Inequalities in the access to diagnosis and treatment of obstructive sleep apnea in Brazil: a cross-sectional study.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is highly prevalent, and positive airway pressure (PAP) therapy is the primary treatment. This study aimed to assess the diagnostic and PAP treatment resources for OSA within Brazil's Unified Health System and to identify potential inequalities and gaps. METHODS: A structured survey was sent to members of the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine to identify sleep laboratories providing OSA diagnosis and/or treatment within Brazil's Unified Health System. The numbers of centers, care team structure, sleep studies availability, PAP accessibility, and follow-up services were characterized in all 5 Brazilian regions. RESULTS: Forty-seven centers were identified: Midwest (n = 4), Northeast (n = 10), North (n = 3), Southeast (n = 22), and South (n = 8). Most centers (70%) provided both OSA diagnosis and treatment, mainly in capitals and/or metropolises (87%). Ten out of 27 Brazilian Federal Units lacked sleep services for OSA management, with the North having the highest proportion of states without a sleep service (71%). The annual number of diagnostic exams for OSA was 14,932, with significant heterogeneity across regions (Midwest: 240; North: 400; Northeast: 3,564; South: 4,380; Southeast: 6,348). Mean waiting times for diagnosis and treatment were 11 and 8 months, respectively. Only 46% of PAP treatments were publicly funded, making legal injunctions and out-of-pocket expenditure common practices. CONCLUSIONS: This study revealed significant disparities in OSA diagnosis and treatment resources across Brazil, with the North region being particularly underserved. The findings underscore an urgent need for strategies to improve sleep care nationwide. CITATION: Drager LF, Santos RB, Pachito D, Albertini CS, Sert Kuniyoshi FH, Eckeli AL. Inequalities in the access to diagnosis and treatment of obstructive sleep apnea in Brazil: a cross-sectional study. J Clin Sleep Med. 2024;20(5):735-742.

Small rodent communities and their associated damage to wheat-groundnut agriculture systems / Pequenas comunidades de roedores e seus danos associados aos sistemas de agricultura de trigo e amendoim

Rodents can cause significant damage to wheat-groundnut crops in developing countries, as well as to stored produce and infrastructure, affecting food security and income of small-holder farmers. Wheat (Triticum aestivum) and groundnuts (Arachis hypogea) are important cash crops for local farmers in Pakistan. Field experiments were performed to assess the extent of rodent damage to wheat-groundnut crops throughout their growth stages (i.e, germination, flowering/peg formation and maturity) in the agro-ecological zones of Pothwar Plateau, Pakistan. We used a quadrat method to record the number of damaged crop plants. On the basis of the trapping data four rodent species were captured from wheat-groundnut cropping systems which were responsible for causing damage, i.e., lesser bandicoot rat (Bandicota bengalensis) was the main species, followed by the short-tailed mole rat (Nesokia indica), the Indian gerbil (Tatera indica) and the bush rat (Golunda ellioti). In both crops, the maximum damage was recorded at crop maturity (10.7 and 14.4%, respectively). The lowest reported damage to wheat and groundnuts was at the germination stage (3.5% and 6.0%, respectively). The lower damage reported at germination could be due to availability of non-crop vegetation at field borders that may be a potential factor influencing damage. Our findings clearly show the considerable amount of damage caused by rodents to wheat-groundnut at maturity across all the agro-ecological zones of Pothwar and indicated that the small mammal composition was more related to maturity stage/season of crops, when the availability of food and climatic condition were favorable and having security under crop shelter. More detailed studies are needed to fully understand the population and breeding ecology of the relevant rodent pest species in relation to damage patterns to optimize management beyond individual structural measures.

Os roedores podem causar danos significativos às culturas de trigo e amendoim nos países em desenvolvimento, bem como aos produtos armazenados e infraestrutura, afetando a segurança alimentar e a renda dos pequenos agricultores. O trigo (Triticum aestivum) e o amendoim (Arachis hypogea) são culturas comerciais importantes para os agricultores locais no Paquistão. Experimentos de campo foram realizados para avaliar a extensão dos danos de roedores às culturas de trigo e amendoim ao longo de seus estágios de crescimento (ou seja, germinação, floração/formação e maturidade) nas zonas agroecológicas de Pothwar Plateau, Paquistão. Usamos um método de quadrat para registrar o número de plantas de cultura danificadas. Com base nos dados de armadilhagem foram capturadas quatro espécies de roedores de sistemas de cultivo de trigo-amendoim que foram responsáveis ​​por causar danos, ou seja, o rato-bandico-pequeno (Bandicota bengalensis) foi a espécie principal, seguido pelo rato-toupeira-de-cauda-curta (Nesokia indica), o gerbilo-da-índia (Tatera indica) e o rato-do-mato (Golunda ellioti). Em ambas as culturas, o dano máximo foi registrado na maturidade da cultura (10,7 e 14,4%, respectivamente). O menor dano relatado ao trigo e ao amendoim foi no estágio de germinação (3,5% e 6,0%, respectivamente). O menor dano relatado na germinação pode ser devido à disponibilidade de vegetação não cultivada nas bordas do campo, que pode ser um fator potencial que influencia o dano. Nossos resultados mostraram claramente a quantidade considerável de danos causados ​​por roedores ao trigo-amendoim na maturidade em todas as zonas agroecológicas de Pothwar e indicaram que a composição de pequenos mamíferos estava mais relacionada ao estágio de maturidade/estação das culturas quando a disponibilidade de alimentos e as condições climáticas eram favoráveis ​​e com segurança sob abrigo de cultivo. Estudos mais detalhados são necessários para entender completamente a ecologia populacional e reprodutiva das espécies de pragas de roedores relevantes em relação aos padrões de danos para otimizar o manejo, além das medidas estruturais individuais.

