Natural Phenolic Compounds with Antithrombotic and Antiplatelet Effects: A Drug-likeness Approach.

BACKGROUND: Thrombosis is one of the major causes of morbidity and mortality in a wide range of vessel diseases. Several studies have been conducted to identify antithrombotic agents from medicinal plants, and phenolic compounds (PCs) have been shown to effectively inhibit plasma coagulation and platelet aggregation. OBJECTIVES: This study aimed to conduct a survey of the natural PCs with proven antithrombotic and antiplatelet activities, as well as to evaluate by computational modeling the physicochemical and toxicological properties of these compounds using drug-likeness approaches. METHODS: The data were collected from the scientific database: 'Web of Science', 'Scifinder', 'Pubmed', 'ScienceDirect' and 'Google Scholar', the different classes of PCs with antithrombotic or antiplatelet effects were used as keywords. These molecules were also evaluated for their Drug-Likeness properties and toxicity to verify their profile for being candidates for new antithrombotic drugs. RESULTS: In this review, it was possible to register 85 lignans, 73 flavonoids, 28 coumarins, 21 quinones, 23 phenolic acids, 8 xanthones and 8 simple phenols. Activity records for tannins were not found in the researched databases. Of these 246 compounds, 213 did not violate any of Lipinski's rules of five, of which 125 (59%) showed non-toxicity, being promising candidates for new potential antithrombotic drugs. CONCLUSION: This review arouses interest in the isolation of phenolic compounds that may allow a new approach for the prevention of both arterial and venous thrombosis, with the potential to become alternatives in the prevention and treatment of cardiovascular diseases.

Cardiovascular Statistics ­ Brazil 2023 / Estatística Cardiovascular ­ Brasil 2023

The publication Cardiovascular Statistics ­ Brazil aims to provide an annual compilation of data and research on the epidemiology of CVDs in Brazil.  The report integrates official statistics from the Brazilian Ministry of Health and other governmental entities alongside data from the GBD project, coordinated by the IHME at the University of Washington. Additionally, it incorporates data derived from various sources and scientific studies, including cohorts and registries, that relate to CVDs and their associated risk factors. This publication is intended for a wide range of individuals, including researchers, clinicians, patients, healthcare policymakers, media professionals, the general public, and other interested parties seeking extensive national data about heart disease and stroke.  Volunteer researchers from various Brazilian universities and research institutions carry out the project. The group is led by a five-member steering committee (ALPR, CAP, DCM, GMMO, and LCCB). The Brazilian Society of Cardiology fully supports this initiative, and the project receives collaborative support from the GBD Brazil Network and an International Committee (GAR, PP, and TAG) from both the IHME/University of Washington (GAR) and the World Heart Federation (PP and TAG). 

A publicação Estatística Cardiovascular ­ Brasil tem por objetivo fornecer uma compilação anual dos dados e das pesquisas sobre a epidemiologia das DCV no Brasil.  Este documento integra as estatísticas oficiais do Ministério da Saúde do Brasil e outras entidades governamentais ao lado de dados do projeto GBD, coordenado pelo IHME da Universidade de Washington. Além disso, incorpora dados derivados de várias fontes e estudos científicos, inclusive coortes e registros, relacionados às DCV e fatores de risco associados. Esta publicação destina-se a um público variado, incluindo pesquisadores, clínicos, pacientes, formuladores de políticas de saúde, profissionais da mídia, o público em geral e todos aqueles que buscam dados nacionais abrangentes sobre DCV e acidente vascular cerebral. Pesquisadores voluntários de várias universidades e instituições de pesquisa brasileiros realizaram este projeto. O grupo é liderado por um comitê diretivo com cinco membros (ALPR, CAP, DCM, GMMO e LCCB). A Sociedade Brasileira de Cardiologia apoia integralmente esta iniciativa e o projeto recebe colaboração da Rede GBD Brasil1 e do GBD International Committee (GAR, PP e TAG) do IHME/Universidade de Washington (GAR) e da World Heart Federation (PP e TAG). 

Improving the quality of external cause of death data in Brazil: evaluation and validation of a new form to investigate garbage codes.

Garbage codes, such as external causes with no specific information, indicate poor quality cause of death data. Investigation of garbage codes via an effective instrument is necessary to convert them into useful data for public health. This study analyzed the performance and suitability of the new investigation of deaths from external causes (IDEC) form to improve the quality of external cause of death data in Brazil. The performance of the IDEC form on 133 external garbage codes deaths was compared with a stratified matched sample of 992 (16%) investigated deaths that used the standard garbage codes form. Consistency between these two groups was checked. The percentage of garbage codes from external causes reclassified into valid causes with a 95% confidence interval (95%CI) was analyzed. Reclassification for specific causes has been described. Qualitative data on the feasibility of the form were recorded by field investigators. Investigation using the new form reduced all external garbage codes by -92.5% (95%CI: -97.0; -88.0), whereas the existing form decreased garbage codes by -60.5% (95%CI: -63.5; -57.4). The IDEC form presented higher effectivity for external-cause garbage codes of determined intent. Deaths that remained garbage codes mainly lacked information about the circumstances of poisoning and/or vehicle accidents. Despite the fact that field investigators considered the IDEC form feasible, they suggested modifications for further improvement. The new form was more effective than the current standard form in improving the quality of defined external causes.

