Perception of public places for physical activity among beneficiaries and non-beneficiaries of health plans: results of the National Health Survey 2019 / Percepção de locais públicos para prática de atividade física entre beneficiários e não beneficiários de planos de saúde: resultados da Pesquisa Nacional de Saúde 2019

This study aimed to evaluate the perception of public places for the practice of physical activity and compare these differences according to health plan beneficiaries and non-beneficiaries. We used data from the 2019 National Health Interview Survey. The outcome was assessed through the following question, "Near your home, is there a public place (square, park, enclosed street, beach) to walk, exercise or play sport?". Descriptive analyses were performed using frequency and 95% confidence intervals (95%CI). The analyses were performed by comparing beneficiaries and non-beneficiaries of health plans and evaluating the results according to sociodemographic variables.The results include data from 20,230 beneficiaries (52.6% women) and 68,301 non-beneficiaries (54.6% women) of health plans, with most of the sample aged between 18 and 39.Overall, 52.1% of non-beneficiaries (95%CI: 51.0 - 53.2) and 67.4% of beneficiaries (95%CI: 65.8 - 68.9) reported having a place near their home for physical activity. We found a dose-effect trend regarding education level and places close to the residence to the practice of physical activity - the higher the level of education, the higher the perception of individuals who reported having adequate places for physical activity.Our findings showed that beneficiaries of health plans have more access to places near their homes to practice physical activity, as well as the most educated

O objetivo deste estudo foiavaliar a percepção de locais públicos para a prática de atividade física e com-parar essas diferenças segundo beneficiários e não beneficiários de planos de saúde. Foram utilizados dados da Pesquisa Nacional de Saúde de 2019. O desfecho foi avaliado por meio da seguinte questão: "Perto de sua casa, existe algum local público (praça, parque, rua fechada, praia) para caminhar, fazer exercícios ou praticar esportes?". Análises descritivas foram realizadas por meio de frequência e intervalo de confiança de 95% (IC95%). As análises foram realizadas comparando beneficiários e não beneficiários de planos de saúde e avaliando os resultados segundo variáveis sociodemográficas.Os resultados incluem dados de 20.230 beneficiários (52,6% mulheres) e 68.301 não-beneficiários (54,6% mulheres) de planos de saúde, ambos com maior parte da amostra com idades entre 18 e 39 anos. No geral, 52,1% dos não beneficiários (IC95%: 51,0 - 53,2) e 67,4% dos beneficiários (IC95%: 65,8 - 68,9) relataram ter um local próximo a sua casa para a prática de atividade física. Encontramos uma tendência dose-resposta em relação à escolaridade e locais próximos à residência para a prática de atividade física - quanto maior a escolaridade, maior a percepção de indivíduos que referiram ter locais adequados para a prática de atividade física.Nossos achados mostraram que os beneficiários de planos de saúde têm mais acesso a locais próximos a suas residências para praticar atividade física, assim como os mais escolarizados

Risk and Resilience Factors for Youth Homelessness in Western Countries: A Systematic Review.

OBJECTIVES: The experience of homelessness for young people can affect social, emotional, and physical development, resulting in poorer physical and mental health outcomes. To reduce rates of youth homelessness, a better understanding of both risk and resilience is needed to inform future intervention development. This article presents a systematic review of published research reporting risk or resilience factors related to homelessness among young people in Western countries. METHODS: After thorough examination for inclusion criteria, 665 abstracts of peer-reviewed quantitative studies of risk or resilience factors for homelessness among young people (ages 0-25) that included an adequate comparison group (e.g., not homeless) were selected. After abstract and full-text screening, 16 articles were reviewed. A primary prevention framework was used to create an explanatory model for the onset of homelessness using risk and resilience factors. RESULTS: Common risk factors for youth homelessness included difficulties with family, mental health or substance use problems, a history of problem behaviors, a history of foster care, homelessness as a child, and running away. Common protective factors included a supportive family, a college education, and high socioeconomic status. Findings were integrated into a provisional developmental model of youth homelessness risk. Clinical implications of the model for service development are discussed, and a model for monitoring homelessness risk and resilience factors is proposed. CONCLUSIONS: Factors affecting homelessness risk among youths and adults differ, with family, foster care, and schooling playing a much more important role among youths. Findings highlight opportunities for youth homelessness prevention strategies and monitoring.

