Kidney Disease and Proteomics: A Recent Overview of a Useful Tool for Improving Early Diagnosis.

Kidney disease is a critical and potentially life-threatening degenerative condition that poses a significant global public health challenge due to its elevated rates of morbidity and mortality. It manifests primarily in two distinct clinical forms: acute kidney injury (AKI) and chronic kidney disease (CKD). The development of these conditions hinges on a multitude of factors, including the etiological agents and the presence of coexisting medical conditions. Despite disparities in their underlying pathogenic mechanisms, both AKI and CKD can progress to end-stage kidney disease (ESKD). This advanced stage is characterized by organ failure and its associated complications, greatly increasing the risk of mortality. There is an urgent need to delve into the pathogenic mechanisms underlying these diseases and to identify novel biomarkers that can facilitate earlier diagnosis. Such early detection is crucial for enhancing the efficacy of therapy and impeding disease progression. In this context, proteomic approaches have emerged as invaluable tools for uncovering potential new markers of different pathological conditions, including kidney diseases. In this chapter, we overview the recent discoveries achieved through diverse proteomic techniques aimed at identifying novel molecules that may play a pivotal role in kidney diseases such as diabetic kidney disease (DKD), IgA nephropathy (IgAN), CKD of unknown origin (CKDu), autosomal dominant polycystic kidney disease (ADPKD), lupus nephritis (LN), hypertensive nephropathy (HN), and COVID-19-associated acute kidney injury (COVID-AKI).

Alamandine attenuates oxidative stress in the right carotid following transverse aortic constriction in mice.

OBJECTIVE: Pressure overload can result in significant changes to the structure of blood vessels, a process known as vascular remodeling. High levels of tension can cause vascular inflammation, fibrosis, and structural alterations to the vascular wall. Prior research from our team has demonstrated that the oral administration of alamandine can promote vasculoprotective effects in mice aorta that have undergone transverse aortic constriction (TAC). Furthermore, changes in local hemodynamics can affect the right and left carotid arteries differently after TAC. Thus, in this study, we aimed to assess the effects of alamandine treatment on right carotid remodeling and the expression of oxidative stress-related substances induced by TAC. METHODS AND RESULTS: Male C57BL/6 mice were categorized into three groups: Sham, TAC, and TAC treated with alamandine (TAC+ALA). Alamandine treatment was administered orally by gavage (30 µg/kg/day), starting three days before the surgery, and continuing for a period of fourteen days. Morphometric analysis of hematoxylin and eosin-stained sections revealed that TAC induced hypertrophic and positive remodeling in the right carotid artery. Picrosirius Red staining also demonstrated an increase in total collagen deposition in the right carotid artery due to TAC-induced vascular changes. Alamandine treatment effectively prevented the increase in reactive oxygen species production and depletion of nitric oxide levels, which were induced by TAC. Finally, alamandine treatment was also shown to prevent the increased expression of nuclear factor erythroid 2-related factor 2 and 3-nitrotyrosine that were induced by TAC. CONCLUSION: Our results suggest that alamandine can effectively attenuate pathophysiological stress in the right carotid artery of animals subjected to TAC.

Psychometric properties of the Providers Survey in the Brazilian context of mental health: a validation study

ABSTRACT BACKGROUND: Precisely determining the aspects related to an instrument's validity and reliability measures allows for greater assurance of the quality of the results. OBJECTIVES: To analyze the psychometric properties of The Providers Survey in the Brazilian context of mental health services. DESIGN AND SETTING: The instrument validation study was conducted in Montes Claros, Minas Gerais, Brazil. METHODS: The validation study was conducted using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist to analyze its validity and reliability. RESULTS: A committee of expert judges performed content validation after which the Content Validity Index was calculated. Construct validation took place through Exploratory Factor Analysis using the Kaiser-Meyer-Olkin Test criterion and Bartlett's Sphericity Test. Reliability was verified using test-retest reliability. The significance level adopted for the statistical tests was 5% (P < 0.05). The final instrument comprised 54 questions. The Content Validity Index was 97%. Exploratory Factor Analysis identified a Kaiser-Meyer-Olkin index of 0.901 and Bartlett's Sphericity Test with P < 0.001. We obtained a Cronbach's alpha coefficient of 0.95 and an intraclass correlation coefficient of 0.849. CONCLUSIONS: The Providers Survey, translated and adapted into Portuguese, was named the Work Assessment Instrument for the Recovery of Mental Health. It presented adequate psychometric properties for evaluating work-related practices for the recovery of psychosocial care network users.

Psychometric properties of the Providers Survey in the Brazilian context of mental health: a validation study.