Gestão da informação e tradução do conhecimento no trabalho de enfermeiros(as) da atenção primária à saúde no estado da Paraíba - Nordeste do Brasil / Information management and knowledge translation in the work of primary health care nurses in the state of Paraíba - Northeast Brazil / Gestión de la información y traducción del conocimiento en el trabajo de enfermeras de atención primaria de salud en el estado de Paraíba - Nordeste de Brasil

Objetivo: Analisar a gestão da informação e tradução do conhecimento, considerando diferentes variáveis do acesso à informação, no processo de trabalho, dos(as) Enfermeiros(as) da Atenção Primária à Saúde (APS) em atuação no estado da Paraíba, Nordeste do Brasil. Material e Métodos: Estudo de métodos mistos; integração de dados quantitativos e dados qualitativo. Utilizou-se a estratégia "Transformativa Concomitante", em que os dados quantitativos e qualitativos, foram coletados concomitantemente. Pesquisa realizada no estado da Paraíba entre novembro de 2019 a agosto de 2021, nos serviços da Atenção Primária à Saúde do modelo tradicional de Unidades Básicas de Saúde e os do modelo da Estratégia Saúde da Família. Dos(as) 1.635 enfermeiras(as) em atuação nesses modelos de atenção na Paraíba, 462 participaram do estudo quantitativo. Na pesquisa qualitativa 45 profissionais foram selecionados: 09 no município intermediário adjacente; 21 nos municípios rurais adjacentes e 15 no município urbano, selecionado nesta tipologia, o município de João Pessoa. Foram incluídos enfermeiros(as) que desenvolviam práticas de assistência ou gestão na APS e na ESF. Excluídos, enfermeiros(as) na APS há menos de três anos; que não exercessem preceptoria nos serviços, consultoria; e sem vínculo formal de trabalho e aqueles ausentes do trabalho por férias ou licença de qualquer natureza. Os dados quantitativos foram processados através do software SPSS®, versão 21. No processamento dos qualitativos, utilizou-se o software NVivo®; e adotou-se a técnica de análise de conteúdo temática. Para os estudos de métodos mistos, fez-se a integração dos resultados quantitativos e qualitativos, favorecendo as análises das evidências da pesquisa. O projeto de pesquisa teve aprovação do Comitê de Ética em Pesquisa da Faculdade de Ciências da Saúde da Universidade de Brasília, sob Parecer nº 3.619.308 e do Certificado de Apresentação de Apreciação Ética - CAAE nº 20814619.2.0000.0030. Resultados: A maioria, dos(as) profissionais pesquisados(as), acessa informações relativas à Atenção Primária à Saúde/Estratégia Saúde da Família. O principal meio de acesso é digital. Os lugares de acesso, prevaleceram a casa e o trabalho. As fontes governamentais, são acessadas por 330 profissionais, seguidas das mídias sociais. As revistas científicas, foram referidas por 187 (40,5%) participantes da pesquisa. Os livros especializados são acessadas por menos da metade dos(as) pesquisados(as): apenas 155 (33,5%). Mais da metade dos(as) pesquisados(as), 235 (50,9%), registraram não terem participado de seminários e/ou encontros científicos de sua área de atuação, nos últimos dois anos. Apenas 28 profissionais, 6,1%; dos enfermeiros(as) estão associados(as) à Associação Brasileira de Enfermagem; e apenas 1 (0,2%) afirmou estar associado(a) à Associação Brasileira de Enfermagem de Família e Comunidade. Mais de 90% (418 profissionais) revelaram a necessidade de aprimorar seus conhecimentos em Atenção Primária à Saúde/Estratégia Saúde da Família. Conclusão: O estudo evidenciou que os profissionais em atuação na Atenção Primária à Saúde na Paraíba, avançam no que concerne à gestão da informação e tradução do conhecimento, uma vez que a maioria dos pesquisado(as) relataram acessar as informações. Embora predomine o acesso às fontes governamentais, as publicações cientificas e livros especializados, ainda são referenciais adotas pelos profissionais. Quase a totalidade dos pesquisados(as), demonstraram necessidade de aprimorar seus conhecimentos no que tange à sua área atuação ­ a Atenção Primária à Saúde/Estratégia Saúde da Família. Criticamente, há de se ressaltar, a baixa participação dos profissionais quando se busca investigar a sua associação a entidades representativas da Enfermagem. (AU)

Objective: To analyze information management and knowledge translation, considering different variables of access to information, in the work process, of Primary Health Care (PHC) Nurses working in the state of Paraíba, Northeast of Brazil. Brazil. Material and Methods: Mixed methods study; integration of quantitative data and qualitative data. The "Transformative Concomitant" strategy was used, in which quantitative and qualitative data were collected concomitantly. Research carried out in the state of Paraíba between November 2019 and August 2021, in the Primary Health Care services of the traditional model of Basic Health Units and those of the Family Health Strategy model. Of the 1,635 nurses working in these care models in Paraíba, 462 participated in the quantitative study. In the qualitative research, 45 professionals were selected: 09 in the adjacent intermediate municipality; 21 in the adjacent rural municipalities and 15 in the urban municipality, selected in this typology, the municipality of João Pessoa. Nurses who developed care or management practices in PHC and ESF were included. Excluded, nurses in PHC for less than three years; who did not exercise preceptorship in services, consultancy; and without formal employment relationship and those absent from work on vacation or leave of any kind. Quantitative data were processed using SPSS® software, version 21. In the processing of qualitative data, NVivo® software was used; and the thematic content analysis technique was adopted. For mixed methods studies, quantitative and qualitative results were integrated, favoring the analysis of research evidence. The research project was approved by the Research Ethics Committee of the Faculty of Health Sciences, University of Brasília, under Opinion nº 3.619.308 and the Certificate of Presentation of Ethical Appreciation - CAAE nº 20814619.2.0000.0030. Results: Most of the professionals surveyed access information related to Primary Health Care/Family Health Strategy. The main means of access is digital. The places of access, home and work prevailed. Government sources are accessed by 330 professionals, followed by social media. Scientific journals were mentioned by 187 (40.5%) research participants. Specialized books are accessed by less than half of those surveyed: only 155 (33.5%). More than half of those surveyed, 235 (50.9%), reported not having participated in seminars and/or scientific meetings in their area of expertise in the last two years. Only 28 professionals, 6.1%; of nurses are associated with the Brazilian Nursing Association; and only 1 (0.2%) claimed to be associated with the Brazilian Association of Family and Community Nursing. More than 90% (418 professionals) revealed the need to improve their knowledge in Primary Health Care/Family Health Strategy. Conclusion: The study showed that professionals working in Primary Health Care in Paraíba, advance in terms of information management and knowledge translation, since most respondents reported accessing information. Although access to government sources predominates, scientific publications and specialized books are still references adopted by professionals. Almost all of those surveyed demonstrated the need to improve their knowledge regarding their area of activity ­ Primary Health Care/Family Health Strategy. Critically, it should be noted the low participation of professionals when seeking to investigate their association with representative entities of Nursing. (AU)

