Lipase-mediated alcoholysis for in situ production of ester bioaromas in licuri oil for cosmetic applications.

Bioaromas can be produced by lipases either through their hydrolytic or (trans)esterifying activities. Therefore, this work reports the development of a lipase-catalyzed biotransformed licuri oil, forming volatile ethyl esters with odor notes resembling tropical fruits. Ethyl octanoate formation was promoted when 7.0 % (m/v) Lipozyme 435® was used to convert a grain alcohol:licuri oil mixture (51:49, v/v) at 58ºC and 70 rpm for 6 hours. The biotransformed oil has shown antimicrobial activity against Staphylococcus hominis, S. epidermidis, and Corynebacterium xerosis, bacteria associated with bad skin odor. Finally, this biotransformed oil was used without further treatments (e.g., recovery or purification procedures) to prepare two cosmetic formulations (in a dosage of 1.5 %), aiming for both fragrant and deodorant activity.

Does Transcranial Direct Current Stimulation reduce central and peripheral muscle fatigue in recreational runners? A triple-blind, sham-controlled, randomized, crossover clinical study.

BACKGROUND: Runners seek health benefits and performance improvement. However, fatigue might be considered a limiting factor. Transcranial Direct Current Stimulation (tDCS) has been investigated to improve performance and reduce fatigue in athletes. While some studies showing that tDCS may improve a variety of physical measures, other studies failed to show any benefit. OBJECTIVE: To evaluate the acute effects of tDCS on central and peripheral fatigue compared to a sham intervention in recreational runners. METHODS: This is a triple-blind, controlled, crossover study of 30 recreational runners who were randomized to receive one of the two interventions, anodal or sham tDCS, after the fatigue protocol. The interventions were applied to the quadriceps muscle hotspot for 20 min. Peak torque, motor-evoked potential, and perceived exertion rate were assessed before and after the interventions, and blood lactate level was assessed before, during, and after the interventions. A generalized estimated equation was used to analyze the peak torque, motor-evoked potential, and blood lactate data, and the Wilcoxon test was used for perceived exertion rate data. RESULTS: Our findings showed no difference between anodal tDCS and sham tDCS on peak torque, motor-evoked potential, blood lactate, and perceived exertion rate. CONCLUSION: The tDCS protocol was not effective in improving performance and reducing fatigue compared to a sham control intervention. BRAZILIAN CLINICAL TRIALS REGISTRY: RBR-8zpnxz.

[Overview of long COVID in Brazil: a preliminary analysis of a survey to think about health policies]. / Panorama da COVID longa no Brasil: análise preliminar de um inquérito para pensar políticas de saúde.

Characterized by symptoms that remain or appear for the first time within three months of SARS-CoV-2 infection, long COVID can manifest itself in different ways, including in non-hospitalized or asymptomatic cases. Thus, this study offers an overview of long COVID in Brazil, especially of its diagnosis, symptoms, and challenges for new health management. Data from a study that investigated long COVID in people affected by COVID-19 were used. These original data stem from a survey with adult Brazilians (aged 18 years or older) who had COVID-19 that collected information from March 14 to April 14, 2022, by a questionnaire on social media. The questionnaire addressed sociodemographic characteristics, history of COVID-19 infections, vaccination against the disease, investigation of health status and quality of life before and after COVID-19, and search and access to treatment. Of the 1,728 respondents, 720 were considered eligible for analysis, of which 496 (69%) had long COVID. Individuals with long COVID reported clinical manifestations such as anxiety (80%), memory loss (78%), generalized pain (77%), lack of attention (75%), fatigue (73%), hair loss (71%), sleep changes (70%), mood swings (62%), malaise (60%), and joint pain (59%). Most sought health services during and after the acute phase of COVID-19 (94 and 80%, respectively), representing the need to structure the healthcare system for these patients.

Caracterizada por sintomas que permanecem ou aparecem pela primeira vez em até três meses após a infecção pelo SARS-CoV-2, a COVID longa pode se manifestar de diferentes formas, inclusive entre casos não hospitalizados ou assintomáticos. Nesse sentido, este artigo apresenta um panorama da COVID longa no Brasil, com ênfase no diagnóstico, nos sintomas e nos desafios para a nova gestão da saúde. Foram utilizados dados de um estudo realizado com objetivo de investigar a COVID longa em pessoas acometidas pela COVID-19, com dados originais de um inquérito com indivíduos brasileiros adultos (18 anos ou mais) que tiveram COVID-19, coletados entre 14 de março e 14 de abril de 2022, por meio de questionário divulgado em redes sociais. O questionário abordou características sociodemográficas, histórico de infecções por COVID-19, vacinação contra a doença, investigação da situação de saúde e da qualidade de vida antes e após a COVID-19, além da busca e acesso a tratamento. Dos 1.728 respondentes, 720 foram considerados elegíveis para a análise. Desses, 496 (69%) tiveram COVID longa. Os indivíduos com COVID longa reportaram manifestações clínicas como ansiedade (80%), perda de memória (78%), dor generalizada (77%), falta de atenção (75%), fadiga (73%), queda de cabelo (71%), alterações de sono (70%), alterações de humor (62%), indisposição (60%) e dor nas articulações (59%). A maioria procurou os serviços de saúde durante e após a fase aguda de COVID-19 (94% e 80%, respectivamente), o que representa a necessidade de estruturar o sistema de saúde para atender esses pacientes.

