Objective: analyse the occurrence of interpersonal violence against adolescents in the state of Ceará, identifying associations between types of violence and sociodemographic characteristics. Method: ecological study using secondary data on interpersonal violence against adolescents, produced by Epidemiological Surveillance and recorded in the Information System on Diseases and Notification (SINAN), from 2009 to 2022, in the state of Ceará, Brazil. Descriptive analyses were performed to characterise the occurrence of violence. The association between this occurrence and the explanatory variables was assessed using simple linear regression. Results: in the state of Ceará, the highest occurrence of violence was among female adolescents aged 15 to 19 years (59.04%). The home was the location with the highest occurrence (p<0.002). The aggressor was mostly the victim’s mother and father. The assaults occurred more than once. Conclusion: adolescents showed vulnerabilities and greater exposure to other forms of violence, based on their sociodemographic characteristics, with potential risks to health problems and/or illnesses, impairing their health conditions.
Introduction: exclusive breastfeeding up to six months is a well-established recommendation by the World Health Organization, supported by robust evidence of its benefits for child health. However, global and national rates remain below ideal levels, with less than half of Brazilian children being exclusively breastfed until that age. Early introduction of complementary foods is associated with increased risks of overweight, obesity, and changes in the infant gut microbiota. The choice of ultra-processed foods reflects not only concerns about children’s health but may also indicate socioeconomic inequalities disguised as convenience. Factors such as low maternal education, reduced family income, and limited access to health services can negatively influence feeding practices early in life. Objective: to analyze the relationship between neonatal screening, socioeconomic conditions, and early introduction of complementary feeding among infants under six months of age. Method: infant feeding patterns were investigated in relation to neonatal care indicators (heel prick test, hearing screening, and pentavalent vaccination). The effects of neonatal care were analyzed using multivariate logistic regression models, with sex, caregiver’s race/skin color, and per capita income as control variables, and feeding practices as outcomes. A significance level of p < 0.05 was adopted. Statistical analyzes were performed using SPSS software version 25. Results: the prevalence of exclusive breastfeeding was 25.9%. Consumption of healthy foods was observed in 89.2% of infants, while 57.3% consumed unhealthy foods. Non-nutritive liquid intake occurred in 45.9% of infants. Socioeconomic characterization showed that most caregivers were female, self-identified as brown, and 89.8% of families had a per capita income below two minimum wages. Furthermore, 9.6% of infants did not undergo the heel prick test before the fifth day of life, and 44.2% did not take the hearing test before the second day of life. Additionally, 16.5% of infants presented incomplete pentavalent vaccination, with fewer than three doses administered. Conclusion: early introduction of complementary feeding among infants under six months was associated with delayed neonatal screening, incomplete vaccination, and unfavorable socioeconomic conditions. Infants who underwent timely neonatal screening showed a higher prevalence of exclusive breastfeeding, while families with lower income were more likely to discontinue breastfeeding early. These findings highlight the importance of public policies integrating health actions and social equity measures to promote adequate feeding practices from the first months of life.
Introduction: epidemics have recurrently shaped human history, influencing demographic processes, social organization, economic systems, and public health policies. The COVID-19 pandemic has renewed interest in understanding historical epidemic patterns and their implications for contemporary health systems. Objective: to analyze the most impactful epidemics in world and Brazilian history, contextualizing COVID-19 within a historical framework and identifying recurring epidemiological, social, and political patterns. Methods: this is a narrative historical-epidemiological review based on classical and contemporary literature, historical documents, epidemiological records, and scientific publications addressing major epidemics and pandemics from antiquity to the present, with emphasis on Brazil. Results: the analysis demonstrates that epidemics such as plague, cholera, influenza, smallpox, tuberculosis, and COVID-19 share common determinants, including population density, social inequality, urbanization, sanitation deficits, and delayed public health responses. Recurrent social reactions, misinformation, resistance to sanitary measures, and political tensions were observed across different historical periods. Conclusion: epidemics are not isolated events but recurring phenomena shaped by social, environmental, and political contexts. Historical knowledge is essential to strengthen public health preparedness, guide evidence-based policies, and reduce the impact of future pandemics.
