Óbitos por neoplasia maligna do colo do útero registrados no SIH/SUS entre 2013 e 2022 / Deaths from Malignant Neoplasms of the Cervix Registered in the SIH/SUS between 2013 and 2022

O impacto que a neoplasia maligna do colo do útero tem na população mundial e em políticas públicas é notório. Vide a importância do assunto, o objetivo deste artigo é analisar o número de óbitos por neoplasia maligna do colo do útero segundo local de residência, local de internação e faixa etária, no período de 2013 a 2022 registrados no Sistema de Informações Hospitalares do SUS - SIH/SUS. Trata-se de um estudo descritivo transversal. A coleta de dados foi realizada em Sistemas de Informação hospedados no DATASUS/TABNET. Os resultados revelaram uma discrepância no número de óbitos nos estados brasileiros quando comparados o local de internação e o local de residência. A faixa etária com maior número de óbitos foi registrada dos 50 a 54 anos; tendo a pandemia da COVID-19 impactado na redução dos registros nos anos de 2020 e 2021. Conclui-se que a neoplasia maligna do colo do útero representa um desafio para a saúde pública no Brasil, com aumento do número de óbitos registrados ao longo dos anos, embora isso possa ser influenciado por fatores como densidade populacional e qualidade dos registros. Observou-se disparidade entre óbitos por internação e óbitos por residência entre estados, indicando a necessidade de estratégias específicas de prevenção e controle, além de análises mais abrangentes considerando outras fontes de informação e fatores contribuintes para essas diferenças.

The impact of malignant cervical neoplasms on the global population and public policies is notable. Given the importance of this issue, the objective of this article is to analyze the number of deaths from malignant cervical neoplasms by place of residence and place of hospitalization and age group during the period from 2013 to 2022, as recorded in the Hospital Information System of SUS (SIH/SUS). This is a descriptive cross-sectional study. Data collection was performed using Information Systems hosted on DATASUS/TABNET. The results revealed discrepancies in the number of deaths across Brazilian states when comparing the place of hospitalization and place of residence. The age group with the highest number of deaths was recorded from 50 to 54 years; the COVID-19 pandemic impacted the reduction in records in 2020 and 2021. It is concluded that malignant cervical neoplasm represents a challenge for public health in Brazil, with an increase in the number of deaths recorded over the years, although this may be influenced by factors such as population density and the quality of records. Disparities between deaths by hospitalization and deaths by residence among states were observed, indicating the need for specific prevention and control strategies, as well as more comprehensive analyses considering other sources of information and contributing factors to these differences.

O impacto do uso de métodos contraceptivos orais na função sexual de mulheres em idade reprodutiva / The impact of the use of oral contraceptive methods on the sexual function of women of reproductive age

Objetivo: Investigar o impacto dos contraceptivos orais hormonais na função sexual de mulheres. Métodos: Estudo transversal realizado por meio do questionário traduzido e validado "Índice da Função Sexual Feminina", capaz de estimar o risco de disfunção sexual feminina. Dados sociodemográficos, ginecológicos, medicamentosos e outros foram avaliados e correlacionados estatisticamente a esse escore, estimando possíveis causas da disfunção sexual, com destaque para o uso de anticoncepcional oral. O estudo foi baseado em uma amostragem por conveniência, incluindo mulheres > 18 anos em idade reprodutiva, de 04/01/2021 a 04/01/2022, obedecendo aos critérios de inclusão e exclusão. Resultados: Participaram deste estudo 105 mulheres com média e desvio-padrão de idade de 23,4 ± 3,8 anos, predominantemente heterossexuais (84,0%) e bissexuais (13,2%). A maioria delas (93,4%) utiliza métodos contraceptivos, sendo esses anticoncepcional oral (45,3%), DIU hormonal (19,8%) e camisinha (17,0%). A composição hormonal mais utilizada foi levonorgestrel (26,4%) e etinilestradiol (25,5%). Oitenta por cento das mulheres são sexualmente ativas, 69,3% delas têm parceria fixa, 42,5% tinham relações quase sempre e 33,0% referiam que as relações sexuais eram sempre satisfatórias. Houve boa adequação da amostra (0,865) e significância estatística (p < 0,0001). Utilizar ou não método contraceptivo apresentou diferença nos domínios desejo, satisfação e dor. Contudo, as questões do histórico sexual foram as que mais apresentaram relevância estatística em relação aos domínios. Conclusão: Apesar de outros estudos serem necessários para provar a hipótese de que os contraceptivos orais têm impacto negativo na função sexual feminina, é clara a importância de os profissionais de saúde já estarem cientes dessa possibilidade e saberem como abordá-la.