Validation of the Pediatric Canadian Triage and Acuity Scale at the Emergency Department of a Tertiary Children's Hospital in Costa Rica.

BACKGROUND: The Pediatric Canadian Triage and Acuity Scale (PedCTAS) is a recognized system that prioritizes care by the severity of illness. The goal of this study was to describe and analyze the results from the implementation of the PedCTAS in a tertiary children's hospital in Costa Rica. METHODS: This was a retrospective observational study of children presenting to the emergency department (ED) from 1st January to 31st December of 2019 in the only children's hospital in Costa Rica. Outcome measures were hospitalization, ICU admission, waiting times from triage to physician time (TPT), left without being seen (LWBS), length of stay (LOS), in relation to the triage level, and final disposition. RESULTS: A total of 93,001 patients were admitted to the ED. The proportion for hospitalizations according to triage category was 85.3%, 40%, 14%, 4.3%, and 2% for patients triaged at CTAS levels I, II, III, IV, and V respectively. A total of 2045 (2.19%) patients were LWBS. Some 585 (0.62%) patients were admitted to ICU. Median TPT for each category was for levels I:12 min, II:20 min, III:22 min, IV:34 min, and V:54 min. The LOS in the ED patients triaged as levels I and II stayed longer and the mortality rate was also higher in patients classified as levels I and II. The mortality rate was for level I patients 44.2% (23 patients) and level II 1.4% (8 patients). CONCLUSIONS: This study shows evidence of validation of the PedCTAS in a developing country in Latin America. Implementation of a validated triage tool in our country helps us to provide improvements in the care of pediatric patients in the ED.

Timed artificial insemination in crossbred mares: Reproductive efficiency and costs.

Timed artificial insemination (TAI) has boosted the use of conventional artificial insemination (CAI) by employing hormonal protocols to synchronize oestrus and ovulation. This study aimed to evaluate the efficiency of a hormonal protocol for TAI in mares, based on a combination of progesterone releasing intravaginal device (PRID), prostaglandin (PGF2α ) and human chorionic gonadotropin (hCG); and compare financial costs between CAI and TAI. Twenty-one mares were divided into two groups: CAI group (CAIG; n = 6 mares; 17 oestrous cycles) and TAI group (TAIG; n = 15 mares; 15 oestrous cycles). The CAIG was subjected to CAI, involving follicular dynamics and uterine oedema monitoring with ultrasound examinations (US), and administration of hCG (1,600 IU) when the dominant follicle (DF) diameter's ≥35 mm + uterine oedema + cervix opening. The AI was performed with fresh semen (500 × 106 cells), and embryo was recovered on day 8 (D8) after ovulation. In TAI, mares received 1.9 g PRID on D0. On D10, PRID was removed and 6.71 mg dinoprost tromethamine was administered. Ovulation was induced on D14 (1,600 IU of hCG) regardless of the DF diameter's, and AI was performed with fresh semen (500 × 106 cells). On D30 after AI, pregnancy was confirmed by US. The pregnancy rate was 80.0% in TAIG and 82.3% in CAIG (p > .05). The TAI protocol resulted in 65% reduction in professional transport costs, and 40% reduction in material costs. The TAI was as efficient as CAI, provided reduction in costs and handlings, and is recommended in mares.

Targeting the Immune System With Mesenchymal Stromal Cell-Derived Extracellular Vesicles: What Is the Cargo's Mechanism of Action?

The potent immunomodulatory activities displayed by mesenchymal stromal cells (MSCs) have motivated their application in hundreds of clinical trials to date. In some countries, they have subsequently been approved for the treatment of immune disorders such as Crohn's disease and graft-versus-host disease. Increasing evidence suggests that their main mechanism of action in vivo relies on paracrine signaling and extracellular vesicles. Mesenchymal stromal cell-derived extracellular vesicles (MSC-EVs) play a prominent role in intercellular communication by allowing the horizontal transfer of microRNAs, mRNAs, proteins, lipids and other bioactive molecules between MSCs and their targets. However, despite the considerable momentum gained by MSC-EV research, the precise mechanism by which MSC-EVs interact with the immune system is still debated. Available evidence is highly context-dependent and fragmentary, with a limited number of reports trying to link their efficacy to specific active components shuttled within them. In this concise review, currently available evidence on the molecular mechanisms underlying the effects of MSC-EV cargo on the immune system is analyzed. Studies that pinpoint specific MSC-EV-borne mediators of immunomodulation are highlighted, with a focus on the signaling events triggered by MSC-EVs in target immune cells. Reports that study the effects of preconditioning or "licensing" in MSC-EV-mediated immunomodulation are also presented. The need for further studies that dissect the mechanisms of MSC-EV cargo in the adaptive immune system is emphasized. Finally, the major challenges that need to be addressed to harness the full potential of these signaling vehicles are discussed, with the ultimate goal of effectively translating MSC-EV treatments into the clinic.

