Crise global da atenção primária à saúde / Global crisis in primary health care / Crisis global de la atención primaria

Enquanto no Norte Global se discute uma crise na Atenção Primária à Saúde, a maioria dos países nunca chegou a constituir sistemas de saúde baseados propriamente numa atenção primária robusta. Nesse cenário, o Brasil apresenta uma tendência mais favorável, com conquistas importantes para a atenção primária e a medicina de família e comunidade nos últimos dez anos. Restam desafios a serem superados para que o Sistema Único de Saúde alcance níveis satisfatórios de acesso a seus serviços, com profissionais adequadamente formados e valorizados pela população.

While the Global North is discussing a crisis in primary health care, the majority of countries have never managed to establish health systems based on robust primary care. Brazil presents a more favorable trend, with important achievements for primary care and family practice over the last ten years. There are still challenges to be overcome so that the Unified Health System achieves satisfactory levels of access to its services, with professionals who are properly trained and valued by the public.

Mientras que en el Norte Global se habla de una crisis de la atención primaria, la mayoría de los países nunca han creado realmente sistemas sanitarios basados en una atención primaria robusta. Brasil, muestra una tendencia más favorable, con importantes logros para la atención primaria y la medicina familiar y comunitaria en los últimos diez años. Aún quedan retos por superar para que el Sistema Único de Salud alcance niveles satisfactorios de acceso a sus servicios, con profesionales debidamente formados y valorados por la población.

Bypassing sources of care by level and coverage: Access to essential services in Peru and Uruguay in the post-pandemic era.

BACKGROUND AND AIMS: Healthcare provision to distinct social groups in Latin America contributes to inequities. Individuals make active choices by bypassing their coverage and intended healthcare source. After the pandemic, we sought to characterize bypassing behaviors and quantify their effects on access to essential services. METHODS: Cross-sectional data from a population-based telephone survey in Peru and Uruguay were analyzed. Participants were selected by random digit dialing. Outcomes were defined as access to preventive screenings and satisfaction of emerging health needs. Bypassing by level was defined as when participants went around primary care for the usual source of care or last preventive visit; bypassing by coverage when care was sought outside of public coverage or social security. Sociodemographic characteristics were included, and the adjusted average treatment effect was calculated. RESULTS: Data from 1,255 participants in Peru and 1,237 participants in Uruguay were analyzed. Bypassing behaviors by level (32% Peru; 60% Uruguay) and coverage (29% Peru; 21% Uruguay) were more prevalent in more privileged groups, especially in Peru. System competence was low overall and varied by bypassing mode, especially in Peru. In the adjusted analysis, statistically significant differences were found in bypassing by coverage in Peru (-8% difference in unmet health needs) and by level in Uruguay (5% more unmet needs). CONCLUSION: Provision of essential preventive services was insufficient in both countries. In Peru, bypassing could serve as a proxy measure of inequities. Reminders of preventive services could be offered to bypassers of primary care. Profound health system reforms are needed to ensure equitable access to essential services.

Hydrochar from sawdust and sewage sludge - a potential media for retaining heavy metals in sustainable drainage systems (SuDS).

Waste valorization is an essential aspect of sustainable development. From this perspective, co-hydrothermal carbonization (Co-HTC) is a promising thermochemical process for converting organic waste into hydrochar. Hydrochar is a solid material whose physicochemical properties could make it suitable for adsorbing pollutants such as heavy metals. Accordingly, this work evaluated the hydrochar from Co-HTC of sawdust and non-dewatered sewage sludge as a potential adsorbent of heavy metals at low concentrations. In the context of sustainable drainage systems (SuDS), it is notable that heavy metals are present at very low but still potentially harmful concentrations, which presents a potential opportunity for the application of hydrochar. Thus, three hydrochars (H-180, H-215, and H-250), produced by Co-HTC at 180, 215, and 250 °C, were tested herein for their ability to retain lead (Pb2+). The H-180 presented better performance than other hydrochars (H-215 and H-250), suggesting that chemisorption could be the main adsorption mechanism. Interestingly, the presence of other cationic heavy metals (Cu2+, Zn2+, Cd2+, Cr6+, and Ni2+) did not hinder the Pb2+ adsorption, for which the removal efficiency remained close to 100%. In fact, in such a multi-metal system, hydrochar can be suitable for capturing both lead and cadmium. Therefore, the hydrochar from Co-HTC of sawdust and non-dewatered sewage sludge can be useful for removing heavy metals at low concentrations, such as those found in urban runoff waters. Although further studies are required, these findings suggest hydrochar as a potential material for application in SuDS.

