Evaluación de la consistencia interna y dimensionalidad de la Escala de Capital Social Cognitivo en adultos colombianos

Introducción: durante las últimas dos décadas, el concepto de capital social se ha utilizado con creciente frecuencia en las ciencias de la salud debido a las relaciones directas e indirectas entre el capital social y la salud física y mental de las poblaciones. Por tanto, es necesario construir un instrumento para cuantificar este concepto con seguridad y confiabilidad. Objetivo: analizar la consistencia interna y dimensionalidad de una escala de siete ítems para medir el capital social en adultos de la población general de Colombia. Metodología: se realizó un estudio de validación en línea, que incluyó una muestra de 700 adultos de entre 18 y 76 años, el 68 % eran mujeres. Los participantes completaron una escala de siete ítems llamada Escala de Capital Social Cognitivo (ECSC). El alfa de Cronbach y el omega de McDonald se calcularon para probar la consistencia interna. Se realizaron análisis factoriales exploratorios y confirmatorios para explorar la dimensionalidad de la ECSC. Resultados: la ECSC presentó una consistencia interna baja (alfa de Cronbach de 0,56 y omega de McDonald de 0,59) y pobre dimensionalidad. Seguidamente, se probó una versión de cinco ítems (ECSC-5). La ECSC-5 mostró una alta consistencia interna (alfa de Cronbach de 0,79 y omega de McDonald de 0,80) y una estructura unidimensional con indicadores de bondad de ajuste aceptables. Discusión: la ECSC-5 presenta alta consistencia interna y una estructura unidimensional para medir el capital cognitivo social en adultos colombianos. Se recomienda la ECSC-5 para la medición del capital social en la población general colombiana. Futuras investigaciones deben corroborar estos hallazgos en aplicaciones de lápiz y papel y explorar otros indicadores de confiabilidad y validez.

Introduction: During the last two decades, the concept of social capital has been used increasingly frequently in health sciences due to the direct and indirect relationships between social capital and populations' physical and mental health. Therefore, it is necessary to build an instrument to quantify this concept confidently and reliably. Objective: The study aimed to internal consistency and dimensionality of a seven-item scale to measure social capital in Colombia's general population of adults. Methods: An online validation study included a sample of 700 adults aged between 18 and 76 years; 68% were females. Participants completed a seven-item scale called the Cognitive Social Capital Scale (CSCS). Cronbach's alpha and McDonald's omega were computed to test internal consistency. The authors explore the internal consistency and dimensionality of the CSCS. Results: The CSCS presented a low internal consistency (Cronbach's alpha of 0.56 and McDonald's omega of 0.59) and poor dimensionality. Then, the researchers tested a five-item version (CSCS-5). The CSCS-5 showed high internal consistency (Cronbach's alpha of 0.79 and McDonald's omega of 0.80) and a one-dimension structure with acceptable goodness-of-fit indicators. Discussion: The CSCS-5 presents high internal consistency and a one-dimensional structure to measure cognitive capital social in the Colombian sample. Authors can recommend measuring social capital in the general Colombian population. Further research should corroborate this pencil and paper application findings and explore other reliability and validity indicators.

Factors associated with non-treatment of hypertension and gender differences at baseline in the ELSA-Brasil cohort

The treatment of arterial hypertension (AH) contributes to the reduction of morbidity and mortality. Gender differences are likely to play a role, as non-treatment is associated with clinical and sociodemographic aspects. The aim of this study was to investigate the factors associated with non-treatment of AH and gender differences in hypertensive individuals from the ELSA-Brasil cohort. The study was conducted with 5,743 baseline hypertensive cohort participants. AH was considered if there was a previous diagnosis or if systolic blood pressure (SBP) was ≥140 and/or diastolic BP (DBP) was ≥90 mmHg. Sociodemographic and anthropometric data, lifestyle, comorbidities, and use of antihypertensive medications were evaluated through interviews and in-person measurements. Treatment with renin-angiotensin-aldosterone system inhibitors (RAASi) or other antihypertensive medications and non-treatment were evaluated with multivariate logistic regression. Non-treatment was observed in 32.8% of hypertensive individuals. Of the 67.7% treated individuals, 41.1% received RAASi. Non-treatment was associated with alcohol consumption in women (OR=1.41; 95%CI: 1.15-1.73; P=0.001), lowest schooling level in men (OR=1.70; 95%CI: 1.32-2.19; P<0.001), and younger age groups in men and women (strongest association in males aged 35-44 years: OR=4.58, 95%CI: 3.17-6.6, P<0.001). Among those using RAASi, a higher proportion of white, older individuals, and with more comorbidities was observed. The high percentage of non-treatment, even in this civil servant population, indicated the need to improve the treatment cascade for AH. Public health policies should consider giving special attention to gender roles in groups at higher risk of non-treatment to reduce inequities related to AH in Brazil.

Relación entre la compatibilidad del HLA y la pérdida del injerto en trasplante renal de donante cadavérico: Un análisis por propensity score matching en Colombia / Relationship between HLA compatibility and graft loss in renal transplant from a deceased donor: An analysis by propensity score matching in Colombia

Introducción. En Colombia, solo un 24 % de los pacientes en lista recibieron un trasplante renal, la mayoría de donante cadavérico. Para la asignación de órganos se considera el HLA A-B-DR, pero la evidencia reciente sugiere que el HLA A-B no está asociado con los desenlaces del trasplante. El objetivo de este estudio fue evaluar la relevancia del HLA A-B-DR en la sobrevida del injerto de los receptores de trasplante renal. Métodos. Estudio de cohorte retrospectivo que incluyó pacientes trasplantados renales con donante cadavérico en Colombiana de Trasplantes, desde 2008 a 2023. Se aplicó un propensity score matching (PSM) para ajustar las covariables en grupos de comparación por compatibilidad y se evaluó la relación del HLA A-B-DR con la sobrevida del injerto renal por medio de la prueba de log rank y la regresión de Cox. Resultados. Se identificaron 1337 pacientes transplantados renales, de los cuales fueron mujeres un 38,7 %, con mediana de edad de 47 años y de índice de masa corporal de 23,8 kg/m2. Tras ajustar por PSM las covariables para los grupos de comparación, la compatibilidad del HLA A-B no se relacionó significativamente con la pérdida del injerto, con HR de 0,99 (IC95% 0,71-1,37) para HLA A y 0,75 (IC95% 0,55-1,02) para HLA B. Solo la compatibilidad por HLA DR fue significativa para pérdida del injerto con un HR de 0,67 (IC95% 0,46-0,98). Conclusión. Este estudio sugiere que la compatibilidad del HLA A-B no influye significativamente en la pérdida del injerto, mientras que la compatibilidad del HLA DR sí mejora la sobrevida del injerto en trasplante renal con donante cadavérico

Introduction. In Colombia, only 24% of patients on the waiting list received a renal transplant, most of them from cadaveric donors. HLA A-B-DR is considered for organ allocation, but recent evidence suggests that HLA A-B is not associated with transplant outcomes. The objective of this study was to evaluate the relevance of HLA A-B-DR on graft survival in kidney transplant recipients. Methods. Retrospective cohort study that included kidney transplant recipients with a cadaveric donor in Colombiana de Trasplantes from 2008 to 2023. A propensity score matching (PSM) was applied to adjust the covariates in comparison groups for compatibility, and the relationship of HLA A-B-DR with kidney graft survival was evaluated using the log rank test and Cox regression. Results. A total of 1337 kidney transplant patients were identified; of those, 38.7% were female, with median age of 47 years, and BMI 23.8 kg/m2. After adjusting the covariates with PSM for the comparison groups, HLA A-B matching was not significantly related to graft loss, with HR of 0.99 (95% CI 0.71-1.37) and 0.75 (95% CI 0.55-1.02), respectively. Only HLA DR matching was significant for graft loss with an HR of 0.67 (95% CI 0.46-0.98). Conclusions. This study suggests that HLA A-B matching does not significantly influence graft loss, whereas HLA DR matching does improve graft survival in renal transplantation with a cadaveric donor.