Introduction: the global prevalence of abdominal aortic aneurysms was 0.92% in 2019, with regional variations related to risk factors and access to treatment. Endovascular repair has become the preferred approach due to its lower mortality rate than open surgery, with a significant increase in use between 2004 and 2015. Within this context, percutaneous endovascular repair has emerged as a minimally invasive alternative, associated with a reduction in complications and surgical time, although its effectiveness may be limited in cases of complex vascular anatomy. Percutaneous access to the femoral artery has been widely used, providing lower morbidity, emphasizing the importance of careful vascular planning. Objective: evaluating the experience of a vascular surgery service in using the percutaneous endovascular aneurysm repair technique and comparing the outcomes related to percutaneous access and conventional access by femoral dissection. Methods: this is an observational, descriptive, and retrospective study with a quantitative approach, conducted with 42 patients who consecutively underwent endovascular repair via percutaneous access or femoral dissection at a private tertiary hospital located in Santo André, São Paulo. Data was extracted from electronic medical records and organized into spreadsheets for analysis of clinical and epidemiological variables. Results: of the 67 patients initially assessed, 42 met the inclusion criteria, 71.43% were male and 28.57% female. Elective procedures accounted for 52.38% of cases, while 47.62% were emergency surgeries. The overall rate of local complications was 16.67%, and the perioperative mortality rate was 14.28%. There was a higher perioperative mortality rate in patients who underwent femoral dissection (20%) compared to puncture access (5.9%), although this was not statistically significant. The Perclose ProGlide device had a success rate of 98.48%. The most frequent pathology was abdominal aortic aneurysm (42.86%). Conclusion: the percutaneous approach had lower rates of local complications and perioperative mortality compared to femoral dissection, proving to be a safer and more effective alternative for the endovascular treatment of aortic pathologies. On the other hand, dissection, because it is a more invasive procedure, was associated with a higher incidence of local complications, reinforcing the preference for the percutaneous approach whenever technically feasible.
Introduction: in Brazil, non-pharmacological measures were put into practice to reduce the transmission of SARS-CoV-2. Objective: evaluate the effect of Social Distancing on the incidence of COVID-19 in the municipalities of Espírito Santo. Methods: ecological study by regional aggregate to evaluate the effect of SD by the Work Mobility on the adjusted municipal incidence rate of COVID-19 in Espírito Santo from March 2020 to December 2022. Results: Covid incidence rates were positively associated with Work Mobility (β:0,028; IC: -0,010; 0,047). When stratified by health region and density tertiles, only the South region and the tertile with the highest demographic density maintained the association. Conclusion: the adoption of Social Distancing measures should incorporate demographic density as a vulnerability criterion in future epidemiological risk situations.
Introduction: hypertrophy of the ligamentum flavum, also called yellow ligament, is a major contributor to lumbar spinal canal stenosis in degenerative spine diseases. Elastic fibers, collagen, proteoglycans and glycosaminoglycans are key components of the extracellular matrix of the ligamentum flavum, playing essential roles in maintaining its structural integrity and function. However, the molecular mechanisms underlying ligamentum flavum hypertrophy, particularly those involving alterations in glycosaminoglycans composition, remain poorly understood. Objective: to analyze the composition of glycosaminoglycans in the ligamentum flavum of patients with degenerative lumbar spine diseases, with the aim of identifying molecular alterations associated with ligamentum flavum hypertrophy. Methods: thirty Ligamentum flavum samples were surgically obtained from patients diagnosed with either lumbar disc herniation or spinal canal stenosis. Sulfated glycosaminoglycans were extracted, identified, and quantified using agarose gel electrophoresis and specific glycosidases digestion. Ligamentum flavum thickness was measured using magnetic resonance imaging, and statistical analyses were performed to assess correlations between ligamentum flavum thickness and glycosaminoglycans composition. Results: a significant increase in chondroitin sulfate level was detected and found to be positively correlated with the degree of ligamentum flavum thickening. In contrast, dermatan sulfate levels did not show significant variation across different degrees of ligamentum flavum hypertrophy. Conclusion: ligamentum flavum hypertrophy in degenerative lumbar spine conditions is associated with specific alterations in glycosaminoglycans composition, particularly an increase in chondroitin sulfate content. These findings suggest that chondroitin sulfate, a highly anionic constituent of the extracellular matrix, may play a pivotal role in the pathophysiology of ligamentum flavum thickening observed in degenerative lumbar spine disease.
Obesity, considered a severe global epidemic, is increasing worldwide and has negatively impacted public health, leading to a rise in non-communicable chronic diseases. In this epidemiological scenario, anthropometric indicators capable of early identification of general and abdominal obesity, as well as predicting the risk of other health complications, are essential. The Body Roundness Index emerges as an alternative to the Body Mass Index, as it is a useful tool for identifying abdominal obesity and fat distribution, which are directly associated with cardiometabolic complications and mortality. Therefore, the Body Roundness Index is considered a promising tool for developing epidemiological population studies, clinical obesity diagnosis, and future risk prediction.
