City-wide Analysis of Electronic Health Records Reveals Gender and Age Biases in the Administration of Known Drug-Drug Interactions

The occurrence of drug-drug-interactions (DDI) from multiple drug dispensations is a serious problem, both for individuals and health-care systems, since patients with complications due to DDI are likely to reenter the system at a costlier level. We present a large-scale longitudinal study (18 months) of the DDI phenomenon at the primary- and secondary-care level using electronic health records (EHR) from the city of Blumenau in Southern Brazil (pop. $\approx 340,000$). We found that 181 distinct drug pairs known to interact were dispensed concomitantly to 12\% of the patients in the city's public health-care system. Further, 4\% of the patients were dispensed drug pairs that are likely to result in major adverse drug reactions (ADR)---with costs estimated to be much larger than previously reported in smaller studies. The large-scale analysis reveals that women have a 60\% increased risk of DDI as compared to men; the increase becomes 90\% when considering only DDI known to lead to major ADR. Furthermore, DDI risk increases substantially with age; patients aged 70-79 years have a 34\% risk of DDI when they are dispensed two or more drugs concomitantly. Interestingly, a statistical null model demonstrates that age- and female-specific risks from increased polypharmacy fail by far to explain the observed DDI risks in those populations, suggesting unknown social or biological causes. We also provide a network visualization of drugs and demographic factors that characterize the DDI phenomenon and demonstrate that accurate DDI prediction can be included in healthcare and public-health management, to reduce DDI-related ADR and costs

Body fat assessment by bioelectrical impedance and its correlation with different anatomical sites used in the measurement of waist circumference in children

OBJECTIVE: To compare the different anatomical sites used in the measurement of waist circumference, as well as the effectiveness of these landmarks to predict the percentage of body fat by tetrapolar bioelectrical impedance analysis. METHODS: We evaluated 205 children from 6 to 9 years of age of both sexes. Data on weight, height and waist circumference were collected at three different sites: at the lower abdominal curvature, above the navel and at the midpoint between the last rib and the iliac crest. Nutritional status was assessed through the body mass index (BMI)/age as recommended by the World Health Organization. RESULTS: The sample was considered homogeneous in terms of sex, and the mean age was 7.2±1.2 years. Regarding nutritional status, 6.3% of the children had low weight, 75.1% were eutrophic, 7.3% were overweight, and 11.2% were obese. Among males, there was no statistical difference between the different sites of measurement; in females, the measurement above the navel was statistically higher. In the correlation analysis, the midpoint measurement showed the best correlation with percentage of body fat, with values of 0.50 in boys and 0.62 in girls. CONCLUSION: Waist circumference measured at the midpoint between the last rib and the iliac crest presented the best correlation with percentage of body fat.OBJETIVO: Comparar os diferentes pontos anatômicos de medida da circunferência da cintura, bem como a eficácia desses locais em predizer o percentual de gordura corporal mensurado pela bioimpedância elétrica tetrapolar. MÉTODOS: Foram avaliadas 205 crianças de 6 a 9 anos de idade de ambos os sexos. Foram coletados dados de peso, estatura e circunferência da cintura em três locais diferentes: na menor curvatura abdominal, sobre a cicatriz umbilical e no ponto médio entre a última costela e crista ilíaca. A avaliação do estado nutricional foi realizada a partir do índice de massa corporal/idade recomendado pela Organização Mundial de Saúde. RESULTADOS: No presente estudo houve homogeneidade entre os sexos, e a idade média foi de 7,2±1,2 anos. Em relação ao estado nutricional, 6,3% das crianças apresentaram baixo peso, 75,1% eram eutróficas, 7,3% apresentaram sobrepeso e 11,2% obesidade. No sexo masculino não houve diferença estatística entre os diferentes locais de medida. No feminino, a medida sobre a cicatriz umbilical foi estatisticamente maior. Na análise de correlação, a circunferência medida no ponto médio foi a que obteve melhor correlação com o percentual de gordura corporal, com valores de 0,50 nos meninos e 0,62 nas meninas. CONCLUSÃO: A circunferência da cintura medida no ponto médio entre a crista ilíaca e ultima costela foi a que apresentou melhor correlação com o percentual de gordura corporal.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de ViçosaUniversidade Federal de São Paulo (UNIFESP)UFVUNIFESPUNIFESPSciEL

