Effects of primary health care and socioeconomic aspects on the dispersion of COVID-19 in the Brazilian Northeast: Ecological study of the first pandemic wave.

BACKGROUND: The COVID-19 pandemic has had a negative impact on socioeconomic and public health conditions of the population. AIM: To measure the temporal evolution of COVID-19 cases in cities near the countryside outside metropolitan areas of northeastern Brazil and the impact of the primary care organization in its containment. METHODS: This is a time-series study, based on the first three months of COVID-19 incidence in northeastern Brazil. Secondary data were used, the outcome was number of COVID-19 cases. Independent variables were time, coverage and quality score of basic health services, and demographic, socioeconomic and social isolation variables. Generalizable Linear Models with first order autoregression were applied. RESULTS: COVID-19 spreads heterogeneously in cities near the countryside of Northeastern Brazilian cities, showing associations with the city size, socioeconomic and organizational indicators of services. The Family Health Strategy seems to mitigate the speed of progression and burden of the disease, in addition to measures such as social isolation and closure of commercial activities. CONCLUSION: The spread of COVID-19 reveals multiple related factors, which require coordinated intersectoral actions in order to mitigate its problems, especially in biologically and socially vulnerable populations.

Dioclea violacea lectin inhibits tumorigenesis and tumor angiogenesis in vivo.

Dioclea violacea seed mannose-binding lectin (DvL) has attracted considerable attention because of its interesting biological activities, including antitumor, antioxidant, and anti-inflammatory activities. This study evaluated the cytotoxic effect of DvL on tumor and normal cells using the mitochondrial activity reduction (MTT) assay, the carcinogenic and anti-carcinogenic activity by the epithelial tumor test (ETT) in Drosophila melanogaster, and the anti-angiogenic effect by the chick embryo chorioallantoic membrane (CAM) assay. Data demonstrated that DvL promoted strong selective cytotoxicity against tumor cell lines, especially A549 and S180 cells, whereas normal cell lines were weakly affected. Furthermore, DvL did not promote carcinogenesis in D. melanogaster at any concentration tested, but modulated DXR-induced carcinogenesis at the highest concentrations tested. In the CAM and immunohistochemical assays, DvL inhibited sarcoma 180-induced angiogenesis and promoted the reduction of VEGF and TGF-ß levels at all concentrations tested. Therefore, our results demonstrated that DvL is a potent anticancer, anti-angiogenic, and selective cytotoxic agent for tumor cells, suggesting its potential application as a prototype molecule for the development of new drugs with chemoprotective and/or antitumor effects.

Physical exercise for the treatment of non-ulcerated chronic venous insufficiency.

