Are heart attacks deadlier on weekends? Evidence of weekend effect in Brazil.

This article aims to examine the effects of weekend admission on in-hospital mortality for patients with acute myocardial infarction (AMI) in Brazil. Information from the Hospital Information System of the Unified Health System (SIH/SUS) of urgently admitted patients diagnosed with acute myocardial infarction (AMI) between 2008 and 2018 was used, made available through the Hospital Admission Authorization (AIH). Multivariable logistic regression models, controlling for observable patient characteristics, hospital characteristics and year and hospital-fixed effects, were used. The results were consistent with the existence of the weekend effect. For the model adjusted with the inclusion of all controls, the chance of death observed for individuals hospitalized on the weekend is 14% higher. Our results indicated that there is probably an important variation in the quality of hospital care depending on the day the patient is hospitalized. Weekend admissions were associated with in-hospital AMI mortality in Brazil. Future research should analyze the possible channels behind the weekend effect to support public policies that can effectively make healthcare equitable.

Are heart attacks deadlier on weekends? Evidence of weekend effect in Brazil / Os ataques cardíacos são mais letais nos fins de semana? Evidência do "efeito final de semana" no Brasil

Abstract This article aims to examine the effects of weekend admission on in-hospital mortality for patients with acute myocardial infarction (AMI) in Brazil. Information from the Hospital Information System of the Unified Health System (SIH/SUS) of urgently admitted patients diagnosed with acute myocardial infarction (AMI) between 2008 and 2018 was used, made available through the Hospital Admission Authorization (AIH). Multivariable logistic regression models, controlling for observable patient characteristics, hospital characteristics and year and hospital-fixed effects, were used. The results were consistent with the existence of the weekend effect. For the model adjusted with the inclusion of all controls, the chance of death observed for individuals hospitalized on the weekend is 14% higher. Our results indicated that there is probably an important variation in the quality of hospital care depending on the day the patient is hospitalized. Weekend admissions were associated with in-hospital AMI mortality in Brazil. Future research should analyze the possible channels behind the weekend effect to support public policies that can effectively make healthcare equitable.

Resumo O objetivo deste artigo é examinar os efeitos da internação no final de semana na mortalidade hospitalar de pacientes com infarto agudo do miocárdio (IAM) no Brasil. Foram utilizadas informações do Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS) de pacientes internados em urgência com diagnóstico de infarto agudo do miocárdio (IAM) entre 2008 e 2018, disponibilizados por meio da Autorização de Internação Hospitalar (AIH). Foram usados modelos de regressão logística multivariada, controlando as características observáveis ​​do paciente, características do hospital e efeitos fixos de ano e hospital. Os resultados foram consistentes com a existência do efeito fim de semana. Para o modelo ajustado com a inclusão de todos os controles, a chance de óbito observada para indivíduos internados no final de semana é 14% maior. Nossos resultados indicaram que provavelmente existe uma variação importante na qualidade da assistência hospitalar dependendo do dia em que o paciente fica internado. Internações em finais de semana foram associadas à mortalidade por IAM intra-hospitalar no Brasil. Pesquisas futuras devem analisar os possíveis canais por trás do weekend effect para subsidiar políticas públicas que possam efetivamente tornar o atendimento equitativo.

Impact of Weekday on Short-term Surgical Outcomes After Lumbar Fusion Surgery.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of this study is to investigate whether weekday lumbar spine fusion surgery has an impact on surgical and inpatient physical therapy (PT) outcomes. SUMMARY OF BACKGROUND DATA: Timing of surgery has been implicated as a factor that may impact outcomes after spine surgery. Previous literature suggests that there may be an adverse effect to having surgery on the weekend. METHODS: All patients ≥18 years who underwent primary lumbar spinal fusion from 2014 to 2020 were retrospectively identified. Patients were subdivided into an early subgroup (surgery between Monday and Wednesday) and a late subgroup (surgery between Thursday and Friday). Surgical outcome variables included inpatient complications, 90-day readmissions, and 1-year revisions. PT data from the first inpatient PT session included hours to PT session, AM-PAC Daily Activity or Basic Mobility scores, and total gait trial distance achieved. RESULTS: Of the 1239 patients identified, 839 had surgery between Monday and Wednesday and 400 had surgery between Thursday and Friday. Patients in the later surgery subgroup were more likely to experience a nonsurgical neurologic complication (3.08% vs. 0.86%, P =0.008); however, there was no difference in total complications. Patients in the early surgery subgroup had their first inpatient PT session earlier than patients in the late subgroup (15.7 vs. 18.9 h, P <0.001). However, patients in the late subgroup achieved a farther total gait distance (98.2 vs. 75.4, P =0.011). Late surgery was a significant predictor of more hours of PT (est.=0.256, P =0.016) and longer length of stay (est.=2.277, P =0.001). There were no significant differences in readmission and revision rates. CONCLUSIONS: Patients who undergo surgery later in the week may experience more nonsurgical neurologic complications, longer wait times for inpatient PT appointments, and longer lengths of stay. This analysis showed no adverse effect of later weekday surgery as it relates to total complications, readmissions, and reoperations. LEVEL OF EVIDENCE: Level III.

Exercise improves intestinal IgA production by T-dependent cell pathway in adults but not in aged mice.

