleó la regresión de Poisson con varianza robusta, adoptando la entrada jerárquica de variables. Se calcularon fracciones atribuibles poblacionales (FAP) en las variables de estilo de vida, a fin de dimensionar el impacto de los factores modificables en la salud de los trabajadores. La prevalencia de la hipertensão arterial en esta población fue de 28,6% (IC95%: 25,9-31,5), los factores distales: edad > 40 años, color de piel negra y renta familiar ≥ 3 salarios mínimos; factores intermedios: consumo abusivo de alcohol, consumo de tabaco, percepción de un consumo elevado de sal e inactividad física y el factor proximal: sobrepeso y obesidad se asociaron positivamente con la hipertensão arterial. El cálculo de la FAP permitió observar que, si se produjese una reducción o eliminación de hábitos y comportamientos relacionados con el estilo de vida de este público, se reduciría en un 56,1% la prevalencia de la ECNT estudiada. La identificación de factores modificables y cómo pueden interferir negativamente en la salud de hombres trabajadores posibilita la planificación de intervenciones en el propio lugar de trabajo, con el fin de alcanzar al mayor número de individuos para reducir los efectos mortíferos de las ECNT.

Quality of Actions to Control Cervical Cancer in Bahia, Brazil.

OBJECTIVE: To assess the quality of the actions to control cervical cancer (CC) and its correlates. METHODS: This is a cross-sectional study conducted from January to March 2019 in 19 municipalities in Bahia, Brazil, with a sample of 241 doctors and nurses from primary health care (PHC). Three dependent variables were chosen- "Performance of educational, promotion, prevention, and monitoring actions" (D1); "Access to diagnostic tests" (D2); "Non-occurrence of high grade cervical squamous intraepithelial lesions (HSIL)" (D3). Poisson regression with robust variance was used, adopting hierarchical input variables to estimate the prevalence ratios and confidence intervals of 95%. RESULTS: The following prevalence rates were found: D1  39.8% (95% CI: 33.8-46.2); D2  73.9% (95% CI: 67.9-79.1); and D3  46.4% (95% CI: 39.9-53.0). These dimensions remained associated with the dependent variables: D1- having professional training courses on the topic; consideration to ensure that collection takes place appropriately by a professional; and women having access to medical transport; D2- nurses treating low-grade lesions; D3- recording the Papanicolaou in electronic medical records; D1 and D2- professionals joining the service through public tender; D1 and D3- working in the PHC (≥ 2 years); D2 and D3- recording Papanicolaou in physical records; and performance of Papanicolaou by residents. CONCLUSION: Better trained professionals and professionals working in stable work arrangements are associated with comprehensive actions to control CC. Such strategies indicate that investments in work management result in a more organized PHC and more solution-centered work processes. Therefore, working in the PHC for a longer time and nurses performing more clinical actions (collection and treatment) are favored by such organizational actions. Investments in diagnostic support contribute to perceptions of more comprehensive actions to control CC. 
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