Conhecimento e adesão de estudantes de enfermagem às medidas de precaução-padrão / Conocimientos y adhesión de estudiantes de enfermería a las medidas de precaución estándar / Nursing students' knowledge and compliance with standard precautions

Resumo Objetivo Descrever o conhecimento e a adesão dos estudantes de graduação em enfermagem às medidas de precaução-padrão. Métodos Estudo descritivo e quantitativo com 161 acadêmicos de enfermagem. Os dados foram coletados entre setembro e outubro de 2020, mediante formulário eletrônico e processados no programa Statistical Package for the Social Sciences, por meio de análises descritivas. Resultados Os escores médios de conhecimento e adesão às medidas de precaução-padrão demonstraram níveis satisfatórios, ou seja, superiores à metade do escore possível. Os estudantes reconheceram que essas medidas se estendem além dos cuidados para com pacientes com diagnósticos de infecção ou que se encontram no período de incubação do processo infeccioso. Contudo, limitam seu objetivo à proteção da equipe de saúde, preterindo a proteção do paciente. A higienização das mãos, assim como a utilização de luvas em procedimentos que envolviam contato com material biológico potencialmente contaminado, foram as medidas mais adotadas pelos estudantes. Observou-se que a adesão às medidas protetivas é maior nos períodos finais da graduação. Conclusão Evidenciaram-se fragilidades no conhecimento dos estudantes no que tange às noções básicas que norteiam e embasam a adoção das medidas de segurança; revela-se ser fundamental um currículo de enfermagem que, de forma contínua, ao longo dos ciclos acadêmicos incorpore no seu escopo de discussões a prevenção e o controle das infecções relacionadas à assistência à saúde. Tal cuidado se refletirá não só na qualidade da assistência prestada, como também na manutenção da saúde desse estudante - futuro trabalhador da área.

Resumen Objetivo Describir los conocimientos y la adhesión de estudiantes de la carrera de enfermería a las medidas de precaución estándar. Métodos Estudio descriptivo y cuantitativo con 161 académicos de enfermería. Los datos fueron recopilados entre septiembre y octubre de 2020, mediante formulario electrónico, y fueron procesados en el programa Statistical Package for the Social Sciences, por medio de análisis descriptivos. Resultados La puntuación promedio de conocimiento y adhesión a las medidas de precaución estándar demostraron niveles satisfactorios, es decir, superiores a la mitad de la puntuación posible. Los estudiantes admitieron que estas medidas se extienden más allá de los cuidados a pacientes con diagnóstico de infección o que se encuentran en el período de incubación del proceso infeccioso. No obstante, limitan su objetivo a la protección del equipo de salud, descuidando la protección del paciente. La higienización de las manos, así como el uso de guantes en procedimientos que implicaban contacto con material biológico potencialmente contaminado, fueron las medidas más adoptadas por los estudiantes. Se observó que la adhesión a las medidas de protección es mayor en los períodos finales de la carrera. Conclusión Se evidenciaron debilidades en los conocimientos de los estudiantes en lo que atañe a las nociones básicas que orientan y respaldan la adopción de las medidas de seguridad. Resulta fundamental un diseño curricular de enfermería que, de forma continua y a lo largo de los ciclos académicos, incorpore en sus temas de discusión la prevención y el control de las infecciones asociadas a la atención de salud. Este cuidado se verá reflejado no solo en la calidad de la atención brindada, sino también en la conservación de la salud de ese estudiante, futuro trabajador del área.

Abstract Objective To describe nursing students' knowledge and compliance with standard precautions. Methods This is a descriptive and quantitative study with 161 nursing students. Data were collected between September and October 2020, through an electronic form and processed in the Statistical Package for the Social Sciences program, through descriptive analyses. Results The mean scores of knowledge and compliance with standard precautions showed satisfactory levels, i.e., higher than half of the possible score. Students recognized that these measures extend beyond care for patients diagnosed with infection or who are in the incubation period of the infectious process. However, they limit their objective to the health team protection, neglecting patient protection. Hand hygiene, as well as the use of gloves in procedures involving contact with potentially contaminated biological material, was the most adopted measure by students. It was observed that compliance with protective measures is higher in the final periods of graduation. Conclusion We identified weaknesses in students' knowledge regarding the basic notions that guide and support the adoption of security measures. It is essential to have a nursing curriculum that, throughout the academic cycles, continuously incorporates the prevention and control of infections related to health care in its scope of discussions. This care will be reflected not only in the quality of the care provided, but also in the maintenance of students' health - future workers in the area.

