Exploring the Feasibility of a Cancer Awareness Program for High School Students in a Brazilian School: A Pilot Study.

Cancer is a leading cause of mortality globally and is projected to be the primary cause of death in Brazil by 2030. Yet, for high school students, information and understanding about cancer are primarily offered through standard biology lessons. This study aimed to assess the feasibility of a brief educational intervention related to cancer among high school students in a Brazilian private school. Participants attended a 1-h online session regarding different aspects of cancer. A self-reported questionnaire about the main topics addressed in the session was filled out before [pre] and after [post] the educational intervention and the results were compared by McNemar's chi-square test. From 900 parents invited, 44 (4.9%) responded to the invitation and agreed with their children's participation, and 24 students attended the activity. The questionnaire was easy to fill out for the students and allowed us to measure differences after the educational intervention. The high school students considered the most interesting topics cancer myths and protective/risk factors. The project was feasible and showed easy application and better knowledge after the educational intervention. The main challenge is related to the access to parents to authorize their children's participation. Designing interventions that focus on cancer education might be a viable way to increase prevention and early diagnosis with implications for students, their families, and the community.

Adsorption-desorption behavior of heavy metals in aquatic environments: Influence of sediment, water and metal ionic properties.

Limited knowledge of the combined effects of water and sediment properties and metal ionic characteristics on the solid-liquid partitioning of heavy metals constrains the effective management of urban waterways. This study investigated the synergistic influence of key water, sediment and ionic properties on the adsorption-desorption behavior of weakly-bound heavy metals. Field study results indicated that clay minerals are unlikely to adsorb heavy metals in the weakly-bound fraction of sediments (e.g., r = -0.37, kaolinite vs. Cd), whilst dissociation of metal-phosphates can increase metal solubility (e.g., r = 0.61, dissolved phosphorus vs. Zn). High salinity favors solubility of weakly-bound metals due to cation exchange (e.g., r = 0.60, conductivity vs. Cr). Dissolved organic matter does not favor metal solubility (e.g., r = -0.002, DOC vs. Pb) due to salt-induced flocculation. Laboratory study revealed that water pH and salinity dictate metal partitioning due to ionic properties of Ca2+ and H+. Selectivity for particulate phase increased in the order Cu>Pb>Ni>Zn, generally following the softness (2.89, 3.58, 2.82, 2.34, respectively) of the metal ions. Desorption followed the order Ni>Zn>Pb>Cu, which was attributed to decreased hydrolysis constant (pK1 = 9.4, 9.6, 7.8, 7.5, respectively). The study outcomes provide fundamental knowledge for understanding the mobility and potential ecotoxicological impacts of heavy metals in aquatic ecosystems.

Influence of land use class and configuration on water-sediment partitioning of heavy metals.

Influence of land use and population characteristics on solid-liquid partitioning of heavy metals in aquatic ecosystems is little understood. This study hypothesised that the partitioning of heavy metals (Cd, Cr, Cu, Ni, Pb and Zn) between water and sediments is influenced by different land use classes, their configuration patterns including patch density, Shannon's diversity index, largest patch index, and splitting index and population density. Relationships between variables were investigated from different distances to the stream network (sub-catchment and riparian scales) and considering land use patterns within individual land use classes and individual sub-catchments as a whole (class and landscape levels, respectively). The study outcomes confirmed that the influence of land use and configuration on metals partitioning is scale independent. However, population density increases metal bioavailability at the riparian scale compared to the sub-catchment scale. Agricultural lands discharge the highest fractions of dissolved metals at both spatial scales (eigenvectors = 0.409 - sub-catchment, and -0.533 - riparian, whilst metals have opposite loadings). Positive relationships between splitting index and metal partitioning confirmed that the division of anthropogenic land uses into smaller patches reduces water pollution. However, high fragmentation of forested areas increases the fraction of soluble metals. Further, high patch density and patch diversity are beneficial for controlling the solubility of some metals. Configuration metrics at the landscape level fundamentally reproduce the patterns of the largest land use type and are not effective for assessing metal partitioning. Therefore, analyses at the class level are preferred. This research investigation contributes essential knowledge to improve land use management strategies and, thereby, help safeguard urban waterways.

Water-sediment interactions and mobility of heavy metals in aquatic environments.

