Non-regulated aromatic amines in clothing purchased in Spain and Brazil: Screening-level exposure and health impact assessment.

The staggering amount of chemicals in clothes and their harmful effects on human health and the environment have attracted the attention of regulatory agencies and the scientific community worldwide. Azo dyes are synthetic dyestuffs with widespread use in textile industries, currently classified as emerging pollutants of great health concern to consumers. These compounds may release one or more aromatic amines (AAs) after reductive cleavage of their azo bounds. Twenty-two AAs have already been regulated due to their carcinogenic effects. However, since information on their potential toxicity is not currently available, several AAs have not been still regulated by the European Union. Considering this gap, the present study aimed to assess the levels of forty non-regulated AAs in 240 clothing items from Spain and Brazil. The potential impact on the health of vulnerable population groups after dermal exposure to those garments was also evaluated. In Brazil, at least one AA was detected in the clothes, while in samples obtained in Spain, only two of them showed values below the limit of detection for AAs. In 75 clothes, at least one of the measured AAs was higher than the hazardous threshold (30 mg/kg), which can mean risks to human health since these compounds are suspected to be mutagenic. Aniline, the most common AA, showed a high detection rate (82%) in clothes, with significantly higher concentrations in items commercialized in Brazil (0.35 vs. 0.17 mg/kg; p = 0.032). Moreover, o-aminobenzenesulfonic and p-phenylenediamine, suspected mutagenic, were found at relevant concentrations in several clothes, mainly made of synthetic fibers. In this study, the hazard index associated with exposure to AAs through clothing was low (0.006-0.13) for all the population groups of both countries in the medium-bound scenario. However, its value was close to 1 for Brazilian pregnant women (0.998) when the maximum concentration value was considered under an upper-bound scenario. The risk of exposure to non-regulated AAs may be underestimated since only dermal exposure was considered for risk assessment. Moreover, the co-occurrence of other carcinogenic and non-carcinogenic substances present in skin-contact clothes should mean an additional source of potential risk.

Doenças crônicas não transmissíveis e seus fatores de risco na população beneficiária do Programa Bolsa Família: uma revisão integrativa / Chronic non-communicable diseases and their risk factors in the bolsa família program beneficiary population: an integrative review / Enfermedades crónicas no transmisibles y sus factores de riesgo en la población que se beneficia del programa bolsa família: una revisión integradora

Objetivo: sintetizar as evidências científicas sobre a ocorrência de doenças crônicas não transmissíveis (DCNT) e seus fatores de risco (FR) na população beneficiária do Programa Bolsa Família (PBF). Métodos: trata-se de uma revisão integrativa da literatura, cuja busca por publicações de 2004 a 2020 foi feita nas seguintes bases de dados: Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS) e Indice Bibliográico Español en Ciencias de la Salud (IBECS), via Biblioteca Virtual da Saúde (BVS); Medline, via Pubmed, SCOPUS (via Portal CAPES); e Scientific Electronic Library Online - SciELO. Resultados: foram selecionados 23 artigos, os quais foram agrupados em três categorias: 1) Prevalência dos fatores de risco para DCNT em mulheres beneficiárias do PBF: as mulheres beneficiárias apresentaram piores desfechos no consumo de tabaco, menor prática de atividade física, maior prevalência de diabetes, hipertensão e obesidade; 2) Estado nutricional e insegurança alimentar em crianças, adolescentes e famílias beneficiárias do PBF: os estudos apontaram para uma elevada prevalência de obesidade e coexistência de déficit estatural em crianças beneficiárias; e 3) Consumo alimentar de beneficiários do PBF: foi identificado um padrão não saudável de alimentação. Conclusão: usuários do PBF apresentam elevadas prevalências de fatores de risco para doenças crônicas não transmissíveis e pior padrão alimentar. Esses dados reforçam a importância de o PBF estar sendo direcionado às populações mais vulneráveis, visando mitigar as imensas desigualdades sociais. No entanto, é necessário avançar em outras políticas públicas de proteção social que impactem os determinantes sociais e melhorem a qualidade de vida de extensa camada da população brasileira.(AU)

occurrence and their risk factors (RF) in the Bolsa Família Program (BFP) beneficiary population. Methods: this is an integrative literature review whose search for publications from 2004 to 2020 was carried out in the following databases: Latin American and Caribbean Literature in Health Sciences (LILACS) and Indice Bibliográico Español en Ciencias de la Salud (IBECS), via the Virtual Health Library (VHL); Medline, via Pubmed, Scopus (via Portal CAPES); and Scientific Electronic Library Online - SciELO. Results: 23 articles were selected and grouped into three categories: 1) Prevalence of risk factors for NCDs in BFP beneficiary women: beneficiary women had worse outcomes in tobacco consumption, lower physical activity, higher prevalence of diabetes, hypertension, and obesity; 2) Nutritional status and food insecurity in BFP beneficiary children, adolescents and families: the studies pointed to a high prevalence of obesity and coexistence of height deficit in beneficiary children; and 3) Food consumption of BFP beneficiaries: an unhealthy eating pattern was identified. Conclusion: BFP users have a high prevalence of risk factors for chronic non-communicable diseases and worse dietary patterns. These data reinforce the importance of the BFP being directed to the most vulnerable populations, aiming to mitigate the immense social inequalities. However, it is necessary to advance other public policies of social protection that impact the social determinants and improve the life quality of a large part of the Brazilian population.(AU)