The effect of vitamin D deficiency on the retinal microvasculature: an observational case-control study / O efeito da deficiência de vitamina D nos microvasos da retina: um estudo caso-controle observacional

ABSTRACT Purpose: To determine the effects of vitamin D deficiency on retinal microvascularity using optical coherence tomography angiography. Methods: This study was designed as an observational case-control study. Ninety-eight eyes of patients with vitamin D deficiency and 96 eyes of healthy participants with serum vitamin D level >30 ng/mL were studied. Macula centered, 6.00 × 6.00 mm scan size images were taken. The vessel densities in the superficial and deep retinal capillary plexus, foveal avascular zone area, and choriocapillaris flow area were measured. Results: The groups were comparable in terms of best-corrected visual acuity, sex, axial length, refractive error, age, and adjusted intraocular pressure. The average vitamin D level was significantly lower in the study group (p=0.021). The whole, parafoveal, and perifoveal vessel densities in the deep capillary plexus were considerably higher in the study group than in the control group (p=0.012, p=0.014, and p=0.023, respectively). The foveal avascular zone area and the choriocapillaris flow area were similar in both groups (p=0.37 and p=0.27, respectively) there was a strong negative correlation between the serum vitamin D level and vessel density in the whole image, parafoveal, and perifoveal regions of the deep capillary plexus in the study group (Spearman's rho=-0.71, p=0.043; Spearman's rho= -0.79, p=0.011; and Spearman's rho = -0.74, p=0.032; respectively). Conclusion: An increase in vessel density might originate from vascular structural changes caused by vitamin D deficiency. The increased vessel density, especially in the deep capillary plexus, can enable early diagnosis of vitamin D-associated vasculopathy.

RESUMO Objetivo: Determinar os efeitos da deficiência de vitamina D nos microvasos da retina usando angiotomografia de coerência óptica. Métodos: Este estudo foi planejado para ser do tipo caso-controle observacional. Foram avaliados 98 olhos de pacientes com deficiência de vitamina D e 96 olhos de participantes saudáveis com nível sérico de vitamina D superior a 30 ng/mL. Foram adquiridas imagens de varredura centralizadas na mácula, com um tamanho de 6,00 × 6,00 mm. Mediram-se a densidade dos vasos nos plexos capilares superficial e profundo da retina, a área da zona avascular foveal e a área do fluxo coriocapilar. Resultados: Os grupos mostraram-se semelhantes em relação à melhor acuidade visual corrigida, ao gênero, ao comprimento axial, ao erro refrativo, à idade e à pressão intraocular ajustada. O nível médio de vitamina D foi significativamente menor no grupo de estudo (p=0,021). As densidades total, parafoveal e perifoveal do plexo capilar profundo foram significativamente maiores no grupo de estudo que no grupo controle (respectivamente, p=0,012, p=0,014 e p=0,023). As áreas da zona avascular foveal e do fluxo coriocapilar foram semelhantes nos dois grupos (respectivamente, p=0,37 e p=0,27). Além disso, houve uma forte correlação negativa do nível sérico de vitamina D com as densidades vasculares medidas em toda a imagem e nas regiões parafoveais e perifoveais do plexo capilar profundo no grupo de estudo (respectivamente, ρ de Spearman = −0,71, p=0,043; ρ de Spearman = −0,79, p=0,011; e ρ de Spearman = −0,74, p=0,032). Conclusão: Pode ocorrer um aumento na densidade vascular da retina devido a alterações estruturais dos vasos causadas pela deficiência de vitamina D. O aumento da densidade vascular, especialmente no plexo capilar profundo, pode ser usado para o diagnóstico precoce da vasculopatia associada à deficiência de vitamina D.

Emerging vaccine nanotechnology: From defense against infection to sniping cancer

Looking retrospectively at the development of humanity, vaccination is an unprecedented medical landmark that saves lives by harnessing the human immune system. During the ongoing coronavirus disease 2019 (COVID-19) pandemic, vaccination is still the most effective defense modality. The successful clinical application of the lipid nanoparticle-based Pfizer/BioNTech and Moderna mRNA COVID-19 vaccines highlights promising future of nanotechnology in vaccine development. Compared with conventional vaccines, nanovaccines are supposed to have advantages in lymph node accumulation, antigen assembly, and antigen presentation; they also have, unique pathogen biomimicry properties because of well-organized combination of multiple immune factors. Beyond infectious diseases, vaccine nanotechnology also exhibits considerable potential for cancer treatment. The ultimate goal of cancer vaccines is to fully mobilize the potency of the immune system as a living therapeutic to recognize tumor antigens and eliminate tumor cells, and nanotechnologies have the requisite properties to realize this goal. In this review, we summarize the recent advances in vaccine nanotechnology from infectious disease prevention to cancer immunotherapy and highlight the different types of materials, mechanisms, administration methods, as well as future perspectives.