GERAÇÃO AUTOMATIZADA DE GABARITO E CORREÇÃO DE EXERCÍCIOS EM PLATAFORMA PARA O ENSINO DO PENSAMENTO COMPUTACIONAL

Este artigo apresenta a automatização da geração e correção de exercícios em ambiente já existente para o ensino do pensamento computacional. Para o desenvolvimento, foi utilizada a última versão deste ambiente desenvolvido na linguagem Java. O algoritmo de Dijkstra foi utilizado para encontrar os caminhos mínimos entre os objetivos do mapa. A combinação de caminhos de menor tamanho é transformada em uma sequência de instruções para executar esse percurso, gerando o gabarito do exercício. A correção compara os resultados obtidos pelo aluno com o gabarito. Após testes realizados com crianças, teve-se como resultado que essas elas se sentiram motivadas a buscar melhores soluções nos exercícios por possuir um gabarito com a comparação

Conhecimento sobre aleitamento materno entre estudantes de Enfermagem e Medicina (Salvador, Bahia)

Even with all the described benefits of breastfeeding, we still observe that this practice is not the ideal all over the world, fact that leads more importance to the medical and nurse professionals about the adequate knowledge.Compare the knowledge about breastfeeding among medical and nurse students, in the beginning and final of the graduate course, 88 from the beginning and 85 from the end of the courses. Afterwards the questionnaire was stratificated  in eight blocks of questions, and each one has received a score according the number of questions. It hasn´t found statistical differences between the score averages of students from the beginning of the courses, but it was noted a significant difference between the knowledge in the end of both courses. The Medicine students presented at the end of course an averages rank higher than those of nursing students. There is an improvement of knowledge about breastfeeding in both graduate courses, but the differences need more investigation.Apesar da importância comprovada dos vários benefícios do aleitamento materno, tem-se observado a amamentação como uma prática ainda aquém da ideal entre muitas comunidades em todo o mundo, o que torna ainda mais importante o papel dos profissionais de medicina e de enfermagem na assistência puerperal, a fim de incentivar adequadamente o aleitamento materno. Este estudo teve como objetivo comparar o conhecimento sobre aleitamento materno dos estudantes de graduação, no início e no final dos cursos médico e de enfermagem. Foram aplicados 173 questionários, durante três dias, sendo 88 do início dos cursos (32 do primeiro ano de Enfermagem e 56 do primeiro ano de Medicina) e 85 do final dos cursos (47 dos sexto e sétimo semestres de Enfermagem e 38 dos décimo primeiro e décimo segundo semestres de Medicina). Posteriormente, o instrumento foi estratificado em oito blocos de perguntas, e cada um recebeu um escore de acordo com o número de questões. Não foram encontradas diferenças significativas entre as médias de escores de graduandos do início de curso, mas constatou-se que há diferença significativa entre o conhecimento dos grupos no início e no final dos cursos analisados. O grupo de estudantes de Medicina, no final do curso, apresentou uma média e um rank médio significativamente maiores, se comparados ao grupo no final do curso de Enfermagem. Concluiu-se que houve um aumento do conhecimento sobre o aleitamento materno durante o curso de graduação de ambos os cursos, porém a diferença do conhecimento observada entre os graduandos de final de curso de Medicina e Enfermagem precisa ser mais bem investigada

Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases.

The increase in the number of reported cases of microcephaly in Pernambuco State, and Northeast Brazil, characterized an epidemic that led the Brazilian Ministry of Health to declare a national public health emergency. The Brazilian Ministry of Health initially defined suspected cases as newborns with gestational age (GA) ≥ 37 weeks and head circumference (HC) ≤ 33cm, but in December 2015 this cutoff was lowered to 32cm. The current study aimed to estimate the accuracy, sensitivity, and specificity of different cutoff points for HC, using ROC curves, with the Fenton and Intergrowth (2014) curves as the gold standard. The study described cases reported in Pernambuco from August 8 to November 28, 2015, according to sex and GA categories. The Fenton and Intergrowth methods provide HC growth curves according to GA and sex, and microcephaly is defined as a newborn with HC below the 3rd percentile in these distributions. Of the 684 reported cases, 599 were term or post-term neonates. For these, the analyses with ROC curves show that according to the Fenton criterion the cutoff point with the largest area under the ROC curve, with sensitivity greater than specificity, is 32cm for both sexes. Using the Intergrowth method and following the same criteria, the cutoff points are 32cm and 31.5cm for males and females, respectively. The cutoff point identified by the Fenton method (32cm) coincided with the Brazilian Ministry of Health recommendation. Adopting Intergrowth as the standard, the choice would be 32cm for males and 31.5cm for females. The study identified the need to conduct critical and on-going analyses to evaluate cutoff points, including other characteristics for microcephaly case definition

Diagnóstico socioeconômico dos agricultores do Agreste Paraibano para implantação da Produção Agroecológica Integrada e Sustentável - PAIS