BACKGROUND: Precisely determining the aspects related to an instrument's validity and reliability measures allows for greater assurance of the quality of the results. OBJECTIVES: To analyze the psychometric properties of The Providers Survey in the Brazilian context of mental health services. DESIGN AND SETTING: The instrument validation study was conducted in Montes Claros, Minas Gerais, Brazil. METHODS: The validation study was conducted using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist to analyze its validity and reliability. RESULTS: A committee of expert judges performed content validation after which the Content Validity Index was calculated. Construct validation took place through Exploratory Factor Analysis using the Kaiser-Meyer-Olkin Test criterion and Bartlett's Sphericity Test. Reliability was verified using test-retest reliability. The significance level adopted for the statistical tests was 5% (P < 0.05). The final instrument comprised 54 questions. The Content Validity Index was 97%. Exploratory Factor Analysis identified a Kaiser-Meyer-Olkin index of 0.901 and Bartlett's Sphericity Test with P < 0.001. We obtained a Cronbach's alpha coefficient of 0.95 and an intraclass correlation coefficient of 0.849. CONCLUSIONS: The Providers Survey, translated and adapted into Portuguese, was named the Work Assessment Instrument for the Recovery of Mental Health. It presented adequate psychometric properties for evaluating work-related practices for the recovery of psychosocial care network users.

Mortalidade de professores no estado de Goiás: análise de série temporal / Mortality of teachers in the state of Goiás: a time serie analysis

Análise de perfil epidemiológico e a tendência da mortalidade de professores da educação básica e do ensino superior no Estado de Goiás, no período de 2008 a 2017. Método: série temporal, com dados do Sistema de Informações sobre Mortalidade. Para a análise da tendência da mortalidade utilizou-se modelos de regressão linear e considerou-se p<0,05. Resultados: foram levantados 2.439 óbitos, maior frequência de óbitos no sexo feminino, em indivíduos de cor branca e com idade entre 50 e 69 anos. Entre as mulheres, as neoplasias malignas foram as principais causas de óbito, enquanto entre os homens destacaram-se as doenças do aparelho circulatório. Identificou-se tendência temporal de aumento dos óbitos (0,134 para as neoplasias malignas, 0,132 para as doenças do aparelho circulatório, 0,252 para as causas externas e 0,212 para as doenças do aparelho respiratório). Considerando todas as causas de óbito o incremento foi de 0,040 (p<0,000). Conclusão: há aumento de mortalidade de professores por causas evitáveis

Objective: to analyze the epidemiologic profile and the trends in mortality of teachers from basic education and higher education professors in the state of Goiás, in the period from 2008 to 2017. Method: time series, with data from the Mortality Information System. In order to analyze the trend in mortality, a linear regression model was used, considering p<0.05. Results: 2,439 deaths were recorded, with higher frequency of deaths within female sex, white and aged from 50 to 69 years. Among the women, malignant neoplasms were the main causes of death, whilst among men, circulatory system diseases stood out. It was identified a temporal trend of increase in deaths (0.134 for malignant neoplasms, 0.132 for circulatory system diseases, 0.252 for external causes and 0.212 for respiratory system diseases). Considering all the causes of death, the increase was 0.040 (p<0.000). Conclusion: there is an increase in mortality of teachers and professors due to avoidable causes

Correlation between fatigue and quality of life self-reported by adolescents with cerebral palsy.

OBJECTIVES: to investigate the correlation between fatigue and quality of life in adolescents with cerebral palsy who are susceptible to more significant fatigue and lower quality of life. METHODS: cross-sectional study conducted with 101 adolescents with cerebral palsy. Instruments such as the Pediatric Quality of Life Inventory and Gross Motor Function Classification System were used, and Kolmogorov-Smirnov, Mann-Whitney, and Spearman tests were applied. RESULTS: older adolescents self-reported higher fatigue levels, and female adolescents, quadriplegic, with worse motor function, older, and not attending school had lower quality of life scores. Higher fatigue levels correlated with lower quality of life in all domains (p<0.01), especially in tiredness (general and mental) and functioning (social, academic, and psychosocial). CONCLUSIONS: fatigue correlated negatively with the quality of life of adolescents with cerebral palsy, showing that the higher the level of fatigue, the more compromised is the adolescents' life.

