Older adults, appendicular anthropometric measurements, and poor functional performance are predictors of sarcopenia in individuals with head and neck squamous cell carcinoma.

OBJECTIVE: To identify predictors of sarcopenia (demographical, anthropometric measurements, tumor-related clinical characteristics, performance status, and serum C-reactive protein (CRP) and albumin levels in individuals with head and neck squamous cell carcinoma (HNSCC). MATERIAL AND METHODS: This cross-sectional study selected diagnosed with HNSCC (n = 125). Sarcopenia was defined as low muscle strength and low physical performance. Association between sarcopenia and anthropometric assessments (weight, height, body mass index, triceps skinfold, mid-upper arm circumference [MUAC], mid-upper arm muscle circumference, mid-upper arm fat area [UFA], mid-upper arm bone free muscle area, calf circumference, and appendicular skeletal muscle mass and index), tumor clinical characteristics (anatomical site, tumor size, and cervical metastasis), performance status scale (Eastern Cooperative Oncology Group Performance Status [ECOG-PS]), and CRP and albumin levels was analyzed using binary logistic regression models. RESULTS: The diagnosis of sarcopenia was identified in 28 (22.4%) individuals with HNSCC. Being an older adult increases the odds of association with sarcopenia in individuals with HNSCC (odds ratio [OR] = 1.05). Increments in MUAC measurement reduce the odds of association with sarcopenia (OR = 0.69), while the increase in the UFA measurement increases the odds of association with sarcopenia (OR = 1.33). Poor ECOG-PS scores increase the odds of association with sarcopenia in individuals with HNSCC (OR = 5.54). CONCLUSION: Early identification of easy-to-perform, cost-effective predictors of sarcopenia tends to favor the implementation of personalized therapeutic and supportive interventions in individuals with HNSCC.

Association between health risk behaviors and food consumption in adolescents.

The study aims to evaluate the association between substance use and social isolation with food consumption in adolescents. A cross-sectional study was conducted with 2,040 adolescents from a medium-sized city in Brazil. The exposures assessed were the use of alcohol, tobacco, and other substances, and social isolation. The outcomes were the regular consumption (≥5 times/week) of beans, fruit/fruit salad, candies, and soft drinks, and an unhealthy eating score. The association between health risk behaviors and food consumption was assessed through logistic and linear regressions. Regular users of alcohol were more likely to have regular consumption of candies and soft drinks, and those who used tobacco regularly were less likely to have regular bean consumption and more likely to have regular candies consumption. The use of at least one substance was negatively associated with regular bean consumption and positively associated with regular consumption of sweets and soft drinks. Socially isolated adolescents were less likely to have regular bean consumption. Substance use was positively associated with the unhealthy eating score. In conclusion, substance use and social isolation were associated with less regular consumption of healthy food markers and greater regular consumption of unhealthy food markers.

Association between lifestyle and emotional aspects of food consumption during the COVID-19 pandemic.

BACKGROUND AND AIMS: Adequate nutrition during infectious outbreaks require a personal management strategy, especially when there are emotional factors involved. To evaluate the association between lifestyle and emotional aspects of food consumption during the pandemic COVID-19. METHODS AND RESULTS: Cross-sectional study using online self-applied questionnaire with 15,372 active schoolteachers who worked in primary education (kindergarten, elementary and high school) from Minas Gerais, Brazil. Poisson Regression model with robust variance was used to determine the association between lifestyle and emotional aspects and food consumption. Greater adherence to the healthy consumption profile showed a statistically significant association with decreased weight (PR = 1.58; p = 0.000), decreased physical activity (PR = 1.27; p = 0.000), reduced income, (PR = 1.26; p = 0.000), reduced alcohol consumption (PR = 1.22; p = 0.000), and changes in mental health (PR = 1.19; p = 0.000). Unhealthy consumption profile was significantly correlated with weight gain (PR = 1.54; p = 0.000), consuming more alcohol, or started drinking during the pandemic (PR = 1.44; p = 0.000), increased physical activity (PR = 1.43; p = 0.000); increased cigarette consumption (PR = 1.17; p = 0.000), and being a younger adult (PR = 1.17; p = 0.000). CONCLUSIONS: The COVID-19 pandemic influenced the food profiles of basic education teachers in the Minas Gerais state education system in a bidirectional manner, favoring the practice of consuming healthy or unhealthy foods.