Objective: To investigate the impact of hormonal oral contraceptives on women's sexual function. Methods: Cross-sectional study carried out using the translated and validated questionnaire "Index of Female Sexual Function", capable of estimating the risk of female sexual dysfunction. Sociodemographic, gynecological, medication and other data were evaluated and statistically correlated to this score, estimating possible causes of sexual dysfunction, with emphasis on the use of oral contraceptives. The study was based on a convenience sample, including women > 18 years of reproductive age, from 01/04/2021 to 01/04/2022, following inclusion and exclusion criteria. Results: The study included 105 women with a mean and standard deviation of (23.4 ± 3.8) years old, predominantly heterosexual (84.0%) and bisexual (13.2%). Most of them (93.4%) use contraceptive methods, these being (45.3%) oral contraceptives, (19.8%) hormonal IUDs and (17.0%) condoms. The most used hormonal composition was levonorgestrel (26.4%) and ethinylestradiol (25.5%). Eighty percent of the women are sexually active, 69.3% of them have a steady partner, 42.5% almost always had sex and 33.0% said that sex was always satisfactory. There was good sample adequacy (0.865) and statistical significance (p < 0.0001). Using or not using a contraceptive method showed a difference in the desire, satisfaction and pain domains. However, sexual history questions were the ones that showed the most statistical relevance in relation to the domains. Conclusion: Although further studies are needed to prove the hypothesis that oral contraceptives have a negative impact on female sexual function, it is clear that health professionals are already aware of this possibility and know how to approach it.

Uncovering COVID-19 infection determinants in Portugal: towards an evidence-based spatial susceptibility index to support epidemiological containment policies.

BACKGROUND: COVID-19 caused the largest pandemic of the twenty-first century forcing the adoption of containment policies all over the world. Many studies on COVID-19 health determinants have been conducted, mainly using multivariate methods and geographic information systems (GIS), but few attempted to demonstrate how knowing social, economic, mobility, behavioural, and other spatial determinants and their effects can help to contain the disease. For example, in mainland Portugal, non-pharmacological interventions (NPI) were primarily dependent on epidemiological indicators and ignored the spatial variation of susceptibility to infection. METHODS: We present a data-driven GIS-multicriteria analysis to derive a spatial-based susceptibility index to COVID-19 infection in Portugal. The cumulative incidence over 14 days was used in a stepwise multiple linear regression as the target variable along potential determinants at the municipal scale. To infer the existence of thresholds in the relationships between determinants and incidence the most relevant factors were examined using a bivariate Bayesian change point analysis. The susceptibility index was mapped based on these thresholds using a weighted linear combination. RESULTS: Regression results support that COVID-19 spread in mainland Portugal had strong associations with factors related to socio-territorial specificities, namely sociodemographic, economic and mobility. Change point analysis revealed evidence of nonlinearity, and the susceptibility classes reflect spatial dependency. The spatial index of susceptibility to infection explains with accuracy previous and posterior infections. Assessing the NPI levels in relation to the susceptibility map points towards a disagreement between the severity of restrictions and the actual propensity for transmission, highlighting the need for more tailored interventions. CONCLUSIONS: This article argues that NPI to contain COVID-19 spread should consider the spatial variation of the susceptibility to infection. The findings highlight the importance of customising interventions to specific geographical contexts due to the uneven distribution of COVID-19 infection determinants. The methodology has the potential for replication at other geographical scales and regions to better understand the role of health determinants in explaining spatiotemporal patterns of diseases and promoting evidence-based public health policies.

Tradução e adaptação transcultural do questionário Congestion Quantifier Five-Item para o português brasileiro / Translation and cross-cultural adaptation of the Congestion Quantifier Five-Item questionnaire to Brazilian Portuguese

Introdução: A rinite alérgica (RA) é considerada a doença de maior prevalência entre as doenças respiratórias crônicas, e embora seja uma doença benigna, interfere na qualidade de vida dos indivíduos afetados, sendo a congestão nasal o sintoma mais incômodo relatado pelos pacientes. O questionário Congestion Quantifier Five-Item (CQ5), validado em inglês americano, foi desenvolvido para avaliar a gravidade e o impacto provocados pela congestão nasal em indivíduos adultos com RA. O presente estudo teve como objetivo traduzir e adaptar transculturalmente o questionário CQ5 para o português brasileiro e verificar se esta versão traduzida pode ser compreendida por indivíduos portadores de RA. Métodos: Seguindo as diretrizes da International Society for Pharmacoeconomics and Outcomes Research (ISPOR), o questionário CQ5 foi traduzido e adaptado para o português do Brasil. Esta versão em português foi aplicada em voluntários com rinite alérgica juntamente com um questionário de compreensão. Resultados: As etapas de preparação, tradução direta, reconciliação, retrotradução, revisão da retrotradução, harmonização, análise cognitiva da tradução, revisão dos resultados da análise cognitiva e finalização, revisão, e relatório final propostas pela ISPOR foram realizadas. A versão final foi aplicada em 41 voluntários (32,2 ± 7,8) com boa compreensão em todos os itens. Conclusão: O questionário CQ5 foi traduzido e adaptado para o português (Brasil) com boa compreensão em indivíduos com RA.

