Feline leishmaniasis in an animal shelter in northeastern Brazil: Clinical aspects, coinfections, molecular detection, and serological study of a new recombinant protein.

Infection and clinical cases of leishmaniasis caused by Leishmania infantum in cats have been increasingly reported in several countries, including Brazil. In this study, we used an enzyme-linked immunosorbent assay (ELISA) and an immunochromatographic test (ICT) based on a recombinant antigen (rKDDR-plus) to detect anti-Leishmania antibodies in cats from an animal shelter in northeastern Brazil. We compared the results with an ELISA using L. infantum crude antigen (ELISA-CA). We also investigated the presence of Leishmania DNA in blood or ocular conjunctival samples as well as the association between Leishmania PCR positivity and serological positivity to feline immunodeficiency virus (FIV), feline leukemia virus (FeLV) and Toxoplasma gondii. Concerning serological assays, a higher positivity was detected using the ICT-rKDDR-plus (7.5%; 7/93) as compared to ELISA-rKDDR-plus (5.4%; 5/93) and ELISA-CA (4.3%; 4/93). Upon PCR testing, 52.7% (49/93) of the ocular conjunctival swabs and 48.3% (44/91) of the blood samples were positive. Together, PCR and serological testing revealed overall positivities of 73.1% (68/93) and 12.9% (12/93), respectively. Among PCR-positive samples, 45.5% (31/68) showed co-infection with FIV, 17.6% (12/68) with FeLV, and 82.3% (56/68) with T. gondii. More than half of the PCR-positive cats showed at least one clinical sign suggestive of leishmaniasis (58.8%; 40/68) and dermatological signs were the most frequent ones (45.5%; 31/68). Both tests employing the recombinant antigen rKDDR-plus (i.e., ICT-rKDDR-plus and ELISA-rKDDR-plus) detected more positive cats than the ELISA-CA but presented low overall accuracy. PCR testing using either blood or ocular conjunctival samples detected much more positive cats than serological tests.

Scorpion envenomation in Brazil and its relationship with the social determinants of health: A population-based ecological study.

This study comprehensively analyzed cases of scorpion envenomation in Brazil, exploring the temporal trends and geographic patterns of such incidents between January 1, 2012, and December 31, 2022. Simultaneously, we assessed the correlation between scorpion envenomation and social determinants of health and social vulnerability. We conducted a population-based ecological study, gathering information on the number of scorpion envenomation cases in Brazil, as well as socioeconomic data and social vulnerability indicators across the 5,570 Brazilian municipalities. The season-trend model, based on the classical additive decomposition method, informed estimations of scorpion envenomation variations over time. The spatial correlation of scorpion envenomation with socioeconomic and vulnerability indicators was assessed using the Bivariate Moran's I. A total of 1,343,224 cases of scorpion envenomation were recorded in Brazil from Jan 2012 to Dec 2022. A single increasing time trend was observed for the entire country for this period (APC 8.94, P < 0.001). The seasonal analysis was significant for Brazil as a whole and all regions (p < 0.001), with peaks evident between October and November. The spatial distribution of cases was heterogeneous, with spatial clusters concentrated in the high-risk Southeast and Northeast regions. There was a high incidence of scorpion envenomation in municipalities facing social vulnerability, and, paradoxically, in those with better sanitation and waste collection. Our study revealed a heterogeneous geographical distribution of scorpion accidents in Brazil. Municipalities with higher social vulnerability exhibited a high incidence of scorpion envenomation.

Sporothrix brasiliensis Infection Modulates Antimicrobial Peptides and Stress Management Gene Expression in the Invertebrate Biomodel Galleria mellonella.

Sporothrix brasiliensis is the most pathogenic species, responsible for the Brazilian cat-transmitted sporotrichosis hyperendemic. In this scenario, an investigation of the pathogen-host interaction can provide relevant information for future treatment strategies. To this end, the invertebrate Galleria mellonella has proven to be a suitable alternative for evaluating the virulence of pathogenic fungi, since the insect immune system is similar to the mammalian innate immune response. The aim of this work was to investigate phenotypic and molecular aspects of the immune response of G. mellonella throughout the S. brasiliensis infection. Hemocyte density and the evolution of the fungal load were evaluated. In parallel, RT-qPCR expression analysis of genes encoding antimicrobial peptides (Gallerimycin and Galiomycin) and stress management genes (C7 Contig 15362 and C8 Contig 19101) was conducted. The fungal load and hemocyte densities increased simultaneously and proportionally to the deleterious morphological events and larvae mortality. Gallerimycin, C7 Contig 15362 and C8 Contig 19101 genes were positively regulated (p < 0.05) at distinct moments of S. brasiliensis infection, characterizing a time-dependent and alternately modulated profile. Galiomycin gene expression remained unchanged. Our results contribute to the future proposal of potential alternative pathways for treating and consequently controlling S. brasiliensis zoonosis, a major public health issue in Latin America.

