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Abstract Background Warfarin is an oral anticoagulant that is very useful in preventing thromboembolism, though it is considered a drug with a high risk of causing adverse events. Considering the practical challenges in controlling oral anticoagulation, the patients on warfarin could benefit from educational strategies aimed at behavioral changes, active participation in self-care, and adherence to drug therapy. Objective The aim was to construct and validate the EmpoderACO protocol for behavioral changes in warfarin patients. Methods The methodological steps were: definition of concepts and domains of self-care, identification of objectives, construction and selection of items, assessment of content validity, and pre-test in the target population. Results Relevance, adequacy, clarity, and internal reliability of the instrument’s items were assessed by a multidisciplinary judges committee (JC) through the E-surv web platform, obtaining an average agreement of ≥0.91. The understanding of the instrument measured by the target population revealed adequate clarity with a coefficient average of 0.96. Conclusion EmpoderACO can aid in qualifying the communication process between medical professionals and patients, as well as in improving adherence to both treatment and clinical outcomes, and can be replicated in healthcare settings.

Resumo Fundamento A varfarina é um anticoagulante oral útil para prevenção de tromboembolismo, embora seja considerado fármaco de alto risco de causar eventos adversos. Considerando os desafios práticos no controle da anticoagulação oral, os pacientes poderiam se beneficiar de estratégias educacionais que visem mudança de comportamento, participação ativa no autocuidado e adesão à farmacoterapia. Objetivo Construir e validar o protocolo EmpoderACO para mudança de comportamento em pacientes em uso de varfarina. Métodos As etapas metodológicas foram: definição de conceitos e domínios do autocuidado, identificação dos objetivos, construção e seleção dos itens, avaliação da validade de conteúdo e pré-teste na população alvo. Resultados Relevância, adequação, clareza e confiabilidade interna dos itens do instrumento foram avaliadas por comitê de juízes multiprofissional pela plataforma web E-surv, obtendo-se média de concordância ≥0,91. A compreensão do instrumento pela população-alvo teve clareza adequada com média de 0,96. Conclusão O EmpoderACO poderá contribuir para qualificar o processo de comunicação entre profissionais e pacientes, melhorar a adesão ao tratamento e os resultados clínicos, podendo ser replicado nos serviços de saúde.

https://doi.org/10.36660/abc.20220576

Lesão Miocárdica e Prognóstico em Pacientes Hospitalizados com COVID-19 no Brasil: Resultados do Registro Nacional de COVID-19
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Barbosa, Hannah Cardoso