Background: Allergic rhinitis (AR) is considered the most prevalent disease among chronic respiratory diseases, although it is a benign disease, could impact the quality of life of affected individuals, with nasal congestion being the most bothersome symptom reported by patients. Congestion Quantifier Five-Item (CQ5) questionnaire was validated in American English, and was developed to assess the severity and the impact of nasal congestion in adults with AR. The present study aimed to translate and to perform a cross-cultural adaptation of the CQ5 questionnaire to Brazilian Portuguese and to verify if this translated version can be understood by individuals with AR. Methods: Following the guidelines of International Society for Pharmacoeconomics and Outcomes Research (ISPOR), CQ5 questionnaire was translated and adapted to Brazilian Portuguese. The Portuguese version was applied with a comprehension questionnaire to volunteers with allergic rhinitis. Results: These steps of: preparation; forward translation; reconciliation; back-translation; back-translation review; harmonization; cognitive debriefing; review cognitive debriefing results and finalization; proofreading; and final report proposed by ISPOR were carried out. The final version was applied in 41 volunteers (32,2 ± 7,8) with good understanding of all items. Conclusion: The CQ5 questionnaire was translated, and crossculturally adapted to Brazilian Portuguese with good understanding in individuals with AR.

Socio-Environmental Vulnerability Index: An Application to Rio de Janeiro-Brazil.

Objectives: The concept of vulnerability has been used more frequently in several studies, in an attempt to better understand the specificities and needs of different population groups, both in environmental and socio-economical terms. The aim of this study is to identify, characterize and analyze populations in situations of socio-environmental vulnerability in the city of Rio de Janeiro, based on social, economic, environmental and public health indicators organized into a summary index - the Socio-Environmental Vulnerability Index. Methods: The methodology integrated 15 indicators in a Multi-Criteria Decision Analysis into a Geographic Information System. Results: According to our results, socio-environmental vulnerability in Rio de Janeiro is aggravated by at-risk situations and environmental degradation. These aspects are jeopardized by the population density in slum areas, where the most disadvantaged groups live in a process of environmental and urban exclusion. Conclusion: The study concludes about the importance of these tools in guiding resource allocation and their contribution to formulating and implementing more effective public policies.

Patient safety culture in critical and non-critical areas: a comparative study.

OBJECTIVE: to compare the perception of patient safety culture among health workers from critical and non-critical areas. METHOD: cross-sectional study with health workers from critical and non-critical areas of a large hospital. Data collection used a characterization instrument and the Safety Attitudes Questionnaire. The analysis was performed in the Predictive Analytics Software Statistic®. RESULTS: a total of 393 workers participated, predominantly women, over 43 years old, nursing technicians, with a partner, and children. Results indicated that the areas have a negative perception of patient safety (66.5%, ±12.7 critical; 63.5%, ±14.4 non-critical). Only job satisfaction had a positive score (83.0%, ±15.9 critical; 80.1%, ±17.5 non-critical). There was a relationship between being a worker in critical areas and having a positive perception of the unit's management (p = 0.041). CONCLUSION: both areas have a negative perception of the safety culture. Although critical areas have obtained more positive evaluations, the results did not show statistical significance when compared to non-critical areas.

Accessibility to urgent and emergency care services in low-density territories: the case of Baixo Alentejo, Portugal.

Access to health care is a sensitive issue in low population density territories, as these areas tend to have a lower level of service provision. One dimension of access is accessibility. This paper focuses on measuring the accessibility to urgent and emergency care services in the Portuguese region of Baixo Alentejo, a territory characterized by low population density. Data for the calculation of accessibility is the road network, and the methodology considers the application of a two-level network analyst method: time-distance by own mean (car or taxi) to the urgent care services and the time distance to emergency services as a way to get assistance and to go to urgent care services. While urgent care accessibility meets the requirements stipulated in the Integrated Medical Emergency System's current legislative framework, the simulation of different scenarios of potential accessibility shows intra-regional disparities. Some territories have a low level of accessibility. Older adults, the poorly educated, and low-income population, also have the lowest levels of accessibility, which translates into dually disadvantageous situation since the potential users of emergency services are most likely to belong to this group of citizens.

Accessibility to urgent and emergency care services in low-density territories: the case of Baixo Alentejo, Portugal / Acessibilidade à rede de serviços de urgência em territórios de baixa densidade: o caso do Baixo Alentejo, Portugal

Abstract Access to health care is a sensitive issue in low population density territories, as these areas tend to have a lower level of service provision. One dimension of access is accessibility. This paper focuses on measuring the accessibility to urgent and emergency care services in the Portuguese region of Baixo Alentejo, a territory characterized by low population density. Data for the calculation of accessibility is the road network, and the methodology considers the application of a two-level network analyst method: time-distance by own mean (car or taxi) to the urgent care services and the time distance to emergency services as a way to get assistance and to go to urgent care services. While urgent care accessibility meets the requirements stipulated in the Integrated Medical Emergency System's current legislative framework, the simulation of different scenarios of potential accessibility shows intra-regional disparities. Some territories have a low level of accessibility. Older adults, the poorly educated, and low-income population, also have the lowest levels of accessibility, which translates into dually disadvantageous situation since the potential users of emergency services are most likely to belong to this group of citizens.