A Produção Agroecológica Integrada e Sustentável (PAIS) é um projeto desenvolvido pelo SEBRAE com a Fundação Banco do Brasil (FBB) que tem como objetivo desenvolver a produção da agricultura familiar em todo o país através da produção de hortaliças agroecológicas e a criação de galinhas. O presente artigo tem como objetivo diagnosticar as condições socioeconômica e ambiental das famílias integrantes da agricultura familiar do Agreste Paraibano para implantação da Produção Agroecológica Integrada e Sustentável – PAIS. Observou-se que 72,32% dos entrevistados são do sexo masculino, a maioria possui idade entre 31-40 anos, possui apenas o ensino fundamental e recebem rendas complementares do governo, a exemplo do Bolsa Família. Conclui-se que nas comunidades pesquisadas há um desenvolvimento tanto na qualidade de vida dos trabalhadores como no meio ambiente e que a agricultura familiar proporciona para os moradores uma sustentabilidade e rentabilidade econômica, no entanto faltam investimentos e projetos que viabilizem um maior desenvolvimento.The Integrated and Sustainable Agroecological Production (PAIS) is a project developed by Sebrae with the Bank of Brazil Foundation (FBB) which aims to develop the production of family farms across the country through the production of agroecological vegetables and raising chickens. This article aims to diagnose the socio-economic and environmental conditions of the members of family farming families of Paraiba Agreste to implement the Integrated and Sustainable Agroecological Production - PAIS. It was observed that 72.32% of respondents are male, most have age between 31-40 years, only has elementary school and receive government supplementary incomes, such as the Bolsa Familia. We conclude that in the communities surveyed there is a development in both quality of life of workers and the environment and that family farming provides to the residents a sustainability and economic profitability, however lacking investments and projects that enable further development.Eje A6: Desarrollo Rural, Movimientos Sociales, Estado y AgroecologíaFacultad de Ciencias Agrarias y Forestale

Sesbania virgata (Cav.) Pers. seedlings growth in a degraded area after clay extraction

This experiment intended to evaluate the initial growth of Sesbania virgata (Cav.) Pers. (sesbânia) seedlings planted with distinct fertilizers in a degraded area after clay extraction. The seedlings were inoculated with Rhizobium and arbuscular mycorrhizal fungi. The experiment was carried out in a randomized complete-block design. Each experimental unit had 4 repetitions with 16 seedlings. The treatments were: 1. control; 2. ferkal (0,6 kg hole-1); 3. urban waste (0,8 kg hole-1); 4. sugar cane filter cake (0,6 kg hole-1) and 5. simple super phosphate (0,1 kg hole-1). Along the first 3 months the rate of surviving plants was evaluated. Height and diameter at the soil level had been bimonthly measured until the tenth month of growth. At this time were also measured the N, P and K nutrient contents of the leaves as well as the biomass production. No difference among the treatments had been observed for these variables. Effects of fertilization on the growth and production of biomass were not found out under the conditions of this study. Lenght and superficial thin root area (diameter larger and smaller than 0,3mm) were evaluated 14 months after planting. Higher values of length and thinner superficial area of the smallest roots were verified in comparison to the larger ones (more than 0,3 mm). Urban waste and sugar cane filter cake stimulated root production.O objetivo deste trabalho foi testar o crescimento inicial de mudas de Sesbania virgata (Cav.) Pers. (sesbânia), plantadas em uma área degradada por extração de argila, em covas fertilizadas. As mudas foram inoculadas com rizóbio e fungos micorrízicos arbusculares. O experimento foi instalado em blocos ao acaso, com 4 repetições, sendo as parcelas constituídas por 16 plantas. Os tratamentos foram: 1. testemunha; 2. ferkal (0,6 kg cova-1); 3. composto de lixo urbano (0,8 kg cova-1); 4. torta de filtro (0,6 kg cova-1); e 5. superfosfato simples (0,1 kg cova-1). Nos 3 primeiros meses, foram avaliados os percentuais de sobrevivência e, bimestralmente, o crescimento em altura e diâmetro ao nível do solo, até o 10o mês após o plantio. Nessa ocasião, também foram determinados os teores foliares de N, P e K e a produção de fitomassa, não tendo sido constatada diferença significativa entre os tratamentos para essas variáveis. Não foi verificado efeito da fertilização sobre o crescimento e a produção de fitomassa de sesbânia, nas condições deste estudo. O comprimento e área superficial de raízes finas (diâmetros maiores e menores que 0,3 mm) foram avaliados aos 14 meses, tendo-se constatado diferenças significativas. Verificou-se maior comprimento e superfície de raízes mais finas em comparação àquelas maiores que 0,3 mm de diâmetro. O composto de lixo urbano e a torta de filtro estimularam a produção de raízes

A genome survey of Moniliophthora perniciosa gives new insights into Witches' Broom Disease of cacao