Ablação por Cateter para Fibrilação Atrial em Pacientes com Fração de Ejeção do Ventrículo Esquerdo ≤ 45%: Uma Metanálise de Ensaios Clínicos Randomizados / Catheter Ablation for Atrial Fibrillation in Patients with Left Ventricular Ejection Fraction ≤ 45%: A Meta-Analysis of Randomized Controlled Trials

Resumo Fundamento A fibrilação atrial (FA) e a insuficiência cardíaca (IC) coexistem frequentemente, resultando em desfechos adversos. No entanto, permanecem controvérsias quanto à eficácia da ablação por cateter (AC) em pacientes com FA com disfunção ventricular esquerda grave. Objetivos O objetivo deste estudo foi realizar uma metanálise de ensaios prospectivos randomizados e controlados para avaliar a eficácia da AC versus terapia médica (TM) em pacientes com FA com fração de ejeção do ventrículo esquerdo (FEVE) ≤45%. Métodos Procuramos na literatura estudos que comparassem AC com TM em pacientes com FA com FEVE ≤45%. Foi realizada uma metanálise de 7 ensaios clínicos, incluindo 1.163 pacientes com FA e IC. A análise de subgrupo foi realizada com base na FEVE basal. Todos os testes foram bilaterais; apenas o valor p <0,05 foi considerado estatisticamente significativo. Resultados Descobrimos que a AC estava associada a menor mortalidade por todas as causas (taxa de risco: 0,52, IC 95%: 0,37 a 0,72; p<0,01) e maiores melhorias na FEVE (diferença média: 4,80%, IC 95%: 2,29% a 7,31%; p<0,01) em comparação com TM. Os pacientes do grupo AC apresentaram menor risco de hospitalização por IC e recorrência de FA e qualidade de vida significativamente melhor do que aqueles do grupo TM. Os resultados da análise de subgrupo indicaram que pacientes com disfunção ventricular esquerda mais leve melhoraram a FEVE após a ablação de FA (diferença média: 6,53%, IC 95%: 6,18% a 6,88%; p<0,01) em comparação com pacientes com doença mais grave (diferença média : 2,02%, IC 95%: 0,87% a 3,16%; p<0,01). Conclusões Nossa metanálise demonstrou que a AC foi associada a melhorias significativas nos resultados de pacientes com FA com FEVE ≤45%. Além disso, pacientes com FA com disfunção ventricular esquerda mais leve poderiam se beneficiar mais com a AC.

Abstract Background Atrial fibrillation (AF) and heart failure (HF) frequently coexist, resulting in adverse outcomes. However, controversies remain regarding the efficacy of catheter ablation (CA) in AF patients with severe left ventricular dysfunction. Objectives The purpose of this study was to perform a meta-analysis of prospective randomized controlled trials to evaluate the efficacy of CA versus medical therapy (MT) in AF patients with left ventricular ejection fraction (LVEF) ≤45%. Methods We searched the literature for studies that compared CA to MT in AF patients with LVEF ≤45%. A meta-analysis of 7 clinical trials was performed, including 1163 patients with AF and HF. Subgroup analysis was performed based on baseline LVEF. All tests were 2-sided; only the p-value <0.05 was considered statistically significant. Results We found that CA was associated with lower all-cause mortality (risk ratio: 0.52, 95% CI: 0.37 to 0.72; p<0.01) and greater improvements in LVEF (mean difference: 4.80%, 95% CI: 2.29% to 7.31%; p<0.01) compared to MT. Patients in the CA group had a lower risk of HF hospitalization and AF recurrence and a significantly better quality of life than those in the MT group. The results of subgroup analysis indicated that patients with milder left ventricular dysfunction improved LVEF after AF ablation (mean difference: 6.53%, 95% CI: 6.18% to 6.88%; p<0.01) compared to patients with more severe disease (mean difference: 2.02%, 95% CI: 0.87% to 3.16%; p<0.01). Conclusions Our meta-analysis demonstrated that CA was associated with significant improvements in outcomes of AF patients with LVEF ≤45%. Additionally, AF patients with milder left ventricular dysfunction could benefit more from CA.

Factores que influyen en la supervivencia de pacientes con diálisis en El Salvador / Influencing Factors in the Survival of Dialysis Patients in El Salvador

Introducción. La enfermedad renal crónica es responsable de aproximadamente 2,4 millones de defunciones a nivel mundial. La supervivencia a los cinco años después de iniciar diálisis se encuentra entre un 39 a 60 % dependiendo del país. Objetivo. Describir la situación epidemiológica de los pacientes con diálisis y analizar los factores que influyen en la supervivencia de pacientes a cinco años de iniciar tratamiento sustitutivo renal en El Salvador. Metodología. Estudio de cohorte retrospectivo de los pacientes incluidos en el Registro Nacional de Diálisis y Trasplante Renal desde enero de 2016 hasta febrero de 2023. El seguimiento se comenzó al inicio de la diálisis, el evento de interés fue la muerte del paciente. Se utilizó el método de Kaplan-Meier para determinar la supervivencia al año y a los cinco años y la regresión de Cox con el modelo de Royston-Parmar para analizar los factores que influyen sobre la supervivencia a los cinco años. Resultados. El estudio incluyó 7088 pacientes, la supervivencia a uno y cinco años fue del 79,5 % (IC 95 %: 78,6-80,5) y 50,6 % (IC 95 %: 49,1-52,1) respectivamente. La regresión de Cox para la edad de inicio de tratamiento resultó en un hazard ratio de 1,02 (IC 95 %: 1,01-1,02), mientras que para el oficio de ser agricultor el hazard ratio fue 1,1 (IC 95 %: 1,01-1,18) y para la etiología hipertensiva el hazard ratio fue de 0,7 (IC 95 %: 0,64-0,78). Conclusión. La edad de inicio de tratamiento y el ser agricultor están asociados con una menor supervivencia a cinco años en pacientes con diálisis

Introduction. The chronic kidney disease is responsible for approximately 2.4 million deaths worldwide, in El Salvador during 2019 death rate was 72.9 for 100 000 habitants, five year survival in patients after starting dialysis was between 39 and 60 % depending on the country. Objective. Analyze the factors that influence the five years survival in patients after starting renal replacement therapy in El Salvador. Methodology. It is a retrospective cohort study from patients included in dialysis and renal replacement therapy national registry from January 2016 to February 2023, the start point for the following was the initiation of dialysis, the event of interest was patient ́s death, the Kaplan-Meier method was used to determine one year and five year survival; and Cox regression with Royston-Parmar model was used to analyze the factors that influence survival. Results. The study included 7088 patients, one and five-years survival was 79.5 % (CI 95 %: 78.6-80.5) and 50.6 % (CI 95 %: 49.1-52.1) respectively. The Cox regression for age of treatment initiation resulted in a hazard ratio of 1.02 (CI 95 %: 1.01-1.02), while for farmers, the hazard ratio was 1.09 (CI 95 %: 1.00-1.18), for hypertensive etiology the hazard ratio was 0.7 (CI 95 %: 0.64-0.78). Conclusion. Data suggest that age of treatment initiation, and jobs related to agriculture were associated with less five year survival in dialysis patients.