Resumo Em territórios de baixa densidade populacional, o acesso aos cuidados de saúde é uma questão delicada, pois essas áreas tendem a ter um nível mais baixo de prestação de serviços. Uma dimensão do acesso é a medição da acessibilidade. Este artigo tem como propósito medir a acessibilidade aos serviços de urgência e aos meios de emergência médica na região portuguesa do Baixo Alentejo, território caracterizado por uma baixa densidade populacional. A metodologia considera o método network analyst aplicado à rede viária, em dois níveis: o cálculo da distância-tempo aos serviços de urgência usando modo próprio (carro ou táxi); e o cálculo da distância-tempo recorrendo aos meios de socorro e emergência como forma de aceder aos serviços de urgência. Embora se considere que a acessibilidade às urgências atende ao atual quadro legislativo do Sistema Integrado de Emergência Médica, a simulação de diferentes cenários no Baixo Alentejo mostra a existência de disparidades intra-regionais no que se refere à acessibilidade aos serviços de urgência. Verifica-se que é a população idosa, de baixa instrução e residente em zonas com baixa densidade populacional quem apresenta menores índices de acessibilidade, o que traduz uma situação duplamente desvantajosa, uma vez que estes são os maiores utilizadores destes serviços.

From Livable Communities to Livable Metropolis: Challenges for Urban Mobility in Lisbon Metropolitan Area (Portugal).

Urban mobility plays an important role in addressing urban livability. The complexification and dispersion of travel due to the improvement of transport and the multiplication of our daily living places underline the relevance of multilevel territorial planning, recognizing that the knowledge of local differences is essential for more effective urban policies. This paper aims (1) to comprehend conceptually how urban mobility contributes to the urban livability from the local to metropolitan level and (2) to assess the previous relation toward a livable metropolis based on the readily available statistics for the Lisbon Metropolitan Area. Hence, a triangulation between conceptual, political/operative, and quantitative/monitoring approaches is required. The methodology follows four steps: (1) literature review focusing on the quantification of urban mobility within the urban livability approach; (2) data collection from the Portuguese statistics system; (3) data analysis and results, using principal component analysis (PCA) followed by cluster analysis (CA); (4) discussion and conclusions. In Portugal, although it is implicit, consistency is evident between the premises of recent urban mobility policies and respective planning instruments, such as the Sustainable Urban Mobility Plans (SUMP), and the premises of urban livability as an urban movement. Focusing on the national statistics system, the available indicators that meet our quality criteria are scarce and represent a reduced number of domains. Even so, they allow identifying intra-metropolitan differences in the Lisbon Metropolitan Area (LMA) that could support multilevel planning instruments. The results identified five principal components related to commuting at the local and intermunicipal level, including car use as well as social and environmental externalities, and they reorganized the 18 LMA municipalities into eight groups, clearly isolating Lisbon, the capital, from the others. The identification of sensitive territories and respective problems based on urban livability principles is fundamental for an effective urban planning from livable communities to livable metropolis.

Maximum phonation time in the pulmonary function assessment / Tempo máximo de fonação para avaliação da função pulmonar

ABSTRACT Purpose: to evaluate the reliability of the maximum phonation time (MPT) and Vital Capacity intra and inter-examiner, by means of the single-breath counting test (CT) and the sustained /a/ phoneme, and the slow vital capacity (SVC). Methods: a reliability study carried out in three groups of healthy individuals, each group with 30 volunteers, allocated according to age. SVC was measured using a spirometer, while the MPT was assessed by the phoneme /a/ and CT. The data were analyzed using SPSS version 20.0. Initially, descriptive statistics were used and for data reliability, the intraclass correlation coefficient (ICC). Results: the Intraclass Correlation Coefficients (ICC) were considered excellent, with significant results above 0.92 for SVC and greater than 0.79 for CT and phoneme /a/. Regarding the inter-examiner evaluation, the ICCs were also significant for both SVC with values greater than 0.96, and for CT and the phoneme /a/ with values greater than 0.85. The error inherent in the technique was assessed using the standard error of the measurement for intra and inter-examiner analyses with values ranging from 1.79 to 3.29 for phoneme /a/, 3.20 to 6.58 for CT and 65, 05 to 206.73 for SVCml. Conclusion: phonation techniques with the phoneme /a/ and CT, as well as SVC, have an excellent reliability, due to intra and inter-examiner agreement measures.

RESUMO Objetivo: avaliar a concordância do tempo máximo de fonação (TMF) com a Capacidade Vital, intra e interexaminador, por meio da técnica de contagem numérica em uma única respiração (TC) e do fonema /a/ sustentado e da capacidade vital lenta (CVL). Métodos: trata-se de um estudo de concordância realizado em três grupos de indivíduos saudáveis, cada grupo com 30 voluntários, alocados de acordo a idade. A CVL foi mensurada por meio do espirômetro, enquanto o TMF foi avaliado pela emissão do fonema/a/ e da TC. Os dados foram analisados pelo programa SPSS versão 20.0. Inicialmente utilizou-se estatística descritiva e para concordância dos dados foi utilizado o coeficiente de correlação intraclasse (CCI). Resultados: os Coeficientes de Correlação Intraclasse (CCI) intraexaminadores foram considerados excelentes, com resultados significantes acima de 0,92 para a CVL e maiores que 0.79 para a TC e fonema/a/. Em relação à avaliação interexaminadores, os CCIs também foram significantes tanto para a CVL com valores maiores que 0,96 quanto para a TC e o fonema/a/ com valores maiores que 0,85. O erro inerente a técnica foi avaliada por meio do erro padrão da medida para as analises intra e interexaminadores com valores que variaram de 1,79 a 3,29 para fonema/a/, 3,20 a 6,58 para TC e 65,05 a 206,73 para CVLml. Conclusão: as técnicas de fonação com o fonema /a/ e TC, assim como a CVL, demonstraram uma excelente concordância intra e interexaminadores.