Back pain occurred due to changes in routinary activities among Brazilian schoolteachers during the COVID-19 pandemic.

OBJECTIVE: This study's main objective was to investigate the emergence of back pain as a consequence to changes in usual activities due to the COVID-19 pandemic among teachers in public schools in the state of Minas Gerais, Brazil. METHODS: A cross-sectional study was conducted among 15,276 schoolteachers using an online questionnaire. The variables included sociodemographic and occupational data, health situation, habits and behaviors during the COVID-19 pandemic. Bivariate analyses using Pearson's chi-square test and multiple analyses using Poisson regression were performed to identify the associated factors. RESULTS: About 58% of schoolteachers reported back pain due to changes in routine activities during the pandemic. The adjusted model showed a correlation between back pain and female sex, longer working hours, overwork, difficulties concerning distance working, negative changes in health status and quality of sleep; frequent feeling of sadness, depression, or anxiety; use of medications to relax, sleep or against stress/anxiety/depression; physical inactivity or negative changes in the practice of physical activities; increased body weight; reduction of leisure time; increased time of use of computer or tablet and overload of housework. CONCLUSION: During the COVID-19 pandemic, schoolteachers reported a high prevalence of emergence of back pain, which delineates a contradiction in terms: on the one hand, distance education allows social distancing that contributes to the preservation of teachers' health by reducing the risk of contamination by COVID-19. On the other hand, it imposes new demands that-in disagreement with working conditions-can threaten the health of these workers.

Contextual and individual determinants of tooth loss in adults: a multilevel study.

BACKGROUND: Tooth loss represents a known marker of health inequality. The association between tooth loss and unfavorable socioeconomic conditions is evident when analyzed at an individual level. However, the effects of contextual characteristics on tooth loss need to be better investigated and understood. The objective of this study was to analyze tooth loss among Brazilian adults (35-44 years of age), in accordance with individual and contextual social characteristics. METHODS: This was a multilevel cross-sectional study with data from 9564 adult participants from the Brazilian Oral Health Survey - SBBrasil 2010. The dependent variable was the number of lost teeth and the independent variables were grouped into structural (socioeconomic & political context) and intermediary (socioeconomic position, behavioral & biological factors, and health services) determinants. Multilevel Hierarchical Negative Binomial Regression was conducted and the Mean Ratio (MR) was estimated. RESULTS: Brazilian adults lost a mean of 7.57 (95% CI 7.1-8.1) teeth. Among the contextual variables, the number of teeth lost was higher among residents of municipalities with high and medium/low Municipal Human Development Index (MHDI) and in municipalities that did not have public water fluoridation. Among the individual variables, dental loss was higher among those who declared themselves yellow/black/brown/indigenous, were older, who had lower income, who had never visited a dentist, who had used dental services for more than a year and those whose most recent visit to the dentist was due to oral health problems. On the other hand, dental loss was lower among adults with higher education levels and males. CONCLUSIONS: The number of missing teeth was associated with unfavorable contextual and individual conditions, which reinforces the need to reduce social inequality and guarantee regular, lifetime access to dental services.

Different criteria for body mass index classification for excess weight screening in children aged six to ten years.

OBJECTIVE: To evaluate the agreement between body mass index (BMI) parameters applied to children aged six to ten years in the city of Montes Claros (MG), Brazil with national and international criteria, also calculating their sensitivity and specificity regarding excess weight screening. METHODS: A sample comprising 4151 children aged six to ten years was assessed, with height and body mass determined for BMI calculation. The obtained values were classified according to cutoff points established by the World Health Organization (WHO), International Obesity Task Force (IOTF), Centers for Disease Control and Prevention (CDC), Conde & Monteiro, and a recent local proposal. The agreement index between the mentioned criteria was calculated and thereafter the sensitivity and specificity. RESULTS: The local proposal was proven to be highly consistent in most combinations, especially concerning the excess weight criteria of the World Health Organization (WHO) (k=0.895). Regarding excess weight, the local proposal presented sensitivity and specificity values of 0.8680 and 0.9956, respectively, indicating high BMI discrimination power. CONCLUSIONS: The locally applied BMI parameters for children aged six to ten years represent a valid, highly viable and practical proposal for excess weight screening in this population group, improving professional decision-making in their follow-up.