Análise dos feminicídios no estado de Pernambuco: violência de gênero e invisibilidade / Analysis of femicides in the state of Pernambuco: gender-based violence and invisibility / Análisis de los feminicidios en el estado de Pernambuco: violencia de género e invisibilidad

O feminicídio é um fenômeno decorrente da herança patriarcal machista e de estruturas sociais historicamente permeadas por relações desiguais de gênero. O objetivo desta dissertação, que é um estudo ecológico, foi analisar os aspectos epidemiológicos dos feminicídios registrados em Pernambuco, entre 2016 e 2019. Como proxy dos eventos de feminicídio, foi admitido como referência o registro de homicídios e de mortes por causas indeterminadas de mulheres no Sistema de Informações sobre Mortalidade. Foram estabelecidas etapas de buscas com o linkage probabilístico em bases de dados da saúde e, de forma complementar, de revisões manuais em plataforma do Tribunal de Justiça de Pernambuco (TJPE) e mídias noticiosas online. Realizou-se a descrição dos dados mediante a distribuição de frequências, medidas de tendência central e dispersão. Para analisar o padrão espacial das taxas de feminicídio, foram utilizados o método bayesiano empírico local e o índice de autocorrelação de Moran. Aplicou-se a regressão logística hierarquizada para verificar a associação entre o feminicídio e a violência interpessoal e estimar a razão de chances (Odds Ratio) com intervalos de confiança de 95% (IC95%). Assim, foram localizados 490 feminicídios, o que correspondeu a uma taxa de 2,5 por 100.000 mulheres. A maior proporção de feminicídios foi identificada pela busca manual em mídias noticiosas online e na base processual do TJPE (n = 247; 50,41%). As características principais das vítimas são: idade entre 20 e 39 anos (n = 286; 58,37%); raça/cor negra (n = 400; 81,63%); sem companheiro(a) (n = 407; 83,06%); e escolaridade superior a oito anos de estudo (n = 303; 61,84%). A autocorrelação espacial do evento foi confirmada pelo índice global de Moran das taxas suavizadas (I = 0,3; p = 0,001); a autocorrelação local reforça a interiorização do evento ao apontar área crítica (Q1) formada por municípios localizados na macrorregião do Vale do São Francisco e Araripe. No nível de determinação distal, identificou-se que as seguintes variáveis elevam as chances de ocorrência do feminicídio: residir em município de pequeno porte (OR = 2,10); indisponibilidade de delegacias especializadas no atendimento à mulher (OR = 1,11); e ausência de encaminhamentos para rede assistencial e protetiva na oportunidade de agressão anterior (OR = 1,32). Nos determinantes intermediários, destacou-se que, quanto maior é a intensidade do meio de ação empregado na prática da violência, maior é a chance do desfecho fatal, ressaltando-se o uso de objeto perfurocortante (OR = 3,93) e arma de fogo (OR = 11,14). E, acerca dos determinantes proximais, as vítimas inseridas na faixa etária entre 10 e 19 anos apresentaram menor chance quanto à ocorrência de feminicídio (OR = 0,51). A caracterização da população de estudo pode proporcionar a ampliação dos conhecimentos sobre violência estrutural contra as mulheres, aspectos da notificação e da rede assistencial e protetiva. A análise espacial identificou a interiorização do evento e áreas de transição em Pernambuco, as quais requerem priorização de intervenções. E a modelagem evidenciou que as mulheres estão expostas a múltiplos fatores de risco para a ocorrência de feminicídio, de forma que a discussão, de modo particularizado a todos os níveis de determinação, faz-se ainda mais necessária.

Feminicide results from the sexist patriarchal heritage and social structures historically permeated by unequal gender relations. This ecological study analyzes the epidemiological aspects of feminicides recorded in Pernambuco between 2016 and 2019. Records of homicides and undetermined causes of death of women available in the Mortality Information System were the proxy for feminicide events and accepted as reference. Search steps were established with probabilistic linkage in health databases, as well as manual reviews on the Pernambuco Court of Justice (TJPE) platform and online news media as a complement. Data were described by the distribution of frequencies, measures of central tendency and dispersion. Local empirical Bayesian method and Moran's autocorrelation index were used in the spatial pattern analysis of femicide rates. Hierarchical logistic regression was applied to verify the association between femicide and interpersonal violence and to estimate the Odds Ratio with 95% confidence intervals (95%CI). Search returned a total of 490 feminicides, corresponding to a rate of 2.5 per 100,000 women. The highest proportion of feminicides was identified by manual search in online news media and in the TJPE database (n = 247; 50.41%). Most victims were aged between 20 and 39 years (n = 286; 58.37%), black (n = 400; 81.63%), had no partner (n = 407; 83.06%) and with over eight years of schooling (n = 303; 61.84%). Spatial autocorrelation of the event was confirmed by the Global Moran Index of smoothed rates (I = 0.3; p = 0.001). Local autocorrelation reinforces the interiorization of the phenomenon by pointing to a critical area (Q1) formed by municipalities located in the Vale do São Francisco and Araripe macroregion. At the distal level, the following variables increase the chances of feminicide: living in a small city (OR = 2.10); unavailability of specialized police stations (OR = 1.11); and absence of referrals to the care and protection network in the event of a previous aggression (OR = 1.32). Regarding intermediate determinants, the greater the violence inflicted the greater the chance of a fatal outcome, emphasizing the use of sharp objects (OR = 3.93) and firearms (OR = 11.14). Regarding proximal determinants, victims in the age group 10-19 years old were less likely to be a victim of femicide (OR = 0.51). Characterizing the study population can further knowledge about structural violence against women, and aspects of the notification and the care and protection network. Spatial analysis pointed to the interiorization of the phenomenon and transition areas in Pernambuco, requiring prioritization of interventions. The modeling showed that women are exposed to multiple risk factors for feminicide and further discussions at all levels of determination are necessary.

El feminicidio es un fenómeno derivado de la herencia patriarcal machista y de estructuras sociales históricamente permeadas por relaciones desiguales de género. Este estudio de tipo ecológico tuvo por objetivo analizar los aspectos epidemiológicos de los feminicidios registrados en Pernambuco, en el período entre 2016 y 2019. Como proxy de los eventos de feminicidio, se utilizó como referencia el registro de homicidios y de causas indeterminadas de muertes de mujeres en el Sistema de Informaciones sobre Mortalidad. Se establecieron etapas de búsquedas con vinculación probabilística en las bases de datos de salud y, de forma complementaria, búsquedas manuales en la plataforma del Tribunal de Justicia de Pernambuco (TJPE) y medios en línea. Para describir los datos se utilizaron la distribución de frecuencias, medidas de tendencia central y dispersión. Para analizar el padrón espacial de las tasas de feminicidio se emplearon el método bayesiano empírico local y el índice de autocorrelación de Moran. Se aplicó la regresión logística jerarquizada para constatar la asociación entre el feminicidio y la violencia interpersonal, y estimar la razón de posibilidades (Odds Ratio) con intervalos de confianza del 95% (IC95%). Los resultados apuntaron a 490 feminicidios, lo que correspondió a una tasa de 2,5 por 100.000 mujeres. La mayor proporción de feminicidios se identificó mediante la búsqueda manual en prensa en línea y en la base procesal del TJPE (n = 247; 50,41%). Las principales características de las víctimas fueron edad entre 20 y 39 años (n = 286; 58,37%), raza/color negro (n = 400; 81,63%), sin compañero(a) (n = 407; 83,06%) y nivel de estudios superior a ocho años de estudio (n = 303; 61,84%). La autocorrelación espacial del evento se confirmó mediante el índice de Moran global de las tasas suavizadas (I = 0,3, p = 0,001); la autocorrelación local refuerza la interiorización del evento al señalar área crítica (Q1) formada por municipios situados en la macrorregión del Valle de São Francisco y Araripe. En el nivel de determinación distal se identificó que las siguientes variables aumentan las posibilidades de feminicidio: residir en municipio de pequeño tamaño, (OR = 2,10); indisponibilidad de comisarías especializadas en la atención a la mujer (OR = 1,1); y ausencia de remisiones a la red asistencial y protectora en la ocasión de agresión anterior (OR = 1,32). En los determinantes intermediarios, se destacó que cuanto mayor es la intensidad del medio de acción empleado en la práctica de la violencia, mayor es la posibilidad de desenlace fatal, destacándose el empleo de objeto cortopunzante (OR = 3,93) y arma de fuego (OR = 11,14). En cuanto a los determinantes proximales, las víctimas comprendidas en el tramo de edad comprendido entre los 10 y los 19 años presentaron menos posibilidad de incidencia de feminicidio (OR = 0,51). La caracterización de la población de estudio puede proporcionar la ampliación de los conocimientos sobre violencia estructural contra la mujer, aspectos de la notificación y de la red asistencial protectora. El análisis espacial identificó la interiorización del evento y áreas de transición en Pernambuco, las cuales requieren priorización de las intervenciones. Y el modelaje reveló que las mujeres están expuestas a múltiples factores de riesgo para la incidencia de feminicidio y el debate, de modo particularizado de todos los niveles de determinación, se hace todavía más necesario.