The adsorption-desorption behaviour of heavy metals in aquatic environments is complex and the processes are regulated by the continuous interactions between water and sediments. This study provides a quantitative understanding of the effects of nutrients and key water and sediment properties on the adsorption-desorption behaviour of heavy metals in riverine and estuarine environments. The influence levels of the environmental factors were determined as conditional regression coefficients. The research outcomes indicate that the mineralogical composition of sediments, which influence other sediment properties, such as specific surface area and cation exchange capacity, play the most important role in the adsorption and desorption of heavy metals. It was found that particulate organic matter is the most influential nutrient in heavy metals adsorption in the riverine environment, while particulate phosphorus is more important under estuarine conditions. Dissolved nutrients do not exert a significant positive effect on the release of heavy metals in the riverine area, whilst dissolved phosphorus increases the transfer of specific metals from sediments to the overlying water under estuarine conditions. Furthermore, the positive interdependencies between marine-related ions and the release of most heavy metals in the riverine and estuarine environments indicate an increase in the mobility of heavy metals as a result of cation exchange reactions.

Physico-chemical properties of sediments governing the bioavailability of heavy metals in urban waterways.

Bioavailability is a critical facet of metal toxicity. Although past studies have investigated the individual role of sediment physico-chemical properties in relation to the bioavailability of heavy metals, their collective effects are little-known. Further, limited knowledge exists on the contribution of nutrients to metal bioavailability. In this study, the influence of physico-chemical properties of sediments, including total organic carbon (TOC), total phosphorus (TP), total nitrogen (TN), cation exchange capacity (CEC), specific surface area (SSA), and mineralogical composition to metal bioavailability is reported. The weak-acid extraction method was used to measure Cd, Cr, Cu, Ni, Pb and Zn as the potentially bioavailable fraction in sediments in an urban creek. The results confirmed that Cu has strong selectivity for organic matter (r = 0.814, p < 0.01). Cr bioavailability was influenced by either sediment mineralogy, nutrients, CEC or SSA. Zn, Ni and Pb showed strong affinity to mineral oxides, though their preferred binding positions were with nutrients, particularly organic matter (r = 0.794, 0.809, and 0.753, p < 0.01, respectively). The adsorption of Cd was strongly influenced by the competition with other metals and its bioavailability was weakly influenced by ion exchange (CEC: r = 0.424, p < 0.01). The study results indicate that nitrogen and phosphorus compounds can elevate metal bioavailability due to complexation reactions. Generally, the estuarine area was more favourable for the adsorption of weakly-bound metals. This is concerning as estuaries generate high biogeochemical activity and are economically important.

Dose-response relationship between physical activity and mortality in adults with noncommunicable diseases: a systematic review and meta-analysis of prospective observational studies.

BACKGROUND: This study aims to investigate the relationship between post-diagnosis physical activity and mortality in patients with selected noncommunicable diseases, including breast cancer, lung cancer, type 2 diabetes, ischemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), osteoarthritis, low back pain and major depressive disorder. METHODS: A systematic search was conducted of PubMed, Scopus and the Web of Science from their inception to August 2018. Additionally, the search was updated in August 2019. Eligibility criteria included prospective observational studies examining the relationship between at least three physical activity categories (e.g. low, moderate, high) and all-cause mortality as the primary outcome. RESULTS: In total, 28 studies were included in the meta-analysis: 12 for breast cancer, 6 for type 2 diabetes, 8 for ischemic heart disease and 2 for COPD. The linear meta-analysis revealed that each 10 metabolic equivalent task hours increase of physical activity per week was associated with a 22% lower mortality rate in breast cancer patients (Summary Hazard Ratio [HR], 0.78; 95% CI: 0.71, 0.86; I2: 90.1%), 12% in ischemic heart disease patients (HR, 0.88; 95% CI: 0.83, 0.93; I2: 86.5%), 30% in COPD patients (HR, 0.70; 95% CI: 0.45, 1.09; I2: 94%) and 4% in type 2 diabetes patients (HR, 0.96; 95% CI: 0.93, 0.99; I2: 71.8%). There was indication of a non-linear association with mortality risk reductions even for low levels of activity, as well as a flattening of the curve at higher levels of activity. The certainty of evidence was low for breast cancer, type 2 diabetes and ischemic heart disease but only very low for COPD. CONCLUSION: Higher levels of post-diagnosis physical activity are associated with lower mortality rates in breast cancer, type 2 diabetes, ischemic heart disease and COPD patients, with indication of a no-threshold and non-linear dose-response pattern.