Accuracy Study of Kato-Katz and Helmintex Methods for Diagnosis of Schistosomiasis Mansoni in a Moderate Endemicity Area in Sergipe, Northeastern Brazil.

Schistosomiasis is a neglected tropical disease (NTD) caused by blood flukes from the genus Schistosoma. Brazil hosts the main endemic area in the Americas, where Schistosoma mansoni is the only species causing the disease. Kato-Katz (KK) thick smear is the WHO recommended screening test for populational studies, but there is growing evidence for the sensitivity limitations associated with KK, especially in areas with low parasite loads. Helmintex (HTX) is another highly sensitive egg-detection method, based on the magnetic properties of S. mansoni eggs and their isolation in a magnetic field. The objective of this study is to evaluate both KK and HTX in a moderate endemic locality, Areia Branca, located in the municipality of Pacatuba, in the state of Sergipe in northeastern Brazil. From 234 individual fecal samples, two KK thick smears were prepared and evaluated for each sample. Similarly, 30 g of each fecal sample was processed by HTX protocol. Eggs were detected in 80 (34.18%) residents. Twenty-three (9.83%) samples were positive for eggs (only by KK), and 77 (32.91%) samples showed positive for eggs (only by HTX). Sensitivity, specificity, and accuracy estimates gave values of 28.75%, 100% and 75.64%, respectively, for KK, and 96.25%, 100% and 98.72% respectively, for HTX. The positive predictive value was 100% for both methods, while the negative predictive value was 72.99% for KK and 98.09% for HTX. Overall, HTX presented a superior performance compared to the one sample, two slides KK examination. The study confirms the role of HTX as a reference method for the definition of true-positive samples in comparative accuracy studies and its potential role in the late stages when the certification of schistosomiasis transmission interruption is required. Diagnostic tests are important tools for the elimination of this NTD, besides the effective implementation of safe water, basic sanitation, snail control, and the treatment of infected populations.

Knowledge, Attitude and Practices towards the Prevention of Schistosomiasis Mansoni in an Endemic Area of Alagoas, Northeast Brazil.

We analyzed the knowledge, attitudes and practices (KAP) of schistosomiasis mansoni prevention in an endemic area of Brazil. This cross-sectional study was conducted between March and May 2021, with 412 participants living in the municipality of Feira Grande, Alagoas, Brazil. Data collection occurred through visits to the Health Center Urbano II and Massapê, through an interview with a structured questionnaire to identify the levels of KAP regarding schistosomiasis prevention. Of all respondents, 70.87% lived in rural areas, 22.66% reported a history of past schistosomiasis and 52.71% never participated in schistosomiasis control program actions. Factors associated with better KAP scores were being part of an older age group, not using rainwater and having no history of past schistosomiasis. Specifically, among the domains, attitude was the highest score and knowledge was the lowest. Participation in a health intervention program, knowing someone who had schistosomiasis and having been informed through a public health program seemed to have an important impact on the population's KAP. Our results contributed to broadening perceptions about schistosomiasis prevention, highlighting the positive impacts that health programs and interventions have on disease control.

Exame do pé diabético: fatores de risco de ulceração em pacientes com diabetes mellitus / Examen del pie diabético: factores de riesgo de ulceración en pacientes con diabetes mellitus / Diabetic foot exam: risk factors of ulceration in patients with diabetes mellitus

Objetivo: descrever a evolução dos fatores de risco para o desenvolvimento de úlceras nos pés de pacientes com DM, em três exames subsequentes num período de 3 anos, num centro de especialidades médicas. Método: estudo descritivo, retrospectivo e longitudinal, com 102 pacientes, entre os anos de 2016 e 2019, que realizaram três exames dos pés sequenciais, fundamentado no padrão estabelecido pelo consenso internacional do pé diabético, sendo eles avaliação neuropática, vascular, dermatológica e uso dos calçados, coletado do Sistema do Pé Diabético. Resultados: 86,27% dos pacientes declararam sintomas neuropáticos, principalmente queimação, dormência e formigamento. A maioria hipertensos (74,71%) e idosos (67,65%), desses 13,73% com infarto prévio e 72,55% eram do sexo feminino. Do primeiro ao terceiro exame, o "risco muito baixo" aumentou 7,84% e "risco baixo" 8,83%, já o "risco elevado" reduziu 17,65%. Conclusão: a realização sistemática do exame clínico dos pés, associado a estratégias educativas efetivas, resultam num controle mais eficaz do risco de ulceração.

