Inflammatory markers in prepubertal children and their associations with abdominal fat.

OBJECTIVE: To evaluate the association between inflammatory markers and abdominal fat assessed by ultrasound in prepubertal children with and without excess weight. METHODS: A cross-sectional study involving 241 prepubertal children, 156 with obesity, 37 with overweight, and 48 with normal weight, aged five to ten years, who were followed at a research unit on Childhood Obesity from a teaching hospital belonging to a public health system. The concentration of interleukin-6, tumor necrosis factor-α and C-reactive protein were assessed and regression analyses, considering outcome variables such as abdominal wall and intra-abdominal fat thickness measured by ultrasound, were performed. RESULTS: The findings highlighted an association between abdominal fat and inflammatory markers, even in children at this young age group. Subcutaneous fat showed a stronger association with inflammatory biomarkers compared to intra-abdominal fat when performing logistic regression, with a positive association between tumor necrosis factor-α and abdominal wall thickness equal to or greater than the 75th percentile in adjusted logistic regression (OR: 18.12; CI 95 %: 1.57: 209.55). CONCLUSIONS: Abdominal wall fat, in contrast to what is often observed in adults, appears to have a greater impact on chronic inflammation related to excessive weight in very young children.

Efficacy and safety of ozone therapy for knee osteoarthritis: an umbrella review of systematic reviews.

The objective of this study is to evaluate the effectiveness and safety of ozone therapy (OT) in the treatment of knee osteoarthritis (KOA), which is the most common form of the disease. We analysed systematic reviews (SRs) of randomised controlled trials (RCTs) using the "A MeaSurement Tool to Assess systematic Reviews" (AMSTAR2) instrument to evaluate their quality. We developed a narrative synthesis report with eight SRs (15 RCTs/3,685 patients) to summarise the findings. The AMSTAR2 analysis indicated that all reviews had critically low confidence ratings. Statistically significant effects in pain reduction using OT compared to placebo groups were reported in three SRs. OT was shown to be comparable to other therapies in one SR and not superior in the other five. Six SRs highlighted the need for additional RCTs with improved methodological quality to confirm the efficacy of OT for KOA. SRs found fewer consistent effects for improving joint function. Regarding safety, seven SRs reported a low prevalence of minor adverse events linked with OT. Finally, this umbrella review highlights the beneficial effects and safety of OT in the treatment of KOA, particularly in pain control. The low methodological quality of RCTs and SRs limits the possibility of drawing conclusions on the effectiveness of the procedure in comparison to other therapies. Ensure adequate compliance with guidelines such as Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and AMSTAR2 has the ability to improve the quality of SRs in this area.

Postweaning Development Influences Endogenous VPAC1 Modulation of LTP Induced by Theta-Burst Stimulation: A Link to Maturation of the Hippocampal GABAergic System.

Long-term potentiation (LTP) induced by theta-burst stimulation (TBS) undergoes postweaning developmental changes partially linked to GABAergic circuit maturation. Endogenous vasoactive intestinal peptide (VIP) acting on its VPAC1 receptor strongly influences LTP induced by theta-burst stimulation (TBS), an effect dependent on GABAergic transmission. Although VPAC1 receptor levels are developmentally regulated during embryogenesis, their variation along postweaning development is unknown, as is the VPAC1 modulation of LTP or its relation to hippocampal GABAergic circuit maturation. As such, we investigated how VPAC1 modulation of LTP adjusts from weaning to adulthood along with GABAergic circuit maturation. As described, LTP induced by mild TBS (5 bursts, 4 pulses delivered at 100 Hz) was increasingly greater from weaning to adulthood. The influence of the VPAC1 receptor antagonist PG 97-269 (100 nM) on TBS-induced LTP was much larger in juvenile (3-week-old) than in young adult (6-7-week-old) or adult (12-week-old) rats. This effect was not associated with a developmental decrease in synaptic VPAC1 receptor levels. However, an increase in pre and post-synaptic GABAergic synaptic markers suggests an increase in the number of GABAergic synaptic contacts that is more prominent than the one observed in glutamatergic connections during this period. Conversely, endogenous VPAC2 receptor activation did not significantly influence TBS-induced LTP. VPAC2 receptor levels enhance pronouncedly during postweaning development, but not at synaptic sites. Given the involvement of VIP interneurons in several aspects of hippocampal-dependent learning, neurodevelopmental disorders, and epilepsy, this could provide important insights into the role of VIP modulation of hippocampal synaptic plasticity during normal and altered brain development potentially contributing to epileptogenesis.