Epidemiologia e desfecho dos pacientes de alto risco cirúrgico admitidos em unidades de terapia intensiva no Brasil / Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil

RESUMO Objetivo: Definir o perfil epidemiológico e os principais determinantes de morbimortalidade dos pacientes cirúrgicos não cardíacos de alto risco no Brasil. Métodos: Estudo prospectivo, observacional e multicêntrico. Todos os pacientes cirúrgicos não cardíacos admitidos nas unidades de terapia intensiva, ou seja, considerados de alto risco, no período de 1 mês, foram avaliados e acompanhados diariamente por, no máximo, 7 dias na unidade de terapia intensiva, para determinação de complicações. As taxas de mortalidade em 28 dias de pós-operatório, na unidade de terapia intensiva e hospitalar foram avaliadas. Resultados: Participaram 29 unidades de terapia intensiva onde foram realizadas cirurgias em 25.500 pacientes, dos quais 904 (3,5%) de alto risco (intervalo de confiança de 95% - IC95% 3,3% - 3,8%), tendo sido incluídos no estudo. Dos pacientes envolvidos, 48,3% eram de unidades de terapia intensiva privadas e 51,7% de públicas. O tempo de internação na unidade de terapia intensiva foi de 2,0 (1,0 - 4,0) dias e hospitalar de 9,5 (5,4 - 18,6) dias. As taxas de complicações foram 29,9% (IC95% 26,4 - 33,7) e mortalidade em 28 dias pós-cirurgia 9,6% (IC95% 7,4 - 12,1). Os fatores independentes de risco para complicações foram Simplified Acute Physiology Score 3 (SAPS 3; razão de chance − RC = 1,02; IC95% 1,01 - 1,03) e Sequential Organ Failure Assessment Score (SOFA) da admissão na unidade de terapia intensiva (RC =1,17; IC95% 1,09 - 1,25), tempo de cirurgia (RC = 1,001; IC95% 1,000 - 1,002) e cirurgias de emergências (RC = 1,93; IC95% 1,10 - 3,38). Em adição, foram associados com mortalidade em 28 dias idade (RC = 1,032; IC95% 1,011 - 1,052) SAPS 3 (RC = 1,041; IC95% 1,107 - 1,279), SOFA (RC = 1,175; IC95% 1,069 - 1,292) e cirurgias emergenciais (RC = 2,509; IC95% 1,040 - 6,051). Conclusão: Pacientes com escores prognósticos mais elevados, idosos, tempo cirúrgico e cirurgias emergenciais estiveram fortemente associados a maior mortalidade em 28 dias e mais complicações durante permanência em unidade de terapia intensiva.

ABSTRACT Objective: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. Methods: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. Results: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). Conclusion: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.

Dose-response relationship between physical activity and mortality in people with non-communicable diseases: a study protocol for the systematic review and meta-analysis of cohort studies.

INTRODUCTION: This study protocol outlines our planned systematic review and dose-response meta-analysis of postdiagnosis physical activity and mortality in people with non-communicable diseases (NCDs). METHODS AND ANALYSIS: This study is based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols. A systematic literature search will be conducted in various databases-namely, PubMed, Scopus and Web of Science-by two researchers in order to identify prospective observational studies that investigate postdiagnosis physical activity or activity-related energy expenditure and mortality in individuals with NCDs. The target population is adults (≥18 years of age) with one of the following nine NCDs: low back pain, type 2 diabetes mellitus, osteoarthritis, depressive disorder, chronic obstructive pulmonary disease, breast cancer, lung cancer, stroke or ischaemic heart disease. We will focus on all-cause mortality as the primary outcome and investigate indication-specific mortality as the secondary outcome. For each study identified as a result of the literature search, we will conduct graphical dose-response analyses of mortality as a function of activity-related energy consumption. If more than two studies are available for one disease, we will perform linear and non-linear dose-response meta-analyses for said disease using random-effects models. We will investigate the heterogeneity of the studies and publication bias. To assess the risk of bias and the quality of the included studies, we will use the Risk Of Bias In Non-randomised Studies - of Interventions tool, which is a Cochrane tool. ETHICS AND DISSEMINATION: This systematic review will be conducted in compliance with ethical precepts. As the systematic review is based on published studies, approval from an ethics committee is not required. The systematic review and meta-analysis will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018103357.