Dietary habits of lesser bandicoot rat (Bandicota Bengalensis) in an agro-ecosystem, Pothwar Plateau, Pakistan / Hábitos alimentares de rato bandicoot (Bandicota Bengalensis) em um agroecossistema do Planalto de Pothwar, Paquistão

Abstract Dietary habits of bandicoot rats (bandicota bengalensis) were investigated in the agricultural crops of the Pothwar Plateau, Pakistan by analysing stomach contents. The research activities were conducted in major field crops including wheat-groundnut and in the fallow lands during non-crop season at the field boundaries. The specimens were captured from the fields using kill/snap traps, and dissected to collect their stomach samples for laboratory analysis. Light microscopic slides of the plant material were recovered from stomach samples and the reference materials were collected from the field. Results revealed that the bandicoot rat predominantly fed upon cultivated crops during cropping season but consumed wild vegetation during non-cropping season. There was no significance difference between summer and winter diets. Most frequently consumed crop food items were wheat (Triticum aestivum; 28.57%), groundnut (Arachis hypogea; 11.26%), sorghum (Sorghum bicolor; 10.17%), chickpea (Cicer arietinum; 9.52%), maize (Zea mays; 6.49%), millet (Pennisetum glaucum; 5.84%), barley (Hordeum vulgare; 4.98%) and mustard (Brassica campestris; 4.98%). Among wild vegetation were consumed khbal gha (Cynodon dactylon; 7.79%), baron dhab (Demostachya bipinnata; 7.36%) and Prickly flower (Achyranthes aspera; 3.03%). The study concludes that, in addition to consuming wheat and groundnut crops, the Lesser bandicoot rat also subsists on grasses, weeds, and some fodder crops, as important component of its diet in agro-ecosystem of the Pothwar Plateau.

Resumo Os hábitos alimentares de ratos bandicoot (Bandicota bengalensis) foram investigados nas plantações agrícolas do planalto de Pothwar, Paquistão, por meio da análise do conteúdo estomacal. As atividades da pesquisa foram conduzidas nas principais culturas de campo, incluindo trigo e amendoim, e em terras de pousio durante a estação não agrícola nos limites do campo. Os espécimes foram capturados dos campos usando armadilhas kill/snap e dissecados para coletar suas amostras de estômago para análise laboratorial. Lâminas de microscopia de luz do material vegetal foram recuperadas de amostras de estômago; os materiais de referência foram coletados no campo. Os resultados revelaram que o rato bandicoot alimentava-se predominantemente de culturas cultivadas durante a época de cultivo, mas consumia vegetação selvagem durante a época de não colheita. Não houve diferença significativa entre as dietas de verão e inverno. Os alimentos agrícolas mais frequentemente consumidos foram trigo (Triticum aestivum; 28,57%), amendoim (Arachis hypogea; 11,26%), sorgo (Sorghum bicolor; 10,17%), grão de bico (Cicer arietinum; 9,52%), milho (Zea mays; 6,49%), milheto (Pennisetum glaucum; 5,84%), cevada (Hordeum vulgare; 4,98%) e mostarda (Brassica campestris; 4,98%). Entre a vegetação silvestre foram consumidos khbal gha (Cynodon dactylon; 7,79%), barão dhab (Demostachya bipinnata; 7,36%) e flor espinhosa (Achyranthes aspera; 3,03%). O estudo conclui que, além de consumir culturas de trigo e amendoim, o rato bandicoot pequeno também subsiste de gramíneas, ervas daninhas e algumas culturas forrageiras, componentes importantes de sua dieta no agroecossistema do planalto de Pothwar.

Phylogenetic status and diet of red fox (Vulpes vulpes griffithii) inhabiting Ayubia National Park, Pakistan

Abstract The red fox (Vulpes vulpes) is a medium-sized carnivore that occurs in different regions of Pakistan, however, still lacks scientific data on its ecology and distribution. The current study investigated the phylogenetic status and diet of the red fox (V.v. griffithii) occurring in Ayubia National Park, Pakistan. Through camera trapping and molecular analysis, we confirmed the occurrence of red fox in the study area. Based on mitochondrial cytochrome B (304 bp) and limited sampling, nearly all red foxes of Ayubia National Park and surrounding Himalayan ranges fall within Holarctic maternal lineage, whereas red foxes found in plains of Pakistan are part of the basal Palearctic maternal lineage. Using 32 scats, we found that red fox diet comprises of 80% animal-based prey species (both wild and domestic) and 19% plant matter. The wild animal prey species included Cape hare (Lepus capensis) and flying squirrel (Pteromyini sp.), which constituted 17% and 15% of diet, respectively. Red foxes infrequently consumed House mouse (Mus musculus), Himalayan Palm civet (Paguma larvata) and sheep (Ovis aries), each comprising around 6% to 9% of red fox diet. The fox species also scavenged on domestic donkey opportunistically. Based on our sampling, our study suggests that the red fox (V.v. griffithii) that occurs in Ayubia National Park and across the lesser Himalayan ranges belongs to Holarctic maternal lineage. The study also highlights consumption of plant seeds by red foxes, indicating it may play an important ecological role in seed dispersal in Ayubia National Park.