Are we assessing motor competence? Evidence-informed constructs for motor competence in preschoolers through an Exploratory Graph Analysis.

Motor competence (MC) is conceptually defined as a multidimensional latent construct that covers the proficient performance in motor skills and its underlying mechanisms This study aimed to statistically provide arguments that MC is a network of interconnected constructs, such as FMS, coordination, and its underlying mechanisms, which are responsible for preschoolers' proficiency in motor tasks. Participated 102 preschoolers (65 girls, M age = 4.22 ± 0.19) who were assessed for the Test of Gross Motor Development - 2nd edition, the Motor Competence Assessment, and the Supine-to-Stand. Data were explored using Exploratory Graph Analysis, using the EGAnet package in RStudio. A four-dimensional structure (61.2% of interactions) comprising tasks of the different protocols was underlined, in which all the nodes presented stable and adequate indexes (≥0.65; TEFI = -2.67). Four dimensions of MC were highlighted, namely Dimension 1, which combined movements for locomotor patterns; Dimension 2, comprising three process-oriented measures of object control skills to project objects; Dimension 3, which comprised of skills which require body coordination to displace body through space; and Dimension 4, composed by object control skills evaluated through product-oriented measures. For a better understanding of MC, the assessment of these different aspects that comprises MC should be considered.

Tools, Technologies and Frameworks for Digital Twins in the Oil and Gas Industry: An In-Depth Analysis.

The digital twin (DT), which involves creating a virtual replica of a physical asset or system, has emerged as a transformative set of tools across various industries. In the oil and gas (O&G) industry, the development of DTs represents a significant evolution in how companies manage complex operations, enhance safety, and optimize decision-making processes. Despite these significant advancements, the underlying tools, technologies, and frameworks for developing DTs in O&G applications remain non-standardized and unfamiliar to many O&G practitioners, highlighting the need for a systematic literature review (SLR) on the topic. Thus, this paper offers an SLR of the existing literature on DT development for O&G from 2018 onwards, utilizing Scopus and Web of Science Core Collection. We provide a comprehensive overview of this field, demonstrate how it is evolving, and highlight standard practices and research opportunities in the area. We perform broad classifications of the 98 studies, categorizing the DTs by their development methodologies, implementation objectives, data acquisition, asset digital development, data integration and preprocessing, data analysis and modeling, evaluation and validation, and deployment tools. We also include a bibliometric analysis of the selected papers, highlighting trends and key contributors. Given the increasing number of new DT developments in O&G and the many new technologies available, we hope to provide guidance on the topic and promote knowledge production and growth concerning the development of DTs for O&G.

Graphene Quantum Dots from Natural Carbon Sources for Drug and Gene Delivery in Cancer Treatment.

Cancer therapy is constantly evolving, with a growing emphasis on targeted and efficient treatment options. In this context, graphene quantum dots (GQDs) have emerged as promising agents for precise drug and gene delivery due to their unique attributes, such as high surface area, photoluminescence, up-conversion photoluminescence, and biocompatibility. GQDs can damage cancer cells and exhibit intrinsic photothermal conversion and singlet oxygen generation efficiency under specific light irradiation, enhancing their effectiveness. They serve as direct therapeutic agents and versatile drug delivery platforms capable of being easily functionalized with various targeting molecules and therapeutic agents. However, challenges such as achieving uniform size and morphology, precise bandgap engineering, and scalability, along with minimizing cytotoxicity and the environmental impact of their production, must be addressed. Additionally, there is a need for a more comprehensive understanding of cellular mechanisms and drug release processes, as well as improved purification methods. Integrating GQDs into existing drug delivery systems enhances the efficacy of traditional treatments, offering more efficient and less invasive options for cancer patients. This review highlights the transformative potential of GQDs in cancer therapy while acknowledging the challenges that researchers must overcome for broader application.