Patient safety culture in critical and non-critical areas: a comparative study / Cultura de seguridad del paciente en áreas críticas y no críticas: estudio comparativo / Cultura de segurança do paciente em áreas críticas e não críticas: estudo comparativo

ABSTRACT Objective: to compare the perception of patient safety culture among health workers from critical and non-critical areas. Method: cross-sectional study with health workers from critical and non-critical areas of a large hospital. Data collection used a characterization instrument and the Safety Attitudes Questionnaire. The analysis was performed in the Predictive Analytics Software Statistic®. Results: a total of 393 workers participated, predominantly women, over 43 years old, nursing technicians, with a partner, and children. Results indicated that the areas have a negative perception of patient safety (66.5%, ±12.7 critical; 63.5%, ±14.4 non-critical). Only job satisfaction had a positive score (83.0%, ±15.9 critical; 80.1%, ±17.5 non-critical). There was a relationship between being a worker in critical areas and having a positive perception of the unit's management (p = 0.041). Conclusion: both areas have a negative perception of the safety culture. Although critical areas have obtained more positive evaluations, the results did not show statistical significance when compared to non-critical areas.

RESUMEN Objetivo: comparar la percepción de la cultura de seguridad del paciente entre trabajadores de salud de áreas críticas y no críticas. Método: estudio transversal con trabajadores de salud de las áreas críticas y no críticas de un hospital de gran porte. La recolección de datos utilizó instrumento de caracterización y el Safety Attitudes Questionnaire. El análisis ocurrió en el Predictive Analytics Software Statistic®. Resultados: participaron 393 trabajadores, entre los cuales predominaron mujeres, con más de 43 años, técnicas de enfermería, casadas y con hijos. Resultados indicaron que las áreas han tenido percepción negativa de la seguridad del paciente (66,5%, ±12,7 críticas; 63,5%, ±14,4 no críticas). Solamente la satisfacción en el trabajo obtuvo score positivo (83,0%, ±15,9 críticas; 80,1%, ±17,5 no críticas). Hubo relación entre el hecho de ser trabajador de áreas críticas y haber tenido percepción positiva para gerencia de la unidad (p = 0,041). Conclusión: las dos áreas poseen percepción negativa de la cultura de seguridad. Aunque áreas críticas obtuvieron evaluaciones más positivas, los resultados no presentaron significancia estadística cuando comparados a las áreas no críticas.

RESUMO Objetivo: comparar a percepção da cultura de segurança do paciente entre trabalhadores de saúde de áreas críticas e não críticas. Método: estudo transversal com trabalhadores de saúde das áreas críticas e não críticas de um hospital de grande porte. A coleta de dados utilizou instrumento de caracterização e o Safety Attitudes Questionnaire. A análise ocorreu no Predictive Analytics Software Statistic®. Resultados: participaram 393 trabalhadores, predominantemente mulheres, acima de 43 anos, técnicas de enfermagem, com companheiro e filhos. Resultados indicaram que as áreas têm percepção negativa da segurança do paciente (66,5%, ±12,7 críticas; 63,5%, ±14,4 não críticas). Somente a satisfação no trabalho obteve escore positivo (83,0%, ±15,9 críticas; 80,1%, ±17,5 não críticas). Houve relação entre ser trabalhador de áreas críticas e ter percepção positiva para gerência da unidade (p = 0,041). Conclusão: ambas as áreas têm percepção negativa da cultura de segurança. Embora áreas críticas tenham obtido avaliações mais positivas, os resultados não apresentaram significância estatística quando comparados às áreas não críticas.

Obesity is a risk factor for exercise-induced bronchospasm in asthmatic adolescents.

