Sleep duration and quality during the COVID-19 pandemic and the association with physical activity and screen time among Brazilian college students.

BACKGROUND: As a result of social isolation during the COVID-19 pandemic, changes in sleep patterns have been observed in many countries, as well as changes in physical activity and screen time. The objective was to investigate sleep duration and quality during the COVID-19 pandemic and its association with physical activity and screen time. METHODS: Cross-sectional study with students from a University in Rio de Janeiro who answered an online questionnaire between August 2020 and March 2021. Physical activity was assessed using IPAQ-SF. Sleep was investigated based on questions about duration and sleep quality change, and screen time through self-reported questions. Multinomial logistic regression was performed to assess the association between physical activity and screen time with sleep duration and quality. Secondary analyses investigated the influence of the isolation time on this association. The confounding factors used were diagnosis of COVID-19, time of isolation, anxiety, depression, skin color, and gender. RESULTS: A total of 771 college students with a mean age of 24.5 years (±8.6) answered the questionnaire. About 75% reported more than 8 h of screen time per day and 49.8% were physically inactive. Regarding sleep, 54.9% had worsening sleep, while 40.6% had inadequate sleep duration during the pandemic. Physical activity was associated with improved sleep quality (Odds ratio (OR) 1.72; confidence interval (95% CI) 1.05-2.97). Also, physically active students who spent more than 14 weeks in social isolation demonstrated improved sleep quality (OR 1.99; 95% CI 1.02-3.78) compared to physically inactive individuals. No association was observed for sleep duration. No association was observed between screen time and sleep quality, or sleep duration. CONCLUSION: During the COVID-19 pandemic, there was considerable worsening of sleep quality, and physical activity was positively associated with improved sleep quality.

Effect of different levels of whole corn germ on energy values and ileal digestibility in broilers.

This study evaluated the effects of broiler age (A) and levels of replacement (L) of control diet (CD) on the utilization of energy and nutrients of whole corn germ. 720 one-day-old broilers (b) were allocated at completely randomized design to six treatments and six replicates, in three assays: pre-starter (1-8 days, 10 b/cage), starter (15-22 days, 6 b/cage), and grower (28-35 days, 4 b/cage) phases. The treatments were: CD and four test diets (L): 100, 150, 200, 250, or 300 g kg-1 of the CD replaced by WCG levels. The data were adjusted to the response surface model. The stationary points for apparent energy metabolizable (AME) and AME corrected for nitrogen balance (AMEn) were: 4173 and 3591 kcal kg-1, respectively, and coefficients of gross energy (AMCGE), crude protein (AMCCP), dry matter (AMCDM), and ether extract (AMCEE) were: 49.3, 40.4, 72.6, and 61.3%, respectively; and Ileal digestibility coefficient of crude protein (IDCCP), dry matter (IDCDM), digestibility crude protein values (DCP), and digestibility dry matter value (DDM) were: 78.0, 57.96, 8.50, and 56.17%, respectively. The EP for AMEn was at 18 days of age, 28 g kg-1 WCG. There was a correlation between A and L on digestibility and metabolisability of nutrient's WCG.

Nanostructured ZnO thin film to enhance gutta-percha's adhesion to endodontic sealers.

BACKGROUND: Gutta-percha (GP) combined with an endodontic sealer is still the core material most widely used for tridimensional obturation. The sealer acts as a bonding agent between the GP and the root dentinal walls. However, one of the main drawbacks of GP core material is the lack of adhesiveness to the sealer. ZnO thin films have many remarkable features due to their considerable bond strength, good optical quality, and excellent piezoelectric, antibacterial, and antifungal properties, offering many potential applications in various fields. This study aimed to explore the influence of GP surface's functionalization with a nanostructured ZnO thin film on its adhesiveness to endodontic sealers. METHODS: Conventional GP samples were divided randomly into three groups: (a) Untreated GP (control); (b) GP treated with argon plasma (PT); (c) Functionalized GP (PT followed by ZnO thin film deposition). GP's surface functionalization encompassed a multi-step process. First, a low-pressure argon PT was applied to modify the GP surface, followed by a ZnO thin film deposition via magnetron sputtering. The surface morphology was assessed using SEM and water contact angle analysis. Further comprehensive testing included tensile bond strength assessment evaluating Endoresin and AH Plus Bioceramic sealers' adhesion to GP. ANOVA procedures were used for data statistical analysis. RESULTS: The ZnO thin film reproduced the underlying surface topography produced by PT. ZnO thin film deposition decreased the water contact angle compared to the control (p < 0.001). Endoresin showed a statistically higher mean bond strength value than AH Plus Bioceramic (p < 0.001). There was a statistically significant difference between the control and the ZnO-functionalized GP (p = 0.006), with the latter presenting the highest mean bond strength value. CONCLUSIONS: The deposition of a nanostructured ZnO thin film on GP surface induced a shift towards hydrophilicity and an increased GP's adhesion to Endoresin and AH Bioceramic sealers.