Introduction: Binge eating disorders and behaviors (BEDB) are frequently associated with multiple comorbid conditions, including obesity, metabolic disorders, and cardiovascular diseases, which often result in significant functional impairment and impose a substantial health burden. Given the clinical and public health relevance of these associations, this study aimed to estimate the lifetime, 12-month, and 30-day prevalence of BEDB—encompassing bulimia nervosa (BN), binge eating disorder (BED), and any binge eating disorders/behaviors (ABEDB)—while also examining their associations with chronic somatic conditions and sociodemographic characteristics. Methods: The study utilized data from the São Paulo Megacity Mental Health Survey, a population-based study comprising a representative sample of 2,942 adult residents of the São Paulo metropolitan area. Diagnoses were assessed using the Composite International Diagnostic Interview (CIDI 3.0), administered via face-to-face interviews, to determine lifetime, 12-month, and 30-day prevalence rates of DSM-IV-defined BN, BED, and ABEDB. Additional data included demographics and anthropometric measures (weight, height) as well as self-reported chronic health conditions, such as autoimmune disorders, neck/back pain, headaches, other chronic pain, brain/cardiovascular diseases, hypertension, chronic pulmonary disease, diabetes or glucose intolerance and gastrointestinal ulcer. Statistical analysis employed cross-tabulations to assess prevalence distributions by sociodemographic variables and comorbidity with chronic conditions and overweight, while bivariate analyses and Poisson’s regression models (STATA 17.0) evaluated associations, with significance set at p< 0.05. Results: The lifetime, 12-month, and 30-day prevalence estimates were, respectively, 2.0% (SE 0.3), 0.9% (SE 0.2), and 0.4% (SE 0.1) for BN; 4.7% (SE 0.3), 1.8% (SE 0.3), and 1.2% (SE 0.2) for BED; and 9.0% (SE 0.5), 3.4% (SE 0.4), and 2.0% (SE 0.3) for ABEDB. Women presented significantly higher BEDB rates, except for 12-month BN. Although prevalence was consistently higher among younger cohorts for all eating-related conditions, age-related differences reached statistical significance only for lifetime ABEDB. No significant differences emerged based on marital status, education, or income. Comorbidity analyses revealed that lifetime BN was most prevalent among individuals with gastrointestinal ulcers (8.2%, SE 2.8), headaches (3.5%, SE 0.6), neck/back pain (3.3%, SE 0.6), and hypertension (3.1%, SE 0.7). Lifetime BED showed elevated rates in those with chronic pulmonary disease (13.2%, SE 6.0), arthritis/rheumatism (10.0%, SE 2.1), gastrointestinal ulcers (9.2%, SE 2.6), neck/back pain (8.9%, SE 1.3), other chronic pain (7.7%, SE 1.2), and headaches (6.6%, SE 0.9). Similarly, lifetime ABEDB was most prevalent among respondents reporting gastrointestinal ulcers (18.1%, SE 3.1), neck/back pain (14.0%, SE 1.9), headaches (12.8%, SE 1.2), and other chronic pain (11.7%, SE 1.5). Conclusion: Binge eating disorders and behaviors are more prevalent among women and demonstrate high comorbidity with chronic health conditions, particularly gastrointestinal, musculoskeletal, and pain-related disorders. These findings highlight the need for integrated public health strategies and clinical interventions to address the dual burden of BEDBs and chronic somatic conditions, ensuring comprehensive care for affected individuals.
Introduction: cases of congenital syphilis have been increasing in Brazil, and the quality of data recorded in the surveillance system may impact the information used in primary care. Objective: To evaluate the quality of data in the epidemiological surveillance system for congenital syphilis from 2017 to 2021. Methods: evaluation study using descriptive statistics and Spearman’s correlation test, analyzing records of congenital syphilis in the Notifiable Diseases Information System, in order to evaluate completeness, consistency and timeliness of data entry (2017–2021), as well as its linkage with the Mortality Information System, in order to evaluate representativeness. Results: a total of 1,575 cases were reported during the study period. Completeness ranged from 92.5% to 96.2%, while consistency ranged between 80.4% and 97.3%. The time between diagnosis and notification was delayed (median of 3 to 4 days), while data entry was timelier (median of 3 to 8 days). The representativeness of this system was classified as moderate, with a correlation of 0.65 (p ≤ 0.001) between the records of deaths in the analyzed systems. Nevertheless, consistency between the reported deaths and the completion of the date of occurrence was considered very poor. Conclusion: the surveillance system for congenital syphilis was considered complete and consistent in most of the evaluated points, agile in entering cases, late in detecting them and moderately representative, indicating the need for improvement; however, it is important for the implementation of surveillance actions.