Self-report of worse back pain among teachers at state schools in Minas Gerais during the COVID-19 pandemic.

Introduction: One of the consequences of halting face-to-face educational activities during the COVID-19 pandemic was worse back pain. Objectives: To evaluate worse back pain in teachers working in elementary state schools in Montes Claros, MG. Methods: This is a websurvey-type epidemiological survey using an on-line questionnaire to assess sociodemographic characteristics, working conditions, health condition, and behaviors during the pandemic. Poisson regression was performed, with robust variance. Results: 15,641 teachers were included, and 35.4% reported worse back pain during the pandemic. It was found that the prevalence of a worse condition was higher among women (prevalence ratio = 1.15), between 40 and 49 years old (prevalence ratio = 1.14), teaching for more than 11 years (prevalence ratio = 1.11; 1.19), working more than 21 hours (PR = 1.05; 1.11), with difficulty to work remotely (prevalence ratio = 1.16), with poor quality of life (prevalence ratio = 1.30) or not (prevalence ratio = 0.84), obese (prevalence ratio = 1.07), sad or depressed (prevalence ratio = 1.21), anxious or nervous (prevalence ratio = 1.57), consuming alcoholic beverage (prevalence ratio = 1.16), with poor dietary habits (prevalence ratio = 1.07), more screen time (prevalence ratio = 1.24), sedentary lifestyle (prevalence ratio = 1.13), and social distancing (prevalence ratio = 1.08). Conclusions: The pandemic worsened back pain in teachers, demonstrating a need for addressing the issue, aiming at improving the quality of life of these professionals.

Introdução: Uma das consequências da suspensão das atividades presenciais educacionais durante a pandemia da covid-19 foi o aumento da dor nas costas. Objetivos: Avaliar o aumento da dor nas costas em professores, em atividade, na educação básica de escolas estaduais de Montes Claros, Minas Gerais. Métodos: Trata-se de inquérito epidemiológico do tipo websurvey, através de questionário on-line, para avaliação das características sociodemográficas, condições de trabalho, situação de saúde e comportamentos durante a pandemia. Foi realizada regressão de Poisson, com variância robusta. Resultados: Participaram 15.641 professores, sendo que 35,4% relataram piora da dor nas costas durante a pandemia. Houve prevalência da piora do quadro nos seguintes grupos: sexo feminino (razão de prevalência = 1,15), idade entre 40 e 49 anos (razão de prevalência = 1,14), acima de 11 anos na docência (razão de prevalência = 1,11; 1,19), jornada de trabalho superior a 21 horas (razão de prevalência = 1,05; 1,11), dificuldade no trabalho remoto (razão de prevalência = 1,16), qualidade de vida com piora (razão de prevalência = 1,30) ou não (razão de prevalência = 0,84), obesos (razão de prevalência = 1,07), tristes ou deprimidos (razão de prevalência = 1,21), ansiosos ou nervosos (razão de prevalência = 1,57), que consumiam bebidas alcóolicas (razão de prevalência = 1,16), com pior padrão alimentar (razão de prevalência = 1,07), tempo de tela aumentado (razão de prevalência = 1,24), ausência de atividades (razão de prevalência = 1,13) e adesão total ao distanciamento social (razão de prevalência = 1,08). Conclusões: O período pandêmico trouxe um agravo na dorsalgia em professores, o que demonstra uma necessidade de atenção à questão, visando uma melhoria na qualidade de vida desses profissionais.

Evaluation of the properties of WHODAS-12 measurements in individuals with Chagas disease in Brazil.

