Sociodemographic, behavioral, obstetric, and healthcare factors associated with low weight at birth: a case-control study

ABSTRACT BACKGROUND: Understanding social determinants is crucial for implementing preventive strategies, especially for low birth weight (LBW)—a public health issue that severely increases the risk of morbimortality in children. OBJECTIVE: This study aimed to identify the factors associated with LBW among newborns, assisted by the Brazilian Unified Health System. DESIGN AND SETTING: It analyzed data from newborns and their mothers. The sample was selected by convenience from users of the public health system in Francisco Beltrão (Paraná, Brazil). METHODS: Cases (n = 26) were babies weighing ≤ 2,500 g and controls (n = 52) > 2,500 g. All babies were assessed and paired by sex and date of birth in a 1:2 proportion. Statistical power was computed a posteriori, revealing a power of 87% (α = 0.05). RESULTS: Strong and significant differences were found in the bivariate analysis, in which the number of current smokers or those who quit during pregnancy was higher among mothers of babies with LBW. Moreover, the gestational weeks were lower among these cases. Logistic regression models indicated that the gestational week (odds ratio [OR] = 0.17, 95% confidence interval [CI]:0.05-0.54) and fathers' educational level (high school or above; OR = 0.22, 95% CI:0.06-0.99) were related to lower chances of low birth weight. CONCLUSIONS: Our findings confirm previous investigations on LBW's multi-causality, showing that the gestational week could reduce up to 82% chances of a baby being born with ≤ 2,500 g. Its association with paternal education underlines the importance of comprehensive policies to protect newborns.

Assessing a cut-off point for the diagnosis of abnormal uterine bleeding using the Menstrual Bleeding Questionnaire (MBQ): a validation and cultural translation study with Brazilian women

ABSTRACT BACKGROUND: Abnormal uterine bleeding (AUB) is a common condition, and the Menstrual Bleeding Questionnaire (MBQ) is used for its assessment. OBJECTIVES: To translate, assess the cut-off point for diagnosis, and explore psychometric properties of the MBQ for use in Brazilian Portuguese. DESIGN AND SETTING: Prospective cohort study including 200 women (100 with and 100 without AUB) at a tertiary referral center. METHODS: MBQ translation involved a pilot-testing phase, instrument adjustment, data collection, and back-translation. Cut-off point was obtained using receiver operating curve analysis. Menstrual patterns, impact on quality of life due to AUB, internal consistency, test-retest, responsiveness, and discriminant validity were assessed. For construct validity, the Pictorial Blood Assessment Chart (PBAC) and World Health Organization Quality of Life - abbreviated version (WHOQOL-BREF) were applied. RESULTS: Women with AUB were older, had higher body mass indices, and had a worse quality of life during menstruation. Regarding the MBQ's psychometric variables, Cronbach's alpha coefficient was > 0.70 in all analyses, high intraclass correlation coefficient was found in both groups; no ceiling and floor effects were observed, and construct validity was demonstrated (correlation between MBQ score, PBAC score, and clinical menstrual cycle data). No difference between MBQ and PBAC scores were perceived after the test-retest. Significant differences were found between MBQ and PBAC scores before and after treatment. An MBQ score ≥ 24 was associated with a high probability of AUB; accuracy of 98%. CONCLUSION: The MBQ is a reliable questionnaire for Brazilian women. The cut-off ≥ 24 shows high accuracy to discriminate AUB.

Potentially inappropriate medications with older people in intensive care and associated factors: a historic cohort study

ABSTRACT BACKGROUND: The epidemiology of potentially inappropriate medications (PIMs) in critical care units remains limited, especially in terms of the factors associated with their use. OBJECTIVE: To estimate the incidence and factors associated with PIMs use in intensive care units. DESIGN AND SETTING: Historical cohort study was conducted in a high-complexity hospital in Brazil. METHODS: A retrospective chart review was conducted on 314 patients aged ≥ 60 years who were admitted to intensive care units (ICUs) at a high-complexity hospital in Brazil. The dates were extracted from a "Patient Safety Project" database. A Chi-square test, Student's t-test, and multivariable logistic regression analyses were performed to assess which factors were associated with PIMs. The statistical significance was set at 5%. RESULTS: According to Beers' criteria, 12.8% of the identified drugs were considered inappropriate for the elderly population. The incidence rate of PIMs use was 45.8%. The most frequently used PIMs were metoclopramide, insulin, antipsychotics, non-steroidal anti-inflammatory drugs, and benzodiazepines. Factors associated with PIMs use were the number of medications (odds ratio [OR] = 1.17), length of hospital stay (OR = 1.07), and excessive potential drug interactions (OR = 2.43). CONCLUSIONS: Approximately half of the older adults in ICUs received PIM. Patients taking PIMs had a longer length of stay in the ICU, higher numbers of medications, and higher numbers of potential drug interactions. In ICUs, the use of explicit methods combined with clinical judgment can contribute to the safety and quality of medication prescriptions.