A History of Trauma is Associated with Aggression, Depression, Non-Suicidal Self-Injury Behavior, and Suicide Ideation in First-Episode Psychosis.

The association between trauma and psychosis outcomes is well-established, and yet the impact of trauma on comorbid clinical symptoms-such as aggression, non-suicidal self-injury behavior (NSSIB), suicide ideation, and suicide behavior-for those with psychosis is unclear. To effectively treat those with first-episode psychosis (FEP) and a history of trauma, we need to understand the impact of trauma on their whole presentation. FEP participants were recruited from an Early Psychosis Program (N = 187, ages 12-35, 72.2% male). Clinicians gathered history of trauma, aggression, and suicide data, and rated current symptom severity and functioning. Data was coded using clinician rated measures, self-report measures, and retrospective clinical chart review. Regression analyses examined whether trauma was associated with a history of aggression, suicidal ideation, suicide behavior, NSSIB, symptoms, and functioning. Trauma was associated with aggression, aggression severity and type of aggression (aggression towards others). Trauma was also associated with depression severity, suicide ideation, most severe suicide ideation, and NSSIB. Trauma was not associated with suicide behavior, severity of suicide behavior or psychosocial functioning. Integrating trauma treatment into FEP care could reduce rates of depression, aggression, suicide ideation, and NSSIB for those with a history of trauma. To reduce suicide attempt occurrence and improve functioning, more research is needed.

The Incorporation of Extracellular Vesicles from Mesenchymal Stromal Cells Into CD34+ Cells Increases Their Clonogenic Capacity and Bone Marrow Lodging Ability.

Mesenchymal stromal cells (MSC) may exert their functions by the release of extracellular vesicles (EV). Our aim was to analyze changes induced in CD34+ cells after the incorporation of MSC-EV. MSC-EV were characterized by flow cytometry (FC), Western blot, electron microscopy, and nanoparticle tracking analysis. EV incorporation into CD34+ cells was confirmed by FC and confocal microscopy, and then reverse transcription polymerase chain reaction and arrays were performed in modified CD34+ cells. Apoptosis and cell cycle were also evaluated by FC, phosphorylation of signal activator of transcription 5 (STAT5) by WES Simple, and clonal growth by clonogenic assays. Human engraftment was analyzed 4 weeks after CD34+ cell transplantation in nonobese diabetic/severe combined immunodeficient mice. Our results showed that MSC-EV incorporation induced a downregulation of proapoptotic genes, an overexpression of genes involved in colony formation, and an activation of the Janus kinase (JAK)-STAT pathway in CD34+ cells. A significant decrease in apoptosis and an increased CD44 expression were confirmed by FC, and increased levels of phospho-STAT5 were confirmed by WES Simple in CD34+ cells with MSC-EV. In addition, these cells displayed a higher colony-forming unit granulocyte/macrophage clonogenic potential. Finally, the in vivo bone marrow lodging ability of human CD34+ cells with MSC-EV was significantly increased in the injected femurs. In summary, the incorporation of MSC-EV induces genomic and functional changes in CD34+ cells, increasing their clonogenic capacity and their bone marrow lodging ability. Stem Cells 2019;37:1357-1368.

Life expectancy of follicular lymphoma patients in complete response at 30 months is similar to that of the Spanish general population.