Introduction: Hypermutated high-affinity immunoglobulin A (IgA), neutralizes toxins and drives the diversification of bacteria communities to maintain intestinal homeostasis although the mechanism underlies the impact of moderate aerobic exercise (MAE) on the IgA-generation via T-dependent (TD) is not fully know. Therefore, the aim of this study was to determine the effect of long-time MAE on the production of IgA through the TD pathway in Peyer´s patches of the small intestine from aged mice. Methods: MAE protocol consisted of twenty 3-month-old (young) BALB/c mice running in an endless band at 0° inclination and a speed of 10 m/h for 5 days a week and resting 2 days on the weekend until reaching 6-month-old (adulthood, n=10) or 24-month-old (aging, n=10). Groups of young, adult, or elderly mice were included as sedentary controls (n=10/per group). At 6 or 24 months old, all were sacrificed, and small intestine samples were dissected to prepare intestinal lavages for IgA quantitation by ELISA and to obtain suspensions from Peyer´s patches (PP) and lamina propria (LP) cells for analysis of T, B, and plasma cell subpopulations by flow cytometry and mRNA analysis expression by RT-qPCR of molecular factors related to differentiation of B cells to IgA+ plasma cells, class switch recombination, and IgA-synthesis. Statistical analysis was computed with two-way ANOVA (factor A=age, factor B=group) and p<0.05 was considered for statistically significant differences. Results: Compared to age-matched sedentary control, in exercised elderly mice, parameters were either increased (IgA concentration, IL-21, IL-10 and RDH mRNA expression), decreased (α-chain mRNA, B cells, mIgA+ B cells, mIgM+ B cells and IL-4 mRNA) or unchanged (PP mIgA+ plasmablasts and LP cyt-IgA+ plasma cells). Regarding the exercised adult mice, they showed an up-modulation of IgA-concentration, mRNA expression IL-21, IL-10, and RDH and cells (PP B and T cells, mIgM+ plasmablasts and LP cyt-IgA+plasma cells). Conclusion: Our findings suggest that MAE restored the IgA production in adult mice via the TD cell pathway but does not in aged mice. Other studies are necessary to know in more detail the impact of long-time MAE on the TD pathway to produce IgA in aging.

Combined Effect of Leisure-Time Physical Activity and Sedentary Behavior on Abdominal Obesity in ELSA-Brasil Participants.

INTRODUCTION: Abdominal obesity is a pattern of obesity that has been considered a public health problem. Physical activity is considered an important factor for the prevention of abdominal obesity. Increased time in sedentary behavior has been associated with negative health outcomes, including abdominal obesity. OBJECTIVE: The aim of this study was to investigate which combination of leisure-time physical activity and sedentary behavior contributes most to the prevention of abdominal obesity in adults participating in ELSA-Brasil (Longitudinal Study of Adult Health). METHODS: The study was cross-sectional and participants from the first follow-up of the ELSA-Brasil cohort (2012-2014) were analyzed. The independent variables were physical activity, assessed by IPAQ, and sedentary behavior, assessed by a standard questionnaire applied in ELSA-Brasil; the dependent variable was abdominal obesity, determined by waist circumference. The covariates analyzed were the following: age, education, binge drinking, smoking and menopause. The associations between the dependent variable and the independent variables were analyzed using logistic regression. The odds ratio with 95 CI% was estimated. RESULTS: For men, the combinations were more significant when they were more physically active and spent less time on the sedentary behaviors analyzed, on both a weekday and a weekend day. For menopausal women, both younger and older, all associations of the combinations between sufficient leisure-time physical activity and little time spent in sedentary behaviors contributed to the prevention of abdominal obesity. In non-menopausal women, positive associations were observed in almost all combinations between leisure-time physical activity and sedentary behaviors, with some results that were not statistically significant among younger women. CONCLUSIONS: Our results showed that being sufficiently active and reducing the time spent in sedentary behavior was the combination that contributed the most to the prevention of abdominal obesity, both in men and women.

Weekend effect of air pollutants in small and medium-sized cities: The role of policies stringency to COVID-19 containment.

Although the pattern of air pollutants has been extensively studied during the COVID-19 pandemic, the weekend effect has been rarely investigated. In order to understand the impact of policies stringency as well as the interruption-recovery pattern, the aim of the study was to investigate the levels of air pollutants (O3, NO2, SO2, PM2.5, PM10) and PM2.5/PM10 ratio before and after the COVID-19 pandemic in four cities in the state of Rio Grande do Sul, Brazil, evaluating the weekend effect at these two scenarios and also identifying how the restriction measures applied locally had an impact on this effect. For this, daily data from two years of monitoring of air pollutants were collected and the weekend effect was calculated based on the levels from Monday to Friday (weekday) and Saturday and Sunday (weekend). There was a positive weekend effect for almost all criteria air pollutants in the four cities, and an intrinsic relation between the weekend effect and the restriction measures adopted. A negative weekend effect was observed in the scenario characterized by less restrictive and more permissive policies for daily and occupational activities. Conversely, when more stringent measures were implemented, this trend was reversed and higher intensities of positive weekend effect were observed as restrictions increased. In conclusion, the COVID-19 perturbation to air quality changed as regions tighten and loosen restrictions on human mobility. These insights that can guide responsible authorities about future strategies and policies for air quality control.

