Resumo Objetivou-se realizar uma análise espacial da taxa de mortalidade hospitalar (TMH) por síndrome respiratória aguda grave (SRAG) atribuída à COVID-19 em crianças e adolescentes no Brasil no período de 2020 a 2021. Utilizou-se o método de cluster para agrupar as unidades federativas (UFs) com base na TMH. Em 2020, clusters com altas TMHs foram formados por UFs Norte/Nordeste. Em 2021, houve redução na TMH. Os clusters com maiores taxas permaneceram na região N/NE. Diferenças regionais foram observadas nas TMHs. Os achados podem refletir as desigualdades sociais e o acesso à atenção hospitalar, principalmente na faixa etária de menores de 1 ano pela gravidade da doença neste grupo.

Abstract The objective was to perform a spatial analysis of the hospital mortality rate (HMR) due to severe acute respiratory syndrome (SARS) attributed to COVID-19 among children and adolescents in Brazil from 2020 to 2021. A cluster method was used to group federal units (FUs) based on HMR. In 2020, clusters with high HMRs were formed by north/northeast FUs. In 2021, there was a reduction in HMR. Clusters with higher rates remained in the N/NE region. Regional differences were observed in the HMR. The findings may reflect social inequalities and access to hospital care, especially in the under 1-year-old age group due to the severity of the disease in this group.

Abstract The objective was to perform a spatial analysis of the hospital mortality rate (HMR) due to severe acute respiratory syndrome (SARS) attributed to COVID-19 among children and adolescents in Brazil from 2020 to 2021. A cluster method was used to group federal units (FUs) based on HMR. In 2020, clusters with high HMRs were formed by north/northeast FUs. In 2021, there was a reduction in HMR. Clusters with higher rates remained in the N/NE region. Regional differences were observed in the HMR. The findings may reflect social inequalities and access to hospital care, especially in the under 1-year-old age group due to the severity of the disease in this group.

Resumo Objetivou-se realizar uma análise espacial da taxa de mortalidade hospitalar (TMH) por síndrome respiratória aguda grave (SRAG) atribuída à COVID-19 em crianças e adolescentes no Brasil no período de 2020 a 2021. Utilizou-se o método de cluster para agrupar as unidades federativas (UFs) com base na TMH. Em 2020, clusters com altas TMHs foram formados por UFs Norte/Nordeste. Em 2021, houve redução na TMH. Os clusters com maiores taxas permaneceram na região N/NE. Diferenças regionais foram observadas nas TMHs. Os achados podem refletir as desigualdades sociais e o acesso à atenção hospitalar, principalmente na faixa etária de menores de 1 ano pela gravidade da doença neste grupo.

Abstract The objective was to perform a spatial analysis of the hospital mortality rate (HMR) due to severe acute respiratory syndrome (SARS) attributed to COVID-19 among children and adolescents in Brazil from 2020 to 2021. A cluster method was used to group federal units (FUs) based on HMR. In 2020, clusters with high HMRs were formed by north/northeast FUs. In 2021, there was a reduction in HMR. Clusters with higher rates remained in the N/NE region. Regional differences were observed in the HMR. The findings may reflect social inequalities and access to hospital care, especially in the under 1-year-old age group due to the severity of the disease in this group.

Resumo Objetivou-se realizar uma análise espacial da taxa de mortalidade hospitalar (TMH) por síndrome respiratória aguda grave (SRAG) atribuída à COVID-19 em crianças e adolescentes no Brasil no período de 2020 a 2021. Utilizou-se o método de cluster para agrupar as unidades federativas (UFs) com base na TMH. Em 2020, clusters com altas TMHs foram formados por UFs Norte/Nordeste. Em 2021, houve redução na TMH. Os clusters com maiores taxas permaneceram na região N/NE. Diferenças regionais foram observadas nas TMHs. Os achados podem refletir as desigualdades sociais e o acesso à atenção hospitalar, principalmente na faixa etária de menores de 1 ano pela gravidade da doença neste grupo.