Numerous tests employed to predict cardiac and functional status are expensive and not widely accessible for a considerable number of patients, particularly those diagnosed with Chagas disease (CD) residing in remote and endemic regions. To date, there is no knowledge of studies that have validated instruments that address functionality in an expanded way, including the biopsychosocial factors in patients with CD. This study aims to evaluate the psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS 2.0), in its 12-item shortened version (WHODAS-12) when applied to patients with CD. This is a cross-sectional study of a prospective cohort that follows individuals with CD (SaMi-Trop). Data collection took place between October 2019 and March 2020. In the interviews, sociodemographic information, life habits, clinical information, and indicators of disability measured by WHODAS-12 were collected. Descriptive analysis, internal consistency and construct validity of the instrument were performed. A total of 628 patients with CD were interviewed, most were women (69.5%), their mean age was of 57 years, and most declared an average self-perception of health (43.4%). The 12 items of WHODAS-12 were distributed into three factors, which together account for 61% of the variance. The Kaiser-Meyer-Olkin (KMO) index was 0.90, indicating adequacy of the sample for factor analysis. The internal consistency of the global scale showed alpha = 0.87. The percentage of incapacity was 16.05%, indicating mild incapacity for the evaluated patients. WHODAS-12 is a valid and reliable measure to assess the disability of the Brazilian population with CD.

Interrelationships between dissatisfaction with teaching work and depressive symptoms: Structural equation modelling. / Inter-relações entre insatisfação com o trabalho docente e sintomas depressivos: modelagem com equações estruturais.

The objective of this article is to evaluate the interrelationships of factors associated with depressive symptoms (DS) in teachers, considering dissatisfaction with the teaching job as a possible mediator. This was a cross-sectional study using data from 700 teachers from the public school system of a Brazilian municipality. The outcome of interest was DS, as assessed using the Beck Depression Inventory (BDI). Direct and indirect interrelationships between the outcome and dissatisfaction with work, age, income, lifestyle and adiposity were tested. These variables composed the operational model tested by structural equation modelling. Older age (ß=0.12) and greater dissatisfaction with work (ß=0.12) were directly associated with DS. A more favourable lifestyle (ß=-0.60) and adiposity (ß=-0.10) were associated with a lower occurrence of DS. The variables lifestyle (ß=-0.06) and adiposity (ß=-0.02) also had negative indirect effects on DS, mediated by job dissatisfaction. The structural equation model tested identified interrelationships that influenced DS. Dissatisfaction with teaching work was associated with DS and mediated the relationship of other factors with such symptoms.

O objetivo deste artigo é avaliar inter-relações de fatores associados a sintomas depressivos (SD) em professores, considerando a insatisfação com o trabalho docente como possível mediador. Estudo transversal utilizando dados de 700 professores da rede pública de ensino de um município brasileiro. O desfecho de interesse foi SD aferido pelo Inventário de Depressão de Beck (BDI). Foram testadas inter-relações diretas e indiretas entre o desfecho e insatisfação com o trabalho, idade, renda, estilo de vida e adiposidade. Essas variáveis compuseram modelo operacional testado por meio de modelagem de equações estruturais. A maior idade (ß=0,12) e a maior insatisfação com o trabalho (ß=0,12) associaram-se diretamente aos SD. Já o estilo de vida mais favorável (ß=-0,60) e a adiposidade (ß=-0,10), associaram-se a menor ocorrência de SD. As variáveis estilo de vida (ß=-0,06) e adiposidade (ß=-0,02) também apresentaram efeitos indiretos negativos nos SD, mediados pela insatisfação com o trabalho. O modelo de equação estrutural testado identificou inter-relações que influenciaram os SD. A insatisfação com o trabalho docente associou-se aos SD e mediou a relação de outros fatores sobre tais sintomas.

Physical Activity among Elderly Teachers Working in Basic Education Schools.

This study aimed to assess the levels of physical activity (PA) among elderly teachers. It was an epidemiological, cross-sectional, and analytical web survey conducted with teachers working in public basic education schools. Data collection took place between October and December 2021 through an online form. The dependent variable was physical activity practice, classifying teachers as either physically active or inactive. Descriptive, bivariate, and multiple analyses were performed using Poisson Regression with robust variance. A total of 1907 teachers participated in the study, of whom 5.6% were elderly, ranging in age from 60 to 72 years. Regarding PA practice, elderly teachers were found to be more physically inactive compared with adult teachers (PR = 1.18; 95% CI = 1.04; 1.34). Conclusion: A statistically significant difference in PA practice was observed between adult and elderly teachers, indicating that elderly teachers are more physically inactive.