Quality of life of older adults in Family Health Strategy: a cross-sectional study

ABSTRACT BACKGROUND: With the increase in the older adult population, it is essential to identify the living and health conditions that can impact the quality of life of these individuals. OBJECTIVES: To identify the domains and factors associated with the quality of life of older adults under the Family Health Strategy program. DESIGN AND SETTING: This was a cross-sectional analytical study was conducted in the municipality of Palmas, Tocantins, Brazil. METHODS: We assessed 449 older adults enrolled in the Family Health Strategy program. Data were collected between April and July, 2018. World Health Organization Quality of Life Assessment (WHOQOL-OLD) was used to assess the quality of life (QoL) and multiple linear regression was used to estimate the factors associated with QoL. RESULTS: The QoL domain with the highest score was death and dying (mean = 70.4), and the lowest score was for sensory functions (mean = 61.0 points). The factors associated with QoL were single marital status (β = -4.55; P = 0.014), level of independence for daily living activities (β = 4.92; P < 0.001), self-assessment of regular health (β = 5.35; P < 0.001), and poor health (β = -8.67; P < 0.001). CONCLUSION: The death and dying domain of QoL presented the highest score. Marital status, impairment in daily activities, and health self-assessment were associated with QoL.

Global research trends related to coronavirus disease 2019 and the aged: a bibliometric analysis

ABSTRACT BACKGROUND: A bibliometric analysis covering only the production of original studies or considering world production until 2022 has yet to be conducted. The creation and advancement of vaccines have also influenced research priorities, demonstrating the need for a new approach to this subject. OBJECTIVES: To analyze worldwide scientific production related to coronavirus disease 2019 (COVID-19) and the aged and to describe what has already been produced. DESIGN AND SETTING: Bibliometric analysis with a quantitative approach. METHOD: The search terms "COVID-19," "SARS-CoV-2," "Aged," and "Elderly" were used to retrieve articles from the Web of Science database. A total of 684 articles were included in the analysis. Data were imported into RStudio Desktop Software and linked to R Software. The Bibliometrix R package and VOSviewer software were used for analysis. RESULTS: Most articles were published in 2020. These were produced by 4,937 authors and published in 379 journals. The keyword most used by the authors was "COVID-19." Publications from 77 countries were obtained. China had the highest article production ranking, and Spain collaborated the most. The articles addressed the implications of the pandemic on the aged, the relationship between vaccination in the aged, and the implications for the disease itself. CONCLUSION: Further research should be conducted, mainly concerning vaccines and vaccination of the aged, owing to the need for and importance of immunization in this risk group, including assessing the long-term effects of vaccines.

Assessing the effect of prophylactic ankle taping on ankle and knee biomechanics during landing tasks in healthy individuals: A cross-sectional observational study

ABSTRACT BACKGROUND: Current research supports the fact that prophylactic ankle taping (AT) is effective in preventing ankle injuries in amateur and elite sports athletes. OBJECTIVE: This study aimed to investigate the effect of AT on balance, knee valgus during drop jump and single-leg countermovement jump (SL-CMJ) landings, and ankle range of motion (ROM) restriction in healthy participants. DESIGN AND SETTING: A cross-sectional observational study was conducted at the Universidad Europea de Madrid, Madrid, Spain. METHODS: Participants: Thirty-nine healthy individuals participated in this study and performed the movements under two conditions (with and without tape). Outcome measurements: ankle ROM, balance, SL-CMJ height, flight time, ground time, and knee valgus. Before any intervention, a random process was developed with a 1:1 allocation ratio, and the participants were assigned to groups A (tape-no tape) and B (no tape-tape). RESULTS: Significant differences between tape and no-tape moments were observed for drop jump knee valgus flexion (P = 0.007), with an increase in knee valgus in participants with ankle taping. Similarly, the Y-balance testshowed a significant decrease in all variables (P = 0.001 and), ankle dorsiflexion (P = 0.001) in participants with ankle taping. CONCLUSIONS: AT is effective for immediate ankle ROM restriction. However, an increase in knee valgus during drop jump task and a decrease in lower limb balance were observed during drop jump task. Based on these results, it can be concluded that AT application in healthy individuals should not be recommended as it results in increase in injury risk factors.

Is ankle taping effective to limit the ankle dorsiflexion in a single-training session? An observational study in semi-professional basketball players

ABSTRACT BACKGROUND: Ankle taping (AT) is effective in preventing ankle sprain injuries in most common sports and is employed in rehabilitation and prevention sports. OBJECTIVE: This study aimed to investigate the effectiveness of AT to restricting excessive frontal plane ankle movements in semi-professional basketball players throughout the training session. DESIGN AND SETTING: A cross-sectional study was performed at the Universidad Europea de Madrid. METHODS: Forty male and female semi-professional basketball players were divided into two groups. The ankle dorsiflexion range of motion (ROM) and interlimb asymmetries in a weight-bearing lunge position were evaluated at four time points: 1) with no tape, 2) before practice, at 30 min of practice, and 3) immediately after practice. RESULTS: In male basketball players, no differences were observed in the right and left ankles between the baseline and 30 min and between baseline and 90 min of assessment. In female athletes, significant differences were reported between baseline and pre-training assessments for the right ankle and also significant differences between baseline and 90 min in both ankles. CONCLUSIONS: Ankle taping effectively decreased the ankle dorsiflexion ROM in male and female basketball players immediately after application. However, ROM restriction was very low after 30 and 90 min, as assessed in a single basketball practice. Therefore, the classic taping method should be revised to develop new prophylactic approaches, such as the implementation of semi-rigid bracing techniques or the addition of active stripes during training or game pauses.