Efedrina intramuscular para profilaxis de la hipotensión secundaria a la anestesia subaracnoidea en operaciones de cesáreas / Intramuscular ephedrine for prophylaxis of hypotension secondary to subarachnoid anesthesia in cesarean sections

Introducción: la hipotensión arterial es el efecto adverso más frecuente de la anestesia subaracnoidea en las operaciones de cesáreas, representa un serio riesgo tanto para la madre como para el niño, de ahí la necesidad de su profilaxis. Objetivo: evaluar la eficacia del uso de la efedrina por vía intramuscular con respecto al método tradicional en la prevención de la hipotensión arterial secundaria a la anestesia subaracnoidea.Método: se realizó un estudio experimental, controlado y aleatorizado en el Hospital General Provincial Docente Dr. Antonio Luaces Iraola de Ciego de Ávila, en el período de noviembre de 2011 hasta junio de 2014. Se trabajó con 200 pacientes, que cumplían con los criterios establecidos en el estudio, las que fueron asignadas a dos grupos: uno al cual se le aplicó la efedrina por vía intramuscular sobreañadida al tratamiento habitual con bupivacaína isobárica al 0,5 porciento (grupo experimental) y otro al que se le aplicó solo la técnica de uso habitual (grupo control).Resultados: la incidencia de hipotensión fue menor en el grupo experimental y se encontró estabilidad en la frecuencia cardíaca. El número de bolos de efedrina usados en el grupo experimental fue menor que en el grupo control al igual que la aparición de complicaciones. El Apgar de los recién nacidos no tuvo variaciones en ambos grupos.Conclusiones: el uso de efedrina por vía intramuscular resultó ser un método eficaz como profilaxis de la hipotensión arterial en las pacientes operadas por cesárea(AU)

Introduction: arterial hypotension is the most frequent adverse effect of subarachnoid anesthesia in cesarean operations, it represents a serious risk for both mother and child, hence the need for prophylaxis.Objective: to evaluate the efficacy of the use of ephedrine intramuscularly with respect to the traditional method in the prevention of arterial hypotension secondary to subarachnoid anesthesia.Method: an experimental, controlled and randomized study was carried out in the General Provincial Teaching Hospital r. Antonio Luaces Iraola of Ciego de Ávila, from November 2011 to June 2014. It worked with 200 patients, who met the criteria established in the study, which were assigned to two groups: one to which ephedrine was applied intramuscularly, added to the usual treatment with isobaric bupivacaine 0,5 percent (experimental group) and another to which only the technique of habitual use was applied (control group).Results: the incidence of hypotension was lower in the experimental group and stability in heart rate was found. The number of ephedrine boluses used in the experimental group was lower than in the control group, as well as the appearance of complications.Conclusions: the intramuscular ephedrine proved to be an effective method as prophylaxis of arterial hypotension in patients operated on by cesarean section(AU)

Oil-suspended particulate material aggregates as a tool in preventing potential ecotoxicological impacts in the São Paulo river, Todos os Santos Bay, Bahia, Brazil: Influence of salinity and suspended particulate material.

Recent studies have revealed the occurrence of a natural process of interaction between oil droplets and suspended particulate material, resulting in the formation of aggregates which are dispersed in the water column, known as oil-suspended particulate material aggregates (OSAs). The experiments aimed to investigate the contribution of OSAS in indicating where most likely is the oil sedimentation in the São Paulo river, Todos os Santos Bay, Brazil, in order to predict possible ecotoxicological risks caused by oil spills. The results showed that salinity and MPS concentration interfere on the formation of aggregates. In addition, the point 3 was nominated as the most vulnerable area to the potential ecotoxicological impacts of oil spills and should be treated as a priority area for the application of preventive and mitigating techniques.