Objetivo: Analizar la gestión de la información y la traducción del conocimiento, considerando diferentes variables de acceso a la información en el proceso de trabajo de Enfermeras de Atención Primaria a la Salud (APS) que actúan en la provincia de Paraíba, región Nordeste de Brasil. Material y métodos: Estudio de métodos mixtos; integración de datos cuantitativos y datos cualitativos. Se utilizó la Estrategia Transformativa Concomitante, en la que se recolectaron datos cuantitativos y cualitativos de manera concomitante. Investigación realizada en Paraíba, entre noviembre de 2019 y agosto de 2021, en los servicios de APS del modelo tradicional de Unidades Básicas de Salud (UBS) y de Estrategia de Salud de la Familia (ESF). De los 1.635 enfermeros que actúan en esos modelos de atención en Paraíba, 462 participaron del estudio cuantitativo. En la investigación cualitativa fueron seleccionados 45 profesionales: nueve en el municipio intermedio colindante; 21 en municipios rurales adyacentes; y 15 en el municipio urbano seleccionado en esta tipología, João Pessoa. Se incluyeron enfermeros que desarrollaron prácticas de cuidado o gestión en la APS y en la ESF. Excluidos: enfermeros en APS por menos de tres años; que no ejercieron preceptoría en servicios/consultoría; que no tenían relación laboral formal; y que estaban ausentes del trabajo por vacaciones o licencias de cualquier tipo. Los datos cuantitativos se procesaron a través del software SPSS®, versión 21. En el procesamiento cualitativo se utilizó el software NVivo® y se adoptó la técnica de análisis de contenido temático. Para los estudios de métodos mixtos, se realizó la integración de los resultados cuantitativos y cualitativos, favoreciendo el análisis de las evidencias de la investigación. El proyecto fue aprobado por el Comité de Ética en Investigación de la Facultad de Ciencias de la Salud de la Universidad de Brasilia, bajo el Dictamen nº 3.619.308 y el Certificado de Presentación de Apreciación Ética - CAAE nº 20814619.2.0000.0030. Resultados: la mayoría de los profesionales encuestados accede a información relacionada con la APS/ESF. El principal medio de acceso es digital. Los lugares de acceso que prevalecieron son el hogar y el trabajo. Las fuentes gubernamentales son consultadas por 330 profesionales, seguidas de las redes sociales. Las revistas científicas fueron mencionadas por 187 (40,5%) participantes de la investigación. A los libros especializados acceden menos de la mitad de los encuestados: sólo 155 (33,5%). Más de la mitad de los encuestados, 235 (50,9%), informaron no haber participado en seminarios y/o reuniones científicas en su área de especialización en los últimos dos años. Sólo 28 profesionales (el 6,1%) de los enfermeros están asociados a la Asociación Brasileña de Enfermería; y sólo 1 (0,2%) está asociado a la Asociación Brasileña de Enfermería Familiar y Comunitaria. Más del 90% (418 profesionales) revelaron la necesidad de mejorar sus conocimientos en Atención Primaria de Salud/Estrategia de Salud de la Familia. Conclusión: el estudio mostró que los profesionales que actúan en la Atención Primaria de Salud de Paraíba avanzan en términos de gestión de la información y traducción del conocimiento, una vez que la mayoría de los encuestados informaron tener acceso a la información. Si bien predomina el acceso a fuentes gubernamentales, las publicaciones científicas y los libros especializados siguen siendo referencias adoptadas por los profesionales. Casi todos los encuestados demostraron la necesidad de mejorar su conocimiento sobre su área de actuación ­ Atención Primaria de Salud/Estrategia de Salud de la Familia. Críticamente, se destaca la baja participación de los profesionales cuando se busca investigar su vinculación con entidades representativas de la Enfermería. (AU)

Patterns of abuse of elderly people in Brazil: analysis of notifications.

This study aimed to describe the characteristics of elderly people abuse notifications by gender and to assess notification patterns according to gender. We analyzed data from the Brazilian Information System for Notificable Diseases (SINAN) in 2017. We carried out a descriptive analysis of victim characteristics, violence, and the probable perpetrator according to gender. Pearson's χ2 test was used to assess the significance between groups. Then, we verified the main relationships between the studied characteristics and the victim's gender by simple correspondence analysis (SCA). Thus, 17,311 cases/suspicions of elderly people abuse were notified, corresponding to 7.2% of the total number of violence notifications. Of these victims, 50.4% were white, 42.3% were married, and 17.2% had a disability/disorder; 76.9% occurred at home, 62.8% included physical violence, and 49.5% were cases of repeated violence. Most perpetrators were men (62%), and violence by two or more perpetrators was observed in 62.8% of the cases. SCA evidenced inequalities in older adults' gender, which proved to be higher among women. Physical violence was the most common among younger and old individuals, whereas neglect/abandonment tended to occur more frequently among the oldest individuals, and was most often committed by daughters. In sum, this study demonstrated evidence of gender-based violence, especially among older adults. Disability proved to be an essential characteristic for neglect/abandonment in older adults. In this context, policies are needed to reduce gender inequalities and implement a care network for older adults who are victims of violence.