Spatiotemporal relationship between agriculture, livestock, deforestation, and visceral leishmaniasis in Brazilian legal Amazon.

Visceral leishmaniasis (VL) is an urgent public health concern in Brazil. We evaluated the spatiotemporal distribution of VL to better understand the effects of economic activities related to agriculture, livestock, and deforestation on its incidence in the Brazilian Legal Amazon (BLA). The data on newly confirmed cases of VL in Brazilian municipalities from 2007 to 2020 were extracted from the Brazilian Notifiable Diseases Information System (SINAN) and analyzed. The data on agricultural production (planted area in hectares) and livestock (total number of cattle) were obtained from the Brazilian Institute of Geography and Statistics (IBGE), whereas deforestation data (in hectares) were obtained from the Amazon Deforestation Estimation Project (PRODES). SatScan and the local indicators of spatial association (LISA) were used to identify the spatial and temporal patterns of VL and its relationships with economic and environmental variables. The cumulative incidence rate was found to be 4.5 cases per 100,000 inhabitants. Based on the LISA results, areas with a high incidence of VL and deforestation were identified in the states of Roraima, Pará, and Maranhão. Strengthening deforestation monitoring programs and environmental enforcement actions can help implement public policies to control illegal deforestation and mitigate the socio-environmental vulnerability in the BLA. Therefore, areas identified in this study should be prioritized for controlling VL.

Role of Vaccination Strategies to Host-Pathogen Dynamics in Social Interactions.

This study presents extended Immunity Agent-Based Model (IABM) simulations to evaluate vaccination strategies in controlling the spread of infectious diseases. The application of IABM in the analysis of vaccination configurations is innovative, as a vaccinated individual can be infected depending on how their immune system acts against the invading pathogen, without a pre-established infection rate. Analysis at the microscopic level demonstrates the impact of vaccination on individual immune responses and infection outcomes, providing a more realistic representation of how the humoral response caused by vaccination affects the individual's immune defense. At the macroscopic level, the effects of different population-wide vaccination strategies are explored, including random vaccination, targeted vaccination of specific demographic groups, and spatially focused vaccination. The results indicate that increased vaccination rates are correlated with decreased infection and mortality rates, highlighting the importance of achieving herd immunity. Furthermore, strategies focused on vulnerable populations or densely populated regions prove to be more effective in reducing disease transmission compared to randomly distributed vaccination. The results presented in this work show that vaccination strategies focused on highly crowded regions are more efficient in controlling epidemics and outbreaks. Results suggest that applying vaccination only in the densest region resulted in the suppression of infection in that region, with less intense viral spread in areas with lower population densities. Strategies focused on specific regions, in addition to being more efficient in reducing the number of infected and dead people, reduce costs related to transportation, storage, and distribution of doses compared to the random vaccination strategy. Considering that, despite scientific efforts to consolidate the use of mass vaccination, the accessibility, affordability, and acceptability of vaccines are problems that persist, investing in the study of strategies that mitigate such issues is crucial in the development and application of government policies that make immunization systems more efficient and robust.

Exploring Limit Cycles of Differential Equations through Information Geometry Unveils the Solution to Hilbert's 16th Problem.

The detection of limit cycles of differential equations poses a challenge due to the type of the nonlinear system, the regime of interest, and the broader context of applicable models. Consequently, attempts to solve Hilbert's sixteenth problem on the maximum number of limit cycles of polynomial differential equations have been uniformly unsuccessful due to failing results and their lack of consistency. Here, the answer to this problem is finally obtained through information geometry, in which the Riemannian metrical structure of the parameter space of differential equations is investigated with the aid of the Fisher information metric and its scalar curvature R. We find that the total number of divergences of |R| to infinity provides the maximum number of limit cycles of differential equations. Additionally, we demonstrate that real polynomial systems of degree n≥2 have the maximum number of 2(n-1)(4(n-1)-2) limit cycles. The research findings highlight the effectiveness of geometric methods in analyzing complex systems and offer valuable insights across information theory, applied mathematics, and nonlinear dynamics. These insights may pave the way for advancements in differential equations, presenting exciting opportunities for future developments.