Caracterizado por síntomas que permanecen o aparecen por primera vez dentro de los tres meses posteriores a la infección por SARS-CoV-2, la COVID larga puede manifestarse de diferentes formas, incluso entre casos no hospitalizados o asintomáticos. En este sentido, este artículo presenta un panorama la COVID larga en Brasil, con énfasis en el diagnóstico, los síntomas y los desafíos para la nueva gestión de la salud. Se utilizaron datos de una encuesta realizada para investigar la COVID larga en personas afectadas por COVID-19. Se trata de datos originales de una encuesta con individuos brasileños adultos (18 años o más), que tuvieron COVID-19, con datos recolectados entre el 14 de marzo y el 14 de abril de 2022, por medio de un cuestionario divulgado en las redes sociales. El cuestionario abordó características sociodemográficas, historial de infecciones por COVID-19, vacunación contra la enfermedad, investigación de la situación de salud y de la calidad de vida antes y después de COVID-19, además de la búsqueda y acceso a tratamiento. De los 1.728 encuestados, 720 fueron considerados elegibles para el análisis. De ellos, 496 (69%) tenían COVID larga. Las personas con COVID larga informaron manifestaciones clínicas como ansiedad (80%), pérdida de memoria (78%), dolor generalizado (77%), falta de atención (75%), fatiga (73%), pérdida de cabello (71%), cambios en el sueño (70%), cambios de humor (62%), malestar (60%) y dolor en las articulaciones (59%). La mayoría recurrió a los servicios de salud durante y después de la fase aguda de COVID-19 (94% y 80%, respectivamente), lo que representa la necesidad de estructurar el sistema de salud para atender a estos pacientes.

Repercussões na saúde mental de profissionais da saúde de um hospital público do Recife durante a pandemia de COVID-19 / Repercussions on the mental health of health professionals at a public hospital in Recife during the COVID-19 pandemic

Objetivo: analisar fatores associados à ansiedade e depressão em profissionais de saúde que prestam assistência a pacientes com COVID-19 em um hospital público de Recife. Método: estudo transversal, com aplicação de questionário online contendo variáveis sociodemográficas e relacionadas ao trabalho e instrumento escala de depressão, ansiedade e estresse. Realizadas análises descritivas das variáveis independentes e análise bivariada usando regressão linear da relação entre a variável dependente e das variáveis independentes. Resultados: 77 profissionais responderam ao questionário. A fisioterapia foi a categoria profissional associada à ansiedade, e o setor de atuação no COVID- 19 e o tempo de exercício foram associados à depressão. Conclusão: são imprescindíveis as ações de promoção da saúde mental desses profissionais, considerando, principalmente, os impactos da pandemia de COVID-19.

Aim: This article aimed to analyze factors associated with anxiety and depression in health professionals who provide care to patients with COVID-19 in Recife public hospital. Method: cross-sectional study, with the application of an online questionnaire containing sociodemographic and work-related variables and the Depression, Anxiety, and Stress Scale instrument. Descriptive analyses of the independent variables and bivariate analysis were performed using linear regression of the relationship between the dependent and the independent variables. Results: 77 professionals answered the questionnaire. Physiotherapy was the professional category associated with anxiety, and the sector of activity in COVID-19 and exercise time were associated with depression. Conclusion: actions to promote the mental health of these professionals are essential, mainly considering the impacts of the COVID-19 pandemic.

Manifestation and sociodemographic microdata of Brazil's Unified Health System Ombudsman.

OBJECTIVES: This article presents the process of extraction and treatment of two datasets from the General Ombudsman of the Brazilian Unified Health System (OUVSUS). The resulting datasets allow the analysis of manifestation characteristics and sociodemographic profile of the citizens that performed these manifestations. DATA DESCRIPTION: The first dataset depicts the characteristics of the manifestations registered by the General Ombudsman. Each row represents an individual manifestation and contains information such as the registration date, classification, input channel, and subject, among others. The second dataset is constituted of sociodemographic information for each citizen that performed a manifestation, and characteristics such as sexual orientation, race, age, and geographic location of the citizen are presented, among others.

Can evidence drive health equity in the COVID-19 pandemic and beyond?

Using scoping review methods, we systematically searched multiple online databases for publications in the first year of the pandemic that proposed pragmatic population or health system-level solutions to health inequities. We found 77 publications with proposed solutions to pandemic-related health inequities. Most were commentaries, letters, or editorials from the USA, offering untested solutions, and no robust evidence on effectiveness. Some of the proposed solutions could unintentionally exacerbate health inequities. We call on health policymakers to co-create, co-design, and co-produce equity-focussed, evidence-based interventions with communities, focussing on those most at risk to protect the population as a whole. Epidemiologists collaborating with people from other relevant disciplines may provide methodological expertise for these processes. As epidemiologists, we must interrogate our own methods to avoid propagating any unscientific biases we may hold. Epidemiology must be used to address, and never exacerbate, health inequities-in the pandemic and beyond.