Differential Type-I Interferon Response in Buffy Coat Transcriptome of Individuals Infected with SARS-CoV-2 Gamma and Delta Variants.

The innate immune system is the first line of defense against pathogens such as the acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The type I-interferon (IFN) response activation during the initial steps of infection is essential to prevent viral replication and tissue damage. SARS-CoV and SARS-CoV-2 can inhibit this activation, and individuals with a dysregulated IFN-I response are more likely to develop severe disease. Several mutations in different variants of SARS-CoV-2 have shown the potential to interfere with the immune system. Here, we evaluated the buffy coat transcriptome of individuals infected with Gamma or Delta variants of SARS-CoV-2. The Delta transcriptome presents more genes enriched in the innate immune response and Gamma in the adaptive immune response. Interactome and enriched promoter analysis showed that Delta could activate the INF-I response more effectively than Gamma. Two mutations in the N protein and one in the nsp6 protein found exclusively in Gamma have already been described as inhibitors of the interferon response pathway. This indicates that the Gamma variant evolved to evade the IFN-I response. Accordingly, in this work, we showed one of the mechanisms that variants of SARS-CoV-2 can use to avoid or interfere with the host Immune system.

Perfil sociodemográfico e citológico de mulheres em investigação de neoplasia cérvico-uterina em um serviço secundário / Sociodemographic and cytological profile of women undergoing investigation for cervical-uterine neoplasia in a secondary service

Objetivo: analisar o perfil sociodemográfico e comparar as diferenças das características de mulheres com alterações citológicas de alto grau em um serviço da atenção secundária. Método: estudo transversal retrospectivo de 2017 a 2021 realizado em 160 prontuários (CAAE 51800621.3.0000.5240). Resultados: predominaram mulheres com média de idade 40,7 anos, escolaridade abaixo do ensino médio, tiveram um a três filhos, não utilizavam preservativos e anticoncepcionais, não tabagistas e com alterações citopatológicas alto grau. As características com maiores percentuais para lesões citopatológicas de alto grau foram mulheres com quatro ou mais gestações, idade do parto menor ou igual a 18 anos, coitarca menor ou igual a 15 anos e tabagistas. Conclusão: serviços da rede de atenção, especialmente da atenção primária à saúde, devem capacitar permanentemente os profissionais visando cumprimento de fluxos assistenciais preconizadas pelas recomendações das diretrizes brasileiras de rastreamento da neoplasia cérvico-uterina atentando ao perfil encontrado de mulheres encaminhadas a atenção secundária.(AU)

Objective: analyzes the sociodemographic profile and compare the differences in the characteristics of women with high-grade cytological alterations in a secondary care service. Method: retrospective cross-sectional study from 2017 to 2021 carried out in 160 medical records (CAAE 51800621.3.0000.5240). Results: women predominated with a mean age of 40.7 years, education below high school, had one to three children, did not use condoms and contraceptives, non-smokers and with high-grade cytopathological alterations. The characteristics with the highest percentages for high-grade cytopathological lesions were women with four or more pregnancies, age at birth less than or equal to 18 years, coitarche less than or equal to 15 years, and smokers. Conclusion: services of the care network, especially primary health care, should permanently train professionals in order to comply with the care flows recommended by the recommendations of the Brazilian guidelines for screening cervical uterine neoplasia, paying attention to the profile found of women referred to secondary care.(AU)

Objetivo: analizar el perfil sociodemográfico y comparar las diferencias en las características de mujeres con alteraciones citológicas de alto grado en un servicio de segundo nivel de atención. Método: estudio transversal retrospectivo de 2017 a 2021 realizado en 160 historias clínicas (CAAE 51800621.3.0000.5240). Resultados: predominaron las mujeres con edad media de 40,7 años, escolaridad inferior a la secundaria, con uno a tres hijos, no usuarias de preservativo y anticonceptivos, no fumadoras y con alteraciones citopatológicas de alto grado. Las características con mayor porcentaje de lesiones citopatológicas de alto grado fueron mujeres con cuatro o más embarazos, edad al nacer menor o igual a 18 años, coitarquia menor o igual a 15 años y fumadoras. Conclusión: servicios de la red de atención, especialmente la atención primaria a la salud, deben capacitar permanentemente a los profesionales para cumplir con los flujos de atención recomendados por las recomendaciones de las directrices brasileñas para el tamizaje de la neoplasia cérvico-uterina, prestando atención al perfil encontrado de las mujeres referidas atención secundaria.(AU)