Resumo A raposa-vermelha (Vulpes vulpes) é um carnívoro de médio porte que ocorre em diferentes regiões do Paquistão, porém ainda carece de dados científicos sobre sua ecologia e distribuição. O presente estudo investigou o status filogenético e a dieta da raposa-vermelha (V.v. griffithii) que ocorre no Parque Nacional de Ayubia, Paquistão. Por meio de armadilhas fotográficas e análises moleculares, confirmamos a ocorrência de raposa-vermelha na área de estudo. Com base no citocromo B mitocondrial (304 bp) e amostragem limitada, quase todas as raposas-vermelhas do Parque Nacional de Ayubia e áreas circundantes do Himalaia se enquadram na linhagem materna holártica, enquanto as raposas-vermelhas encontradas nas planícies do Paquistão fazem parte da linhagem materna basal paleártica. Usando 32 fezes, descobrimos que a dieta da raposa-vermelha compreende 80% de espécies de presas de origem animal (selvagens e domésticas) e 19% de matéria vegetal. As espécies de presas de animais selvagens incluíram a lebre-do-cabo (Lepus capensis) e o esquilo-voador (Pteromyini sp.), que constituíram 17% e 15% da dieta, respectivamente. As raposas-vermelhas consumiam raramente ratos domésticos (Mus musculus), algas do Himalaia (Paguma larvata) e ovelhas (Ovis aries), cada um compreendendo cerca de 6% a 9% da dieta da raposa-vermelha. A espécie de raposa também se alimentava de burros domésticos de forma oportunista. Com base em nossa amostragem, nosso estudo sugere que a raposa-vermelha (V.v. griffithii) que ocorre no Parque Nacional de Ayubia e nas cordilheiras menores do Himalaia pertence à linhagem materna holártica. O estudo também destaca o consumo de sementes de plantas por raposas-vermelhas, indicando que pode desempenhar um papel ecológico importante na dispersão de sementes no Parque Nacional de Ayubia.

Dietary habits of lesser bandicoot rat (Bandicota Bengalensis) in an agro-ecosystem, Pothwar Plateau, Pakistan

Abstract Dietary habits of bandicoot rats (bandicota bengalensis) were investigated in the agricultural crops of the Pothwar Plateau, Pakistan by analysing stomach contents. The research activities were conducted in major field crops including wheat-groundnut and in the fallow lands during non-crop season at the field boundaries. The specimens were captured from the fields using kill/snap traps, and dissected to collect their stomach samples for laboratory analysis. Light microscopic slides of the plant material were recovered from stomach samples and the reference materials were collected from the field. Results revealed that the bandicoot rat predominantly fed upon cultivated crops during cropping season but consumed wild vegetation during non-cropping season. There was no significance difference between summer and winter diets. Most frequently consumed crop food items were wheat (Triticum aestivum; 28.57%), groundnut (Arachis hypogea; 11.26%), sorghum (Sorghum bicolor; 10.17%), chickpea (Cicer arietinum; 9.52%), maize (Zea mays; 6.49%), millet (Pennisetum glaucum; 5.84%), barley (Hordeum vulgare; 4.98%) and mustard (Brassica campestris; 4.98%). Among wild vegetation were consumed khbal gha (Cynodon dactylon; 7.79%), baron dhab (Demostachya bipinnata; 7.36%) and Prickly flower (Achyranthes aspera; 3.03%). The study concludes that, in addition to consuming wheat and groundnut crops, the Lesser bandicoot rat also subsists on grasses, weeds, and some fodder crops, as important component of its diet in agro-ecosystem of the Pothwar Plateau.

Resumo Os hábitos alimentares de ratos bandicoot (Bandicota bengalensis) foram investigados nas plantações agrícolas do planalto de Pothwar, Paquistão, por meio da análise do conteúdo estomacal. As atividades da pesquisa foram conduzidas nas principais culturas de campo, incluindo trigo e amendoim, e em terras de pousio durante a estação não agrícola nos limites do campo. Os espécimes foram capturados dos campos usando armadilhas kill/snap e dissecados para coletar suas amostras de estômago para análise laboratorial. Lâminas de microscopia de luz do material vegetal foram recuperadas de amostras de estômago; os materiais de referência foram coletados no campo. Os resultados revelaram que o rato bandicoot alimentava-se predominantemente de culturas cultivadas durante a época de cultivo, mas consumia vegetação selvagem durante a época de não colheita. Não houve diferença significativa entre as dietas de verão e inverno. Os alimentos agrícolas mais frequentemente consumidos foram trigo (Triticum aestivum; 28,57%), amendoim (Arachis hypogea; 11,26%), sorgo (Sorghum bicolor; 10,17%), grão de bico (Cicer arietinum; 9,52%), milho (Zea mays; 6,49%), milheto (Pennisetum glaucum; 5,84%), cevada (Hordeum vulgare; 4,98%) e mostarda (Brassica campestris; 4,98%). Entre a vegetação silvestre foram consumidos khbal gha (Cynodon dactylon; 7,79%), barão dhab (Demostachya bipinnata; 7,36%) e flor espinhosa (Achyranthes aspera; 3,03%). O estudo conclui que, além de consumir culturas de trigo e amendoim, o rato bandicoot pequeno também subsiste de gramíneas, ervas daninhas e algumas culturas forrageiras, componentes importantes de sua dieta no agroecossistema do planalto de Pothwar.

The importance of applying the statement of assent to children and adolescents: a qualitative study.