High-intensity interval training in people with spinal cord injury: a systematic review / Entrenamiento por intervalos de alta intensidad en personas con lesiones medulares: una revisión sistemática / Treinamento intervalado de alta intensidade em pessoas com lesão da medula espinhal: revisão sistemática

ABSTRACT Objective: Analyze the effects of high-intensity interval training (HIIT) on cardiometabolic parameters, and cardiorespiratory fitness to compile the most used HIIT training types in adults with spinal cord injury (SCI). Methods: This is a systematic review of searches performed in the electronic databases PubMed / Medline, Science Direct, and Google Scholar. Studies included I) needed to apply HIIT training II) adults with SCI to analyze III) cardiometabolic aspects and cardiorespiratory fitness. Two independent reviewers selected the articles for inclusion, extracted their data, and assessed their methodological quality. Results: 654 studies were found. Thus, 12 studies, 11 pre- and post-intervention, and one control group (CG) with 106 participants were analyzed. Pre- and post-HIITT intervention results revealed significant improvement in cardiorespiratory fitness and cardiometabolic aspects (VO2peak, LDH, HDL, insulin resistance). In addition, GC results revealed significant improvement in cardiorespiratory fitness observed in the intervention group (HIIT) compared to the moderate-low intensity (GC) group. Seven studies used the arm ergometer as the primary exercise modality. Two studies described functional electrical stimulation (FES) performed with the arm ergometer plus electrical stimulation in the lower limbs. None reported heart rate dynamics during the study period. Conclusion: High-intensity interval training improves physical fitness and cardiometabolic health in adults with SCI. Evidence level II; Systematic Review of level II studies.

RESUMEN Objetivo: Analizar los efectos del entrenamiento interválico de alta intensidad (HIIT) sobre los parámetros cardiometabólicos, fitness cardiorrespiratorio y recopilar los tipos de HIIT más utilizados en el entrenamiento en adultos con lesión medular (LME). Métodos: Se trata de una revisión sistemática, para lo cual se realizaron búsquedas en bases de datos electrónicas PubMed/Medline, Science Direct y Google Scholar. Se incluyeron estudios que I) necesitaban aplicar entrenamiento HIIT en II) adultos con SCI y analizar III) aspectos cardiometabólicos y aptitud cardiorrespiratoria. Dos revisores independientes seleccionaron los artículos para su inclusión, extrajeron sus datos y evaluaron su calidad metodológica. Resultados: De los 654 estudios encontrados, se analizaron 12 estudios, 11 pre y post intervención y 1 grupo control (GC) con un total de 106 participantes. Los resultados previos y posteriores a la intervención HIIT revelaron una mejora significativa en la aptitud cardiorrespiratoria y los aspectos cardiometabólicos (VO2pico, LDH, HDL, resistencia a la insulina). Los resultados de GC revelaron una mejora significativa en la aptitud cardiorrespiratoria observada del grupo de intervención (HIIT) en comparación con el grupo de intensidad moderada-baja (GC). Siete estudios utilizaron el ergómetro de brazo como la modalidad principal de ejercicio. Dos estudios describieron la estimulación eléctrica funcional (EEF) realizada con el ergómetro de brazo más la estimulación eléctrica en los miembros inferiores. Ninguno informó la dinámica de la frecuencia cardíaca durante el período de estudio. Conclusiones: El entrenamiento intervalos de alta intensidad mejora la condición física y la salud cardiometabólica en adultos con LME. Evidencia de nivel II; Revisión sistemática de estudios de nivel II.

RESUMO Objetivo: Analisar os efeitos do treinamento intervalado de alta intensidade (HIIT) nos parâmetros cardiometabólicos, aptidão cardiorrespiratória e compilar os tipos de HIIT mais utilizados no treinamento em adultos com lesão da medula espinhal (LME). Métodos: Trata-se de revisão sistemática, para a qual foram realizadas pesquisas nas bases de dados eletrônicas PubMed / Medline, Science Direct e Google Scholar. Foram incluídos estudos em que I) o treinamento HIIT era aplicado em II) adultos com LME e analisaram III) os aspectos cardiometabólicos e aptidão cardiorrespiratória. Dois revisores independentes selecionaram os artigos para a inclusão, extraindo seus dados e avaliarando a sua qualidade metodológica. Resultados: 654 estudos foram encontrados. Desses, 12 estudos, 11 pré e pós intervenção e 1 grupo controle (GC) com um total de 106 participantes foram analisados. Resultados pré e pós intervenção de HIIT revelaram significante melhora na aptidão cardiorrespiratória e aspectos cardiometabólicos (VO2pico, LDH, HDL, resistência à insulina). Resultados do GC revelaram uma significativa melhoria na aptidão cardiorrespiratória observada no grupo de intervenção (HIIT) em relação ao grupo de intensidade moderada-baixa (GC). Sete estudos usaram o ergômetro de braço como modalidade de exercício primária. Dois estudos descreveram a estimulação elétrica funcional (EEF) realizada com o ergômetro de braço adicionando estimulação elétrica nos membros inferiores. Nenhum relatou a dinâmica da frequência cardíaca durante o período do estudo. Conclusão: O treinamento intervalado de alta intensidade melhora a aptidão física e a saúde cardiometabólica em adultos com LME. Nível de evidência II; Revisão sistemática de Estudos de Nível II.