; Martins, Maria Auxiliadora Parreiras

; Jesus, Jordana Cristina de

; Meira, Karina Cardoso

; Passaglia, Luiz Guilherme

; Sacioto, Manuela Furtado

; Bezerra, Adriana Falangola Benjamin

; Schwarzbold, Alexandre Vargas

; Maurílio, Amanda de Oliveira

; Farace, Barbara Lopes

; Silva, Carla Thais Cândida Alves da

; Cimini, Christiane Corrêa Rodrigues

; Silveira, Daniel Vitorio

; Carazai, Daniela do Reis

; Ponce, Daniela

; Costa, Emanuel Victor Alves

; Manenti, Euler Roberto Fernandes

; Cenci, Evelin Paola de Almeida

; Bartolazzi, Frederico

; Madeira, Glícia Cristina de Castro

; Nascimento, Guilherme Fagundes

; Velloso, Isabela Vasconcellos Pires

; Batista, Joanna d’Arc Lyra

; Morais, Júlia Drumond Parreiras de

; Carvalho, Juliana da Silva Nogueira

; Ruschel, Karen Brasil

; Martins, Karina Paula Medeiros Prado

; Zandoná, Liege Barella

; Menezes, Luanna Silva Monteiro

; Kopittke, Luciane

; Castro, Luís César de

; Nasi, Luiz Antônio

; Floriani, Maiara Anschau

; Souza, Maíra Dias

; Carneiro, Marcelo

; Bicalho, Maria Aparecida Camargos

; Lima, Maria Clara Pontello Barbosa

; Godoy, Mariana Frizzo de

; Guimarães-Júnior, Milton Henriques

; Mendes, Paulo Mascarenhas

; Delfino-Pereira, Polianna

; Ribeiro, Raquel Jaqueline Eder

; Finger, Renan Goulart

; Menezes, Rochele Mosmann

; Francisco, Saionara Cristina

; Araújo, Silvia Ferreira

; Oliveira, Talita Fischer

; Oliveira, Thainara Conceição de

; Polanczyk, Carisi Anne

; Marcolino, Milena Soriano

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 2 elocation e20220151

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento As complicações cardiovasculares da COVID-19 são aspectos importantes da patogênese e do prognóstico da doença. Evidências do papel prognóstico da troponina e da lesão miocárdica em pacientes hospitalizados com COVID-19 na América Latina são ainda escassos. Objetivos Avaliar a lesão miocárdica como preditor independente de mortalidade hospitalar e suporte ventilatório mecânico em pacientes hospitalizados, do registro brasileiro de COVID-19. Métodos Este estudo coorte é um subestudo do registro brasileiro de COVID-19, conduzido em 31 hospitais brasileiros de 17 cidades, de março a setembro de 2020. Os desfechos primários incluíram mortalidade hospitalar e suporte ventilatório mecânico invasivo. Os modelos para os desfechos primários foram estimados por regressão de Poisson com variância robusta, com significância estatística de p<0,05. Resultados Dos 2925 pacientes [idade mediana de 60 anos (48-71), 57,1%], 27,3% apresentaram lesão miocárdica. A proporção de pacientes com comorbidades foi maior nos pacientes com lesão miocárdica [mediana 2 (1-2) vs. 1 (0-20)]. Os pacientes com lesão miocárdica apresentaram maiores valores medianos de peptídeo natriurético cerebral, lactato desidrogenase, creatina fosfoquinase, N-terminal do pró-peptídeo natriurético tipo B e proteína C reativa em comparação a pacientes sem lesão miocárdica. Como fatores independentes, proteína C reativa e contagem de plaquetas foram relacionados com o risco de morte, e neutrófilos e contagem de plaquetas foram relacionados ao risco de suporte ventilatório mecânico invasivo. Os pacientes com níveis elevados de troponina apresentaram um maior risco de morte (RR 2,03, IC95% 1,60-2,58) e suporte ventilatório mecânico (RR 1,87;IC95% 1,57-2,23), em comparação àqueles com níveis de troponina normais. Conclusão Lesão cardíaca foi um preditor independente de mortalidade hospitalar e necessidade de suporte ventilatório mecânico em pacientes hospitalizados com COVID-19.

Abstract Background Cardiovascular complications of COVID-19 are important aspects of the disease’s pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. Objectives To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. Methods This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. Results Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. Conclusion Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.

https://doi.org/10.36660/abc.20220151

The Challenges of Implementing a Text Message Intervention to Promote Behavioral Change in Primary Care Patients With Hypertension and Diabetes
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Oliveira, João Antonio de Queiroz

; Cimini, Christiane

; Almeida, Vania

; Maia, Junia Xavier

; Resende, Raissa Eda

; Gualberto, Leticia Alves

; Santos, Pedro Henrique Lauar

; Gomes, Paulo R.

; Bonisson, Leonardo

; Paixão, Maria Cristina

; Costa, Janaina Moutinho

; Cardoso, Clareci Silva

; Santo, Karla

; Ribeiro, Antonio

; Martins, Maria Auxiliadora

; Marcolino, Milena S.

International Journal of Cardiovascular Sciences

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2023, Volume 36 elocation e20220050

Abstract: En | Text: En | PDF: En

Abstract Background Controlling blood pressure and glycemic levels is a challenge that requires innovative solutions. Objective To assess the feasibility of implementing a text message intervention among low-income primary care patients, as well as to assess self-reported behavioral change. Methods A set of 200 text messages was developed on healthy eating, physical activity, adherence, and motivation. Participants from Vale do Mucuri, MG, Brazil diagnosed with diabetes or hypertension or undergoing screening for those diseases, received 5 to 8 messages per week for 6 months. They answered a questionnaire to report their satisfaction and behavioral changes. Results Of the 136 patients, 117 (86.0%) answered the questionnaire. Most reported that the messages were very useful (86.3%), easy to understand (90.6%), and were very helpful for behavioral change (65.0%); 84.6% reported that they had started eating healthier. The most frequent reported lifestyle changes were: improved diet quality (85.5%), reduced portions (65.8%), and weight loss (56.4%). The majority of patients shared the messages (60.7%) with family or other acquaintances, considered the number of messages to be adequate (89.7%) and would recommend the program to others (95.7%). Conclusion An intervention based on text messages to promote behavioral change in patients with hypertension or diabetes in primary care is feasible in low-resource settings. Future studies are needed to assess the program’s long-term effects on clinical outcomes.

https://doi.org/10.36660/ijcs.20220050

Screening of Perinatal Depression Using the Edinburgh Postpartum Depression Scale
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Oliveira, Tenilson Amaral

; Luzetti, Guilherme Guarany Cardoso Magalhães

; Rosalém, Márcia Maria Auxiliadora

; Mariani Neto, Corintio

Revista Brasileira de Ginecologia e Obstetrícia

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may 2022, Volume 44 N. 5 Pages 452 - 457