BACKGROUND: Chronic venous insufficiency (CVI) is a condition related to chronic venous disease that may progress to venous leg ulceration and impair quality of life of those affected. Treatments such as physical exercise may be useful to reduce CVI symptoms. This is an update of an earlier Cochrane Review. OBJECTIVES: To evaluate the benefits and harms of physical exercise programmes for the treatment of individuals with non-ulcerated CVI. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 28 March 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing exercise programmes with no exercise in people with non-ulcerated CVI. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were intensity of disease signs and symptoms, ejection fraction, venous refilling time, and incidence of venous leg ulcer. Our secondary outcomes were quality of life, exercise capacity, muscle strength, incidence of surgical intervention, and ankle joint mobility. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We included five RCTs involving 146 participants. The studies compared a physical exercise group with a control group that did not perform a structured exercise programme. The exercise protocols differed between studies. We assessed three studies to be at an overall unclear risk of bias, one study at overall high risk of bias, and one study at overall low risk of bias. We were not able to combine data in meta-analysis as studies did not report all outcomes, and different methods were used to measure and report outcomes. Two studies reported intensity of CVI disease signs and symptoms using a validated scale. There was no clear difference in signs and symptoms between groups in baseline to six months after treatment (Venous Clinical Severity Score mean difference (MD) -0.38, 95% confidence interval (CI) -3.02 to 2.26; 28 participants, 1 study; very low-certainty evidence), and we are uncertain if exercise alters the intensity of signs and symptoms eight weeks after treatment (MD -4.07, 95% CI -6.53 to -1.61; 21 participants, 1 study; very low-certainty evidence). There was no clear difference in ejection fraction between groups from baseline to six months follow-up (MD 4.88, 95% CI -1.82 to 11.58; 28 participants, 1 study; very low-certainty evidence). Three studies reported on venous refilling time. We are uncertain if there is an improvement in venous refilling time between groups for baseline to six-month changes (MD 10.70 seconds, 95% CI 8.86 to 12.54; 23 participants, 1 study; very low-certainty evidence) or baseline to eight-week change (MD 9.15 seconds, 95% CI 5.53 to 12.77 for right side; MD 7.25 seconds, 95% CI 5.23 to 9.27 for left side; 21 participants, 1 study; very low-certainty evidence). There was no clear difference in venous refilling index for baseline to six-month changes (MD 0.57 mL/min, 95% CI -0.96 to 2.10; 28 participants, 1 study; very low-certainty evidence). No included studies reported the incidence of venous leg ulcers. One study reported health-related quality of life using validated instruments (Venous Insufficiency Epidemiological and Economic Study (VEINES) and 36-item Short Form Health Survey (SF-36), physical component score (PCS) and mental component score (MCS)). We are uncertain if exercise alters baseline to six-month changes in health-related quality of life between groups (VEINES-QOL: MD 4.60, 95% CI 0.78 to 8.42; SF-36 PCS: MD 5.40, 95% CI 0.63 to 10.17; SF-36 MCS: MD 0.40, 95% CI -3.85 to 4.65; 40 participants, 1 study; all very low-certainty evidence). Another study used the Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-20), and we are uncertain if exercise alters baseline to eight-week changes in health-related quality of life between groups (MD 39.36, 95% CI 30.18 to 48.54; 21 participants, 1 study; very low-certainty evidence). One study reported no differences between groups without presenting data. There was no clear difference between groups in exercise capacity measured as time on treadmill (baseline to six-month changes) (MD -0.53 minutes, 95% CI -5.25 to 4.19; 35 participants, 1 study; very low-certainty evidence). We are uncertain if exercise improves exercise capacity as assessed by the 6-minute walking test (MD 77.74 metres, 95% CI 58.93 to 96.55; 21 participants, 1 study; very low-certainty evidence). Muscle strength was measured using dynamometry or using heel lifts counts. We are uncertain if exercise increases peak torque/body weight (120 revolutions per minute) (changes from baseline to six months MD 3.10 ft-lb, 95% CI 0.98 to 5.22; 29 participants, 1 study; very low-certainty evidence). There was no clear difference between groups in baseline to eight-week change in strength measured by a hand dynamometer (MD 12.24 lb, 95% CI -7.61 to 32.09 for the right side; MD 11.25, 95% CI -14.10 to 36.60 for the left side; 21 participants, 1 study; very low-certainty evidence). We are uncertain if there is an increase in heel lifts (n) (baseline to six-month changes) between groups (MD 7.70, 95% CI 0.94 to 14.46; 39 participants, 1 study; very low-certainty evidence). There was no clear difference between groups in ankle mobility measured during dynamometry (baseline to six-month change MD -1.40 degrees, 95% CI -4.77 to 1.97; 29 participants, 1 study; very low-certainty evidence). We are uncertain if exercise increases plantar flexion measured by a goniometer (baseline to eight-week change MD 12.13 degrees, 95% CI 8.28 to 15.98 for right leg; MD 10.95 degrees, 95% CI 7.93 to 13.97 for left leg; 21 participants, 1 study; very low-certainty evidence). In all cases, we downgraded the certainty of evidence due to risk of bias and imprecision. AUTHORS' CONCLUSIONS: There is currently insufficient evidence to assess the benefits and harms of physical exercise in people with chronic venous disease. Future research into the effect of physical exercise should consider types of exercise protocols (intensity, frequency, and time), sample size, blinding, and homogeneity according to the severity of disease.

Temporomandibular disorders: knowledge, competency, and attitudes of predoctoral dental students.

OBJECTIVE: To evaluate knowledge, competency, and attitudes related to temporomandibular disorders (TMD) among predoctoral dental students, and to investigate the curricular organization of contents related to TMD and occlusion. METHODS: Predoctoral dental students (n = 147) answered a questionnaire with topics related to TMD. Another questionnaire evaluated the organization of TMD and occlusion courses. RESULTS: Contents related to TMD and occlusion were taught in the same course in all dental schools. The students' responses showed low agreement with the current gold standards pertaining to TMD. Most students declared that they did not feel confident to treat patients with TMD (62.6%), were not satisfied with the content pertaining to TMD (55.8%), and considered a lack of clinical practice to be the primary limitation in their training (59.2%). DISCUSSION: Students' knowledge of basic concepts related to TMD was limited, highlighting the need for readjustment of the dental curriculum to increase clinical experience.