INTRODUCTION: Exercise-induced bronchospasm (EIB) is common in young asthmatics and obesity is becoming an epidemic in this population. Both conditions can give rise to or worsen respiratory symptoms upon exercise and may interfere with recreational and sports activities. OBJECTIVE: To investigate the association between obesity and the risk and severity of EIB in asthmatic children and adolescents. METHODS: This study included data from asthmatic patients aged between 7 and 19 years undergoing treadmill running tests to evaluate EIB, defined as a reduction greater than or equal to 10% in forced expiratory volume in the first second (FEV1 ) compared to baseline. Eutrophic, obese, and overweight individuals were categorized according to body mass index z-score (eutrophic, -0.5 < z ≤ 1; overweight, 1 < z < 2; and obese, z ≥ 2). RESULTS: Of the 156 individuals studied (42% female), 58% were eutrophic, 22% overweight, and 19% obese. Seventy-three individuals (47%) presented with EIB, with higher risk among obese (OR, 2.86; 95% CI, 1.00-8.14; P = .05). Asthma severity was another independent risk factor for EIB (OR, 2.95; 95% CI, 1.36-6.42; P = .006). The number of patients in whom FEV1 returned to baseline values (difference less than 10% from baseline) at the 13th minute after challenge was lower in obese individuals compared to eutrophic and overweight ones (P = .04). Baseline FEV1 , gender, or age were not found to be risk factors for EIB in any of the groups. CONCLUSION: Obese youngsters with asthma present a greater risk for EIB with slower recovery than their nonobese peers. Clinicians should be aware of this association, especially in those with more severe disease, for adequate recognition and treatment.

"Geografias" do acesso dos idosos aos cuidados de saúde primários na Área Metropolitana de Lisboa, Portugal - um território de diferenças / "Geographies" of primary healthcare access for older adults in the Lisbon Metropolitan Area, Portugal - a territory of differences

Resumo Vários autores têm refletido sobre a questão do acesso aos serviços de saúde, considerando a existência de várias dimensões, nas quais se inclui a disponibilidade e a acessibilidade. No contexto de envelhecimento que caracteriza as sociedades, a população idosa precisa de mais cuidados de saúde, e a acessibilidade a essas unidades assume importância acrescida. O objetivo do estudo é caracterizar o acesso da população idosa aos serviços de saúde, confrontando as possibilidades decorrentes da oferta de serviços com os padrões de procura. Do confronto entre oferta e procura resulta a possibilidade de identificar as dinâmicas intrarregionais e associá-las às diferentes condições socioeconômicas dos idosos, ao seu enquadramento familiar, modo de transporte e tipo de serviço. Esta abordagem considera duas fases metodológicas: o cálculo do potencial de cobertura populacional das unidades de cuidados primários, considerando a acessibilidade física recorrendo aos modos pedonal e rodoviário; e o confronto desses valores com a procura dos serviços, determinada a partir de inquéritos realizados aos residentes. Concluiu-se que, apesar dos equipamentos de saúde prestadores de cuidados primários terem sido programados como serviço de proximidade, a forma de prestação do serviço, as características socioeconômicas da população idosa e o modelo de urbanização apontam para diferenças relevantes no contexto da Área Metropolitana de Lisboa.

Abstract Several authors have reflected upon access to health services considering several dimensions, such as availability and accessibility. Due to the aging of societies, the older population's demands for healthcare increase, and accessibility to these units acquires special importance. Our study aims to characterize the access of older people to healthcare services, facing the possibilities arising from service supply and demand patters. From the supply and demand confrontation, comes the possibility of identifying intraregional dynamics and associating them with the various socioeconomic conditions of older people, family background, modes of transportation, and type of service. This approach considers two methodological phases: calculating the potential for primary healthcare coverage, considering physical accessibility for pedestrian and highway modes; and confronting these values with services demand, determined from surveys conducted with residents. We concluded that, although healthcare centers were designed as a proximity service, service provision, socioeconomic aspects, and the urbanization model entail meaningful inequalities of access in the context of the Lisbon Metropolitan Area.

Grape peel powder promotes intestinal barrier homeostasis in acute TNBS-colitis: A major role for dietary fiber and fiber-bound polyphenols.

Inflammatory bowel diseases are characterized by impaired intestinal barrier function. This study aimed to evaluate the effects of grape peel powder (GPP) and its bioactive rich-fractions on the barrier function and colonic injury in a model of colitis induced by 2,4,6 trinitrobenzene sulfonic acid (TNBS). Wistar rats received diets supplemented with either GPP (8%), extractable polyphenols (EP), non-extractable polyphenols-rich fraction (NEP-F), or polyphenols-poor, fiber-rich fraction (F) from grapes at amounts equivalent to the GPP group during 15 days before and for 7 days after colitis induction. NEP-F has decreased the extension of colonic lesion but the other grape peel bioactive fractions did not protect against macroscopic or microscopic colonic damage, EP diet increased macroscopic colonic damage. GPP, EP, and NEP-F reduced claudin-2 mRNA expression, whereas GPP and F fraction increased occludin and ZO-1 mRNA expression. All experimental diets reduced the colitis-triggered increase of MMP-9 mRNA expression. Colitis reduced by 30% the production of cecal short-chain fatty acids (SCFA). GPP and NEP-F completely protected against this effect, whereas F fraction was ineffective. Only GPP and NEP-F were able to decrease the upregulation of GRP94 mRNA triggered by colitis. Dietary fiber seems to reestablish the intestinal barrier function, whereas fiber-bound phenolics were able to restore cecal metabolism to produce beneficial metabolites like SCFA and to reduce the activation of the unfolded protein response.

Effect of herbicides in the oxidative stress in crop winter species.