Spatial and temporal patterns of infant mortality and its components in Rio de Janeiro / Padrões espaciais e temporais da mortalidade infantil e seus componentes no Rio de Janeiro

ABSTRACT Objectives. The study aims to assess the trend of neonatal, post-neonatal, and infant mortality from 1996 to 2020 within the metropolitan region of the state of Rio de Janeiro and other regions. Methods. Ecological study using the region as analysis unity. Data were accessed from the Mortality Information System and Live Birth Information System in the capital Rio de Janeiro, in the neighboring areas of Niterói, São Gonçalo, Baixada Fluminense, and the remaining regions of the state of Rio de Janeiro State. We applied Poisson multilevel modeling, where the models' response variables were infant mortality and its neonatal and post neonatal components. Fixed effects of the adjusted models were region and death year variables. Results. During the 1996-2020 period, the Baixada Fluminense showed the highest infant mortality rate as to its neonatal and post neonatal components. All adjusted models showed that the more recent the year the lower the mortality risk. Niterói showed the lowest adjusted risk of infant mortality and its neonatal and post neonatal components. Conclusion. Baixada Fluminense showed the highest mortality risk for infant mortality and its neonatal and post-neonatal components in the metropolitan region. The stabilization in mortality rates in recent years was identified by the research.

RESUMO Objetivos. Avaliar a tendência da mortalidade neonatal, pós-neonatal e infantil de 1996 a 2020, na região metropolitana do estado do Rio de Janeiro e nas outras regiões. Métodos. Estudo ecológico utilizando regiões como unidade de análise. Os dados foram acessados no Sistema de Informações sobre Mortalidade e Sistema de Informações sobre Nascidos Vivos da Capital (Rio de Janeiro), dos territórios vizinhos (Niterói, São Gonçalo e Baixada Fluminense) e das outras regiões do Estado do Rio de Janeiro. Utilizamos a modelagem multinível de Poisson, onde as variáveis de resposta dos modelos foram mortalidade infantil e seus componentes neonatal e pós-neonatal. Os efeitos fixos dos modelos ajustados foram região e ano da morte. Resultados. No período 1996-2020, a Baixada Fluminense apresentou a maior taxa de mortalidade infantil de seus componentes neonatal e pós-natal na região metropolitana. Todos os modelos ajustados mostraram que quanto mais recente o ano, menor o risco de mortalidade. O risco ajustado da mortalidade infantil e seus componentes neonatal e pós-neonatal foi menor em Niterói. Conclusão. A Baixada Fluminense apresentou o maior risco de mortalidade infantil e de seus componentes neonatal e pós-neonatal na região metropolitana. Detectamos estabilização das taxas de mortalidade nos últimos anos.

Accuracy of two methods to detect the presence of halitosis: the volatile sulfur compounds concentration in the mouth air and the information from a close person.

This study aimed to analyze the accuracy of two methods for detecting halitosis, the organoleptic assessment by a trained professional (OA) with volatile sulfur compounds (VSC) measurement via Halimeter® (Interscan Corporation) and information obtained from a close person (ICP). Participants were patients and companions who visited a university hospital over one year period to perform digestive endoscopy. A total of 138 participants were included in the VSC test, whose 115 were also included in the ICP test. ROC curves were constructed to establish the best VSC cut-off points. The prevalence of halitosis was 12% (95%CI: 7% to 18%) and 9% (95%CI 3% to 14%) for the OA and ICP, respectively. At the cut-off point >80 parts per billion (ppb) VSC, the prevalence of halitosis was 18% (95%CI: 12% to 25%). At the cut-off point >65 ppb VSC, sensitivity and specificity were 94% and 76%, respectively. At the cut-off point >140 ppb, sensitivity was 47% and specificity 96%. For the ICP, sensitivity was 14% and specificity 92%. VSC presents high sensitivity at the cut-off point of >65 ppb and high specificity at the cut-off point of >140 ppb. ICP had high specificity, but low sensitivity. The OA can express either occasional or chronic bad breath, whereas the ICP can be a potential instrument to detect chronic halitosis.