Introduction: there are many distinct mental disorders, with different presentations. They are generally characterized by a combination of abnormal thoughts, perceptions, emotions, behavior, and relationships with others. Mental disorders include depression, bipolar disorder, schizophrenia, alcoholism, substance abuse disorders, psychosis in general, dementia, and developmental disorders, including autism. Even so, it is one of the areas that receives the least attention and funding from public health. Around 1 billion people live with a mental disorder, 3 million people lose their lives every year due to harmful alcohol use, and one person dies every 40 seconds by suicide. Objective: to analyze mortality due to mental and behavioral disorders in Brazil from 2009 to 2019. Method: this is a cross-sectional, observational, ecological epidemiological study using official data from the Mortality Information System (MSS) and the Hospital Information System. Data were collected by place of occurrence and place of residence among patients in Brazil from 2009 to 2019. Hospital Admission Authorization Forms and Admission Notification Forms were included. The data source was the Death Certificate. Results: analyzing mortality due to mental and behavioral disorders between the sexes, it was noted that only male patients showed a reduction in the rate in all Brazilian regions, highlighting the Northeast ( β = -0.27, p = 0.001), Southeast ( β = -0.20, p = 0.003) and South ( β = -0.19, p = 0.023) regions, which showed significant reductions. When making a comparison in the studied series, both sexes showed a reduction, but only the male sex had a significant decline (male: β = -0.20, p = 0.001; female: β = -0.03, p = 0.146). Conclusion: mortality from mental and behavioral disorders revealed higher rates in 2011 (7,376), corresponding to a greater proportion of males (11.25), especially single individuals, in all regions of the Brazilian federation unit. Regarding the total analysis of deaths in the study series, there was an increase in mortality among females, with prevalence in the Northeast Region and in widowed marital status.
Introduction: exposure to adverse childhood experiences is considered an important predictor for excess weight or obesity. Objective: this study aimed to analyze the link between exposure to adverse childhood experiences and excess weight in late adolescence. Methods: the data were obtained between 2016 and 2017. A binary logistic regression model was used to investigate the link between to adverse childhood experiences and excess weight in late adolescence, independently of adjustment variable. A 5% significance level and 95% confidence interval were adopted. Results: a total of 2,285 adolescents aged between 15 and 19 years old, from a metropolitan region of Brazil, participated in the study. “Sexual abuse” (OR=1.39; CI95%: 1.008-1.921), “domestic violence” (OR=1.71; CI95%: 1.066-2.734), “parental divorce or separation” (OR=1.3; CI95%: 1.015-1.689), “physical neglect” (OR=1.90; CI95%: 1.354-2.672), “emotional neglect” (OR=1.76; CI95%: 1.279-2.432), and cumulative exposure to between four and 10 adversities (OR=1.64; CI95%: 1.049-2.564) were positively linked with excess weight in late adolescence, compared to those who did not experience such adversities. Conclusion: it is concluded that adolescents who have experienced to adverse childhood experiences are more likely to become overweight compared to those who have not suffered such adversities. Thus, it is suggested that greater attention is paid to adverse childhood experiences in the prevention and treatment of obesity in adolescence.