Correlation between fatigue and quality of life self-reported by adolescents with cerebral palsy / Correlación entre fatiga y calidad de vida de autoinformes de adolescentes con parálisis cerebral / Correlação entre fadiga e qualidade de vida autorrelatadas por adolescentes com paralisia cerebral

ABSTRACT Objectives: to investigate the correlation between fatigue and quality of life in adolescents with cerebral palsy who are susceptible to more significant fatigue and lower quality of life. Methods: cross-sectional study conducted with 101 adolescents with cerebral palsy. Instruments such as the Pediatric Quality of Life Inventory and Gross Motor Function Classification System were used, and Kolmogorov-Smirnov, Mann-Whitney, and Spearman tests were applied. Results: older adolescents self-reported higher fatigue levels, and female adolescents, quadriplegic, with worse motor function, older, and not attending school had lower quality of life scores. Higher fatigue levels correlated with lower quality of life in all domains (p<0.01), especially in tiredness (general and mental) and functioning (social, academic, and psychosocial). Conclusions: fatigue correlated negatively with the quality of life of adolescents with cerebral palsy, showing that the higher the level of fatigue, the more compromised is the adolescents' life.

RESUMEN Objetivos: investigar correlación entre fatiga y calidad de vida en adolescentes con parálisis cerebral y susceptibles a mayor fatiga y a menor calidad de vida. Métodos: estudio transversal conducido con 101 adolescentes con parálisis cerebral. Utilizado los instrumentos Pediatric Quality of Life Inventory y Gross Motor Function Classification System. Aplicadas las pruebas de Kolmogorov-Smirnov, Mann-Whitney y de Spearman. Resultados: adolescentes mayores informaron mayor nivel de fatiga; y adolescentes del sexo femenino, cuadripléjicos, con peor función motora, mayores y que no frecuentaban escuela presentaron menores escores de calidad de vida. Mayor nivel de fatiga se correlacionó con menor calidad de vida en todos los dominios (p<0,01), principalmente en agotamiento (general y mental) y en función (social, escolar y psicosocial). Conclusiones: la fatiga se correlacionó negativamente con la calidad de vida de adolescentes con parálisis cerebral, mostrando que, cuanto mayor el nivel de fatiga, más comprometida es la vida de los adolescentes.

RESUMO Objetivos: investigar a correlação entre fadiga e qualidade de vida em adolescentes com paralisia cerebral e suscetíveis à maior fadiga e à menor qualidade de vida. Métodos: estudo transversal conduzido com 101 adolescentes com paralisia cerebral. Utilizaram-se os instrumentos Pediatric Quality of Life Inventory e Gross Motor Function Classification System. Aplicaram-se os testes de Kolmogorov-Smirnov, Mann-Whitney e de Spearman. Resultados: adolescentes mais velhos autorrelataram maior nível de fadiga; e adolescentes do sexo feminino, quadriplégicos, com pior função motora, mais velhos e que não frequentavam escola apresentaram menores escores de qualidade de vida. Maior nível de fadiga correlacionou-se com menor qualidade de vida em todos os domínios (p<0,01), principalmente em cansaço (geral e mental) e em função (social, escolar e psicossocial). Conclusões: a fadiga correlacionou-se negativamente com a qualidade de vida de adolescentes com paralisia cerebral, mostrando que, quanto maior o nível de fadiga, mais comprometida é a vida dos adolescentes.

Silicon and mechanical damage increase polyphenols and vitexin in Passiflora incarnata L.

Passiflora incarnata L. is a species of global pharmacological importance, has not been fully studied in the context of cultivation and management. It is known that silicon acts on abiotic stress and promotes phenols synthesis. The practice of mechanical damage is widely used in P. incarnata crops, and its interaction with silicon can have a significant influence on plant metabolism. Therefore, our objective was to investigate the effects of silicon and mechanical damage on photosynthesis, polyphenols and vitexin of P. incarnata. The experiment was conducted in a factorial design with SiO2 concentrations (0, 1, 2, 3 mM) and presence or absence of mechanical damage. It was found that mechanical damage improved photosynthetic performance at lower concentrations or absence of silicon. Moreover, this condition promoted an increasing in vitexin concentration when SiO2 was not provided. The application of 3 mM Si is recommended to increase polyphenols and vitexin, without harming dry mass of aerial part. The interaction between silicon and mechanical damage could be a tool to increase agronomic yield and commercial value of the P. incarnata crop.

Trend of fall-related mortality among the elderly.

OBJECTIVE: To analyze the temporal trend of fall-related mortality in elderly in Brazil from 2008 to 2016. METHOD: Study of time series of rates of fall-related mortality according to CID-10 from 2008 to 2016. Data from the Mortality Information System on death registers of people ≥ 60 living in Brazil were used. The specific rates of fall-related mortality among the elderly were calculated through the ratio between the number of deaths and the elderly population of that year and region. The populational information was obtained from the 2000 and 2010 censuses. The variation rate and temporal trend were obtained through linear regression (p < 0.05). RESULTS: The fall-related deaths among the elderly aged ≥ 60 amounted to 72,234 (31.2%). Falls from the same level were the most frequent (53.8%) and death rates in all ages ranged from 29.7 to 44.7 per 100,000 elders. Fall-related deaths increased with age. CONCLUSION: There was a growing trend of fall-related deaths among elderly in all age groups, an event which is avoidable through the adoption of preventive measures. The high rates and growing trend of fall-related deaths, as well as the aging of the Brazilian population, suggest that public policies for protecting the elderly must be prioritized.