Dietary patterns and socioeconomic, demographic, and health-related behaviors during pregnancy. A cross-sectional study

ABSTRACT BACKGROUND: The identification and understanding of dietary factors and other characteristics that influence gestational weight gain can contribute to the formulation of strategies to promote healthy eating habits before and during pregnancy. OBJECTIVE: To investigate the association between dietary patterns, sociodemographic and obstetric characteristics, and health-related behaviors in pregnant women. DESIGN AND SETTING: A cross-sectional study was conducted on women undergoing prenatal care in the Unified Health System of Colombo, Paraná, Brazil, from February 2018 to September 2019. METHOD: A weekly food frequency questionnaire was administered, and dietary patterns were identified through factor analysis. Median regression models were constructed to identify the associations between dietary pattern scores and variables. RESULTS: Complete data were obtained from 495 pregnant women. Three dietary patterns were identified: 1) "healthy," with higher factor loadings for the weekly consumption of raw vegetables, cooked vegetables, and fresh fruits; 2) "Western," including soft drinks or artificial juice, candies, milk, and dairy products, and processed cold meat; and 3) "traditional," beans and meat. Pregnant women aged 30 years or older (coefficient [Coef.] 0.86, 95% confidence interval [CI] 0.38-1.33) with moderate/intense physical activity (Coef. 0.32, 95% CI 0.02-0.62) had higher adherence to the "healthy" pattern. Adolescents and smokers adhered more to the "traditional" pattern (Coef. 0.17, 95% CI 0.01-0.33). CONCLUSION: Age, smoking status, and physical activity were associated with dietary patterns in pregnant women.

Sobrevivência em fadiga de coroas bioinspiradas bilaminadas: estudo in vitro / Fatigue survival rate of bioinspired bilaminar crowns: in vitro study

O objetivo deste estudo foi avaliar o comportamento biomecânico através da resistência à fadiga e análise por elementos finitos de coroas bioinspiradas bilaminadas com infraestruturas modificadas na superfície vestibular (Estudo A) e utilizando diferentes materiais cerâmicos com módulos elásticos distintos (Estudo B). Para isso, foram confeccionados 90 preparos para coroa total em resina epóxi G10, sobre os quais foram preparadas coroas bioinspiradas de acordo com os seguintes grupos: Estudo A - IC (infraestrutura convencional), IME (infraestrutura modificada estratificada) e IMC (infraestrutura modificada cimentada), todas confeccionadas em dissilicato de lítio (infraestrutura) + porcelana (recobrimento); Estudo B ­ DL+LEU (dissilicato de lítio + leucita), LEU+DL (leucita + dissilicato de lítio), CH+DL (cerâmica híbrida + dissilicato de lítio) e CH+LEU (cerâmica híbrida + leucita). Para o Estudo A, todas as infraestruturas foram usinadas; os recobrimentos dos grupos IC e IME foram confeccionados através da estratificação, e os recobrimentos do grupo IMC foram usinados. Já para o Estudo B, todas as peças foram usinadas, de acordo com o material cerâmico de cada grupo. Em seguida, foi realizada a cimentação adesiva dos recobrimentos sobre as infraestruturas (a depender do grupo) e das coroas sobre os preparos utilizando cimento resinoso fotopolimerizável (Variolink Esthetic LC). Após a cimentação, os espécimes foram submetidos ao teste de fadiga cíclica (10.000 ciclos, 20Hz), e como desfecho foram considerados dois eventos, em que o primeiro foi a ocorrência de trinca e/ou lascamento (evento 1) e o segundo foi a falha catastrófica do conjunto (evento 2). Os valores de carga e número de ciclos para falha em que foram observados os eventos 1 e 2 foram utilizados para realizar a análise de sobrevivência de acordo com Kaplan-Meier e Log-Rank (Mantel-Cox; 95%). As marcas de fratura e o modo de falha das coroas foram avaliados e classificados por estereomicroscópio óptico e microscópio eletrônico de varredura. Por fim, foi realizada análise por elementos finitos (FEA) para ambos os estudos, a fim de avaliar a distribuição de tensões sobre as coroas e interface adesiva. Para o Estudo A, os resultados do teste de fadiga mostraram que, considerando o evento 1 (trinca/lascamento), os grupos IC e IMC apresentaram médias de carga fadiga estatisticamente significantes entre si (733,33 N e 913,33 N, respectivamente), enquanto o grupo IME apresentou média superior (1.020 N). O mesmo foi observado para o número de ciclos em fadiga para todos os grupos. Ao considerar o evento 2 (falha catastrófica), os três grupos apresentaram médias estatisticamente semelhantes entre si (~1.028 N). Os resultados de FEA mostraram que o grupo IC concentrou maior tensão de tração do que os grupos IME e IMC. Para o Estudo B, no teste de fadiga, o grupo DL+LEU apresentou a maior média de resistência à fadiga (evento 1: 913,33 N e evento 2: 1033,33 N), enquanto todas as outras combinações de materiais cerâmicos analisadas foram estatisticamente semelhantes entre si, considerando carga e número de ciclos. Com relação ao FEA, os grupos com cerâmica híbrida (CH+DL e CH+LEU) apresentaram menores picos de concentração de tensão na infraestrutura do que os grupos com cerâmicas vítreas (DL+LEU e LEU+DL), porém, em contrapartida, concentraram maior tensão na interface adesiva. Com isso, conclui-se que a utilização da infraestrutura modificada é uma alternativa viável e promissora para tratamentos reabilitadores, apresentando sobrevivência em fadiga e distribuição de tensões satisfatórias. Além disso, a combinação entre uma infraestrutura de dissilicato de lítio e recobrimento de cerâmica a base de leucita corresponde a melhor abordagem considerando a infraestrutura modificada.(AU)