Morphometry of cryopreserved organs from the gastrointestinal system of squirrel monkeys (Saimiri sciureus, Linnaeus, 1758) for improvement of management.

BACKGROUND: Nonhuman primates (NHPs) are fundamental for countless types of research and their phylogenetic similarities with humans make them valuable biomodels. Saimiri (squirrel monkeys) is the New World simian genus that is most widely used in research; however, little is known about the morphology of the gastrointestinal tract (GIT) of these animals. METHODS: The morphological and topographical aspects of GIT organs from 14 previously frozen carcasses of captive squirrel monkeys (Saimiri sciureus) were described as a means for refining clinical and laboratory diagnoses, with the aim of providing a basis for clinical assessments and animal management. The carcasses were gradually thawed, macroscopically evaluated for their appearance, measured, weighed, photographed, and necropsied. The characteristics of all the GIT organs (main and accessories) were evaluated, with measurement of the dimensions and description of the shape, consistency, and color of each one. RESULTS: The stomach of squirrel monkeys is simple and of non-compartmentalized type and the cecum does not have numerous folds, compared with other species. These characteristics are compatible with omnivorous simian species with no adaptive digestive specialization for the food fermentation process. Significant correlations were found between the weights of the carcass and GIT (p < .05); carcass and tongue (0.83; p < .01); and liver and right salivary gland (0.83; p < .01). It was also observed that the animals showed good body score conformation and GIT organs in good condition, which indicated that their nutritional management had been adequate. Regarding the correlations found among the organs: (i) squirrel monkeys with heavier carcasses had better-developed GIT with greater food storage capacity; (ii) the bigger the animal was, the greater its overall muscle development was, including that of the tongue, which would enable intensification of its feeding activity; and (iii) the measurements of the esophagus, small and large intestines, pancreas, and salivary glands were not sex-dependent in Saimiri sciureus. CONCLUSIONS: Previously cryopreserved carcasses of squirrel monkeys can be used for gastrointestinal system studies, with the potential to make clinical, zootechnical, management, and scientific contributions.

Community violence in neighborhoods and common mental disorders among Brazilian adolescents.

BACKGROUND: This study aims to explore the association between exposure to neighborhood violence and the presence of common mental disorders (CMDs) among Brazilian adolescents aged 12 to 17 years. Additionally, we aim to analyze whether sex, age and race are modifiers of the effect of this association. METHODS: The study comprised 1,686 adolescents residing in the municipality of Rio de Janeiro, situated in the Southeast region of Brazil. To measure exposure to community violence, we constructed three crime indicators using data from Civil Police of the State of Rio de Janeiro: crimes against property, nonlethal crimes, and lethal crimes. Employing geospatial analysis based on the adolescents' residence location, logistic regression modeling was performed to measure the association between violence and CMDs. RESULTS: Adolescents living in regions with higher rates of the three types of violence studied herein were more likely to have CMDs, with odds ratios (ORs) ranging from 2.33 to 2.99. When stratified by sex, age and race, girls, older adolescents and blacks have a greater magnitude of effect on the measure of association, indicating a heightened risk for CMDs. CONCLUSION: This study provides important contributions to the public health field, as it reveals new information on the influence of community violence on the mental health of adolescents. Given the elevated rates of violence globally, knowing the effects of such violence on adolescents becomes crucial for the prevention and treatment of CMDs within this population.

Enhancing the Longevity and Functionality of Ti-Ag Dry Electrodes for Remote Biomedical Applications: A Comprehensive Study.