Continuity of care during severe civil unrest with a model of community-based HIV care: a retrospective cohort study from Haiti.

Background: There are limited data on the effectiveness of differentiated service delivery (DSD) for HIV care during sociopolitical turmoil. We assessed outcomes with a DSD model of care that includes patient choice between community-based antiretroviral therapy (ART) centres, home-based ART dispensing, or facility-based care at GHESKIO clinic during a period of severe civil unrest in Port-au-Prince, Haiti. Methods: This retrospective analysis included data on patients with at least one HIV visit at GHESKIO between May 1, 2019, and December 31, 2021. Multivariable logistic regression models were used to assess predictors of attending ≥1 community visit during the study period, and failure to attend timely visits. HIV-1 RNA test results were reported among patients who had been ART for ≥3 months at last visit. Findings: Of the 18,625 patients included in the analysis, 9659 (51.9%) attended at least one community visit. The proportion of community visits ranged from 0.3% (2019) to 44.1% (2021). Predictors of ≥1 community visit included male sex (aOR: 1.13; 95% CI: 1.06, 1.20), secondary education (aOR: 1.07; 95% CI: 1.01, 1.14), income > $USD 1.00/day (aOR: 1.24; 95% CI: 1.14, 1.35), longer duration on ART (aOR: 1.08 per additional year; 95% CI: 1.07, 1.09), and residence in Carrefour/Gressier (p < 0.0001 in comparisons with all other zones). Younger age and shorter time on ART were associated with late visits and loss to follow-up. Among 12,586 patients with an on-time final visit who had been on ART for ≥3 months, 11,131 (88.4%) received a viral load test and 9639 (86.6%) had HIV-1 RNA < 1000 copies/mL. Interpretation: The socio-political situation in Haiti has presented extraordinary challenges to the health care system, but retention and viral suppression rates remain high with a model of community-based HIV care. Additional interventions are needed to improve outcomes for younger patients, and those with shorter time on ART. Funding: No funding.

Design, develop, and implement the strategic information system on health, dependence, and healthy aging: an analysis of the Mexican experience.

BACKGROUND: The Decade of Healthy Aging (2021-2030) emerges as a 10 years strategy to improve the lives of older adults, their families, and the communities in which they live. One of the actions defined in this framework is related to improving the measurement, monitoring, and understanding of characteristics, factors, and needs related to aging and health. The aim was to analyze and assess the process of construction and development of the Strategic Information System on Health, Funcional Dependence and Aging (SIESDE, for its acronym in Spanish). SIESDE will provide strategic information in Mexico at the municipal, state, and national levels that support the public policies on healthy aging. METHODS: The system processes and analyzes the data sources of the Health Information Systems and the National System of Statistical and Geographical Information. SIESDE comprises three components: (1) Design, construction, and evaluation of the indicators; (2) storage, management, and visualization, and (3) diffusion and translation of information. RESULTS: A total of 135 indicators were built on seven themes: (1) demographic, socioeconomic, and aging conditions, (2) health, (3) functional dependence, (4) healthy aging, (5) health services, (6) social and physical environments, and (7) complex indicators. CONCLUSIONS: SIESDE is an effective system for providing an overall view of health, aging, and functional dependence.

Pathways to strengthen the climate resilience of health systems in the Peruvian Amazon by working with Indigenous leaders, communities and health officers.