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Objetivo Identificar as pacientes com quadro de depressão na gravidez e puerpério imediato através da escala de depressão pós-parto de Edimburgo (EPDS). Métodos Estudo observacional transversal que incluiu 315mulheres no ciclo grávidopuerperal com idades entre 14 e 44 anos, que foramatendidas no HospitalMaternidade Leonor Mendes de Barros entre 1° de Julho de 2019 e 30 de Outubro de 2020. O ponto de corte utilizado foi ≥ 12 da EPDS para definir se a paciente apresentava depressão. Resultados Encontramos 62 (19,7%) com depressão. Baixa renda familiar, multiparidade, menor número de consultas pré-natal, antecedentes de transtornos emocionais, insatisfação com a gravidez, mau relacionamento com o parceiro, e agressão psicológica foram fatores de risco associados à depressão na gravidez ou no período pós-parto imediato. Antecedentes de depressão e agressão psicológica durante a gravidez foram preditores significativos de depressão perinatal na análisemultivariada. Conclusão O estudo mostrou uma associação significativa entre a ocorrência de depressão e os fatores psicossociais acima mencionados. O pré-natal e o puerpério imediato permitem identificar através da EPDS tais pacientes e estabelecer uma linha de cuidados para melhorar o bem-estar materno e do recém-nascido.

Abstract Objective To detect depression during pregnancy and in the immediate postpartum period using the Edinburgh postpartum depression scale (EPDS). Methods Cross sectional study of 315 women, aged between 14 and 44 years, who received perinatal care at the Leonor Mendes de Barros Hospital, in São Paulo, between July 1st, 2019 and October 30th, 2020. The cutoff point suggesting depression was ≥ 12. Results The screening indicated 62 (19.7%) patients experiencing depression. Low family income, multiparity, fewer prenatal appointments, antecedents of emotional disorders, dissatisfaction with the pregnancy, poor relationship with the partner, and psychological aggression were all risk factors associated with depression in pregnancy or in the immediate postpartum period. Antecedents of depression and psychology aggression during pregnancy were significant variables for predicting perinatal depression in the multivariate analysis. Conclusion There is a significant association between the occurrence of perinatal depression and the aforementioned psychosocial factors. Screening patients with the EPDS during perinatal and postpartum care could facilitate establishing a line of care to improve the wellbeing of mother and infant.

https://doi.org/10.1055/s-0042-1743095

La industria farmacéutica en Colombia en la literatura académica interdisciplinaria: revisión de alcance, 1990-2018
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Mendoza-Ruiz, Adriana

; Oliveira, Maria Auxiliadora

; Paranhos, Julia

Innovar

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mar 2022, Volume 32 N. 83 Pages 153 - 174

RESUMEN: La industria farmacéutica es un sector estratégico tanto para el desarrollo de un país como por sus interfaces con los sectores de salud, ciencia, tecnología e innovación. El objetivo de este trabajo fue analizar la literatura académica publicada sobre la industria farmacéutica en Colombia entre 1990 y 2018. Para ello, se realizó una revisión de alcance en la que, en total, 84 trabajos fueron incluidos: 71 artículos científicos y 13 documentos de literatura gris. Una tendencia al crecimiento de la literatura fue observada pero con persistencia del predominio de análisis económicos, financieros y de propiedad intelectual. Los únicos estudios sobre desarrollo tecnológico industrial farmacéutico, usando fuentes primarias, fueron publicados entre 2007 y 2010. No fueron identificados análisis centrados en ese sector usando como fuente secundaria las Encuestas de Desarrollo e Innovación Tecnológica. Aunque los estudios con abordaje histórico, organizacional y de procesos de transformación de materiales contribuyeron al conocimiento sobre algunas empresas de capital nacional, se corroboró la persistencia de la brecha en el estudio del desarrollo y la acumulación de las capacidades de innovación de los fabricantes farmacéuticos, privados y públicos, en Colombia.

RÉSUMÉ: L'industrie pharmaceutique est un secteur stratégique à la fois pour le développement d'un pays et pour ses interfaces avec les secteurs de la santé, de la science, de la technologie et de l'innovation. L'objectif de ce travail était d'analyser la littérature académique publiée sur l'industrie pharmaceutique en Colombie entre 1990 et 2018. Pour cela, on a mené une revue de la portée dans laquelle, au total, 84 articles ont été inclus : 71 articles scientifiques et 13 articles de littérature grise. On a observé une tendance à la croissance de la littérature, mais avec la persistance de la prédominance des analyses économiques, financières et de propriété intellectuelle. Les seules études sur le développement technologique de .'industrie pharmaceutique, utilisant des sources primaires, ont été publiées entre 2007 et 2010. Aucune analyse portant sur ce secteur n'a été identifiée en utilisant les enquêtes de Développement et Innovation Technologique comme source secondaire. Bien que les études avec une approche historique, organisationnelle et des processus de transformation des matériaux aient contribué à la connaissance de certaines entreprises à capital national, on a confirmé la persistance de l'écart dans l'étude du développement et de l'accumulation des capacités d'innovation des fabricants de produits pharmaceutiques, privés et publiques, en Colombie.