The use of immunochemotherapy has improved the outcome of follicular lymphoma (FL). Recently, complete response at 30 months (CR30) has been suggested as a surrogate for progression-free survival. This study aimed to analyse the life expectancy of FL patients according to their status at 30 months from the start of treatment in comparison with the sex and age-matched Spanish general population (relative survival; RS). The training series comprised 263 patients consecutively diagnosed with FL in a 10-year period who needed therapy and were treated with rituximab-containing regimens. An independent cohort of 693 FL patients from the Grupo Español de Linfomas y Trasplante Autólogo de Médula Ósea (GELTAMO) group was used for validation. In the training cohort, 188 patients were in CR30, with a 10-year overall survival (OS) of 53% and 87% for non-CR30 and CR30 patients, respectively. Ten-year RS was 73% and 100%, showing no decrease in life expectancy for CR30 patients. Multivariate analysis indicated that the FL International Prognostic Index was the most important variable predicting OS in the CR30 group. The impact of CR30 status on RS was validated in the independent GELTAMO series. In conclusion, FL patients treated with immunochemotherapy who were in CR at 30 months showed similar survival to a sex- and age-matched Spanish general population.

Risk of, and survival following, histological transformation in follicular lymphoma in the rituximab era. A retrospective multicentre study by the Spanish GELTAMO group.

The diagnostic criteria for follicular lymphoma (FL) transformation vary among the largest series, which commonly exclude histologically-documented transformation (HT) mandatorily. The aims of this retrospective observational multicentre study by the Spanish Grupo Español de Linfoma y Transplante Autólogo de Médula Ósea, which recruited 1734 patients (800 males/934 females; median age 59 years), diagnosed with FL grades 1-3A, were, (i) the cumulative incidence of HT (CI-HT); (ii) risk factors associated with HT; and (iii) the role of treatment and response on survival following transformation (SFT). With a median follow-up of 6·2 years, 106 patients developed HT. Ten-year CI-HT was 8%. Considering these 106 patients who developed HT, median time to transformation was 2·5 years. High-risk FL International Prognostic Index [Hazard ratio (HR) 2·6, 95% confidence interval (CI): 1·5-4·5] and non-response to first-line therapy (HR 2·9, 95% CI: 1·3-6·8) were associated with HT. Seventy out of the 106 patients died (5-year SFT, 26%). Response to HT first-line therapy (HR 5·3, 95% CI: 2·4-12·0), autologous stem cell transplantation (HR 3·9, 95% CI: 1·5-10·1), and revised International Prognostic Index (HR 2·2, 95% CI: 1·1-4·2) were significantly associated with SFT. Response to treatment and HT were the variables most significantly associated with survival in the rituximab era. Better therapies are needed to improve response. Inclusion of HT in clinical trials with new agents is mandatory.

Long-term complication in follicular lymphoma: assessing the risk of secondary neoplasm in 242 patients treated or not with 90-yttrium-ibritumomab-tiuxetan.

BACKGROUND: Non-Hodgkin lymphoma patients have a 25% increased risk of secondary primary neoplasms (SPNs). Regarding the controversy about the increased risk of SPN in patients exposed to radioimmunotherapy (RIT), we have analyzed this issue in a cohort of follicular lymphoma (FL) patients treated with/without RIT. PATIENTS AND METHODS: A retrospective study including all consecutive FL patients diagnosed since 2001 was performed. Demographic, clinical data including the incidence of any kind of neoplasm (excluding basocellular skin carcinoma) were recorded. RESULTS: A total of 242 patients were registered, male/female: 103/139, mean age: 59.9 yr (15-86), stage IV (57.8%), and Follicular Lymphoma Prognostic Index (FLIPI) low-risk (62.15%) predominance. Ninety-six patients (39.7%) were treated with 90Y-IT. The median follow-up for patients treated or not with 90Y-IT was 61 (8-273) and 38 (1-171) months. With respect to SPN incidence, 38 (15.6%) patients have at least two cancers, in 17 (44.7%), FL was the SPN; for the rest (226), the global incidence of SPNs was 9.3% (21), but there were no differences related to the exposition or not to 90Y-IT (P = 0.26). In seven patients, more than two (2-6) different therapies were registered; four were exposed to fludarabine-based therapy, three to radiotherapy and two to autologous stem-cell transplantation, and in the RIT cohort, two patients developed myelodysplastic syndrome. CONCLUSION: This is one of the largest single institution reports assessing the risk of SPN in FL patients treated (96) or not (146) with 90Y-IT. It seems that 90Y-IT does not increase significantly the risk of SPN but avoiding its use after fludarabine and other intense cytotoxic schemes is recommended.