Objetivo: Describir la evolución de los factores de riesgo para el desarrollo de úlceras en los pies de pacientes con DM, en tres exámenes subsecuentes en un período de 3 años, en un centro de especialidades médicas. Método: estudio descriptivo, retrospectivo y longitudinal, con 102 pacientes, entre los años 2016 y 2019, que realizaron tres exámenes de los pies secuenciales, fundamentado en el patrón establecido por el consenso internacional del pie diabético, siendo ellos evaluación neuropática, vascular, dermatológica y uso de calzado, recogido del Sistema del Pie Diabético. Resultados: 86,27% de los pacientes declararon síntomas neuropáticos, principalmente ardor, entumecimiento y hormigueo. La mayoría hipertensos (74,71%) y ancianos (67,65%), de esos 13,73% con infarto previo y 72,55% eran mujeres. Del primero al tercer examen, el "riesgo muy bajo" aumentó un 7,84% y "riesgo bajo" un 8,83%, mientras que el "riesgo alto" redujo un 17,65%. Conclusión: la realización sistemática del examen clínico de los pies, asociado a estrategias educativas efectivas, resultan en un control más eficaz del riesgo de ulceración.

Objective: to describe the evolution of risk factors for the development of foot ulcers in patients with DM, in three subsequent exams over a period of 3 years, in a medical specialty center. Method: a descriptive, retrospective and longitudinal study, with 102 patients, between the years 2016 and 2019, who performed three sequential foot exams, based on the standard established by the international consensus of the diabetic foot, being use of footwear, collected from the Diabetic Foot System. Results: 86.27% of patients reported neuropathic symptoms, mainly burning, numbness and tingling. Most were hypertensive (74.71%) and elderly (67.65%), of these, 13.73% had previous infarction and 72.55% were female. From the first to the third examination, the "very low risk" increased 7.84% and the "low risk" 8.83%, while the "high risk" reduced 17.65%. Conclusion: the systematic clinical feet exam, associated with effective educational strategies, results in a more effective control of the risk of ulceration.

Adherence to secondary prevention measures after acute coronary syndrome in patients associated exclusively with the public and private healthcare systems in Brazil.

Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity.

Spatial clusters, social determinants of health and risk of COVID-19 mortality in Brazilian children and adolescents: A nationwide population-based ecological study.

Background: Data regarding the geographical distribution of cases and risk factors for COVID-19 death in children and adolescents are scarce. We describe the spatial distribution of COVID-19 cases and deaths in paediatric population and their association with social determinants of health in Brazil. Methods: This is a population-based ecological study with a spatial analysis of all cases and deaths due to COVID-19 in Brazil among children and adolescents aged 0-19 years from March 2020 to October 2021. The units of analysis were the 5570 municipalities. Data on COVID-19 cases and deaths, social vulnerability, health inequities, and health system capacity were obtained from publicly available databases. Municipalities were stratified from low to very high COVID-19 incidence and mortality using K-means clustering procedures, and spatial clusters and relative risks were estimated using spatial statistics with Poisson probability models. The relationship between COVID-19 estimates and social determinants of health was explored by using multivariate Beta regression techniques. Findings: A total of 33,991 COVID-19 cases and 2424 deaths among children and adolescents aged 0-19 years were recorded from March 2020 to October 2021. There was a spatial dependence for the crude mortality coefficient per 100,000 population in the paediatric population aged 0-19 years (I Moran 0·10; P < 0·001). Forty municipalities had higher mortality rates, of which 20 were in states from the Northeast region. Seven spatial clusters were identified for COVID-19 mortality, with four clusters in the Northeast region and three in the North region. Municipalities with higher social inequality and vulnerability had higher COVID-19 mortality in the paediatric population. Interpretation: The main clusters of risk for mortality among children and adolescents were identified in municipalities in the North and Northeast regions, which are the regions with the worst socioeconomic indicators and greatest health disparities in the country. Our findings confirmed the higher burden of COVID-19 for Brazilian paediatric population in municipalities with higher social inequality and vulnerability and worse socioeconomic indicators. To reduce the burden of COVID-19 on children, mass immunisation is necessary. Funding: None.

Quality of Life among Patients with Acute Coronary Syndromes Receiving Care from Public and Private Health Care Systems in Brazil.

(1) Background: Quality of life (QOL) is used as a health indicator to assess the effectiveness and impact of therapies in certain groups of patients. This study aimed to analyze the QOL of patients with acute coronary syndrome (ACS) who received medical treatment by a public or private health care system. (2) Methods: This observational, prospective, longitudinal study was carried out in four referral hospitals providing cardiology services in Sergipe, Brazil. QoL was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey. The volunteers were divided into two groups (public or private health care group) according to the type of health care provided. Multiple linear regression models were used to evaluate QoL at 180 days after ACS. (3) Results: A total of 581 patients were eligible, including 44.1% and 55.9% for public and private health care, respectively. At 180 days after ACS, the public health care group had lower QoL scores for all domains (functional capacity, physical aspects, pain, general health status, vitality, social condition, emotional profile, and health) (p < 0.05) than the private group. The highest QoL level was associated with male sex (p < 0.05) and adherence to physical activity (p ≤ 0.003) for all assessed domains. (4) Conclusions: This shows that social factors and health status disparities influence QoL after ACS in Sergipe.