Hemoglobin analysis after overload training in athletes / Análise de hemoglobina após treinamento de sobrecarga em atletas / Análisis de la hemoglobina tras el entrenamiento de sobrecarga en atletas

ABSTRACT Introduction: The cardiovascular system provides athletes with the proper conditions for blood circulation, ensuring the stability and normal metabolism of the body's internal environment during exercise. Objective: Investigate the effect of overload training on the hemoglobin of male taekwondo athletes. Methods: Twenty-one male taekwondo athletes (level 2 or higher) were selected and trained for four weeks, five days per week, with an initial load intensity of 60% of the maximum heart rate and a weekly intensity increase of 10%. Before training and on every weekend during training, hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), reticulocyte count (Ret) were checked, RBC volume distribution width (RDW), hemoglobin content distribution width (HDW), mean reticulocyte volume (MCVr), mean reticulocyte hemoglobin concentration (CHCMr), serum iron (Fe) and ferritin (Fer). Results: After four weeks of increasing load training, athletes showed a progressive and significant decrease in Hb (P<0.01), manifested as exercise-induced hypohemoglobin, and MCV, MCH, MCHC, CHCMr, HDW, and serum ferritin were significantly or extremely decreased(P<0.) 05, P<0.01); RDW increased significantly (P<0.05); Changes in Ret and serum iron showed no statistical significance (P>0.05). Correlation analysis found that hemoglobin concentration had the highest correlation with MCHC and CHCMr. Conclusion: Four-week incremental load training can induce exercise-induced hypohemoglobin in male taekwondo athletes, its changes being most correlated with MCHC and CHCMr, but without significant correlation with serum Fe, RDW, HDW, and MCV. Level of Evidence: Therapeutic Studies -Investigation of Outcomes.

RESUMO Introdução: O sistema cardiovascular fornece aos atletas as condições propícias para a circulação sanguínea, garantindo a estabilidade e o metabolismo normal do ambiente interno corporal durante o exercício. Objetivo: Investigar o efeito do treinamento em sobrecarga sobre a hemoglobina dos atletas masculinos de Taekwondo. Métodos: Vinte e um atletas masculinos de taekwondo (nível 2 ou superior) foram selecionados e treinados durante 4 semanas, 5 dias por semana, com uma intensidade de carga inicial de 60% da frequência cardíaca máxima e um aumento de intensidade semanal de 10%. Antes do treinamento e em todos os fins de semana durante o treinamento, foi verificada a hemoglobina (Hb), volume corpuscular médio (MCV), hemoglobina corpuscular média (MCH), concentração corpuscular média de hemoglobina (MCHC), contagem de reticulócitos (Ret), largura de distribuição do volume de hemácias (RDW), largura de distribuição do conteúdo de hemoglobina (HDW), volume médio de reticulócitos (MCVr), concentração média de hemoglobina reticulócitos (CHCMr), ferro sérico (Fe) e ferritina (Fer). Resultados: Após 4 semanas em treinamento de carga crescente, os atletas mostraram uma diminuição progressiva e significativa em Hb(P<0,01), manifestada como hipohemoglobina induzida por exercício, e MCV, MCH, MCHC, CHCMr, HDW, e ferritina sérica foram significativamente ou extremamente diminuídos(P<0). 05, P<0,01); RDW aumentou significativamente (P<0,05); Alterações de Ret e ferro sérico não apresentaram significância estatística (P>0,05). A análise de correlação constatou que a concentração de hemoglobina teve a maior correlação com MCHC e CHCMr. Conclusão: O treinamento de carga incremental de quatro semanas pode induzir hipohemoglobina induzida por exercício em atletas taekwondo masculinos, sendo suas alterações mais correlacionadas com MCHC e CHCMr, mas sem correlação significativa com Fe sérico, RDW, HDW e MCV. Nível de evidência: Estudos Terapêuticos -Investigação dos Resultados.

RESUMEN Introducción: El sistema cardiovascular proporciona a los deportistas las condiciones propicias para la circulación sanguínea, garantizando la estabilidad y el metabolismo normal del medio corporal interno durante el ejercicio. Objetivo: Investigar el efecto del entrenamiento de sobrecarga en la hemoglobina de los atletas masculinos de taekwondo. Métodos: Se seleccionaron 21 atletas masculinos de taekwondo (de nivel 2 o superior) y se entrenaron durante 4 semanas, 5 días a la semana, con una intensidad de carga inicial del 60% de la frecuencia cardíaca máxima y un aumento semanal de la intensidad del 10%. Antes del entrenamiento y cada fin de semana durante el mismo, se comprobó la hemoglobina (Hb), el volumen corpuscular medio (MCV), la hemoglobina corpuscular media (HCM), la concentración de hemoglobina corpuscular media (MCH) y el recuento de reticulocitos (Ret), Anchura de distribución del volumen de glóbulos rojos (RDW), anchura de distribución del contenido de hemoglobina (HDW), volumen reticulocitario medio (MCVr), concentración media de hemoglobina reticulocitaria (CHCMr), hierro sérico (Fe) y ferritina (Fer). Resultados: Después de 4 semanas de entrenamiento con carga creciente, los atletas mostraron una disminución progresiva y significativa de la Hb (P<0,01), que se manifestó como hipohemoglobina inducida por el ejercicio, y el MCV, el MCH, el MCHC, el CHCMr, el HDW y la ferritina sérica disminuyeron de forma significativa o extrema (P<0,01). 05, P<0,01); el ADE aumentó significativamente (P<0,05); los cambios en el Ret y el hierro sérico no mostraron significación estadística (P>0,05). El análisis de correlación encontró que la concentración de hemoglobina tenía la mayor correlación con MCHC y CHCMr. Conclusión: El entrenamiento de carga incremental de cuatro semanas puede inducir hipohemoglobina inducida por el ejercicio en atletas masculinos de taekwondo, siendo sus cambios los más correlacionados con MCHC y CHCMr, pero sin correlación significativa con el Fe sérico, RDW, HDW y MCV. Nivel de evidencia: Estudios terapéuticos - Investigación de resultados.