<p>Abstract</p> <p>Background</p> <p>The basidiomycete fungus <it>Moniliophthora perniciosa </it>is the causal agent of Witches' Broom Disease (WBD) in cacao (<it>Theobroma cacao</it>). It is a hemibiotrophic pathogen that colonizes the apoplast of cacao's meristematic tissues as a biotrophic pathogen, switching to a saprotrophic lifestyle during later stages of infection. <it>M. perniciosa</it>, together with the related species <it>M. roreri</it>, are pathogens of aerial parts of the plant, an uncommon characteristic in the order Agaricales. A genome survey (1.9× coverage) of <it>M. perniciosa </it>was analyzed to evaluate the overall gene content of this phytopathogen.</p> <p>Results</p> <p>Genes encoding proteins involved in retrotransposition, reactive oxygen species (ROS) resistance, drug efflux transport and cell wall degradation were identified. The great number of genes encoding cytochrome P450 monooxygenases (1.15% of gene models) indicates that <it>M. perniciosa </it>has a great potential for detoxification, production of toxins and hormones; which may confer a high adaptive ability to the fungus. We have also discovered new genes encoding putative secreted polypeptides rich in cysteine, as well as genes related to methylotrophy and plant hormone biosynthesis (gibberellin and auxin). Analysis of gene families indicated that <it>M. perniciosa </it>have similar amounts of carboxylesterases and repertoires of plant cell wall degrading enzymes as other hemibiotrophic fungi. In addition, an approach for normalization of gene family data using incomplete genome data was developed and applied in <it>M. perniciosa </it>genome survey.</p> <p>Conclusion</p> <p>This genome survey gives an overview of the <it>M. perniciosa </it>genome, and reveals that a significant portion is involved in stress adaptation and plant necrosis, two necessary characteristics for a hemibiotrophic fungus to fulfill its infection cycle. Our analysis provides new evidence revealing potential adaptive traits that may play major roles in the mechanisms of pathogenicity in the <it>M. perniciosa</it>/cacao pathosystem.</p

Novel deletion alleles carrying CYP21A1P/A2 chimeric genes in Brazilian patients with 21-hydroxylase deficiency

<p>Abstract</p> <p>Background</p> <p>Congenital adrenal hyperplasia due to 21-hydroxylase deficiency is caused by deletions, large gene conversions or mutations in <it>CYP21A2 </it>gene. The human gene is located at 6p21.3 within a <it>locus </it>containing the genes for putative serine/threonine Kinase <it>RP</it>, complement <it>C4</it>, steroid 21-hydroxylase <it>CYP21 </it>tenascin <it>TNX</it>, normally, in a duplicated cluster known as RCCX module. The <it>CYP21 </it>extra copy is a pseudogene (<it>CYP21A1P</it>). In Brazil, 30-kb deletion forming monomodular alleles that carry chimeric <it>CYP21A1P/A2 </it>genes corresponds to ~9% of disease-causing alleles. Such alleles are considered to result from unequal crossovers within the bimodular <it>C4/CYP21 locus</it>. Depending on the localization of recombination breakpoint, different alleles can be generated conferring the locus high degree of allelic variability. The purpose of the study was to investigate the variability of deleted alleles in patients with 21-hydroxylase deficiency.</p> <p>Methods</p> <p>We used different techniques to investigate the variability of 30-kb deletion alleles in patients with 21-hydroxylase deficiency. Alleles were first selected after Southern blotting. The composition of <it>CYP21A1P/A2 </it>chimeric genes was investigated by ASO-PCR and MLPA analyses followed by sequencing to refine the location of recombination breakpoints. Twenty patients carrying at least one allele with <it>C4/CYP21 </it>30-kb deletion were included in the study.</p> <p>Results</p> <p>An allele carrying a <it>CYP21A1P/A2 </it>chimeric gene was found unusually associated to a <it>C4B/C4A </it><it>Taq </it>I 6.4-kb fragment, generally associated to <it>C4B </it>and <it>CYP21A1P </it>deletions. A novel haplotype bearing both p.P34L and p.H62L, novel and rare mutations, respectively, was identified in exon 1, however p.P30L, the most frequent pseudogene-derived mutation in this exon, was absent. Four unrelated patients showed this haplotype. Absence of p.P34L in <it>CYP21A1P </it>of normal controls indicated that it is not derived from pseudogene. In addition, the combination of different approaches revealed nine haplotypes for deleted 21-hydroxylase deficiency alleles.</p> <p>Conclusions</p> <p>This study demonstrated high allelic variability for 30-kb deletion in patients with 21-hydroxylase deficiency indicating that a founder effect might be improbable for most monomodular alleles carrying <it>CYP21A1P/A2 </it>chimeric genes in Brazil.</p