Participatory democratic practices in the construction of social development agendas in municipalities in the southeast of Brazil

We present the results of a study that focused on local processes of implementation of social agendas - Agenda 21 and Healthy Cities - in the Southeast region of Brazil, relating the effort and its effects on the social determinants of health, especially those who may be understood by considering the relationship between social actors and system. There were 6 case studies to analyze the social experience to implement their agenda. Individual and collective interviews, survey documentation and direct observation of the experiences that produced the data were analyzed according to the previously defined research themes. Results show that values such as participation, collective construction of policies, sustainability and empowerment becomes part of the ideology and experience of those directly involved and is interfering so that positive actions have been adopted in the municipalities where they were developed, promoting health and quality of life of citizens living in these places.Se presentan los resultados de un estudio sobre los procesos locales de desarrollo de agendas sociales - Ciudades Saludables y Agenda 21 - en ciudades de la región sureste de Brasil, relacionando el esfuerzo empleado y sus efectos sobre los determinantes sociales de la salud, especialmente aquellos que se pueden comprender teniendo en cuenta la relación entre actores sociales y sistema. Se realizaron 6 estudios de caso para analizar la experiencia social de implementar las agendas. Entrevistas individuales y colectivas, reunión de documentación y observación directa produjeron los datos que se analizaron en términos de temas de investigación previamente definidos. Los resultados muestran que valores como participación, construcción colectiva de políticas, sostenibilidad y empoderamiento se convierten en parte de la ideología y experiencia de los directamente involucrados y que interfieren para la adopción de acciones positivas, promoviendo la salud y la calidad de vida de los ciudadanos que viven en estos lugares.Este artigo apresenta os resultados e a análise de um estudo que focalizou os processos locais de implantação das agendas sociais - Cidades Saudáveis e Agenda 21 - em municípios da região Sudeste do Brasil, relacionando o esforço realizado e seus efeitos sobre os determinantes sociais de saúde, especialmente os que podem ser apreendidos considerando-se a relação entre atores sociais e sistema. Realizaram-se estudos de caso em seis municípios para análise da experiência social de implementação da respectiva agenda. Entrevistas individuais e coletivas, levantamento de documentação e observação direta produziram os dados que foram analisados em função de temas de pesquisa previamente definidos. Resultados demonstram que valores como participação, construção coletiva de políticas, sustentabilidade e empoderamento, passam a integrar o ideário e a experiência dos atores diretamente envolvidos, além de interferirem ao ponto de ações positivas serem adotadas e implementadas, para promover a saúde e a qualidade de vida dos cidadãos que vivem nestes locais.Universidade de São Paulo Faculdade de Saúde PúblicaUniversidade Estadual de Campinas Faculdade de Ciências Médica Departamento de Saúde ColetivaUSP Faculdade de Saúde PúblicaUSP Faculdade de saúde PúblicaUniversidade de São Paulo e do Centro de Estudos Faculdade de Saúde Pública Departamento de Prática de Saúde PúblicaUniversidade Federal de São Paulo (UNIFESP) CEPEDOCCentro de Estudos, Pesquisa e Documentação em Cidades SaudáveisMinistério da Saúde Fundação Oswaldo Cruz Centro de Pesquisas Aggeu MagalhãesUNIFESP, CEPEDOCSciEL

Participatory democratic practices in the construction of social development agendas in municipalities in the southeast of Brazil

We present the results of a study that focused on local processes of implementation of social agendas - Agenda 21 and Healthy Cities - in the Southeast region of Brazil, relating the effort and its effects on the social determinants of health, especially those who may be understood by considering the relationship between social actors and system. There were 6 case studies to analyze the social experience to implement their agenda. Individual and collective interviews, survey documentation and direct observation of the experiences that produced the data were analyzed according to the previously defined research themes. Results show that values such as participation, collective construction of policies, sustainability and empowerment becomes part of the ideology and experience of those directly involved and is interfering so that positive actions have been adopted in the municipalities where they were developed, promoting health and quality of life of citizens living in these places.Este artigo apresenta os resultados e a análise de um estudo que focalizou os processos locais de implantação das agendas sociais - Cidades Saudáveis e Agenda 21 - em municípios da região Sudeste do Brasil, relacionando o esforço realizado e seus efeitos sobre os determinantes sociais de saúde, especialmente os que podem ser apreendidos considerando-se a relação entre atores sociais e sistema. Realizaram-se estudos de caso em seis municípios para análise da experiência social de implementação da respectiva agenda. Entrevistas individuais e coletivas, levantamento de documentação e observação direta produziram os dados que foram analisados em função de temas de pesquisa previamente definidos. Resultados demonstram que valores como participação, construção coletiva de políticas, sustentabilidade e empoderamento, passam a integrar o ideário e a experiência dos atores diretamente envolvidos, além de interferirem ao ponto de ações positivas serem adotadas e implementadas, para promover a saúde e a qualidade de vida dos cidadãos que vivem nestes locais.Se presentan los resultados de un estudio sobre los procesos locales de desarrollo de agendas sociales - Ciudades Saludables y Agenda 21 - en ciudades de la región sureste de Brasil, relacionando el esfuerzo empleado y sus efectos sobre los determinantes sociales de la salud, especialmente aquellos que se pueden comprender teniendo en cuenta la relación entre actores sociales y sistema. Se realizaron 6 estudios de caso para analizar la experiencia social de implementar las agendas. Entrevistas individuales y colectivas, reunión de documentación y observación directa produjeron los datos que se analizaron en términos de temas de investigación previamente definidos. Los resultados muestran que valores como participación, construcción colectiva de políticas, sostenibilidad y empoderamiento se convierten en parte de la ideología y experiencia de los directamente involucrados y que interfieren para la adopción de acciones positivas, promoviendo la salud y la calidad de vida de los ciudadanos que viven en estos lugares.10312