Weekend effect on air pollutant levels in southernmost cities of Brazil with different economic activities.

In view of the current premises of the need to investigate air pollution in small- and medium-sized cities, combined with concerns regarding the weekly behavior of air pollutants, this study aimed to investigate the weekly pattern of air pollution (O3, NO2, SO2, PM2.5) and the weekend effect in 4 Brazilian cities with different main economic activities. Our main findings include (1) positive weekend effect for all the assessed air pollutants in the four cities; therefore, in the southernmost region of Brazil, there was an increase in the concentration of air pollutants during weekends when compared to weekdays; (2) the highest levels of NO2 and SO2 were observed in the city characterized by the economic activity revolving around coal mining and generation of electricity through the burning of this mineraloid in a coal-fired power plant, while the highest levels of PM2.5 were in the city with economic activity linked to industries, due to its recognized industrial complex; and (3) the seasonal evaluation of the weekend effect showed different behaviors for the air pollutants in each location, which is related to the set of meteorological conditions, economic activities, and population mobility in each location. In conclusion, our results demonstrate the aspects of pollution between cities and highlight that the comprehensive understanding of the weekend effect and its intricacies allows the responsible personal and government authorities to gain deep insights into the true effectiveness of future control strategies and the development of possible action plans.

Physical environmental opportunities for active play and physical activity level in preschoolers: a multicriteria analysis.

BACKGROUND: Active play opportunities seems to influence the level of physical activity during childhood. However, a gap remains about which environmental opportunities including the daycare physical environment could have a positive impact on the level of physical activity in preschoolers. OBJECTIVES: (1) To develop an index to measure the environmental opportunities of free active play for preschoolers of middle-income countries; (2) to check the relationship and contribution of the index to explain objectively the level of physical activity. METHODS: A quantitative, cross-sectional, exploratory study with 51 preschool children. The established criteria for the index according to the literature were: (1) Outdoor time on typical days of the week. (2) Outdoor time on a typical weekend day. (3) The presence of internal space and external environment in the child's home that allows playing. (4) Presence of patio with space for games at the school. (5) Presence of a playground with a toy at the school. We applied multi-attribute utility theory for the determination of the multicriteria index of physical environmental opportunities. Pearson's correlation analysis and simple linear regression were used to verify the association between the index and the physical activity level. RESULTS: The index showed a positive correlation with the level of physical activity, e.g., the average time of MVPA (r = 0.408, p = 0.003). The univariate linear regression demonstrated that the quality of physical environmental opportunities for physical activity explained 20% of the preschooler's classification as active and 16% of the time in moderate to vigorous physical activity (p < 0.001). CONCLUSION: Physical environmental opportunities for active play have a positive effect on physical activity in preschoolers and should be encouraged in different social segments.

El "efecto fin de semana" en pacientes que asisten a urgencias por hemorragia digestiva superior no varicosa. La experiencia en un hospital de alta complejidad / The "Weekend Effect" in patients admitted to the Emergency Unit with non-variceal upper gastrointestinal bleeding. A high-complexity hospital experience

Resumen Introducción y objetivos: el "efecto fin de semana" se define como un incremento en la mortalidad en pacientes que ingresan a centros asistenciales durante el fin de semana o días festivos. Este estudio se realizó para evaluar el posible "efecto fin de semana" en pacientes con hemorragia digestiva superior (HDS) con base en una experiencia de 3 años en un hospital de alta complejidad en Latinoamérica. Materiales y métodos: estudio observacional descriptivo realizado entre 2016 y 2018. Se describieron las características demográficas, factores de riesgo, síntomas de ingreso, hallazgos endoscópicos y diferentes intervenciones médicas. Además, se compararon los tiempos de realización de endoscopia, estancia hospitalaria y mortalidad entre los pacientes admitidos durante el fin de semana frente a días entre semana. Resultados: el análisis incluyó 274 pacientes en fines de semana y festivos (39,1 %) frente a pacientes en días entre semana (60,9 %). La mediana de edad fue de 68,5 años (rango intercuartílico [RIC]: 53-79), el 56,6 % fueron hombres. Las manifestaciones más comunes fueron melenas y hematemesis. La úlcera péptica fue el diagnóstico endoscópico más común (48,7 %). Los tiempos de estancia hospitalaria (7,38 ± 8,7 frente a 7,38 ± 7,1; p = 0,234) y mortalidad (1,9 % frente a 4,2 %; p = 0,274) fueron similares en ambos grupos. Se realizó una mayor cantidad de endoscopias después de las 24 horas en pacientes ingresados el fin de semana (19,6 % frente a 9,6 %; p = 0,041). Conclusiones: en esta cohorte no se presentó el "efecto fin de semana", no se observan diferencias en relación con la estancia hospitalaria, ni con la mortalidad en pacientes ingresados por HDS.