Objetivo: sintetizar evidencias científicas sobre la ocurrencia de enfermedades crónicas no transmisibles (ECNT) y sus factores de riesgo (FR) en la población beneficiaria del Programa Bolsa Familia (PBF). Método: se trata de una revisión bibliográfica integradora, cuya búsqueda de publicaciones entre 2004 y 2020 fue realizada en las bases de datos Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) e Índice Bibliográfico Español en Ciencias de la Salud (IBECS) a través de la Biblioteca Virtual en Salud (BVS), Medline a través del Pubmed, Scopus (vía Portal CAPES) y Scientific Electronic Library Online - SciELO...(AU)

Intervención y familias migrantes: análisis crítico de la «vulnerabilidad¼ desde los/las profesionales / Intervention and migrant families: critical analysis of "vulnerability" from professionals / Intervenção e famílias migrantes: análise crítica da "vulnerabilidade" dos profissionais

Resumen (analítico) Se indagan los significados que adquiere la noción de vulnerabilidad en la intervención social con familias migrantes en Santiago de Chile en relación con el sistema de xenofobia y racismo imperante. Se llevó a cabo una investigación cualitativa usando entrevistas semiestructuradas y un análisis de contenido, en una muestra de diez profesionales del ámbito psicosocial que trabajan con población migrante en la región metropolitana de Chile. Los resultados revelan cómo desde la intervención social se construye una noción de sujeto migrante asociado a la vulnerabilidad, en donde la matriz xenófoba y racista agudiza las dinámicas de exclusión. Asimismo, se desprenden valoraciones moralistas negativas sobre el ejercicio parental, una sobreculturalización de sus prácticas de cuidados y la verificación de formas sutiles de control, disciplinamiento y normalización de las familias migrantes.

Abstract (analytical) This paper analyzes the meanings that the notion of vulnerability acquires in social interventions with migrant families in Santiago de Chile in relation to a system that has high levels of xenophobia and racism. Qualitative research was carried out using semi-structured interviews and content analysis in a sample consisting of 10 professionals from the psychosocial field who work with the migrant population in the Metropolitan Region of Chile. The results reveal how the social intervention constructs a notion of a migrant subject strongly associated with vulnerability in which the xenophobic and racist matrix exacerbates the dynamics of exclusion. In addition, negative evaluations are expressed by participants in the study about parental practices, an over-culturalization of their care practices and the verification of subtle forms of control, discipline and normalization of migrant families.

Resumo (analítico) O artigo investiga os sentidos adquiridos pela noção de vulnerabilidade na intervenção social com famílias migrantes em Santiago do Chile em relação ao sistema vigente de xenofobia e racismo. Realizou-se uma pesquisa qualitativa por meio de entrevistas semiestruturadas e análise de conteúdo, em uma amostra composta por 10 profissionais da área psicossocial que atuam com a população migrante na Região Metropolitana do Chile. Os resultados revelam como, a partir da intervenção social, se constrói uma noção de sujeito migrante irredutivelmente associado à vulnerabilidade, onde a matriz xenófoba e racista exacerba a dinâmica da exclusão. Além disso. avaliações moralistas negativas são emitidas sobre o exercício parental, uma superculturalização de suas práticas de cuidado e a verificação de formas sutis de cuidar. derivado, controle, disciplina e normalização das famílias migrantes.

Disparities in Excess Mortality Between Indigenous and Non-Indigenous Brazilians in 2020: Measuring the Effects of the COVID-19 Pandemic.

