Determinantes de saúde em crianças dos 3 aos 10 anos

RESUMO 1: Introdução: Os estilos de vida atuais sugerem comportamentos de risco que estão na base do perfil de saúde do país. Objetivo: Avaliar os estilos de vida e sua associação com dados sociodemográficos numa amostra de crianças portuguesas dos 3 aos 10 anos de idade. Participantes e métodos: Estudo transversal de natureza quantitativa num universo de 1617 crianças dos jardins de infância e escolas do 1.º ciclo dos dois agrupamentos de escolas de Tondela e do agrupamento de escolas de Vouzela. A amostra do estudo foi constituída por um total de 1385 crianças. A análise estatística dos dados foi efetuada com recurso ao software estatístico IBM SPSS versão 21.0. A comparação de proporções foi realizada através do teste Qui-quadrado, onde as prevalências foram expressas em proporções, com base no nível de significância de p=0,05, com intervalos de confiança de 95%. Resultados: Constatou-se que as crianças com mais idade apresentavam uma menor adesão a comportamentos alimentares saudáveis, uma maior prevalência de atividade física (49,2%), no entanto, foram, também aquelas que apresentaram um maior índice de atividades sedentárias (27,1%). Os rapazes apresentaram maiores níveis de atividade física (51,6%) e índices mais elevados de comportamentos sedentários (28,6%). Relativamente à zona de residência, existiu uma maior prevalência de consumo de legumes (73,2%) e fastfood (24,0%) e de comportamentos sedentários (26,1%) em zonas urbanas. As crianças que pertenciam a agregados familares de rendimentos mais favoráveis e com maior nível de habilitações literárias consumiam mais leite e derivados, legumes e praticavam mais atividade física. No entanto, apresentaram maior prevalência de consumo de fastfood e comportamentos sedentários. Conclusões:Torna-se perceptível a necessidade de se intervir nos grupos mais vulneráveis no sentido de uma mais eficaz equidade em saúde. Palavras-chave: Crianças; estilos de vida; dados sociodemográficos; escolas.ABSTRACT 1: Introduction: The current lifestyles suggests risk behaviors that are the basis of a country's health profile. Objective: Assess the lifestyles and its association with sociodemographic variables among a sample of Portuguese children from 3 to 10 years old. Participants and methods: A Cross-sectional study was desgined with a total of 1617 children from public schools, from the two main school groups of Tondela and Vouzela. The final study sample was built with a total of 1385 children. Statistical analysis was performed using the IBM SPSS software version 21.0 for Windows. Comparison of proportions was performed using the “Chi-square” test, where prevalences were expressed as proportions, based on the significance level of p = 0.05, with a 95% confidence intervals. Results: It was found that the older children had a lower adherence to healthy eating habits and a higher prevalence of physical activity (49.2%). However, there were also those with higher rate of sedentary activities (27.1%). The boys had higher levels of physical activity (51.6%) and higher rates of sedentary behaviors (28.6%). With regard to residence area, there was a higher prevalence of consumption of vegetables (73.2%), fastfood (24.0%) and sedentary behaviors (26.1%) in urban areas. Children belonging to households of more favorable monthly earnings and a higher level of educational qualifications consumed more dairy product, vegetables and practiced more physical activity. However, they had a higher prevalence of fastfood consumption and sedentary behaviors. Conclusions: It becomes noticeable the need to make an intervention on the most vulnerable groups to obtain more effective health equity. Keywords: Children; lifestyles; sociodemographic data; schools.RESUMO 2: Introdução: As iniquidades de género na distribuição de recursos estão ainda profundamente associadas à saúde precária e à diminuição do bem-estar das mulheres e das crianças. Objetivo: Analisar a influência dos fatores materno-fetais nos estilos de vida numa amostra de crianças portuguesas dos 3 aos 10 anos de idade Participantes e métodos: Estudo transversal de natureza quantitativa num universo de 1617 crianças dos jardins de infância e escolas do 1.º ciclo dos dois agrupamentos de escolas de Tondela e do agrupamento de escolas de Vouzela. A amostra do estudo foi constituída por um total de 1385 crianças. A análise estatística dos dados foi efetuada com recurso ao software estatístico IBM SPSS versão 21.0. A comparação de proporções foi realizada através do teste Qui-quadrado, onde as prevalências foram expressas em proporções, com base no nível de significância de p=0,05, com intervalos de confiança de 95%. Resultados: As crianças que habitam em meio rural apresentavam um peso à nascença superior comparativamente às do meio urbano (93,7%). As grávidas com mais idade obtiveram uma prevalência de antecipação da primeira consulta de gravidez mais elevada (96,5%) assim como uma prevalência mais elevada de consultas de vigilância durante a gravidez (97,2%) quando comparadas com as grávidas mais novas. As mães com habilitações literárias superiores ao 9.º ano de escolaridade apresentavam uma prevalência de amamentação superior (58,0%) e os seus filhos uma prevalência de consumo de fastfood superior (64,9%) quando comparadas com as mães com habilitações literárias inferiores. Conclusões: Denota-se a importância da maturidade, formação e capacitação das mães para os cuidados maternos e neonatais. Palavras-chave: crianças; estilos de vida; fatores materno-fetais.ABSTRACT 2: Introduction: Gender inequalities in the distribution of resources is still deeply associated with poor health and reduced welfare of women and children. Objective: To analyze the influence of maternal and fetal factors in lifestyles of children, in a sample of children from 3 to 10 years old. Participants and methods: A Cross-sectional study was desgined with a total of 1617 children from public schools, from the two main school groups of Tondela and Vouzela. The final study sample was built with a total of 1385 children. Statistical analysis was performed using the IBM SPSS software version 21.0 for Windows. Comparison of proportions was performed using the “Chi-square” test, where prevalences were expressed as proportions, based on the significance level of p = 0.05, with a 95% confidence intervals. Results: Children who live in rural areas presented a higher birth weight compared to those who live in urban areas (93.7%). Older pregnant women obtained a higher prevalence of the first medical appointment antecipation (96.5%) as well as a higher prevalence of medical appointments during pregnancy (97.2%) when compared with younger pregnant women. Mothers with qualifications higher than the 9th grade showed a higher prevalence of breastfeeding (58.0%) and their children presented a higher prevalence of fastfood consumption (64.9%) when compared with mothers with lower educational qualifications. Conclusion: To denote the importance of maturity and training of mothers in maternal and neonatal care. Keywords: children; lifestyles; maternal fetal factors