This study aims to evaluate the lifespan of Ti-Ag dry electrodes prepared using flexible polytetrafluoroethylene (PTFE) substrates. Following previous studies, the electrodes were designed to be integrated into wearables for remote electromyography (EMG) monitoring and electrical stimulation (FES) therapy. Four types of Ti-Ag electrodes were prepared by DC magnetron sputtering, using a pure-Ti target doped with a growing number of Ag pellets. After extensive characterization of their chemical composition and (micro)structural evolution, the Ti-Ag electrodes were immersed in an artificial sweat solution (standard ISO-3160-2) at 37 °C with constant stirring. Results revealed that all the Ti-Ag electrodes maintained their integrity and functionality for 24 h. Although there was a notable increase in electrical resistivity beyond this timeframe, the acquisition and transmission of (bio)signals remained viable for electrodes with Ag/Ti ratios below 0.23. However, electrodes with higher Ag content (Ag/Ti = 0.31) became insulators after 7 days of immersion due to excessive Ag release into the sweat solution. This study concludes that higher Ag/Ti atomic ratios result in heightened corrosion processes on the electrode's surface, consequently diminishing their lifespan despite the advantages of incorporating Ag into their composition. This research highlights the critical importance of evaluating electrode longevity, especially in remote biomedical applications like smart wearables, where electrode performance over time is crucial for reliable and sustained monitoring and stimulation.

Community violence and internalizing mental health symptoms in adolescents: A systematic review.

PURPOSES: Mental disorders are responsible for 16% of the global burden of disease in adolescents. This review focuses on one contextual factor called community violence that can contribute to the development of mental disorders OBJECTIVE: To evaluate the impact of community violence on internalizing mental health symptoms in adolescents, to investigate whether different proximity to community violence (witness or victim) is associated with different risks and to identify whether gender, age, and race moderate this association. METHODS: systematic review of observational studies. The population includes adolescents (10-24 years), exposition involves individuals exposed to community violence and outcomes consist of internalizing mental health symptoms. Selection, extraction and quality assessment were performed independently by two researchers. RESULTS: A total of 2987 works were identified; after selection and extraction, 42 works remained. Higher exposure to community violence was positively associated with internalizing mental health symptoms. Being a witnessing is less harmful for mental health than being a victim. Age and race did not appear in the results as modifiers, but male gender and family support appear to be protective factors in some studies. CONCLUSION: This review confirms the positive relationship between community violence and internalizing mental health symptoms in adolescents and provides relevant information that can direct public efforts to build policies in the prevention of both problems.

Correlates and impact of DSM-5 binge eating disorder, bulimia nervosa and recurrent binge eating: a representative population survey in a middle-income country.

PURPOSE: Binge eating disorder (BED), bulimia nervosa (BN) and recurrent binge eating (RBE) are binge eating spectrum conditions causing a significant impact in individual's health and functioning. Information regarding those conditions came mostly from high-income countries. The objective of this study was to assess the prevalence of DSM-5 BED, BN and RBE and correlates in a representative sample from a metropolitan area of a middle-income country. METHODS: The data were obtained from a cross-sectional population-based household survey in two stages in Rio de Janeiro, Brazil. Noninstitutionalized residents aged 18-60 years were assessed by lay interviewers using the Questionnaire of Eating and Weight Patterns-5 (QEWP-5). Positive cases and a paired sample screen-negative cases were reassessed by phone with the Eating Disorders Section of SCID-I-P (adapted for DSM-5). The data were collected from September 2019 to February 2020. RESULTS: Overall, 2297 individuals were interviewed. Prevalence of BED was 1.4%, BN 0.7%, RBE 6.2%. Psychiatric comorbidities, such as depression, anxiety and ADHD were significantly more prevalent in people with BED, BN and RBE than in people without these eating problems. Several medical conditions, when controlling for body mass index, were significantly more prevalent in people with BED, BN and RBE. People with BED and BN had marked impairments in work/school, social and family life, reduced mental and physical HRQoL and under half had sought treatment. CONCLUSION: As in high income countries, in Rio de Janeiro, Brazil, BED, BN and RBE are prevalent conditions and are associated with elevated BMI, functional impairment, psychiatric and medical comorbidity and poorer HRQoL.

Advances in Microfluidics for the Implementation of Liquid Biopsy in Clinical Routine.