Analysis of evaluations performed by undergraduate nursing alumni: a Brazilian multicenter study.

OBJECTIVE: To compare evaluations performed by undergraduate nursing alumni in three dimensions: sociodemographic characterization, identification and insertion into the job market, and professional training evaluation. METHODS: Cross-sectional, quantitative, and multicenter study with alumni of three Brazilian public institutions. Data analysis was carried out according to the internal reliability of the used instrument and by applying descriptive statistics. RESULTS: The participants were 446 alumni who obtained their degrees from 2013 to 2016. Most were women, white (44%) or brown (38%), and were between 25 and 30 years old. Most had a specialization degree or were studying to obtain one (54%), had a paid occupation (89%), and were employed by a single institution (60%), with the care area prevailing (57%) in the sample. High levels of satisfaction were found among alumni of two institutions in the evaluation of content learning and essential experiences for training, whereas the other institution obtained better evaluations regarding professional practice. CONCLUSION: The profile of academic experiences, graduate education, and entry into the job market varied according to the evaluated institution. The findings favored critical-reflective analysis of the institutions' pedagogical projects.

Hemodynamic phenotyping of transgenic rats with ubiquitous expression of an angiotensin-(1-7)-producing fusion protein.

Activation of the angiotensin (Ang)-converting enzyme (ACE) 2/Ang-(1-7)/MAS receptor pathway of the renin-angiotensin system (RAS) induces protective mechanisms in different diseases. Herein, we describe the cardiovascular phenotype of a new transgenic rat line (TG7371) that expresses an Ang-(1-7)-producing fusion protein. The transgene-specific mRNA and the corresponding protein were shown to be present in all evaluated tissues of TG7371 with the highest expression in aorta and brain. Plasma Ang-(1-7) levels, measured by radioimmunoassay (RIA) were similar to control Sprague-Dawley (SD) rats, however high Ang-(1-7) levels were found in the hypothalamus. TG7371 showed lower baseline mean arterial pressure (MAP), assessed in conscious or anesthetized rats by telemetry or short-term recordings, associated with increased plasma atrial natriuretic peptide (ANP) and higher urinary sodium concentration. Moreover, evaluation of regional blood flow and hemodynamic parameters with fluorescent microspheres showed a significant increase in blood flow in different tissues (kidneys, mesentery, muscle, spleen, brown fat, heart and skin), with a resulting decrease in total peripheral resistance (TPR). TG7371 rats, on the other hand, also presented increased cardiac and global sympathetic tone, increased plasma vasopressin (AVP) levels and decreased free water clearance. Altogether, our data show that expression of an Ang-(1-7)-producing fusion protein induced a hypotensive phenotype due to widespread vasodilation and consequent fall in peripheral resistance. This phenotype was associated with an increase in ANP together with an increase in AVP and sympathetic drive, which did not fully compensate the lower blood pressure (BP). Here we present the hemodynamic impact of long-term increase in tissue expression of an Ang-(1-7)-fusion protein and provide a new tool to investigate this peptide in different pathophysiological conditions.

Angiotensin-(1-7)/Mas receptor modulates anti-inflammatory effects of exercise training in a model of chronic allergic lung inflammation.

AIMS: Exercise training increases circulating and tissue levels of angiotensin-(1-7) [Ang-(1-7)], which was shown to attenuate inflammation and fibrosis in different diseases. Here, we evaluated whether Ang-(1-7)/Mas receptor is involved in the beneficial effects of aerobic training in a chronic model of asthma. MATERIAL AND METHODS: BALB/c mice were subjected to a protocol of asthma induced by ovalbumin sensitization (OVA; 4 i.p. injections) and OVA challenge (3 times/week for 4 weeks). Simultaneously to the challenge period, part of the animals was continuously treated with Mas receptor antagonist (A779, 1 µg/h; for 28 days) and trained in a treadmill (TRE; 60% of the maximal capacity, 1 h/day, 5 days/week during 4 weeks). PGC1-α mRNA expression (qRT-PCR), plasma IgE and lung cytokines (ELISA), inflammatory cells infiltration (enzymatic activity assay) and airway remodeling (by histology) were evaluated. KEY FINDINGS: Blocking the Mas receptor with A779 increased IgE and IL-13 levels and prevented the reduction in extracellular matrix deposition in airways in OVA-TRE mice. Mas receptor blockade prevented the reduction of myeloperoxidase activity, as well as, prevented exercise-induced IL-10 increase. These data show that activation of Ang-(1-7)/Mas receptor pathway is involved in the anti-inflammatory and anti-fibrotic effects of aerobic training in an experimental model of chronic asthma. SIGNIFICANCE: Our results support exercise training as a non-pharmacological tool to defeat lung remodeling induced by chronic pulmonary inflammation. Further, our result also supports development of new therapy based on Ang-(1-7) or Mas agonists as important tool for asthma treatment in those patients that cannot perform aerobic training.