Prevalence and maternal risk factors of congenital malformations in newborns from Sergipe, Northeastern Brazil / Prevalência e fatores de risco maternos de malformações congênitas em recém-nascidos de Sergipe, Nordeste do Brasil

INTRODUCTION: Due to the importance of infant death caused by congenital malformations worldwide, more studies are necessary to determine the prevalence of these disorders serving as the basis for more effective control measures. OBJECTIVE: To determine the prevalence and evaluate maternal risk factors for congenital malformations in newborns. METHODS: A cross-sectional and retrospective study was performed in the reference maternity hospital for high-risk pregnancies in the state of Sergipe, northeastern Brazil. Data were collected from the medical records and declarations of live births of 16,518 births between January 2014 and December 2016, being included children with identified congenital malformations. Data were analyzed using the odds ratio, chisquare, and Fisher's exact test with p<0.05. RESULTS: The study population was composed of 369 newborns with congenital malformations, which corresponds to 2.23% of total births. 53.9% were male, 47.9% had low birth weight and, 52.5% had adequate Apgar score. Anomalies affecting the musculoskeletal system were the most prevalent (30.9%), with polydactyly being the most frequent (53.5%). The number of prenatal consultations, education, and gestational age were the main observed maternal risk factors of congenital malformations. Anomalies of the circulatory system (OR=3.2 CI95% 1.3-7.84), multiple malformations (OR=9.24 CI95% 3.07-27.83), and chromosomal syndromes (OR=2.72 CI95% 1.48-5.01) were the most commonly associated with newborn deaths. CONCLUSION: The study presents the prevalence and risk factors related to malformations in the state of Sergipe, and improvements on maternal care and socioeconomic variables are important to decrease the number of malformations cases in Brazil.

INTRODUÇÃO: Devido à importância mundial relacionada à morte infantil causada por malformações congênitas, mais estudos são necessários para conhecer a prevalência destas enfermidades servindo de base para medidas de controle mais efetivos. OBJETIVO: Determinar a prevalência e avaliar fatores de risco materno para malformações congênitas em recém-nascidos. MÉTODO: Estudo transversal e retrospectivo na maternidade de referência para gestação de alto risco do estado de Sergipe, Nordeste do Brasil. Os dados foram coletados a partir dos prontuários médicos e declarações de nascido-vivo de 16.518 recém-nascidos entre janeiro de 2014 e dezembro de 2016, sendo incluídos aqueles com malformações congênitas identificadas. Foram utilizados razão de possibilidades, teste de qui-quadrado e exato de Fisher, com p<0,05. RESULTADOS: A população estudada foi composta por 369 recém-nascidos, que corresponde a 2,23% do total de nascimentos, 53,9% do sexo masculino, 47,9% com baixo peso ao nascer e 52,5% com Apgar adequado. Anomalias do sistema musculoesquelético foram as mais prevalentes (30,9%), tendo a polidactilia como a mais frequente (53,5%). O número de consultas de pré-natal, escolaridade e idade gestacional foram os principais fatores de risco maternos observados para as malformações congênitas. As anomalias do sistema circulatório (OR=3,2 IC95% 1,3-7,84), múltiplas malformações (OR=9,24 IC95% 3,07-27,83) e síndromes cromossômicas (OR=2,72 IC95% 1,48-5,01) foram as mais associadas com mortes dos recém-nascidos. CONCLUSÃO: O estudo apresenta a prevalência e os fatores de risco relacionados às malformações no estado de Sergipe, e melhorias no cuidado materno e nas variáveis socioeconômicas são importantes para diminuir o número de casos de malformações no Brasil.

Diabetes mellitus type 2: factors related to adherence to self-care.

OBJECTIVES: to analyze the sociodemographic and clinical variables related to the adherence to self-care activities in people with diabetes mellitus type 2. METHODS: quantitative, cross-sectional study, carried out with 270 people with diabetes from December 2019 to October 2020, in São Luís, Maranhão. RESULTS: the adherence to self-care was greater when it comes to medications (Md=7.0) and foot care (Md= 6.0), but lower in regard to blood sugar testing (Md=1.0), exercise (Md=2,0), and diet (general) (Md=4.0). The variables age group (p=0.007), educational level (p=0.015), body mass index (p=0.035), complications with diabetes (p=0.009), and nutritional follow-up (p=0.000) had associations with self-care activities. CONCLUSIONS: identifying the factors related to the adherence to self-care was found to be essential to strengthen the line of care in chronic diseases and to direct educational actions, aiming to improve the quality of life of people with diabetes.

Clinical characteristics and risk factors for maternal deaths due to COVID-19 in Brazil: a nationwide population-based cohort study.