Epileptiform activity influences theta-burst induced LTP in the adult hippocampus: a role for synaptic lipid raft disruption in early metaplasticity?

Non-epileptic seizures are identified as a common epileptogenic trigger. Early metaplasticity following seizures may contribute to epileptogenesis by abnormally altering synaptic strength and homeostatic plasticity. We now studied how in vitro epileptiform activity (EA) triggers early changes in CA1 long-term potentiation (LTP) induced by theta-burst stimulation (TBS) in rat hippocampal slices and the involvement of lipid rafts in these early metaplasticity events. Two forms of EA were induced: (1) interictal-like EA evoked by Mg2+ withdrawal and K+ elevation to 6 mM in the superfusion medium or (2) ictal-like EA induced by bicuculline (10 µM). Both EA patterns induced and LTP-like effect on CA1 synaptic transmission prior to LTP induction. LTP induced 30 min post EA was impaired, an effect more pronounced after ictal-like EA. LTP recovered to control levels 60 min post interictal-like EA but was still impaired 60 min after ictal-like EA. The synaptic molecular events underlying this altered LTP were investigated 30 min post EA in synaptosomes isolated from these slices. EA enhanced AMPA GluA1 Ser831 phosphorylation but decreased Ser845 phosphorylation and the GluA1/GluA2 ratio. Flotillin-1 and caveolin-1 were markedly decreased concomitantly with a marked increase in gephyrin levels and a less prominent increase in PSD-95. Altogether, EA differentially influences hippocampal CA1 LTP thorough regulation of GluA1/GluA2 levels and AMPA GluA1 phosphorylation suggesting that altered LTP post-seizures is a relevant target for antiepileptogenic therapies. In addition, this metaplasticity is also associated with marked alterations in classic and synaptic lipid raft markers, suggesting these may also constitute promising targets in epileptogenesis prevention.

Repeated adolescent pregnancy in Brazil from 2015 to 2019.

OBJECTIVE: The aim of this study was to assess the rate of repeated pregnancy in adolescence and its association with early marriage and education level. METHODS: This is a cross-sectional study conducted by searching the Live Births Data System. The study included all adolescents in the age group 10-19 years with live births from 2015 to 2019 (n=2,405,248), divided into three groups: G1: primiparas; G2: with 1 previous pregnancy; and G3: with two or more previous pregnancies. RESULTS: Total repeated pregnancies remained stable, along the years. In the age group 10-14 years, the decrease in the period was from 5.0 to 4.7%, whereas in the age group 15-19 years, it was from 27.8 to 27.3%. Being married or in a stable union increases by 96% the chance of repeated pregnancy in the age group 10-14 years (p<0.001; OR=1.96; 95% confidence interval [CI] 1.85-2.09). In the age group 15-19 years, the chance of repeated pregnancy among the married or in stable union increased 40% (p<0.001; OR=1.40; 95%CI 1.39-1.41)). Girls aged 10-14 years with an education level of<8 years had a 64% higher chance of repeated pregnancy (p<0.001; OR=1.64; 95%CI 1.53-1.75), and among those aged 15-19 years, there was a 137% higher chance of repeated pregnancy (p<0.001; OR=2.37; 95%CI 2.35-2.38). CONCLUSION: Repeated pregnancy in adolescence in Brazil remains very high over the years. There is an association between low education level and early marriage with repeated pregnancies in adolescence.

Is bad breath associated with dyspepsia? An association and an equivalence study.

Halitosis affects all populations worldwide. The presence of chronic halitosis may be related to a health problem. Patients with bad breath usually seek a gastroenterologist and, in some cases, invasive and expensive exams, such as digestive endoscopy, are performed to investigate the etiology of halitosis. This study aimed to investigate whether the prevalence of bad breath in patients diagnosed with dyspepsia (any pain or discomfort in the upper abdomen) is higher than or equivalent to that in non-dyspeptic patients. This is a cross-sectional study that included 312 patients from university hospitals in the city of Rio de Janeiro (141 dyspeptic patients and 171 non-dyspeptic ones). The presence of halitosis was defined based on different cutoff points. Association analyses were performed using a log-binomial model and 95% confidence intervals were calculated for the coefficients, adjusting for sex and age. The equivalence test (Westlake) was used to test the hypothesis of equivalence between the proportions of patients with bad breath in the two groups (dyspeptic vs. non-dyspeptic), considering an equivalence band of ± 15%. The prevalence of bad breath ranged from 30% to 64% according to the definition of bad breath. Dyspepsia was not associated with bad breath in any of the three definitions of bad breath (two specific ones and a sensitive one). The proportion of patients with marked bad breath was equivalent in patients with and without dyspepsia.