Abstract Introduction and Objectives: The "Weekend Effect" refers to an increase in mortality of patients admitted to health care centers on weekends or holidays. This study was performed to assess the impact of weekend admissions in patients with upper gastrointestinal bleeding (UGIB) based on a three year-experience in a high-complexity hospital in Latin America. Materials and Methods: A descriptive observational study was performed between 2016 and 2018. Data on demographic characteristics, risk factors, symptoms, endoscopic findings, and medical treatment was described. Moreover, the time to perform an endoscopy, the length of hospital stay, and the mortality level among patients admitted on weekends were compared with the same factors during the week. Results: The analysis included 274 patients admitted during the weekend and holidays (39.1%) versus patients admitted during the week (60.9%). The median age was 68.5 years old (interquartile range [IQR]: 53-79), and 56.6% were men. The most common conditions were tarry stools and hematemesis. Peptic ulcer was the most common endoscopic diagnosis (48.7%). Similar results were found in the length of hospital stay (7,38 ± 8,7 versus 7,38 ± 7,1; p = 0,234) and mortality groups (1,9 % versus 4,2 %; p = 0,274). A higher number of endoscopies 24 hours after the patient was admitted was performed (19,6 % versus 9,6 %; p = 0,041). Conclusions: The "Weekend Effect" was not present in the analyzed group, and there are no significant differences related to the length of hospital stay or the mortality of patients diagnosed with UGIB.

Violência sexual facilitada por drogas: caracterização e experiências de mulheres atendidas em um hospital especializado do Paraná / Drug-facilitated sexual violence: characterization and experiences of women treated at a specialized hospital in Paraná

Resumo: A violência sexual, enquanto crime facilitado por substâncias químicas, denomina-se Violência Sexual Facilitada por Drogas ou em inglês, Drug-Facilitated Sexual Assault (DFSA). Emergiram as seguintes perguntas de pesquisa: qual é o perfil das mulheres que sofreram violência sexual facilitadas por drogas, atendidas em um hospital especializado? Qual a experiência de mulheres que vivenciaram a violência sexual facilitada por drogas? Teve-se como objetivos: caracterizar as mulheres que sofreram DFSA, atendidas em um hospital especializado do Paraná, entre os anos de 2010 e 2019; e conhecer a percepção de mulheres atendidas em um hospital especializado do Paraná sobre a experiência da DFSA. Trata-se de uma pesquisa com duas abordagens metodológicas. O primeiro objetivo utilizou a abordagem quantitativa, descritiva e transversal, com utilização de 342 dados da ficha de notificação individual. O segundo objetivo recebeu abordagem qualitativa, por entrevistas com 18 mulheres que sofreram DFSA, e os dados foram analisados mediante análise temática por Bardin, com apoio do software webQDA. Assim, emergiram três categorias: Contexto em que a DFSA ocorreu; A busca por ajuda após a DFSA; e Dificuldades e estratégias de enfrentamento após a vivência da DFSA. Identificaram-se 342 notificações de DFSA entre 18 e 62 anos, concentrando 53,3% entre 20 e 29 anos; 75% brancas; 28% ensino médio completo e 26% superior completo; 39% trabalhadoras, 22% estudantes e 74,8% solteiras. A DFSA ocorreu 62% no final de semana; 47% na madrugada; 38% em residências e 27% em via pública. No hospital especializado, 82% receberam profilaxias para Infecções Sexualmente Transmissíveis (IST);79% imunização para hepatite B; 74% anticoncepção de emergência; e 65% denunciaram com coleta de vestígios. Nas entrevistas, o álcool foi a substância química mais relatada e houve suspeita de adição de drogas secretamente nas bebidas. A DFSA ocorreu em ambientes de descontração, acompanhadas por conhecidos, com perda de consciência e acordaram após a DFSA nas festas ou residências. A DFSA causou sentimentos negativos de medo, vergonha e culpa associados ao consumo de álcool. Procuraram por apoio informal e por apoio formal para diminuir consequências na saúde mental e física. O medo de contrair IST foi motivante para buscar ajuda e houve desconhecimento e barreiras no acesso à rede intersetorial e hospital especializado. No primeiro contato com o hospital especializado, a experiência evidenciou-se positiva e destacaram a assistência da enfermagem. Constataram-se dificuldades em superar o vivido com isolamento e fobia social e reconheceram a necessidade de terapia. O apoio informal, relacionamento afetivo-sexual, convívio social, trabalho e estudos foram estratégias de enfrentamento para superar a DFSA. Evidenciou-se o desconhecimento da rede intersetorial pelas mulheres e por parte dos profissionais consultados. Destacou-se a falta de adesão ao seguimento ambulatorial, pois desejavam esquecer a DFSA e buscaram assistência em outros serviços. Reconheceram que ao falar da DFSA colaborou com a recuperação, que pode levar à conscientização e ajudar outras mulheres. Ao se aprofundar sobre a DFSA, concluise que os profissionais e a enfermagem necessitam de uma postura livre de préjulgamentos, proporcionar conforto e apoio emocional para a recuperação dessas mulheres.