Pilates vs aerobic training effects in hypertensives: randomized trial / Efectos del pilates vs entrenamiento aeróbico en hipertensos: ensayo aleatorizado / Efeitos do pilates vs treinamento aeróbio em hipertensos: ensaio randomizado

ABSTRACT Introduction: The Pilates method (PM) combines slow-deep breathing with strengthening and stretching exercises. However, it has been proposed as a method of physical conditioning for several decades and only recently aroused academic/scientific interest, with few reports of the effects of this intervention in hypertensive patients. Objective: to compare PM to aerobic training (AT) effects on hypertensive subjects' blood pressure (BP), functional capacity and autonomic balance. Methods: Twenty-four hypertensive subjects were randomly allocated into two groups: ATG performed three 40 min sessions/week, moderate intensity (40-70% of reserve HR), and PMG performed two 60 min sessions/week; both during the same eight weeks period. Blood pressure (casual and for 24 hours), 6-minute walking test (6-MWT) and autonomic balance were evaluated before and after intervention. Results: There was a reduction on systolic BP (SBP, p=0.007), diastolic (p=0.032) and mean blood pressure (MBP, p=0.016), measured on 24h, on PMG. There was also a 24h SBP reduction on ATG (p=0.021). The PMG had a greater reduction on 24h SBP (-3.4 mmHg, 95% CI -6.6 to -0.2) and MBP (-3.3 mmHg, 95% CI -6.3 to -0.3) than the ATG. ATG held a longer distance in 6-MWT. Casual BP and autonomic balance had no difference. Conclusion: This PM protocol was superior to AT on BP monitored for 24 hours in hypertensive subjects, but AT was better for functional capacity. The eight weeks of training were not enough to change the autonomic balance. Level of Evidence: I; High-quality randomized clinical trial with or without statistically significant difference, but with narrow confidence intervals.

RESUMEN Introducción: el método Pilates (MP) combina la respiración lenta-profunda con ejercicios de fortalecimiento y estiramiento. Aunque se ha propuesto como un método de acondicionamiento físico durante varias décadas, solo recientemente despertó interés académico/científico, con pocos reportes de los efectos de esta intervención en pacientes hipertensos. Objetivo: comparar los efectos del MP con el entrenamiento aeróbico (EA) sobre la presión arterial (PA), la capacidad funcional y el equilibrio autónomo en sujetos hipertensos. Métodos: Veinticuatro sujetos hipertensos fueron asignados aleatoriamente en dos grupos: GEA realizó tres sesiones de 40 min/semana, intensidad moderada (40-70% de la FC de reserva), y GMP realizó dos sesiones de 60 min/semana; ambos durante el mismo período de 8 semanas. La presión arterial (casual y durante 24 horas), la prueba de marcha de 6 minutos y el equilibrio autonómico se evaluaron antes y después de la intervención. Resultados: Hubo una reducción de la PA sistólica (PAS, p = 0,007), diastólica (p = 0,032) y presión arterial media (PAM, p = 0,016), medida a las 24 h, en GMP. También hubo una reducción de PAS en 24 h en GEA (p = 0,021). El GMP tuvo una mayor reducción en la PAS de 24 h (-3,4 mmHg, CI del 95%: -6,6 a -0,2) y la PAM (-3,3 mmHg, CI del 95%: -6,3 a -0,3) que la GEA. GEA mantuvo una mayor distancia en la prueba de marcha de 6 minutos. La PA casual y el equilibrio autónomo no tuvieron diferencias. Conclusión: Este protocolo de MP fue superior al EA en la PA monitoreada durante 24 horas en sujetos hipertensos, pero el EA fue mejor para la capacidad funcional. Las ocho semanas de entrenamiento no fueron suficientes para cambiar el equilibrio autonómico. Nivel de Evidencia: I; Estudio clínico aleatorizado de alta calidad con o sin diferencia estadísticamente significativa, pero con intervalos de confianza estrechos.

RESUMO Introdução: O método Pilates (MP) combina respiração lenta e profunda com exercícios de fortalecimento e alongamento. Embora tenha sido proposto como método de condicionamento físico por várias décadas, só recentemente despertou-se o interesse acadêmico/científico, com poucos relatos dos efeitos dessa intervenção em hipertensos. Objetivos: comparar os efeitos do MP com o treinamento aeróbio (TA) sobre a pressão arterial (PA), capacidade funcional e equilíbrio autonômico em hipertensos. Métodos: Vinte e quatro hipertensos foram alocados aleatoriamente em dois grupos: O grupo GTA realizou três sessões de 40 min/semana, intensidade moderada (40-70% da FC de reserva), e o grupo GMP, que realizou duas sessões de 60 min/semana; ambos durante o mesmo período de 8 semanas. A pressão arterial (casual e após 24 horas), o teste de caminhada de 6 minutos (TC6) e o equilíbrio autonômico foram avaliados antes e depois da intervenção. Resultados: Houve redução da PA sistólica (PAS, p = 0,007), diastólica (p = 0,032) e da pressão arterial média (PAM, p = 0,016), medida em 24h, sem GMP. Também houve redução da PAS em 24h no GTA (p = 0,021). O GMP teve uma redução maior em 24h PAS (-3,4 mmHg, IC 95% -6,6 a -0,2) e PAM (-3,3 mmHg, IC 95% -6,3 a -0,3) do que o GTA. O GTA manteve uma maior distância no TC6. A PA casual e o equilíbrio autonômico não apresentaram diferenças estatísticas. Conclusão: Este protocolo de MP foi superior ao TA na PA monitorada por 24 horas em hipertensos, porém o TA foi superior para a capacidade funcional. As oito semanas de treinamento não foram suficientes para alterar o equilíbrio autonômico. Nível de Evidência: 1; Estudo clínico randomizado de alta qualidade com ou sem diferença estatisticamente significativa, mas com intervalos de confiança estreitos.