Mortality in community-dwelling elderly: coefficient and associated factors.

OBJECTIVE: Analyze the coefficient, associated factors, and causes of mortality in community-dwelling elderly. METHOD: Longitudinal and analytical study. Data collection, at baseline, was performed in the elderly's home. The first wave occurred after 42 months. Complementary data collection identified the cause of death. Variables analyzed: demographic, social, economic, and clinical. Logistic regression was used for data analysis. RESULTS: The coefficient of mortality was 7.9%. The variables associated with mortality were longevity, inability to read, absence of religious practice, stroke, consultation, and hospitalization in the last 12 months. The main groups of primary causes of death were ill-defined and unspecified causes of mortality, respiratory system diseases, and neoplasms. CONCLUSION: The coefficient of mortality in community-dwelling elderly was lower than national and international studies investigated.

Depressão em pacientes atendidos em serviço de saúde mental: fatores associados e diagnósticos de enfermagem / Depression in patients served in mental health service: prevalence and associated factors / Depresión en pacientes atendidos en servicio de salud mental: prevalencia y factores associados

OBJETIVO: estimar a prevalência de depressão em pacientes atendidos em Centro de Atenção Psicossocial, identificar os fatores sociodemográficos e diagnósticos de Enfermagem associados ao desfecho. MÉTODO: estudo transversal, realizado entre janeiro a junho de 2018, em 370 prontuários de pacientes atendidos, no período de 2002 a 2016, em Centro de Atenção Psicossocial de um município do norte de Minas Gerais, Brasil. Com o auxílio de um instrumento, foram coletados dados clínicos, sociodemográficos e diagnósticos de Enfermagem. Os diagnósticos de Enfermagem foram validados por especialistas com suporte no raciocínio diagnóstico de Risner. Realizaram-se análises descritiva, bivariada e regressão logística. RESULTADOS: dos 370 pacientes, 57 (15,4%) apresentaram depressão. A maioria (53,2%) era composta por indivíduos do sexo feminino e a média de idade foi de 36 anos. Os diagnósticos de Enfermagem prioritários entre os pacientes com depressão foram: humor deprimido (100%), crise (68,4%), insônia (45,6%) e risco de suicídio (49,1%). As variáveis independentes que impactaram, de forma significativa, o desfecho depressão foram: sexo feminino (p=0,012), insônia (p=0,006) e risco de suicídio (p<0,001). CONCLUSÃO: identificar precocemente possíveis fatores e diagnósticos de Enfermagem associados à pessoa com depressão poderá auxiliar na implementação de cuidados acurados a pacientes com esse problema atendidos em Centro de Atenção Psicossocial.

OBJECTIVE: estimate the prevalence of depression in patients seen in a psychosocial care center, identify the sociodemographic factors and nursing diagnoses associated with the outcome. METHOD: cross-sectional study, carried out between January and June 2018, in 370 medical records of patients treated, from 2002 to 2016, in a psychosocial care center in a municipality in the north of Minas Gerais, Brazil. With the aid of an instrument, clinical, sociodemographic and nursing diagnoses data were collected. Nursing diagnoses were validated by specialists with support for Risner's diagnostic reasoning. Descriptive, bivariate analysis and logistic regression were performed. RESULTS: of the 370 patients, 57 (15.4%) had depression. The majority (53.2%) were female and the average age was 36 years. The priority nursing diagnoses among patients with depression were: depressed mood (100%), crisis (68,4%), insomnia (45,6%) and risk of suicide (49,1%). The independent variables that significantly impacted the depression outcome were: female gender (p=0,012), insomnia (p=0,006) and risk of suicide (p<0,001). CONCLUSION: early identification of possible nursing factors and diagnoses associated with a person with depression may help in the implementation of accurate care for patients with this problem treated at a psychosocial care center.