Atuação do enfermeiro em saúde mental na estratégia de saúde da família / The role of mental health nurses in the family health strategy

Objetivos: conhecer a atuação do enfermeiro e os cuidados desempenhados em saúde mental na Estratégia de Saúde da Família. Método: estudo descritivo e qualitativo, tendo como cenário um polo de matriciamento em saúde mental. A coleta de dados foi realizada por meio de entrevista individual, com questionário semiestruturado. Resultados: os resultados obtidos foram agrupados e discutidos por meio das seguintes categorias: ações de enfermagem no campo da saúde mental desenvolvidas na Estratégia de Saúde da Família e apoio matricial em Saúde Mental como elemento facilitador da prática de enfermagem. Conclusão: os enfermeiros têm desenvolvido ações de enfermagem no campo da saúde mental na Estratégia de Saúde da Família, e o apoio matricial atua como principal elemento facilitador da prática de enfermagem, reafirmando a Reforma Psiquiátrica Brasileira. Em contrapartida, a sobrecarga de ações e a restrita formação em saúde mental são elementos que dificultam o trabalho desse profissional.

Objectives: to know the role of nurses and the care performed in mental health in the Family Health Strategy. Method: a descriptive, exploratory, and qualitative study, with a scenario of matrix support in mental health. Data collection was carried out through individual interviews and with a semi-structured questionnaire. Results: the results obtained were grouped and discussed through the following categories: Nursing actions mental health field developed in the Family Health Strategy, and Matrix Support in Mental Health as a facilitating element of nursing practice. Conclusion: nurses have developed nursing actions mental health field in the Family Health Strategy and matrix support acts as the main facilitator of nursing practice, reaffirming the Brazilian Psychiatric Reform. On the other hand, the overload of actions and the limited training in mental health are elements that hinder the work of these professionals.

The anti-inflamatory effect of Andira anthelmia lectin in rats involves inhibition of the prostanoid pathway, TNF-α and lectin domain.

OBJECTIVE: To investigate the effect and mechanisms of Andira anthelmia lectin in rat models of acute inflammation. MATERIAL: AAL anti-inflammatory activity was evaluated in Wistar rat models of paw edema and peritonitis. METHODS: AAL (0.01-1 mg/kg i.v.) was injected 30 min before stimulation with carrageenan and with initial and late phase inflammatory mediators into the animals paw or peritoneum for evaluation of cell migration (optical and intravital microscopy), paw edema (plethysmometry and histopathology); hyperalgesia (analgesimetry). RESULTS: AAL inhibited leukocyte migration induced by carrageenan, mainly neutrophils to the peritoneal fluid, decreasing leukocyte adhesion. In the peritoneal fluid, AAL reduced the gene expression of TNF-α and cyclooxygenase, as well the levels of PGE2. AAL inhibited the paw edema induced by carrageenan, serotonin, histamine, TNF-α, PLA2 and PGE2, but not by L-arginine. In this model, AAL also inhibited mechanical hypernociception induced by TNF-α, PGE2, db-cAMP and capsaicin, and the activity of myeloperoxidase in the paw tissues. CONCLUSION: AAL presents anti-inflammatory effect in acute models of rat inflammation involving the participation of prostaglandins, TNF-α and lectin domain.

White dot syndrome in a patient with presumed ocular tuberculosis: a case report.

BACKGROUND: This manuscript describes a case of a patient with presumed ocular tuberculosis masquerading as multiple evanescent white dot syndrome. CASE PRESENTATION: A 32-year-old male patient presented with a complaint of reduced visual acuity in the left eye. Retinal fundus exam of the left eye revealed gray-whitish deep lesions predominantly nasal to the optic disc. The lesions were more clearly identifiable on fundus autofluorescence (FAF) imaging, fluorescein angiography (FA) and en face optical coherence tomography (OCT). FA also indicated retinal vasculitis and papillitis. Swept-source OCT B-scan demonstrated loss of the ellipsoid layer in the regions corresponding to the lesions detected by FAF. A positive tuberculin skin test (TST) confirmed presumed tuberculosis, and a related WDS diagnosis was made. Specific antituberculosis therapy was instituted with favorable anatomical recovery and visual outcome. CONCLUSION: Multiple evanescent white dot syndrome (MEWDS) may be manifestation of presumed ocular tuberculosis, and multimodal retinal exams can provide a better understanding of atypical diseases and their follow-up.

Effect of milk replacer feeding rate and frequency of preweaning dairy calves in the southeastern United States: Glucose metabolism.