Girls victims of sexual aggression in Baixada Fluminense

SUMMARY OBJECTIVE: This study aimed to describe the current situation of sexual aggression and assess the adhesion to ambulatory care follow-up. METHODS: This is a cross-sectional study involving female children and adolescents aged 0-19 years, treated at the Center for Multiprofessional Care of Sexual Violence of the General Hospital of Nova Iguaçu, from 2014 to 2018. RESULTS: Of the 453 children and adolescents, 264 (58.3%) were <14 years of age and 189 (41.7%) were 14-19 years of age. In both groups, 78% were black. School delay of >2 years was found in 15.6% of children in the age group <14 years and 40.5% of adolescents in the age group 14-19 years [p<0.001; OR=3.7 (2.1-65)]. In girls aged £13 years, abuse usually occurred at home (73.2%), which was perpetrated by one aggressor (91%) and known to the victim (91.2%). In adolescents aged ≥14 years, 84.1% of rapes occurred outside the home, practiced by one aggressor (74.8%), 57.8% were unknown, and in 91.2% of cases, there was use of physical force and/or verbal threats. The victims aged <14 years have 14 times more chance of experiencing aggression within the family setting [p<0.001; OR=14.3 (8.2-25.6)] and 16 times more chance of experiencing aggression from known persons [p<0.001; OR=16.2 (9.2-29.8)]. On the contrary, adolescents aged ≥14 years have three times more chance of being abused by more than one aggressor [p<0.001; OR=3.3 (1.8-6.1)]. CONCLUSION: Black girls, especially those aged <14 years, are in a situation of greater vulnerability for sexual violence, have less adhesion to follow-up, and often experience aggression in the household setting.

Girls victims of sexual aggression in Baixada Fluminense.

OBJECTIVE: This study aimed to describe the current situation of sexual aggression and assess the adhesion to ambulatory care follow-up. METHODS: This is a cross-sectional study involving female children and adolescents aged 0-19 years, treated at the Center for Multiprofessional Care of Sexual Violence of the General Hospital of Nova Iguaçu, from 2014 to 2018. RESULTS: Of the 453 children and adolescents, 264 (58.3%) were <14 years of age and 189 (41.7%) were 14-19 years of age. In both groups, 78% were black. School delay of >2 years was found in 15.6% of children in the age group <14 years and 40.5% of adolescents in the age group 14-19 years [p<0.001; OR=3.7 (2.1-65)]. In girls aged £13 years, abuse usually occurred at home (73.2%), which was perpetrated by one aggressor (91%) and known to the victim (91.2%). In adolescents aged ≥14 years, 84.1% of rapes occurred outside the home, practiced by one aggressor (74.8%), 57.8% were unknown, and in 91.2% of cases, there was use of physical force and/or verbal threats. The victims aged <14 years have 14 times more chance of experiencing aggression within the family setting [p<0.001; OR=14.3 (8.2-25.6)] and 16 times more chance of experiencing aggression from known persons [p<0.001; OR=16.2 (9.2-29.8)]. On the contrary, adolescents aged ≥14 years have three times more chance of being abused by more than one aggressor [p<0.001; OR=3.3 (1.8-6.1)]. CONCLUSION: Black girls, especially those aged <14 years, are in a situation of greater vulnerability for sexual violence, have less adhesion to follow-up, and often experience aggression in the household setting.

Characterization of COVID-19 cases in a poor community in Rio de Janeiro/Brazil focusing on the agglomeration-poverty dichotomy / Caracterização dos casos de COVID-19 em uma comunidade carente no Rio de Janeiro/Brasil com foco na dicotomia aglomeração-pobreza

Abstract This study aims to characterize the morbidity of COVID-19 in the year 2020 by identifying the most vulnerable areas and areas of clustering of cases in a favela from Rio de Janeiro/Brazil known as Manguinhos. This is a cross-sectional descriptive study performed from March 16, 2020, to August 12, 2020. We described the sociodemographic profile of the cases and performed spatial analysis using point and Kernel maps. Incidence rates were calculated by sex, age, and sub-regions. The incidence rate was 202/10,000. We detected clusters of cases west, central-north, and central-south of Manguinhos. High incidence rates were observed also in sub-regions of central-north, central-south, and southwest. In the sub-regions with high incidence, the percentage of people depending on financial governmental aid ranged between 13% and 21%. The sub-regions with the highest agglomeration of cases in the territory of Manguinhos coincide with the regions with the highest incidence rates, but not with the poorest regions of the territory.