Abstract The objective was to perform a spatial analysis of the hospital mortality rate (HMR) due to severe acute respiratory syndrome (SARS) attributed to COVID-19 among children and adolescents in Brazil from 2020 to 2021. A cluster method was used to group federal units (FUs) based on HMR. In 2020, clusters with high HMRs were formed by north/northeast FUs. In 2021, there was a reduction in HMR. Clusters with higher rates remained in the N/NE region. Regional differences were observed in the HMR. The findings may reflect social inequalities and access to hospital care, especially in the under 1-year-old age group due to the severity of the disease in this group.

Resumo Objetivou-se realizar uma análise espacial da taxa de mortalidade hospitalar (TMH) por síndrome respiratória aguda grave (SRAG) atribuída à COVID-19 em crianças e adolescentes no Brasil no período de 2020 a 2021. Utilizou-se o método de cluster para agrupar as unidades federativas (UFs) com base na TMH. Em 2020, clusters com altas TMHs foram formados por UFs Norte/Nordeste. Em 2021, houve redução na TMH. Os clusters com maiores taxas permaneceram na região N/NE. Diferenças regionais foram observadas nas TMHs. Os achados podem refletir as desigualdades sociais e o acesso à atenção hospitalar, principalmente na faixa etária de menores de 1 ano pela gravidade da doença neste grupo.

ABSTRACT Overcoming malnutrition in all its forms, which is also manifested in the obesity epidemic, is one of the priorities of the 2030 Agenda and the Sustainable Development Goals. This article presents reflections on food insecurity in Brazil, based on topics such as population growth, climate change, biodiversity and traditional and regenerative food systems; it also addresses the role of social initiatives to guarantee the Human Right to Adequate Food. The Nutrition and Poverty Research Group, Planetary Health - Brazil Group, and the Center for Artificial Intelligence (C4AI) - AgriBio Axis, assume that the organized and systemic resumption of the initiatives mentioned out in this position paper can contribute to the articulation between research, public policies and services, to combat all forms of malnutrition, as a complex and priority problem to ensure social welfare.

RESUMO O combate à má alimentação em todas as suas formas, que também se expressa na epidemia da obesidade, é uma das prioridades da Agenda 2030 e dos Objetivos de Desenvolvimento Sustentável. Este artigo traz elementos sobre insegurança alimentar no Brasil, a partir de temas relativos ao crescimento populacional, mudanças climáticas, biodiversidade e sistemas alimentares tradicionais e regenerativos; trata também do papel dos movimentos sociais para a garantia do Direito Humano à Alimentação Adequada. O Grupo de Pesquisa em Nutrição e Pobreza, o Saúde Planetária Brasil, e o Centro de Inteligência Artificial (C4AI) - Eixo AgriBio, entendem que a retomada organizada e sistêmica das frentes apontadas neste artigo de posicionamento, pode constituir um caminho para a articulação entre pesquisa, serviço e políticas públicas na direção do combate à fome e às demais manifestações da má alimentação, enquanto problema complexo prioritário para a garantia do bem-estar social.

Abstract To assess the in vitro and in situ effect of experimental combined fluoride and calcium nanocomposite solutions on dental caries prevention. Nanocompound mesoporous silica (MS) with calcium (Ca) and sodium fluoride (NaF) - (MSCaNaF); MS with NaF (MSNaF), NaF solution (positive control), and deionized water (negative control - CG) were studied. The specimens (n=130) were submitted in vitro to a multispecies biofilm in the presence of 2% sucrose. After 24 h and 48 h, the culture medium pH, the percent of surface mineral loss (%SML), and lesion depth (ΔZ) were analyzed. In the in situ study, 10 volunteers participated in four phases of 7-days each. The products were applied on the specimens (n=240) before 20% sucrose solution drips. The polysaccharides (SEPS and IEPS), %SML and roughness (Sa) were evaluated. There was an in vitro decrease in pH values in 24h and 48h, compared to baseline. The MSCaNaF and MSNaF groups obtained lower values of %SML and ΔZ (p < 0.05) than CG and NaF after 24h and were similar to NaF after 48h (p<0.05). In situ results showed similar SEPS and IEPS among all groups after 48h. An after 7-days, the nanocomposites had similar values (p>0.05), while NaF was similar to CG (p>0.05). After 48h, the MSCaNaF and MSNaF reduced the %SML (p<0.05). After 7-days, both experimental nanocomposites were similar to NaF (p>0.05). Regarding Sa, MSCaNaF was better than NaF for both periods (p<0.05). The nanocomposites controlled the in vitro and in situ enamel demineralization, mainly in the initial periods.