OBJETIVO: estimar la prevalencia de depresión en pacientes atendidos en un centro de atención psicosocial, identificar los factores sociodemográficos y diagnósticos de enfermería asociados al resultado. MÉTODO: estudio transversal, realizado entre enero y junio de 2018, en 370 historias clínicas de pacientes atendidos, de 2002 a 2016, en un centro de atención psicosocial de un municipio del norte de Minas Gerais, Brasil. Con la ayuda de un instrumento se recolectaron datos de diagnósticos clínicos, sociodemográficos y de enfermería. Los diagnósticos de enfermería fueron validados por especialistas con apoyo del razonamiento diagnóstico de Risner. Se realizó análisis descriptivo, bivariado y regresión logística. RESULTADOS: de los 370 pacientes, 57 (15,4%) tenían depresión. La mayoría (53,2%) eran mujeres y la edad media era de 36 años. Los diagnósticos de enfermería prioritarios entre los pacientes con depresión fueron: estado de ánimo deprimido (100%), crisis (68,4%), insomnio (45,6%) y riesgo de suicidio (49,1%). Las variables independientes que impactaron significativamente el resultado de la depresión fueron: sexo femenino (p=0,012), insomnio (p=0,006) y riesgo de suicidio (p<0,001). CONCLUSIÓN: la identificación temprana de posibles factores de enfermería y diagnósticos asociados a una persona con depresión puede ayudar en la implementación de una atención adecuada a los pacientes con este problema atendidos en un centro de atención psicosocial.

Percurso assistencial de pacientes convivendo com câncer de pulmão / Care pathway of patients living with lung cancer / Recorrido asistencial de pacientes que conviven con cáncer de pulmón

Resumo Este artigo analisa dificuldades enfrentadas por pacientes com câncer de pulmão e familiares em seu itinerário diagnóstico e terapêutico. Trata-se de pesquisa qualitativa, baseada no método de grupo focal, de que participaram pacientes e familiares. Das falas dos participantes, destacam-se duas categorias de análise: "início do percurso e diagnóstico" e "em busca do tratamento: barreiras". Discute-se a dificuldade de diagnóstico causada por problemas de infraestrutura dos serviços, pela escassez de recursos financeiros dos pacientes, pela inadequação da rede de saúde pública e pelo despreparo profissional. Após o diagnóstico, apresenta-se o percurso em busca do tratamento e as barreiras financeiras, geográficas, estruturais e de processo de trabalho na saúde pública. Resultados mostram que pacientes de pequenos municípios ou da zona rural se deparam com mais dificuldades para acessar os serviços. Conclui-se que o percurso assistencial, no setor público, é prejudicado por desigualdades e vulnerabilidades em saúde que se refletem em dificuldade de acesso e demora no diagnóstico e tratamento da doença.

Abstract This article analyzes the feelings and difficulties of lung cancer patients and their families regarding diagnostic and therapeutic itineraries. This is qualitative research with focus group of patient/family dyads. Two categories of analysis stood out: 'Pathway start and Diagnosis' and 'In search of treatment: barriers'. The difficulty of diagnosis is discussed due to the lack of infrastructure of services, scarce financial resources of patients, inadequate public health network and unpreparedness for diagnosis. After diagnosis, we present the path in search of treatment and the financial, geographical, structural and work process barriers in public health. Patients in small municipalities or rural areas face more difficulties in accessing health services. We conclud that the care pathway in the public sector is influenced by health inequalities and vulnerabilities, reflecting less access to services and delayed diagnosis and treatment of the disease.

Resumen Este artículo analiza las dificultades enfrentadas por los pacientes con cáncer de pulmón y sus familiares en su recorrido diagnóstico y terapéutico. Se trata de una investigación cualitativa, con base en el método de grupo focal, en el que participaron pacientes y familiares. De los diálogos de los participantes, destacan dos categorías de análisis: "inicio del recorrido y diagnóstico" y "en busca de tratamiento: barreras". Se discute la dificultad de diagnóstico causada por problemas de infraestructura de los servicios, por la escasez de recur¬sos financieros de los pacientes, por la inadecuación de la red de salud pública y por la falta de preparación profesional. Tras el diagnóstico, tiene lugar el recorrido en busca del tratamiento y las barreras financieras, geográficas, estructurales y de proceso de trabajo en la salud pública. Los resultados muestran que pacientes de municipios pequeños o de la zona rural se enfrentan a más dificultades para acceder a los servicios. Se con¬cluye que el recorrido asistencial, en el sector público, está perjudicado por desigualdades y vulnerabilidades en salud que se reflejan en dificultad de acceso y retraso en el diagnóstico y tratamiento de la enfermedad.

Alamandine improves cardiac remodeling induced by transverse aortic constriction in mice.