This study aimed to estimate the number of excess deaths among Indigenous Peoples associated with the COVID-19 pandemic in 2020 and to assess the disparities in excess mortality between Indigenous and non-Indigenous Brazilians. A time series analysis of weekly mortality data including all deaths from January 2015 to December 2020 was conducted. The number of expected deaths for 2020 was estimated using an over-dispersed Poisson model that accounts for demographic changes, temporal trends, and seasonal effects in mortality. Weekly excess deaths were calculated as the difference between the number of observed deaths and the expected deaths. Regional differences in Indigenous mortality were investigated. A significant increase in Indigenous mortality was observed from April 1 to December 31, 2020. An estimated 1149 (95% CI 1018-1281) excess deaths was found among Indigenous Brazilians in 2020, representing a 34.8% increase from the expected deaths for this population. The overall increase in non-Indigenous mortality was 18.1%. The Indigenous population living in the Brazilian Amazon area was the earliest-affected Indigenous group, with one of the highest proportional increases in mortality. Disparities in excess mortality revealed a disproportionate burden of COVID-19 among Indigenous Brazilians compared to their non-Indigenous counterparts. Findings highlight the importance of implementing an effective emergency plan that addresses the increased vulnerability of Indigenous Peoples to COVID-19.

Occupational Stress and Mental Health Among Healthcare Workers Serving Socially Vulnerable Populations During the COVID-19 Pandemic.

The purpose of this study was to analyze occupational and personal stressors, mental health indicators, perceived discrimination and help-seeking behaviors among healthcare workers and providers (HCWPs) serving socially vulnerable groups such as immigrants, refugees, farmworkers, homeless individuals, people living in poverty, and other disadvantaged populations in the United States (U.S.) during the COVID-19 pandemic. Using a cross-sectional descriptive approach, we gathered information between July and September 2020, from a sample of 407 affiliates of two national organizations of clinic-based HCWPs who worked at federally funded and community safety-net clinics. Informed consent was obtained from all participants who completed a self-administered online survey available in English and Spanish. Our results indicated that the HCWPs serving vulnerable groups in the midst of the pandemic experienced high levels of occupational and personal stressors as well as anxiety and depressive symptomology. Major occupational stressors were excessive workload, long working-hours, and institutional barriers to refer and follow-up on their clients' access to needed social services. High-rated personal stressors included sleep disorders, lack of and child-care, partner's loosing job, and other family related situations. Our findings suggest that HCWPs working with vulnerable populations need specialized interventions that bolster their mental health and well-being as the pandemic continues to unfold. We recommend implementing initiatives that encourage HCWPs' to be actively involved in clinic decisions regarding employee safety and protection as well as in management decisions to improve work place infrastructure and capacity to respond to the social needs of their clients. Lessons learned from the pandemic are useful tools in designing protocols for addressing the mental-health needs of HCWPs in health-care organizations that attend to socially underprivileged populations.

Manejo nutricional de pacientes con infección por Covid-19 en la Unidad Técnica de Nutrición del Hospital de Especialidades Carlos Andrade Marín / Nutritional management of patients with Covid-19 infection in the Technical Nutrition Unit of the Carlos Andrade Marín Specialties Hospital

La aparición del coronavirus tipo 2 del Síndrome Respiratorio Agudo grave (SARS-CoV-2) y su afectación como nuevo Coronavirus de 2019 (Covid-19), ha sido sorprendente por su rápido contagio y progresión de la enfermedad. Todos los grupos etarios pueden ser afectados, pero la población vulnerable es aquella que tiene más de 50 años, inmunosupresión, malnutridos o enfermedades degenerativas no transmisibles como hipertensión, diabetes y enfermedades pulmonares. Aquellos pacientes con múltiples morbilidades se encuentran asociados a procesos de malnutrición y son ellos los que podrían llegar a desarrollar complicaciones por la enfermedad y necesitar de cuidados intensivos1. El correcto manejo del estado nutricional busca prevenir el riesgo de complicaciones relacionadas con el déficit calórico proteico y el aumento de la actividad catabólica; la bibliografía detalla cómo la malnutrición genera compromiso al disminuir la musculatura respiratoria, cardíaca, esquelética y coadyuvar a la falla orgánica. El reto para la nutrición en esta pandemia es poder identificar a la población en riesgo y crear un soporte nutricional adecuado para cada paciente2. Las guías de manejo proporcionan recomendaciones útiles y rápidas para el diagnóstico y tratamiento nutrioterapéutico especializado.

The emergence of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), and its affectation as the new Coronavirus of 2019 (Covid- 19), has been surprising due to its rapid transmission and disease progression. All age groups can be affected, but the vulnerable population is those over 50 years of age, immunosuppression, malnourished or non-communicable degenerative diseases such as hypertension, diabetes and pulmonary diseases. Those patients with multiple morbidities are associated with malnutrition processes and they are the ones who could develop complications due to the disease and require intensive care1. The correct management of nutritional status seeks to prevent the risk of complications related to protein caloric deficit and increased catabolic activity; the literature details how malnutrition generates compromise by decreasing respiratory, cardiac and skeletal muscle and contributing to organ failure. The challenge for nutrition in this pandemic is to identify the population at risk and create adequate nutritional support for each patient2. Management guidelines provide useful and rapid recommendations for diagnosis and specialized nutriotherapeutic treatment.