Territory, neglected diseases and the action of community and endemic combat agents / Território, doenças negligenciadas e ação de agentes comunitários e de combate a endemias

ABSTRACT OBJECTIVE To characterize knowledge, practices, and professional experience of community health agents (ACS) and endemic combat agents (ACE) on leprosy and Chagas disease (DC), during participation in an integrated training workshop in the IntegraDTNs-Bahia project. METHODS Descriptive and exploratory case study, involving health agents and endemic combat agents participating in a training workshop on the shared role of these professionals in health care and surveillance processes. The project was developed in the municipalities of Anagé, Tremedal and Vitória da Conquista, in the southwestern State of Bahia, 2019-2020. A specific instrument was applied, with questions related to knowledge and practices of surveillance and care for leprosy and Chagas disease. Descriptive analysis of the data, in addition to consolidation of the lexical analysis, was performed. RESULTS Out of a total of 135 participants (107 ACS and 28 ACE), 80.7% of them have been working for at least 12 years, without previous participation in joint training processes. Only 17.9% of endemic combat agentes reported having participated in training on leprosy and none reported developing specific actions to control the disease. For Chagas disease, 36.4% of community health agents participated in training more than a decade before, while for 60.7% of endemic combat agents the last training was carried out in the last five years. The development of educational actions for Chagas disease was more frequent for endemic combat agents (64.3%). When asked about ways of recognizing diseases, the term "skin spots" was the most reported (38 times) for leprosy and, for Chagas disease, the term "I don't know" (17 times). CONCLUSION Processes of health agents and endemic combat agents action in realities endemic for leprosy and Chagas disease in the interior of Bahia proved to be fragmented in the territories. For these diseases, the distance between surveillance and health care actions is reinforced, including in training processes. The importance of innovative permanent and integrated education actions is reiterated to actually promote changes in practices.

RESUMO OBJETIVO Caracterizar conhecimentos, práticas e experiência profissional de agentes comunitários de saúde (ACS) e agentes de controle de endemias (ACE) sobre hanseníase e doença de Chagas (DC), durante participação em oficina de formação integrada no projeto IntegraDTNs-Bahia. MÉTODOS Estudo de caso descritivo e exploratório, envolvendo comunitários de saúde e agentes de controle de endemias, participantes de oficina de formação sobre o papel compartilhado desses profissionais no processo de vigilância e atenção à saúde. Projeto desenvolvido nos municípios de Anagé, Tremedal e Vitória da Conquista, no Sudoeste do Estado da Bahia, 2019-2020. Aplicou-se instrumento específico prévio com questões relativas a conhecimentos e práticas de vigilância e atenção para hanseníase e doença de Chagas. Análise descritiva dos dados, além de consolidação da análise léxica. RESULTADOS Do total de 135 participantes (107 ACS e 28 ACE), 80,7% deles atuam há pelo menos 12 anos, sem participação prévia em processos de formação conjunta. Apenas 17,9% dos agentes de controle de endemias relataram ter participado de capacitações sobre hanseníase e nenhum informou desenvolver ações específicas de controle da doença. Para a doença de Chagas, 36,4% dos agentes comunitários de saúde participaram de capacitações há mais de uma década, enquanto para 60,7% dos agentes de controle de endemias a última capacitação foi realizada nos últimos cinco anos. O desenvolvimento de ações educativas para a doença de Chagas foi mais frequente para agentes de controle de endemias (64,3%). Quando perguntados sobre formas de reconhecimento das doenças, a palavra "manchas na pele" foi a mais relatada (38 vezes) para hanseníase e, para a doença de Chagas, a palavra "não sei" (17 vezes). CONCLUSÃO Os processos de atuação de agentes comunitários de saúde e agentes de controle de endemias em realidades endêmicas para hanseníase e doença de Chagas no interior da Bahia revelaram-se desintegrados nos territórios. Para essas doenças, reforça-se o distanciamento entre ações de vigilância e de atenção à saúde, inclusive nos processos de capacitação. Reitera-se a importância de ações inovadoras de educação permanentes e integradas para promover de fato mudanças nas práticas.

Comportamiento de la enfermedad periodontal inflamatoria crónica en pacientes diabéticos / Behavior of chronic inflammatory periodontal disease in diabetic patients

RESUMEN Introducción: La diabetes promueve alteración en la función de neutrófilos y la deposición en los tejidos periodontales de los productos finales derivados de la glicolización avanzada. Por ello, los diabéticos son vulnerables a la enfermedad periodontal inflamatoria crónica. Estudiar su comportamiento es indispensable para acometer acciones integrales y efectivas para su control y tratamiento. Objetivo: Determinar el comportamiento de la enfermedad periodontal inflamatoria crónica en pacientes de la Consulta de Atención Integral al Paciente Diabético en el Municipio Santa Cruz del Sur. Métodos: Se realizó un estudio descriptivo transversal, desde septiembre 2018 hasta mayo 2019, en el que se incluyeron 60 pacientes que acudieron durante ese período que presentaban más de 10 dientes en boca, afección periodontal inflamatoria crónica y dieron su consentimiento para participar. Se realizó examen clínico periodontal y examen radiográfico periapical. Resultados: El mayor número de pacientes con enfermedad periodontal inflamatoria crónica fue de 41-60 años de edad, predominó el sexo femenino, en ambas variables prevaleció la periodontitis crónica avanzada, afección preponderante también en los pacientes de más de 10 años de padecimiento de la diabetes mellitus. Conclusiones: En los pacientes con control metabólico inadecuado imperó la periodontitis crónica avanzada seguida de la moderada.