In recent years, we have seen major advances in the field of liquid biopsy and its implementation in the clinic, mainly driven by breakthrough developments in the area of molecular biology. New developments have seen an integration of microfluidics and also biosensors in liquid biopsy systems, bringing advantages in terms of cost, sensitivity and automation. Without a doubt, the next decade will bring the clinical validation and approval of these combined solutions, which is expected to be crucial for the wide implementation of liquid biopsy systems in clinical routine.

In Vitro Hepatotoxic and Neurotoxic Effects of Titanium and Cerium Dioxide Nanoparticles, Arsenic and Mercury Co-Exposure.

Considering the increasing emergence of new contaminants, such as nanomaterials, mixing with legacy contaminants, including metal(loid)s, it becomes imperative to understand the toxic profile resulting from these interactions. This work aimed at assessing and comparing the individual and combined hepatotoxic and neurotoxic potential of titanium dioxide nanoparticles (TiO2NPs 0.75-75 mg/L), cerium oxide nanoparticles (CeO2NPs 0.075-10 µg/L), arsenic (As 0.01-2.5 mg/L), and mercury (Hg 0.5-100 mg/L) on human hepatoma (HepG2) and neuroblastoma (SH-SY5Y) cells. Viability was assessed through WST-1 (24 h) and clonogenic (7 days) assays and it was affected in a dose-, time- and cell-dependent manner. Higher concentrations caused greater toxicity, while prolonged exposure caused inhibition of cell proliferation, even at low concentrations, for both cell lines. Cell cycle progression, explored by flow cytometry 24 h post-exposure, revealed that TiO2NPs, As and Hg but not CeO2NPs, changed the profiles of SH-SY5Y and HepG2 cells in a dose-dependent manner, and that the cell cycle was, overall, more affected by exposure to mixtures. Exposure to binary mixtures revealed either potentiation or antagonistic effects depending on the composition, cell type and time of exposure. These findings prove that joint toxicity of contaminants cannot be disregarded and must be further explored.

Frequent premature ventricular contractions. Association of burden and complexity with prognosis according to the presence of structural heart disease.

INTRODUCTION: Premature ventricular contractions (PVC) have been associated with mortality and heart failure (HF) regardless the presence of structural heart disease (SHD). The aim of this study was assessing the impact of burden and complexity of PVCs on prognosis, according to presence of SHD. METHODS: 312 patients were retrospectively evaluated out of 1967 consecutive patients referred for 24-hr Holter at a single hospital, with a PVC count >1% of total beats. Two groups with and without SHD. PVC burden (PVC%), presence of complex forms, incidence of all-cause death, combined outcomes of all-cause death and cardiovascular hospitalizations, HF death and HF hospitalizations and, sudden death (SD) or hospitalizations due to ventricular arrhythmias (VA)were assessed. RESULTS: Premature ventricular contraction burden was 2.7 (IQR: 1.6-6.7). SHD patients had more polymorphic PVCs, 77% versus 65%, p = .022, triplets and episodes of non-sustained ventricular tachycardia (NSVT): 44% versus 27%, p = .002; 30% versus 12%, p < .0001. In idiopathic patients, a PVC% in the third quartile was independently associated with all-cause mortality hazard ratio (HR) 2.288 (1.042-5.026) p = .039, but not in SHD. The complexity of the PVCs was not independently associated with outcomes in both groups. In SHD group, NSVT was associated with lower survival free from SD and VA hospitalizations, p = .028; after multivariable, there was a trend for a higher arrhythmic outcome with NSVT, HR 3.896 (0.903-16.81) p = .068. CONCLUSION: Premature ventricular contractions in SHD showed more complex patterns. In idiopathic patients, a higher PVC count was associated with higher mortality but not is SHD patients. Complexity was not independently associated with worse prognosis.

Neighborhood physical disorder and common mental disorders in adolescence.

OBJECTIVE: The aim of this study is to estimate the association between observed indicators of neighborhood physical disorder and common mental disorders in adolescents. METHODS: The study population included 2506 adolescents from three Brazilian state capitals (Rio de Janeiro, Porto Alegre, and Fortaleza) who participated in the Cardiovascular Risk Study in Adolescents (ERICA), a cross-sectional school-based study conducted in 2013-2014. Common mental disorders were assessed using the 12-item General Health Questionnaire. Measures of neighborhood physical disorder were based on the 2010 Brazilian census data and were derived using principal component analysis. RESULTS: Although associations were found between some exposure components and CMD, there were no clear or consistent trends across exposure quartiles. CONCLUSION: Overall, there was no evidence of an association between observed indicators of neighborhood physical disorder and common mental disorders. Future studies should explore alternative tools for measuring neighborhood physical disorder to minimize the likelihood of exposure misclassification.