ABSTRACT: The pharmaceutical industry is strategic for the development of a country, considering its association with health, science, technology and innovation sectors. The objective of this work was to examine the academic literature focused on the Colombian pharmaceutical industry published between 1990 and 2018. To do that, we carried out a scoping review of 84 papers: 71 scientific articles and 13 gray literature documents. A trend towards the growth of related literature was observed, although economic, financial and intellectual property studies remain as the main repertoire. Findings show that the only studies addressing technological development within this industry using primary sources were published between 2007 and 2010. In addition, none of the works in the sample used the Technological Development and Innovation Surveys as a secondary source of information. Despite the fact that some studies with a historical, organizational and materials transformation process' approach contributed to the knowledge of some national companies, the persisting gap in the study of the development and accumulation of innovation capacities by pharmaceutical manufacturers, both private and public, in Colombia was confirmed.

RESUMO: A indústria farmacêutica é um setor estratégico para o desenvolvimento de um país e por suas interfaces com os setores da saúde, da ciência, da tecnologia e da inovação. Nesse sentido, o objetivo deste trabalho é analisar a literatura acadêmica publicada sobre a indústria farmacêutica na Colômbia entre 1990 e 2018. Para isso, foi realizada uma revisão de escopo em que, em total, 84 trabalhos foram incluídos: 71 artigos científicos e 13 documentos de literatura cinzenta. Uma tendência ao crescimento da literatura foi observada, mas com persistência do predomínio de análises econômicas, financeiras e de propriedade intelectual. Os únicos estudos sobre desenvolvimento tecnológico industrial farmacêutico, usando fontes primárias, foram publicados entre 2007 e 2010. Não foram identificadas análises centralizadas nesse setor com a utilização de questionários de desenvolvimento e inovação tecnológica como fonte secundária. Embora os estudos com abordagem histórica, organizacional e de processos de transformação de materiais tenham contribuído para o conhecimento sobre algumas empresas de capital nacional, constatou-se a persistência da lacuna no estudo do desenvolvimento e no acúmulo das capacidades de inovação dos fabricantes farmacêuticos, privados e públicos, na Colômbia.

https://doi.org/10.15446/innovar.v32n83.99922 124 downloads

Benzodiazepines utilization in Brazilian older adults: a population-based study
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Freire, Marina de Borba Oliveira

; Da Silva, Bruna Gonçalves Cordeiro

; Bertoldi, Andréa Dâmaso

; Fontanella, Andréia Turmina

; Mengue, Sotero Serrate

; Ramos, Luiz Roberto

; Tavares, Noemia Urruth Leão

; Pizzol, Tatiane da Silva Dal

; Arrais, Paulo Sérgio Dourado

; Farias, Mareni Rocha

; Luiza, Vera Lucia

; Oliveira, Maria Auxiliadora

; Menezes, Ana Maria Baptista

Revista de Saúde Pública

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2022, Volume 56 elocation 10

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO OBJETIVO Avaliar a utilização de benzodiazepínicos (BZD) em idosos brasileiros,a partir de dados da Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM). MÉTODOS A PNAUM é um estudo transversal, conduzido entre 2013 e 2014, com representatividade da população urbana brasileira. No presente estudo, foram incluídos indivíduos com 60 anos ou mais (n = 9.019). Foi calculada a prevalência de utilização de BZD nos 15 dias anteriores à coleta dos dados da pesquisa, geral e segundo as variáveis independentes, por meio de análise bruta e ajustada, utilizando modelo hierárquico de regressão de Poisson. A coleta de dados foi realizada por meio de entrevista domiciliar. RESULTADOS A prevalência de utilização de BZD em idosos foi de 9,3% (IC95%: 8,3–10,4). Após análise ajustada, foram associados à maior utilização de BZD: sexo feminino (RP = 1,88; IC95%: 1,52–2,32), depressão (RP = 5,31; IC95%: 4,41–6,38), multimorbidade (RP = 1,44; IC95%: 1,20–1,73), visita à emergência ou internação hospitalar nos últimos 12 meses (RP = 1,42; IC95%: 1,18–1,70), polifarmácia (RP = 1,26; IC95%: 1,01–1,57) e autopercepção de saúde ruim ou muito ruim (RP = 4,16; IC95%: 2,10–8,22). A utilização foi menor na região Norte (RP = 0,18; IC95%: 0,13–0,27) e em indivíduos que relataram consumo abusivo de álcool no último mês (RP = 0,42; IC95%: 0,19–0,94). CONCLUSÃO Apesar das recomendações contrárias ao uso, os resultados demonstraram elevada prevalência de utilização de BZD em idosos, particularmente naqueles que apresentam depressão, além de amplas diferenças em relação às regiões do país e ao sexo do indivíduo.