BACKGROUND: Monitoring the characteristics and associated factors for death among pregnant and postpartum women with coronavirus disease 19 (COVID-19) is necessary. We investigated the clinical characteristics and risk factors associated with maternal deaths in a nationwide cohort of Brazil. METHODS: This was a population-based cohort of all pregnant and postpartum women hospitalised with COVID-19 notified to the Sistema de Informação de Vigilância Epidemiológica da Gripe of Brazil (SIVEP-Gripe), from February 2020 to September 2021. The primary outcome was time to in-hospital death, with risk factors analysed with univariable and multivariable Cox proportional hazards regression models. RESULTS: Cumulative observation time was 248 821 person-days from hospital admission to the end of follow-up for 15 105 individuals. There were 1858 deaths (12.3%) for a maternal mortality rate of 7.5 (95% CI 7.1-7.8) per 1000 patients-days. The cumulative mortality increased over time. Black/Brown ethnicity had a higher risk of death than women self-identifying as White. Women in the North, Northeast, Central-West and Southeast regions had higher risk of death than women in the South region. The characteristics independently associated with death were a postpartum status on admission [adjusted hazard ratio, HR 1.4 (95% confidence interval, CI 1.2-1.6)], pre-existing clinical conditions [adjusted HRs 1.2 (95%CI 1.1-1.3) for one and 1.3 (95%CI 1.1-1.5) for two comorbidities], hypoxaemia on admission [adjusted HR 1.2 (95%CI 1.1-1.4)] and requiring non-invasive [adjusted HR 2.6 (95%CI 2.1-3.3)] or invasive ventilatory support [adjusted HR 7.1 (95%CI 5.6-9.2)]. CONCLUSION: In Brazil, the in-hospital maternal mortality rate due to COVID-19 is high and the risk of death increases with the length of hospitalisation. Socio-demographic and biological factors are associated with an increased risk of maternal death. The presence of respiratory signs and symptoms should be considered early markers of disease severity and an adequate management is necessary. Our findings reinforce the need for vaccination of pregnant and postpartum women against COVID-19.

Diabetes mellitus type 2: factors related to adherence to self-care / Diabetes mellitus tipo 2: factores relacionados a la adhesión al autocuidado / Diabetes mellitus tipo 2: fatores relacionados com a adesão ao autocuidado

ABSTRACT Objectives: to analyze the sociodemographic and clinical variables related to the adherence to self-care activities in people with diabetes mellitus type 2. Methods: quantitative, cross-sectional study, carried out with 270 people with diabetes from December 2019 to October 2020, in São Luís, Maranhão. Results: the adherence to self-care was greater when it comes to medications (Md=7.0) and foot care (Md= 6.0), but lower in regard to blood sugar testing (Md=1.0), exercise (Md=2,0), and diet (general) (Md=4.0). The variables age group (p=0.007), educational level (p=0.015), body mass index (p=0.035), complications with diabetes (p=0.009), and nutritional follow-up (p=0.000) had associations with self-care activities. Conclusions: identifying the factors related to the adherence to self-care was found to be essential to strengthen the line of care in chronic diseases and to direct educational actions, aiming to improve the quality of life of people with diabetes.

RESUMEN Objetivos: analizar variables sociodemográficas y clínicas relacionadas a la adhesión a actividades de autocuidado en personas con diabetes mellitus tipo 2. Métodos: estudio cuantitativo, transversal, realizado con 270 personas con diabetes, entre diciembre de 2019 y octubre de 2020, en São Luís, Maranhão. Resultados: hubo adhesión más favorable al autocuidado cuanto al uso del medicamento (Md=7,0) y cuidados con los pies (Md= 6,0) y adhesión menos deseable cuanto al monitoreo de la glucemia (Md=1,0), práctica de actividad física (Md=2,0) y alimentación general (Md=4,0). Las variables franja etaria (p=0,007), escolaridad (p=0,015), índice de masa corporal (p=0,035), complicación del diabetes (p=0,009) y acompañamiento nutricional (p=0,000) presentaron relación con las actividades de autocuidado. Conclusiones: la identificación de factores relacionados a la adhesión al autocuidado se mostró esencial para el fortalecimiento de la línea de cuidados en enfermedades crónicas y direccionamiento de acciones educativas, visando mejorar la calidad de vida de personas con diabetes.

RESUMO Objetivos: analisar as variáveis sociodemográficas e clínicas relacionadas com a adesão às atividades de autocuidado em pessoas com diabetes mellitus tipo 2. Métodos: estudo quantitativo, transversal, realizado com 270 pessoas com diabetes, entre dezembro de 2019 e outubro de 2020, em São Luís, Maranhão. Resultados: houve adesão mais favorável ao autocuidado quanto ao uso do medicamento (Md=7,0) e cuidados com os pés (Md= 6,0) e adesão menos desejável quanto à monitorização da glicemia (Md=1,0), prática da atividade física (Md=2,0) e alimentação geral (Md=4,0). As variáveis faixa etária (p=0,007), escolaridade (p=0,015), índice de massa corporal (p=0,035), complicação do diabetes (p=0,009) e acompanhamento nutricional (p=0,000) apresentaram associação com as atividades de autocuidado. Conclusões: a identificação dos fatores relacionados com a adesão ao autocuidado mostrou-se essencial para o fortalecimento da linha de cuidados em doenças crônicas e direcionamento das ações educativas, visando melhorar a qualidade de vida das pessoas com diabetes.