Improving the quality of external cause of death data in Brazil: evaluation and validation of a new form to investigate garbage codes / Melhorando a qualidade dos dados de causa externa de morte no Brasil: avaliação e validação de um novo formulário para investigar códigos garbage / Mejora en la calidad de los datos de causa externa de muerte en Brasil: evaluación y validación de un nuevo formulario para investigar códigos garbage

Garbage codes, such as external causes with no specific information, indicate poor quality cause of death data. Investigation of garbage codes via an effective instrument is necessary to convert them into useful data for public health. This study analyzed the performance and suitability of the new investigation of deaths from external causes (IDEC) form to improve the quality of external cause of death data in Brazil. The performance of the IDEC form on 133 external garbage codes deaths was compared with a stratified matched sample of 992 (16%) investigated deaths that used the standard garbage codes form. Consistency between these two groups was checked. The percentage of garbage codes from external causes reclassified into valid causes with a 95% confidence interval (95%CI) was analyzed. Reclassification for specific causes has been described. Qualitative data on the feasibility of the form were recorded by field investigators. Investigation using the new form reduced all external garbage codes by -92.5% (95%CI: -97.0; -88.0), whereas the existing form decreased garbage codes by -60.5% (95%CI: -63.5; -57.4). The IDEC form presented higher effectivity for external-cause garbage codes of determined intent. Deaths that remained garbage codes mainly lacked information about the circumstances of poisoning and/or vehicle accidents. Despite the fact that field investigators considered the IDEC form feasible, they suggested modifications for further improvement. The new form was more effective than the current standard form in improving the quality of defined external causes.

Códigos garbage (códigos inespecíficos ou incompletos), como causas externas sem informações específicas, indicam dados de má qualidade sobre a causa da morte. É necessário investigar os códigos garbage com um instrumento efetivo para convertê-los em dados úteis para a saúde pública. Este estudo analisou o desempenho e a adequação do novo formulário de investigação de óbitos por causas externas (IDEC) para melhorar a qualidade dos dados de causa externa de morte no Brasil. O desempenho deste formulário em 133 óbitos com códigos garbage de causas externas foi comparado com uma amostra estratificada e pareada de 992 (16%) óbitos investigados que utilizaram o formulário padrão de códigos garbage existente. A consistência entre esses dois grupos foi verificada. Analisou-se o percentual de códigos garbage de causas externas reclassificados em causas válidas com um intervalo de 95% de confiança (IC95%). A reclassificação para causas específicas foi descrita. Dados qualitativos sobre a viabilidade do formulário foram registrados por pesquisadores de campo. A investigação com o novo formulário reduziu todos os códigos garbage de causas externas em -92,5% (IC95%: -97,0; -88,0) enquanto o formulário existente diminuiu os códigos garbage em -60,5% (IC95%: -63,5; -57,4). O formulário IDEC foi mais eficaz para os códigos garbage de causa externa sem intenção indeterminada. As mortes que permaneceram como códigos garbage careciam principalmente de informações detalhadas sobre as circunstâncias do envenenamento e dos acidentes de trânsito. O formulário IDEC foi considerado viável pelos investigadores de campo, no entanto, eles sugeriram modificações para um maior aperfeiçoamento. O novo formulário foi mais eficaz do que o formulário padrão atual na melhoria da qualidade das causas externas definidas.

Códigos garbage (códigos inespecíficos o incompletos), como causas externas inespecíficas, son los indicadores de datos de mala calidad sobre la causa de muerte. Es necesario investigar los códigos garbage con un instrumento eficaz para convertirlos en datos útiles para la salud pública. Este estudio analizó el desempeño y la adecuación del nuevo formulario de investigación de muertes por causas externas (IDEC) para mejorar la calidad de los datos de causa externa de muerte en Brasil. El desempeño de este formulario en 133 muertes con códigos garbage de causas externas se comparó con una muestra estratificada y emparejada de 992 (16%) muertes investigadas que usaron el formulario estándar de códigos garbage existente. Se comprobó la consistencia entre estos dos grupos. Se analizó el porcentaje de códigos garbage por causas externas reclasificados en causas válidas con un intervalo del 95% de confianza (IC95%). Se procedió a una reclasificación por causas específicas. Los datos cualitativos sobre la viabilidad del formulario fueron registrados por investigadores de campo. La investigación con el nuevo formulario tuvo una reducción de todos los códigos garbage de causas externas en -92,5% (IC95%: -97,0; -88,0), mientras que el formulario existente redujo todos los códigos garbage de causas externas en -60,5% (IC95%: -63,5; -57,4). El formulario IDEC fue el más efectivo para códigos garbage de causa externa sin intención indeterminada. Las muertes que quedaron como códigos garbage carecían principalmente de información detallada sobre las circunstancias de envenenamiento y de accidentes de tránsito. Los investigadores de campo confirmaron la viabilidad del formulario IDEC, además de sugerir modificaciones para mejorarlo. El nuevo formulario fue el más efectivo que el formulario estándar actual en cuanto a la mejora de la calidad de las causas externas definidas.

Patterns of abuse of elderly people in Brazil: analysis of notifications / Padrões de abuso de idosos no Brasil: uma análise de notificações / Patrones de maltrato a las personas mayores en Brasil: análisis de las notificaciones

This study aimed to describe the characteristics of elderly people abuse notifications by gender and to assess notification patterns according to gender. We analyzed data from the Brazilian Information System for Notificable Diseases (SINAN) in 2017. We carried out a descriptive analysis of victim characteristics, violence, and the probable perpetrator according to gender. Pearson's χ2 test was used to assess the significance between groups. Then, we verified the main relationships between the studied characteristics and the victim's gender by simple correspondence analysis (SCA). Thus, 17,311 cases/suspicions of elderly people abuse were notified, corresponding to 7.2% of the total number of violence notifications. Of these victims, 50.4% were white, 42.3% were married, and 17.2% had a disability/disorder; 76.9% occurred at home, 62.8% included physical violence, and 49.5% were cases of repeated violence. Most perpetrators were men (62%), and violence by two or more perpetrators was observed in 62.8% of the cases. SCA evidenced inequalities in older adults' gender, which proved to be higher among women. Physical violence was the most common among younger and old individuals, whereas neglect/abandonment tended to occur more frequently among the oldest individuals, and was most often committed by daughters. In sum, this study demonstrated evidence of gender-based violence, especially among older adults. Disability proved to be an essential characteristic for neglect/abandonment in older adults. In this context, policies are needed to reduce gender inequalities and implement a care network for older adults who are victims of violence.