BACKGROUND: Indigenous knowledge and responses were implemented during the COVID-19 pandemic to protect health, showcasing how Indigenous communities participation in health systems could be a pathway to increase resilience to emergent hazards like climate change. This study aimed to inform efforts to enhance climate change resilience in a health context by: (1) examining if and how adaptation to climate change is taking place within health systems in the Peruvian Amazon, (2) understanding how Indigenous communities and leaders' responses to climatic hazards are being articulated within the official health system and (3) to provide recommendations to increase the climate change resilience of Amazon health systems. METHODS: This study was conducted among two Peruvian Amazon healthcare networks in Junin and Loreto regions. A mixed methodology design was performed using a cross-sectional survey (13 healthcare facilities), semistructured interviews (27 official health system participants and 17 Indigenous participants) and two in-person workshops to validate and select key priorities (32 participants). We used a climate-resilient health system framework linked to the WHO health systems building blocks. RESULTS: Indigenous and official health systems in the Peruvian Amazon are adapting to climate change. Indigenous responses included the use of Indigenous knowledge on weather variability, vegetal medicine to manage health risks and networks to share food and resources. Official health responses included strategies for climate change and response platforms that acted mainly after the occurrence of climate hazards. Key pathways to articulate Indigenous and official health systems encompass incorporating Indigenous representations in climate and health governance, training the health work force, improving service delivery and access, strengthening the evidence to support Indigenous responses and increasing the budget for climate emergency responses. CONCLUSIONS: Key resilience pathways call for a broader paradigm shift in health systems that recognises Indigenous resilience as valuable for health adaptation, moves towards a more participatory health system and broadens the vision of health as a dimension inherently tied to the environment.

[Evidence for Health Promotion in Brazil: report on a rapid response serviceEvidencia para la promoción de la salud en Brasil: informe sobre un servicio de respuesta rápida]. / Evidências para a Promoção da Saúde no Brasil: relato de um serviço de resposta rápida.

Objective: Present the experience of a rapid response service to support decision-making in health systems. Methodology: Description of the processes and results of a service that produces rapid reviews and evidence maps to support decision-making under the National Health Promotion Policy, as well as the authors' perception of the work process. Results: The rapid response service started in 2020. By December 2023, 54 rapid reviews and five evidence maps had been produced, covering nine health promotion topics. These products were developed in 14 stages by a team made up of a coordinator, supervisors, proofreaders, and a librarian. The development of rapid responses involved a knowledge translation process, with continuous interactions between the requesting teams and production teams. Establishing effective communication was a critical factor in delivering products on time and in line with the needs of decision-makers and their supporters. Conclusion: Rapid response services can help improve the use of evidence for decision-making in health policies and health systems.

Objetivo: Presentación de la experiencia de un servicio de respuesta rápida para brindar apoyo a la toma de decisiones en materia de salud. Método: Se describen los procesos y resultados de un servicio de elaboración de revisiones rápidas y mapas de evidencia para brindar apoyo a la toma de decisiones en el marco de la Política Nacional de Promoción de la Salud, así como la percepción de los autores sobre el proceso de trabajo. Resultados: El servicio de respuesta rápida se inició en el 2020. Hasta diciembre del 2023, se habían elaborado 54 revisiones rápidas y cinco mapas de evidencia, que abarcaban nueve temas de promoción de la salud. Estos productos fueron elaborados en 14 etapas por un equipo formado por un coordinador, varios supervisores y revisores y un bibliotecario. La elaboración de respuestas rápidas fue un proceso de traducción del conocimiento e implicó una interacción continua entre los equipos solicitantes y el equipo de elaboración. El establecimiento de una comunicación eficaz fue un factor decisivo para entregar los productos a tiempo y en consonancia con las necesidades de los responsables de la toma de decisiones y su personal de apoyo. Conclusión: Los servicios de respuesta rápida pueden ayudar a mejorar el uso de evidencia en la toma de decisiones relacionadas con las políticas y los sistemas de salud.

Unveiling the Coordinated Action of DesK/DesR and YvfT/YvfU to Control the Expression of an ABC Transporter in Bacillus subtilis.

Two-component systems (TCSs) are vital signal transduction pathways ubiquitous among bacteria, facilitating their responses to diverse environmental stimuli. In Bacillus subtilis, the DesK histidine kinase thermosensor, together with the response regulator DesR, constitute a TCS dedicated to membrane lipid homeostasis maintenance. This TCS orchestrates the transcriptional regulation of the des gene, encoding the sole desaturase in these bacteria, Δ5-Des. Additionally, B. subtilis possesses a paralog TCS, YvfT/YvfU, with unknown target gene(s). In this work, we show that YvfT/YvfU controls the expression of the yvfRS operon that codes for an ABC transporter. Interestingly, we found that this regulation also involves the action of DesK/DesR. Notably, opposite to des, yvfRS transcription is induced at 37°C and not at 25°C. Our in vivo and in vitro experiments demonstrate that both YvfU and DesR directly bind to the operon promoter region, with DesR exerting its control over yvfRS expression in its unphosphorylated state. Our study uncovers an intriguing case of cross-regulation where two homologous TCSs interact closely to finely tune gene expression in response to environmental cues. These findings shed light on the complexity of bacterial signal transduction systems and their critical role in bacterial adaptability.