Qualidade de vida de pessoas com diabetes seis meses após término de programa educativo / Quality of life of people with diabetes six months after the end of an educational program / Calidad de vida de las personas con diabetes seis meses después de la finalización de un programa educativo

Objetivo: Avaliar a qualidade de vida de pessoas com diabetes mellitus seis meses após o término da participação em programa educativo. Método: estudo descritivo de abordagem quantitativa desenvolvido com 32 pessoas com diabetes mellitus acompanhadas no ambulatório de um hospital universitário de Sergipe. Para a coleta de dados foram utilizados três instrumentos, um para a caracterização sociodemográfica e clínica e dois para avaliação da qualidade de vida, o Whoqol-bref e o B-PAID. Resultados: Houve declínio da qualidade de vida, sobretudo nos domínios Relações sociais e Ambiente e aumento do sofrimento em viver com o diabetes. Foi observada correlação positiva e estatisticamente significativa entre o sexo e a medida de qualidade de vida WhoqoL-bref, com os homens tendo apresentado melhor avaliação. Conclusão: O declínio da qualidade de vida e o aumento do sofrimento em viver com o diabetes podem estar associados ao término das atividades do programa de educação em saúde. (AU)

Objective: To evaluate the quality of life of people with diabetes mellitus six months after the end of their participation in an educational program. Methods: A descriptive study with a quantitative approach developed with 32 people with diabetes mellitus monitored at the outpatient clinic of a university hospital in Sergipe. For data collection, three instruments were used, one for the sociodemographic and clinical characterization and two for the assessment of quality of life. Results: There was a decline in the quality of life, especially in the Social Relationship and Environment domains and an increase in the suffering of living with diabetes. A positive and statistically significant correlation was observed between gender and the quality of life measure, with men having a better evaluation. Conclusion: The decline in quality of life and the increase in suffering in living with diabetes may be associated with the termination of activities in the health education program. (AU)

Objetivo: Evaluar la calidad de vida de personas con diabetes mellitus a los seis meses de finalizar su participación en un programa educativo. Métodos: Estudio descriptivo con abordaje cuantitativo desarrollado con 32 personas con diabetes mellitus monitorizadas en la consulta externa de un hospital universitario de Sergipe. Para la recolección de datos se utilizaron tres instrumentos, uno para la caracterización sociodemográfica y clínica y dos para la evaluación de la calidad de vida. Resultados: Hubo una disminución en la calidad de vida, especialmente en los dominios de Relaciones Sociales y Medio Ambiente y un aumento en el sufrimiento de vivir con diabetes. Se observó una correlación positiva y estadísticamente significativa entre el sexo y la medida de calidad de vida siendo los hombres quienes obtuvieron una mejor evaluación. Conclusión: El deterioro de la calidad de vida y el aumento del sufrimiento al vivir con diabetes pueden estar asociados con el final de las actividades del programa de educación para la salud. (AU)

Increased Accuracy to c-Fos-Positive Neuron Counting.

There is not a described method to count the core label of c-Fos-positive neurons, avoiding false-positive and false-negative results. The aim of this manuscript is to provide guidelines for a secure and accurate method to calculate a threshold to select which core of c-Fos-positive neurons marked by immunofluorescence has to be scored. A background percentage was calculated by dividing the intensity value (0 to 255) of the core of c-Fos-positive neurons by its surrounding background from the 8-bit images obtained in a previous study. Using the background percentage from 20% up to 98%, raising 2% once for each score, as threshold to choose which core has to be counted, a script was written for the R program to count the number of the c-Fos-positive neurons and the comparison between control and experimental groups. The differences of the average number of the core counted c-Fos-positive neurons between control and experimental groups, at all thresholds studied, showed a rising value related to an increase of the background percentage threshold as well as a decrease of its p value related to an increase of the threshold of background percentage. For the smallest thresholds (high intensity of label), the differences between groups are suppressed (false negative). However, for the biggest thresholds (nonspecific label), these differences are always the same (false positive). Therefore, to avoid the false-negative and the false-positive values, it was chosen as the threshold of 62% the inflection point of the linear regression, which is equally different from the biggest and smallest values of the differences between groups.