The process of building up regional health management in the state of São Paulo: subsidies for analysis

This article presents the main results of the survey on the regional management building process in the State of São Paulo, during the discussion of the COAP / Care Networks, in order to provide a basis for understanding this process of regional health pact, focusing on the metropolitan areas of Bauru, Santos, Grande ABC and the Ribeira Valley. In addition to the results presented on the health regions studied, the methodology used in the development of the construction of profiles of the regions is itself a proposal for a methodology of analyzing regional health profiles. The first section presents the general methodology for analyzing health regions. The second part covers the results and discussion of the research, organized into two items. The first refers to the analysis of the profiles of the five São Paulo health regions surveyed. The second item analyzes the main aspects of the process of regional health pact in São Paulo, highlighting strengths and limitations, based on interviews with municipal managers and supporters of the Council of Municipal Health Secretaries of São Paulo in these regions.

Este artigo apresenta os resultados gerais da pesquisa sobre o processo de construção da gestão regional no estado de São Paulo, durante a discussão do COAP/redes de atenção, com o intuito de fornecer subsídios para a compreensão deste processo de pactuação regional da saúde, com enfoque nas regiões de saúde de Bauru, Baixada Santista, Grande ABC e Vale do Ribeira, no estado de São Paulo. Além dos resultados apresentados sobre as regiões de saúde estudadas, a metodologia utilizada no desenvolvimento da construção dos perfis das regiões constitui em si uma proposta metodológica de análise de perfis regionais de saúde. A primeira parte do artigo apresenta a metodologia geral adotada para a análise das regiões de saúde; a segunda, abrange os resultados e a discussão da pesquisa, organizados em dois itens. O primeiro destes itens refere-se à análise dos perfis das cinco regiões de saúde pesquisadas no Estado. O segundo, analisa os principais aspectos do processo de pactuação regional da saúde em São Paulo, destacando potencialidades e limites, a partir de entrevistas realizadas com gestores municipais e apoiadores do Conselho de Secretários Municipais de Saúde de São Paulo dessas regiões.

Parasitic fauna of Pimelodus maculatus (Osteichthyes: Pimelodidae) from the Itajaí-Açu river in Blumenau, state of Santa Catarina, Brazil / Parasitofauna de Pimelodus maculatus (Osteichthyes: Pimelodidae) do rio Itajaí-Açu em Blumenau, Estado de Santa Catarina, Brasil - DOI: 10.4025/actascibiolsci.v29i1.159

Little is known on parasitic fauna of freshwater fish in the State of Santa Catarina. Specimens of mandi, Pimelodus maculatus, were collected in the Itajaí-Açu River, Blumenau, state of Santa Catarina, from March through December, 2005, for parasitological analysis. From a total of 82 examined fish, all of them were parasitized for at least one parasite species. During the sampling, the pH, dissolved oxygen, electric conductivity and water temperature, as well as the environment temperature and weather conditions two days before each sample were measured. The highest values of prevalence and mean intensity of infection were observed for Monogenoidea (96.3%; 100.23), followed by Henneguya sp. (63.4%), Procamallanus (Spirocamallanus) pimelodus (51.2%; 3.02), Trichodina sp. (30.5%), Parspina argentinensis (24.4%; 3.30), Diplostomum sp. (17%; 1.00), Dichelyne pimelodi (8.5%; 1.00) and Goezeella agostinhoi (6.1%; 1.00). There was positive correlation between the total length of the hosts and the mean intensity of infection by Monogenoidea.

Pouco se conhece sobre a parasitofauna de peixes de água doce no Estado de Santa Catarina. Espécimes de mandi, Pimelodus maculatus foram coletados no rio Itajaí-Açu, Blumenau, Estado de Santa Catarina, entre março e dezembro de 2005, para anáise parasitolóica. De 82 peixes analisados, todos apresentaram pelo menos uma espécie de parasito. Durante as amostragens foram medidos o pH, o oxigênio dissolvido, a condutividade elérica e a temperatura da água, bem como a temperatura ambiente e as condições do tempo nos dois dias que precederam a coleta. Os maiores valores de prevalêcia e intensidade média de infecção foram observados por Monogenoidea (96,3%; 100,23), seguido por Henneguya sp. (63,4%), Procamallanus (Spirocamallanus) pimelodus (51,2%; 3,02), Trichodina sp. (30,5%), Parspina argentinensis (24,4%; 3,30), Diplostomum sp. (17%; 1,00), Dichelyne pimelodi (8,5%; 1,00) e Goezeella agostinhoi (6,1%; 1,00).