ABSTRACT OBJECTIVE To evaluate the utilization of benzodiazepines (BZD) in Brazilian older adults, based on the Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de Medicamentos (PNAUM - National Survey of Access, Use and Promotion of Rational Use of Medicines). METHODS The PNAUM is a cross-sectional study conducted between 2013 and 2014, representing the Brazilian urban population. In the present study, we included 60 years or older (n = 9,019) individuals. We calculated the prevalence of BZD utilization in the 15 days prior to survey data collection according to independent variables, using a hierarchical Poisson regression model. A semistructured interview performed empirical data collection (household interview). RESULTS The prevalence of BZD utilization in the older adults was 9.3% (95%CI: 8.3–10.4). After adjustments, BZD utilization was associated with female sex (PR = 1.88; 95%CI: 1.52–2.32), depression (PR = 5.31; 95%CI: 4.41–6, 38), multimorbidity (PR = 1.44; 95%CI: 1.20–1.73), emergency room visit or hospitalization in the last 12 months (PR = 1.42; 95%CI: 1.18–1.70 ), polypharmacy (PR = 1.26; 95%CI: 1.01–1.57) and poor or very poor self-rated health (PR = 4.16; 95%CI: 2.10–8.22). Utilization was lower in the North region (PR = 0.18; 95%CI: 0.13–0.27) and in individuals who reported abusive alcohol consumption in the last month (PR = 0.42; 95%CI: 0.19–0.94). CONCLUSION Despite contraindications, results showed a high prevalence of BZD utilization in older adults, particularly in those with depression, and wide regional and sex differences.

https://doi.org/10.11606/s1518-8787.2022056003740

Benzodiazepines utilization in Brazilian older adults: a population-based study
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Freire, Marina de Borba Oliveira

; Da Silva, Bruna Gonçalves Cordeiro

; Bertoldi, Andréa Dâmaso

; Fontanella, Andréia Turmina

; Mengue, Sotero Serrate

; Ramos, Luiz Roberto

; Tavares, Noemia Urruth Leão

; Pizzol, Tatiane da Silva Dal

; Arrais, Paulo Sérgio Dourado

; Farias, Mareni Rocha

; Luiza, Vera Lucia

; Oliveira, Maria Auxiliadora

; Menezes, Ana Maria Baptista

Revista de Saúde Pública

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2022, Volume 56 elocation 10

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.11606/s1518-8787.2022056003740

Factors associated with the development of leprosy in Brazilian contacts: a systematic review
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Alecrin, Edilamar Silva de

; Oliveira, Ana Laura Grossi de

; Guimarães, Nathália Sernizon

; Lyon, Sandra

; Martins, Maria Auxiliadora Parreiras

; Rocha, Manoel Otávio da Costa

Revista do Instituto de Medicina Tropical de São Paulo

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2022, Volume 64 elocation e55

Abstract: En | Text: En | PDF: En

ABSTRACT People who interact with leprosy patients in their environment, neighborhood, family, or social relationships are at risk to develop the disease. This systematic review investigated the risk and protective factors associated with the development of leprosy in Brazilian contacts. The studies were found in Cochrane Library, PubMed (MEDLINE), Embase, Virtual Health Library, grey literature and hand search until July 2021. The study selection, data extraction and quality assessment were independently performed by two investigators. The quality assessment was performed using the Newcastle-Ottawa Scale (NOS). This review was registered in PROSPERO (CRD42020160680). Seventeen articles fulfilled the inclusion criteria (n=544). The immunological and molecular factors, such as Anti-phenolic Glycolipid Antibodies (Anti-PGL-1) seropositivity, negative Mitsuda test, absence of Bacillus Calmette-Guérin (BCG) scar, positive Polymerase Chain Reaction (PCR) in blood; age and race; conviviality, education, contact time and type of contact, as well as elements related to the index case (bacilloscopic index; genetic conditions, family relationships), and some combined factors were shown to be relevant risk factors associated with the development of the disease in Brazilian leprosy contacts. The protective factors reported were the presence of one or more BCG scars, positive Mitsuda test, and education level. All selected studies were considered of high quality according to NOS. The knowledge of disease-related risk and protective factors provides the scientific basis for decision-making in the management of the disease in leprosy contacts.

https://doi.org/10.1590/s1678-9946202264055

Características e Tendências na Mortalidade em Diferentes Fenótipos de Insuficiência Cardíaca na Atenção Primária
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Jorge, Antonio José Lagoeiro

; Barbetta, Leticia Mara dos Santos

; Correia, Eduardo Thadeu de Oliveira

; Martins, Wolney de Andrade

; Leite, Adson Renato

; Saad, Maria Auxiliadora Nogueira

; Santos, Márcia Maria Sales dos

; Correia, Dayse Mary

; Rosa, Maria Luiza Garcia

; Chermont, Sérgio

; Santos, Cárita Cunha dos

; Mesquita, Evandro Tinoco

Arquivos Brasileiros de Cardiologia

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aug 2021, Volume 117 N. 2 Pages 300 - 306

