Os fenômenos físicos e químicos no processo digestivo: análise de livros didáticos, percepção de alunos do Ensino Médio e avaliação de uma mídia educacional

Estamos desenvolvendo um DVD com experimentos simples e de baixo custo sobre fenômenos químicose físicos da digestão. Neste trabalho mostramos uma avaliação de livros didáticos e da compreensão doaluno sobre o tema do DVD, além de uma avaliação dos vídeos desenvolvidos. Apesar da importância dadaao livro didático pelos professores, os livros do PNLEM não atendem plenamente às recomendações doscurrículos oficiais sobre o tema abordado. Talvez, este seja o motivo pelo qual os alunos não o identificaramde maneira plena na avaliação. A avaliação positiva dos vídeos por alunos do ensino médio sugere que elespodem ser bem aproveitados na sala de aula. (FAPERJ

Desenvolvimento de ferramentas multimidiáticas para o ensino de bioquímica

A bioquímica é uma disciplina do ciclo básico de diferentes cursos da área de Ciências da Saúde. Porém,apesar dos avanços observados nos livros didáticos de bioquímica, a visualização de estruturas e reaçõesainda é muito limitada, já que as representações são estáticas, longe de ser ideal. Nosso grupo vem desenvolvendoum material multimidiático, consistindo de vídeos que combinam filmes, animações e dinâmicamolecular com o objetivo de auxiliar no processo de ensino-aprendizagem em bioquímica. Apoio: FAPERJe PR5/UFRJ

Cancer and Pregnancy: Estimates in Italy from Record-Linkage Procedures between Cancer Registries and the Hospital Discharge Database

Simple Summary Concurrence of pregnancy and cancer diagnosis is an uncommon but not rare event: about 1 pregnancy-associated cancer (PAC) out of 1000 pregnancies is the estimation currently available. This frequency is growing due to postponing childbearing to age groups more at risk of cancer. Interest in this topic is both epidemiological and clinical: improvement of diagnostic and therapeutic techniques makes management of cancer increasingly compatible with pregnancy. The occurrence of PAC challenges women and clinicians who need to manage the two events, safeguarding fetal outcomes without changing the maternal prognosis. This retrospective study aims to provide estimates for PAC and its time trend in Italy by analyzing cross-referenced data from population-based cancer registries and hospital discharges. The proposed methodology is applicable to other populations with available data from Cancer Registries linkable at an individual level with hospitalizations.Abstract The aim of this study is to describe the frequency and trend of pregnancy-associated cancer (PAC) in Italy, an increasingly relevant phenomenon due to postponing age at childbirth. To this purpose, a population-based retrospective longitudinal study design based on cohorts of women aged 15-49 diagnosed with cancer and concomitant pregnancy is proposed. The study uses 19 population-based Cancer Registries, covering about 22% of Italy, and linked at an individual level with Hospital Discharge Records. A total of 2,861,437 pregnancies and 3559 PAC are identified from 74,165 women of the cohort with a rate of 1.24 PAC per 1000 pregnancies. The most frequent cancer site is breast (24.3%), followed by thyroid (23.9%) and melanoma (14.3%). The most frequent outcome is delivery (53.1%), followed by voluntary termination of pregnancy and spontaneous abortion (both 12.0%). The trend of PAC increased from 2003 to 2015, especially when the outcome is delivery, thus confirming a new attitude of clinicians to manage cancer throughout pregnancy. This represents the first attempt in Italy to describe PAC from Cancer Registries data; the methodology is applicable to other areas with the same data availability. Evidence from this study is addressed to clinicians for improving clinical management of women with PAC

Stellar metallicity from optical and UV spectral indices: Test case for WEAVE-StePS

Context. The upcoming generation of optical spectrographs on four meter-class telescopes, with their huge multiplexing capabilities, excellent spectral resolution, and unprecedented wavelength coverage, will provide high-quality spectra for thousands of galaxies. These data will allow us to examine of the stellar population properties at intermediate redshift, an epoch that remains unexplored by large and deep surveys. Aims. We assess our capability to retrieve the mean stellar metallicity in galaxies at different redshifts and signal-to-noise ratios (S/N), while simultaneously exploiting the ultraviolet (UV) and optical rest-frame wavelength coverage. Methods. The work is based on a comprehensive library of spectral templates of stellar populations, covering a wide range of age and metallicity values and built assuming various star formation histories, to cover an observable parameter space with diverse chemical enrichment histories and dust attenuation. We took into account possible observational errors, simulating realistic observations of a large sample of galaxies carried out with WEAVE at the William Herschel Telescope at different redshifts and S/N values. We measured all the available and reliable indices on the simulated spectra and on the comparison library. We then adopted a Bayesian approach to compare the two sets of measurements in order to obtain the probability distribution of stellar metallicity with an accurate estimate of the uncertainties. Results. The analysis of the spectral indices has shown how some mid-UV indices, such as BL3580 and Fe3619, can provide reliable constraints on stellar metallicity, along with optical indicators. The analysis of the mock observations has shown that even at S/N = 10, the metallicity can be derived within 0.3 dex, in particular, for stellar populations older than 2 Gyr. The S/N value plays a crucial role in the uncertainty of the estimated metallicity and so, the differences between S/N = 10 and S/N = 30 are quite large, with uncertainties of ~0.15 dex in the latter case. On the contrary, moving from S/N = 30 to S/N = 50, the improvement on the uncertainty of the metallicity measurements is almost negligible. Our results are in good agreement with other theoretical and observational works in the literature and show how the UV indicators, coupled with classic optical ones, can be advantageous in constraining metallicities. Conclusions. We demonstrate that a good accuracy can be reached on the spectroscopic measurements of the stellar metallicity of galaxies at intermediate redshift, even at low S/N, when a large number of indices can be employed, including some UV indices. This is very promising for the upcoming surveys carried out with new, highly multiplexed, large-field spectrographs, such as StePS at the WEAVE and 4MOST, which will provide spectra of thousands of galaxies covering large spectral ranges (between 3600 and 9000 Å in the observed frame) at relatively high S/N (>10 Å -1)F.R.D., A.I., M.L, S.Z., A.G., F.L.B. acknowledge financial support from grant 1.05.01.86.16 – Mainstream 2020. A.F.M. acknowledges support from RYC2021-031099-I and PID2021-123313NAI00 of MICIN/AEI/10.13039/501100011033/FEDER,UE. L.C. acknowledges financial support from Comunidad de Madrid under Atraccion de Talento grant 2018-T2/TIC-11612 and Spanish Ministerio de Ciencia e Innovacion MCIN/AEI/10.13039/501100011033 through grant PGC2018-093499-BI00. R.G.B. acknowledges financial support from the grants CEX2021-001131-S funded by MCIN/AEI/10.13039/501100011033 and to PID2019-109067-GB100. A.V. acknowledges support from grant PID2019-107427GB-C32 and PID2021-123313NA-I00 from the Spanish Ministry of Science, Innovation and Universities MCIU. This work has also been supported through the IAC project TRACES, which is partially supported through the state budget and the regional budget of the Consejería de Economía, Industria, Comercio y Conocimiento of the Canary Islands Autonomous Community. A.V. also acknowledges support from the ACIISI, Consejería de Economía, Conocimiento y Empleo del Gobierno de Canarias and the European Regional Development Fund (ERDF) under grant with reference ProID202101007

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population