Clinical Prediction Rule for Stratifying Risk of Pulmonary Multidrug-Resistant Tuberculosis

Multidrug-resistant tuberculosis (MDR-TB), resistance to at least isoniazid and rifampin, is a worldwide problem.To develop a clinical prediction rule to stratify risk for MDR-TB among patients with pulmonary tuberculosis.Derivation and internal validation of the rule among adult patients prospectively recruited from 37 health centers (Perú), either a) presenting with a positive acid-fast bacillus smear, or b) had failed therapy or had a relapse within the first 12 months.Among 964 patients, 82 had MDR-TB (prevalence, 8.5%). Variables included were MDR-TB contact within the family, previous tuberculosis, cavitary radiologic pattern, and abnormal lung exam. The area under the receiver-operating curve (AUROC) was 0.76. Selecting a cut-off score of one or greater resulted in a sensitivity of 72.6%, specificity of 62.8%, likelihood ratio (LR) positive of 1.95, and LR negative of 0.44. Similarly, selecting a cut-off score of two or greater resulted in a sensitivity of 60.8%, specificity of 87.5%, LR positive of 4.85, and LR negative of 0.45. Finally, selecting a cut-off score of three or greater resulted in a sensitivity of 45.1%, specificity of 95.3%, LR positive of 9.56, and LR negative of 0.58.A simple clinical prediction rule at presentation can stratify risk for MDR-TB. If further validated, the rule could be used for management decisions in resource-limited areas

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Functional Characterization of an Aspergillus fumigatus Calcium Transporter (PmcA) that Is Essential for Fungal Infection