The objective of this study was to evaluate the biomechanical behavior through fatigue resistance and finite element analysis of bilaminar bioinspired crowns with modified infrastructures on the buccal surface (Study A) and using different ceramic materials with different elastic moduli (Study B). For this, 90 preparations were made for a full crown in G10 epoxy resin, on which bioinspired crowns were prepared according to the following groups: Study A - CI (conventional infrastructure), SMI (stratified modified infrastructure) and CMI (cemented modified infrastructure ), all made of lithium disilicate (infrastructure) + porcelain (veneer); Study B ­ LD+LEU (lithium disilicate + leucite), LEU+LD (leucite + lithium disilicate), HC+LD (hybrid ceramic + lithium disilicate) and HC+LEU (hybrid ceramic + leucite). For Study A, all infrastructures were machined; the coverings of the CI and SMI groups were made through stratification technique, and the veneers of the SMI group were machined. For Study B, all pieces were machined, according to the ceramic material of each group. Then, the veneers were cemented into their infrastructures (depending on the group) and crowns were cemented into preparations using light-cured resin cement (Variolink Esthetic LC). After cementing, the specimens were subjected to the cyclic fatigue test (10,000 cycles, 20Hz), and as an outcome two events were considered: the occurrence of cracking and/or chipping (event 1) and catastrophic failure (event 2). The load (N) and number of cycles to failure in which events 1 and 2 were observed were used to perform the survival analysis according to Kaplan-Meier and Log-Rank (Mantel- Cox; 95%). The fracture marks and failure mode of the crowns were evaluated and classified by optical stereomicroscope and scanning electron microscope. Finally, finite element analysis (FEA) was performed for both studies in order to evaluate the stress distribution over the crowns and adhesive interface. For Study A, the results of the fatigue test showed that, considering event 1 (cracking/chipping), the CI and CMI groups presented average to failure that were statistically significant compared to each other (733.33 N and 913.33 N, respectively), while the SMI group showed higher averages (1,020 N). Same pattern was observed for the number of cycles under fatigue for both groups. When considering event 2 (catastrophic failure), the three groups presented statistically similar means (~1,028 N). The FEA results showed that the CI group concentrated greater tensile stress than the CMI and SMI groups. For Study B, in the fatigue test, the LC+LEU group presented the highest average fatigue resistance (event 1: 913.33 N and event 2: 1033.33 N), while all other combinations of ceramic materials analyzed were statistically similar to each other, considering load and number of cycles. Regarding FEA, the groups with hybrid ceramics (HC+LC and HC+LEU) showed lower stress concentration peaks in the infrastructure than the groups with glass ceramics (LC+LEU and LEU+LC), however, on the other hand, concentrated greater tension at the adhesive interface. With this, it is concluded that the use of modified infrastructure is a viable and promising alternative for oral rehabilitation treatments, presenting satisfactory fatigue survival and adequate stress distribution. Furthermore, the combination of a lithium disilicate infrastructure and a leucite-based ceramic coating corresponds to the best approach considering the modified infrastructure.(AU)

Ascending Aortic Surgery for Small Aneurysms in Men and Women

ABSTRACT Introduction: According to recent data, thoracic aortic surgery has reduced morbidity and mortality including ascending aortic aneurysm treatment; however, women are at increased postoperative risk of adverse outcomes. Objective: Our aim was to evaluate early and late outcomes in male and female patients who underwent pre-emptive ascending aortic replacement (AAR). Methods: From January 2013 to September 2021, 91 patients (56 [61.5%] men and 35 [38.5%] women) underwent AAR for small (ranged from 5.0 to 5.5 cm) non-syndromic aneurysms. A propensity score-based adjustment of the groups was performed. We compared clinical outcomes between males and females. Results: Preoperative normalized aortic diameters were significantly larger in females (2.9 [2.7; 3.2] cm/m2) than in males (2.5 [2.3; 2.6] cm/m2, P<0.001), without differences in absolute values (51 [49; 53] mm vs. 52 [50; 53] mm, P=0.356). There were no significant differences in neurological, cardiac, pulmonary, and renal complications in both groups before and after matching. In-hospital mortality was 1 (1.8%) and 2 (5.7%) (P=0.307) in male and female patients in unmatched groups and 1 (2.9%) and 2 (5.7%) (P=0.553) in matched groups, respectively. Univariate logistic regression analysis revealed that the only risk factor for in-hospital mortality was age (odds ratio 1.117, 95% confidence interval 1.003-1.244; P=0.04). The overall survival rate was 83.5±0.06% in men and 94.3±0.04% in women at 36 months (P=0.404). Conclusion: Ascending aortic surgery for aneurysms ranged from 5.0 to 5.5 cm seems to have tolerable early and late outcomes in men and women.

Correlation analysis of cardiopulmonary exercise test indices and conditions of overweight patients with obstructive sleep apnea: a retrospective study

ABSTRACT BACKGROUND: The cardiopulmonary function of patients with obstructive sleep apnea (OSA) is significantly lower than that of patients with simple snoring and is significantly related to the severity of OSA. Currently, only a few studies have been conducted on cardiopulmonary exercise testing in overweight patients with OSA. OBJECTIVE: To analyze the correlation between cardiopulmonary exercise test (CPET) indices and the condition of overweight patients with OSA. DESIGN AND SETTING: Retrospective study in Guangdong Provincial Hospital of Chinese Medicine. METHODS: This study included 73 hospitalized overweight patients. The patients were divided into no, mild, moderate, and severe OSA groups. Differences in the CPET indices among the four groups were compared. The correlation between the CPET indices and conditions was analyzed. RESULTS: No, mild, moderate, and severe OSA groups had 18 men and 5 women, 11 men and 3 women, 12 men and 2 women, and 21 men and 1 woman, respectively (P > 0.05). No significant difference was observed in resting pulmonary function among the four groups (P > 0.05). In the CPET, the anaerobic threshold, maximum oxygen uptake, and oxygen pulse were significantly lower in the severe OSA group than those in the normal OSA group (P < 0.05). Moreover, CPET indices negatively correlated with the apnea-hypopnea index. CONCLUSION: Changes in CPET indices occurred earlier than changes in resting pulmonary function in patients with OSA. CPET might be a potential method for evaluating the severity of OSA combined with overweight status.

Dinâmica espaço-temporal e fatores associados à mortalidade neonatal / Space-temporal dynamics and factors associated with newborn mortality / Dinámica Espacio-temporal y factores asociados a la mortalidad del recién nacido

Objetivo:analisar a distribuição espacial e temporal da mortalidade neonatal e fatores associados no Piauí de 2007 a 2017. Método: foi utilizado o método Joinpoint, estatística bayesiana e a técnica de varredura Scan. A análise multivariada dos indicadores foi realizada através do modelo Ordinary Least Squares Estimation, considerando-se p<0,05. Resultados: a mortalidade neonatal reduziu de forma linear e significativa ao longo do período estudado. As maiores taxas bayesianas variaram de 16,34 a 18,38 óbitos por 1.000 nascidos vivos, especialmente no Sudeste piauiense. Houve associação negativa entre a mortalidade neonatal e as variáveis: Taxa de analfabetismo (ß = -0,60; p= 0,027), Cobertura da Estratégia Saúde da Família (ß = -2,80; p= 0,023) e Índice de Desenvolvimento Humano Municipal (ß = -0,60; p= 0,003). Conclusão: a mortalidade neonatal segue decrescente e sua distribuição no território mostrou-se irregular. Indicadores socioeconômicos e de saúde influenciam a mortalidade neonatal no Piauí

Objective: to analyze the spatial and temporal distribution of neonatal mortality and associated factors in Piauí from 2007 to 2017. Method: the Joinpoint method, Bayesian statistics and the Scan technique were used. The multivariate analysis of the indicators was performed using the Ordinary Least Squares Estimation model, considering p<0.05. Results: neonatal mortality decreased linearly and significantly over the period studied. The highest Bayesian rates ranged from 16.34 to 18.38 deaths per 1,000 live births, especially in Southeast Piauí. There was a negative association between neonatal mortality and the variables: Illiteracy rate (ß = -0.60; p= 0.027), Family Health Strategy Coverage (ß = -2.80; p= 0.023) and Human Development Index Municipal (ß = -0.60; p= 0.003). Conclusion: neonatal mortality continues to decrease and its distribution in the territory proved to be irregular. Socioeconomic and health indicators influence neonatal mortality in Piauí

Objetivos: analizar la distribución espacial y temporal de la mortalidad neonatal y factores asociados en Piauí de 2007 a 2017. Método: se utilizó el método Joinpoint, la estadística bayesiana y la técnica Scan. El análisis multivariado de los indicadores se realizó mediante el modelo de Estimación por Mínimos Cuadrados Ordinarios, considerando p<0,05. Resultados: la mortalidad neonatal disminuyó lineal y significativamente durante el período estudiado. Las tasas bayesianas más altas oscilaron entre 16,34 y 18,38 muertes por 1.000 nacidos vivos, especialmente en el Sudeste de Piauí. Hubo asociación negativa entre la mortalidad neonatal y las variables: Tasa de Analfabetismo (ß = -0,60; p= 0,027), Cobertura de la Estrategia de Salud de la Familia (ß = -2,80; p= 0,023) e Índice de Desarrollo Humano Municipal (ß = -0,60; p= 0,003). Conclusión: la mortalidad neonatal continúa en descenso y su distribución en el territorio resultó ser irregular. Indicadores socioeconómicos y de salud influyen en la mortalidad neonatal en Piauí