Introduction: hepatopulmonary Syndrome contributes to increased morbidity in cirrhotic patients, and liver transplantation is currently the recognized curative treatment. Considering the importance of reducing mortality and morbidity in this group, the objective is to analyze the prevalence of postoperative complications in patients with hepatopulmonary syndrome. Objective: our study aims to expand knowledge about how hepatopulmonary syndrome influences the postoperative period of these pediatric patients. Methods: aretrospective analysis was conducted on pediatric patients (children and adolescents up to 18 years old) who underwent liver transplantation at a quaternary hospital between May 2018 and December 2023. Out of 295 pediatric transplants during the evaluated period, 18 were excluded due to retransplantation. Among the remaining 277 cases, 16 (5,77%) had confirmed Hepatopulmonary Syndrome through arterial blood gas analysis or echocardiogram with microbubble study. For patients with Hepatopulmonary Syndrome, were evaluated pre-transplant oxygen arterial pressure level, home oxygen therapy dependency before transplantation, intensive care unit stay duration, hospitalization duration, incidence of vascular and biliary complications, and mortality. Data was analyzed with the chi-square test with Yates correction and considered significant at p< .05. Results: among 3 patients dependent on oxygen before transplantation, one was documented oxygen-free within 3 months post-surgery. Arterial thrombosis was identified in 25% of patients, Portal vein thrombosis in 18,75% and biliary complications occurred in 50% of patients. All these complications were more prevalent in patients with, than without Hepatopulmonary Syndrome (p = 0.00019 for biliary complications, p=0.052 for arterial and = 0.01 for portal complications). The lethality was 37,5%, and 18,7% among those without Hepatopulmonary Syndrome (p> 0.05). Conclusions: pediatric patients with Hepatopulmonary Syndrome undergoing liver transplantation demonstrated a higher incidence of postoperative complications (specifically biliary complications and portal vein thrombosis) when compared with transplant patients without Hepatopulmonary Syndrome.
Purpose: this study aims to investigate the main complaints and ocular health problems in a specific region to facilitate better planning of public resources and the formulation of strategies aimed at reducing and controlling visual impairments and blindness. The focus is on assessing the epidemiological profile of patients treated at the ophthalmological emergency room of Santo André. Methods: we conducted a cross-sectional and retrospective study involving 165,714 patients who sought primary care at the ophthalmic emergency room of Centro Hospitalar Municipal de Santo André from 2011 to 2016. Data on age, gender, city of origin, diagnosis, conducted treatment, and date of care were collected. Descriptive statistics were employed to summarize the dataset, and distributions were presented using measures of central tendency and variability. Qualitative data were displayed in absolute and relative frequencies. Results: during the analyzed period, a total of 165.714 patients sought treatment at the ophthalmological emergency room. Among them, 52.25% were men, and 47.75% were women. The mean age of the general population seeking care was 37±20 years. External diseases (56.22%) and ocular trauma (14.12%) were the leading reasons for these visits. Conclusion: this study provides a comprehensive analysis of the epidemiological profile of patients attending a reference service in ophthalmic emergency during the proposed period. The findings reveal noteworthy changes in the population’s profile over the last decade. These insights can inform and guide healthcare providers and policymakers in implementing targeted interventions to address eye health issues effectively.
Introduction: this case report highlights the unique and severe impact of social stigma on the clinical course of leprosy. It presents the story of a 63-year-old patient diagnosed with indeterminate leprosy who lived in social isolation for over 30 years and ultimately died due to multiple health complications. The case illustrates how stigmatization can substantially aggravate the biopsychosocial burden of a condition that is potentially controllable with early diagnosis and adequate treatment. Case Report: the main clinical features included progressive physical and psychological deterioration, compounded by self-isolation and lack of social support. Despite the availability of treatment, the patient experienced a therapeutic failure attributed mainly to delayed diagnosis, social neglect, and the absence of coordinated follow-up. Method: this retrospective, descriptive report was based on data extracted from medical records and analyzed qualitatively. Results: The findings reveal that operational and sociocultural barriers, such as incomplete patient records, stigmatizing attitudes, and limited involvement in the self-care process, contributed to the deterioration of the patient’s clinical condition and a reduced quality of life. Discussion: the case highlights the importance of a comprehensive care approach in leprosy management, extending beyond pharmacological treatment. Early diagnosis must be accompanied by psychosocial support and strategies to combat stigma and promote inclusion. One of the main findings of this case is that therapeutic success in leprosy is intrinsically related to social determinants of health; in the absence of effective strategies to address stigma and longitudinal, integrated follow-up, even clinically treatable conditions can progress to adverse outcomes. Conclusion: The limiting factor of this report was the sparse chronological documentation in the medical records. Beyond pharmacotherapy, the active involvement of the patient’s social network is essential in mitigating stigma, preserving self-esteem, promoting treatment adherence, and supporting social inclusion.