ABSTRACT Objective To investigate the prevalence of internet gaming disorder (IGD) symptoms in a sample of Brazilian adults, and its association with personality, psychiatric symptoms and psychosocial measures. Methods We evaluated 219 adults online recruited using questionnaires and psychometric scales. We evaluated the behavior and pattern of internet games using the Game Addiction Scale (GAS). We tested the association of the previous measures with the GAS scores by spearman correlations and multiple regression analysis. Results Of our sample, 74% played games online. We found correlations between IGD symptoms and most symptoms of mental disorders, with small or moderate effect sizes, as well as correlations with the personality traits of agreeableness (r = -0.272; p < 0.001), conscientiousness (r = - 0.314; p < 0.001), and neuroticism (r = 0.299; p < 0.001). Additionally, we found a negative association with psychosocial outcomes such as quality of life (r = -0.339; p < 0.001) and life satisfaction (r = - 0.202; p < 0.003). The multivariate model included the personality traits of conscientiousness and agreeableness and symptoms of dissociation and somatization as predictors. The prevalence of IGD was 9% in those who played online games. Conclusion IGD is correlated with different areas of the individual’s life, such as personality, quality of life, and several common symptoms of mental disorders. The prevalence can be considered high among players (9%). Conscientiousness, agreeability, somatic symptoms, and dissociative symptoms were associated with the symptoms of IGD.

RESUMO Objetivo Investigar a prevalência de sintomas do transtorno do jogo pela internet (TJI) em uma amostra de adultos brasileiros e sua associação com personalidade, sintomas psiquiátricos e medidas psicossociais. Métodos Avaliamos 219 adultos recrutados on-line por meio de questionários e escalas psicométricas. Avaliamos o comportamento e o padrão dos jogos na internet usando a Game Addiction Scale (GAS). Testamos a associação das medidas anteriores com as pontuações na GAS por meio de correlações de Spearman e análise de regressão múltipla. Resultados De nossa amostra, 74% jogavam jogos on-line. Encontramos correlações entre sintomas do TJI e a maioria dos sintomas de transtornos mentais, com tamanhos de efeito pequenos ou moderados, bem como correlações com os traços de personalidade de amabilidade (r = -0,272; p < 0,001), conscienciosidade (r = - 0,314; p < 0,001) e neuroticismo (r = 0,299; p < 0,001). Além disso, encontramos uma associação negativa com resultados psicossociais, como qualidade de vida (r = -0,339; p < 0,001) e satisfação com a vida (r = - 0,202; p < 0,003). O modelo multivariado incluiu os traços de personalidade de conscienciosidade e amabilidade e sintomas de dissociação e somatização como preditores. A prevalência de TJI foi de 9% entre os que jogavam jogos on-line. Conclusão O TJI está correlacionado com diferentes áreas da vida do indivíduo, como personalidade, qualidade de vida e vários sintomas comuns de transtornos mentais. A prevalência pode ser considerada alta entre os jogadores (9%). Conscienciosidade, amabilidade, sintomas somáticos e sintomas dissociativos estavam associados aos sintomas do TJI.

BACKGROUND Epidemiological data related to leishmaniases or Leishmania infection in horses are scarce. However, studies carried out in different regions in the world showed equids parasitised by Leishmania braziliensis, L. infantum and L. martiniquensis. OBJECTIVES Identify the Leishmania species causing cutaneous leishmaniasis in a mare, living in Rio de Janeiro State (Brazil), and search the presence of Leishmania viruses in the isolated parasite. METHODS Isoenzymes and polymerase chain reaction (PCR) targeting ITSrDNA region followed by sequencing were conducted for typing the isolated parasite. A search for Leishmania virus infection was also performed. FINDINGS The mare presented skin nodules and ulcers in the left pinna caused by Leishmania spp. that was detected by culture and PCR. The parasite was identified as Leishmania (Mundinia) martiniquensis, infected by Leishbunyavirus (LBV), representing the first description of this species in South America. The animal travelled to different Brazilian regions, but not to outside the country. MAIN CONCLUSIONS The worldwide distribution of L. martiniquensis and its infection by LBV were confirmed in this study, indicating the autochthonous transmission cycle in Brazil. The clinical profile of the disease in the mare, showing fast spontaneous healing of cutaneous lesions, may indicate that skin lesions related to L. martiniquensis infection in horses might be underdiagnosed.