Investigation of the molecular genetic causes of non-syndromic primary ovarian ınsufficiency by next generation sequencing analysis

ABSTRACT Objective: The aim of this study is to investigate the molecular genetic causes of non-syndromic primary ovarian insufficiency (POI) cases with the gene panel based on next generation sequencing analysis and to establish the relationship between genotype and phenotype. Subjects and methods: Twenty three cases aged 14-40 years followed up with POI were included. Patients with a karyotype of 46, XX, primary or secondary amenorrhea before the age of 40, with elevated FSH (>40 IU/mL) and low AMH levels (<0.03 ng/mL) were included in the study. Molecular genetic analyzes were performed by the next generation sequencing analysis method targeted with the TruSightTM Exome panel. Results: Median age of the cases was 17.8 (14.0-24.3) years, and 12 (52%) cases admitted before the age of 18. Fifteen (65%) patients had consanguineous parents. In 2 (8.6%) cases, variants detected were in genes that have been previously proven to cause POI. One was homozygous variant in FIGLA gene and the other was homozygous variant in PSMC3IP gene. Heterozygous variants were detected in PROK2, WDR11 and CHD7 associated with hypogonadotropic hypogonadism, but these variants are insufficient to contribute to the POI phenotype. Conclusion: Genetic panels based on next generation sequencing analysis technologies can be used to determine the molecular genetic diagnosis of POI, which has a highly heterogeneous genetic basis.

Multivariate guard-bands and total risk assessment on multiparameter evaluations with correlated and uncorrelated measured values

Abstract The quality, efficacy, and safety of medicines are usually verified by analytical results. Measurement uncertainty is a critical aspect for the reliability of these analytical results. The pharmacopeial compendia usually adopt a simple acceptance rule that does not consider information from measurement uncertainty. In this work, we compared decision-making using simple acceptance and decision rules with the use of guard-band for multiparameter evaluation of ofloxacin ophthalmic solution and acyclovir topical cream. Ciprofloxacin ophthalmic solution and acyclovir topical cream samples were subject to pharmacopeial tests and assays. Multivariate guard-band widths were calculated by multiplying the standard uncertainty (u) by an appropriate multivariate coverage factor (k'). The multivariate coverage factor (k') was obtained by the Monte Carlo method. According to the simple acceptance rule, all the results obtained for ciprofloxacin ophthalmic solution and acyclovir topical cream are within the specification limits. However, the risk of false conformity decisions increases for ciprofloxacin tests. Decisions made using the simple acceptance rule and decision rules with the use of guard-band may differ. The simple acceptance rule may increase the risk of false conformity decisions when the measured value is close to the regulatory specification limits and/or when the measurement uncertainty value is inappropriately high. Nevertheless, the guard-band decision rule will always reduce the risk of false conformity decisions. Therefore, using information on measurement uncertainty in conformity assessment is highly recommended to ensure the proper efficacy, safety, and quality of medicines.

Síndrome pós-COVID-19: sintomas persistentes, impacto funcional, qualidade de vida, retorno laboral e custos indiretos - estudo prospectivo de casos 12 meses após a infecção / Síndrome post-COVID-19: síntomas persistentes, impacto funcional, calidad de vida, retorno al trabajo y costos indirectos - estudio prospectivo de casos 12 meses tras la infección / Post-COVID-19 syndrome: persistent symptoms, functional impact, quality of life, return to work, and indirect costs - a prospective case study 12 months after COVID-19 infection

Os sintomas persistentes da síndrome pós-COVID-19 acarretam impactos negativos na saúde, qualidade de vida e produtividade. O objetivo deste trabalho foi descrever os sintomas persistentes da síndrome pós-COVID-19, principalmente neurológicos, e as repercussões cognitivas, emocionais, motoras, de qualidade de vida e de custos indiretos, 12 meses após a infecção. Pacientes com primeiros sintomas entre janeiro e junho de 2021 evoluíram com síndrome pós-COVID-19 e procuraram atendimento na unidade da Rede SARAH de Hospitais de Reabilitação em Fortaleza, Ceará, Brasil. As informações foram obtidas no início do acompanhamento e por entrevista telefônica após 12 meses da infecção. Participaram do estudo 58 pessoas, com idade média de 52,8 anos (±10,5) e 60% permaneceram em UTI. Os sintomas mais frequentes na admissão foram: fadiga (64%), artralgia (51%) e dispneia (47%); e após 12 meses: fadiga (46%) e alteração de memória (39%). Foram identificadas alterações nas escalas/testes funcionais: PCFS, MoCA, HAD, FSS, SF-36, TLS5x, Timed up and go, caminhada de 6 minutos e preensão manual. Os custos indiretos totais foram de USD 227.821,00, com 11.653 dias de absenteísmo; 32% dos pacientes não voltaram a trabalhar. Melhores resultados de TLS5x e SF-36, nas dimensões capacidade funcional, aspecto físico, vitalidade e dor, demonstraram associação com retorno laboral (p ≤ 0,05). Os sintomas persistentes mais frequentes foram: fadiga, artralgia, dispneia, ansiedade e depressão, com repercussões negativas na funcionalidade cognitiva, emocional, motora e qualidade de vida. Esses sintomas perduraram por mais de um ano, principalmente fadiga e alteração de memória, sendo esta última mais relatada tardiamente. Houve dificuldade importante de retorno laboral e custos indiretos de USD 4.847,25 por pessoa/ano.

Síntomas persistentes del síndrome post-COVID-19 provocan impactos negativos en la salud, calidad de vida y productividad. El objetivo fue describir los síntomas persistentes del síndrome post-COVID-19, sobre todo neurológicos, y las repercusiones cognitivas, emocionales, motoras, de calidad de vida y los costos indirectos, 12 meses tras la infección. Pacientes que tuvieron los primeros síntomas entre enero y junio de 2021, desarrollaron síndrome post-COVID-19 y buscaron atención en la unidad de la Red SARAH de Hospitales de Rehabilitación en Fortaleza, Ceará, Brasil. Las informaciones se obtuvieron al inicio del seguimiento y por entrevista telefónica 12 meses tras la infección. Participaron 58 personas, con edad de 52,8±10,5 años y el 60% permaneció en la UTI. Los síntomas más frecuentes al ingreso fueron: fatiga (64%), artralgia (51%) y disnea (47%); tras 12 meses fueron: fatiga (46%) y alteración de memoria (39%). Se identificaron alteraciones en las escalas/testes funcionales: PCFS, MoCA, HAD, FSS, SF-36, TLS5x, timed up and go, caminar por 6 minutos y prensión manual. Los costos indirectos totales fueron USD 227.821,00, con 11.653 días de absentismo. El 32% de los pacientes no volvió a trabajar. Mejor TLS5x y SF-36 en las dimensiones capacidad funcional, aspecto físico, vitalidad y dolor demostraron una asociación con el retorno al trabajo (p ≤ 0,05). Los síntomas persistentes más frecuentes fueron fatiga, artralgia, disnea, ansiedad y depresión, con repercusiones negativas en la funcionalidad cognitiva, emocional, motora y calidad de vida. Estos síntomas continuaron por más de un año, sobre todo la fatiga y la alteración de la memoria, siendo esta última reportada con más frecuencia tardíamente. Hubo una dificultad importante en el retorno al trabajo y costos indirectos de USD 4.847,25 persona/año.