Panorama da COVID longa no Brasil: análise preliminar de um inquérito para pensar políticas de saúde / Overview of long COVID in Brazil: a preliminary analysis of a survey to think about health policies / Panorama de la COVID larga en Brasil: un análisis preliminar de una encuesta para pensar en políticas de salud

Caracterizada por sintomas que permanecem ou aparecem pela primeira vez em até três meses após a infecção pelo SARS-CoV-2, a COVID longa pode se manifestar de diferentes formas, inclusive entre casos não hospitalizados ou assintomáticos. Nesse sentido, este artigo apresenta um panorama da COVID longa no Brasil, com ênfase no diagnóstico, nos sintomas e nos desafios para a nova gestão da saúde. Foram utilizados dados de um estudo realizado com objetivo de investigar a COVID longa em pessoas acometidas pela COVID-19, com dados originais de um inquérito com indivíduos brasileiros adultos (18 anos ou mais) que tiveram COVID-19, coletados entre 14 de março e 14 de abril de 2022, por meio de questionário divulgado em redes sociais. O questionário abordou características sociodemográficas, histórico de infecções por COVID-19, vacinação contra a doença, investigação da situação de saúde e da qualidade de vida antes e após a COVID-19, além da busca e acesso a tratamento. Dos 1.728 respondentes, 720 foram considerados elegíveis para a análise. Desses, 496 (69%) tiveram COVID longa. Os indivíduos com COVID longa reportaram manifestações clínicas como ansiedade (80%), perda de memória (78%), dor generalizada (77%), falta de atenção (75%), fadiga (73%), queda de cabelo (71%), alterações de sono (70%), alterações de humor (62%), indisposição (60%) e dor nas articulações (59%). A maioria procurou os serviços de saúde durante e após a fase aguda de COVID-19 (94% e 80%, respectivamente), o que representa a necessidade de estruturar o sistema de saúde para atender esses pacientes.

Characterized by symptoms that remain or appear for the first time within three months of SARS-CoV-2 infection, long COVID can manifest itself in different ways, including in non-hospitalized or asymptomatic cases. Thus, this study offers an overview of long COVID in Brazil, especially of its diagnosis, symptoms, and challenges for new health management. Data from a study that investigated long COVID in people affected by COVID-19 were used. These original data stem from a survey with adult Brazilians (aged 18 years or older) who had COVID-19 that collected information from March 14 to April 14, 2022, by a questionnaire on social media. The questionnaire addressed sociodemographic characteristics, history of COVID-19 infections, vaccination against the disease, investigation of health status and quality of life before and after COVID-19, and search and access to treatment. Of the 1,728 respondents, 720 were considered eligible for analysis, of which 496 (69%) had long COVID. Individuals with long COVID reported clinical manifestations such as anxiety (80%), memory loss (78%), generalized pain (77%), lack of attention (75%), fatigue (73%), hair loss (71%), sleep changes (70%), mood swings (62%), malaise (60%), and joint pain (59%). Most sought health services during and after the acute phase of COVID-19 (94 and 80%, respectively), representing the need to structure the healthcare system for these patients.

Caracterizado por síntomas que permanecen o aparecen por primera vez dentro de los tres meses posteriores a la infección por SARS-CoV-2, la COVID larga puede manifestarse de diferentes formas, incluso entre casos no hospitalizados o asintomáticos. En este sentido, este artículo presenta un panorama la COVID larga en Brasil, con énfasis en el diagnóstico, los síntomas y los desafíos para la nueva gestión de la salud. Se utilizaron datos de una encuesta realizada para investigar la COVID larga en personas afectadas por COVID-19. Se trata de datos originales de una encuesta con individuos brasileños adultos (18 años o más), que tuvieron COVID-19, con datos recolectados entre el 14 de marzo y el 14 de abril de 2022, por medio de un cuestionario divulgado en las redes sociales. El cuestionario abordó características sociodemográficas, historial de infecciones por COVID-19, vacunación contra la enfermedad, investigación de la situación de salud y de la calidad de vida antes y después de COVID-19, además de la búsqueda y acceso a tratamiento. De los 1.728 encuestados, 720 fueron considerados elegibles para el análisis. De ellos, 496 (69%) tenían COVID larga. Las personas con COVID larga informaron manifestaciones clínicas como ansiedad (80%), pérdida de memoria (78%), dolor generalizado (77%), falta de atención (75%), fatiga (73%), pérdida de cabello (71%), cambios en el sueño (70%), cambios de humor (62%), malestar (60%) y dolor en las articulaciones (59%). La mayoría recurrió a los servicios de salud durante y después de la fase aguda de COVID-19 (94% y 80%, respectivamente), lo que representa la necesidad de estructurar el sistema de salud para atender a estos pacientes.