Differences in Social Determinants of Health between Urban Indigenous Migrants and Non-Indigenous People in North-Eastern Mexico: An Analysis to Prioritize.

The degree to which social determinants of health differ between indigenous migrants and non-indigenous people born and raised locally is currently unknown. We compared social determinants of health between indigenous migrants and non-indigenous people from urban north-eastern Mexico. Additionally, we ranked priorities for addressing the negative social determinants of health. This was a population-based comparative cross-sectional study (n = 235 indigenous migrants and 168 non-indigenous people). A two-stage non-random sampling was carried out from June to August of 2019. Heads of households ≥18 years and those with the ability to communicate in Spanish were recruited house by house. Structural and intermediary determinants of health were identified according to the World Health Organization Conceptual Framework and priorities were ranked using Z-scores. Being a migrant indigenous increased 1.6 times the odds of low education (95% CI = 1.1, 2.4). In addition, the migrant indigenous status increased the odds of poor housing, unhealthy behaviour and low social cohesion (p < 0.05). Housing, behaviours and health service accessibility were top priorities for indigenous migrants and structural determinants for non-indigenous people. The findings show that the right to access the social determinants of health has not yet been guaranteed for indigenous communities.

The electronic nose as a rule-out test for tuberculosis in an indigenous population.

INTRODUCTION: To end the tuberculosis (TB) epidemic, efficient diagnostic tools are needed. In a previous calibration study, a portable 'point of care' electronic nose device (AeonoseTM ) proved to be a promising tool in a hospital setting. We evaluated this technology to detect TB in an indigenous population in Paraguay. METHODS: A total of 131 participants were enrolled. eNose results were compared with anamnesis, physical examinations, chest radiography and mycobacterial cultures in individuals with signs and symptoms compatible with TB. The eNose analysis was performed in two stages: first, the training with a combination of a previous study population plus 47 participants from the new cohort (total n = 153), and second, the 'blind prediction' of 84 participants. RESULTS: 21% of all participants (n = 131) showed symptoms and/or chest radiography abnormalities suspicious of TB. No sputum samples resulted culture positive for Mycobacterium tuberculosis complex. Only one patient had a positive smell print analysis. In the training model, the specificity was 92% (95% confidence interval (CI): 85%-96%) and the negative predictive value (NPV) was 95%. In the blind prediction model, the specificity and the NPV were 99% (95% CI: 93%-99%) and 100%, respectively. Although the sensitivity and positive predictive value of the eNose could not be assessed in this cohort due to the small sample size, no active TB cases were found during a one year of follow-up period. CONCLUSION: The eNose showed promising specificity and negative predictive value and might therefore be developed as a rule-out test for TB in vulnerable populations.

Renin Angiotensin System (RAS) and Immune System Profile in Specific Subgroups with COVID-19.

BACKGROUND: The identification of vulnerable subgroups and risk factors associated with the susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) infection and coronavirus disease 2019 (COVID-19) is of utmost importance in a pandemic scenario. Potential interactions between renin-angiotensin system (RAS), immune markers and COVID-19 play a role in disease outcome in specific groups of patients. OBJECTIVE: This review aimed to describe the particularities of the RAS and the immune system profile of particular subgroups of patients. METHODS: This non-systematic review summarizes evidence on SARS-CoV-2 infection in specific subgroups of patients and possible relationships between immune system, RAS and the pathophysiology of COVID-19. RESULTS: The RAS and the immune system exert a role in the pathogenesis and prognosis of COVID-19, mainly in cases of hypertension, diabetes, obesity and other chronic diseases. The overactivation of the ACE/Ang II/AT1R axis and the enhancement of inflammation contribute to deleterious effects of COVID-19. Likewise, pregnant women and elderly patients usually display immune responses that are less effective in withstanding exposition to viruses, while children are relatively protected against severe complications of COVID-19. Women, conversely, exhibit stronger antiviral responses and are less sensitive to the effects of increased Ang II. Future Perspectives: The recognition of vulnerable subgroups and risk factors for disease severity is essential to better understand the pandemic. Precision medicine tools, including proteomics and metabolomics approaches, identified metabolic patterns of the severe form of disease and might be the alternative to diagnose, evaluate and predict the prognosis and the efficiency of therapies.