Aspergillus fumigatus is a primary and opportunistic pathogen, as well as a major allergen, of mammals. The Ca+2-calcineurin pathway affects virulence, morphogenesis and antifungal drug action in A. fumigatus. Here, we investigated three components of the A. fumigatus Ca+2-calcineurin pathway, pmcA,-B, and -C, which encode calcium transporters. We demonstrated that CrzA can directly control the mRNA accumulation of the pmcA-C genes by binding to their promoter regions. CrzA-binding experiments suggested that the 5′-CACAGCCAC-3′ and 5′-CCCTGCCCC-3′ sequences upstream of pmcA and pmcC genes, respectively, are possible calcineurin-dependent response elements (CDREs)-like consensus motifs. Null mutants were constructed for pmcA and -B and a conditional mutant for pmcC demonstrating pmcC is an essential gene. The ΔpmcA and ΔpmcB mutants were more sensitive to calcium and resistant to manganese and cyclosporin was able to modulate the sensitivity or resistance of these mutants to these salts, supporting the interaction between calcineurin and the function of these transporters. The pmcA-C genes have decreased mRNA abundance into the alveoli in the ΔcalA and ΔcrzA mutant strains. However, only the A. fumigatus ΔpmcA was avirulent in the murine model of invasive pulmonary aspergillosis

Kwapa: Gente del río. Estrategias transmedia de impacto social

PAP Alter Código produce materiales de interacción audiovisual que se organizan en un universo transmedia, trabaja con personas de todas las edades, su meta es difundir representaciones no estigmatizantes de grupos socialmente desfavorecidos, además de compartir esta visión a todo aquel que colabore en el proyecto. En la temporada de verano 2023, el equipo Alter CÓDIGO continuó con el desarrollo del videojuego “A la orilla del río”, para ello la organización del trabajo se dividió en múltiples áreas tanto como comunitarias como digitales para dar una mayor profundidad al producto. Los avances más significativos van desde una versión más actualizada del guion, storyboards, una primera animación, un demo, este último de lo que sería el gameplay, y un minijuego. Asimismo, se muestra la vinculación comunitaria e impacto social que se logró con el desarrollo de los talleres de intervención fotográfica con niños acerca de su territorio. Paralelamente se aborda la creación de redes sociales y página web para la difusión del proyecto por fuera del PAP. En los dos meses de trabajo se cumplieron con los ideales del Proyecto de Aplicación Profesional y se logró una difusión transmedia. A pesar de que el proyecto aún no llega a su finalización, los avances y el alcance superaron las metas que se otorgaron al inicio de la temporada.ITESO, A.C

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Comparative Genomic Analysis of Human Fungal Pathogens Causing Paracoccidioidomycosis

Paracoccidioides is a fungal pathogen and the cause of paracoccidioidomycosis, a health-threatening human systemic mycosis endemic to Latin America. Infection by Paracoccidioides, a dimorphic fungus in the order Onygenales, is coupled with a thermally regulated transition from a soil-dwelling filamentous form to a yeast-like pathogenic form. To better understand the genetic basis of growth and pathogenicity in Paracoccidioides, we sequenced the genomes of two strains of Paracoccidioides brasiliensis (Pb03 and Pb18) and one strain of Paracoccidioides lutzii (Pb01). These genomes range in size from 29.1 Mb to 32.9 Mb and encode 7,610 to 8,130 genes. To enable genetic studies, we mapped 94% of the P. brasiliensis Pb18 assembly onto five chromosomes. We characterized gene family content across Onygenales and related fungi, and within Paracoccidioides we found expansions of the fungal-specific kinase family FunK1. Additionally, the Onygenales have lost many genes involved in carbohydrate metabolism and fewer genes involved in protein metabolism, resulting in a higher ratio of proteases to carbohydrate active enzymes in the Onygenales than their relatives. To determine if gene content correlated with growth on different substrates, we screened the non-pathogenic onygenale Uncinocarpus reesii, which has orthologs for 91% of Paracoccidioides metabolic genes, for growth on 190 carbon sources. U. reesii showed growth on a limited range of carbohydrates, primarily basic plant sugars and cell wall components; this suggests that Onygenales, including dimorphic fungi, can degrade cellulosic plant material in the soil. In addition, U. reesii grew on gelatin and a wide range of dipeptides and amino acids, indicating a preference for proteinaceous growth substrates over carbohydrates, which may enable these fungi to also degrade animal biomass. These capabilities for degrading plant and animal substrates suggest a duality in lifestyle that could enable pathogenic species of Onygenales to transfer from soil to animal hosts.National Institute of Allergy and Infectious Diseases (U.S.)National Institutes of Health. Department of Health and Human Services (contract HHSN266200400001C)National Institutes of Health. Department of Health and Human Services(contract HHSN2722009000018C)Brazil. National Council for Scientific and Technological Developmen

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life