Quantitative relationship between physical activity and antihypertensives in elderly women / Relación cuantitativa entre actividad física y antihipertensivos en ancianas / Relação quantitativa entre atividade física e anti-hipertensivos em idosas

ABSTRACT Introduction: Physical activity is an important tool to manage systemic arterial hypertension. However, less is known about the relationship of physical activity with the number of antihypertensive drugs used by older adults. Objective: The aim of this study was to compare the number of antihypertensive drugs used by older female adults (aged ≥ 60 years) with a low level of physical activity with the number used by those with a high level of physical activity, and to verify how many participants used more than two antihypertensive drugs. Methods: Twenty-eight physically active older women with systemic arterial hypertension who participated in a physical activity program for community-dwelling older female adults were divided into two groups: participants who presented lower habitual physical activity levels were placed in group 1 and participants that presented higher habitual physical activity levels were placed in group 2, according to the Baecke questionnaire. In addition, the number of antihypertensive drugs used by participants was collected. Results: The number of prescribed antihypertensive drugs was 2.0 (median) for both groups investigated. There was no significant difference between groups regarding the number of antihypertensive tablets prescribed (p>0.05). Although there was no statistical difference, a higher proportion of participants from the lower physical activity group used more than two antihypertensive drugs. Conclusion: The level of habitual physical activity did not affect the number of antihypertensive tablets used by hypertensive elderly women. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMEN Introducción: La actividad física es una herramienta importante para el manejo de la hipertensión arterial sistémica. Sin embargo, se sabe poco sobre la relación de la actividad física con la cantidad de medicamentos antihipertensivos utilizados por las ancianas. Objetivo: El objetivo de este estudio fue hacer una comparación entre el número de medicamentos antihipertensivos utilizados por mujeres adultas mayores (≥ 60 años) y bajo nivel de actividad física con el número utilizado por aquellas con alto nivel de actividad física, y verificar cuántas de las participantes usaron más de dos medicamentos antihipertensivos. Métodos: Veintiocho ancianas físicamente activas con hipertensión arterial sistémica que participaron en un programa de actividad física para mujeres adultas mayores residentes en la comunidad fueran divididas en dos grupos: las participantes que presentaron niveles más bajos de actividad física habitual se ubicaron en el grupo 1 y las participantes que presentaron los mayores niveles de actividad física se ubicaron en el grupo 2, según el cuestionario de Baecke. Además, se recogió el número de medicamentos antihipertensivos utilizados por las participantes. Resultados: El número de comprimidos antihipertensivos prescritos fue de 2,0 (mediana) para ambos grupos investigados. No hubo diferencia significativa entre los grupos en cuanto al número de medicamentos antihipertensivos prescritos (p>0,05). Aunque no hubo diferencia estadística, una mayor proporción de participantes del grupo de menor actividad física usó más de dos medicamentos antihipertensivos. Conclusión: El nivel de actividad física habitual no afectó el número de comprimidos antihipertensivos utilizados por las ancianas hipertensas. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

RESUMO Introdução: A atividade física é uma importante ferramenta no manejo da hipertensão arterial sistêmica. No entanto, pouco se sabe sobre a relação entre a atividade física e a quantidade de anti-hipertensivos usados por idosos. Objetivo: O objetivo deste estudo foi realizar uma comparação entre o número de anti-hipertensivos usados por idosas (≥ 60 anos) com baixo nível de atividade física com o número usado por aquelas com alto nível de atividade física, verificando quantas participantes usaram mais de dois anti-hipertensivos. Métodos: Vinte e oito idosas fisicamente ativas com hipertensão arterial sistêmica que participavam de um programa de atividade física para idosas da comunidade foram divididas em dois grupos: as participantes que apresentaram níveis mais baixos de atividade física habitual foram colocadas no grupo 1 e as participantes que apresentaram maiores níveis de atividade física foram colocados no grupo 2, de acordo com o questionário de Baecke. Ademais, coletou-se o número de medicamentos anti-hipertensivos utilizados pelas participantes. Resultados: O número de fármacos anti-hipertensivos prescritos foi de 2,0 (mediana) para ambos os grupos investigados. Não houve diferença significativa entre os grupos quanto ao número de comprimidos anti-hipertensivos prescritos (p>0,05). Embora não tenha havido diferença estatística, uma maior proporção de participantes entre o grupo de menor atividade física utilizava mais de dois anti-hipertensivos. Conclusão: O nível de atividade física habitual não afetou a quantidade de comprimidos anti-hipertensivos utilizados pelas idosas hipertensas. Nível de evidência II; Estudos terapêuticos - Investigação dos resultados do tratamento.