Evaluation of Cardiovascular Parameters of ASA I and ASA II Patients Undergoing Dental Implant Surgery Under Intravenous Sedation with Midazolam: A Retrospective Analysis

The purpose of this research was to compare the vital signs of ASA II patients undergoing dental implant surgery under intravenous anesthesia to those of ASA I patients. From a specialist course in Implant Dentistry, 41 medical records (22 ASA I and 19 ASA II patients) were analyzed. Age, gender, ASA classification, blood pressure, heart rate, and oxygen saturation were all measured. Pre-surgery, following the onset of local anesthetic, at the end of the initial implant insertion, and at the end of surgery were all used to collect vital signs. Student's t-test (p<0.05) was used to determine inter- and intra-group data associations. The crossing of operative moments pre-surgical and installation of the first implant in both systolic (p<=0.01) and diastolic (p<=0.03) pressure was statistically significant in ASA I patients. In contrast, there was only a statistical difference in the verification of peripheral oxygen saturation data at preoperative and local anesthesia times in ASA II patients (p<=0.04). When comparing the time of installation of the first implant (p<=0.03) and at the end of surgery (p<=0.02), with respect to systolic pressure, ASA II presented statistically higher, while variable oxygen saturation at the beginning of local anesthesia in ASA I was statistically higher (p<=0.04). It is proposed that intravenous sedation acts in a compensatory manner in patients with systemic disease, leading both groups' behavior to be similar.

El propósito de esta investigación fue comparar los signos vitales de pacientes ASA II sometidos a cirugía de implante dental bajo anestesia intravenosa con los de pacientes ASA I. Se analizaron 41 historias clínicas de un curso de especialista en Implantología (22 pacientes ASA I y 19 ASA II). Se midieron la edad, el sexo, la clasificación ASA, la presión arterial, la frecuencia cardíaca y la saturación de oxígeno. Se tomarn los signos vitales antes de la cirugía, después del inicio de la anestesia local, al final de la inserción inicial del implante y al final de la cirugía. Se utilizó la prueba t de Student (p<0,05) para determinar las asociaciones de datos entre e intragrupos. El cruce de los momentos operatorios prequirúrgicos y de instalación del primer implante tanto en la presión sistólica (p<=0,01) como en la diastólica (p<=0,03) fue estadísticamente significativo en los pacientes ASA I. En contraste, solo hubo diferencia estadística en la verificación de los datos de saturación periférica de oxígeno en el momento preoperatorio y de anes- tesia local en los pacientes ASA II (p<=0,04). Al comparar el tiempo de instalación del primer implante (p<=0,03) y al final de la cirugía (p<=0,02), con respecto a la presión sistólica, el ASA II se presentó estadísticamente mayor, mientras que la variable saturación de oxígeno al inicio de la anestesia local en El ASA I fue estadísticamente mayor (p<0,4). Se propone que la sedación intravenosa actúa de forma compensatoria en pacientes con enfermedad sistémica, lo que hace que el comportamiento de ambos grupos sea similar.

Glucose Transport and Utilization in the Hippocampus: From Neurophysiology to Diabetes-Related Development of Dementia.

The association of diabetes with cognitive dysfunction has at least 60 years of history, which started with the observation that children with type 1 diabetes mellitus (T1D), who had recurrent episodes of hypoglycemia and consequently low glucose supply to the brain, showed a deficit of cognitive capacity. Later, the growing incidence of type 2 diabetes mellitus (T2D) and dementia in aged populations revealed their high association, in which a reduced neuronal glucose supply has also been considered as a key mechanism, despite hyperglycemia. Here, we discuss the role of glucose in neuronal functioning/preservation, and how peripheral blood glucose accesses the neuronal intracellular compartment, including the exquisite glucose flux across the blood-brain barrier (BBB) and the complex network of glucose transporters, in dementia-related areas such as the hippocampus. In addition, insulin resistance-induced abnormalities in the hippocampus of obese/T2D patients, such as inflammatory stress, oxidative stress, and mitochondrial stress, increased generation of advanced glycated end products and BBB dysfunction, as well as their association with dementia/Alzheimer's disease, are addressed. Finally, we discuss how these abnormalities are accompained by the reduction in the expression and translocation of the high capacity insulin-sensitive glucose transporter GLUT4 in hippocampal neurons, which leads to neurocytoglycopenia and eventually to cognitive dysfunction. This knowledge should further encourage investigations into the beneficial effects of promising therapeutic approaches which could improve central insulin sensitivity and GLUT4 expression, to fight diabetes-related cognitive dysfunctions.

Prevalence and associations of temporomandibular disorders in older Brazilian adults.

OBJECTIVE: The objective of the study was to estimate the prevalence of temporomandibular disorders (TMD) and describe associations in a representative sample of community-dwelling older Brazilian adults. BACKGROUND: TMD cause recurrent or chronic pain and dysfunction with substantial impacts on quality of life, but little is known of their occurrence and associated factors among older adults. MATERIALS AND METHODS: This was a cross-sectional study using data from the second wave of the Brazilian Longitudinal Study of Aging, a nationally representative sample of older Brazilian adults aged 50 or older. The presence of temporomandibular disorder symptoms was measured by the Fonseca Anamnestic Index. Independent variables included sociodemographic characteristics, general health conditions and self-reported oral health measures. The association between the independent variables and TMD symptoms was evaluated using logistic regression models. RESULTS: Complete information for the variables of interest was available for 9391 individuals. The overall prevalence of TMD symptoms was 18.0% (95% CI 14.4-22.1). Relative to older adults aged 50-59 those in all age categories had lower odds of TMD symptoms. Individuals with depression, pain, sleep problems and self-reported poor general health had higher odds of reporting TMD symptoms. None of the oral health measures were related to TMD. CONCLUSION: The prevalence of TMD symptoms among Brazilian older adults is associated with demographic and general health conditions, but not with dentition status.