The persistent symptoms of post-COVID-19 syndrome negatively impact health, quality of life, and productivity. This study aimed to describe the persistent symptoms of post-COVID-19 syndrome (especially neurological ones) and their 12-month post-infection cognitive, emotional, motor, quality of life, and indirect cost repercussions. Patients showing the first symptoms of COVID-19 from January to June 2021 who developed post-COVID-19 syndrome and sought care at the Fortaleza Unit (Ceará, Brazil) of the SARAH Network of Rehabilitation Hospitals were included in this study. Information was obtained at the baseline follow-up and by telephone interview 12 months post-infection. In total, 58 people participated in this study with an average age of 52.8±10.5 years, of which 60% required an ICU. The most frequent symptoms on admission included fatigue (64%), arthralgia (51%), and dyspnea (47%), whereas, after 12 months, fatigue (46%) and memory impairment (39%). The following scales/functional tests showed alterations: PCFS, MoCA, HAD, FSS, SF-36, TLS5x, timed up and go, 6-minute walk, and handgrip. Indirect costs totaled USD 227,821.00, with 11,653 days of absenteeism. Moreover, 32% of patients were unable to return to work. Better TLS5x and higher SF-36 scores in the functional capacity, physical functioning, vitality, and pain dimensions were associated with return to work (p ≤ 0.05). The most frequent persistent symptoms referred to fatigue, arthralgia, dyspnea, anxiety, and depression, which negatively affected cognitive, emotional, and motor function and quality of life. These symptoms lasted for over a year, especially fatigue and memory alteration, the latter of which being the most reported after COVID-19 infections. Results also show a significant difficulty returning to work and indirect costs of USD 4,847.25 per person/year.

Tendência da taxa de mortalidade por câncer de mama em mulheres com 20 anos ou mais no Brasil, 2005-2019 / Trend in breast cancer mortality rate among women aged 20 years or older in Brazil, 2005-2019

Resumo O objetivo é analisar a tendência da taxa de mortalidade por câncer de mama e sua correlação com o status de desenvolvimento socioeconômico no Brasil. Estudo ecológico de séries temporais realizado nos 26 estados, Distrito Federal e regiões do Brasil. As fontes de dados foram o Sistema de Informação sobre Mortalidade (número de óbitos), o Instituto Brasileiro de Geografia e Estatística (população residente) e o estudo da Carga Global de Doenças (socio-demographic index - SDI). Foram usados dados de 2005 a 2019. A tendência foi analisada pelos modelos de regressão de Prais-Winsten. A relação entre a taxa de mortalidade e o SDI foi analisada pelo coeficiente de correlação de Spearman. No período do estudo ocorrerem 207.683 óbitos por câncer de mama. A taxa padronizada de mortalidade média foi de 19,95 óbitos por 100.000 mulheres no Brasil. O Brasil e todas as regiões apresentaram tendência crescente da mortalidade. Do total de estados, 22 apresentaram tendência crescente. Verificou-se relação positiva entre a taxa de mortalidade e o SDI. A taxa de mortalidade padronizada por câncer de mama apresentou tendência crescente no Brasil, em todas as regiões e na maioria das unidades da federação. Verificou-se associação direta entre mortalidade e SDI, indicando maior magnitude em regiões mais desenvolvidas.

Abstract The aim is to analyze the trend in breast cancer mortality rates and its correlation with the socioeconomic development status in Brazil. It involved an ecological time series study carried out in the 26 units of the federation, Federal District and regions of Brazil. Data sources included the Mortality Information System (number of deaths), the Brazilian Institute of Geography and Statistics (resident population) and the study of the Global Burden of Disease (Socio-demographic Index - SDI). Data from 2005 to 2019 were used. The trend was analyzed using Prais-Winsten regression models. The relationship between the mortality rate and the SDI was analyzed using Spearman's correlation coefficient. During the study period, 207,683 deaths from breast cancer occurred. The average standardized mortality rate was 19.95 deaths per 100,000 women in Brazil. All the regions of Brazil showed an increasing trend in mortality. Of the total federative units, 22 showed an increasing trend. There was a positive relationship between the mortality rate and the SDI. The standardized mortality rate for breast cancer showed an increasing trend in Brazil, in all regions and in most states. There was a direct association between mortality and SDI, indicating a greater magnitude in more developed regions.

Effect of different palatal expanders with miniscrews in surgically assisted rapid palatal expansion: A non-linear finite element analysis

ABSTRACT Introduction: Surgically assisted rapid palatal expansion (SARPE) has been the treatment of choice in subjects presenting skeletally mature sutures. Objective: The purpose of this study was to analyze stress distribution and displacement of the craniofacial and dentoalveolar structures resulting from three types of palatal expanders with surgical assistance using a non-linear finite element analysis. Material and Methods: Three different palatal expanders were designed: Model-I (tooth-bone-borne type containing four miniscrews), Model-II (tooth-bone-borne type containing two miniscrews), and Model-III (bone-borne type containing four miniscrews). A Le Fort I osteotomy was performed, and a total of 5.0 mm palatal expansion was simulated. Nonlinear analysis (three theory) method (geometric nonlinear theory, nonlinear contact theory, and nonlinear material methods) was used to evaluate stress and displacement of several craniofacial and dentoalveolar structures. Results: Regardless of the maxillary expander device type, surgically assisted rapid palatal expansion produces greater anterior maxillary expansion than posterior (ANS ranged from 2.675 mm to 3.444 mm, and PNS ranged from 0.522 mm to 1.721 mm); Model-I showed more parallel midpalatal suture opening pattern - PNS/ANS equal to 54%. In regards to ANS, Model-II (1.159 mm) and Model-III (1.000 mm) presented larger downward displacement than Model-I (0.343 mm). PNS displaced anteriorly more than ANS for all devices; Model-III presented the largest amount of forward displacement for PNS (1.147 mm) and ANS (1.064 mm). All three type of expanders showed similar dental displacement, and minimal craniofacial sutures separation. As expected, different maxillary expander designs produce different primary areas and levels of stresses (the bone-borne expander presented minimal stress at the teeth and the tooth-bone-borne expander with two miniscrews presented the highest). Conclusions: Based on this finite element method/finite element analysis, the results showed that different maxillary expander designs produce different primary areas and levels of stresses, minimal displacement of the craniofacial sutures, and different skeletal V-shape expansion.

RESUMO Introdução: A expansão rápida da maxila assistida cirurgicamente (ERMAC) tem sido o tratamento de escolha em indivíduos que apresentam suturas esqueleticamente maduras. Objetivo: O objetivo deste estudo foi avaliar, utilizando uma análise não linear com elementos finitos, a distribuição de tensões e os deslocamentos das estruturas craniofaciais e dentoalveolares gerados por três tipos de expansores palatinos usados na ERMAC. Material e Métodos: Três tipos de expansores palatinos foram projetados: Modelo I (dento-osseossuportado com quatro mini-implantes), Modelo II (dento-osseossuportado com dois mini-implantes) e Modelo III (osseossuportado com quatro mini-implantes). Uma osteotomia Le Fort I foi realizada e foi simulada uma expansão palatina total de 5,0 mm. Um método de análise não linear (três teorias - teoria da não-linearidade geométrica, teoria do contato não linear e métodos para materiais não lineares) foi utilizado para avaliar a tensão e o deslocamento de diversas estruturas craniofaciais e dentoalveolares. Resultados: Independentemente do tipo de aparelho expansor palatino, a ERMAC produziu maior expansão anterior da maxila do que posterior (ENA variou de 2,675 mm a 3,444 mm e ENP variou de 0,522 mm a 1,721 mm); o Modelo I apresentou padrão de abertura mais paralela da sutura palatina mediana, com ENP/ENA igual a 54%. Com relação à ENA, o Modelo II (1,159 mm) e o Modelo III (1,000 mm) apresentaram maior deslocamento para baixo do que o Modelo I (0,343 mm). A ENP deslocou-se mais para anterior do que a ENA com todos os aparelhos; o Modelo III apresentou o maior deslocamento para anterior da ENP (1,147 mm) e da ENA (1,064 mm). Os três tipos de expansores apresentaram deslocamento dentário semelhante e separação mínima das suturas craniofaciais. Como esperado, diferentes designs de expansores palatinos produzem diferentes áreas primárias e níveis de tensões (o expansor osseossuportado apresentou tensão mínima nos dentes, e o expansor dento-osseossuportado com dois mini-implantes apresentou o maior). Conclusões: Com base nesse estudo de elementos finitos, os resultados mostraram que diferentes designs de expansores palatinos produzem diferentes áreas primárias e níveis de tensão, com deslocamento mínimo das suturas craniofaciais e diferentes expansões esqueléticas em forma de V.