The objective of this experiment was to examine the effect of milk replacer (MR) feeding rate (FR) and frequency (FF) on glucose metabolism before and after weaning during summer and winter in the subtropical climate of the southeastern United States. Holstein calves (n = 48/season) were enrolled at 8 d of age (DOA) in the summer (June to August, body weight = 40.6 ± 0.7 kg) and winter (November to January, body weight = 41.9 ± 0.8 kg). In each season, calves were randomly assigned to 1 of 4 treatments in a 2 × 2 factorial arrangement including 2 FR [0.65 (low) or 0.76 kg of solids/d (high) of a 26% CP and 17% fat MR] and 2 FF [2× (0700 and 1600 h) or 3× (0700, 1600, and 2200 h)]. Calves were managed similarly and housed in polyethylene hutches bedded with sand. Milk replacer (12.5%) was fed based on treatments until 42 DOA when FR was reduced by half and offered 1×/d (0700 h) for 7 d. Plasma was collected weekly at 1400 h for analyses of glucose and insulin concentrations in all calves. Pre- and postprandial glucose and insulin concentrations of a subset of calves (n = 10/treatment per season) were measured on 20 DOA. A subset of calves (n = 8/treatment per season) was subjected to an intravenous glucose tolerance test (GTT) on 27 and 57 DOA and insulin challenge on 28 and 58 DOA at 1030 h. Average ambient temperature was 26.1 ± 2.2°C in summer and 12.9 ± 5.4°C in winter. During the preweaning period in both seasons, feeding high increased plasma glucose concentrations compared with low, and increasing FF reduced basal insulin concentrations. Compared with 2×, feeding 3× did not affect postprandial glucose but lowered insulin in the summer, whereas in the winter, increased glucose from 30 to 180 min but lowered insulin from 240 to 420 min after MR feeding. Following GTT before weaning in both seasons, 3× reduced insulin increment and area under the curve compared with 2× without affecting glucose disposal. After weaning, treatment did not affect glucose disposal or insulin responses after GTT during winter, but calves fed 3× had faster glucose disposal and stronger insulin responses than 2× during summer. In both summer and winter, preweaned calves fed 3× had greater decrement and area under the curve of plasma glucose after insulin challenge, suggesting enhanced peripheral tissue insulin response compared with 2×. This effect persisted after weaning only during summer. Increasing FR had no effect on metabolic responses in both seasons. In conclusion, increasing MR FF from 2 to 3 times per day reduced insulin secretion but enhanced insulin response on peripheral tissues of preweaned calves regardless of season.

Effects of milk replacer feeding rate and frequency of preweaning dairy calves in the southeastern United States: Performance, abomasal emptying, and nutrient digestibility.

To evaluate the effects of milk replacer (MR) feeding rate (FR) and frequency (FF) on performance, abomasal emptying, and nutrient digestibility in the southeastern United States, Holstein calves (n = 48/season) were enrolled at 8 d of age (DOA) during summer [June to August, body weight (BW; mean ± SD) = 40.71 ± 4.35 kg] and winter (November to January, BW = 42.03 ± 3.83 kg). Within season, calves were randomly assigned to 1 of 4 treatments in a 2 × 2 factorial arrangement including 2 FR [0.65 (low) or 0.76 kg of solid per day (high) of a 26% crude protein and 17% fat MR], and 2 FF [2× (0700 and 1600 h) or 3× (0700, 1600, and 2200 h) daily]. Calves were housed in polyethylene hutches and managed similarly throughout the trial. Milk replacer (12.5% solids) was fed to calves based on their respective treatments until 42 DOA, when MR allowance was reduced by 50% and offered once a day (0700 h) for the following 7 d until weaning. Calves remained on trial until 63 DOA. Calf starter and water were offered ad libitum. Ambient temperature and relative humidity inside and outside hutches were measured hourly. Starter and MR intakes were recorded daily. Respiration rate and rectal temperature were recorded 3 times a week. Structural growth and BW were measured weekly. Acetaminophen (50 mg/kg of BW) mixed with MR was fed to a subset of calves (0700 h, n = 10/treatment per season) on 20 DOA. Plasma was collected at 15, 30, 60, 90, 120, 150, 180, 210, 240, 270, 300, 330, 360, 420, and 480 min after feeding, to analyze acetaminophen. The acetaminophen concentration-time curve was modeled to the first derivative of Siegel's modified power exponential equation, and the time for plasma acetaminophen to reach maximum (Tmax) was calculated to evaluate abomasal emptying rate. During the pre- (14.9-17.9 DOA) and postweaning (51.0-54.0 DOA) periods, a subset (n = 8/treatment per season) of calves was used to determine the apparent digestibility of nutrients, using chromic oxide as the external marker. Feeding 3× reduced preweaning respiration rate during summer and reduced rectal temperature during winter. Increasing FR improved BW gain and structural growth. Feeding more times per day tended to improve growth during winter but not summer. We found no effect of treatment on nutrient digestibility. Increasing FR had no effect on Tmax during winter but tended to delay Tmax of plasma acetaminophen during summer. Regardless of season, increasing FF lowered Tmax of plasma acetaminophen. In conclusion, increasing FF accelerated abomasal emptying and might reduce heat load of preweaning dairy calves but improved growth only during winter. Increased MR allowance improved growth in both seasons but delayed abomasal emptying only under heat stress conditions.