ABSTRACT Introduction: Diabetes promotes impaired neutrophil function and deposition in periodontal tissues of end products derived from advanced glycolization. The refore, diabetics are vulnerable to chronic inflammatory periodontal disease. Studying their behavior is essential to undertake comprehensive and effective actions for their control and treatment. Objective: To determine the behavior of chronic inflammatory periodontal disease in patients of the Comprehensive Care Consultation for Diabetic Patients in the Municipality of Santa Cruz del Sur. Methods: A cross-sectional descriptive study was carried out, in the period from September 2018 to May 2019, in which 60 patients who were attended during this period were included, they had more than 10 teeth in the mouth with chronic inflammatory periodontal disease and gave their consent to participate. A periodontal clinical examination and periapical radiographic examination were performed. Results: The largest number of patients with periodontal disease were 41-60 years old, female sex predominated, in both variables advanced chronic periodontitis prevailed, also preponderant in patients with more than 10 years of suffering from diabetes mellitus. Conclusions: Advanced chronic periodontitis prevailed in patients with inadequate metabolic control, followed by moderate.

Cost-Effectiveness Analysis of Implantable Cardioverter Defibrillator Therapy for Primary Prevention Patients with Additional Risk Factors in Brazil

Abstract Background: Implantable cardiac defibrillators (ICDs) therapy for primary prevention (PP) of sudden cardiac arrest (SCA) is well-established but underutilized globally. The Improve SCA study has identified a cohort of patients called 1.5 primary prevention (1.5PP), based on PP patients with the presence of documented risk factors: non-sustained ventricular tachycardia, frequent premature ventricular contractions, left ventricular ejection fraction < 25%, and pre-syncope or syncope. Objective: This study evaluated the cost-effectiveness of ICD therapy compared to no ICD among 1.5PP patients in the Brazilian public healthcare system. Methods: Modified inputs to a published Markov model were applied to compare costs and outcomes of ICD therapy to no ICD therapy from the Brazilian payer's perspective. Mortality and utility estimates were obtained from the IMPROVE SCA trial. Additional effectiveness inputs were sourced from the literature. Cost inputs were obtained from the Brazilian Unified Health System and the Ministry of Health. Costs were discounted at 4.7%; quality-adjusted life years (QALYs) were discounted at 1.45%. This study applied a willingness-to-pay (WTP) value of three times Brazil's gross domestic product (GDP) in 2017, R$105,723 (Brazilian Real). Results: The total discounted lifetime costs for ICD therapy were R$100,920 compared to R$43,866 for no ICD therapy. Total discounted QALYs for ICD therapy and no ICD therapy were 9.85 and 7.15, respectively. The incremental cost effectiveness ratio was R$21,156 per QALY and less than the R$105,723 WTP threshold. Results from sensitivity analyses were consistent with base case results. Conclusions: ICD therapy compared to no ICD therapy is cost-effective in the 1.5PP population in Brazil. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

Utilidad y uso masivo de mascarillas frente a virus respiratorios: a propósito de la COVID-19 / Utility and massive use of masks against respiratory viruses: on purpose of COVID-19

RESUMEN Fundamento: la COVID-19 se ha propagado con rapidez por todo el mundo y los estudios sobre el desarrollo de nuevos medicamentos y vacunas continúan en proceso. El uso de equipos de protección personal, el lavado de manos y el distanciamiento social, a la fecha son las principales medidas de defensa contra la infección. Objetivo: describir la evidencia actual sobre la efectividad del uso de mascarillas de tela frente a las mascarillas quirúrgicas y respiradores, así como la eficacia del uso comunitario de mascarillas para controlar la propagación del SARS-CoV-2. Métodos: se realizó una revisión de la literatura y análisis de la información utilizando los descriptores: COVID-19, SARS-CoV-2, personal protective equipment, masks, efficacy, efficiency, population. A partir de la información obtenida, se realizó una revisión bibliográfica de un total de 1 788 artículos publicados en las bases de datos MEDLINE/PubMed, SciELO y LILACS, sin restricciones de idioma se eliminaron los duplicados y aquellos que no se ajustaban al objetivo del estudio, seleccionando para la revisión 52 artículos. Resultados: existe mucha evidencia sobre el beneficio del uso continuo y masivo de mascarillas como herramienta para mitigar la transmisión de COVID-19 y otras enfermedades respiratorias en la comunidad. Las mascarillas de tela, de seguir las recomendaciones para su adecuada fabricación, ofrecen buena protección y su rendimiento es comparable al de las mascarillas quirúrgicas en la comunidad. Los respiradores deben ser reservados para el personal sanitario en el ámbito nosocomial, ya que ofrecen una apropiada protección en ambientes cerrados y de alta carga viral. Conclusiones: el uso masivo de mascarillas puede complementar las estrategias de contención y prevención frente a enfermedades infecciosas de origen respiratorio incluida la COVID-19. Sin embargo, es necesario realizar más estudios específicos sobre el tema que ayuden a comprender mejor su rendimiento en campo.