Alamandine is the newest identified peptide of the renin-angiotensin system (RAS) and has protective effects in the cardiovascular system. Although the involvement of classical RAS components in the genesis and progression of cardiac remodeling is well known, less is known about the effects of alamandine. Therefore, in the present study we investigated the effects of alamandine on cardiac remodeling induced by transverse aortic constriction (TAC) in mice. Male mice (C57BL/6), 10-12 wk of age, were divided into three groups: sham operated, TAC, and TAC + ALA (30 µg/kg/day alamandine for 14 days). The TAC surgery was performed under ketamine and xylazine anesthesia. At the end of treatment, the animals were submitted to echocardiographic examination and subsequently euthanized for tissue collection. TAC induced myocyte hypertrophy, collagen deposition, and the expression of matrix metalloproteinase (MMP)-2 and transforming growth factor (TGF)-ß in the left ventricle. These markers of cardiac remodeling were reduced by oral treatment with alamandine. Western blotting analysis showed that alamandine prevents the increase in ERK1/2 phosphorylation and reverts the decrease in 5'-adenosine monophosphate-activated protein kinase (AMPK)α phosphorylation induced by TAC. Although both TAC and TAC + ALA increased SERCA2 expression, the phosphorylation of phospholamban in the Thr17 residue was increased solely in the alamandine-treated group. The echocardiographic data showed that there are no functional or morphological alterations after 2 wk of TAC. Alamandine treatment prevents myocyte hypertrophy and cardiac fibrosis induced by TAC. Our results reinforce the cardioprotective role of alamandine and highlight its therapeutic potential for treating heart diseases related to pressure overload conditions.NEW & NOTEWORTHY Alamandine is the newest identified component of the renin-angiotensin system protective arm. Considering the beneficial effects already described so far, alamandine is a promising target for cardiovascular disease treatment. We demonstrated for the first time that alamandine improves many aspects of cardiac remodeling induced by pressure overload, including cell hypertrophy, fibrosis, and oxidative stress markers.

Trends in pediatric hospitalizations for ambulatory care sensitive respiratory diseases in Brazil.

OBJECTIVE: To analyze the trend in hospitalization rates for ambulatory care sensitive respiratory diseases (ACSRD) of children under five years of age in Brazil. DESIGN: Time series study of hospitalization rates using secondary information from the Hospital Information System of the Brazil's Unified Health System. SAMPLE: Hospitalizations of children under five years of age living in Brazilian regions. Hospitalizations were separated according to cause: nose and throat infections, asthma, bacterial pneumonias, and lung diseases. MEASUREMENTS: Rates were calculated for total hospitalizations for ACSRD, and by cause, age group, and region. Trends were analyzed by using means of simple linear regression and were classified into stationary (p ≥ .05), ascending (ß positive and p < .05) or declining (ß negative and p < .05) trends. RESULTS: All regions showed stationary trends in total hospitalization rates for ACSRDs, except in the Southeast, where trends were ascending. Asthma was the only cause that showed a declining trend. Bacterial pneumonias showed stationary trends, while lung diseases and nose and throat infections had predominantly ascending trends. CONCLUSION: Brazil's hospitalization rates for ACSRDs are high. Investigations into primary health care organization and work processes, as well as socioeconomic, cultural, and geographical factors are necessary.

Analysis of the trend of hospitalizations for asthma in children and adolescents in Brazil.

OBJECTIVE: To analyze the trend of hospitalizations for asthma in children and adolescents by region and age group in Brazil, from 2008 to 2017. METHOD: This is a time-series study with secondary data regarding hospitalizations for asthma in children and adolescents, according to age, region, and gender. Descriptive statistics procedures were used with measures of central tendency to calculate the variation between the periods of 2008 and 2017. Rates of hospitalizations were calculated specifically by age group and region. Time trend analysis was performed by simple linear regression, considered as stationary (p>0.05), declining (p<0.05 and negative regression coefficient), or ascending (p<0.05) and positive regression coefficient). RESULTS: The present study identified a higher proportion of hospitalizations for asthma in Brazil in children aged 5-9 years. Regarding gender, there were more hospitalizations in boys. The region that presented the highest proportion of hospitalizations, in all age groups investigated, was the Northeast. As for the trend analysis, this article showed that, in Brazil, there was a trend toward a reduction in hospitalization rates for asthma. CONCLUSION: In Brazil, there was a tendency to reduce hospitalizations for all investigated age groups. The Northeast was the only region that showed a decline in all age groups.

Swimming training improves cardiovascular autonomic dysfunctions and prevents renal damage in rats fed a high-sodium diet from weaning.