Supercritical CO2 as a Valuable Tool for Aroma Technology.

This review addresses the possibilities of using supercritical carbon dioxide (SC-CO2) in the flavor industry in extraction and fractionation processes and its use as a reaction medium to generate aroma esters. The advantages and disadvantages are presented, comparing SC-CO2 processing with traditional methods. The most distinguishable features of SC-CO2 include mild reaction conditions, time savings, fewer toxicity concerns, higher sustainability, and the possibility of modulating solvent selectivity according to the process conditions (such as pressure and temperature). Thus, this review indicates the potential of using SC-CO2 to obtain a high selectivity of compounds that can be applied in aroma technology and related fields.

Vacinação contra poliomielite no Brasil de 2011 a 2021: sucessos, reveses e desafios futuros / Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead

Resumo A queda de coberturas vacinais (CV) na infância, entre elas a da poliomielite, vem se tornando uma preocupação sanitária. O objetivo foi analisar a tendência temporal das coberturas das três doses da vacina contra a poliomielite nos primeiros 12 meses de vida entre 2011 e 2021, com destaque na pandemia de COVID-19, além de mapear as CV no Brasil. Foi realizado um estudo ecológico com técnicas de série temporal interrompida (STI) e análise espacial, a partir dos dados do Sistema de Informação do Programa Nacional de Imunização. A tendência da CV foi ajustada pelo estimador de variância de Newey-West, segundo as unidades federadas e o Índice de Privação Brasileiro. A distribuição da CV foi estimada por modelos bayesianos e os aglomerados espaciais pelos índices de Moran global e local, identificando áreas de menor cobertura nas Regiões de Saúde. Observa-se perda da CV ao longo do período em todas as regiões do país, sendo maiores no Norte e no Nordeste e se acentuando durante a pandemia. As maiores quedas foram identificadas em estados e regiões de saúde com maior vulnerabilidade social. A queda na CV mostra que o risco de reintrodução do vírus selvagem é iminente e os desafios precisam ser enfrentados com o fortalecimento do Sistema Único de Saúde.

Abstract The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).

Vacinação do sarampo no Brasil: onde estivemos e para onde vamos? / Measles vaccination in Brazil: where have we been and where are we headed?

Resumo A reemergência de doenças imunopreveníveis devido à queda das coberturas vacinais (CV) tem sido documentada em vários países. O objetivo foi analisar a CV, a homogeneidade das CV e os casos de sarampo no Brasil de 2011 a 2021, com enfoque no período da pandemia de COVID-19, sua tendência temporal, distribuição espaço-temporal e fatores associados aos aglomerados de menor CV. Trata-se de um estudo ecológico sobre a CV de sarampo (dose 1), com métodos de série temporal interrompida e de avaliação da disposição espaço-temporal, por meio do teste de varredura na identificação de aglomerados de CV. A partir de 2015, observa-se queda progressiva das CV e da homogeneidade, acentuando-se após 2020 em todas as regiões, particularmente Norte e Nordeste. Aglomerados de baixa CV foram associados a piores indicadores de desenvolvimento humano, desigualdade social e menor acesso à Estratégia de Saúde da Família. No Brasil, a pandemia intensificou as iniquidades em saúde, com baixas CV de sarampo em municípios socialmente mais vulneráveis e desiguais. Há risco de circulação do vírus, reafirmando o desafio de fortalecer a atenção básica, aprimorar a comunicação em saúde e garantir acesso à vacina, diminuindo oportunidades perdidas de vacinação e a hesitação vacinal.

Abstract The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted.

Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead. / Vacinação contra poliomielite no Brasil de 2011 a 2021: sucessos, reveses e desafios futuros.

The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).

A queda de coberturas vacinais (CV) na infância, entre elas a da poliomielite, vem se tornando uma preocupação sanitária. O objetivo foi analisar a tendência temporal das coberturas das três doses da vacina contra a poliomielite nos primeiros 12 meses de vida entre 2011 e 2021, com destaque na pandemia de COVID-19, além de mapear as CV no Brasil. Foi realizado um estudo ecológico com técnicas de série temporal interrompida (STI) e análise espacial, a partir dos dados do Sistema de Informação do Programa Nacional de Imunização. A tendência da CV foi ajustada pelo estimador de variância de Newey-West, segundo as unidades federadas e o Índice de Privação Brasileiro. A distribuição da CV foi estimada por modelos bayesianos e os aglomerados espaciais pelos índices de Moran global e local, identificando áreas de menor cobertura nas Regiões de Saúde. Observa-se perda da CV ao longo do período em todas as regiões do país, sendo maiores no Norte e no Nordeste e se acentuando durante a pandemia. As maiores quedas foram identificadas em estados e regiões de saúde com maior vulnerabilidade social. A queda na CV mostra que o risco de reintrodução do vírus selvagem é iminente e os desafios precisam ser enfrentados com o fortalecimento do Sistema Único de Saúde.