ABSTRACT The objective of this study was to assess the effects of two levels of soybean hulls (0 and 400.1 g/kg) and whole or ground corn in the diet of newborn crossbred dairy male calves on intake, performance, blood indicators, and feeding cost. Twenty-eight calves with an average weight of 33.0±6.2 kg and four days of age were distributed into four treatment groups in a completely randomized design (n = 7) for 56 days. Weekly samples of feed, diets, and leftovers were collected to determine dry matter and nutrient intakes. To evaluate apparent digestibility, samples were taken using titanium dioxide as a maker. Blood samples were also collected to evaluate blood indicators. The inclusion of soybean hulls resulted in greater neutral detergent fiber intake by the calves, but reduced their non-fibrous carbohydrates intake, which was also reduced by the use of whole corn in the diet. Although the total digestible nutrients content of diets decreased with the use of whole corn and inclusion of soybean hulls, its intake did not vary (0.75 kg/d), regardless of the factors analyzed. The apparent digestibilities of dry matter (0.87 kg/kg) and crude protein (0.89 kg/kg) were similar, resulting in similar performance between the animals, regardless of the factors analyzed. In the quantities evaluated, the use of soybean hulls or whole corn did not affect blood indicators and was insufficient to reduce feed costs; the cost of daily feed was $2.06, while the cost per kilogram of gain was $3.74. The inclusion of up to 400.1 g/kg of soybean hulls or the replacement of ground corn with whole corn does not affect the performance of crossbred dairy calves during the preweaning period, demonstrating that both can be used in animal feed during this phase of production.

ABSTRACT Background: Women living with human immunodeficiency virus (HIV) (WLWH) are more likely to be infected with the oncogenic human papillomavirus (HPV). We assessed the prevalence of high-risk (HR) (16/18/31/33/35/39/45/51/52/56/58/59/68/73/82), probable high-risk (pHR) (26/53/66), and low-risk (LR) (6/11/40/42/43/44/54/61/70) HPV types and their associated risk factors. Methods: This cross-sectional study of WLWH aged 18-64 years included one laboratory and eight HIV-specialty healthcare facilities in the pilot network. Descriptive statistics were used to assess sociodemographic and behavioral characteristics. Adjusted analyses were conducted to evaluate risk factors associated with HR and/or pHR HPV infection in WLWH. Results: From May/2021 to May/2022, 1,914 (92.5%) WLWH participated in the pilot study and had valid HPV-DNA results of self-collected vaginal samples. The median age of the participants was 45 years, 60.1% had ≥ 9 years of schooling, 80.5% were ≤ 18 years at first sexual intercourse, and 51.7% had > 4 sexual partners throughout life. The prevalence of any HPV type, HR HPV, pHR HPV, and LR HPV was 65.8%, 49.6%, 16.7%, and 40.0%, respectively. Age was inversely associated with pHR and/or HR-HPV (p < 0.001), and education level was inversely associated with HR-HPV (p = 0.003) types. Any HR or pHR was associated with being single (p = 0.029) and exchanging sex for drugs (p = 0.037). Conclusions: The prevalence of HPV, especially HR HPV, among WLWH is high in Brazil, highlighting the need for HPV screening in this population. Self-collection of vaginal samples is an important strategy for increasing testing access.