Biopsychosocial inequality, active lifestyle and chronic health conditions: a cross-sectional National Health Survey 2013 in Brazil.

This study estimated the biopsychosocial factors related to active physical behavior in the Brazilian population with and without chronic non-transmissible disease (NCD). Cross-sectional study of the National Health Survey (NHS) in Brazil, with 60,202 individuals in 2013. Participants were randomly selected by complex sampling. The outcome was physically active behavior measured by performing a minimum of 150 min of physical exercise per week. The independent variables were social and psychological characteristics, lifestyle and health. Cox regression was applied to estimate the prevalence ratio (PR). There are 29,666 (48.3%; 95% CI 47.0-50.0) participants reported having NCD. Not being a smoker or alcoholic, living in an urban area (PR = 1.44; CI95% 1.23-1.68/PR = 1.38; CI95% 1.08-1.75), having informal social support (PR = 1.26; CI95% 1.10-1.44/PR = 1.19; CI95% 1.05-1.34), A social class (PR = 0.43; CI95% 0.25-0.73/PR = 0.46; CI95% 0.26-0.80), high schooling (PR = 0.34; CI95% 0.23-0.51/PR = 0.33; CI95% 0.24-0.46) as well as paid work (PR = 0.87; CI95% 0.78-0.96/PR = 0.89; CI95% 0.79-0.99) are more associated with active lifestyle in both groups. However, only in the group without NCD, the male sex (PR = 1.42; CI95% 1.28-1.57), no having some disability (PR = 1.31; CI95% 1.03-1.66) and having private health insurance (PR = 1.26; CI95% 1.13-1.41) were more associated with active behavior, while in the group with NCD, being elderly (PR = 1.22; CI95% 1.05-1.42), not be white (PR = 0.85; CI95% 0.77-0.95) and not having restful sleep (PR = 1.23; CI95% 1.08-1.40) are associated with active lifestyle. People with and without NCD in Brazil have very close active behavior, however, some biopsychosocial factors such as: sex, age, lifestyle, socioeconomic level are unevenly associated with the active lifestyle in the groups. Thus, therapeutic or preventive proposals as well as public policies for health promotion must observe these distinctions when elaborating their actions.

Caracterização clínica e epidemiológica de idosos de uma instituição de longa permanência / Clinical and epidemiological characterization of the elderly in a long-term institution / Caracterización clínico-epidemiológica del anciano en una institución de larga duración

Objetivo: Caracterizar clínica e epidemiologicamente os idosos residentes em uma instituição de longa permanência para idosos no Norte de Minas Gerais, Brasil. Método: Estudo descritivo e transversal realizado com a população idosa residente em uma instituição de longa permanência. Foi realizada entrevista individual com a aplicação de um instrumento de caracterização sociodemográfica, a Escala Katz e Teste do Relógio, no período entre 2018 e 2019. Os dados foram submetidos à análise estatística descritiva. Resultados: Participaram do estudo 116 idosos com média de idade de 78,240 (±9,21) anos, a maioria do sexo masculino (n=70; 60,3%), raça parda (n=74; 63,8%) e solteiros (n=77; 66,4%). Quanto aos resultados da Escala de Katz e Teste do Relógio, os participantes foram classificados como mais funcionais (n=39; 33,6%) e com inabilidade (n=90; 77,6%) respectivamente. Conclusões: A caracterização do perfil e o levantamento de problemas reais e potenciais contribuíram para o cuidado com os idosos que precisam ser apropriados e direcionados para que os idosos alcancem a máxima qualidade de vida, independência e funcionalidade. (AU)

Objective: Characterizing clinically and epidemiologically the elderly residents in a long-term care facility for the elderly in Northern Minas Gerais, Brazil. Methods: A descriptive and transversal character study conducted with the elderly population residing in a long-term institution. An individual interview was conducted with the application of a sociodemographic characterization instrument, the Katz Scale and Clock Test, in the period between 2018 and 2019. The data were subjected to descriptive statistical analysis. Results: Participated in the study 116 elderly people with an average age of 78.240 (± 9.21) years old, mostly male (NO = 70; 60.3%), mixed race (NO = 74; 63.8%) and single (NO = 77; 66.4%). Regarding the results of the Katz Scale and Clock Test, the participants were classified as more functional (NO = 39; 33.6%) and with disability (NO = 90; 77.6%) respectively. Conclusion: The characterization of the profile and the survey of real and potential problems contributed to the care for the elderly, which need to be appropriate and directed so that the elderly achieve the maximum quality of life, independence and functionality. (AU)