Most herbicides applied in crop field, stay in the soil for a period, affecting next crop or even the plants using as green manure. Nowadays, the use of herbicides grow to increase productivity, mainly in the grain producing region north of Rio Grande do Sul state. The objective of this study was to evaluate the effects of herbicides fomesafen and sulfentrazone on antioxidant system in Avena sativa1, Vicia sativa2, Raphanus sativus and Lupinus albus. The plants were exposed to varying concentrations of fomesafen3 (0, 0.125, 0.25 and 0.5 kg ha -1) and sulfentrazone (0, 0.3, 0.6 and 1.2 kg ha-1). For this, the activities of, ascorbat peroxidase, catalase and guaiacol enzymes were analyzed, and the levels of MDA were quantificated. Fomesafen and sulfentrazone promoted alterations in balance of plants generating oxidative stress and elicited the response of the antioxidant system of plants, mainly in the high doses of fomesafen, for the species V. sativa and R. sativus. At the same time, the 1,2 kg ha -1 dose of sulfentrazone generated lipid peroxidation for V. sativa, R. sativus and L. albus. Additionally, A. sativa was the species that demonstrated low alterations on antioxidant system with the exposure to herbicide fomesafen and sulfentrazone. Thus, we can we can suggest that the species present a better response in defense of the oxidative stress generated by the herbicides.

Ilex paraguariensis: Potential antioxidant on aluminium toxicity, in an experimental model of Alzheimer's disease.

Ilex paraguariensis, yerba mate is a native plant from the southern region of Brazil. Studies showed that yerba mate has an antioxidant potential, which could help to reduce the risk of developing neurodegenerative diseases, as Alzheimer's Disease (AD). It's known that I. paraguariensis grows in acid soils with aluminium (Al), which is bioavailable in these soils. Al has a neurotoxic potential related with the progression of neurological disorders. This study aim was to evaluate the potential of I. paraguariensis in the etiology of AD using strains of Caenorhabditis elegans and the concentration of Al and antioxidants in the yerba mate extract. The results of the I. paraguariensis infusions made at 65°C and at 75° C show that there was no significant difference between both temperatures when preparing the tea infusion in relation to the presence of Al, methylxanthines, phenolic compounds and flavonoids. Additionally, in the case of Al, there was no difference between the extracts prepared at both temperatures. The behavioral parameters of C. elegans were altered after a long-term exposure to both factors: I. paraguariensis extract and Al. Through the antioxidant levels results along with the Al content on the Acetylcholinesterase (AChE) activity it is possible to observe that the acute and chronic exposure to Al and I. paraguariensis leaves extract are very similar to wild-type worms. Moreover, we can observe that the results in both the transgenic strains long-term exposed to I. paraguariensis leaves extract and to the Al concentrations presented an increase in the AChE activity.

Effect of high fat diets on the NTPDase, 5'-nucleotidase and acetylcholinesterase activities in the central nervous system.

High fat diets are associated with the promotion of neurological diseases, such as Alzheimer disease (AD). This study aim investigate the high fat diets role to promotion of AD using as biochemistry parameter of status of central nervous system through the NTPDase, 5'-nucleotidase and acetylcholinesterase (AChE) activities in brain of young rats. The intake of high fat diets promotes an inhibition of purinergic and cholinergic functions, mainly in the long-term exposure to saturated and saturated/unsaturated diets. The AChE activity was decreased to supernatant and synaptosomes tissues preparations obtained from cerebral cortex in average of 20%, to both groups exposed to saturated and saturated/unsaturated diets, when compared to the control group. Very similar results were found in hippocampus and cerebellum brain areas. At same time, the adenine nucleotides hydrolysis in synaptosomes of cerebral cortex were decreased to ATP, ADP and AMP after the long-term exposure to high fat diets, as saturated and saturated/unsaturated. The inhibition of ATP hydrolysis was of 26% and 39% to saturated and saturated/unsaturated diets, respectively. ADP hydrolysis was decreased in 20% to saturated diet, and AMP hydrolysis was decreased in 25% and 33% to saturated and saturated/unsaturated diets, respectively, all in comparison to the control. Thus, we can suggest that the effects of high diets on the purinergic and cholinergic nervous system may contribute to accelerate the progressive memory loss, to decline in language and other cognitive disruptions, such as AD patients presents.

Postharvest UV-C irradiation stimulates the non-enzymatic and enzymatic antioxidant system of 'Isabel' hybrid grapes (Vitis labrusca×Vitis vinifera L.).

Ultraviolet light type C (UV-C) was studied as a tool to increase enzymatic and non-enzymatic antioxidant defenses and phytochemical levels in 'Isabel' grapes (Vitis labrusca×Vitis vinifera L.). Grapes were exposed to 0, 0.5, 1.0, 2.0, or 4.0kJm-2 UV-C and stored for 1, 3, or 5days post-treatment. One day after UV-C irradiation, the activities of grape antioxidant enzymes and thiols were increased, especially at 1.0 and 2.0kJm-2. These doses increased total phenolic content by almost 20%, while 0.5 and 4.0kJm-2 had no effects. Total monomeric anthocyanin content was increased by >35% by UV-C at 1.0kJm-2; however, anthocyanin profile was unchanged. Grape skin antioxidant capacity was also improved by UV-C irradiation. The 1.0kJm-2 UV-C was considered the hormetic dose. Postharvest UV-C had an elicitor effect on 'Isabel' grapes, positively impacting the antioxidant capacity and phytochemical content.