BACKGROUND According to the last 2023 Monkeypox (Mpox) Outbreak Global Map from the Centres for Disease Control and Prevention (CDC), more than 100 countries with no Mpox infection report cases. Brazil stands out in this group and is the second country with the highest number of cases in the last outbreak. OBJECTIVE To contribute to knowledge of the virus infection effects in a cellular model, which is important for diagnosis infections not yet included in a provider´s differential diagnosis and for developing viral inhibition strategies. METHODS We describe a virus isolation protocol for a human clinical sample from a patient from Brazil, the viral growth in a cell model through plaque forming units (PFU) assay, reverse transcriptase polymerase chain reaction (RT-PCR) and transmission electron microscopy (TEM). FINDINGS We follow the viral isolation in Vero cell culture from a Mpox positive clinically diagnosed sample and show the infection effects on cellular structures using a TEM. MAIN CONCLUSIONS Understanding the impact of viral growth on cellular structures and its replication kinetics may offer better strategies for the development of new drugs with antiviral properties.

Abstract The rising fructose intake in sugar-sweetened beverages and ultra-processed foods relates to the high incidence of nonalcoholic fatty liver disease. This study aimed to examine the effects of long-term high-fructose diet intake (for 16 or 20 weeks) on progressive hepatic damage, focusing on the endoplasmic reticulum stress markers and fibrogenesis as possible triggers of liver fibrosis. Forty 3-month-old male C57BL/6J mice were randomly divided into four nutritional groups: C16 (control diet for 16 weeks), C20 (control diet for 20 weeks), HFRU16 (high-fructose diet for 16 weeks), and HFRU20 (high-fructose diet for 20 weeks). Both HFRU groups showed oral glucose intolerance and insulin resistance, but only the HFRU20 group exhibited increased inflammation. The increased lipogenic and endoplasmic reticulum stress markers triggered hepatic fibrogenesis. Hence, time-dependent perivascular fibrosis with positive immunostaining for alpha-smooth muscle actin and reelin in HFRU mice was observed, ensuring fibrosis development in this mouse model. Our study showed time-dependent and progressive damage on hepatic cytoarchitecture, with maximization of hepatic steatosis without overweight in HFRU20 mice. ER stress and liver inflammation could mediate hepatic stellate cell activation and fibrogenesis, emerging as targets to prevent NAFLD progression and fibrosis onset in this dietary model.

Resumo A presente revisão sistemática (PROSPERO: CRD42020148630) tem como hipótese que o ganho de peso excessivo durante a gravidez está associado aos padrões alimentares compostos por alimentos ultraprocessados. Desta forma, objetivou-se investigar a associação entre o padrão alimentar a posteriori e o ganho de peso durante a gestação. A busca de artigos foi realizada em nove bases de dados. Dois revisores selecionaram os artigos nestas bases e extraíram as informações utilizadas na revisão. Duas escalas foram utilizadas para avaliar a qualidade dos estudos selecionados: Escala de Avaliação da Qualidade de New Castle-Ottawa para estudos baseados em coortes e a Ferramenta de Avaliação de Estudos Transversais (escala AXIS) para estudos transversais. No total, foram identificados 11 trabalhos com variação do tamanho amostral (n=173-5.733). As mulheres que apresentaram maior adesão aos padrões alimentares saudáveis e tradicionais (frutas, hortaliças e vegetais, nozes e laticínios) apresentarammenor ganho de peso gestacional (GPG). A maior ingestão de padrões alimentares mistos e ocidentais ricos em alimentos ultraprocessados foi associada a uma maior prevalência de GPG excessivo (24,48-55,20%). Os padrões alimentares gestacionais derivados a posteriori que apresentaram componentes ultraprocessados ricos em gordura e açúcares apresentaram associação como maior GPG; os padrões alimentares saudáveis e tradicionais foram relacionados a melhores condições de saúde maternoinfantil, como GPG adequado.

Abstract The present systematic review (PROSPERO: CRD42020148630) hypothesizes the association of excessive weight gain during pregnancywith dietary patterns composed of ultraprocessed foods. Thus, the objective was to investigate the association between dietary patterns after analysis and weight gain during pregnancy. The search for articles was performed in nine databases. Two reviewers selected the articles in the databases and extracted from them the data used in the review. Two scales were used to evaluate the quality of the selected studies: New Castle-Ottawa Quality Assessment for cohort-based studies and Appraisal tool for Cross-Sectional Studies (AXIS) for cross-sectional-based studies. In total, 11 studies were identified with sample size variation (n=173-5,733). Women presenting more adherence to healthy and traditional patterns (fruits, vegetables, salads, nuts, and dairy) recorded less excessive gestational weight gain (GWG). Higher intake ofmixed patterns and western patterns rich in ultraprocessed foods were associated with a higher prevalence of excessive GWG (24.48- 55.20%). Gestational dietary patterns a posteriori-derived that have presented ultraprocessed components rich in fat and sugars presented association with high GWG; healthy and traditional dietary patterns were related to better mother-child health conditions, such as adequate GWG.