Objetivo: Caracterizar clínica y epidemiológicamente a los ancianos residentes en un centro de atención a largo plazo para ancianos en el Norte de Minas Gerais, Brasil. Métodos: Un estudio descriptivo y transversal realizado con población anciana residente en una institución de larga duración. Se realizó una entrevista individual con la aplicación de un instrumento de caracterización sociodemográfica, la Escala de Katz y Test de Reloj, en el período comprendido entre 2018 y 2019. Los datos fueron sometidos al análisis estadístico descriptivo. Resultados: Participaron del estudio 116 ancianos con una edad media de 78.240 (± 9,21) años, en su mayoría varones (n = 70; 60,3%), mestizos (n = 74; 63,8%) y solteros (n = 77; 66,4%). En cuanto a los resultados de la Escala de Katz y la Prueba del Reloj, los participantes fueron clasificados como más funcionales (n = 39; 33,6%) y con discapacidad (n = 90; 77,6%) respectivamente. Conclusion: La caracterización del perfil y el relevamiento de problemas reales y potenciales contribuyeron al cuidado del anciano, que debe ser adecuado y dirigido para que el anciano alcance la máxima calidad de vida, independencia y funcionalidad. (AU)

COVID-19 in Brazilian cities: Impact of social determinants, coverage and quality of primary health care.

BACKGROUND: Brazil, as many other countries, have been heavily affected by COVID-19. This study aimed to analyze the impact of Primary health care and the family health strategy (FHS) coverage, the scores of the National Program for Improving Primary Care Access and Quality (PMAQ), and socioeconomic and social indicators in the number of COVID-19 cases in Brazilian largest cities. METHODS: This is an ecological study, carried out through the analysis of secondary data on the population of all Brazilian main cities, based on the analysis of a 26-week epidemiological epidemic week series by COVID-19. Statistical analysis was performed using Generalized Linear Models with an Autoregressive work correlation matrix. RESULTS: It was shown that greater PHC coverage and greater FHS coverage together with an above average PMAQ score are associated with slower dissemination and lower burden of COVID-19. CONCLUSION: It is evident that cities with less social inequality and restrictions of social protection combined with social development have a milder pandemic scenario. It is necessary to act quickly on these conditions for COVID-19 dissemination by timely actions with high capillarity. Expanding access to PHC and social support strategies for the vulnerable are essential.

Dissemination of COVID-19 in inland cities of Northeastern Brazil.

BACKGROUND: SARS-CoV-2 causes the new coronavirus disease (COVID-19) and it is weakening all health systems. Therefore, the most vulnerable populations are exposed to harmful consequences, such as illness and death. Thus, this study aims to estimate the temporal effect of COVID-19 dissemination on social indicators of the Northeastern region of Brazil. METHODS: An ecological time-series study was developed with the following: diagnosed cases of COVID-19 in the largest inland cities of Northeast Brazil, Human Development Index (HDI), poverty incidence, and Gini coefficient. Cities with high HDI, poverty rate, and Gini presented a larger number of patients. RESULTS: It was observed by evaluating case trends that COVID-19 spreads unevenly in inland cities of the Northeastern region of Brazil. CONCLUSIONS: In this sense, we emphasize that regional health managers should support small cities with vulnerable population and social assistance.

Depressão em pacientes atendidos em serviço de saúde mental: fatores associados e diagnósticos de enfermagem / Depression in patients served in mental health service: prevalence and associated factors / Depresión en pacientes atendidos en servicio de salud mental: prevalencia y factores associados

OBJETIVO: estimar a prevalência de depressão em pacientes atendidos em Centro de Atenção Psicossocial, identificar os fatores sociodemográficos e diagnósticos de Enfermagem associados ao desfecho. MÉTODO: estudo transversal, realizado entre janeiro a junho de 2018, em 370 prontuários de pacientes atendidos, no período de 2002 a 2016, em Centro de Atenção Psicossocial de um município do norte de Minas Gerais, Brasil. Com o auxílio de um instrumento, foram coletados dados clínicos, sociodemográficos e diagnósticos de Enfermagem. Os diagnósticos de Enfermagem foram validados por especialistas com suporte no raciocínio diagnóstico de Risner. Realizaram-se análises descritiva, bivariada e regressão logística. RESULTADOS: dos 370 pacientes, 57 (15,4%) apresentaram depressão. A maioria (53,2%) era composta por indivíduos do sexo feminino e a média de idade foi de 36 anos. Os diagnósticos de Enfermagem prioritários entre os pacientes com depressão foram: humor deprimido (100%), crise (68,4%), insônia (45,6%) e risco de suicídio (49,1%). As variáveis independentes que impactaram, de forma significativa, o desfecho depressão foram: sexo feminino (p=0,012), insônia (p=0,006) e risco de suicídio (p<0,001). CONCLUSÃO: identificar precocemente possíveis fatores e diagnósticos de Enfermagem associados à pessoa com depressão poderá auxiliar na implementação de cuidados acurados a pacientes com esse problema atendidos em Centro de Atenção Psicossocial.