ABSTRACT Background: COVID-19 has spread rapidly around the world and studies on the development of new drugs and vaccines are still in progress. Therefore, the use of personal protective equipment, hand washing and social distancing, to date are the main defense measures against infection. Objective: to describe the current evidence on the effectiveness of the use of cloth masks compared to surgical masks and respirators, as well as the efficacy of community use of masks to control the spread of SARS-CoV-2. Methods: a literature review and analysis of the information was carried out using the Medical Subject Headings (MeSH) descriptors linked to free terms: COVID-19, SARS-CoV-2, Personal Protective Equipment, Masks, Efficacy, Efficiency, Population. Based on the information obtained, a bibliographic review of a total of 1,788 articles published in the MEDLINE / PubMed, SciELO and LILACS databases was carried out. Without language restrictions, duplicates and those that did not meet the objective of the study were eliminated from the study, selecting 52 articles for the present review. Results: there is much evidence about the benefit of the continuous and massive use of masks as a tool to mitigate the transmission of COVID-19 and other respiratory diseases in the community. Cloth masks, if they follow the recommendations for their proper manufacture, offer good protection and their performance is comparable to that of surgical masks in the community. Respirators should be reserved for healthcare personnel in the nosocomial setting as they offer appropriate protection in closed environments with a high viral load. Conclusions: the massive use of masks can complement the containment and prevention strategies against infectious diseases of respiratory origin including COVID-19. However, more specific studies are needed on the subject to help better understand its performance in the field.

Tendências Recentes de Mortalidade Cardiovascular nas Regiões de Saúde do Estado do Rio de Janeiro e Capital / Recent Trends in Cardiovascular Mortality in Rio de Janeiro State Health Regions and Capital

Resumo Fundamento: A mortalidade por doenças cardiovasculares (DCV) vem mostrando tendência à estabilização em alguns países, incluindo o Brasil e o estado do Rio de Janeiro, após décadas de queda. Não encontramos análises detalhadas dessa tendência para o estado do Rio de Janeiro. Objetivo: Analisar as tendências da mortalidade prematura e tardia por doenças do aparelho circulatório (DAC), doença isquêmica do coração (DIC) e doença cerebrovascular (DCBV) por sexo nas regiões de saúde do estado do Rio de Janeiro e capital (1996-2016). Métodos: Dados de óbitos e população foram obtidos no DATASUS/MS. Taxas foram compensadas por códigos mal definidos, corrigidos pelos códigos cardiovasculares mal definidos e ajustadas por sexo e idade pelo método direto. O Joinpoint Trend Analysis Software foi empregado para calcular a variação percentual anual (APC) e variação percentual anual média (AAPC). Foram consideradas para o estudo APC e AAPC significativamente diferentes de zero, calculadas por um teste de student com significância de 5%. Resultados: A mortalidade por DIC estabilizou ou até aumentou em pelo menos 50% das localidades analisadas (EAPC ≥0). Nas regiões Norte e Noroeste, nenhuma mudança foi observada. Para DCBV, apenas uma região apresentou estabilidade na mortalidade (EAPC próximo a 0). Para as outras regiões, a taxa continuou a diminuir (APC <0) até 2016. Conclusão: Esses resultados observados no Rio de Janeiro devem se repetir em várias regiões brasileiras e apontam para a necessidade de uma resposta na abordagem dos comportamentos no estilo de vida. Os médicos da atenção primária devem estar familiarizados com a tendência desfavorável da doença isquêmica do coração entre os adultos mais jovens e rastrear ativamente os fatores de risco para DCV, com atenção especial às mulheres.