Factors associated with the lifestyle of state basic education teachers of state during the pandemic.

OBJECTIVE: To analyze the prevalence and factors associated with the lifestyle profile of public basic education teachers in Minas Gerais during the COVID-19 pandemic. METHOD: Epidemiological websurvey carried out with public basic education teachers in Minas Gerais. Data collection took place from August to September2020 via digital form. Anthropometric, sociodemographic, work, and lifestyle characteristics were evaluated. Poisson Regression was used. RESULTS: 15,641 teachers participated and 31.1% had inadequate health habits. There was a higher prevalence among men (PR=1.38; 95%CI:1.31;1.45), older age (PR=1.20; 95%CI: 1.07;1.34), greater weekly workload (RP=1.10; 95%CI:1.03;1.17) and those dissatisfied with work (RP=1.21; 95%CI:1.15;1.27). As a protective factor, professors with longer teaching experience (RP=0.92; 95%CI:0.87;0.98) and those hired or appointed (PR=0.89; 95%CI:0.85) ;0.94). CONCLUSION: Lifestyle inadequacy was found among older male teachers, with longer working hours and job dissatisfaction.

Increased Depression and the Worsening of Depressive Symptoms Associated with Physical Inactivity during the COVID-19 Pandemic: A Two-Phase Cross-Sectional Study.

The COVID-19 pandemic has increased the incidence of depression and other mental disorders in the general population, influenced by various individual and contextual factors. Physical activity (PA) interventions offer a promising approach to mitigating the negative mental health effects of the pandemic. This study aims to analyze the association between PA and depressive symptoms. A total of 785 individuals aged 37.4 ± 13.2 years (72.5% female) were evaluated at two different time points: the first between 2018 and 2019, and the second during the COVID-19 pandemic in 2020. Depressive symptoms, demographic, and socioeconomic data were assessed using the Beck Depression Inventory to estimate depressive symptoms. Frequency analysis and binary and multinomial regression were employed for data analysis. The prevalence of mild depressive symptoms increased from 23.1% before the pandemic to 35.1% during the pandemic. Our findings reveal that practicing PA before the pandemic was a protective factor (OR: 0.19; 95% CI: 0.13, 0.30; p < 0.001) against mild depressive symptoms. Additionally, individuals who continued to practice PA during the pandemic had a lower chance of presenting mild (OR: 0.21; 95% CI: 0.15, 0.30) and moderate/severe (OR: 0.15; 95% CI: 0.08, 0.27) symptoms. Furthermore, our study shows that PA, which was already a protective factor before the pandemic, remained protective during the pandemic, even for those with the highest levels of depression.

Analysis of ECOG performance status in head and neck squamous cell carcinoma patients: association with sociodemographical and clinical factors, and overall survival.

PURPOSE: In the present study, we analyzed sociodemographical and clinical factors, and the Eastern Cooperative Oncology Group performance status (ECOG-PS) scale in head and neck squamous cell carcinoma (HNSCC) patients. We evaluated the impact of a range of variables on overall survival. METHODS: We investigated a sample of HNSCC patients (n = 671), using sociodemographical and clinical information, and survival data collected from a review of epidemiological, clinical, and treatment reports. Statistical associations were analyzed by bivariate and multivariate statistical tests. Statistical significance was set at p < 0.05. RESULTS: Of patients 85.4% recorded good ECOG-PS scores. Poor ECOG-PS scores were associated with the covariates indicative of dysphagia [odd ratios (OR) = 2.660, CI 95% = 1.661­4.260, p = 0.000] and large-size malignant disease (T3­T4; OR = 5.337, CI 95% = 2.251­12.652, p = 0.000). Overall survival analysis revealed that ECOG-PS scores (OR = 1.879, CI 95% = 1.162­3.038, p = 0.010), tumor size (OR = 1.665, CI 95% = 1.035­2.680, p = 0.036), and the presence of cervical metastasis (OR = 3.145, CI 95% = 2.008­4.926, p = 0.000) were independent predictors. CONCLUSION: Evaluation of physical consumption in head and neck cancer patients at diagnosis may indicate a more aggressive type of malignant disease. Thus, the ECOG-PS scale may help to identify HNSCC patients in need of rapid referral, who may benefit from specific therapeutic and rehabilitative interventions.