Este estudo teve como objetivo descrever as características das notificações de abuso de idosos por sexo e avaliar os padrões de notificação de acordo com o sexo. Foram analisados dados do Sistema de Informação de Agravos de Notificação de 2017. A análise descritiva das características da vítima, da violência e do provável agressor foi feita de acordo com o sexo. O teste do χ2 de Pearson foi utilizado para avaliar a significância entre os grupos. Em seguida, as principais relações entre as características estudadas e o sexo da vítima foram verificadas por meio da análise de correspondência simples (ACS). Assim, 17.311 casos ou suspeitas de abuso de idosos foram notificados, correspondendo a 7,2% do total de notificações de violência. Dessas vítimas, 50,4% são brancas, 42,3% casadas e 17,2% têm uma deficiência ou um transtorno. Dos casos, 76,9% ocorreram em casa, sendo 62,8% por violência física e 49,5% por violência recorrente. A maioria dos perpetradores é do sexo masculino (62%), e observamos violência por dois ou mais perpetradores em 62,8%. A ACS evidenciou desigualdades no sexo dos idosos, em que o número de mulheres era maior. A violência física mais comum entre adultos, mais jovens e mais velhos, é a negligência ou o abandono dos mais frágeis e mais idosos, mais frequentemente praticada pela filha. Em suma, o estudo evidenciou a violência de gênero, especialmente entre os idosos, e a debilidade como característica essencial para a negligência ou abandono dessa população. Nesse contexto, são necessárias políticas para reduzir as desigualdades, especialmente as de gênero, e implementar uma rede de cuidado aos idosos vítimas de violência.

El objetivo del presente estudio es describir las características de las notificaciones de malos tratos a personas mayores por sexo y evaluar los patrones de notificación en función del sexo. Se analizaron los datos del Sistema Brasileño de Información de Enfermedades de Notificación (SINAN) de 2017. Se realizó un análisis descriptivo de las características de la víctima, la violencia y el probable agresor según el sexo. Se utilizó la prueba χ2 de Pearson para evaluar la significación entre grupos. A continuación, se verificaron las principales relaciones entre las características estudiadas y el sexo de la víctima mediante análisis de correspondencias simples (ACS). Así, se notificaron 17.311 casos/sospechas de malos tratos a personas mayores, lo que corresponde al 7,2% del número total de notificaciones de violencia. De estas víctimas, el 50,4% son de raza blanca, el 42,3% están casadas y el 17,2% tienen una discapacidad/trastorno. El 76,9% ocurrieron en el hogar, el 62,8% se debieron a violencia física y el 49,5% fueron violencia reincidente. La mayoría de los agresores son hombres (62%), y la violencia ejercida por dos o más agresores se observó en el 62,8%. El ACS evidenció desigualdades en el sexo de los adultos mayores, observándose una mayor incidencia entre las mujeres. La violencia física más común entre los adultos más jóvenes y mayores, es la negligencia/abandono entre los adultos más frágiles y mayores, cometida con mayor frecuencia por la hija. En resumen, el estudio evidenció la violencia basada en el sexo, especialmente entre adultos mayores, y la fragilidad como característica esencial para la ocurrencia de negligencia/abandono en adultos mayores. En este contexto, son necesarias políticas que reduzcan las desigualdades, especialmente las de sexo, e implementen una red de atención a los adultos mayores víctimas de violencia.

FUCA2 and TSTA3 expression in gastric cancer: candidate biomarkers of malignant transformation.

INTRODUCTION: Aberrant fucosylation is closely related to malignant transformation, cancer detection, and evaluation of treatment efficacy. The fucosylation process requires GDP-L-fucose, fucosyltransferases, and fucosidases. In gastric cancer (GC), fucosylation alterations were associated with tumor formation, metastasis inhibition, and multi-drug resistance. It is not clear whether tissue-specific transplantation antigen P35B (TSTA3) and alpha-L-fucosidase 2 (FUCA2) have any effect on the development of GC. MATERIALS AND METHODS: We used immunohistochemistry to assess the expression of TSTA3 and FUCA2 in 71 gastric adenocarcinoma samples and their relationship with clinicopathological parameters. RESULTS: TSTA3 expression was associated with lower histological grade I and II (P = 0.0120) and intestinal type Lauren classification (P = 0.0120). TSTA3 immunopositivity could predict Lauren's classification. Analysis of mRNA expression in GC validation cohorts corroborates the significant TSTA3 association with histological grade observed in our study. However, no associations were found between TSTA3 staining and overall survival. FUCA2 expression was markedly increased in GC tissues compared with non-tumoral tissues (P < 0.0001) and was associated with surgical staging III and IV (P = 0.0417) and advanced histological grade tumor states (P = 0.0125). CONCLUSIONS: Alterations of FUCA2 and TSAT3 immunoexpression could lay the basis for future studies using cell glycosylation as a biomarker for the planning of therapeutic strategy in primary gastric cancer.

Avaliação da citotoxicidade in vitro e genotoxicidade ex-vivo em compostos da Pavonia glazioviana Gürke (Malvaceae / Evaluation of in vitro cytotoxicity and ex-vivo genotoxicity in compounds from Pavonia glazioviana Gürke(Malvaceae)

Introdução: as terapias alternativas que utilizam plantas medicinais e fitoterápicos são bastante comuns no Brasil. Dentre várias espécies vegetais brasileiras utilizadas em terapias destacam-se as espécies da família Malvaceae. Objetivos: o presente estudo teve como objetivo avaliar a citotoxicidade in vitro e a genotoxicidade ex-vivo em compostos da Pavonia glazioviana Gürke espécie brasileira pertencente à família Malvaceae. Metodologia: métodos in vitro foram utilizados para verificar o potencial citotóxico por meio de ensaios hemolíticos e anti-hemolíticos e da análise genotóxica ex-vivo. O Extrato Etanólico Bruto (EEB) e Fração Clorofórmico (FC) foram obtidos na amostra vegetal utilizada neste estudo. Resultados: os produtos EEB-Pg e FC-Pg apresentaram baixo efeito citotóxico apenas nas concentrações de 50 e 100 µg / mL. As amostras expostas às concentrações de 500 e 1000 µg / mL apresentaram índice hemolítico alto a moderado com lise superior a 60%. Foi descrito efeito anti-hemolítico moderado em todas as amostras tratadas com 500 e 1000 µg / mL, com hemólise < 60%. Além disso, os compostos mostraram baixo efeito genotóxico ex-vivo, com um índice geral de células normais superior a 84% em todas as concentrações. Conclusões: os resultados sugerem um baixo perfil tóxico dos compostos obtidos da espécie Pavonia glazioviana, indicando limites seguros para o uso desses produtos naturais.