Guidelines for the management and treatment of periodic fever syndromes Cryopyrin-associated periodic syndromes (cryopyrinopathies – CAPS)

AbstractObjectiveTo establish guidelines based on cientific evidences for the management of cryopyrin associated periodic syndromes.Description of the evidence collection methodThe Guideline was prepared from 4 clinical questions that were structured through PICO (Patient, Intervention or indicator, Comparison and Outcome), to search in key primary scientific information databases. After defining the potential studies to support the recommendations, these were graduated considering their strength of evidence and grade of recommendation.Results1215 articles were retrieved and evaluated by title and abstract; from these, 42 articles were selected to support the recommendations.Recommendations1. The diagnosis of CAPS is based on clinical history and clinical manifestations, and later confirmed by genetic study. CAPS may manifest itself in three phenotypes: FCAS (mild form), MWS (intermediate form) and CINCA (severe form). Neurological, ophthalmic, otorhinolaryngological and radiological assessments may be highly valuable in distinguishing between syndromes; 2. The genetic diagnosis with NLRP3 gene analysis must be conducted in suspected cases of CAPS, i.e., individuals presenting before 20 years of age, recurrent episodes of inflammation expressed by a mild fever and urticaria; 3. Laboratory abnormalities include leukocytosis and elevated serum levels of inflammatory proteins; and 4. Targeted therapies directed against interleukin-1 lead to rapid remission of symptoms in most patients. However, there are important limitations on the long-term safety. None of the three anti-IL-1β inhibitors prevents progression of bone lesions

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Bone-Marrow Stem Cells and Acellular Human Amniotic Membrane in a Rat Model of Heart Failure

Myocardial infarction (MI) remains the leading cause of cardiovascular death worldwide and a major cause of heart failure. Recent studies have suggested that cell-based therapies with bone marrow stem cells (BMSC) and human amniotic membrane (hAM) would recover the ventricular function after MI; however, the mechanisms underlying these effects are still controversial. Herein, we aimed to compare the effects of BMSC and hAM in a rat model of heart failure. MI was induced through coronary occlusion, and animals with an ejection fraction (EF) &lt; 50% were included and randomized into three groups: control, BMSC, and hAM. The BMSC and hAM groups were implanted on the anterior ventricular wall seven days after MI, and a new echocardiographic analysis was performed on the 30th day, followed by euthanasia. The echocardiographic results after 30 days showed significant improvements on EF and left-ventricular end-sistolic and end-diastolic volumes in both BMSC and hAM groups, without significant benefits in the control group. New blood vessels, desmine-positive cells and connexin-43 expression were also elevated in both BMSC and hAM groups. These results suggest a recovery of global cardiac function with the therapeutic use of both BMSC and hAM, associated with angiogenesis and cardiomyocyte regeneration after 30 days

Bone-marrow mononuclear cells and acellular human amniotic membrane improve global cardiac function without inhibition of the NLRP3 Inflammasome in a rat model of heart failure

Abstract Recent studies have suggested that therapies with stem cells and amniotic membrane can modulate the inflammation following an ischemic injury in the heart. This study evaluated the effects of bone-marrow mononuclear cells (BMMC) and acellular human amniotic membrane (AHAM) on cardiac function and NLRP3 complex in a rat model of heart failure.On the 30th day,the echocardiographic showed improvements on ejection fraction and decreased pathological ventricular remodeling on BMMC and AHAM groups.Oxidative stress analysis was similar between the three groups,and the NLRP3 inflammasome activity were not decreased with the therapeutic use of both BMMC and AHAM,in comparison to the control group

Transcranial Direct Current Stimulation for Post-Concussion Syndrome: Study Protocol for a Randomized Crossover Trial

BackgroundMild traumatic brain injury (MTBI) represents 70–80% of all treated brain injuries. A considerable proportion of MTBI patients experience post-concussion symptoms for a prolonged period after MTBI, and these symptoms are diagnosed as persistent post-concussion syndrome (PPCS). PPCS is defined as a range of physical, cognitive, and emotional symptoms. However, memory and executive dysfunction seems to be one of the most debilitating symptoms. Recently, non-invasive brain stimulation has been studied as a potential treatment method for traumatic brain injury (TBI) patients. Therefore, our primary goal is to verify the effects of transcranial direct current stimulation (tDCS) in patients with PPCS who demonstrate cognitive deficits in long-term episodic memory, working memory, and executive function following MTBI.Methods/designThis is a randomized crossover trial of patients with a history of MTBI with cognitive deficits in memory and executive function. Thirty adult patients will be randomized in a crossover manner to receive three weekly sessions of anodal tDCS (2 mA) at left dorsolateral prefrontal cortex, left temporal cortex, and sham stimulation that will be performed at 7-day intervals (washout period). The clinical diagnosis of PPCS will be determined using the Rivermead Post-Concussion Symptoms Questionnaire. Patients who meet the inclusion criteria will be assessed with a neuropsychological evaluation. A new battery of computerized neuropsychological tests will be performed before and immediately after each stimulation. Statistical analysis will be performed to determine trends of cognitive improvement.DiscussionThere is paucity of studies regarding the use of tDCS in TBI patients, and although recent results showed controversial data regarding the effects of tDCS in such patients, we will address specifically patients with PPCS and MTBI and no brain abnormalities on CT scan other than subarachnoid hemorrhage. Moreover, due to the missing information on literature regarding the best brain region to be studied, we will evaluate two different regions to find immediate effects of tDCS on memory and executive dysfunction.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT02292589 (https://register.clinicaltrials.gov)