Abstract Background: Cardiovascular disease (CVD) mortality, after several decades of decrease, has shown a tendency towards the stabilization in some countries, including Brazil and Rio de Janeiro state. This new tendency was not further analyzed by gender, age group and region of the Rio de Janeiro state. Objective: To analyze the trends of premature and late mortality from CVD, ischemic heart disease (IHD) and cerebrovascular disease (CBVD) by gender in the city of Rio de Janeiro (capital) and the health regions of Rio de Janeiro state (from 1996 to 2016. Methods: Data on deaths and the population were obtained from DATASUS/MS. The rates were compensated by ill-defined codes, corrected by Ill-Defined Cardiovascular codes and gender and age-adjusted by the direct method (reference population - population of the state of Rio de Janeiro - 2000 census). The Joinpoint Trend Analysis Software was employed. Results: IHD mortality stabilized or even increased for at least 50% of the analyzed areas (EAPC≥0). No change was observed. in the "North" and "Northwest" regions For CBVD, just one region showed stability regarding mortality (EAPC close to 0). For the other regions, the rate continued to decrease (APC<0) until 2016. Conclusion: These results observed in Rio de Janeiro are possibly appropriate to various Brazilian regions and demonstrate that a serious public health response is needed to address lifestyle behaviors. Primary care physicians should also be familiar with the unfavorable tendency in coronary heart disease among younger adults in recent years and actively screen for risk factors for cardiovascular disease, paying special attention to women.

Carotid Intima and Media Thickness Correlation with Central Blood Pressure Measurements by Tonometric and Oscillometric Methods: A Proof of Concept

Abstract Background The early detection of vascular damage in subclinical stages of hypertensive disease may be the key point in the prevention of cardiovascular outcomes. Objectives to correlate parameters of structural vascular damage (measurement of the carotid intima-media thickness) with parameters of functional vascular damage (central hemodynamic measurements) in pre-hypertensive and hypertensive patients taking up to two classes of anti-hypertensive drugs. Methods This was a cross-sectional descriptive study conducted with a convenience sample of patients attending the Liga de Hipertensão Arterial , a multidisciplinary program for the diagnosis and treatment of systemic hypertension, of the Federal university of Goias. Patients with arrythmia, diabetes, previous cardiovascular or cerebrovascular diseases, and end-stage diseases were excluded. Carotid Doppler test, measurements of peripheral and central blood pressure by applanation tonometry (Sphygmocor®) and oscillometry (Mobil-O-Graph®) were performed. The t-test was used for comparisons and the Pearson correlation test for correlations, considering a p<0.05 statistically significant. Results twenty patients (12 women) were evaluated, mean age 53.8 ± 14.3 years. Higher values of central pulse pressure (42.9±13.9 vs. 34.7±9.6, p=0.01) and pulse wave velocity (PWV) (9.0±1.9 vs. 7.9±1.5, p=0.01) were obtained by applanation tonometry compared with oscillometry. No difference between the methods was observed for the other measures. A significant correlation was found between carotid artery intima-media thickness (CA-IMT) and PWV (r=0.659; p=0.002) by the oscillometric test, but not with applanation tonometry. No correlation was found between central hemodynamic variables and the presence of carotid artery plaques. Conclusion PWV, estimated by oscillometry, was the only central hemodynamic parameter that correlated significantly with CA-IMT in pre-hypertensive and hypertensive patients at low cardiovascular risk. International Journal of Cardiovascular Sciences. 2020; [online].ahead print, PP.0-0

Caracterización de la mortalidad por enfermedades cardiovasculares: Cuba, 2009-2018 / Characterization of mortality from cardiovascular diseases: Cuba, 2009-2018

RESUMEN Fundamento: un tercio del total de muertes que ocurren en el mundo, por enfermedades no transmisibles, se deben a las enfermedades cardiovasculares que constituyen la primera causa de muerte a nivel mundial y en Cuba. Objetivo: caracterizar la mortalidad por enfermedades cardiovasculares en Cuba ocurridas en el período 2009-2018. Métodos: se realizó un estudio ecológico. Se utilizaron los anuarios estadísticos, publicados por el Ministerio de Salud Pública de Cuba y la Clasificación Internacional de Enfermedades (CIE-10). Se consideraron las tasas de mortalidad por enfermedades del corazón y su comportamiento por provincias, así como, las tasas de mortalidad por enfermedades del sistema circulatorio y su distribución por grupo de edades. Las tasas usadas fueron las brutas. Resultados: en Cuba las enfermedades del sistema circulatorio aportan una tasa de mortalidad entre 299,4 y 360,0 por 100 000 habitantes con tendencia al incremento. Las tasas de mortalidad para las enfermedades del corazón y de las arterias, arteriolas y vasos capilares, desde el año 2009 hasta el 2018, fueron superiores en los hombres. En cuanto a las enfermedades cerebrovasculares excedieron en las mujeres, excepto en los años 2014, 2016-2018. En el año 2013 y 2015 fueron muy similares para ambos sexos. Dentro de las enfermedades cardiovasculares las del corazón aportaron más años de vida perdidos, secundadas por las cerebrovasculares y en menor magnitud las de las arterias, arteriolas y vasos capilares. Conclusiones: las enfermedades cardiovasculares son un grave problema de salud por lo cual se hace necesario accionar sobre las causas que las originan, para ganar en la percepción de riesgo cardiovascular, en la responsabilidad de cada persona y en el auto cuidado de la salud.