Measles vaccination in Brazil: where have we been and where are we headed? / Vacinação do sarampo no Brasil: onde estivemos e para onde vamos?

The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted.

A reemergência de doenças imunopreveníveis devido à queda das coberturas vacinais (CV) tem sido documentada em vários países. O objetivo foi analisar a CV, a homogeneidade das CV e os casos de sarampo no Brasil de 2011 a 2021, com enfoque no período da pandemia de COVID-19, sua tendência temporal, distribuição espaço-temporal e fatores associados aos aglomerados de menor CV. Trata-se de um estudo ecológico sobre a CV de sarampo (dose 1), com métodos de série temporal interrompida e de avaliação da disposição espaço-temporal, por meio do teste de varredura na identificação de aglomerados de CV. A partir de 2015, observa-se queda progressiva das CV e da homogeneidade, acentuando-se após 2020 em todas as regiões, particularmente Norte e Nordeste. Aglomerados de baixa CV foram associados a piores indicadores de desenvolvimento humano, desigualdade social e menor acesso à Estratégia de Saúde da Família. No Brasil, a pandemia intensificou as iniquidades em saúde, com baixas CV de sarampo em municípios socialmente mais vulneráveis e desiguais. Há risco de circulação do vírus, reafirmando o desafio de fortalecer a atenção básica, aprimorar a comunicação em saúde e garantir acesso à vacina, diminuindo oportunidades perdidas de vacinação e a hesitação vacinal.

Burden of disease due to amphetamines, cannabis, cocaine, and opioid use disorders in South America, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019.

BACKGROUND: South America's substance use profile, poverty, income inequality, and cocaine-supplier role make it a unique place for substance use research. This study investigated the burden of disease attributable to amphetamine use disorder, cannabis use disorder (CAD), cocaine use disorder, and opioid use disorder (OUD) in South America from 1990 to 2019, on the basis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS: GBD 2019 estimated the incidence, prevalence, mortality, years of life lost (YLL), years of life lived with disability (YLD), and disability-adjusted life-years (DALYs) due to substance use disorders in each of the 12 South American countries (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay, and Venezuela). Data were modelled using standardised tools (ie, the Cause of Death Ensemble model, spatio-temporal Gaussian process regression, and disease modelling meta-regression) to generate estimates of each quantity of interest by sex, location, and year. The analysis included comparisons by sex and country, and against regional and global estimates. FINDINGS: In 2019, the highest amphetamine use disorder burden per 100 000 population in South America was in Peru (66 DALYs). CAD DALY rates per 100 000 in South America were stable between 1990 and 2019, except in Chile and Colombia, which had the highest rates in 2019 (19 DALYs for Chile and 18 DALYs for Colombia). OUD DALYs per 100 000 increased during the period in Brazil and Peru, which in 2019 had the highest rates in South America (82 DALYs for Brazil and 70 DALYs for Peru). In 2019, Brazil had the highest cocaine use disorder DALYs per 100 000 (45 DALYs), nearly double its rate in 1990. DALY rates were higher in males than females for each substance use disorder, except in Paraguay. The overall burden of substance use disorders was higher in males than in females, mainly because of cocaine use disorder and CAD, whereas for amphetamine use disorder, the difference between sexes was minimal, and for OUD there was no difference. For males and females, the highest rate of substance use disorders DALYs per 100 000 was for OUD except in Argentina (in males, 58 DALYs for cocaine use disorder vs 52 DALYs for OUD) and in Paraguay (in females, 77 for amphetamine use disorder vs 50 for OUD). CAD DALY rates were generally the lowest among the substance use disorders for males and females. Amphetamine use disorder YLD rates were reasonably stable throughout the period and were highest in Peru, Paraguay, and Uruguay (>40 YLD per 100 000). For CAD, YLD rates were stable in all countries except Chile and Colombia. Cocaine use disorder YLD rates per 100 000 for the top four countries (Argentina, Uruguay, Chile, and Brazil) increased from 1990 to 2010 (eg, from 19 to 33 in Brazil), but decreased between 2010 and 2019 (eg, from 36 to 31 in Chile). For OUD, YLD rates showed a slight increase in most countries apart from Brazil, which increased from 52 in 1990 to 80 in 2019 and was top among the countries. Amphetamine use disorder YLL rates per 100 000 were highest in Suriname and Peru during the period, although in Suriname it increased from 2·7 in 2010 to 3·2 in 2019, whereas in Peru it decreased from 2·1 to 1·7. The highest YLL rate for cocaine use disorder was in Brazil, which increased from 3·7 in 1990 to 18·1 in 2019. Between 2000 and 2019, Chile and Uruguay showed the highest OUD YLL rates (11·6 for Chile and 10·9 for Uruguay). A high incidence of CAD was found in Chile, Colombia, Guyana, and Suriname. There were high incidences of amphetamine use disorder in Paraguay, cocaine use disorder in Argentina, and OUD in Ecuador. A decrease in annual prevalence for substance use disorders during the period was observed in Venezuela (amphetamine use disorder, CAD, and OUD), Brazil (CAD and amphetamine use disorder), Colombia (amphetamine use disorder and cocaine use disorder), Peru (amphetamine use disorder and cocaine use disorder), Chile and Suriname (amphetamine use disorder), Uruguay (CAD), and Bolivia (OUD). Overall, the cocaine use disorder burden stabilised then decreased. OUD was less prevalent than other substance use disorders but its burden was the highest. INTERPRETATION: The decrease in the burden of cocaine use disorder probably reflects the success of national standardised treatment programmes. Programmes for amphetamine use disorder, CAD, and OUD management should be improved. We did not find an increase in CAD burden in Uruguay, the country with the highest degree of cannabis decriminalisation in the region. Countries in South America should improve monitoring of substance use disorders, including regular surveys to provide more accurate data on which to base policy decisions. FUNDING: The Bill & Melinda Gates Foundation.