Programas de Protección Nutricional de la Agenda Venezuela / Nutritional protection programs of the Venezuela Agenda

Venezuela ha pasado a ser un país asimétrico, con grandes desigualdades y la inseguridad alimentaria familiar constituye quizás el problema nutricional más importante. En 1996, se comenzó a implementar la "Agenda Venezuela", la cual tiene un componente de protección social, que incluye 14 programas, para compensar a los grupos de población más desfavorecidos por las medidas económicas. Objetivo. Describir y analizar las fortalezas y debilidades de los programas de la Agenda, más vinculados con la situación nutricional. Materiales y métodos. Se basó en el análisis de informes presentados por los organismos ejecutores, de una encuesta de opinión realizada en Caracas, además de entrevistas a coordinadores de los programas. Se examinaron los programas: alimentos estratégicos, subsidio familiar, alimentación escolar, merienda y comedores escolares, hogares y multihogares de cuidado diario. Resultados. Las debilidades más comunes son: deficiente evaluación y apoyo educativo, escasa cobertura, solapamiento de beneficiarios, problemas de tipo logístico y presupuestario. A pesar de la fuerte inversión de recursos, el déficit nutricional en menores de seis años presenta una tendencia ascendente, lo cual reitera que los problemas nutricionales son multicausales y requieren de políticas sociales integrada, estables en el tiempo y focalizadas en los grupos más vulnerables. Conclusiones. Esta situación obliga a replantearse los programas en función a la pertinencia, factibilidad, costo-eficiencia e impacto y ha reiterado, la necesidad de un proceso de descentralización para otorgar más responsabilidad y poder de decisión a los gobiernos estatales, municipales y a la comunidad organizada y lograr un mayor impacto en la población objetivo y su contexto(AU)

Venezuela has become an asymmetric country, with great inequalities and family food insecurity is perhaps the most important nutritional problem. In 1996, the "Venezuela Agenda" began to be implemented, which has a social protection component, which includes 14 programs, to compensate the most disadvantaged population groups for economic measures. Objective. Describe and analyze the strengths and weaknesses of the Agenda programs, more linked to the nutritional situation. Materials and methods. It was based on the analysis of reports submitted by the executing agencies, an opinion poll conducted in Caracas, as well as interviews with program coordinators. The programs were examined: strategic food, family subsidy, school feeding, snack and school canteens, daily care homes and multi-homes. Results. The most common weaknesses are poor evaluation and educational support, poor coverage, overlapping beneficiaries, logistical and budgetary problems. Despite the strong investment of resources, the nutritional deficit in children under six years of age shows an upward trend, which reiterates that nutritional problems have multiple causes and require integrated social policies, stable over time and focused on the most vulnerable groups. Conclusions. This situation forces us to reconsider the programs based on their relevance, feasibility, cost-efficiency and impact and has reiterated the need for a decentralization process to grant more responsibility and decision-making power to state and municipal governments and to the organized community and achieve a greater impact on the target population and its context(AU)

Análisis comparativo de las pautas del consejo de organizaciones internacionales de ciencias médicas (CIOMS)2016. (Parte 3 de 3) / Comparative analysis of the standards of the council of international organizations of medical sciences (CIOMS)2016. (Part 3 of 3)

El este tercer trabajo se presenta el análisis comparativo de las últimas pautas de CIOMS 2016, realizado por estudiantes de la VI Cohorte de la Maestría en Bioética como parte de la evaluación de la asignatura Bioética e Investigación. En estas pautas se abordan de forma novedosa temas tan importantes como la investigación en grupos vulnerables, en situaciones de desastre y brotes de enfermedades de orden natural o creadas por el hombre e investigaciones con conglomerados, así como la compensación por daños, manejo de datos cuando se utiliza el entorno virtual y herramientas digitales y el conflicto de interés, lo cual proporcionará a los investigadores un aporte en su formación y una rápida adaptación a la nueva propuesta CIOMS(AU)

In this third work, the comparative analysis of the latest CIOMS 2016 guidelines, carried out by students of the VI Cohort of the Master in Bioethics, as part of the evaluation of the subject Bioethics and Research is presented. These guidelines deal in a novel way with important issues such as research in vulnerable groups in situations of disaster and outbreaks of natural or man-made diseases and investigations with clusters, as well as compensation for damages, data management when the virtual environment and digital tools and the conflict of interest are used, which will provide researchers with a contribution in their training and a rapid adaptation to the new CIOMS proposal(AU)

Reflexiones sobre la ética de la investigación en Colombia / Reflections on Ethics of Research in Colombia

Resumen Se reflexiona en torno al diseño normativo que regula la investigación en Colombia y las prácticas de los investigadores desde un enfoque ético, abordando asuntos pro blemáticos en las ciencias de la salud, las ciencias sociales y las disciplinas ambien tales, para concluir que se necesita fortalecer el control del Estado en estos temas, la actualización de la normatividad y una mayor formación de los investigadores y miembros de Comités de Ética en investigación, especialmente en: la protección de los participantes, el cuidado de los animales, los conflictos de interés, el manejo de comunidades y de grupos vulnerables, los protocolos comunitarios, el consentimien to informado, la consulta previa, el cuidado de la biodiversidad y el acceso a recursos genéticos.

