Precisamos de um conceito para a influência massiva das novas tecnologias na saúde? A proposta dos Determinantes Digitais da Saúde

Recognizing the significant effects of the New Information and Communication Technologies (NICTs), the work reports the experience of a reflection group on the following question: does the massive and pervasive use of technologies in life, and therefore in health, deserve its own concept for analytical and sociopolitical emphasis? Through the experience systematization proposed by Holliday (2006), we propose the concept of Digital Determinants of Health (DDH) as it reflects the need to better highlight NICTs’ actions in the production of health - both from an epistemological and sociopolitical point of view. By suggesting the DDH concept, we urge the academic community to a more specific debate on the consequences of NICTs in contemporary life, in order to guide actions capable of mitigating negative effects and leveraging the benefits of new technologies in healthcare.Reconociendo los efectos significativos de las Nuevas Tecnologías de la Información y la Comunicación (NTIC), este artículo relata la experiencia de un grupo sobre la cuestión: ¿merece el uso masivo y omnipresente de las tecnologías en la vida, y en consecuencia en la salud, un concepto propio para su prominencia analítica y sociopolítica? Utilizando la sistematización de Holliday (2006), el grupo propuso el concepto de Determinantes Digitales de la Salud (DDS) por la necesidad de destacar la acción de las NTIC en la salud, tanto desde el punto de vista epistemológico como sociopolítico. Con el concepto de DDS, instamos a la comunidad académica a mantener un debate más específico sobre las consecuencias de las NTIC en la vida contemporánea para orientar acciones capaces de mitigar los efectos negativos y maximizar los beneficios de las nuevas tecnologías en la salud.Reconhecendo os efeitos significativos das Novas Tecnologias de Informação e Comunicação (NTICs), o trabalho relata a experiência de um grupo de reflexão sobre a seguinte questão: a utilização de tecnologias de modo massivo e pervasivo na vida e, consequentemente, na saúde, merece conceito próprio para destaque analítico e sociopolítico? Por meio da sistematização de experiências de Holliday (2006), o grupo propõe o conceito de Determinantes Digitais da Saúde (DDS) por entender a necessidade de evidenciar com mais força a ação das NTICs na produção da saúde — tanto do ponto de vista epistemológico, quanto do sociopolítico. Com a sugestão do conceito de DDS, exortamos a comunidade acadêmica a um debate mais específico sobre as consequências das NTICs na vida contemporânea para a orientação de ações capazes de mitigar os efeitos negativos e potencializar os benefícios das novas tecnologias na saúde

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Effect of an extract of Aloe vera on the biodistribution of sodium pertechnetate (Na99mTcO4) in rats Efeito de um extrato de Aloe vera na biodistribuição do pertecnetato de sódio (Na99mTcO4) em ratos

PURPOSE: Aloe vera is a tropical plant popularly known in Brazil as babosa. We have investigated the effect of aqueous extract of Aloe vera on the biodistribution of Na99mTcO4 and laboratorial parameters in Wistar rats. METHODS: Twelve animals were divided into treated and control groups. In the treated group, Aloe vera was given by gavage (5mg/mL/day) during 10 days. The control group received sorbitol by the same way and period. One hour after the last dose, we injected 0.1mL of Na99mTcO4 by orbital plexus. After 60 min, all the animals were killed. Samples were harvested from the brain, liver, heart, muscle, pancreas, stomach, femur, kidneys, blood, testis and thyroid and the percentage of radioactivity (%ATI/g) was determined. Biochemical dosages were performed. RESULTS: There was a significant increase of %ATI/g in blood, femur, kidneys, liver, stomach, testis and thyroid and also in blood levels of AST and ALT. A significant decrease in levels of glucose, cholesterol, triglycerides, creatinine and urea occurred. The statistical analyses were performed by Mann-Whitney test and T-Student test (p<0.05). CONCLUSION: The aqueous extract of Aloe vera facilitated the uptake of Na99mTcO4 in organs of rats and it was responsible to a high increase of levels of AST and ALT.<br>OBJETIVO: Aloe vera é uma planta tropical popularmente conhecida no Brasil por "babosa". Investigou-se o efeito de extrato aquoso do A. vera na biodistribuição do pertecnetato de sódio (Na99mTcO4) e em parâmetros laboratoriais de ratos Wistar. MÉTODOS: Doze animais foram divididos em 2 grupos: tratado e controle. No grupo tratado, o extrato de A. vera foi administrado via oral (5mg/mL/dia) por 10 dias. O grupo controle recebeu sorbitol do mesmo modo. Uma hora após a última dose, ambos receberam 0,1mL de Na99mTcO4 via plexo orbital. Após 60 minutos, os animais foram sacrificados. Foram retiradas amostras do cérebro, fígado, coração, músculo, pâncreas, estômago, fêmur, rins, sangue, testículos e tiróide e determinou-se o percentual de radioatividade por grama (%ATI/g) de cada uma. Dosagens bioquímicas foram realizadas. RESULTADOS: Houve um aumento significativo do %ATI/g no sangue, fêmur, rins, fígado, estômago, testículos e tiróide e nos níveis sanguíneos das enzimas AST e ALT. Ocorreu uma diminuição significativa dos níveis de glicose, colesterol, triglicérides, creatinina e uréia. Análises estatísticas foram feitas pelos testes de Mann-Whitney e T-student (p<0,05). CONCLUSÃO: O extrato aquoso de A. vera facilitou a captação do Na99mTcO4 em órgãos de ratos e foi responsável pelo aumento dos níveis de AST e ALT

Caracterização de crianças e adolescentes vulneráveis residentes de uma cidade Sulmineira

Objetivo: caracterizar crianças e adolescentes vulneráveis socioeconomicamente. Materiais e Métodos: participaram da pesquisa 246 voluntários que responderam a um questionário semiestruturado sobre percepções do local de moradia e segurança pessoal. A cor da pele foi autodeclarada e a Insegurança Alimentar (IA) foi avaliada pela Escala Brasileira de Insegurança Alimentar (EBIA). O estado nutricional foi averiguado pela aferição do peso e altura e posterior cálculo do IMC. Os dados foram analisados pelo teste qui-quadrado através do software SPSS® e apresentados em intervalos de confiança para as proporções.Resultados: a cor de pele predominante foi a negra (43,9% [43,60% - 44,20%]). Não houveram diferenças no padrão de respostas referentes ao local de moradia entre os sujeitos das diferentes cores de pele. Mais de 50% dos voluntários relataram ter medo de pessoas estranhas, 69,9% [57% - 80%] se encontravam IA, 51,8% estavam em excesso de peso e apresentaram consumo médio de 3,57 porções de produtos ultraprocessados diariamente.Conclusão: os voluntários foram caracterizados predominantemente como negros e pardos.  Embora, serem em sua maioria, eutróficos, expressiva parcela se encontrou em excesso de peso e, de tudo, os dados alertam que é uma população que se encontra em IA e com elevado consumo de produtos ultraprocessados

Núcleos de Ensino da Unesp: artigos 2013: volume 2: metodologias de ensino e a apropriação de conhecimento pelos alunos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author