Translation, cross-cultural adaptation, and validation of health and self-management in diabetes questionnaire (HASMID-10) into Brazilian Portuguese

ABSTRACT BACKGROUND: Considering the ability of the health and self-management in diabetes questionnaire (HASMID-10) to verify the impact of self-management on diabetes, we highlight its relevance to scientific research and clinical applicability. However, to date, no study has been conducted to scientifically support its use in other languages. OBJECTIVE: To translate, cross-culturally adapt, and validate the HASMID-10 into the Brazilian Portuguese. DESIGN AND SETTING: A translation, cross-cultural adaptation, and validation study conducted at Ceuma University. METHODS: Study was conducted in accordance with the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and Consensus-based Standards for the Selection of Health Measurement Instruments. We included participants of both sexes diagnosed with diabetes, aged between 18 and 64 years, and without cognitive deficits or any other limitations that would prevent them from answering the questionnaire. We assessed participants using the problem areas in diabetes (PAID) scale and HASMID-10. We assessed reliability using a test-retest model with a 7-day interval between assessments. We used intraclass correlation coefficient (ICC), 95% confidence interval (CI), standard error of measurement (SEM), minimum detectable difference (MDD), Spearman correlation coefficient, and floor and ceiling effects. RESULTS: Sample comprised 116 participants, most of whom were women, overweight, non-practitioners of physical activity, and nonsmokers. We observed significant correlations (P = 0.006; rho = −0.256) between the HASMID-10 and PAID, adequate reliability (ICC = 0.780) and internal consistency (Cronbach's alpha = 0.796). No ceiling or floor effects were observed. CONCLUSION: HASMID-10 has adequate measurement properties and may be used for Brazilians.

A real-world observational study of dupilumab treatment in adult patients with prurigo nodularis

Abstract Background: Prurigo nodularis (PN) is a chronic inflammatory skin condition that has a significant unmet needs for effective treatment options. Objective: To assess the efficacy and safety of dupilumab in adult patients with PN refractory to traditional therapies. Methods: This ongoing, real-life study examined dupilumab treatment in 8 adult patients diagnosed with PN for at least 6 months. The included patients were prescribed 300 mg dupilumab biweekly for at least 16 weeks. Efficacy was the primary outcome by means of multiple standardized scale measurements while safety was also reported. Results: PN patients treated with dupilumab showed notable clinical improvement. After 16 weeks of dupilumab treatment, the mean Investigator Global Assessment (IGA) score reduced from 3.75 to 1.50. Patients mean Numerical Rating Scale Itch Intensity (NRSI), Dermatology Life Quality Index (DLQI), and Hospital Anxiety and Depression Scale (HADS) ratings reduced from 8.625, 15.13, and 14.50 to 1.563, 4.625, and 1.000 respectively. The majority of the patients (87.5%) reported dupilumab as effective while no adverse events have been reported. Study limitations: This study was limited to a small cohort of adult PN patients and a short-time observation period. Conclusions: Dupilumab is effective and tolerable in adult PN patients with significant improvement in skin lesions, itching, and quality of life.

Detection of Bartonella henselae DNA in the blood of patients with livedoid vasculopathy

Abstract Background: Livedoid vasculopathy (LV) manifests as ulcers and atrophic white scars on the lower extremities. The main known etiopathogenesis is hypercoagulability with thrombus formation, followed by inflammation. Thrombophilia, collagen and myeloproliferative diseases may induce LV, but the idiopathic (primary) form predominates. Bartonella spp. may cause intra-endothelial infection and skin manifestations caused by these bacteria may be diverse, including leukocytoclastic vasculitis and ulcers. Objective: The aim of this study was to investigate the presence of bacteremia by Bartonella spp. in patients with difficult-to-control chronic ulcers diagnosed as primary LV. Methods: Questionnaires and molecular tests (conventional PCR, nested PCR and real-time PCR) were applied and liquid and solid cultures were performed in the blood samples and blood clot of 16 LV patients and 32 healthy volunteers. Results: Bartonella henselae DNA was detected in 25% of LV patients and in 12.5% of control subjects but failed to reach statistically significant differences (p = 0.413). Study limitations: Due to the rarity of primary LV, the number of patients studied was small and there was greater exposure of the control group to risk factors for Bartonella spp. infection. Conclusion: Although there was no statistically significant difference between the groups, the DNA of B. henselae was detected in one of every four patients, which reinforces the need to investigate Bartonella spp. in patients with primary LV.

The association of BRAF V600E gene mutation with proliferative activity and histopathological characteristics of congenital melanocytic nevi in children

Abstract Background: A lot of congenital melanocytic nevi (CMN) carry the somatic mutation in the oncogene BRAF V600E. But the detailed histopathologic characteristics and the proliferative activity of CMN with BRAF V600E gene mutation have not been systematically documented. Objective: To identify the proliferative activity and histopathological features correlating them with BRAF V600E gene mutation status in CMN. Methods: CMN were retrospectively identified from the laboratory reporting system. Mutations were determined by Sanger sequencing. The CMN were divided into a mutant group and control group according to whether there was BRAF gene mutation and were strictly matched according to gender, age, nevus size, and location. Histopathological analysis, analysis of Ki67 expression by immunohistochemistry and laser confocal fluorescence microscopy were performed. Results: The differences in Ki67 index, the depth of nevus cell involvement and the number of nevus cell nests between the mutant group and the control group was statistically significant, with p-values of 0.041, 0.002 and 0.007, respectively. Compared with BRAFV600E negative nevi, BRAF V600E positive nevi often exhibited predominantly nested intraepidermal melanocytes, and larger junctional nests, but the difference in this datasets were not statistically significant. The number of nests (p = 0.001) was positively correlated with the proportion of Ki67 positive cells. Study limitations: A small sample of patients were included and there was no follow-up. Conclusions: BRAF V600E gene mutations were associated with high proliferative activity and distinct histopathological features in congenital melanocytic nevi.