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: A classificação da insuficiência cardíaca (IC) por fenótipos possui grande relevância na prática clínica. Objetivo: O estudo visou analisar a prevalência, as características clínicas e os desfechos entre os fenótipos de IC no contexto da atenção primária. Métodos: Trata-se de uma análise de um estudo de coorte que incluiu 560 indivíduos, com idade ≥ 45 anos, que foram selecionados aleatoriamente em um programa de atenção primária. Todos os participantes foram submetidos a avaliações clínicas, dosagem do peptídeo natriurético tipo B (BNP), eletrocardiograma e ecocardiografia em um único dia. A IC com fração de ejeção do ventrículo esquerdo (FEVE) < 40% foi classificado como IC com fração de ejeção reduzida (ICFEr), FEVE de 40% a 49% como IC com fração de ejeção intermediária (ICFEi) e FEVE ≥ 50% como IC com fração de ejeção preservada (ICFEp). Após 5 anos, os pacientes foram reavaliados quanto à ocorrência do desfecho composto de óbito por qualquer causa ou internação por doença cardiovascular. Resultados: Dos 560 pacientes incluídos, 51 pacientes tinham IC (9,1%), 11 dos quais tinham ICFEr (21,6%), 10 tinham ICFEi (19,6%) e 30 tinham ICFEp (58,8%). A ICFEi foi semelhante à ICFEp nos níveis de BNP (p < 0,001), índice de massa do ventrículo esquerdo (p = 0,037) e índice de volume do átrio esquerdo (p < 0,001). O fenótipo de ICFEi foi semelhante ao de ICFEr em relação à doença arterial coronariana (p = 0,009). Após 5 anos, os pacientes com ICFEi apresentaram melhor prognóstico quando comparados aos pacientes com ICFEp e ICFEr (p < 0,001). Conclusão: A prevalência de ICFEI foi semelhante ao observado em estudos anteriores. A ICFEI apresentou características semelhantes a ICFEP neste estudo. Nossos dados mostram que a ICFEi teve melhor prognóstico em comparação com os outros dois fenótipos.

Abstract Background: The classification of heart failure (HF) by phenotypes has a great relevance in clinical practice. Objective: The study aimed to analyze the prevalence, clinical characteristics, and outcomes between HF phenotypes in the primary care setting. Methods: This is an analysis of a cohort study including 560 individuals, aged ≥ 45 years, who were randomly selected in a primary care program. All participants underwent clinical evaluations, b-type natriuretic peptide (BNP) measurements, electrocardiogram, and echocardiography in a single day. HF with left ventricular ejection fraction (LVEF) < 40% was classified as HF with reduced ejection fraction (HFrEF), LVEF 40% to 49% as HF with mid-range ejection fraction (HFmrEF) and LVEF ≥ 50% as HF with preserved ejection fraction (HFpEF). After 5 years, the patients were reassessed as to the occurrence of the composite outcome of death from any cause or hospitalization for cardiovascular disease. Results: Of the 560 patients included, 51 patients had HF (9.1%), 11 of whom had HFrEF (21.6%), 10 had HFmrEF (19.6%) and 30 had HFpEF (58.8%). HFmrEF was similar to HFpEF in BNP levels (p < 0.001), left ventricular mass index (p = 0.037), and left atrial volume index (p < 0.001). The HFmrEF phenotype was similar to HFrEF regarding coronary artery disease (p = 0.009). After 5 years, patients with HFmrEF had a better prognosis when compared to patients with HFpEF and HFrEF (p < 0.001). Conclusion: The prevalence of ICFEI was similar to that observed in previous studies. ICFEI presented characteristics similar to ICFEP in this study. Our data show that ICFEi had a better prognosis compared to the other two phenotypes.

https://doi.org/10.36660/abc.20190912 165 downloads

10.

Training systems, rootstocks and climatic conditions influence quality and antioxidant activity of ‘BRS Cora’ grape
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Costa, Rayssa Ribeiro da

; Ferreira, Talita de Oliveira

; Lima, Maria Auxiliadora Coêlho de

Acta Scientiarum. Agronomy

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2021, Volume 43 elocation e49054

Abstract: En | Text: En | PDF: En

ABSTRACT. Environmental and production factors might affect grapevine physiology. Estimating these effects is essential for planning the harvest and predicting the quality of grapes. The aim of this study was to characterize the quality and antioxidant potential of ‘BRS Cora’ grapes with different training systems and rootstocks in production cycles of the second half of the year under tropical conditions. The experimental design was randomized blocks with sub-subdivided plots over time. Three training systems and two rootstocks were studied in production cycles referring to the second halves of 2017 and 2018. In 2017, the grapes of plants trained with lyre and vertical shoot positioning (VSP) had the highest soluble solids and sugars contents, and in 2018, this response occurred with the overhead trellis system. There was lower variation in titratable acidity between cycles of grapevines trained with VSP and lyre, as well as in those grafted onto ‘IAC 572’. In 2018, lyre with ‘IAC 572’ promoted higher pigment accumulation. Climatic conditions in 2017 provided a higher accumulation of polyphenols and antioxidant activity in grapes of plants trained with lyre with ‘IAC 766’. The efficiency of the training system within each cycle, associated with the effect of the rootstock, resulted in differentiated responses according to climatic conditions.

https://doi.org/10.4025/actasciagron.v43i1.49054 404 downloads

11.