Resumo O objetivo deste estudo é caracterizar a morbidade da COVID-19 no ano de 2020, identificando as áreas mais vulneráveis e áreas de aglomeração de casos em uma favela do Rio de Janeiro/Brasil conhecida como Manguinhos. Trata-se de um estudo descritivo transversal realizado de 16 de março a 12 de agosto de 2020. Descrevemos o perfil sociodemográfico dos casos e fizemos análise espacial por meio de mapas de pontos e Kernel. As taxas de incidência foram calculadas por sexo, idade e sub-regiões. A taxa de incidência foi de 202/10.000 habitantes. Detectamos aglomerados de casos a oeste, centro-norte e centro-sul de Manguinhos. Altas taxas de incidência foram observadas também nas sub-regiões centro-norte, centro-sul e sudoeste. Nas sub-regiões com alta incidência, o percentual de pessoas dependentes de ajuda financeira governamental variou entre 13% e 21%. As sub-regiões com maior aglomeração de casos no território de Manguinhos coincidem com as regiões com as maiores taxas de incidência, mas não com as regiões mais pobres do território.

Is bad breath associated with dyspepsia? An association and an equivalence study

Abstract Halitosis affects all populations worldwide. The presence of chronic halitosis may be related to a health problem. Patients with bad breath usually seek a gastroenterologist and, in some cases, invasive and expensive exams, such as digestive endoscopy, are performed to investigate the etiology of halitosis. This study aimed to investigate whether the prevalence of bad breath in patients diagnosed with dyspepsia (any pain or discomfort in the upper abdomen) is higher than or equivalent to that in non-dyspeptic patients. This is a cross-sectional study that included 312 patients from university hospitals in the city of Rio de Janeiro (141 dyspeptic patients and 171 non-dyspeptic ones). The presence of halitosis was defined based on different cutoff points. Association analyses were performed using a log-binomial model and 95% confidence intervals were calculated for the coefficients, adjusting for sex and age. The equivalence test (Westlake) was used to test the hypothesis of equivalence between the proportions of patients with bad breath in the two groups (dyspeptic vs. non-dyspeptic), considering an equivalence band of ± 15%. The prevalence of bad breath ranged from 30% to 64% according to the definition of bad breath. Dyspepsia was not associated with bad breath in any of the three definitions of bad breath (two specific ones and a sensitive one). The proportion of patients with marked bad breath was equivalent in patients with and without dyspepsia.

Accuracy of two methods to detect the presence of halitosis: the volatile sulfur compounds concentration in the mouth air and the information from a close person

Abstract This study aimed to analyze the accuracy of two methods for detecting halitosis, the organoleptic assessment by a trained professional (OA) with volatile sulfur compounds (VSC) measurement via Halimeter® (Interscan Corporation) and information obtained from a close person (ICP). Methodolody Participants were patients and companions who visited a university hospital over one year period to perform digestive endoscopy. A total of 138 participants were included in the VSC test, whose 115 were also included in the ICP test. ROC curves were constructed to establish the best VSC cut-off points. Results The prevalence of halitosis was 12% (95%CI: 7% to 18%) and 9% (95%CI 3% to 14%) for the OA and ICP, respectively. At the cut-off point >80 parts per billion (ppb) VSC, the prevalence of halitosis was 18% (95%CI: 12% to 25%). At the cut-off point >65 ppb VSC, sensitivity and specificity were 94% and 76%, respectively. At the cut-off point >140 ppb, sensitivity was 47% and specificity 96%. For the ICP, sensitivity was 14% and specificity 92%. Conclusions VSC presents high sensitivity at the cut-off point of >65 ppb and high specificity at the cut-off point of >140 ppb. ICP had high specificity, but low sensitivity. The OA can express either occasional or chronic bad breath, whereas the ICP can be a potential instrument to detect chronic halitosis.