OBJECTIVE: estimate the prevalence of depression in patients seen in a psychosocial care center, identify the sociodemographic factors and nursing diagnoses associated with the outcome. METHOD: cross-sectional study, carried out between January and June 2018, in 370 medical records of patients treated, from 2002 to 2016, in a psychosocial care center in a municipality in the north of Minas Gerais, Brazil. With the aid of an instrument, clinical, sociodemographic and nursing diagnoses data were collected. Nursing diagnoses were validated by specialists with support for Risner's diagnostic reasoning. Descriptive, bivariate analysis and logistic regression were performed. RESULTS: of the 370 patients, 57 (15.4%) had depression. The majority (53.2%) were female and the average age was 36 years. The priority nursing diagnoses among patients with depression were: depressed mood (100%), crisis (68,4%), insomnia (45,6%) and risk of suicide (49,1%). The independent variables that significantly impacted the depression outcome were: female gender (p=0,012), insomnia (p=0,006) and risk of suicide (p<0,001). CONCLUSION: early identification of possible nursing factors and diagnoses associated with a person with depression may help in the implementation of accurate care for patients with this problem treated at a psychosocial care center.

OBJETIVO: estimar la prevalencia de depresión en pacientes atendidos en un centro de atención psicosocial, identificar los factores sociodemográficos y diagnósticos de enfermería asociados al resultado. MÉTODO: estudio transversal, realizado entre enero y junio de 2018, en 370 historias clínicas de pacientes atendidos, de 2002 a 2016, en un centro de atención psicosocial de un municipio del norte de Minas Gerais, Brasil. Con la ayuda de un instrumento se recolectaron datos de diagnósticos clínicos, sociodemográficos y de enfermería. Los diagnósticos de enfermería fueron validados por especialistas con apoyo del razonamiento diagnóstico de Risner. Se realizó análisis descriptivo, bivariado y regresión logística. RESULTADOS: de los 370 pacientes, 57 (15,4%) tenían depresión. La mayoría (53,2%) eran mujeres y la edad media era de 36 años. Los diagnósticos de enfermería prioritarios entre los pacientes con depresión fueron: estado de ánimo deprimido (100%), crisis (68,4%), insomnio (45,6%) y riesgo de suicidio (49,1%). Las variables independientes que impactaron significativamente el resultado de la depresión fueron: sexo femenino (p=0,012), insomnio (p=0,006) y riesgo de suicidio (p<0,001). CONCLUSIÓN: la identificación temprana de posibles factores de enfermería y diagnósticos asociados a una persona con depresión puede ayudar en la implementación de una atención adecuada a los pacientes con este problema atendidos en un centro de atención psicosocial.

Primary health care and social isolation against COVID-19 in Northeastern Brazil: Ecological time-series study.

BACKGROUND: Brazil is witnessing a massive increase of corona virus disease (COVID-19). Its peculiar primary health care (PHC) system faces a burden due to the contagion occurring in the community environment. Then, the aim is to estimate the effect of the coverage of primary health care and social isolation on the evolution of confirmed cases and deaths by COVID-19, controlling sociodemographic, economic and health system aspects. METHODS: A time series design was designed with data on diagnosed cases of COVID-19 and their deaths as outcomes in the capital cities of the Northeast region of Brazil. Independent variables such as PHC coverage, hospital beds, social isolation, demographic density, Gini index and other indicators were analyzed. A Autoregressive Generalized Linear Model method was applied for model the relationship. RESULTS: We identified an exponential growth of cases (y = 0.00250.71x; p-value<0,001). However, there is a high variability in the occurrence of outcomes. PHC coverage≥75% (χ2 = 9.27; p-value = 0.01) and social isolation rate (χ2 = 365.99; p-value<0.001) proved to be mitigating factors for the spread of COVID-19 and its deaths. Capitals with hospital beds ≥ 3.2 per thousand inhabitants had fewer deaths (χ2 = 9.02; p-value = 0.003), but this was influenced by PHC coverage (χ2 = 30,87; p-value<0.001). CONCLUSIONS: PHC mitigates the occurrence of Covid-19 and its deaths in a region of social vulnerability in Brazil together with social isolation. However, it is not known until when the system will withstand the overload in view of the low adhesion to social isolation, the lack of support and appropriate direction from the government to its population.

Specialized nursing terminology for the care of people with COVID-19.