Burnout among primary health care workers in Brazil: results of a multilevel analysis.

PURPOSE: Burnout among health care workers may hamper the quality of care and effectiveness of health systems. Hence, we examined the prevalence of burnout in primary care teams, including community health workers; and investigated associations between individuals' characteristics, team and primary care center factors, and burnout. METHODS: We carried out a cross-sectional study among primary care teams in the city of São Paulo, Brazil (n = 2940). We randomly selected 66 primary care centers. The Maslach burnout inventory was used to investigate burnout. We used multilevel modelling to examine the associations between individuals' characteristics, team and primary care center variables with burnout. RESULTS: We addressed 351 primary care teams, with 11.4% of participants presenting severe burnout. The variance in burnout among primary care workers was partially explained by individuals' characteristics, and by team and primary care center factors. Severe burnout was associated with the following: (1) individuals' characteristics: being black, being younger, a higher length of employment in primary care, and presenting a lack of feedback from supervisors; (2) team factors: working in deprived areas and not receiving the support of a multidisciplinary team; and (3) primary care center factors: inadequate infrastructure (less than one office available per team), and having a bad/very bad relationship with the community council. CONCLUSIONS: To reduce burnout among primary care teams, stakeholders should: (1) train managers/supervisors on leadership styles that prioritize performance feedback, support, and communication skills; (2) allocate catchment areas to teams according to each community's vulnerability; (3) provide a multidisciplinary team to support primary care workers; and (4) offer suitable facilities and infra-structure.

Me-Doped Ti-Me Intermetallic Thin Films Used for Dry Biopotential Electrodes: A Comparative Case Study.

In a new era for digital health, dry electrodes for biopotential measurement enable the monitoring of essential vital functions outside of specialized healthcare centers. In this paper, a new type of nanostructured titanium-based thin film is proposed, revealing improved biopotential sensing performance and overcoming several of the limitations of conventional gel-based electrodes such as reusability, durability, biocompatibility, and comfort. The thin films were deposited on stainless steel (SS) discs and polyurethane (PU) substrates to be used as dry electrodes, for non-invasive monitoring of body surface biopotentials. Four different Ti-Me (Me = Al, Cu, Ag, or Au) metallic binary systems were prepared by magnetron sputtering. The morphology of the resulting Ti-Me systems was found to be dependent on the chemical composition of the films, specifically on the type and amount of Me. The existence of crystalline intermetallic phases or glassy amorphous structures also revealed a strong influence on the morphological features developed by the different systems. The electrodes were tested in an in-vivo study on 20 volunteers during sports activity, allowing study of the application-specific characteristics of the dry electrodes, based on Ti-Me intermetallic thin films, and evaluation of the impact of the electrode-skin impedance on biopotential sensing. The electrode-skin impedance results support the reusability and the high degree of reliability of the Ti-Me dry electrodes. The Ti-Al films revealed the least performance as biopotential electrodes, while the Ti-Au system provided excellent results very close to the Ag/AgCl reference electrodes.

Gender differences in the impact of sleep duration on common mental disorders in school students.

BACKGROUND: Common mental disorders (CMD) in children and adolescents can be initial and non-specific manifestations of more serious mental diseases and often persist into adulthood. Therefore, early detection is important, as is the identification of the factors that impact development. Insufficient sleep represents one of the most common and potentially remediable risks to mental health in children and adolescents for whom chronic sleep loss has become normal. This study aims to investigate the influence of sleep duration on CMD in schoolchildren and adolescents. METHODS: The data for this longitudinal study were derived from the community trial Parents, Students, Community Health Agents and Teachers for Healthy Eating (PAAPAS) in 2016 (N = 2743), with fifth and sixth graders from 18 public schools of Duque de Caxias, Rio de Janeiro, Brazil. CMD were assessed by the General Health Questionnaire (GHQ-12) at baseline and at a 9-month follow-up. Sleep duration was evaluated at baseline and was categorized as short, adequate or long according to age group. The effect of sleep duration on common mental disorders was analysed by sex using linear mixed-effects models. RESULTS: At baseline, the frequency of CMD was 33.2% and was higher in boys than in girls and higher among students with short sleep duration. There was an increase in the CMD score over time among girls with short sleep duration (p < 0.01). Among boys, a similar trajectory of the CMD score was observed in the subgroups with short and long sleep duration, but there was a significant reduction in the subgroup with long sleep duration (p = 0.05). CONCLUSION: Changes in common mental disorder patterns differ according to sex, and short sleep duration seems to be problematic for students' mental health. The promotion of health strategies that involve the family and school environment, such as later school hours, could help change this scenario.