Repeated adolescent pregnancy in Brazil from 2015 to 2019

SUMMARY OBJECTIVE: The aim of this study was to assess the rate of repeated pregnancy in adolescence and its association with early marriage and education level. METHODS: This is a cross-sectional study conducted by searching the Live Births Data System. The study included all adolescents in the age group 10-19 years with live births from 2015 to 2019 (n=2,405,248), divided into three groups: G1: primiparas; G2: with 1 previous pregnancy; and G3: with two or more previous pregnancies. RESULTS: Total repeated pregnancies remained stable, along the years. In the age group 10-14 years, the decrease in the period was from 5.0 to 4.7%, whereas in the age group 15-19 years, it was from 27.8 to 27.3%. Being married or in a stable union increases by 96% the chance of repeated pregnancy in the age group 10-14 years (p<0.001; OR=1.96; 95% confidence interval [CI] 1.85-2.09). In the age group 15-19 years, the chance of repeated pregnancy among the married or in stable union increased 40% (p<0.001; OR=1.40; 95%CI 1.39-1.41)). Girls aged 10-14 years with an education level of<8 years had a 64% higher chance of repeated pregnancy (p<0.001; OR=1.64; 95%CI 1.53-1.75), and among those aged 15-19 years, there was a 137% higher chance of repeated pregnancy (p<0.001; OR=2.37; 95%CI 2.35-2.38). CONCLUSION: Repeated pregnancy in adolescence in Brazil remains very high over the years. There is an association between low education level and early marriage with repeated pregnancies in adolescence.

Applying fuzzy qualitative comparative analysis to identify typical symptoms of COVID-19 infection in a primary care unit, Rio de Janeiro, Brazil.

This study aims to identify a set of symptoms that could be predictive of SARS-CoV-2 cases in the triage of Primary Care services with the contribution of Qualitative Comparative Analysis (QCA) using Fuzzy Sets (fsQCA). A cross-sectional study was carried out in a Primary Health Care Unit/FIOCRUZ from 09/17/2020 to 05/05/2021. The study population was suspect cases that performed diagnostic tests for COVID-19. We collected information about the symptoms to identify which configurations are associated with positive and negative cases. For analysis, we used fsQCA to explain the outcomes "being a positive case" and "not being a positive case". The solution term "loss of taste or smell and no headache" showed the highest degree of association with the positive result (consistency = 0.81). The solution term "absence of loss of taste or smell combined with the absence of fever" showed the highest degree of association (consistency = 0,79) and is the one that proportionally best explains the negative result. Our results may be useful to the presumptive clinical diagnosis of COVID-19 in scenarios where access to diagnostic tests is not available. We used an innovative method used in complex problems in Public Health, the fsQCA.

Prevalence and predictors of anti-SARS-CoV-2 serology in a highly vulnerable population of Rio de Janeiro: A population-based serosurvey.

Background: COVID-19 serosurveys allow for the monitoring of the level of SARS-CoV-2 transmission and support data-driven decisions. We estimated the seroprevalence of anti-SARS-CoV-2 antibodies in a large favela complex in Rio de Janeiro, Brazil. Methods: A population-based panel study was conducted in Complexo de Manguinhos (16 favelas) with a probabilistic sampling of participants aged ≥1 year who were randomly selected from a census of individuals registered in primary health care clinics that serve the area. Participants answered a structured interview and provided blood samples for serology. Multilevel regression models (with random intercepts to account for participants' favela of residence) were used to assess factors associated with having anti-S IgG antibodies. Secondary analyses estimated seroprevalence using an additional anti-N IgG assay. Findings: 4,033 participants were included (from Sep/2020 to Feb/2021, 22 epidemic weeks), the median age was 39·8 years (IQR:21·8-57·7), 61% were female, 41% were mixed-race (Pardo) and 23% Black. Overall prevalence was 49·0% (95%CI:46·8%-51·2%) which varied across favelas (from 68·3% to 31·4%). Lower prevalence estimates were found when using the anti-N IgG assay. Odds of having anti-S IgG antibodies were highest for young adults, and those reporting larger household size, poor adherence to social distancing and use of public transportation. Interpretation: We found a significantly higher prevalence of anti-S IgG antibodies than initially anticipated. Disparities in estimates obtained using different serological assays highlight the need for cautious interpretation of serosurveys estimates given the heterogeneity of exposure in communities, loss of immunological biomarkers, serological antigen target, and variant-specific test affinity. Funding: Fundação Oswaldo Cruz, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ), the European Union's Horizon 2020 research and innovation programme, Royal Society, Serrapilheira Institute, and FAPESP.