[Socio-environmental vulnerability index: a methodological proposal based on the case of Rio de Janeiro, Brazil]. / Índice de vulnerabilidade socioambiental: uma proposta metodológica utilizando o caso do Rio de Janeiro, Brasil.

The term vulnerability has been more frequently used in several studies, striving to better understand the specificities and needs of different population groups. The scope of this study was to identify, characterize and analyze populations in situations of socio-environmental vulnerability in Rio de Janeiro city, consolidating social, economic, environmental, health and public security indicators in a synthesis index - the Socio-Environmental Vulnerability Index. The data sources used were the IBGE-2010 Demographic Census, the Geo-Rio Foundation and the Public Security Institute of the state of Rio de Janeiro. The methodology integrated Multicriteria Decision Analysis into a Geographic Information System. According to our results, the socio-environmental vulnerability in Rio de Janeiro city is aggravated by risk situations and environmental degradation. Those aspects are accentuated by the population density in shantytown areas, where the most disadvantaged strata exist in a process of environmental and urban exclusion. The study makes it possible to locate spatially vulnerable areas, emphasizing the importance of these tools to guide resource allocation, formulation and implementation of more effective public policies.

O termo vulnerabilidade tem sido utilizado com mais frequência, visando uma melhor compreensão acerca dos diferentes grupos populacionais, suas especificidades e necessidades. O objetivo deste estudo foi identificar, caracterizar e analisar populações em situação de vulnerabilidade socioambiental no município do Rio de Janeiro, consolidando indicadores sociais, econômicos, ambientais, de saúde e de segurança pública, em um índice de síntese - o Índice de Vulnerabilidade Socioambiental. A metodologia foi baseada em análise multicritério de apoio à decisão integrada a um Sistema de Informação Geográfica. As fontes de dados utilizadas foram o Censo Demográfico do IBGE-2010, Fundação Geo-Rio e Instituto de Segurança Pública do estado do Rio de Janeiro. Os resultados demonstram que a vulnerabilidade socioambiental no Rio de Janeiro é agravada por situações de risco e degradação ambiental. Estes aspectos são acentuados pelo adensamento das áreas faveladas, onde os estratos mais vulneráveis residem, em um processo de exclusão ambiental e urbana. O estudo permite localizar espacialmente áreas mais vulneráveis, enfatizando a importância destas ferramentas para guiar alocação de recursos, formulação e implementação de políticas públicas mais adequadas.

Índice de vulnerabilidade socioambiental: uma proposta metodológica utilizando o caso do Rio de Janeiro, Brasil / Socio-environmental vulnerability index: a methodological proposal based on the case of Rio de Janeiro, Brazil

Resumo O termo vulnerabilidade tem sido utilizado com mais frequência, visando uma melhor compreensão acerca dos diferentes grupos populacionais, suas especificidades e necessidades. O objetivo deste estudo foi identificar, caracterizar e analisar populações em situação de vulnerabilidade socioambiental no município do Rio de Janeiro, consolidando indicadores sociais, econômicos, ambientais, de saúde e de segurança pública, em um índice de síntese - o Índice de Vulnerabilidade Socioambiental. A metodologia foi baseada em análise multicritério de apoio à decisão integrada a um Sistema de Informação Geográfica. As fontes de dados utilizadas foram o Censo Demográfico do IBGE-2010, Fundação Geo-Rio e Instituto de Segurança Pública do estado do Rio de Janeiro. Os resultados demonstram que a vulnerabilidade socioambiental no Rio de Janeiro é agravada por situações de risco e degradação ambiental. Estes aspectos são acentuados pelo adensamento das áreas faveladas, onde os estratos mais vulneráveis residem, em um processo de exclusão ambiental e urbana. O estudo permite localizar espacialmente áreas mais vulneráveis, enfatizando a importância destas ferramentas para guiar alocação de recursos, formulação e implementação de políticas públicas mais adequadas.

Abstract The term vulnerability has been more frequently used in several studies, striving to better understand the specificities and needs of different population groups. The scope of this study was to identify, characterize and analyze populations in situations of socio-environmental vulnerability in Rio de Janeiro city, consolidating social, economic, environmental, health and public security indicators in a synthesis index - the Socio-Environmental Vulnerability Index. The data sources used were the IBGE-2010 Demographic Census, the Geo-Rio Foundation and the Public Security Institute of the state of Rio de Janeiro. The methodology integrated Multicriteria Decision Analysis into a Geographic Information System. According to our results, the socio-environmental vulnerability in Rio de Janeiro city is aggravated by risk situations and environmental degradation. Those aspects are accentuated by the population density in shantytown areas, where the most disadvantaged strata exist in a process of environmental and urban exclusion. The study makes it possible to locate spatially vulnerable areas, emphasizing the importance of these tools to guide resource allocation, formulation and implementation of more effective public policies.