Obesogenic behavior clusters associated with weight status among Brazilian students: a latent class analysis / Agrupamentos de comportamentos obesogênicos associados com status de peso em estudantes brasileiros: uma análise de classe latente

Abstract This study aimed to examine the association between clusters of physical activity (PA), diet, and television viewing (TV) with weight status among a representative sample of Brazilian students. Data from the National Health School-based Survey (PeNSE) 2015 were analyzed (n = 16,521; mean age 14.8, standard deviation 0.03 year). PA (minutes/week spent in leisure-time, and commuting to/from school), TV (hours/day), and weekly consumption of deep-fried empanadas, candies, sodas, ultra-processed foods, fast foods, green salads or vegetables, and fruits were self-reported on the validated PeNSE questionnaire. Latent class analysis defined behavior classes, and binary logistic regression assessed the association between clustering and weight status. Six classes' types with positive and negative behaviors were identified. Adolescents belonging to the "low TV time and high healthy diet" class had higher chances of being overweight (including obesity) compared to their peers in the "moderate PA and mixed diet" class. No associations were found in the other clusters. Mixed classes with healthy and unhealthy behaviors characterized adolescents' lifestyles and these profiles were related to weight status.

Resumo O estudo objetivou examinar a associação entre agrupamentos de atividade física (AF), dieta e tempo de televisão (TV) com o status do peso em uma amostra representativa de estudantes brasileiros. Foram analisados ​​dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2015 (n = 16.521; idade média 14,8, desvio padrão de 0,03 ano). AF (minutos/semana no lazer e deslocamento para/da escola), assistir televisão (TV) (horas/dia), consumo semanal de doces, refrigerantes, alimentos ultraprocessados/fast-foods, saladas/vegetais e frutas foram coletadas por questionário validado. Análise de classes latentes definiu os perfis de comportamento e a regressão logística binária a associação entre agrupamento e status de peso. Foram identificadas seis classes com comportamentos positivos e negativos. Adolescentes pertencentes à classe "baixo tempo de TV e alta alimentação saudável" apresentaram maior probabilidade de ter sobrepeso/obesidade em comparação com seus pares na classe "AF moderada e dieta mista". Não foram encontradas associações nos outros perfis. Classes com comportamentos saudáveis ​​e não saudáveis ​​caracterizaram o estilo de vida dos adolescentes e estiveram relacionadas com o status de peso.

Comparação dos casos de beribéri entre indígenas e não indígenas, Brasil, 2013 a 2018 / Comparison of beriberi cases in indigenous and non-indigenous people, Brazil, 2013 to 2018

Resumo O beribéri é a manifestação clínica da deficiência grave e prolongada de tiamina (vitamina B1). Doença negligenciada que acomete a população de baixa renda, em situação de insegurança alimentar e nutricional. O objetivo do estudo foi comparar casos de beribéri em indígenas com casos em não indígenas no Brasil. Trata-se de estudo transversal de casos notificados de beribéri no período de 2013 a 2018, no formulário do SUS (FormSUS) do Ministério da Saúde. Foram comparados os casos em indígenas e em não indígenas pelo teste qui-quadrado ou teste exato de Fisher com nível de significância de p < 0,05. No período estudado foram notificados no país 414 casos de beribéri, sendo 210 (50,7%) indígenas. Referiram consumo de bebidas alcoólicas 58,1% dos indígenas e 71,6% dos não-indígenas (p = 0,004); adicionalmente, 71,0% dos indígenas consumiam caxiri (bebida alcoólica tradicional fermentada). Relataram fazer esforço físico diário 76,1% dos indígenas e 40,2% dos não-indígenas (p <0 ,001). Conclui-se que o beribéri no país acomete mais indígenas e está relacionado ao consumo de álcool e ao esforço físico.

Abstract Beriberi is the clinical manifestation of severe and prolonged thiamine (vitamin B1) deficiency. It is a neglected disease that affects low-income populations facing food and nutrition insecurity. The aim of this study was to compare cases of beriberi among indigenous and non-indigenous people in Brazil. We conducted a cross-sectional study using data on cases of beriberi during the period July 2013-September 2018 derived from beriberi notification forms available on the FormSUS platform. Cases in indigenous and non-indigenous patients were compared using the chi-squared test or Fisher's exact test, adopting a significance level of 0.05. A total of 414 cases of beriberi were reported in the country during the study period, 210 of which (50.7%) were among indigenous people. Alcohol consumption was reported by 58.1% of the indigenous patients and 71.6% of the non-indigenous patients (p = 0.004); 71.0% of the indigenous patients reported that they consumed caxiri, a traditional alcoholic drink. Daily physical exertion was reported by 76.1% of the indigenous patients and 40.2% of the non-indigenous patients (p < 0.001). It is concluded that beriberi disproportionately affects indigenous people and is associated with alcohol consumption and physical exertion.