Abstract: Sexual abuse while perpetrated under the effect of chemical substances is called Drug-Facilitated Sexual Assault (DFSA). The following research questions evolved: What is the profile of women who suffered drug-facilitated sexual assault? What is the experience of women who lived drug-facilitated sexual assault? It objectified: to profile women who underwent DFSA, assisted at a reference hospital in Paraná State, Brazil, between 2010 and 2019; to apprehend the perception of women assisted at a reference hospital in Paraná State on their lived experience of DFSA. It is a research study which made use of two methodological approaches. The first objective used a crosscut, descriptive and quantitative approach by means of 342 data from the individual report form. The second objective used a qualitative approach, by means of interviews with 18 women who underwent DFSA, and data were analyzed under Bardin's thematic analysis, supported by the webQDA software. Thus, three categories emerged: Context where the DFSA took place; The search for help after the DFSA; and Difficulties and coping strategies after undergoing the DFSA.342 DFSA reports were identified between 18 and 62 years, prevalence of 53.3% between 20 and 29 years; 75% were Caucasian; 28% were high-school graduates, and 26% were higher-education graduates; 39% worked, 22% were students and 74.8% were single. For 62%, the DFSA occurred during the weekend; 47% during the early hours of morning; 38% at residences, and 27% in public settings. In the reference hospital, 82% took medication for Sexually Transmitted Diseases (STDs), 79% took hepatitis B vaccine; 74%, emergency contraceptives; and 65% reported the DFSA and biological collection was conducted. In the interviews, alcohol was the most reported chemical substance, and suspicion of secretly administered drugs in their drinks. The DFSA occurred in relaxing environments, among acquaintances, losing their conscience and recovering it after the DFSA in parties or residences. The DFSA caused negative feelings of fear, shame and guilt, associated with alcohol ingestion. They searched for formal and informal support in order to reduce the outcomes for their mental and physical health. Their fear of getting STDs made them turn to help, and there was lack of knowledge and barriers to access the intersectoral network and reference hospital. The first contact with the reference hospital evolved in a positive experience, and nursing care stood out. Difficulties were evidenced to overcome what they had experienced, unfolding social withdrawal and phobia, thus, recognizing that they needed psychological therapy. The informal support, sexual-affective relationships, social interaction, work and studies were coping strategies to get over the DFSA. The lack of knowledge about the intersectoral network by the women and the consulted professionals was evidenced. Lack of adherence to outpatient follow-up stood out because they wanted to forget the DFSA and searched other services for support. They recognized that talking about the DFSA helped their recovery, which may lead to awareness and help other women. Going deeper into the DFSA, it was concluded that professionals and nursing professionals require a non-judgemental attitude, providing comfort and emotional support for the women's recovery.

Sleep and Depressive Symptoms in the Morningness/Eveningness-Suicidal Ideation Relationship Depend on School Shift in Mexican Adolescents.

The aim was to analyze the morningness/eveningness (M/E) effect on suicidal ideation through sleep and depressive symptoms mediators with school shift (i.e., morning and afternoon) as moderator. In this study, 586 Mexican adolescents, with a mean age of 16.31 ± 0.92, from a public high school in a double-shift school system (298 from the morning shift and 288 from the afternoon shift) participated. Measurements of sleep, morningness/eveningness (circadian preference), depressive symptomology, and suicidal ideation were completed. Adolescents in the afternoon shift reported a later rise time, bedtime, greater time in bed sleep length, and less social jet lag than in the morning shift. Considering the moderated-mediated analysis, circadian preference and suicidal ideation were mediated by both depressive symptoms and school day's sleep length in the morning shift. In the afternoon shift, no mediation effect was significant. When weekend sleep length was considered in the model, only depressive symptoms had a mediating effect between circadian preference and suicidal ideation in the morning shift; no significant mediating effect was found on the afternoon shift. The results suggest that an afternoon school schedule may act as a protective factor for the adolescent's mental health and may represent a viable option for future interventions.

Nutrient composition of mealtimes and its association with the energy intake of subsequent meals among Mexican adults.

The composition of the diet influences energy intake by affecting satiety. Macronutrients have a hierarchical effect on satiety, where proteins have the greatest influence, followed by carbohydrates and fats. Alcohol consumption has also shown an effect on increasing energy intake in subsequent meals. Most of this evidence comes from studies under controlled conditions but, it is not clear if effects of diet composition are maintained or counteracted by other determinants of EI in real life. In this paper, we described the diet composition by mealtime in a sample of free-living Mexican adults, as well as evaluated its association with the energy intake in subsequent meals between- and within-subjects. We used information from a national cross-sectional survey of the urban Mexican population. Dietary information was collected by an automated multiple-pass 24-h recall and all participants had information from three non-consecutive days (two weekdays and one weekend). We analyzed information from adults from 20 years and older and used mixed-effects hybrid models that isolate the intra-subject, from the between-subject associations using a substitution approach. We found that alcohol and added sugars were associated with an increased EI between- and within-subjects, while fiber was associated with a decreased EI in subsequent meals within-subjects. Between-subjects, the higher intake of proteins was associated with a decrease in EI, whereas carbohydrates were associated with an increased EI in subsequent meals. We concluded that the composition of the diet at one mealtime predicted EI in subsequent meals of free-living subjects. Understanding the effects of diet composition could guide strategies to reduce EI and obesity prevention.

Are the Parents' and Their Children's Physical Activity and Mode of Commuting Associated? Analysis by Gender and Age Group.

BACKGROUND: Some studies have reported a positive parent-child association between physical activity (PA), but few have examined the difference in these associations concerning both genders. The objective of this study was to establish the association between moderate to vigorous physical activity (MVPA) and mode of commuting (MC) of the parents with their children by gender and age group. METHODS: This cross-sectional study included 686 mothers and fathers (43.4 ± 6.5 years old) and their children (children 9.7 ± 1.7 y. and adolescents 14.0 ± 1.7 y.). Each participant completed a questionnaire on PA and MC. Chi-square test, odds ratio for categorical variables, and lineal regressions for continuous variables were used to examine the parent-child associations. RESULTS: An inverse association was found between fathers-children in the weekend MVPA in children and between mothers-adolescents in out-of-school and weekend MVPA. An inverse association was found in MVPA between mothers-girls, and the different parents' MC to work was positively associated with the MC to school in children and adolescents except for the association AC parents-adolescents. The AC was mainly associated between mothers and girls and boys. CONCLUSIONS: A weak association in parent-child MVPA but a strong association in MC between parent-child was found.