NEW FINDINGS: What is the central question of this study? How does swimming exercise training impact hydro-electrolytic balance, renal function, sympathetic contribution to resting blood pressure and cerebrospinal fluid (CSF) [Na+ ] in rats fed a high-sodium diet from weaning? What is the main finding and its importance? An exercise-dependent reduction in blood pressure was associated with decreased CSF [Na+ ], sympathetically driven vasomotor tonus and renal fibrosis indicating that the anti-hypertensive effects of swimming training in rats fed a high-sodium diet might involve neurogenic mechanisms regulated by sodium levels in the CSF rather than changes in blood volume. ABSTRACT: High sodium intake is an important factor associated with hypertension. High-sodium intake with exercise training can modify homeostatic hydro-electrolytic balance, but the effects of this association are mostly unknown. In this study, we sought to investigate the effects of swimming training (ST) on cerebrospinal fluid (CSF) Na+ concentration, sympathetic drive, blood pressure (BP) and renal function of rats fed a 0.9% Na+ (equivalent to 2% NaCl) diet with free access to water for 22 weeks after weaning. Male Wistar rats were assigned to two cohorts: (1) fed standard diet (SD) and (2) fed high-sodium (HS) diet. Each cohort was further divided into trained and sedentary groups. ST normalised BP levels of HS rats as well as the higher sympathetically related pressor activity assessed by pharmacological blockade of ganglionic transmission (hexamethonium). ST preserved the renal function and attenuated the glomerular shrinkage elicited by HS. No change in blood volume was found among the groups. CSF [Na+ ] levels were higher in sedentary HS rats but were reduced by ST. Our findings showed that ST effectively normalised BP of HS rats, independent of its effects on hydro-electrolytic balance, which might involve neurogenic mechanisms regulated by Na+ levels in the CSF as well as renal protection.

Propriedades psicométricas de instrumento para avaliação de egressos de cursos de graduação em enfermagem / Propiedades psicométricas de un instrumento de evaluación de egresados de carreras de enfermería / Psychometric properties of an assessment instrument of graduates of nursing undergraduate courses

Resumo Objetivo Validar psicometricamente o Instrumento Avaliação de Egressos de Enfermagem. Métodos Estudo transversal, quantitativo, realizado em três Cursos de Graduação em Enfermagem localizados nos Estados de São Paulo, Minas Gerais e Acre, Brasil, com 446 participantes. A confiabilidade foi testada pelo alfa de Cronbach (consistência interna e reprodutibilidade) e a validade de construto foi obtida pela análise fatorial exploratória e pela análise dos componentes principais. Resultados O valor do coeficiente Alfa de Cronbach total do instrumento foi de 0,98; os coeficientes de correlação intraclasse total de (94%), evidenciando forte concordância entre as medições. Na análise fatorial, KMO foi de 0,971 e o teste de esfericidade de Bartlett apresentou resultados significativos (p<0,001) para todos os construtos e as matrizes de correlação entre os itens de cada construto. Conclusão As análises psicométricas mostraram resultados favoráveis, evidenciando forte consistência interna do instrumento. O Instrumento Avaliação de Egressos de Enfermagem é válido e confiável para a avaliação da formação profissional do egresso bacharel em Enfermagem.

Resumen Objetivo Validar psicométricamente el instrumento Evaluación de Egresados de Enfermería. Métodos Estudio transversal, cuantitativo, realizado en tres carreras de grado de enfermería ubicadas en los estados de São Paulo, Minas Gerais y Acre, Brasil, con 446 participantes. La fiabilidad fue probada mediante el alfa de Cronbach (consistencia interna y reproducibilidad) y la validez del constructo se obtuvo con el análisis factorial exploratorio y el análisis de los componentes principales. Resultados El valor del coeficiente alfa de Cronbach total del instrumento fue de 0,98. Los coeficientes de correlación intraclase totales fueron del 94 %, lo que evidencia fuerte concordancia entre las mediciones. En el análisis factorial, el KMO fue de 0,971 y la prueba de esfericidad de Bartlett presentó resultados significativos (p<0,001) en todos los constructos y las matrices de correlación entre los ítems de cada constructo. Conclusión Los análisis psicométricos mostraron resultados favorables, lo que evidencia una fuerte consistencia interna del instrumento. El instrumento Evaluación de Egresados de Enfermería es válido y confiable para evaluar la formación profesional del egresado Licenciado en Enfermería.

Abstract Objective Psychometric validation of the Assessment Instrument of Nursing Graduates. Methods Cross-sectional, quantitative study conducted in three Nursing Undergraduate Courses located in the states of São Paulo, Minas Gerais and Acre, Brazil, with 446 participants. Reliability was tested by Cronbach's alpha (internal consistency and reproducibility) and construct validity was obtained by exploratory factor analysis and principal component analysis. Results The overall Cronbach's alpha coefficient of the instrument was 0.98; the overall intraclass correlation coefficient (94%) showed strong agreement between measurements. In factor analysis, KMO was 0.971 and the Bartlett's sphericity test showed significant results (p<0.001) for all constructs and correlation matrices between the items of each construct. Conclusion The psychometric analyzes showed favorable results and a strong internal consistency of the instrument. The Assessment Instrument of Nursing Graduates is valid and reliable to evaluate the professional education of Nursing graduates.