Avaliação das Instituições de Longa Permanência para Idosos no Brasil: um panorama das desigualdades regionais / Evaluation of Long-Term Institutions for Older People in Brazil: an overview of regional inequalities

Resumo O objetivo deste artigo é avaliar as Instituições de Longa Permanência para Idosos (ILPI) brasileiras, segundo o Modelo Teórico Multidimensional Integrado de Qualidade e Atendimento (MIQA), e comparar o desempenho alcançado entre as regiões do país. Estudo ecológico descritivo realizado com dados secundários públicos das ILPI participantes do Censo do Sistema Único da Assistência Social de 2018. Uma Matriz de Avaliação foi construída a partir das variáveis do Censo e do Modelo Teórico MIQA. Parâmetros de qualidade foram empregados para classificar o desempenho das instituições para cada indicador em "incipiente", "em desenvolvimento" ou "desejável. O índice de disparidade foi obtido para cada indicador. Foram analisadas 1.665 instituições. Observaram-se diferenças nos percentuais de ILPI com desempenho "desejável" entre as regiões brasileiras, e a necessidade de aprimoramento na maioria das ILPI em relação à proporção de cuidadores de pessoas idosas, a composição da equipe multiprofissional, a acessibilidade e a oferta de ações de promoção de saúde. Verificou-se a necessidade de apoio governamental para a supressão dos critérios de diferenciações excludentes e para a expansão dos serviços para superar as superlotações.

Abstract This article aims to evaluate the Brazilian Long-Term Institutions for Older People (LTIE), according to the Integrated Multidimensional Theoretical Model of Quality and Service (MIQA), and compare the performance achieved between the regions of the country. Descriptive ecological study carried out with public secondary data from the LTIE participating in the 2018 Census of the Unified Social Assistance System. An Evaluation Matrix was constructed from the Census variables and the MIQA Theoretical Model. Quality parameters were used to classify the institutions' performance for each indicator as "incipient", "developing" or "desirable". The disparity index was obtained for each indicator. 1,665 institutions were analyzed. Differences were observed in the percentages of LTIE with "desirable" performance between Brazilian regions, and the need for improvement in most LTIE in relation to the proportion of caregivers of older people, the composition of the multidisciplinary team, accessibility and supply of health promotion actions. There was a need for government support for the suppression of exclusionary differentiation criteria and for the expansion of services to overcome overcrowding.

The association between multiple cardiovascular risk factors and overweight in Brazilian adolescents: an analysis based on the grade of membership / A associação entre múltiplos fatores de risco cardiovascular e o excesso de peso em adolescentes brasileiros: uma análise baseada no grade of membership

Abstract The aim of the current research is to analyze the coexistence of modifiable risk behaviors for cardiovascular disease (CVD) in 12-to-17-year-old adolescents living in Brazil and their influence on overweight. National, cross-sectional, school-based epidemiological study focused on estimating the prevalence of cardiovascular risk factors and metabolic syndrome in 12 to 17 year old adolescents enrolled in public and private schools in Brazilian counties accounting for more than 100 thousand inhabitants. The grade of membership method was used to identify the coexistence of risk factors among adolescents. The analytical sample comprised 71,552 adolescents. According to the two herein generated profiles, adolescents classified under Profile 2 have shown behaviors such as smoking, alcohol consumption and diet rich in Ultra-processed food intake ≥ 80% of the percentage of total caloric value. In addition, adolescents presenting CVD risk profile have shown increased likelihood of being overweight. The study has found coexistence of risk factors for CVD in Brazilian adolescents, with emphasis on tobacco smoking and alcoholic beverage intake. In addition, it heads towards the analysis of the association between CVD risk factors and health outcomes, such as overweight.

Resumo O objetivo desta pesquisa é analisar a coexistência de comportamentos de risco modificáveis para doenças cardiovasculares (DCV) em adolescentes de 12 a 17 anos residentes no Brasil e sua influência no excesso de peso. Estudo epidemiológico nacional, transversal, de base escolar, com foco em estimar a prevalência de fatores de risco cardiovascular e síndrome metabólica em adolescentes de 12 a 17 anos matriculados em escolas públicas e privadas de municípios brasileiros que somam mais de 100 mil habitantes. O grade of membership foi utilizado para identificar a coexistência de fatores de risco entre os adolescentes. A amostra analítica foi composta por 71.552 adolescentes. De acordo com os dois perfis gerados, os adolescentes classificados no Perfil 2 mostraram comportamentos como fumar, consumo de álcool e dieta rica em alimentos ultraprocessados ≥ 80% da porcentagem do valor calórico total. Além disso, adolescentes com perfil de risco para DCV mostraram maior probabilidade de apresentar excesso de peso. O estudo encontrou coexistência de fatores de risco para DCV em adolescentes brasileiros, com destaque para tabagismo e consumo de bebidas alcoólicas. Além disso, demonstra associação entre fatores de risco para DCV e desfechos de saúde, como o excesso de peso.