Introduction: alternative therapies using medicinal plants and herbal medicines are quite common in Brazil. Among several Brazilian plant species used in therapies, the species of the Malvaceae family stand out. Objetctives: the present study aimed to evaluate the in vitro cytotoxicity and ex-vivo genotoxicity in compounds of the Brazilian Pavonia glazioviana Gürke belonging to the Malvaceae family. Methodology: in vitro methods were used to verify the cytotoxic potential through hemolytic and antihemolytic assays and the ex-vivo genotoxic analysis. The Crude Etanolic Extract (CEE) and Cloroformic Fraction (CF) was obtained in vegetal sample used on this study. Results: the CEE-Pg and CF-Pg products only showed a low cytotoxic effect at the concentrations of 50 and 100 µg/mL. The exposure to the concentrations of 500 and 1000 µg/mL showed a high to moderate hemolytic index with lysis higher than 60%. A moderate anti-hemolytic effect was described in all samples treated with 500 and 1000 µg/mL, with hemolysis <60%. In addition, the compounds showed low ex-vivo genotoxic effect with a general index of normal cells greater than 84% at all concentrations. Conclusion: the results suggest a low toxic profile of the compounds obtained from the Pavonia glazioviana Gürke species belonging to the Malvaceae family, indicating safe limits for the use of these natural products.

Validation of physician certified verbal autopsy using conventional autopsy: a large study of adult non-external causes of death in a metropolitan area in Brazil.

BACKGROUND: Reliable mortality data are essential for the development of public health policies. In Brazil, although there is a well-consolidated universal system for mortality data, the quality of information on causes of death (CoD) is not even among Brazilian regions, with a high proportion of ill-defined CoD. Verbal autopsy (VA) is an alternative to improve mortality data. This study aimed to evaluate the performance of an adapted and reduced version of VA in identifying the underlying causes of non-forensic deaths, in São Paulo, Brazil. This is the first time that a version of the questionnaire has been validated considering the autopsy as the gold standard. METHODS: The performance of a physician-certified verbal autopsy (PCVA) was evaluated considering conventional autopsy (macroscopy plus microscopy) as gold standard, based on a sample of 2060 decedents that were sent to the Post-Mortem Verification Service (SVOC-USP). All CoD, from the underlying to the immediate, were listed by both parties, and ICD-10 attributed by a senior coder. For each cause, sensitivity and chance corrected concordance (CCC) were computed considering first the underlying causes attributed by the pathologist and PCVA, and then any CoD listed in the death certificate given by PCVA. Cause specific mortality fraction accuracy (CSMF-accuracy) and chance corrected CSMF-accuracy were computed to evaluate the PCVA performance at the populational level. RESULTS: There was substantial variability of the sensitivities and CCC across the causes. Well-known chronic diseases with accurate diagnoses that had been informed by physicians to family members, such as various cancers, had sensitivities above 40% or 50%. However, PCVA was not effective in attributing Pneumonia, Cardiomyopathy and Leukemia/Lymphoma as underlying CoD. At populational level, the PCVA estimated cause specific mortality fractions (CSMF) may be considered close to the fractions pointed by the gold standard. The CSMF-accuracy was 0.81 and the chance corrected CSMF-accuracy was 0.49. CONCLUSIONS: The PCVA was efficient in attributing some causes individually and proved effective in estimating the CSMF, which indicates that the method is useful to establish public health priorities.

Prevalência de violência sexual em escolares no Brasil: dados da pesquisa nacional de saúde do escolar 2019 / Prevalencia de la violencia sexual en estudiantes en Brasil: datos de la encuesta nacional de salud escolar 2019 / Prevalence of sexual violence among schoolchildren in Brazil: data from the 2019 national school health

RESUMO Objetivo: analisar a prevalência de violência sexual entre escolares adolescentes de 13 a 17 anos no Brasil. Métodos: estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar de 2019. Foram analisadas as prevalências de abuso sexual e estupro e seus respectivos intervalos de confiança de 95% (IC95%) envolvendo escolares de 13 a 17 anos no Brasil, de acordo com sexo, faixa etária, tipo de instituição, agressor, região admisnistrativa de residência e unidades federadas. Resultados: a prevalência de abuso sexual entre escolares foi de 14,6% (IC95%:14,2;15,1) e de estupro foi de 6,3% (IC95%:6,0;6,6). Maiores prevalências ocorreram entre adolescentes do sexo feminino e da faixa etária de 16 e 17 anos. O agressor mais comum para ambos indicadores foi namorado(a), ex-namorado(a), ficante ou crush. Entre os escolares que sofreram estupro, mais da metade relatou ter sofrido essa violência antes dos 13 anos de idade (53,2%; IC95%: 51,0;55,4). Conclusão: a violência sexual tem elevada prevalência entre os escolares de 13 a 17 anos no Brasil, além de as agressões serem perpetradas, em sua maior parte, por pessoas do núcleo familiar e das relações íntimas e de afeto. É necessário que haja articulação intersetorial para desenvolver políticas públicas que atuem no enfrentamento ao problema.