Spatial analysis to identify unauthorized municipal solid waste disposal sites in rural areas of southern Mexico.

The management of solid waste in rural areas of developing countries faces significant challenges due to economic constraints and irregular human settlements. These factors often lead to the creation of unauthorized disposal sites, which pose risks to human health, ecosystems and the economy. Remote sensing and geographic information system techniques provide a means to understand the complex issues associated with inadequate municipal solid waste (MSW) disposal. This study aimed to identify unauthorized disposal sites in the rural areas of southern Quintana Roo, Mexico, by examining land surface temperature (LST) and vegetation indices as potential indicators of unauthorized final disposal sites (FDSs). The findings reveal that 13% of the study areas have a high, moderate or low probability of hosting unauthorized disposal sites. Additionally, 3 authorized final disposal sites (FDSs) were confirmed, and 20 unauthorized sites were identified. LST and the normalized difference vegetation index were effective in detecting unauthorized sites, as these areas exhibited higher temperatures and less vigorous vegetation compared to adjacent areas. The results provide valuable insights into the issues associated with inadequate waste disposal in rural areas and offer information that can help optimize MSW management and mitigate its environmental and health impacts.

American mistletoes: A dataset of Phoradendron species and their hosts across their distribution range.

Parasite-host systems are a good study model for answering ecological and evolutionary questions. In this regard, mistletoes have been increasingly studied in recent decades in both temperate and tropical zones. The genus Phoradendron is a group of American mistletoes that has been studied from different evolutionary and ecological approaches as a model of parasite-host systems. Currently, however, no systematic compilation of the plant species parasitized by these mistletoes is available. To address this issue, we conducted a thorough search and compilation of interactions between mistletoe species of the genus Phoradendron and their hosts. This involved consulting multiple sources, including monographs, digitized herbaria material, and scientific publications. Additionally, we incorporated information regarding the presence records of Phoradendron from the most authoritative databases at the national, continental, and global levels. This process yielded a comprehensive dataset consisting of two independent tables, offering information on the interactions and occurrences of Phoradendron throughout its distribution range in the Americas. The dataset includes the interactions between 159 mistletoe species and 118 hosts at the family level, 379 hosts at the genus level, and 544 hosts at the species level, totaling 2929 interactions between species of the genus Phoradendron and their hosts. This data paper represents an updated compilation of a genus of parasitic plants, with the purpose of making this database of interactions accessible for researchers to address questions at multiple scales and from disciplines as varied as biogeography, ecology, evolution, and epidemiology. We plan to use and expand this database with subsequent studies from the authors. There are no copyright restrictions on the dataset; please cite this data paper when using data from this publication. We also encourage you to contact the authors if you are interested in contributing to this database.

Transparency and precision in the age of AI: evaluation of explainability-enhanced recommendation systems.

In today's information age, recommender systems have become an essential tool to filter and personalize the massive data flow to users. However, these systems' increasing complexity and opaque nature have raised concerns about transparency and user trust. Lack of explainability in recommendations can lead to ill-informed decisions and decreased confidence in these advanced systems. Our study addresses this problem by integrating explainability techniques into recommendation systems to improve both the precision of the recommendations and their transparency. We implemented and evaluated recommendation models on the MovieLens and Amazon datasets, applying explainability methods like LIME and SHAP to disentangle the model decisions. The results indicated significant improvements in the precision of the recommendations, with a notable increase in the user's ability to understand and trust the suggestions provided by the system. For example, we saw a 3% increase in recommendation precision when incorporating these explainability techniques, demonstrating their added value in performance and improving the user experience.

Machine learning-ready mental health datasets for evaluating psychological effects and system needs in Mexico city during the first year of the COVID-19 pandemic.