Capacidade funcional e fatores associados em idosos insulares: uma revisão sistemática da literatura / Functional capacity and associated factors in island elderly: a systematic review of the literature

Objetivo: o objetivo foi realizar uma revisão sistemática da literatura sobre a capacidade funcional e os fatores associados de idosos residentes em ilhas. Estratégia de pesquisa: a busca ocorreu pela combinação dos descritores "comunicação", "senso de humor e humor como assunto", "atividades cotidianas", "limitação da mobilidade", "autonomia pessoal", "cognição", "ilhas", "idoso" e "idoso de 80 anos ou mais" e dos correspondentes na língua inglesa, nas bases de dados: PubMed, Scopus, Web of Science e Lilacs. Resultados: dos 4761 artigos encontrados, 20 foram selecionados. Fatores individuais, clínicos e os relacionados ao estilo de vida foram identificados. Conclusão: a capacidade funcional de idosos é um fenômeno multifatorial. Poucos artigos são realizados em ilhas e a abordagem do contexto espacial, ambiental dos indivíduos idosos é escassa. Mais estudos com foco nos aspectos ambientais devem ser realizados em ilhas, principalmente nas pequenas em extensão, remotas e com pequenas populações.(AU)

Objective: The objective was to conduct a systematic review of the literature on the functional capacity and associated factors of elderly people living on islands. Research strategy: The search took place by combining the descriptors "communication", "sense of humor and humor as a subject", "daily activities", "limited mobility", "personal autonomy", "cognition", "islands", "elderly" and "elderly aged 80 years or more" and correspondents in the English language, in the databases: PubMed, Scopus, Web of Science and Lilacs. Results: Of the 4761 articles found, 20 were selected. Individual, clinical and lifestyle factors were identified. Conclusion: The functional capacity of the elderly is a multifactorial phenomenon. Few articles are conducted on islands, and the spatial and environmental context of elderly individuals is scarce. More studies focusing on environmental aspects should be carried out on islands, mainly in small ones, remote and with small populations.(AU)

Futile cycle of ß-oxidation and de novo lipogenesis are associated with essential fatty acids depletion in lipoatrophy.

Total absence of adipose tissue (lipoatrophy) is associated with the development of severe metabolic disorders including hepatomegaly and fatty liver. Here, we sought to investigate the impact of severe lipoatrophy induced by deletion of peroxisome proliferator-activated receptor gamma (PPARγ) exclusively in adipocytes on lipid metabolism in mice. Untargeted lipidomics of plasma, gastrocnemius and liver uncovered a systemic depletion of the essential linoleic (LA) and α-linolenic (ALA) fatty acids from several lipid classes (storage lipids, glycerophospholipids, free fatty acids) in lipoatrophic mice. Our data revealed that such essential fatty acid depletion was linked to increased: 1) capacity for liver mitochondrial fatty acid ß-oxidation (FAO), 2) citrate synthase activity and coenzyme Q content in the liver, 3) whole-body oxygen consumption and reduced respiratory exchange rate in the dark period, and 4) de novo lipogenesis and carbon flux in the TCA cycle. The key role of de novo lipogenesis in hepatic steatosis was evidenced by an accumulation of stearic, oleic, sapienic and mead acids in liver. Our results thus indicate that the simultaneous activation of the antagonic processes FAO and de novo lipogenesis in liver may create a futile metabolic cycle leading to a preferential depletion of LA and ALA. Noteworthy, this previously unrecognized cycle may also explain the increased energy expenditure displayed by lipoatrophic mice, adding a new piece to the metabolic regulation puzzle in lipoatrophies.

Estado funcional e fatores associados em pessoas idosas residentes na ilha de Fernando de Noronha: um estudo seccional / Functional status and associated factors in older persons living on the island of Fernando de Noronha: a cross-sectional study