OBJECTIVES: To describe the importance of the Statement of Assent for children and adolescents invited to participate in a clinical study and their main reactions to its explanation. METHODS: This is an exploratory descriptive qualitative study of 17 children and adolescents, who were invited to participate in a clinical study in the field of oncology in a hospital located in Rio de Janeiro (Brazil). Data were analyzed using thematic analysis. RESULTS: Two thematic units were generated after data interpretation: signing the statement of assent, in which participants felt their main role when faced with the possibility of expressing their agreement or not to take part in the study; and understanding of the study, when they showed that they understood the steps of the study by asking pertinent questions to clarify their doubts. Children and adolescents understood the steps of the study contained in the Statement of Assent, were interested and asked questions to clarify their doubts about the study. CONCLUSIONS: The Statement of Assent was important for participants understanding the study and having autonomy over their participation. As the statement strengthened the main role of children and adolescents in the research process, the conclusion was that its use in studies involving the pediatric population should be encouraged.

Small rodent communities and their associated damage to wheat-groundnut agriculture systems.

Rodents can cause significant damage to wheat-groundnut crops in developing countries, as well as to stored produce and infrastructure, affecting food security and income of small-holder farmers. Wheat (Triticum aestivum) and groundnuts (Arachis hypogea) are important cash crops for local farmers in Pakistan. Field experiments were performed to assess the extent of rodent damage to wheat-groundnut crops throughout their growth stages (i.e, germination, flowering/peg formation and maturity) in the agro-ecological zones of Pothwar Plateau, Pakistan. We used a quadrat method to record the number of damaged crop plants. On the basis of the trapping data four rodent species were captured from wheat-groundnut cropping systems which were responsible for causing damage, i.e., lesser bandicoot rat (Bandicota bengalensis) was the main species, followed by the short-tailed mole rat (Nesokia indica), the Indian gerbil (Tatera indica) and the bush rat (Golunda ellioti). In both crops, the maximum damage was recorded at crop maturity (10.7 and 14.4%, respectively). The lowest reported damage to wheat and groundnuts was at the germination stage (3.5% and 6.0%, respectively). The lower damage reported at germination could be due to availability of non-crop vegetation at field borders that may be a potential factor influencing damage. Our findings clearly show the considerable amount of damage caused by rodents to wheat-groundnut at maturity across all the agro-ecological zones of Pothwar and indicated that the small mammal composition was more related to maturity stage/season of crops, when the availability of food and climatic condition were favorable and having security under crop shelter. More detailed studies are needed to fully understand the population and breeding ecology of the relevant rodent pest species in relation to damage patterns to optimize management beyond individual structural measures.

The importance of applying the statement of assent to children and adolescents: a qualitative study / La importancia de la aplicación del término de consentimiento para niños y adolescentes: un estudio cualitativo / A importância da aplicação do termo de assentimento para crianças e adolescentes: um estudo qualitativo

Objective. To describe the importance of the Statement of Assent for children and adolescents invited to participate in a clinical study and their main reactions to its explanation. Methods. This is an exploratory descriptive qualitative study of 17 children and adolescents, who were invited to participate in a clinical study in the field of oncology in a hospital located in Rio de Janeiro (Brazil). Data were analyzed using thematic analysis. Results. Two thematic units were generated after data interpretation: signing the statement of assent, in which participants felt their main role when faced with the possibility of expressing their agreement or not to take part in the study; and understanding of the study, when they showed that they understood the steps of the study by asking pertinent questions to clarify their doubts. Children and adolescents understood the steps of the study contained in the Statement of Assent, were interested and asked questions to clarify their doubts about the study. Conclusion. The Statement of Assent was important for participants understanding the study and having autonomy over their participation. As the statement strengthened the main role of children and adolescents in the research process, the conclusion was that its use in studies involving the pediatric population should be encouraged.

Objetivo. describir la importancia del Formulario de Consentimiento Informado para los niños y adolescentes invitados a participar en un estudio clínico aleatorizado y sus principales reacciones a su explicación. Métodos. se trata de una investigación exploratoria descriptiva con abordaje cualitativo, realizada con 17 niños y adolescentes, quienes fueron invitados a participar de un estudio clínico en el área de oncología en un hospital ubicado en Río de Janeiro (Brasil). A los datos se les realizó análisis temático. Resultados. Luego de la interpretación de los datos, se generaron 2 unidades temáticas: la firma del formulario de consentimiento y la comprensión del estudio. Los niños y adolescentes entendieron las etapas del estudio contenidas en la firma del Término de Asentimiento y se interesaron, haciendo preguntas para aclarar sus dudas sobre la investigación. Conclusión. El consentimiento informado era importante para que los participantes entendieran la investigación y tuvieran autonomía sobre su participación. Al potenciar el protagonismo de los niños y adolescentes en el proceso de investigación, recomendamos que debe fomentarse su uso en los estudios con población pediátrica.

Objetivo. Descrever a importância do Termo de Assentimento para crianças e adolescentes convidados a participar de um estudo clínico e suas principais reações quanto à explicação do mesmo. Métodos. Trata-se de uma pesquisa do tipo descritiva exploratória com abordagem qualitativa, realizada com 17 crianças e adolescentes, que foram convidados a participar de um estudo clínico na área da oncologia em um hospital localizado no Rio de Janeiro (Brasil). Os dados foram analisados empregando-se a análise temática. Resultados. Após a interpretação dos dados, foram geradas 2 unidades temáticas: a assinatura do termo de assentimento em que os participantes se sentiram protagonistas frente a possibilidade de expressarem a concordância ou não em participar da pesquisa, e a compreensão sobre o estudo quando elas mostraram que entenderam as etapas do estudo fazendo perguntas pertinentes para esclarecer suas dúvidas. As crianças e adolescentes compreenderam as etapas do estudo que constavam no Termo de Assentimento e tiveram interesse, fazendo perguntas para esclarecer suas dúvidas com relação à pesquisa. Conclusão. O termo de assentimento foi importante para os participantes compreenderem sobre a pesquisa e para terem autonomia sobre sua participação. Por potencializar o protagonismo de crianças e adolescentes no processo de pesquisar conclui-se que seu uso em estudos que envolvem a população pediátrica deve ser incentivado.