Temporal trend in the incidence of tuberculosis-HIV coinfection in Brazil, by macro-region, Federative Unit, sex and age group, 2010-2021 / Tendencia temporal de la incidencia de coinfección tuberculosis-VIH en Brasil, por macrorregión, Unidad Federativa, sexo y grupo de edad, 2010-2021 / Tendência temporal da incidência de coinfecção tuberculose-HIV no Brasil, por macrorregião, Unidade da Federação, sexo e faixa etária, 2010-2021

ABSTRACT Objective To analyze the temporal trend in the incidence of tuberculosis-HIV coinfection in Brazil, by macro-region, Federative Unit, sex and age group, from 2010 to 2021. Methods: This was a time series study using surveillance data to estimate average annual percentage changes (AAPC), and 95% confidence intervals (95%CI) via joinpoint regression. Results: 122,211 cases of tuberculosis-HIV coinfection were analyzed; a falling trend was identified for Brazil as a whole (AAPC = -4.3; 95%CI -5.1;-3.7), and in the country's Southern (AAPC = -6.2; 95%CI -6.9;-5.5) and Southeast (AAPC = -4.6; 95%CI -5.6;-3.8) regions, even more so during the COVID-19 pandemic (2020-2021); the greatest falling trend was seen in Santa Catarina (AAPC = -9.3; 95%CI -10.1;-8.5), while the greatest rising trend was found in Tocantins (AAPC = 4.1; 95%CI 0.1;8.6); there was a rising trend among males, especially in Sergipe (AAPC = 3.9; 95%CI 0.4;7.9), and those aged 18 to 34 years, especially in Amapá (AAPC = 7.9; 95%CI 5.1;11.5). Conclusion The burden and trends of tuberculosis-HIV coinfection were geographically and demographically disparate.

RESUMEN Objetivo Analizar la tendencia temporal de la incidencia de la coinfección tuberculosis-VIH en Brasil, por Macrorregión, Unidad Federativa, sexo y grupo de edad, 2010-2021. Métodos Estudio de series de tiempo, con datos de vigilancia para la estimación de cambios porcentuales anuales promedio (CPAP) e intervalos de confianza del 95% (IC95%) vía joinpoint regression. Resultados Se analizaron 122.211 casos de coinfección tuberculosis-VIH; se identificó tendencia decreciente en Brasil (CPAP = -4,3; IC95% -5,1;-3,7) y en las regiones Sur (CPAP = -6,2; IC95% -6,9;-5,5) y Sudeste (CPAP = -4,6; IC95% -5,6;-3,8), aumentando durante la pandemia de covid-19; mayor tendencia decreciente ocurrió en Santa Catarina (CPAP = -9,3; IC95% -10,1;-8,5) y creciente en Tocantins (CPAP = 4,1; IC95% 0,1;8,6); hubo tendencia al aumento en el sexo masculino, especialmente Sergipe (CPAP = 3,9; IC95% 0,4;7,9), y en los de 18 a 34 años, especialmente Amapá (CPAP = 7,9; IC95% 5,1;11,5). Conclusión Había disparidades territoriales y demográficas en la carga y las tendencias de la coinfección tuberculosis-VIH.

RESUMO Objetivo Analisar a tendência temporal da incidência da coinfecção tuberculose-HIV no Brasil, por macrorregião, Unidade da Federação, sexo e faixa etária, 2010-2021. Métodos Estudo de séries temporais, com dados de vigilância, para a estimativa de variações percentuais anuais médias (VPAM) e intervalos de confiança de 95% (IC95%), por joinpoint regression. Resultados Foram analisados 122.211 casos de coinfecção tuberculose-HIV; identificou-se tendência decrescente no país (VPAM = -4,3; IC95% 5,1;-3,7) e em suas regiões Sul (VPAM = -6,2; IC95% -6,9;-5,5) e Sudeste (VPAM = -4,6; IC95% -5,6;-3,8), acentuada durante a pandemia de covid-19 (2020-2021); observou-se maior tendência decrescente em Santa Catarina (VPAM = -9,3; IC95% -10,1;-8,5) e maior tendência crescente no Tocantins (VPAM = 4,1; IC95% 0,1;8,6); houve tendência de incremento no sexo masculino, destacando-se Sergipe (VPAM = 3,9; IC95% 0,4;7,9), e na faixa etária de 18-34 anos, sobressaindo-se o Amapá (VPAM = 7,9; IC95% 5,1;11,5). Conclusão Verificaram-se disparidades territoriais e demográficas na carga e nas tendências da coinfecção tuberculose-HIV.

At-home bleaching versus whitening toothpastes for treatment of tooth discoloration: a cost-effectiveness analysis

Abstract Objectives This study aimed to analyze the cost-effectiveness of whitening toothpastes and at-home bleaching for the treatment of tooth discoloration. Methodology A cost-effectiveness economic analysis was conducted, and eight randomized clinical trials were selected based on the whitening agent product used: blue covarine dentifrices (BCD), hydrogen peroxide dentifrices (HPD), dentifrices without bleaching agents (CD, negative control), and 10% carbamide peroxide (CP10, positive control) for at-home bleaching. The consumer/patient perspective was adopted, macro-costing techniques were used and a decision tree model was performed considering the costs in the American and Brazilian markets. The color change evaluation (ΔE*ab) was used to calculate the effectiveness of tooth bleaching. A probabilistic analysis was performed using a Monte Carlo simulation and incremental cost-effectiveness ratios were obtained. Results CP10 resulted in the highest cost-effectiveness compared to the use of dentifrices in both markets. In Brazil, HPD was more cost-effective than BCD and CD. In the US, the increased costs of HPD and BCD did not generate any whitening benefit compared to CD. Conclusions CP10 was more cost-effective than BCD and HPD for tooth bleaching from the perspectives of the Brazilian and American markets. Decision-making should consider the use of CP10 for treating tooth discoloration.

Predicting the outcome of death by CALL Score in COVID-19 patients

SUMMARY OBJECTIVE: The aim of this study was to assess the performance of the CALL Score tool in predicting the death outcome in COVID-19 patients. METHODS: A total of 897 patients were analyzed. Univariate and multivariate logistic regression analyses were conducted to determine the association between characteristics of the CALL Score and the occurrence of death. The relationship between CALL Score risk classification and the occurrence of death was also examined. Receiver operating characteristic curve analysis was performed to identify optimal cutoff points for the CALL Score and the outcome. RESULTS: The study revealed that age>60 years, DHL>500, and lymphocyte count ≤1000 emerged as independent predictors of death. Higher risk classifications of the CALL Score were associated with an increased likelihood of death. The optimal CALL Score cutoff point for predicting the death outcome was 9.5 (≥9.5), with a sensitivity of 70.4%, specificity of 80.3%, and accuracy of 80%. CONCLUSION: The CALL Score showed promising discriminatory ability for death outcomes in COVID-19 patients. Age, DHL level, and lymphocyte count were identified as independent predictors. Further validation and external evaluation are necessary to establish the robustness and generalizability of the CALL Score in diverse clinical settings.