A percepção das puérperas frente à atuação do enfermeiro na promoção do aleitamento materno em um Hospital amigo da Criança do Estado do Pará / The perception of the women who have recently given birth regarding the actuation of the nurse on the breastfeeding promotion in a baby-friendly hospital initiative of Pará state

Objetivo: analisar a percepção das puérperas frente à atuação do enfermeiro na promoção do aleitamento maternoem um hospital amigo da criança do Estado do Pará. Metodologia: estudo exploratório com abordagem qualitativatendo como participantes da pesquisa puérperas internadas no alojamento conjunto da Fundação Santa Casa deMisericórdia do Pará. Atenderam aos critérios de inclusão 17 participantes. A coleta de dados foi por meio de entrevistasemiestruturada com perguntas abertas. Os profissionais foram identificados por letra e por números referente aordem de entrevista realizada. Resultado: foi utilizada a técnica de análise de conteúdo onde o eixo temático geroucomo categoria teórica: a atuação do enfermeiro na promoção do aleitamento; como categoria empírica: orientaçõessobre aleitamento no alojamento conjunto, pelo enfermeiro e como unidades de análises: a maioria das puérperasnão recebeu orientação no pré-natal e receberam orientações superficiais no hospital. Discussão: inúmeras são asdi?culdades encontradas pelas puérperas na prática da amamentação, dentre elas destacam-se: falhas no processo deorientação e falta de incentivo à amamentação desde o pré-natal. Tais fatores isolados ou associados fazem com queas lactantes não amamentem seus ?lhos até o mínimo de tempo de seis meses proposto pela OMS. Essa orientaçãoe incentivo a amamentação não está ocorrendo segundo a pesquisa. Conclusão: conclui-se que ainda existemfalhas no que se diz respeito a promoção ao aleitamento materno, devido a ocupação do profissional enfermeiroem atividades administrativas e pouco interesse em participar de capacitações sobre aleitamento. Entretanto, cabeao enfermeiro promover o aleitamento materno, oferecer suporte e apoio durante todo o período da gravidez, parto,puerpério. É importante enfatizar que os gestores, enfermeiros e outros profissionais de saúde precisam trabalharintegrados, fazendo valer a interdisciplinaridade, onde todos os saberes são utilizados para um único fim, a promoçãodo aleitamento materno.

Objective: Analyses of the perception of the women who have recently given birth regarding the actuation of thenurse on the breastfeeding promotion in a Baby-friendly hospital initiative of Pará State. Methodology: Exploratorystudy with qualitative approach having as participants of the research inmate women who have recently given birthin the accommodation of the Fundação Santa Casa de Misericórdia do Pará. The inclusion criterion counted with 17participants. The data collecting was by means of semi-structured interview with open questions. The professionalswere identified by letters and reference numbers in accordance to order of the interview. Result: The data wasanalyzed utilizing the technics of content analyzes, in which the main theme produced as theoretical category:The Nurse action on the breastfeeding promotion; as empiric category: Breastfeeding orientation at the ensembleaccommodations by the nurse and as analyses units: Most of the women who have recently given birth did notreceive a prenatal orientation. They received a superficial orientation in the hospital. Discussion: numerous arethe difficulties encountered by mothers in breastfeeding, among them stand out flaws in the orientation processand lack of incentive to breastfeeding from prenatal care. These factors alone or associated cause breastfeedingshould not breastfeed their children until the minimum time of six months proposed by the WHO. This guidanceand encouragement of breastfeeding is not going according to the survey. Conclusion: The conclusion is thatthereare yet faults regarding the breastfeeding promotion due the occupation of the nurse in administrative activities andlittle interest about participate of breastfeeding promotion courses. However is obligation of the nurse promoting thebreastfeeding, gives support during all the pregnancy time, childbirth and puerperium. It is important to say that themanagers, nurses and others healthy professionals need to work together to enforce the inter-dicipline of the team inwhich all the learning are used to an unique objective that is the promotion of breastfeeding.

Aplicação das boas práticas por manipuladores de alimentos em lanchonetes da Universidade Federal do Tocantins / Applying best practices for food handlers in cafeterias University of Tocantins

Para obter alimentos de qualidade e que não ofereçam risco à saúde do consumidor é imprescindível que os mesmos tenham sido processados obedecendo às boas práticas (BP). A ausência das BP, durante a manipulação dos alimentos pode agravar a ocorrência de doenças veiculadas por alimentos, causando prejuízos financeiros ao consumidor e ao estabelecimento envolvido. Diante disto, três lanchonetes e um restaurante, localizados na Universidade Federal do Tocantins (UFT), Campus Palmas, foram alvos de estudo para verificar a aplicação das BP, cujo objetivo foi realizar um diagnóstico e capacitar os manipuladores de alimentos. Foi aplicado um questionário aos manipuladores e um checklist ambos baseados na RDC nº 216 da Agência Nacional de Vigilância Sanitária, para avaliar os seus conhecimentos e as condições dos estabelecimentos, respectivamente.