Tempo de prática de atividade física de intensidade moderada a vigorosa e marcadores de síndrome metabólica em adolescentes / Time of practice of moderate to vigorous physical activity and markers of metabolic syndrome in adolescents

Intervenções envolvendo aumento da atividade física em adolescentes mostram-se promissoras em relação à redução de fatores de risco para a síndrome metabólica (SM). Entretanto, ainda não está bem estabelecido o efeito decorrente do acúmulo da atividade física nos dias de semana, final de semana e total. O objetivo do presente estudo foi verificar a correlação da prática de atividade física de intensidade moderada à vigorosa (AFMV), nos dias de semana (AFMV-DS), final de semana (AFMV-FS) e total (AFMV-T), com a SM e seus fatores. Foram avaliados 109 adolescentes de 10 a 16 anos de idade (66% do sexo feminino). A SM foi definida pelos marcadores: circunferência da cintura (CC), pressão arterial (PA), triglicérides, HDL-C e glicemia em jejum. O tempo em AFMV foi mensurada por acelerômetros ActiGraph modelo GT3X (≥ 4 dias de uso, sendo ≥ 1 de final de semana, ≥ 10 horas/dia de uso). O coeficiente de correlação de Spearman foi utilizado para a verificação da associação entre o escore "z" da prática de atividade física (AFMV-DS, AFMV-FS e AFMV-T) com o escore de cada fator da SM e o escore de SM (média dos fatores da SM). Foi verificada correlação inversa entre AFMV-FS e CC (rho = -0,20), PA sistólica (rho = -019) e SM (rho = -0,20). A AFMV-T apresentou correlação inversa com triglicerídeos (rho = -0,19). As magnitudes das correlações revelam pouco ou nenhum efeito. Conclui-se que de forma geral a AFMV parece apresentar pouca correlação com a SM e seus fatores, mas pode ter alguma contribuição em estratégias multifatoriais de tratamento ou prevenção

Interventions involving increased physical activity in adolescents are promising in terms of reducing risk factors for metabolic syndrome (MS). However, is not well established the effect resulting from the accumula-tion of physical activity on weekdays, weekends and total. The objective of the present study was to verify the correlation between moderate-to-vigorous physical activity (MVPA), on weekdays (MVPA-WD), weekend days (MVPA-WE) and total (MVPA-T), with SM and its factors. 109 adolescents aged 10 to 16 years (66% female) were evaluated. MS was defined by the markers: waist circumference ( WC), blood pressure (BP), triglycerides, HDL-C and fasting blood glucose. MVPA time was measured by ActiGraph accelerators model GT3X (≥ 4 days of use, ≥ 1 at the weekend, ≥ 10 hours/day of use). Spearman's correlation coefficient was used to verify the association between the "z" score of physical activity (MVPA-WD, MVPA-WE and MVPA-T) with the "z" score of each of the SM factors and the SM score (mean of SM factors). An inverse correlation was found between MVPA-WE and WC (rho = -0.20), systolic BP (rho = -019) and SM (rho = -0.20). MVPA-T showed an inverse correlation with triglycerides (rho = -0.19). The magnitudes of the cor-relations reveal little or no effect. It is concluded that, in general, MVPA seems to have little correlation with MS and its factors, but it could have some contribution in multifactorial treatment strategies or prevention

Effect of the day and the number of days of application on reproducibility of a questionnaire to assess the food intake in schoolchildren. / Efeito do dia e do número de dias de aplicação na reprodutibilidade de um questionário de avaliação do consumo alimentar de escolares.

INTRODUCTION: The Food Intake and Physical Activity of School Children (Web-CAAFE) is an online questionnaire developed to monitor the diet and physical activity of Brazilian schoolchildren. The study aimed to evaluate the effect of the day of the week and the number of applications on Web-CAAFE reproducibility. METHODS: Schoolchildren in grades 2 to 5 of two municipal schools in Florianópolis (n = 197) filled out the Web-CAAFE twice in the same day, of which 113 filled out the instrument in three non-consecutive days. The analysis was performed using the intraclass correlation (ICC) and logistic regression was used to evaluate the factors associated with poor reproducibility. RESULTS: The reproducibility of the questionnaire was significantly lower for children who filled out their consumption mostly on weekends in relation to weekdays (OR = 2.93; p = 0.045), and was significantly better in girls in relation to boys (OR = 0.29; p< 0.001). Higher CCI was observed on the second and third day of Web-CAAFE application in relation to the first day. These results are relevant for planning future studies that use dietary assessment instruments in children, especially on evaluation of their validity and reproducibility. CONCLUSIONS: The results suggest that at least two days provides acceptable reproducibility results of the Web-CAAFE and that the weekend recall may reduce the reproducibility.

Weekend admissions with ascites are associated with delayed paracentesis: A nationwide analysis of the 'weekend effect'.

INTRODUCTION AND OBJECTIVES: Weekend admissions has previously been associated with worse outcomes in conditions requiring specialists. Our study aimed to determine in-hospital outcomes in patients with ascites admitted over the weekends versus weekdays. Time to paracentesis from admission was studied as current guidelines recommend paracentesis within 24h for all patients admitted with worsening ascites or signs and symptoms of sepsis/hepatic encephalopathy (HE). PATIENTS: We analyzed 70 million discharges from the 2005-2014 National Inpatient Sample to include all adult patients admitted non-electively for ascites, spontaneous bacterial peritonitis (SBP), and HE with ascites with cirrhosis as a secondary diagnosis. The outcomes were in-hospital mortality, complication rates, and resource utilization. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models. RESULTS: Out of the total 195,083 ascites/SBP/HE-related hospitalizations, 47,383 (24.2%) occurred on weekends. Weekend group had a higher number of patients on Medicare and had higher comorbidity burden. There was no difference in mortality rate, total complication rates, length of stay or total hospitalization charges between the patients admitted on the weekend or weekdays. However, patients admitted over the weekends were less likely to undergo paracentesis (OR 0.89) and paracentesis within 24h of admission (OR 0.71). The mean time to paracentesis was 2.96 days for weekend admissions vs. 2.73 days for weekday admissions. CONCLUSIONS: We observed a statistically significant "weekend effect" in the duration to undergo paracentesis in patients with ascites/SBP/HE-related hospitalizations. However, it did not affect the patient's length of stay, hospitalization charges, and in-hospital mortality.