Analysis of socio-demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly.

OBJECTIVE: To investigate the association of socio-demographic and systemic health factors according to the normative conditions of oral health care (dental caries, edentulism, periodontal disease and oral mucosal lesion) in elderly individuals. MATERIAL AND METHODS: A cross-sectional study was carried out in a group of elderly with access to community health care (n = 200). The normative conditions of oral health were then investigated according to the WHO and the SB Brazil criteria. Bivariate analyses were evaluated by the chi-square test and Fisher's exact test. An estimation of prevalence for the covariates was performed using Poisson's regression models. RESULTS: The prevalence of edentulism and oral mucosal lesions was detected in 58% and 21.5% of elderly patients, respectively. In the dentate subjects, the prevalence of dental caries and periodontal disease was 51.2% and 20.8%, respectively. Older men and individuals from lower-income groups exhibited a higher prevalence of dental caries. Elderly women, illiterate individuals, and individuals over the age of 65 years exhibited a higher prevalence of edentulism. Elderly 60-64 years old and those who are employed had a significant association with periodontal disease. CONCLUSION: Socio-demographic factors were associated with some notable oral diseases in the elderly.

Failure to use health services by people with Chagas disease: Multilevel analysis of endemic area in Brazil.

This study aimed to assess the prevalence of non-use of health services in the last year by people with Chagas disease (CD) in an endemic area in Brazil and the contextual and individual factors associated with this non-use. This is a multilevel study that considered contextual and individual data. Contextual data were collected from official publicly accessible databases of the Brazilian government, at the municipal level. The individual data came from the first follow-up of a Brazilian cohort that assessed patients with CD in 21 municipalities in endemic area for the disease. The sample consisted of 1,160 individuals with CD. The dependent variable "use of health services in the last year" was categorized as yes vs. no. The analysis was performed using Poisson regression with robust variance. The prevalence of non-use of health services in the last year was 23.5% (IC95%: 21.1-25.9). The contextual factor "larger population" (PR: 1.6; 95% CI = 1.2-2.0) and individual factors related to the lower severity of the disease as a functional class without limitations (PR: 1.6; 95% CI = 1.2-2.1) and unaltered N-terminal pro b-type natriuretic peptide levels (PR: 2.2; 95% CI = 1.3-3.6) increased the prevalence of non-use of the health service in the last year by people with CD. The results of this study showed that individual determinants are not isolated protagonists of the non-use of health services in the last year by people with CD, which reinforces the need for public policies that consider the contextual determinants of the use of health services by populations affected by the disease.

Contextual influence on poor self-rated health in patients with Chagas disease: multilevel study.

Chagas disease (CD) is recognized by the World Health Organization as one of the thirteen most neglected tropical diseases in the world. Self-perceived health is considered a better predictor of mortality than objective measures of health status, and the context in which one lives influences this predictor. This study aimed to evaluate the prevalence and individual and contextual factors associated with poor self-rated health among CD patients from an endemic region in Brazil. It is a multilevel cross-sectional study. The individual data come from a cross-section of a cohort study named SaMi-Trop. Contextual data was collected from publicly accessible institutional information systems and platforms. The dependent variable was self-perceived health. The analysis was performed using multilevel binary logistic regression. The study included 1,513 patients with CD, where 335 (22.1%) had Poor self-rated health. This study revealed the influence of the organization/offer of the Brazilian public health service and of individual characteristics on the self-perceived health of patients with CD.

Two-year death prediction models among patients with Chagas Disease using machine learning-based methods.