ABSTRACT Background: a third of the total deaths that occur in the world, due to non-transmissible diseases, are due to cardiovascular diseases. They constitute the first cause of death worldwide and in Cuba. Objective: to characterize the mortality from cardiovascular diseases in Cuba that occurred in the period 2009-2018. Methods: an ecological study was carried out. Statistical yearbooks published by the Cuban Ministry of Public Health and the International Classification of Diseases (ICD-10) were used. Mortality rates from heart diseases and their behavior by provinces were considered, as well as mortality rates from diseases of the circulatory system and their distribution by age group. The rates used were gross. Results: in Cuba, diseases of the circulatory system provide a mortality rate between 299.4 and 360.0 per 100 000 inhabitants with a tendency to increase. Mortality rates for diseases of the heart and arteries, arterioles, and capillaries, from 2009 to 2018, were higher in men. Regarding stroke diseases, they exceeded in women, except in the years 2014, 2016-2018. In 2013 and 2015 they were very similar for both sexes. Within cardiovascular diseases, heart diseases contributed more potentially lost years of life, supported by stroke diseases and to a lesser extent those of arteries, arterioles and capillaries. Conclusions: cardiovascular diseases continue to be a serious health problem, which is why it is necessary to act on the causes that cause them, gaining in the perception of cardiovascular risk and in the responsibility, of each person, in the self-care of the health.

Food frequency questionnaire for adults in the Brazilian Northeast region: emphasis on the level of food processing / Questionário de frequência alimentar para adultos da região Nordeste: ênfase no nível de processamento dos alimentos

ABSTRACT OBJECTIVE To develop a quantitative Food Frequency Questionnaire (FFQ) for adults in the Northeast region of Brazil, in order to identify the frequency of consumption of foods considered to be of protection and risk for chronic non-communicable diseases (NCDs), grouping food items by processing level. METHODS To develop the FFQ, data from 7,516 adults from Northeastern Brazil were used, extracted from the 2008-2009 Household Budget Survey. The food lists were elaborated according to the methodology of the relative contribution of each item, identifying foods with the highest relative contribution for macronutrients, fiber, saturated fat, trans fat, sodium and potassium. All foods whose contribution sum was up to 90% composed such lists. The final structure of the FFQ organized the food items in order to respect the mental image of the meals. RESULT The FFQ resulted in 83 food items, distributed in minimally processed, processed and ultra-processed. We chose the previous year as the time to estimate food consumption, and frequency options ranged from "never" to "10 times". The instrument includes guidelines for filling and collects data on serving sizes (small, medium, large and extra-large), as well as additional information on culinary preparations. There was a high percentage of people who were overweight (44.1%). CONCLUSION The study culminated in an FFQ to identify the frequency of consumption of foods considered protective and risk for NCDs. The instrument can support epidemiological studies that evaluate outcomes related to the diet of adults considering the level of food processing, in accordance with the Guia alimentar para a população brasileira .

RESUMO OBJETIVO Desenvolver um Questionário de Frequência Alimentar (QFA) quantitativo para adultos da região Nordeste do Brasil, com o fim de identificar a frequência de consumo de alimentos considerados de proteção e risco para doenças crônicas não transmissíveis (DCNT), agrupando os itens alimentares por nível de processamento. MÉTODOS Para desenvolver o QFA foram utilizados dados de 7.516 adultos do Nordeste do Brasil, extraídos da Pesquisa de Orçamentos Familiares 2008-2009. As listas de alimentos foram elaboradas segundo a metodologia da contribuição relativa do item, nas quais foram identificados os itens alimentares com maior contribuição relativa para macronutrientes, fibra, gordura saturada, gordura trans, sódio e potássio. Tais listas foram compostas de todos os alimentos cujo somatório de contribuição foi de até 90%. Na estrutura final do QFA, os itens alimentares foram organizados de modo a respeitar a imagem mental das refeições. RESULTADOS O QFA resultou em 83 itens alimentares, distribuídos em minimamente processados, processados e ultraprocessados. O ano anterior foi escolhido como tempo para estimar o consumo dos alimentos, e as opções de frequência variaram de "nunca" até "10 vezes". O instrumento inclui orientações para preenchimento e colhe dados sobre o tamanho das porções (pequena, média, grande e extragrande), bem como informações complementares sobre as preparações culinárias. Registrou-se um percentual elevado de pessoas com excesso de peso (44,1%). CONCLUSÃO O estudo culminou em um QFA para identificar a frequência de consumo de alimentos considerados de proteção e risco para DCNT. O instrumento pode subsidiar estudos epidemiológicos que avaliem desfechos relacionados à dieta de adultos considerando o nível de processamento de alimentos, em consonância com o Guia alimentar para a população brasileira .