Influence of Factors Affecting Quality of Life on in-Hospital Cardiovascular Events of Patients with Acute Myocardial Infarction with and without ST-segment Elevation

Abstract Background Acute myocardial infarction (AMI), with and without ST-segment elevation (STEMI and NSTEMI, respectively), is the principal cause of cardiovascular morbidity and mortality in Brazil and around the world. Modifiable risk factors (RF) and quality of life (QOL) may correlate with the type of AMI. Objective To evaluate the influence of QOL and RF on the type of AMI and in-hospital cardiovascular events in STEMI and NSTEMI patients. Methods This was an observational, cross-sectional study. Patients with AMI attending four referral hospitals (three private and one public) for cardiovascular disease treatment were assessed for QOL using the Brazilian version of the 36-item short form survey. A p < 0.05 was considered statistically significant. Results We evaluated 480 volunteers; 51% were treated in one of the private hospitals. In total, 55.6% presented with STEMI, and 44.4% with NSTEMI. Patients from the public hospital were 8.56 times more likely to have STEMI compared to those from the private hospitals. There was a higher prevalence of smokers in STEMI (p < 0.028) patients. QOL was not associated with the type of AMI. A negative patient perception of the physical health and pain domains was observed. Although a significant difference between the physical and the mental health domains was not observed, individual domains were correlated with some in-hospital outcomes. Conclusion There was a higher prevalence of smokers among individuals with STEMI. Domains of QOL showed a statistically significant relationship with the occurrence of in-hospital cardiovascular events, with no difference between the types of AMI.

Spatial clusters, social determinants of health and risk of maternal mortality by COVID-19 in Brazil: a national population-based ecological study.

BACKGROUND: Detailed information on how socio-economic characteristics are related to COVID-19 incident cases and maternal deaths is needed. We investigated the spatial distribution of COVID-19 cases and maternal deaths in Brazil and their association with social determinants of health. METHODS: This was a population-based ecological study with a spatial analysis of all cases and deaths of COVID-19 in the obstetric population. Data on COVID-19 cases and deaths in the obstetric population, social vulnerability, health inequities, and health system capacity at the municipal level were obtained from several publicly sources in Brazil. A Bayesian empirical local model was used to identify fluctuations of the indicators. Spatial statistic tests were used to identity the spatial clusters and measure the municipalities' risk of COVID-19 in the obstetric population. Beta regression was used to characterise the association between socio-economic indicators and the burden of COVID-19. FINDINGS: A total of 13,858 cases and 1,396 deaths due to COVID-19 were recorded in Brazil from March 2020 to June 2021. There was a variation in the number of cases per municipality, with 105 municipalities with rates from 2,210 to 3,884 cases and 45 municipalities with rates from 3,884 to 7,418 cases per 100,000 live births. The maternal mortality ratio also varied widely across municipalities. There was a spatial dependence on smoothed maternal mortality rates (I Moran 0•10; P = 0•010), and 15 municipalities had higher risk of maternal deaths. Municipalities characterized by lower health resources and higher socioeconomic inequalities presented the highest rates of incidence and maternal mortality by COVID-19. INTERPRETATION: In Brazil, COVID-19 cases and deaths in the obstetric population had a heterogeneous geographical distribution, with well-defined spatial clusters mostly located in the countryside. Municipalities with a high degree of socioeconomic dissimilarities showed higher maternal mortality rates than areas with better social and infrastructure indicators. FUNDING: None.

Bariatric Surgery: Late Outcomes in Patients Who Reduced Comorbidities at Early Follow-Up.

Backgroundand Objectives: In severe obesity, a relevant weight loss can promote the reduction of comorbidities, such as systemic arterial hypertension (SAH), dyslipidemia, and diabetes mellitus (DM2). Bariatric surgery (BS) has been an essential resource in the therapy of this disease with a short-term reduction of cardiometabolic risk (CR). This study aimed to evaluate the reduction of factors associated with the CR in patients undergoing BS at a 5-year follow-up. Materials and Methods: This is a longitudinal, retrospective study carried out with patients undergoing BS by the Brazilian Public Healthcare System (PHS). Anthropometric and clinical parameters related to the CR (DM2, dyslipidemia, and SAH), quantified by the Assessment of Obesity-Related Comorbidities (AORC) score, were evaluated at the following moments: admission and preoperative and postoperative returns (3 months, 6 months, 1 to 5 years). Results: The sample had a mean age of 44.69 ± 9.49 years and were predominantly in the age group 20-29 years (34.80%) and women (72.46%). At admission to the service, 42.3% had DM2, 50.7% dyslipidemia, and 78.9% SAH. Regarding BS, the gastric bypass technique was used in 92.86% of the sample, and the waiting time for the procedure was 28.3 ± 24.4 months. In the pre- and postoperative period of 3 months, there was a significant reduction in the frequency of DM2 (p < 0.003), dyslipidemia (p < 0.000), and SAH (p < 0.000). However, at postoperative follow-up from 6 months to 5 years, there was no significant reduction in the comorbidities studied. After five years, 35.7% had total remission of DM2 and 2.9% partial remission of DM2, 44.2% had control and remission of dyslipidemia, and 19.6% of SAH (AORC score ≤ 2 for the comorbidities). Conclusion: BS promoted a reduction of the CR in the first three months after BS in severely obese PHS users.