Trellis systems and rootstocks affect the quality and antioxidant potential of ‘BRS Cora’ grapes in rainy seasons under semiarid conditions
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Costa, Rayssa Ribeiro da

; Ferreira, Talita de Oliveira

; Lima, Maria Auxiliadora Coêlho de

Bragantia

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2021, Volume 80 elocation e0721

Abstract: En | Text: En | PDF: En

ABSTRACT The quality and phenolic compound composition might be affected by production system due to microclimate around the bunches and sunlight interception provided by vegetative canopy architecture and environmental conditions. The aim of this study was to characterize the quality and antioxidant potential of ‘BRS Cora’ grapes with different trellis systems and rootstocks in rainy seasons under tropical conditions. Three trellis systems and two rootstocks were studied in production cycles during the first halves of 2017 and 2018, using a randomized-block experimental design. Interactions between the trellis systems,rootstocks and cycles differentially affect the fruit quality. The association between vertical shoot positioning or an overhead trellis with ‘IAC 766’ induced higher polyphenol compound contents. In turn, the trellis systems overhead trellis and lyre provided greater stability for the berry weight, soluble solids, total soluble sugar contents, yellow flavonoids, total extractable polyphenol compounds or antioxidant activity in both production cycles. The results of this study inferred that the grape quality and phenolic compound composition were not only affected by some specific climatic factors but also by the trellis system, rootstock, and the interaction between the three factors.

https://doi.org/10.1590/1678-4499.20200201 642 downloads

12.

Acesso a medicamentos e cooperação Sul-Sul: um estudo de caso de negociação conjunta de preços na América do Sul
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Oliveira, Beatriz Nascimento Lins de

; Oliveira, Maria Auxiliadora

Cadernos de Saúde Pública

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2021, Volume 37 N. 10 elocation e00170920

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

Resumo: Este artigo tem como objetivo analisar a negociação conjunta de preços de medicamentos de alto custo, que iniciou em 2015 nos âmbitos do Mercado Comum do Sul (Mercosul) e da União de Nações Sul-Americanas (Unasul), com a participação da Organização Pan-Americana da Saúde (OPAS). Apresenta-se como um estudo de caso, baseado em pesquisa documental e entrevistas em profundidade, que descreve a primeira etapa presencial do processo de negociação de preços conduzido pelo Comitê Ad Hoc de Negociação de Preços de Medicamentos de Alto Custo (CAHPM) do Mercosul. Tal processo resultou no estabelecimento de preços-teto na região para o darunavir e o sofosbuvir. No caso do darunavir, houve uma redução do preço global do medicamento, inclusive no preço do Fundo Global de Luta Contra aids, Tuberculose e Malária. Conclui-se que a negociação de preços foi bem-sucedida nos casos mencionados, e a participação do Fundo Estratégico da OPAS na compra dos medicamentos agilizou o processo de compra e a disponibilidade destes nos países.

Abstract: This article aims to analyze joint negotiation of prices on high-cost drugs, which began in 2015 in the frameworks of the Southern Common Market (Mercosur) and the Union of South American Nations (USAN), with the participation of the Pan-Americana Health Organization (PAHO). This is a case study based on document research and in-depth interviews, describing the first face-to-face stage in the price negotiations led by the Mercosur Ad Hoc Committee on Drug Price Negotiations. The process resulted in the establishment of price caps in South America for darunavir and sofosbuvir. In the case of darunavir, there was a reduction in the global price, including the price in the Global Fund to Fight AIDS, Tuberculosis, and Malaria. In conclusion, price negotiation was successful in the above-mentioned cases, and participation by the PAHO Strategic Fund in the drug purchases streamlined their procurement and their availability in the countries.

Resumen: El objetivo de este artículo es analizar la negociación conjunta de precios de medicamentos de alto costo, que comenzó en 2015 en los ámbitos del Mercado Común del Sur (Mercosur) y Unión de Naciones Suramericanas (Unasur), con la participación de la Organización Panamericana de Salud (OPAS). Se presenta como un estudio de caso, basado en investigación documental y entrevistas en profundidad, que describe la primera etapa presencial del proceso de negociación de precios, llevado a cabo por el Comité Ad Hoc de Negociación de Precios de Medicamentos del Mercosur. Tal proceso resultó en el establecimiento de precios-techo en la región para el darunavir y el sofosbuvir. En el caso del darunavir, hubo una reducción del precio global del medicamento, incluso en el precio del Fondo Global de Lucha Contra el SIDA, Tuberculosis y Malaria. Se concluye que la negociación de precios fue muy exitosa en los casos mencionados, y la participación del Fondo Estratégico de la OPAS en la compra de los medicamentos agilizó el proceso de compra y la disponibilidad de los mismos en los países.

https://doi.org/10.1590/0102-311x00170920

13.