A green method based on living macroalgae for the removal of rare-earth elements from contaminated waters.

Low recycling rates of rare earth elements (REEs) are a consequence of inefficient, expensive and/or contaminating methods currently available for their extraction from solid wastes or from liquid wastes such as acid mine drainage or industrial wastewaters. The search for sustainable recovery alternatives was the motivation for this study. For the first time, the capabilities of 6 living macroalgae (Ulva lactuca, Ulva intestinalis, Fucus spiralis, Fucus vesiculosus, Osmundea pinnatifida and Gracilaria sp.) to remove REEs (Y, La, Ce, Pr, Nd, Eu, Gd, Tb, Dy) from laboratory-prepared seawater spiked with REE solutions were evaluated. The assays lasted 72 h with REEs concentrations ranging from 10 to 500 µg L-1. The link between REEs uptake and algal metabolism, surface morphology and chemistry were addressed. Kinetics varied among the species, although most of the removal occurred in the first 24 h, with no equilibrium being reached. Lack of mortality reveal that the algae maintained their metabolism in the presence of the REEs. Green alga U. lactuca stood out as the only capable of efficiently removing at least 60% of all elements, reaching removals up to 90% in some cases. The high bioconcentration factors, derived from mass balance analysis (c.a. 2500) support that the REEs enriched algal biomass (up to 1295 µg g-1) may constitute an effective and environmentally friendly alternative source of REEs to conventional extraction from ores.

Reliability of triage systems for paediatric emergency care: a systematic review.

OBJECTIVE: To present a systematic review on the reliability of triage systems for paediatric emergency care. METHODS: A search of MEDLINE, Cochrane Library, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online, Nursing Database Index and Spanish Health Sciences Bibliographic Index for articles in English, French, Portuguese or Spanish was conducted to identify reliability studies of five-level triage systems for patients aged 0-18 years published up to April 2018. Two reviewers performed study selection, data extraction and quality assessment as recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: Twenty studies on nine triage systems were selected: the National Triage System (n=1); the Australasian Triage Scale (n=3); the paediatric Canadian Triage and Acuity Scale (PedCTAS) (n=5); the Manchester Triage System (MTS) (n=1); the Emergency Severity Index (ESI) (n=5); an adaptation of the South African Triage Scale for the Princess Marina Hospital in Botswana (n=1); the Soterion Rapid Triage System (n=1); the Rapid Emergency Triage and Treatment System-paediatric version (n=2); the Paediatric Risk Classification Protocol (n=1). Ten studies were performed with actual patients, while the others used hypothetical scenarios. The studies were rated low (n=14) or moderate (n=6) quality. Kappa was the most used statistic, although many studies did not specify the weighting. PedCTAS, MTS and ESI V.4 exhibited substantial to almost perfect agreement in moderate quality studies. CONCLUSIONS: There is some evidence on the reliability of the PedCTAS, MTS and ESI V.4, but most studies are limited to the countries where they were developed. Efforts are needed to improve the quality of the studies, and cross-cultural adaptation of those tools is recommended in countries with different professional qualification and sociocultural contexts.

Clinical Impact of Oral Anticoagulation in Patients with Atrial High-rate Episodes.