Chagas disease (CD) is recognized by the World Health Organization as one of the thirteen most neglected tropical diseases. More than 80% of people affected by CD will not have access to diagnosis and continued treatment, which partly supports the high morbidity and mortality rate. Machine Learning (ML) can identify patterns in data that can be used to increase our understanding of a specific problem or make predictions about the future. Thus, the aim of this study was to evaluate different models of ML to predict death in two years of patients with CD. ML models were developed using different techniques and configurations. The techniques used were: Random Forests, Adaptive Boosting, Decision Tree, Support Vector Machine, and Artificial Neural Networks. The adopted settings considered only interview variables, only complementary exam variables, and finally, both mixed. Data from a cohort study with CD patients called SaMi-Trop were analyzed. The predictor variables came from the baseline; and the outcome, which was death, came from the first follow-up. All models were evaluated in terms of Sensitivity, Specificity and G-mean. Among the 1694 individuals with CD considered, 134 (7.9%) died within two years of follow-up. Using only the predictor variables from the interview, the different techniques achieved a maximum G-mean of 0.64 in predicting death. Using only the variables from complementary exams, the G-mean was up to 0.77. In this configuration, the protagonism of NT-proBNP was evident, where it was possible to observe that an ML model using only this single variable reached G-mean of 0.76. The configuration that mixed interview variables and complementary exams achieved G-mean of 0.75. ML can be used as a useful tool with the potential to contribute to the management of patients with CD, by identifying patients with the highest probability of death. Trial Registration: This trial is registered with ClinicalTrials.gov, Trial ID: NCT02646943.

Hospitalizations due to gastrointestinal Chagas disease: National registry.

OBJECTIVES: Analyze the hospitalizations of patients admitted for Chagas disease with gastro-intestinal involvement (CD-GI) in the Brazilian Unified Health System, describe the epidemiological profile, mortality and costs. METHODS: This is an observational study that uses secondary data from the National Hospital Information System (SIH-SUS) for the years 2017-2019. CD-GI admissions were defined by specific ICD-10 codes that identify the main diagnosis. RESULTS: From 2017 to 2019, there were 4,407 hospitalizations for CD-GI in Brazil, considering only public hospitals and those associated with the SUS. This corresponds to an average of 1,470 hospitalizations per year, or 0.6 per 100,000 inhabitants, with significant regional variation. Hospitalizations increased with age and were slightly higher in men. More than 60% were emergencies and in 50% the procedure performed was surgical. The most used code was the one for megaesophagus followed by megacolon. In-hospital mortality was 5.8% and 17.2% went to intensive care units. The median cost was USD$ 553.15 per hospitalization, and an overall cost of USD$ 812,579.98 per year to the SUS budget. CONCLUSION: The numbers, rates and costs presented here are possibly underestimated but they give us an idea of the overall profile of hospitalizations due to CD-GI, which are not rare and are related to significant in-hospital mortality. CD-GI is a neglected manifestation of a neglected disease.

Genome-wide association study for Chagas Cardiomyopathy identify a new risk locus on chromosome 18 associated with an immune-related protein and transcriptional signature.

BACKGROUND: Chronic Chagas Cardiomyopathy (CCC) usually develops between 10 and 20 years after the first parasitic infection and is one of the leading causes of end-stage heart failure in Latin America. Despite the great inter-individual variability in CCC susceptibility (only 30% of infected individuals ever present CCC), there are no known predictors for disease development in those chronically infected. METHODOLOGY/PRINCIPAL FINDINGS: We describe a new susceptibility locus for CCC through a GWAS analysis in the SaMi-Trop cohort, a population-based study conducted in a Chagas endemic region from Brazil. This locus was also associated with CCC in the REDS II Study. The newly identified locus (rs34238187, OR 0.73, p-value 2.03 x 10-9) spans a haplotype of approximately 30Kb on chromosome 18 (chr18: 5028302-5057621) and is also associated with 80 different traits, most of them blood protein traits significantly enriched for immune-related biological pathways. Hi-C data show that the newly associated locus is able to interact with chromatin sites as far as 10Mb on chromosome 18 in a number of different cell types and tissues. Finally, we were able to confirm, at the tissue transcriptional level, the immune-associated blood protein signature using a multi-tissue differential gene expression and enrichment analysis. CONCLUSIONS/SIGNIFICANCE: We suggest that the newly identified locus impacts CCC risk among T cruzi infected individuals through the modulation of a downstream transcriptional and protein signature associated with host-parasite immune response. Functional characterization of the novel risk locus is warranted.