Abstract This paper reflects on the normative design, which regulates research in Colombia and the practices of researchers from an ethical approach, by addressing critical issues in the health sciences, social sciences, and environmental disciplines, to conclude that it is necessary to strengthen state control in these issues, the updating of the regulations and greater training of researchers and members of Ethics Committees in research , especially in the protection of participants, animal care, conflicts of interest, the management of communities, and vulnerable groups, community pro tocols, informed consent, prior consultation, biodiversity care, and access to genetic resources.

HIV Prevalence and Associated Factors in Key Groups and General Population Treated at a Health Care Institution in Colombia in 2019: A Cross-Sectional Study.

BACKGROUND: Research conducted on the prevalence of HIV/AIDS and its associated factors among key groups in Colombia is scarce. The few available studies show heterogeneity in their results and increasing trends of infection. This study analyses the prevalence of HIV and associated factors in key groups served at a health care institution in Colombia in 2019. METHODS: We performed a cross-sectional study with the sample comprised of 5771 subjects from the general population, the LGBTI community, sex workers, people who inject drugs and prisoners. The diagnosis was based on a fourth-generation ELISA. Variables related to sociodemographics, healthcare, sexual risk factors and biological measures of infected subjects were analysed. Prevalence and odds ratios were calculated with 95% confidence intervals, and logistic regression models were performed to identify confounding variables and interactions between independent variables using SPSS 25.0. RESULTS: The prevalence of HIV was 0.27% among the general population, 0.53% among sex workers, 0.66% among the homeless, 2.44% among transgender persons, 2.44% among prisoners, 5.36% among men who have sex with men and 7.92% among injection drug users. The explanatory model showed higher prevalence among men, those with higher education levels, those with no health coverage, those who have sex with people from key groups and those with sexually transmitted infections, with some interactions between the latter variables. CONCLUSION: A high prevalence of infection was found in the key groups, while the main explanatory factors for high infection rates were identified. The data show that national and global goals related to controlling HIV have not been achieved mainly in groups that are at a higher risk of obtaining and transmitting it and, paradoxically, also that are excluded from the national health coverage.

Health and Sexual Rights: Design, Development, and Assessment of the Massive Open Online Course on Lesbian, Gay, Bisexual, Transgender, and Intersex Health Promotion in Brazil.

Background: Massive Open Online Courses (MOOCs) are a teaching format with universal access and the potential and viability to be implemented by health professionals. Despite their proven success in providing high-quality continuing education, usage and offerings of this technology are still scarce in Brazil. Materials and Methods: This article describes the development of an online-based education strategy (MOOC) on the topic of health policies aimed at the Lesbian, Gay, Bisexual, Transgender, and Intersex (LGBTI+) population and analyzes its performance and reach after 6 months. Results: This introductory MOOC course on LGBTI+ health included an assortment of multimedia material and consisted of 30 h of autonomous learning activities divided into two modules, with problem-based evaluation strategies. During its 6-month promotion period, the course had a total of 3,000 people enrolled with a completion rate of ∼20%. Conclusions: Results point to a high interest in LGBTI+ health and high demand for training on this topic among health professionals. This was the first course of its kind administered in Brazil. The MOOC format was successful and reliable in enabling the teaching-learning process.

[Non-fatal unintentional injuries in Mexican population: prevalence and associated factors. Ensanut 2018-19]. / Accidentes no fatales en población mexicana, prevalencia y factores asociados. Ensanut 2018-19.

OBJECTIVE: To estimate the prevalence of non-fatal uninten-tional injuries in Mexican population and to analyze individual, environmental and household factors associated with its occurrence. MATERIALS AND METHODS: A cross-sectional study, analyzed the prevalence of unintentional injuries from Encuesta Nacional de Salud y Nutrición (Ensanut 2018-19), which is a nationally representative health survey designed with a probability, stratified and cluster sampling, in three stages. Association with variables of interest was explored using logistic regression analysis. RESULTS: Prevalence of non-fatal unintentional injuries was 4.5% (IC95%: 4.2-4.7), equivalent to 5.6 million people per year. Of them, 22.3% or 1.2 million suffered permanent consequences. Probability of having unintentional injuries was higher in the North and Center regions, as in Mexico City-State of Mexico; in males from 0 to 59 and females of 60 or more years of age, in people living with disabilities and those who self-reported depres-sion symptoms. CONCLUSIONS: Strengthening unintentional injury prevention is necessary and urgent, especially within vulnerable groups of population.