BACKGROUND: Atrial high-rate episodes (AHREs) are common in pacemaker patients. Our aims were to compare patients with AHREs to those without them and to assess if, in those with AHREs, the initiation of oral anticoagulation (OAC) has any clinical impact on the occurrence of ischemic and hemorrhagic events. METHODS: From 2014-2017 we selected patients with pacemaker in whom AHREs were detected. AHREs were defined as episodes lasting more than 6 minutes if the electrogram was available or more than 6 hours if not. We used an age- and gender-matched population with pacemaker but no AHRE as a control group (observational study). Those with AHRE were referred to their assistant physician to decide OAC initiation, based on individual circumstances (interventional study). In interventional study, the primary outcome was a composite of systemic thromboembolism or major bleeding. Secondary outcomes were clinical relevant nonmajor bleeding, major and nonmajor bleeding, CV death, and death from all causes. RESULTS: AHREs were detected in 86 patients: 69 patients initiated OAC and the remaining 17 patients did not. When comparing patients with and without AHRE, baseline characteristics were not different between the groups, except for indexed left atrium volume-40 mL (IQR: 34-50) in AHRE group versus 35 mL (IQR: 34-40) in control group (P = .014). AHREs were associated with future development of atrial fibrillation (AF) and the risk was higher if AHRE duration was superior to 6 hours. Death and cardiovascular (CV) death were not significantly different between the groups with and without AHRE. Primary outcome occurred in 4.9 per 100 person-year in OAC group versus 3.4 per 100 person-year in non-OAC group (HR 1.4, 95% CI .2-11.3, P = .78). Secondary outcomes were not significantly different in the groups. CONCLUSIONS: In this group of patients with pacemakers, the presence of AHREs was useful for predicting the future development of AF and the risk of AF was higher in those with a longer duration of AHRE. In the AHRE group, OAC therapy was not associated with a significant difference in the risk of thromboembolism or major bleeding.

Prevalence of chronic musculoskeletal conditions and associated factors in Brazilian adults - National Health Survey.

BACKGROUND: Chronic non-communicable diseases entail high impact on health systems in Brazil and worldwide. Among the most frequent are the musculoskeletal conditions which comprise a group of diseases that influence individuals' physical status, quality of life and functional capacity. Epidemiological studies investigating the scale of such conditions in the adult population are scarce in Brazil. This study estimates the prevalence of chronic musculoskeletal conditions and their association with demographic, socioeconomic, behavioural and clinical factors. METHODS: Cross-sectional study with data from Brazil's 2013 National Health Survey (Pesquisa Nacional de Saúde), a nationwide household survey of 60,202 adults. Musculoskeletal conditions were specified by self-reported medical diagnosis of arthritis or rheumatism and self-reported spinal disorders. The variables were examined using a hierarchical model of determination. Prevalences of musculoskeletal conditions were calculated with their respective 95% confidence intervals for Brazil and its five regions. Prevalence ratios (PRs) were obtained by Poisson regression with robust variance. RESULTS: Of the 60,202 individuals evaluated, 21.6% presented musculoskeletal conditions, with higher prevalences for females, older adults, indigenous, those living with a partner, low education, no occupational activity, those living in the South Region of Brazil, in rural areas, daily smokers, sedentary, obese, those who did not drink alcohol, with depressive symptoms or suffering from three or more chronic diseases. Multivariate analysis identified strong associations with advanced age (PR = 3.61; 95% CI 3.27-3.98), depressive symptoms (PR = 1.69; 95% CI 1.57-1.81) and multimorbidity (PR = 1.94; 95% CI 1.77-2.12). CONCLUSIONS: The results show high prevalence of musculoskeletal conditions in Brazil's adult population. Considering the process of aging and steady growth in chronic diseases, this study underlines the need for health policies directed to prevention, treatment and rehabilitation for people affected by chronic musculoskeletal conditions.

Maternal Immunization with Pneumococcal Polysaccharide Vaccine: Persistence of Maternal Antibodies in Infants.

OBJECTIVE: To evaluate the level and the persistence of maternal antibodies in infants after maternal immunization with pneumococcal polysaccharide vaccine (Pn23V). METHODS: Pregnant women were assigned to two groups, during routine low-risk pre-natal visits. The first Group (VAC) received the Pn23V vaccine shortly after enrolment at 28 weeks or later, and the second Group (NO_VAC) received no vaccine. To investigate the antibody persistence, we collected blood samples from the mothers after 1 month of delivery and from the infants at 1 and 6 months of age. RESULTS: Antibody titers were measured for serotypes 1, 6B and 14. Geometric mean antibody concentrations of specific immunoglobulin G were significantly higher in the vaccinated group compared with unvaccinated controls for all three serotypes tested. CONCLUSION: Despite the antibody level's decline, at 6 months of age, proportions >0.35 µg/ml remained higher in the infants of vaccinated mothers than controls for all three serotypes.