RESUMO Antecedentes: Poucos estudos brasileiros investigaram fatores de risco para disfagia e suas complicações associadas em uma grande coorte. Objetivo: Investigar frequência, preditores e desfechos associados da disfagia em pacientes até três meses após acidente vascular cerebral (AVC). Métodos: Selecionamos pacientes admitidos consecutivamente em um centro especializado em AVC agudo. Excluímos pacientes com ataque isquêmico transitório, hemorragia subaracnóidea, trombose venosa cerebral, AVC hemorrágico de causa secundária, AVC não agudo ou aqueles que não consentiram em participar. A deglutição foi avaliada por fonoaudiólogos, por meio do teste de deglutição de volume-viscosidade. A função geral foi avaliada usando-se escala de Rankin modificada, índice de Barthel e medida de independência funcional. Resultados: Foram admitidos 831 pacientes e incluídos 305. A idade média foi 63,6±13,3 anos, o tempo médio da avaliação foi 4,2±4,1 dias e 45,2% apresentavam disfagia. Idade (razão de chances [OR] 1,02; intervalo de confiança [IC95%] 1,00-1,04; p=0,017), história médica conhecida de apneia obstrutiva do sono (OR=5,13; IC95% 1,74-15,15; p=0,003) e gravidade do AVC na admissão hospitalar (OR=1,10; IC95% 1,06-1,15; p<0,001) foram independentemente associados à disfagia. Disfagia (OR=3,78; IC95% 2,16-6,61; p<0,001) e gravidade do AVC (OR=1,05; IC95% 1,00-1,09; p=0,024) foram independentemente associadas com morte ou dependência funcional em três meses. Conclusões: A disfagia esteve presente em quase metade dos pacientes com AVC. Idade, apneia obstrutiva do sono e gravidade do AVC foram preditores de disfagia, que esteve independentemente associada com morte ou dependência funcional em três meses.

ABSTRACT Background: Few Brazilian studies investigated risk factors for dysphagia and associated complications in a large cohort. Objective: To investigate frequency, predictors, and associated outcomes of dysphagia in patients up to three months post-stroke. Methods: Prospective cohort study of consecutively admitted patients in a specialized center for acute stroke. Patients with a transient ischemic attack, subarachnoid hemorrhage, cerebral venous thrombosis, hemorrhagic stroke with secondary cause, non-acute stroke, or those who did not consent to participate were excluded. Swallowing was evaluated by speech language pathologists using Volume-Viscosity Swallow Test. General function at three months post-stroke was assessed using the following instruments: Modified Rankin scale, Barthel Index and Functional Independence Measure. Results: A total of 831 patients were admitted and 305 patients were included according to the inclusion and exclusion criteria. The mean age of patients was 63.6±13.3 years, mean time from stroke to swallowing assessment was 4.2±4.1 days, and 45.2% of the patients had dysphagia. Age (OR=1.02; 95%CI 1.00-1.04; p=0.017), known medical history of obstructive sleep apnea (OR=5.13; 95%CI 1.74-15.15; p=0.003), and stroke severity at hospital admission (OR=1.10; 95%CI 1.06-1.15; p<0.001) were independently associated with dysphagia. Dysphagia (OR=3.78; 95%CI 2.16-6.61; p<0.001) and stroke severity (OR=1.05; 95%CI 1.00-1.09; p=0.024) were independently associated with death or functional dependence at three months. Conclusions: Dysphagia was present in almost half of stroke patients. Age, obstructive sleep apnea, and stroke severity were predictors of dysphagia, which was independently associated with death or functional dependence at three months.