Short Sleep Duration and Extremely Delayed Chronotypes in Uruguayan Youth: The Role of School Start Times and Social Constraints.

During adolescence, biological, psychosocial, and contextual factors converge in a "perfect storm" and have been put forward to explain the delay in chronotype observed at this age and the prevalence of disrupted sleep. This study provides evidence to support that chronotype and sleep patterns (particularly sleep duration) are socially constrained and to identify novel significant social predictors. Uruguayan public school activities are arranged in up to 4 shifts, creating a natural experiment to examine the effect of school timing on questionnaire-based assessments of sleep and chronotype. In this study, 268 high school students (15-18 years old) who attended school either on morning (0730 to 1130 h) or afternoon shifts (1130 h to 1530 h) responded to an adapted School Sleep Habits Survey. Students attending afternoon shifts had later chronotypes (a 1.5-h later midpoint of sleep on free days adjusted for sleep debt) than those attending the morning shift. Besides shift, evening social activities (including dinner time) were further identified as key predictors of late chronotypes, whereas age and gender were not. Sleep on school days was overall advanced and reduced with respect to weekends, and these effects were stronger in morning-shift students. Weekend sleep duration was similar between shifts, which probably caused the prevalence of reduced sleep durations (average weekly sleep duration, SDweek <8 h) to be higher in morning-shift students (almost 80%) than in afternoon-shift ones (34%). Reduced sleep duration was significantly higher in morning-shift students. In addition, age, chronotype, and dinner time became relevant determinants of sleep deficit only in the morning-shift students. Besides the important social constraint of early school start time, this is the first study to confirm the significance of other types of social pressures on both adolescents' chronotype and sleep deficit, which can be useful as potential new targets for effective policies to protect adolescent sleep.

Impact of physical activity during weekdays and weekends on fat mass among adults: 12-month cohort study

ABSTRACT BACKGROUND: Physical activity (PA) practices seem to differ between weekdays and weekends and these pattern changes can affect body fat differently. However, previous studies did not assess the mediation effect of weekday and weekend PA on maintenance of body fat using sophisticated statistical models. OBJECTIVE: To analyze the mediation effect of PA during weekdays and weekends on maintenance of fat mass over a 12-month follow-up. DESIGN AND SETTING: Longitudinal cohort study (12 months) conducted at a public university in Presidente Prudente, Brazil. METHODS: A sample of 225 adults (117 females) was used. Body fatness and fat mass were assessed using dual-energy X-ray absorptiometry. PA levels were assessed using a pedometer. The statistical analysis consisted of paired-sample t tests, independent-sample t tests, Pearson correlations and mediation models. RESULTS: After 12 months, weekend PA had decreased while body composition indicators remained stable (without changes). The correlation between fat mass at baseline and follow-up was high for both sexes (men: 0.966; women: 0.941; P-value = 0.001 for both). Moreover, PA indices were inversely but moderately related to fat mass at baseline and follow-up. Lastly, weekend PA mediated the association between fat mass at baseline and follow-up (P-value < 0.05) by around 2% and 4%. CONCLUSION: Weekend PA mediated the association between fat mass at baseline and fat mass after one year of follow-up among these adults. Further studies are required to investigate the association between physical activity, body fat and other variables such as dietary patterns and sleep time.

Impact of physical activity during weekdays and weekends on fat mass among adults: 12-month cohort study.

BACKGROUND: Physical activity (PA) practices seem to differ between weekdays and weekends and these pattern changes can affect body fat differently. However, previous studies did not assess the mediation effect of weekday and weekend PA on maintenance of body fat using sophisticated statistical models. OBJECTIVE: To analyze the mediation effect of PA during weekdays and weekends on maintenance of fat mass over a 12-month follow-up. DESIGN AND SETTING: Longitudinal cohort study (12 months) conducted at a public university in Presidente Prudente, Brazil. METHODS: A sample of 225 adults (117 females) was used. Body fatness and fat mass were assessed using dual-energy X-ray absorptiometry. PA levels were assessed using a pedometer. The statistical analysis consisted of paired-sample t tests, independent-sample t tests, Pearson correlations and mediation models. RESULTS: After 12 months, weekend PA had decreased while body composition indicators remained stable (without changes). The correlation between fat mass at baseline and follow-up was high for both sexes (men: 0.966; women: 0.941; P-value = 0.001 for both). Moreover, PA indices were inversely but moderately related to fat mass at baseline and follow-up. Lastly, weekend PA mediated the association between fat mass at baseline and follow-up (P-value < 0.05) by around 2% and 4%. CONCLUSION: Weekend PA mediated the association between fat mass at baseline and fat mass after one year of follow-up among these adults. Further studies are required to investigate the association between physical activity, body fat and other variables such as dietary patterns and sleep time.