OBJETIVO: Estimar la prevalencia de lesiones accidentales no fatales en población mexicana y analizar los factores individuales, ambientales y del hogar asociados con su ocu-rrencia. MATERIAL Y MÉTODOS: Se analizó la prevalencia de lesiones accidentales a partir de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2018-19, diseñada con un muestreo probabilístico, estratificado y por conglomerados, en tres etapas. Se evaluó mediante regresión logística su asociación con distintas variables independientes. RESULTADOS: La pre-valencia de lesiones accidentales fue de 4.5% (IC95%: 4.2-4.7), equivalente a 5.6 millones de personas. De ellas, 22.3% o 1.2 millones sufrieron consecuencias permanentes en su estado de salud. La posibilidad de tener una lesión accidental fue mayor en región Norte, Centro y Ciudad de México-Estado de México, en hombres de 0 a 59 años, mujeres de 60 o más años, en personas con alguna discapacidad y en quienes reportaron sentir depresión. CONCLUSIONES: Es necesario y urgente reforzar la prevención de lesiones accidentales, especialmente en grupos vulnerables.

População em Situação de Rua: o Papel da Educação Médica ante a Redução de Iniquidades / The Homeless Population: the Role of Medical Education to Reducing Health Disparities

Resumo: Introdução: Compreendendo a abordagem holística de saúde e considerando as desigualdades brasileiras, infere-se a discrepância dos estados de saúde entre grupos sociais, sobretudo no que concerne à população em situação de rua (PSR). Essas pessoas lidam com o desamparo institucionalizado, e a pandemia da Covid-19 expôs ainda mais essa situação. Quanto à formação dos profissionais de saúde, torna-se fundamental a abordagem do tema. Relato de Experiência: Com base na inclusão de experiências de docentes que articulavam ações de integração ensino-serviço com a equipe do Consultório na Rua de Mossoró, bem como a abordagem de temas relacionados às populações mais vulneráveis em eixo longitudinal ao curso, despertou-se o interesse dos discentes do curso de Medicina da Ufersa para ações direcionadas à PSR. Destarte, surge, em 2019, a ação "Saúde nas Ruas", em parceria com o Consultório na Rua, que fornece suporte à PSR em diversos aspectos, com a participação dos alunos do curso de Medicina. A ação, proposta a partir de iniciativa dos próprios alunos, marcou o início do planejamento da inclusão do atendimento a essa população no programa do internato do curso, bem como a criação de um projeto de extensão longitudinal para ações voltadas à PSR. Nesse processo, os discentes puderam imergir na realidade dessa população, e os usuários tiveram autonomia para compartilhar suas experiências e dores. Discussão: Mediante uma formação acadêmica que visa romper com o modelo tecnicista, os estudantes possibilitaram voz à PSR e, compreendendo essas pessoas como sujeitos do processo, refletiram sobre o agir médico na transformação da realidade em que se inserem. Conclusão: O corpo acadêmico participante potencializou em si a empatia e o desejo por uma saúde pública democrática e acessível. Ficou evidente ainda a imprescindibilidade de trabalhar temas específicos sobre populações vulneráveis, com o objetivo de fortalecer a atuação médica como forma de garantir o direito à saúde.

Abstract: Introduction: A clear discrepancy in the health status between social groups in Brazil, particularly the homeless population (HP), can be inferred from the apparent inequalities when considering health from a holistic perspective. The homeless have to deal with institutionalized abandonment, and the COVID-19 pandemic has accentuated this issue. Addressing this theme has become an essential element of the training of health professionals. Experience Report: The interest of medicine students at UFERSA in actions directed at the HP was triggered by teachers' experiences of coordinating service-learning integration actions with the street health care unit in Mossoró, and tackling issues related to the most vulnerable groups throughout the course. In 2019 the "Health on the Streets" action is therefore launched in partnership with the street health care unit, providing support to the HP in several aspects, and involving the participation of the medicine students. The action, proposed based on the students' own initiative, marked the start of the planning for including care for this group in the internship program of the course, as well as the creation of a longitudinal community outreach project for actions with the HP. The students had the opportunity to immerse themselves in the reality of this population, while the users had the autonomy to share their experiences and sufferings. Discussion: Following an academic method that aims to break away from the technicist model, the students gave voice to the HP and, understanding these people as subjects of the process, reflected on the role of medicine in transforming their reality. Conclusion: The academics who participated in this project enhanced their empathy and desire for democratic and accessible public health. It also became evident that tackling specific issues regarding vulnerable groups is indispensable, with a view to strengthening the role of the physician in guaranteeing the right to health.