Reliability between Cardiovascular Risk Assessment Tools: A Pilot Study

Abstract Background The prevention of cardiovascular disease (CVD) is important in clinical practice due to its high morbidity and mortality. Different guidelines have recommended the use of different cardiovascular risk assessment tools, which may have implications on therapeutic decisions. Objective To evaluate the agreement rate between the Framingham risk score (FRS) and the Systematic Coronary Risk Evaluation (SCORE) tool on CVD risk assessment in disease-free subjects. Methods Cross-sectional study with a sample of 51 subjects treated at the outpatient clinic of a university hospital in Brazil between January 2014 and January 2015. The FRS and two versions of the European SCORE (SCORE-High and SCORE-Low) were used to assess CVD risk; patients were classified as low/moderate risk (< 20% and <5%, respectively) or high risk (≥ 20% and ≥5%, respectively). The agreement rate was evaluated using kappa statistics, a test for interrater reliability that ranges from -1 to 1, and results above 0.6 represent a high agreement rate. Results The FRS classified a higher proportion of subjects as high risk for CVD (35.3% [18/51] vs. 23.5% [12/51] with the SCORE-High and 13.7% [7/51] with SCORE-Low). However, there was a high agreement rate between FRS and SCORE-High (k=0.628). The agreement between FRS and SCORE-Low was poor (k=0.352). Conclusions There was a high agreement rate between FRS and SCORE-High in cardiovascular risk assessment in the study sample. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Children First Study II: an educational programme on cardiovascular prevention in public schools can reduce parents cardiovascular risk

SUMMARY OBJECTIVE: The aim of this study was to analyze whether the implementation of a multidisciplinary educational programme for cardiovascular prevention in public schools can contribute to reducing the Fram INGHAM CARDIOVASCULAR RISK SCORE OF THE CHILDREN'S PARENTS AFTER ONE YEAR. METHODS: This was a prospective, community-based, case-control study carried out in public schools in Sao Paulo, Brasil. Students were randomized to receive healthy lifestyle recommendations by two different approaches. The control group received written cardiovascular health educational brochures for their parents. The intervention group received the same brochures for the parents, and the children were exposed to a weekly educational programme on cardiovascular prevention with a multidisciplinary health team for one year. Clinical and laboratorial data were collected at the onset and end of the study. RESULTS: We studied 265 children and their 418 parents. At the baseline, the rate of parents with intermediate or high Framingham scores (risk of cardiovascular disease over the next 10 years greater than 10%) was 6.9% in the control group and 13.3% in the intervention group. After one year, the rate of parents with intermediate or high Framingham risk score was reduced by 22.2% in the intervention group and increased by 33.3% in the control group (p=0.031). The cardiovascular risk factors that improved in the intervention group were blood pressure, LDL-cholesterol (low-density lipoprotein cholesterol), and glucose levels. CONCLUSION: An educational programme on cardiovascular prevention for school-age children in public schools can reduce the cardiovascular risk of their parents.

RESUMO OBJETIVO: Analisar se a implementação de um programa educacional multidisciplinar para prevenção cardiovascular em escolas públicas durante um ano pode contribuir para reduzir o escore de risco cardiovascular de Framingham dos pais das crianças. MÉTODOS: Estudo prospectivo, de base comunitária, caso-controle em duas escolas públicas de São Paulo, Brasil. Os alunos foram randomizados para receber recomendações de estilo de vida saudável por duas abordagens diferentes. O grupo controle recebeu folhetos educacionais de saúde cardiovascular encaminhados para seus pais. O grupo intervenção recebeu os mesmos folhetos e as crianças foram expostas a um programa educacional semanal, durante um ano, com uma equipe multidisciplinar em prevenção cardiovascular. Dados clínicos e laboratoriais foram coletados no início e no final do estudo. RESULTADOS: Foram sujeitos do estudo 418 pais das crianças das escolas. No início da pesquisa, o total de pais com escore de Framingham intermediário ou alto (risco superior a 10% de doença cardiovascular nos próximos dez anos) foi de 6,9% no grupo controle e de 13,3% no grupo intervenção. Após um ano, dentre os pais com escore de risco de Framingham intermediário ou alto, foi observada redução de 22,2% no grupo intervenção e aumento de 33,3% no grupo controle (p=0,031). Os fatores de risco cardiovascular que melhoraram no grupo de intervenção foram pressão arterial, LDL-colesterol (lipoproteína de baixa densidade) e glicemia. CONCLUSÃO: Um programa educacional de prevenção cardiovascular para crianças em idade escolar, em escolas públicas, pode reduzir o risco cardiovascular de seus pais.