Sociodemographic and obstetric factors related to low birth weight in the context of early pregnancy / Fatores sociodemográficos e obstétricos relacionados ao baixo peso em recém-nascidos no contexto da gravidez precoce

Abstract Objectives: to analyze sociodemographic and obstetric factors that may influence the occurrence of low birth weight in the context of early pregnancy. Methods: the sample consisted of 232 pregnant teenagers, aged 10-19 years old, were assisted at a public maternity hospital in Aracaju-SE during the period of August 2012 to July 2016. The data collection was conducted through a structured questionnaire. Results: low birth weight was observed in 41.38% of the newborns and there was a statistical association between the educational level and the marital status with the occurrence of low birth weight in newborns among teenage mothers, with p=0.0286 and p=0.0247, respectively. Conclusions: the socioeconomic factors may contribute to the occurrence of low birth weight in newborns of teenage mothers and teenage pregnancy at this age represents a serious public health problem.

Resumo Objetivos: analisar os fatores sociodemográficos e obstétricos que podem influenciar na ocorrência do baixo peso ao nascer no contexto da gravidez precoce. Métodos: amostra constou de 232 adolescentes grávidas, na faixa etária de 10 a 19 anos, atendidas em uma maternidade pública de Aracaju-SE, Brasil, durante o período de agosto de 2012 a julho de 2016. A coleta de dados foi realizada através de um questionário estruturado. Resultados: observou-se baixo peso em 41,38% dos recém-nascidos e que o nível de escolaridade e o tipo de vínculo com o parceiro tiveram relevância estatística para a ocorrência do baixo peso em recém-nascidos de mães adolescentes, com p=0,0286 e p=0,0247, respectivamente. Conclusões: os fatores socioeconômicos podem contribuir para a ocorrência de baixo peso em recém-nascidos de mães adolescentese que a gravidez nesta faixa etária constitui grave problema de saúde pública de natureza multifatorial.

Diagnósticos de enfermagem associados a qualidade de vida de mulheres com câncer de mama em quimioterapia / Nursing diagnostics associated with the quality of life of women with breast cancer in chemotherapy / Diagnósticos de enfermería asociados a la calidad de vida de mujeres con cáncer de mama en quimioterapia

Objetivo: Identificar diagnósticos de enfermagem em mulheres com câncer de mama em quimioterapia por meio do mapeamento cruzado dos problemas de saúde com a taxonomia NANDA-I. Método: Estudo descritivo transversal realizado com cinco enfermeiros e 75 mulheres com câncer de mama em quimioterapia, desenvolvido em três fases: levantamento dos problemas de saúde por meio de instrumentos de avaliação da qualidade de vida relacionada à saúde; mapeamento cruzado dos problemas de saúde com características definidoras, fatores relacionados, fatores de risco e títulos diagnósticos; validação do mapeamento por juízes. Resultados: Foram identificados 24 problemas de saúde associados a 13 diagnósticos de enfermagem. Oito foram identificados, com índice de validade de conteúdo ≥ 0,8. Conclusão: O estudo permitiu realizar o mapeamento de diagnósticos de enfermagem a partir de problemas de saúde identificados, por meio de instrumentos de qualidade de vida, em mulheres com câncer de mama em tratamento quimioterápico

Objective: To identify nursing diagnoses in women with breast cancer in chemotherapy through the cross-mapping of health problems with the NANDA-I taxonomy. Method: A cross-sectional descriptive study carried out with five nurses and 75 women with breast cancer in chemotherapy, developed in three phases: survey of health problems by health-related quality of life assessment instruments; cross-mapping of health problems with defining characteristics, related factors, risk factors and diagnostic titles; validation of mapping by judges. Results: 24 health problems associated with 13 nursing diagnoses were identified. Eight were identified, with content index validity ≥0.8. Conclusion: The study allowed the mapping of nursing diagnoses from identified health problems, through quality of life instruments, in women with breast cancer under chemotherapeutic treatment

Objetivo: Identificar diagnósticos de enfermería en mujeres con cáncer de mama en quimioterapia a través del mapeo cruzado de los problemas de salud con la taxonomía NANDA-I. Método: Estudio descriptivo transversal realizado con cinco enfermeros y 75 mujeres con cáncer de mama en quimioterapia, desarrollado en tres fases: levantamiento de los problemas de salud por medio de instrumentos de evaluación de la calidad de vida relacionada a la salud; el mapeo cruzado de los problemas de salud con características definidoras, factores relacionados, factores de riesgo y títulos diagnósticos; validación del mapeo por jueces. Resultados: Se identificaron 24 problemas de salud asociados a 13 diagnósticos de enfermería. Ocho fueron identificados, con índice de validez de contenido ≥0,8. Conclusión: El estudio permitió realizar el mapeo de diagnósticos de enfermería a partir de problemas de salud identificados, por medio de instrumentos de calidad de vida, en mujeres con cáncer de mama en tratamiento quimioterápico