Dietary habits of lesser bandicoot rat (Bandicota Bengalensis) in an agro-ecosystem, Pothwar Plateau, Pakistan.

Dietary habits of bandicoot rats (bandicota bengalensis) were investigated in the agricultural crops of the Pothwar Plateau, Pakistan by analysing stomach contents. The research activities were conducted in major field crops including wheat-groundnut and in the fallow lands during non-crop season at the field boundaries. The specimens were captured from the fields using kill/snap traps, and dissected to collect their stomach samples for laboratory analysis. Light microscopic slides of the plant material were recovered from stomach samples and the reference materials were collected from the field. Results revealed that the bandicoot rat predominantly fed upon cultivated crops during cropping season but consumed wild vegetation during non-cropping season. There was no significance difference between summer and winter diets. Most frequently consumed crop food items were wheat (Triticum aestivum; 28.57%), groundnut (Arachis hypogea; 11.26%), sorghum (Sorghum bicolor; 10.17%), chickpea (Cicer arietinum; 9.52%), maize (Zea mays; 6.49%), millet (Pennisetum glaucum; 5.84%), barley (Hordeum vulgare; 4.98%) and mustard (Brassica campestris; 4.98%). Among wild vegetation were consumed khbal gha (Cynodon dactylon; 7.79%), baron dhab (Demostachya bipinnata; 7.36%) and Prickly flower (Achyranthes aspera; 3.03%). The study concludes that, in addition to consuming wheat and groundnut crops, the Lesser bandicoot rat also subsists on grasses, weeds, and some fodder crops, as important component of its diet in agro-ecosystem of the Pothwar Plateau.

Lipotoxicity-associated inflammation is prevented by guarana (Paullinia cupana) in a model of hyperlipidemia.

Hyperlipidemia causes lipotoxicity which prompts an inflammatory response linked to the development of cardiovascular diseases. Natural compounds have been receiving special attention for its potential to treat diseases, inexpensiveness, and safety. Guarana (Paullinia cupana) has demonstrated notable anti-inflammatory and antioxidant effects, which may prevent chronic diseases caused by changes in lipid profile. Thus, this study aims to evaluate the effect of guarana powder (Paullinia cupana) in the purine metabolism and inflammatory profile in lymphocytes and serum of rats with Poloxamer-407-induced hyperlipidemia. Pretreatment with guarana 12.5, 25, and 50 mg/kg/day or caffeine (0.2 mg/kg/day) by gavage was applied to adult male Wistar rats for a period of 30 days. As a comparative standard, we used simvastatin (0.04 mg/kg) post-induction. Hyperlipidemia was acutely induced with intraperitoneally injection of Poloxamer-407 (500 mg/kg). Guarana powder and caffeine increased the activity of the E-NTPDase (ecto-apyrase), and all pretreatments decreased the E-ADA (ecto-adenosine deaminase) activity, reducing the inflammatory process caused by lipotoxicity. In hyperlipidemic rats, ATP levels were increased while adenosine levels were decreased, guarana and caffeine reverted these changes. Guarana powder, caffeine, and simvastatin also prevented the increase in INF-γ and potentiated the increase in IL-4 levels, promoting an anti-inflammatory profile. Guarana promoted a more robust effect than caffeine. Our results show that guarana powder and caffeine have an anti-inflammatory as seen by the shift from a proinflammatory to an anti-inflammatory profile. The effects of guarana were more pronounced, suggesting that guarana powder may be used as a complementary therapy to improve the lipotoxicity-associated inflammation.

Blood cadmium levels and sources of exposure in an adult urban population in southern Brazil.

BACKGROUND: Cadmium (Cd) is a toxic metal that is widely present in the environment due to geologic and anthropogenic sources. Exposures to high Cd levels may cause nephrotoxicity, carcinogenicity, pulmonary and cardiovascular disease, among others. The goal of this study was to investigate in an adult urban population whether an association exists between sources and levels of Cd exposure and blood Cd concentrations. METHODS: Using a census-based design, a total of 959 adults, aged 40 years or older, were randomly selected. Information on socio-demographics, dietary, and lifestyle background was obtained by household interviews. Blood Cd levels were measured by inductively coupled-plasma mass spectrometry. Geometric means (GM) (95% CI) and the 50th percentile were determined, stratified by sex, age, race, education, income class, smoking status, consumption of vegetables, red meat and milk, occupation and blood pressure. To assess the association between Cd exposure and the aforementioned variables, we estimated the geometric mean ratio (GMR) (95%CI) of blood Cd concentrations. RESULTS AND CONCLUSION: The geometric mean (95%CI) of blood Cd levels in the total population was 0.25 (0.22, 0.27) ug/dL. In a univariate analysis, significantly higher blood Cd levels were found in men (p < 0.001), current and former smokers (p < 0.001), alcohol drinkers (p < 0.001), those who never or almost never consumed milk (p < 0.001), and in subjects with higher diastolic blood pressure (p = 0.03). Significant correlations were found between the number of cigarettes consumed daily and blood Cd levels. Multivariate analysis confirmed higher blood Cd concentrations were associated with alcohol consumption (GMR 95%CI = 1.28, 1.04-1.59) and in former and current smokers (GMR 95% IC = 1.33, 1.06-1.67 and 4.23, 3.24-5.52, respectively). Our results shed novel information on variables associated with blood Cd levels in an urban Brazilian population, and should encourage additional research to prevent environmental Cd exposure, both in Brazil and globally.