OBJECTIVE: To create specialized nursing terminology for the care of people with COVID-19. METHODS: Methodological study, carried out based on the identification of concepts related to the care of the person with the infection, present in the official guidelines of the Brazilian Ministry of Health; the concepts were validated by three specialist nurses; and a cross-mapping of the extracted concepts was done with CIPE® 2019 primitive concepts. RESULTS: Out of 436 unique concepts, being 399 of these validated; of these, 70.9% were in the Classification and referred to the nursing care of people with COVID-19. In the Axis, the concepts related to Focus, Action, and Environment stood out. As for the non-validated concepts, 78.4% were not included in the 2019 version of CIPE®. CONCLUSION: We were able to structure a specialized CIPE® terminology, with the potential to generate nursing care indicators for people with COVID-19.

ICNP® nursing diagnostics for people in-home care.

OBJECTIVES: to identify ICNP® nursing diagnoses in people attended in a home care program. METHODS: cross-sectional study with 131 patients of Home Health Care in a northern municipality of Minas Gerais, Brazil, applied a questionnaire based on Basic Human Needs. It was performed the identification and validation by consensus of specialists with support in Risner's diagnostic reasoning, of the nursing diagnoses of ICNP®, version 2019. RESULTS: from 77 nursing diagnoses, most are inserted in the psychobiological needs (n = 66) and refer to the domains Nutrition; Hydration and electrolytic regulation; Cutaneous-mucous integrity; Locomotion, body mechanics and mobility; Body care; and Learning, Sociability, Recreation, and leisure. From total, forty are negative, followed by positive formulations (n = 15), clinical findings (n = 15) and risk (n = 7). CONCLUSIONS: a profile of the nursing phenomena common to home care is presented, which can be used by nurses in clinical practice, teaching, research, and management.

Structural characterization of anticoagulant and antithrombotic polysaccharides isolated from Caesalpinia ferrea stem barks.

This study aimed to isolate, characterize chemical-structurally and evaluate the effects of polysaccharides from Caesalpinia (Libidibia) ferrea stem barks in the haemostatic system. The deproteinated-polysaccharide extract (PE-Cf) after being fractionated by ion exchange chromatography-DEAE-cellulose resulted in three fractions (FI, FII, FIII) containing total carbohydrates (14.3-38%), including uronic acid (5-16%), and polyphenols (0.94-1.7 mg/g GAE). The polysaccharide fractions presented polydisperse profile in polyacrylamide gel electrophoresis (detected by Stains-All) and molecular masses (9.5 × 104 Da-1.5 × 105 Da) identified by gel permeation chromatography. FT-IR showed absorption bands (1630 cm-1, 1396-1331 cm-1), indicative of uronic acid, and a band at 1071 cm-1, typical of COO- groups of galacturonic acid. The NMR spectra of C. ferrea polysaccharides revealed a central core composed mainly by 5-linked α-Araf and minority components as α-Rhap and α-GalAp. UV spectra of fractions revealed discrete shoulders at 269-275 nm, characteristic of polyphenolic compounds. In vitro, polysaccharides inhibited the intrinsic and/or common coagulation pathway (aPTT test) (2.0-3.7 fold) and the platelet aggregation induced by 3 µM adenosine diphosphate (25-48%) and 5 µg/mL collagen (24%), but not that induced by arachidonic acid. In vivo, the polysaccharides inhibited (36-69%) venous thrombosis induced by hypercoagulability and stasis, showing discrete hemorrhagic effect. In conclusion, the polysaccharides of C. ferrea barks, containing arabinose, galactose, rhamnose and uronic acid, possess anticoagulant, antiplatelet and antithrombotic properties of low hemorrhagic risk, suggesting potential applicability in thromboembolic disorders.

Safe intra-hospital care in context of vulnerability to socio-environmental disasters: implications for nursing.

OBJECTIVES: to analyze the factors involved in safe intra-hospital care, in a context of vulnerability to socio-environmental disasters and their implications for nursing. METHODS: a cross-sectional study of a descriptive and exploratory nature. Semi-structured interviews were conducted with 49 nursing professionals from a hospital in the mountainous region of the state of Rio de Janeiro (Brazil), which suffered a significant impact from a socio-environmental disaster in January 2011. Data were processed by software IRaMuTeQ. RESULTS: aspects related to disaster assistance were presented through a thematic chunk with four classes, through descending hierarchical classification. CONCLUSIONS: for better nursing response in socio-environmental disasters, in an intra-hospital setting, investments for training and continuing education should be prioritized; adequate provision and provision of human, material and technological resources; psychological support for professionals after such events; appropriation of nursing competencies for the development of advanced practices in disasters and effective risk management.