The prevalence of mental health problems constitutes an open challenge for modern societies, particularly for low and middle-income countries with wide gaps in mental health support. With this in mind, five datasets were analyzed to track mental health trends in Mexico City during the pandemic's first year. This included 33,234 responses to an online mental health risk questionnaire, 349,202 emergency calls, and city epidemiological, mobility, and online trend data. The COVID-19 mental health risk questionnaire collects information on socioeconomic status, health conditions, bereavement, lockdown status, and symptoms of acute stress, sadness, avoidance, distancing, anger, and anxiety, along with binge drinking and abuse experiences. The lifeline service dataset includes daily call statistics, such as total, connected, and abandoned calls, average quit time, wait time, and call duration. Epidemiological, mobility, and trend data provide a daily overview of the city's situation. The integration of the datasets, as well as the preprocessing, optimization, and machine learning algorithms applied to them, evidence the usefulness of a combined analytic approach and the high reuse potential of the data set, particularly as a machine learning training set for evaluating and predicting anxiety, depression, and post-traumatic stress disorder, as well as general psychological support needs and possible system loads.

Electronic cigarettes: "wolves in sheep's clothing".

OBJECTIVE: To provide cutting-edge information on the impact and risks of using Electronic Nicotine Delivery Systems (ENDS) by children and adolescents, based on the latest evidence published in the literature. DATA SOURCE: A comprehensive search was carried out on PubMed, using the expressions ''electronic cigarettes'' OR ''electronic nicotine delivery systems" OR "vaping" AND ''adolescent'' AND "risks" AND ''acute lung injury'. All retrieved articles had their titles and abstracts read to identify and fully read the papers reporting the most recent evidence on each subject. SUMMARY OF FINDINGS: The use of ENDS has alarmingly increased in Brazil and around the world. The possibility of customizing use, the choice of flavors and nicotine content, and the general notion that these devices are harmless when compared to conventional cigarettes are some of the factors responsible for this increase. Numerous scientific studies have proven that electronic cigarettes have serious consequences for the respiratory system, such as EVALI (E-cigarette or Vaping-Associated Lung Injury) and difficult-to-control asthma, as well as harmful effects on the neurological, cardiovascular, gastrointestinal, and immunological systems. High concentrations of nicotine make many young people addicted to this substance. In Brazil, commercialization, import, and advertising are prohibited. The viable interventions to address the use of these devices in children and adolescents are prevention and behavioral counseling. CONCLUSION: There is clear scientific evidence that these devices pose a risk to the physical and mental health of children and adolescents.

miRNA heterologous production in bacteria: A systematic review focusing on the choice of plasmid features and bacterial/prokaryotic microfactory.

Bacteria, the primary microorganisms used for industrial molecule production, do not naturally generate miRNAs. This study aims to systematically review current literature on miRNA expression systems in bacteria and address three key questions: (1) Which microorganism is most efficient for heterologous miRNA production? (2) What essential elements should be included in a plasmid construction to optimize miRNA expression? (3) Which commercial plasmid is most used for miRNA expression? Initially, 832 studies were identified across three databases, with fifteen included in this review. Three species-Escherichia coli, Salmonella typhimurium, and Rhodovulum sulfidophilum-were found as host organisms for recombinant miRNA expression. A total of 78 miRNAs were identified, out of which 75 were produced in E. coli, one in R. sulfidophilum (miR-29b), and two in S. typhimurium (mi-INHA and miRNA CCL22). Among gram-negative bacteria, R. sulfidophilum emerged as an efficient platform for heterologous production, thanks to features like nucleic acid secretion, RNase non-secretion, and seawater cultivation capability. However, E. coli remains the widely recognized model for large-scale miRNA production in biotechnology market. Regarding plasmids for miRNA expression in bacteria, those with an lpp promoter and multiple cloning sites appear to be the most suitable due to their robust expression cassette. The reengineering of recombinant constructs holds potential, as improvements in construct characteristics maximize the expression of desired molecules. The utilization of recombinant bacteria as platforms for producing new molecules is a widely used approach, with a focus on miRNAs expression for therapeutic contexts.