Thyroid Function and Sarcopenia: Results from the ELSA-Brasil Study.

OBJECTIVES: We aimed to investigate the association of subclinical thyroid disease and thyroid hormone levels with sarcopenia and its defining components in community-dwelling middle-aged and older adults without overt thyroid dysfunction. DESIGN: Cross-sectional study. SETTING: Active and retired employees from public institutions located in six Brazilian cities. PARTICIPANTS: A total of 6974 participants from the ELSA-Brasil study's second wave, aged 50 years and older, without overt thyroid dysfunction and with complete data for exposure, outcome, and covariates. METHODS: Serum levels of thyrotropin (TSH), free thyroxine, and free triiodothyronine (FT3) were measured and divided in quintiles for the analyses. Participants were classified with euthyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism. Muscle mass was assessed by bioelectrical impedance analysis and muscle strength by handgrip strength. Sarcopenia was defined according to the Foundation for the National Institutes of Health criteria. Possible confounders included sociodemographic characteristics, clinical conditions, and lifestyle. Analyses were performed separately for middle-aged and older adults (≥65 y). RESULTS: The frequencies of sarcopenia, low muscle mass, low muscle strength, subclinical hypothyroidism, and subclinical hyperthyroidism were 1.5%, 20.8%, 3.8%, 9.1%, and .9%, respectively. Subclinical thyroid dysfunction was not associated with sarcopenia and its defining components. Among older adults, TSH had a U-shaped association with sarcopenia and low muscle strength. The odds ratios (ORs) (95% confidence intervals [CIs]) for the associations of the first, second, fourth, and fifth quintile with sarcopenia, respectively, were 5.18 (1.47-18.28), 6.28 (1.82-21.73), 4.12 (1.15-14.76), and 4.81 (1.35-17.10), and with low muscle strength was (OR (95% CI) for the first, second, and fifth quintiles, respectively: 1.43 (1.16-5.07), 2.07 (1.24-4.70), and 2.18 (1.03-4.60). Additionally, FT3 had a negative association with muscle mass in both age strata. CONCLUSION: Subtle thyroid hormone alterations are associated with sarcopenia or its defining components in middle-aged and older adults without overt thyroid dysfunction. J Am Geriatr Soc 68:1545-1553, 2020.

Association between diabetes and cognitive function at baseline in the Brazilian Longitudinal Study of Adult Health (ELSA- Brasil).

Diabetes has been associated with cognitive changes and an increased risk of vascular dementia and Alzheimer's disease, but it is unclear whether there are associations between diabetes and early alterations in cognitive performance. The present study consisted of a cross-section analysis of 14,444 participants aged 35-74 years and from a developing country at baseline in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil); these participants were recruited between 2008 and 2010. We investigated whether there was an association between diabetes and early changes in the cognitive performance of this Brazilian population. To assess cognitive domains, we used the word-list learning, word-list delayed recall and word recognition tests along. Phonemic verbal fluency tests included semantic phonemic test (animals) and a phonemic test (words beginning with the letter F). Executive functions associated with attention, concentration and psychomotor speed were evaluated using the Trail Making Test B. The exposure variable in the study was defined as diabetes. Multiple linear regression was used to estimate the association between diabetes and cognitive performance. The results were adjusted for age, sex, education, hypertension, coronary disease, depression, physical activity, smoking, alcohol consumption, and the cholesterol/HDL-C ratio. We found a significant association between diabetes and decreased memory, language and executive function (attention, concentration and psychomotor speed) performance in this population from a country with a distinct epidemiological profile, even after adjusting for the main intervening variables.

Accuracy of Self-Reported Weight Collected Through a Web-Based Platform in a Weight Loss Trial: Validation Study of the POEmaS Clinical Trial.

Self-reported anthropometric data in web-based weight loss interventions may be inaccurate. We studied the agreement between online self-reported and measured weight in the course of the POEmaS randomized controlled trial. Measured weight was not different from reported one (-0.4 kg; 95%CI -0.93 to 0.12). 95.6% of the cases were within the limits of agreement (Bland-Altman method). Self-reported weight collected online was accurate, which suggests that interventions and outcomes assessment can rely on these data.

Laser Acupuncture for Relieving Nausea and Vomiting in Pediatric Patients Undergoing Chemotherapy: A Single-Blind Randomized Clinical Trial.

Nausea and vomiting are frequent side effects associated with chemotherapy treatments. The aim of this study was to evaluate the efficacy of laser acupuncture in relieving nausea and vomiting in children and adolescents undergoing laser treatment. This is an experimental, randomized, single-blind study. The research was carried out at the INCA (Instituto Nacional de Câncer), a reference institution in the control and treatment of cancer, located in the city of Rio de Janeiro, Brazil. The research project was approved by the INCA Research and Ethics Committee under Registration No. 164/14 and CAAE 3374551.0.3001.5274. Children and adolescents between the ages of 6 and 17 years who were undergoing chemotherapy with drugs of high and medium degrees of emetogenic toxicity were selected. The participants were divided into two groups, A and B. In A, the active acupuncture was applied, and in B, the placebo acupuncture was applied. Analysis of the data indicated that there was significant relief from nausea in the intervention group when compared with the placebo group. A decrease in the number of episodes of vomiting on the second and third days of chemotherapy was also observed. On Days 1, 4, and 5, there was no significant difference in the number of episodes of vomiting in the intervention group as compared with the placebo group. The study concluded that laser acupuncture was effective in relieving nausea within 5 days of chemotherapy and in reducing the number of episodes of vomiting on Days 2 and 3 after chemotherapy.