RESUMEN Objetivo: analizar la prevalencia de la violencia sexual entre los estudiantes adolescentes de 13 a 17 años en Brasil. Métodos: estudio transversal con datos de la Encuesta Nacional de Salud Escolar 2019. Se analizó la prevalencia de abuso sexual y violación y sus respectivos intervalos de confianza del 95% (IC95%) que involucran a estudiantes de 13 a 17 años en Brasil, según sexo, grupo de edad, tipo de institución, agresor, región administrativa de residencia y unidades federadas. Resultados: la prevalencia de los abusos sexuales entre los estudiantes fue del 14,6% (IC95%:14,2;15,1) y de la violación fue del 6,3% (IC95%:6,0;6,6). La mayor prevalencia se dio entre las adolescentes mujeres y en el grupo de edad de 16 y 17 años. El agresor más común para ambos indicadores fue el novio/novia, ex novio, amante o enamorado. Entre los estudiantes que sufrieron una violación, más de la mitad declaró haber sufrido esta violencia antes de los 13 años (53,2%; IC95%: 51,0;55,4). Conclusión: la violencia sexual tiene una alta prevalencia entre los escolares de 13 a 17 años en Brasil, además de que las agresiones son perpetradas principalmente por personas del núcleo familiar y de las relaciones íntimas y afectivas. Es necesario que haya una articulación intersectorial para desarrollar políticas públicas que actúen para enfrentar el problema.

ABSTRACT Objective: to analyze the prevalence of sexual violence among schoolchildren aged from 13 to 17 years old in Brazil. Methods: a cross-sectional study conducted with data from the 2019 National School Health Survey. The prevalence values for sexual abuse and rape and their respective 95% confidence intervals (95% CI) involving students aged from 13 to 17 years old in Brazil were analyzed according to gender, age group, type of institution, aggressor, administrative region of residence and federated units. Results: the prevalence of sexual abuse among schoolchildren was 14.6% (95% CI: 14.2; 15.1) and the one for rape was 6.3% (95% CI: 6.0; 6.6). Higher prevalence values were found among female adolescents an in the age group of 16 and 17 years old. The most common aggressor for both indicators was boyfriend/girlfriend, ex-boyfriend, date or crush. Among the schoolchildren who were victims of rape, more than half reported having suffered this type of violence before 13 years of age (53.2%; 95% CI: 51.0; 55.4). Conclusion: sexual violence has high prevalence among schoolchildren aged from 13 to 17 years old in Brazil, in addition to the aggressions being mostly perpetrated by people from the family nucleus and by individuals with intimate and affection ties. Intersectoral articulation is necessary to develop public policies that act on coping with the problem.

Antinociceptive, anti-inflammatory and antioxidant activities of the crude ethanolic extract and alkaloid fraction of Waltheria viscosissima A. St. - Hil. (Malvaceae).

ETHNOPHARMACOLOGICAL RELEVANCE: The Waltheria viscosissima A. St.- Hil (Malvaceae) is also known as 'Malva branca', has been reported as ethnopharmacologically useful plant containing antinociceptive and anti-inflammatory properties, but scientific evidence is absent. AIM OF THE STUDY: Elucidate the antinociceptive, anti-inflammatory and antioxidant activity of the crude ethanol extract (EEBWa.v) and alkaloid fraction (FAWa.v) of aerial parts of the W. viscosissima in healthy mice with induced inflammation. MATERIALS AND METHODS: EEBWa.v and FAWa.v (50, 100 and 200 mg/kg) and morphine (10 mg/kg) were used in vivo tests of chemical nociception induced by acetic acid (0.6%; 10 mg/kg) and formalin (2.5%) in Swiss male mice. Acute inflammation was induced by carrageenan (1%) in vivo tests and there were several groups tested. The control (inflammation induced without treatment) and the groups treated with EEBWa.v (100 mg/kg), FAWa.v (100 mg/kg) and dexamethasone (2 mg/kg). After this procedure, the animals were euthanized and the peritoneal fluid was collected to evaluate cell migration and redox balance (malondialdehyde - MDA and Total Antioxidant Capacity - TAC). RESULTS: The morphine, EEBWa.v (50 and 100 mg/kg) and FAWa.v (100 mg/kg) significantly reduced the number of abdominal writhes compared to the control group. FAWa.v (100 mg/kg) was superior to FAWa.v (200 mg/kg). In the formalin-induced nociception model (neurogenic phase) EEBWa.v (50 and 200 mg/kg) significantly reduced the number of paw licks. In the inflammatory phase with peripheral action, FAWa.v (100 mg/kg) was superior to EEBWa.v (200 mg/kg). EEBWa.v and FAWa.v (100 mg/kg) proved to be significant for the next experiments. Both samples showed reduction in cell migration, as well as those treated with dexamethasone, in animals with inflammation induced by carrageenan, compared to the untreated group. The redox balance (TAC and MDA) revealed that only EEBWa.v (100 mg/kg) had higher antioxidant potential than the untreated group and the dexamethasone group, p < 0.005 and p < 0.001, respectively. FAWa.v (100 mg/kg) did not show antioxidant activity superior to EEBWa.v. It was also detected that EEBWa.v and FAWa.v (100 mg/kg) failed to inhibit lipid peroxidation. CONCLUSIONS: The W. viscosissima stimulates pain control, which can be mediated by both central and peripheral action. These bioactive compounds showed promising and potential to replace standard medicines. This bioactive effect is statistically similar to morphine and dexamethasone, standard medicines on the market, but with the advantage of antioxidant activity.

Cardiovascular Mortality During the COVID-19 Pandemics in a Large Brazilian City: A Comprehensive Analysis.