Acesso a medicamentos e cooperação Sul-Sul: um estudo de caso de negociação conjunta de preços na América do Sul
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Oliveira, Beatriz Nascimento Lins de

; Oliveira, Maria Auxiliadora

Cadernos de Saúde Pública

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2021, Volume 37 N. 10 elocation e00170920

Abstract: Pt En Es | Text: Pt En Es | PDF: Pt | PDF: En | PDF: Es

https://doi.org/10.1590/0102-311x00170920 27 downloads

14.

Seasonality affects the community of endophytic fungi in coconut (Cocos nucifera) crop leaves
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Oliveira, Rafael José Vilela de

; Sousa, Natalia Mirelly Ferreira de

; Pinto Neto, Walter de Paula

; Bezerra, José Luiz

; Silva, Gladstone Alves da

; Cavalcanti, Maria Auxiliadora de Queiroz

Acta Botanica Brasilica

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dec 2020, Volume 34 N. 4 Pages 704 - 711

Abstract: En | Text: En | PDF: En

ABSTRACT The diversity of endophytic fungi in healthy coconut palm leaves (Cocos nucifera) was assessed by analyzing fungal isolates from three coconut cultivars (yellow dwarf, green dwarf, and a hybrid cultivar PB121) used agriculturally in Brazil. The influence of season (rainy or dry) on the endophytic fungal community was also analyzed. Overall, 318 fungal isolates were obtained from 972 coconut leaf fragments. The rDNA ITS region was sequenced from representative species of the isolated endophytic fungi and the most common species identified were Nigrospora oryzae, Pestalotiopsis sp., and Zasmidium musae. The alpha diversity of the endophytic fungi was also calculated. Nonmetric multidimensional scaling (NMDS) ordination and permutational analysis of variance (PERMANOVA) revealed significant seasonal effects on the composition of the endophyte community. However, practically no influence was observed on the fungal communities for the different cultivars of coconut.

https://doi.org/10.1590/0102-33062020abb0106 341 downloads

15.

Resistência a Antimicrobianos: a formulação da resposta no âmbito da saúde global
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Silva, Rafael Almeida da

; Oliveira, Beatriz Nascimento Lins de

; Silva, Luiza Pinheiro Alves da

; Oliveira, Maria Auxiliadora

; Chaves, Gabriela Costa

Saúde em Debate

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sep 2020, Volume 44 N. 126 Pages 607 - 623

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A Resistência a Antimicrobianos (AMR) tem se revelado como um dos maiores problemas para a saúde pública no nível global. O objetivo deste artigo foi analisar a formulação da resposta à AMR negociada no âmbito da Organização Mundial da Saúde (OMS) por seus Estados-Membros. Foram analisados os relatórios e resoluções produzidos na Assembleia Mundial da Saúde no período de 1998 a 2019. Os achados indicam que, a partir de 2014, foram estabelecidas condições de possibilidade para a aprovação do Plano de Ação Global em AMR de forma mais robusta, abrangendo o conceito de Saúde Única e envolvendo outras instâncias internacionais (FAO, OIE, OMC e PNUMA). A análise dos conteúdos e o uso de diferentes referenciais analíticos, considerando dois setores econômicos – agropecuária e indústria farmacêutica –, mostraram-se relevantes para ilustrar a complexidade da temática, reforçando sua relevância global, reconhecendo a dimensão do uso de antibióticos em animais e as lacunas em inovação tecnológica. Como a OMS, além de ser um importante agente mobilizador para a resposta à AMR no nível global, tem garantido orçamento para ações nessa área mesmo em um contexto de desfinanciamento, conclui-se que a perspectiva da saúde pública deve prevalecer na resposta à AMR.

ABSTRACT Antimicrobial Resistance (AMR) has proved to be a major public health problem at the global level. This paper examined the formulation of the response to AMR negotiated through the World Health Organization (WHO) by its Member States. Related WHO reports and resolutions from 1998 to 2019 were analysed. The findings indicate that, from 2014 on, more robust conditions were established for approval of a Global Action Plan on AMR, encompassing the concept of One Health and involving other international entities (FAO, OIE, WTO and Unep). Content analysis and various analytical frameworks, considering two economic sectors (the livestock and pharmaceutical industries), proved relevant to illustrating the complexity of the issue, reinforcing its global importance and acknowledging the extent of antibiotic use in animals and the gaps in technological innovation. As the WHO is not only an important agent for mobilizing the response to AMR at the global level, but – despite a context of de-funding – has guaranteed a budget for action in this area, it is concluded that the public health perspective should prevail in the response to AMR.

https://doi.org/10.1590/0103-1104202012602

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