Web-Based Digital Health Interventions for Weight Loss and Lifestyle Habit Changes in Overweight and Obese Adults: Systematic Review and Meta-Analysis.

BACKGROUND: Obesity is a highly prevalent condition with important health implications. Face-to-face interventions to treat obesity demand a large number of human resources and time, generating a great burden to individuals and health system. In this context, the internet is an attractive tool for delivering weight loss programs due to anonymity, 24-hour-accessibility, scalability, and reachability associated with Web-based programs. OBJECTIVE: We aimed to investigate the effectiveness of Web-based digital health interventions, excluding hybrid interventions and non-Web-based technologies such as text messaging, short message service, in comparison to nontechnology active or inactive (wait list) interventions on weight loss and lifestyle habit changes in individuals with overweight and obesity. METHODS: We searched PubMed or Medline, SciELO, Lilacs, PsychNet, and Web of Science up to July 2018, as well as references of previous reviews for randomized trials that compared Web-based digital health interventions to offline interventions. Anthropometric changes such as weight, body mass index (BMI), waist, and body fat and lifestyle habit changes in adults with overweight and obesity were the outcomes of interest. Random effects meta-analysis and meta-regression were performed for mean differences (MDs) in weight. We rated the risk of bias for each study and the quality of evidence across studies using the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS: Among the 4071 articles retrieved, 11 were included. Weight (MD -0.77 kg, 95% CI -2.16 to 0.62; 1497 participants; moderate certainty evidence) and BMI (MD -0.12 kg/m2; 95% CI -0.64 to 0.41; 1244 participants; moderate certainty evidence) changes were not different between Web-based and offline interventions. Compared to offline interventions, digital interventions led to a greater short-term (<6 months follow-up) weight loss (MD -2.13 kg, 95% CI -2.71 to -1.55; 393 participants; high certainty evidence), but not in the long-term (MD -0.17 kg, 95% CI -2.10 to 1.76; 1104 participants; moderate certainty evidence). Meta-analysis was not possible for lifestyle habit changes. High risk of attrition bias was identified in 5 studies. For weight and BMI outcomes, the certainty of evidence was moderate mainly due to high heterogeneity, which was mainly attributable to control group differences across studies (R2=79%). CONCLUSIONS: Web-based digital interventions led to greater short-term but not long-term weight loss than offline interventions in overweight and obese adults. Heterogeneity was high across studies, and high attrition rates suggested that engagement is a major issue in Web-based interventions.

Using the Behaviour Change Wheel for Designing an Online Platform for Healthy Weight Loss - "POEmaS".

INTRODUCTION: Behaviour change is a key point in weight management. Digital health interventions are attractive tools to deliver behaviour interventions for weight loss, due to the potential to reach a large number of people. We aimed to report how the Behaviour Change Wheel (BCW) was used to develop and implement a web platform to promote weight loss in Brazilian adults with overweight and obesity. Moreover, we aimed to describe the first 12 weeks of usage of the platform in a randomized controlled trial. METHODS: The BCW framework was used to define intake of fruit/vegetables, ultra-processed products and sweetened beverages, leisure physical activity and sitting time as target behaviours. The BCW components of behaviour-capability, opportunity and motivation were used to make a behaviour diagnosis of the population and BCW second layer oriented the selection of information, goal setting, self-monitoring, feedback, social support and incentives as behaviour techniques. Using these behaviour techniques, a 24-week behaviour intervention delivered by seven different platform functionalities was developed. The platform was tested in a three-arm parallel (basic platform versus enhanced platform versus minimal intervention control group) randomized controlled trial from September 2017 to April 2018. In the present analysis, we classified the platform functionalities according to the BCW behaviour component (capability, opportunity and behaviour) and used descriptive statistics and Spearman correlations to report functionalities usage according to the BCW behaviour component over the first 12 weeks of the trial. The study was approved by the Ethics Committee of the Federal University of Minas Gerais, Brazil and was registered under NCT 03435445. RESULTS: Over the first 12 weeks of the RCT, the 809 participants (619, 76.5% women; mean age 33.7 years, SD 10.3; mean BMI 29.9 kg/m2, SD 4.3) were enrolled for use of the basic and enhance versions of the platform. Capability-driven functionalities were accessed by 455 (56.2%) users with median access of 1 (IQR 1-6) times, whereas opportunity-driven platform functionalities were accessed by 592 participants with 8 (IQR 1-27) median access times and motivation-driven functionalities were accessed by 560 (69.2%) participants with 13 (IQR 1-30) median times of access. Spearman correlations between the use of capability and opportunity functionalities, capability and motivation functionalities and opportunity and motivation functionalities were 0.74 (95% CI 0.70-0.77), 0.74 (95% CI 0.70-0.78), 0.89 (95% CI 0.87-0.91), respectively. DISCUSSION: BCW provided a systematic approach to planning, designing and implementing a complex weight loss intervention based on behaviour change. Moreover, it promoted a clear understanding of the relation between platform functionalities and behaviour determinants. The low use of the capability-driven functionalities might have been related to lack of accuracy in the behaviour diagnosis, as well as to implementation issues. The high correlation between the functionalities use suggests that the BCW approach did not determine the platform usage profile. CONCLUSION: The BCW provided a framework for an evidence-based intervention on weight loss delivered by a web platform. Using the framework led to a clear understanding of the behaviour determinants and their relation to the platform features.