Introduction: The impact of COVID-19 pandemics on cardiovascular diseases (CVD) may be caused by health system reorganization and/or collapse, or from changes in the behaviour of individuals. In Brazil, municipalities were empowered to define regulatory measures, potentially resulting in diverse effects on CVD morbimortality. Objective: To analyse the impact of COVID-19 pandemics on CVD outcomes in Belo Horizonte (BH), the sixth greater capital city in Brazil, including: mortality, mortality at home, hospitalizations, intensive care unit utilization, and in-hospital mortality; and the differential effect according to sex, age range, social vulnerability, and pandemic's phase. Methods: Ecological study analysing data from the Mortality and Hospital Information System of BH residents aged ≥30 years. CVD was defined as in Chapter IX from ICD-10. Social vulnerability was classified by a composite socioeconomic index as high, medium and low. The observed age-standardized rates for epidemiological weeks 10-48, 2020, were compared to the expected rates (mean of 2015-2019). Risk ratios (RiR) were analysed and 95% confidence intervals were calculated for all estimates. Population projected to 2020 for BH and its census tracts were used to calculate rates. Results: We found no changes in CVD mortality rates (RiR 1.01, 95%CI 0.96-1.06). However, CVD deaths occurred more at homes (RiR 1.32, 95%CI 1.20-1.46) than in hospitals (RiR 0.89, 95%CI 0.79-0.99), as a result of a substantial decline in hospitalization rates, even though proportional in-hospital deaths increased. The rise in home deaths was greater in older adults and in had an increasing gradient in those more socially vulnerable (RiR 1.45); for high (RiR 1.45), medium (RiR 1.32) and low vulnerability (RiR 1.21). Conclusion: The greater occurrence of CVD deaths at home, in parallel with lower hospitalization rates, suggests that CVD care was disrupted during the COVID-19 pandemics, which more adversely affected older and more socially vulnerable individuals, exacerbating health inequities in BH.

Maternal Mortality in Brazil, 1990 to 2019: a systematic analysis of the Global Burden of Disease Study 2019.

INTRODUCTION: Maternal death continues to be one of the most challenging public health problems that needs to be addressed in low and middle-income countries. The objective of this study was to describe the problem of maternal death in Brazil, using estimates from the Global Burden of Disease Study (GBD). METHODS: This study used data from the GBD 2019 to show the numbers of deaths and the Maternal Mortality Ratio (MMR) - number of deaths/100,000 live births - in Brazil and its 27 Federated Units (FU), for ages 10 to 54 years, from 1990 to 2019. The annual variation of the MMR was estimated in 1990, 2010, and 2019. The MMR were shown for specific causes as well as for five-year age groups. The estimates were presented with 95% uncertainty intervals (UI). RESULTS: The number of maternal deaths, as well as the MMR showed a 49% reduction from 1990 to 2019. This reduction occurred heterogeneously throughout the country, and the profile of the MMR for specific causes changed between 1990 and 2019: from hypertensive gestation diseases, to indirect maternal deaths, followed by hypertensive gestation diseases. In the extreme age groups, the MMR is higher, with mortality increasing exponentially in direct proportion with age. CONCLUSIONS: Maternal deaths in Brazil have decreased substantially since 1990; however, the numbers still fall short of what was established by the World Health Organization (WHO). Indirect causes are the greatest problem in more than 60% of the FU, especially for hypertensive pregnancy diseases.

Validation of SmartVA using conventional autopsy: A study of adult deaths in Brazil.

Background: Accurate cause of death data are essential to guide health policy. However, mortality surveillance is limited in many low-income countries. In such settings, verbal autopsy (VA) is increasingly used to provide population-level cause of death data. VAs are now widely interpreted using the automated algorithms SmartVA and InterVA. Here we use conventional autopsy as the gold standard to validate SmartVA methodology. Methods: This study included adult deaths from natural causes in São Paulo and Recife for which conventional autopsy was indicated. VA was conducted with a relative of the deceased using an amended version of the SmartVA instrument to suit the local context. Causes of death from VA were produced using the SmartVA-Analyze program. Physician coded verbal autopsy (PCVA), conducted on the same questionnaires, and Global Burden of Disease Study data were used as additional comparators. Cause of death data were grouped into 10 broad causes for the validation due to the real-world utility of VA lying in identifying broad population cause of death patterns. Findings: The study included 2,060 deaths in São Paulo and 1,079 in Recife. The cause specific mortality fractions (CSMFs) estimated using SmartVA were broadly similar to conventional autopsy for: cardiovascular diseases (46.8% vs 54.0%, respectively), cancers (10.6% vs 11.4%), infections (7.0% vs 10.4%) and chronic respiratory disease (4.1% vs 3.7%), causes accounting for 76.1% of the autopsy dataset. The SmartVA CSMF estimates were lower than autopsy for "Other NCDs" (7.8% vs 14.6%) and higher for diabetes (13.0% vs 6.6%). CSMF accuracy of SmartVA compared to autopsy was 84.5%. CSMF accuracy for PCVA was 93.0%. Interpretation: The results suggest that SmartVA can, with reasonable accuracy, predict the broad cause of death groups important to assess a population's epidemiological transition. VA remains a useful tool for understanding causes of death where medical certification is not possible.

Maternal Mortality in Brazil, 1990 to 2019: a systematic analysis of the Global Burden of Disease Study 2019

Abstract INTRODUCTION Maternal death continues to be one of the most challenging public health problems that needs to be addressed in low and middle-income countries. The objective of this study was to describe the problem of maternal death in Brazil, using estimates from the Global Burden of Disease Study (GBD). METHODS This study used data from the GBD 2019 to show the numbers of deaths and the Maternal Mortality Ratio (MMR) - number of deaths/100,000 live births - in Brazil and its 27 Federated Units (FU), for ages 10 to 54 years, from 1990 to 2019. The annual variation of the MMR was estimated in 1990, 2010, and 2019. The MMR were shown for specific causes as well as for five-year age groups. The estimates were presented with 95% uncertainty intervals (UI). RESULTS The number of maternal deaths, as well as the MMR showed a 49% reduction from 1990 to 2019. This reduction occurred heterogeneously throughout the country, and the profile of the MMR for specific causes changed between 1990 and 2019: from hypertensive gestation diseases, to indirect maternal deaths, followed by hypertensive gestation diseases. In the extreme age groups, the MMR is higher, with mortality increasing exponentially in direct proportion with age. CONCLUSIONS Maternal deaths in Brazil have decreased substantially since 1990; however, the numbers still fall short of what was established by the World Health Organization (WHO). Indirect causes are the greatest problem in more than 60% of the FU, especially for hypertensive pregnancy diseases.