Resumo Objetivo Analisar o perfil do estado funcional e os fatores associados em pessoas idosas residentes na Ilha de Fernando de Noronha/Pernambuco, Brasil. Método Tratou-se de um estudo seccional, de caráter analítico, e a coleta de dados foi conduzida entre agosto e outubro de 2019. A população do estudo compreendeu 176 pessoas idosas residentes na ilha. O protocolo de coleta foi aplicado por meio de entrevista para resposta ao questionário de variáveis demográficas, sociais, clínicas e ambientais, e aos instrumentos de avaliação. O estado funcional foi determinado a partir da Análise de Classes Latentes, avaliada pelos protocolos dos domínios: cognição, humor, atividades instrumentais de vida diária, mobilidade e comunicação. Resultados O modelo da análise escolhido possuiu duas classes, nomeadas como: "Boa autonomia e independência" e "Moderada autonomia e dependência parcial". A maioria das pessoas idosas apresentou bom estado funcional e os fatores associados foram: pertencer ao sexo masculino, ser separado ou divorciado, viver sozinho, visitar os amigos ou parentes, ter trabalhado mais de 36 anos, ser alfabetizado, não ter deficiência visual ou auditiva, fazer uso de uma ou duas medicações e ter história de queda. Conclusão O estado funcional das pessoas idosas insulares se apresentou como um fenômeno multifatorial, pois fatores demográficos, sociais e clínicos estiveram associados de forma independente à boa funcionalidade. É importante que a manutenção do estado funcional seja incentivada na implementação de políticas públicas voltadas às especificidades das populações residentes em ilhas.

Abstract Objective To analyze the functional status profile and associated factors in older persons living on Fernando de Noronha Island/Pernambuco, Brazil. Method This was a cross-sectional, analytical study, and data collection was conducted between August and October 2019. The study population comprised 176 older persons living on the island. The collection protocol was applied through an interview to respond to the behavior of demographic, social, clinical and environmental variables, and to the assessment instruments. The functional status was determined from the Analysis of Latent Classes, evaluated by the protocols of the domains: cognition, mood, instrumental activities of daily living, mobility and communication. Results The chosen analysis model had two classes, named as: "Good autonomy and independence" and "Moderate autonomy and partial dependence". Most older persons had good functional status and the associated factors were: being male, being separated or divorced, living alone, visiting friends or relatives, having worked more than 36 years, being literate, not having a visual or hearing impairment, taking one or two medications and having a history of falls. Conclusion The functional status of island older persons was presented as a multifactorial phenomenon, as demographic, social and clinical factors remained independently associated with good functionality. It is important that the maintenance of the functional state is encouraged in the implementation of public policies aimed at the specificities of populations residing on islands.

Associação entre funcionalidade e conhecimentos, atitudes e práticas de prevenção da covid-19 em pessoas idosas / Association between functionality and knowledge, attitudes, and practices of COVID-19 prevention in the older people

Resumo Objetivo Analisar a associação entre funcionalidade e conhecimentos, atitudes e práticas de prevenção da covid-19 em pessoas idosas do município do Recife, Pernambuco, Brasil. Método Estudo transversal com coleta remota entre junho e setembro de 2020, junto a 144 pessoas idosas de ambos os sexos, atendidas nos pontos de referência da covid-19, distribuídos em oito distritos. A variável dependente, conhecimentos, atitudes e práticas de prevenção da covid-19, coletada através do Inquérito CAP, foi construída pela Análise de Classe Latente. A variável independente principal foi a funcionalidade para Atividades Instrumentais da Vida Diária, coletada através da escala de Lawton e Brody. A análise de dados utilizou teste qui-quadrado e análise múltipla de regressão logística multinomial, com significância 5%. Resultados A maioria dos estudados, 44%, apresentou conhecimentos e atitudes regulares e boa prática de prevenção da covid-19. Os participantes independentes apresentaram 4,26 (IC95% 1,46; 12,38) mais chances de ter conhecimentos, atitudes e práticas excelentes para a prevenção da doença. Já os com maior escolaridade apresentaram 3,89 (IC95% 1,16; 12,99) mais chances de ter conhecimentos, atitudes e práticas excelentes, comparados aos que nunca, ambas comparações consideraram intervalo de confiança 95%. Conclusão A prevenção da covid-19 sofreu influência da funcionalidade, mostrando-se que quanto maior a independência funcional, melhor a prevenção nas pessoas idosas. Esse conhecimento leva ao direcionamento de políticas públicas e ações voltadas para a importância da prevenção de doenças na população idosa, bem como para a promoção do envelhecimento saudável.

Abstract Objective To analyze the association between functionality and knowledge, attitudes, and practices of COVID-19 prevention in the elderly population of Recife, Pernambuco, Brazil. Method A cross-sectional study with remote data collection conducted between June and September 2020, involving 144 elderly individuals of both sexes who were served at COVID-19 reference points in eight districts. The dependent variable, knowledge, attitudes, and practices related to COVID-19 prevention, collected through the CAP Survey, was constructed using Latent Class Analysis. The primary independent variable was functionality in Instrumental Activities of Daily Living, collected through the Lawton and Brody scale. Data analysis utilized chi-square tests and multiple multinomial logistic regression analysis, with a significance level of 5%. Results The majority of the participants, 44%, exhibited regular knowledge and attitudes with good COVID-19 prevention practices. Independent participants had 4.26 times greater odds (95% CI: 1.46; 12.38) of possessing excellent knowledge, attitudes, and prevention practices for the disease. Those with higher levels of education had 3.89 times greater odds (95% CI: 1.16; 12.99) of having excellent knowledge, attitudes, and practices compared to those with no education. Both comparisons considered a 95% confidence interval. Conclusion COVID-19 prevention was influenced by functionality, indicating that greater functional independence led to better prevention among the elderly. This understanding directs public policies and actions aimed at the importance of disease prevention in the elderly population, as well as promoting healthy aging.