Pretreatment with quercetin prevents changes in lymphocytes E-NTPDase/E-ADA activities and cytokines secretion in hyperlipidemic rats.

Hyperlipidemia (HL) is a condition associated with endothelial dysfunction and inflammatory disorders. Purinergic system ectoenzymes play an important role in modulating the inflammatory and immune response. This study investigated whether the preventive treatment with quercetin is able to prevent changes caused by hyperlipidemia in the purinergic system, through the activities of E-NTPDase and E-ADA in lymphocytes, and quantify the nucleotides and nucleoside, and the secretion of anti- and proinflammatory cytokines. Animals were divided into saline/control, saline/quercetin 5 mg/kg, saline/quercetin 25 mg/kg, saline/quercetin 50 mg/kg, saline/simvastatin (0.04 mg/kg), hyperlipidemia, hyperlipidemia/quercetin 5 mg/kg, hyperlipidemia/quercetin 25 mg/kg, hyperlipidemia/quercetin 50 mg/kg, and hyperlipidemia/simvastatin. Animals were pretreated with quercetin for 30 days and hyperlipidemia was subsequently induced by intraperitoneal administration of 500 mg/kg of poloxamer-407. Simvastatin was administered after the induction of hyperlipidemia. Lymphocytes were isolated and E-NTPDase and E-ADA activities were determined. Serum was separated for the cytokines and nucleotide/nucleoside quantification. E-NTPDase and E-ADA activities were increased in lymphocytes from hyperlipidemic rats and pretreatment with quercetin was able to prevent the increase in the activities of these enzymes caused by hyperlipidemia. Hyperlipidemic rats when receiving pretreatment with quercetin and treatment with simvastatin showed decreased levels of ATP and ADP when compared to the untreated hyperlipidemic group. The IFN-γ and IL-4 cytokines were increased in the hyperlipidemic group when compared with control group, and decreased when hyperlipidemic rats received the pretreatment with quercetin. However, pretreatment with quercetin was able to prevent the alterations caused by hyperlipidemia probably by regulating the inflammatory process. We can suggest that the quercetin is a promising compound to be used as an adjuvant in the treatment of hyperlipidemia.

Post-thyroidectomy hypothyroidism increases the expression and activity of ectonucleotidases in platelets: Possible involvement of reactive oxygen species.

Signaling mediated by purines is a widespread mechanism of cell-cell communication related to vasomotor responses and the control of platelet function in the vascular system. However, little is known about the involvement of this signaling as well as the role of reactive oxygen species (ROS) in the development of hypothyroidism. Therefore, the present study investigates changes in the purinergic system, including enzyme activities and expression in platelets, and oxidative profiles in patients with post-thyroidectomy hypothyroidism. The nucleoside triphosphate diphosphohydrolase 1 (NTPDase/CD39) expression in patients increased by 40%, and the adenosine triphosphate (ATP) or adenosine diphosphate (ADP) hydrolyzing activity increased by 82% and 70%, respectively. The activities of ecto-5´-nucleotidase and adenosine deaminase (ADA) also significantly enhanced (39% and 52%, respectively), which correlates with a 45% decrease in adenosine concentration. Furthermore, these patients demonstrated an increased production of ROS (42%), thiobarbituric acid reactive substances (TBARS) (115%), carbonyl protein (30%) and a decreased glutathione S-transferase (GST) activity (20%). This study demonstrates that hypothyroidism interferes with adenine nucleoside and nucleotide hydrolysis and this is correlated with oxidative stress, which might be responsible for the increase in ADA activity. This increase causes rapid adenosine deamination, which can generate a decrease in their concentration in the systemic circulation, which can be associated with the development of vascular complications.

Sepsis induced by cecal ligation and perforation (CLP) alters nucleotidase activities in platelets of rats.

Sepsis is a potentially lethal condition, and it is associated with platelet alterations. The present study sought to investigate the activity of ecto-nucleoside triphosphate diphosphohydrolase (E-NTPDase), E-5'-nucleotidase, and ecto-adenosine deaminase (E-ADA) in the platelets of rats that were induced with sepsis. Male Wistar rats were divided into three groups of ten animals each: a negative control group (normal; NC); a group that underwent surgical procedures (sham); and a group that underwent cecal ligation and perforation (CLP). The induction of sepsis was confirmed by bacteremia, and the causative pathogen identified was Escherichia coli. Hematological parameters showed leukocytosis and thrombocytopenia in animals in the septic group. The results also revealed that there were significant (p < 0.05) increases in adenosine triphosphate (ATP) and adenosine monophosphate (AMP) hydrolyses, and in the deamination of adenosine in the CLP group compared to the sham and control groups. Conversely, ADP hydrolysis was significantly decreased (p < 0.05) in the CLP group compared to the sham and control groups. Purine levels were analyzed by high-performance liquid chromatography (HPLC) in serum samples from control, sham, and CLP groups. Increased concentrations of ATP, adenosine, and inosine were found in the CLP group compared to the sham and control groups. Conversely, the concentrations of ADP and AMP in the CPL group were not significantly altered. We suggest that alterations in hematological parameters, nucleotide hydrolysis in platelets, and nucleotide concentrations in serum samples of rats with induced sepsis may be related to thromboembolic events.