Recomendaciones nutricionales para pacientes hospitalizados con infección respiratoria grave (IRAG) sospechosa o confirmada por COVID-19 / Nutritional recommendations for hospitalized patients with severe respiratory infection (SARS) suspected or confirmed by COVID-19

Durante estas tres décadas del cuidado continuo de pacientes hospitalizados hemos reconocido la fisiopa-tología de la respuesta metabólica al estrés y la afectación de los enfermos desde la activación molecular de la sepsis, hasta el compromiso hemodinámico y neurológico del shock, ofreciendo soporte nutricional para obtener mejores resultados para la salud y la vida de nuestros pacientes, mediante recomendaciones que han sido comprobadas en poblaciones heterogéneas con diversas presentaciones en la práctica clínica. En esta revisión de la literatura proponemos sugerencias sobre la intervención nutricional en el paciente con SARS-CoV2 o COVID-19

During last three decades of continuous care of hospitalized patients, we have recognized the pathophysiology of the metabolic response to stress and the involvement of patients, from the molecular activation of sepsis to the hemodynamic and neurological involvement of shock, offering nutritional support to obtain better results for the health and life of our patients, through recommendations that have been verified in heterogeneous populations with different presentations in clinical practice. In this literature review we propose suggestions on nutritional intervention in patients with SARS-CoV2 or COVID-19

Accidentes no fatales en población mexicana, prevalencia y factores asociados. Ensanut 2018-19 / Non-fatal unintentional injuries in Mexican population: prevalence and associated factors. Ensanut 2018-19

Resumen Objetivo: Estimar la prevalencia de lesiones accidentales no fatales en población mexicana y analizar los factores individuales, ambientales y del hogar asociados con su ocurrencia. Material y métodos: Se analizó la prevalencia de lesiones accidentales a partir de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2018-19, diseñada con un muestreo probabilístico, estratificado y por conglomerados, en tres etapas. Se evaluó mediante regresión logística su asociación con distintas variables independientes. Resultados: La prevalencia de lesiones accidentales fue de 4.5% (IC95%: 4.2-4.7), equivalente a 5.6 millones de personas. De ellas, 22.3% o 1.2 millones sufrieron consecuencias permanentes en su estado de salud. La posibilidad de tener una lesión accidental fue mayor en región Norte, Centro y Ciudad de México-Estado de México, en hombres de 0 a 59 años, mujeres de 60 o más años, en personas con alguna discapacidad y en quienes reportaron sentir depresión. Conclusión: Es necesario y urgente reforzar la prevención de lesiones accidentales, especialmente en grupos vulnerables.

Abstract Objective: To estimate the prevalence of non-fatal unintentional injuries in Mexican population and to analyze individual, environmental and household factors associated with its occurrence. Materials and methods: A cross-sectional study, analyzed the prevalence of unintentional injuries from Encuesta Nacional de Salud y Nutrición (Ensanut 2018-19), which is a nationally representative health survey designed with a probability, stratified and cluster sampling, in three stages. Association with variables of interest was explored using logistic regression analysis. Results: Prevalence of non-fatal unintentional injuries was 4.5% (IC95%: 4.2-4.7), equivalent to 5.6 million people per year. Of them, 22.3% or 1.2 million suffered permanent consequences. Probability of having unintentional injuries was higher in the North and Center regions, as in Mexico City-State of Mexico; in males from 0 to 59 and females of 60 or more years of age, in people living with disabilities and those who self-reported depression symptoms. Conclusions: Strengthening unintentional injury prevention is necessary and urgent, especially within vulnerable groups of population.

III. THE ROLE OF THE RESEARCH ETHICS COMMITTEES IN THE REGULATION OF PHARMA-SPONSORED STUDIES.

Participants of Pharma-sponsored research are exposed to risks, benefits, and uncertainties that do not occur in other forms of clinical studies. Ethics committees represent the subjects' first line of protection. This responsibility begins with the study review and ends after all study subjects finish the intervention. The objective of this paper is to review the most common controversial issues found in Pharma-sponsored studies. Potential solutions are proposed to prevent or resolve the polemical aspects. However, different challenges will be faced in the near future (e.g., when new therapies reach their late stage of development). All parties involved in research should work together to guarantee the protection of participants, the paramount principle on which clinical investigation is based. Pharma-sponsored research is a crucial driver to develop and implement innovative approaches to improve the informed consent process and the execution of the studies.

III. The role of the Research Ethics Committees in the regulation of Pharma-Sponsored studies

Participants of Pharma-sponsored research are exposed to risks, benefits, and uncertainties that do not occur in other forms of clinical studies. Ethics committees represent the subjects’ first line of protection. This responsibility begins with the study review and ends after all study subjects finish the intervention. The objective of this paper is to review the most common controversial issues found in Pharma-sponsored studies. Potential solutions are proposed to prevent or resolve the polemical aspects. However, different challenges will be faced in the near future (e.g., when new therapies reach their late stage of development). All parties involved in research should work together to guarantee the protection of participants, the paramount principle on which clinical investigation is based. Pharma-sponsored research is a crucial driver to develop and implement innovative approaches to improve the informed consent process and the execution of the studies.