Introduction: Post-traumatic stress disorder (PTSD) is a public health issue with higher prevalence among public safety professionals due to the traumatic nature of their work. These professionals face significant risks to their mental health, quality of life, and occupational performance. However, data on the prevalence and determining factors of PTSD in this population remain limited. Objective: to assess the prevalence of post-traumatic stress disorder and identify factors associated with its development among public safety professionals. Methods: a cross-sectional study was conducted with 206 public safety professionals from Espírito Santo, Brazil. The PCL-5, WHOQOL-BREF, DASS-21, and socioeconomic questionnaires were applied. PTSD was defined as a PCL-5 score ≥36. Data analysis included non-parametric tests, Poisson regression with robust variance, and chi-square tests using R, SPSS, and STATA. The study was approved by the University of Espirito Santo Research Ethics Committee (approval number 5.382.872/2022). Results: 37.4% of participants showed probable PTSD. Factors associated with lower post-traumatic stress disorder prevalence included older age, male sex, and higher quality of life in the psychological and environmental domains. Greater intensity of stress symptoms was significantly associated with higher prevalence of post-traumatic stress disorder. Conclusion: this study’s findings highlight the association between emotional stress perception, psychological and environmental quality of life domains, and post-traumatic stress disorder, as well as intrinsic factors such as age and sex. These results reinforce the need for the development and implementation of public mental health policies focused on early screening and diagnosis of mental disorders, stress management, and promotion of well-being for public safety professionals, aiming to improve occupational and psychological quality of life, reduce stress, and prevent or manage post-traumatic stress disorder.
Introduction: obesity is a major public health issue, linked to chronic stress and metabolic dysregulation. While biological mechanisms of sedentary behavior in obesity are well known, epigenetic factors, particularly those involving the NR3C1 gene, remain unclear, especially in genes related to the regulation of chronic stress and metabolism, such as NR3C1. Objective: this study aimed to investigate the methylation profile of the NR3C1 gene in obese individuals with physical inactivity. Methods: this cross-sectional study included 119 adult volunteers with obesity (BMI ≥30) who accessed public primary health care services. Individuals using glucocorticoids were excluded. Socioeconomic, health, and lifestyle data were collected using structured questionnaires, and depressive symptoms were assessed using the Beck Depression Inventory (BDI-II). Peripheral blood samples were collected in the morning for cortisol quantification and molecular analysis of the NR3C1 gene via pyrosequencing. Multivariate Poisson regression was applied to identify factors associated with physical inactivity. Results: poisson multivariate regression analysis with robust variance showed that physical inactivity was associated with NR3C1 gene hypermethylation at CpGs 44, 45, and 46 in obese individuals and showed that physical inactivity was associated with low cortisol in the obese population. Conclusion: this study suggests an association between a sedentary lifestyle and changes in NR3C1 gene methylation in obese individuals. The association between physical inactivity and low cortisol levels strengthens the hypothesis that a sedentary lifestyle may involve epigenetic action in the dysregulation of the HPA axis of stress adaptation in obese individuals.
Introduction: chest pain is the leading cause of hospitalization in emergency departments. The presence of care tools can promote the standardization of nursing activities and ensure safer and more effective care. Objective: to develop and validate a nursing care flowchart for the management of patients with acute coronary syndrome in emergency departments, aiming to standardize procedures and improve the quality of care. Method: this methodological study followed the following steps: integrative literature review, cross-mapping, flowchart development, focus group content assessment, and expert validation. Results: twenty-eight scientific articles were selected, and 38 clinical indicators were identified. After cross-mapping, these resulted in 17 interventions and 115 nursing activities. These activities were then developed into a nursing care flowchart , which was assessed by a focus group and validated by experts. Conclusion: the development of a nursing care flowchart is a viable, accessible, and necessary care technology to improve patient care for chest pain due to acute coronary syndrome, throughout all phases of emergency care.
Introduction: most studies on multimorbidity prevalence are conducted in community settings or within primary care in high-income countries. Research in emergency services, particularly in low- and middle-income countries, is scarce. Objective: analyze multimorbidity in patients treated at an emergency care unit in the municipality of Vitória, Espírito Santo, Brazil, in the year 2019. Methods: this cross-sectional study involved 1,177 individuals aged 18 years or older who were treated at an emergency care unit in Vitória, Espírito Santo, Brazil. Participants were randomly selected over a 30-day period in 2019. Structured interviews were conducted, and statistical analyzes included descriptive statistics, bivariate analyses, and Poisson regression. Results: multimorbidity prevalence was 45.5% (≥2 chronic conditions), significantly associated with sex (Prevalence Ratio [PR] in male = 0.6; 95% CI: 0.5–0.7; p < 0.001), age (PR in ≥60 years = 2.4; 95% CI: 1.9–3.0; p < 0.001), and self-rated health (PR in “good/excellent” = 0.7; 95% CI: 0.6–0.8; Over 80% of participants used emergency services in the previous year. Multimorbidity was significantly associated with any use of emergency services (PR = 1.3; 95% CI: 1.1–1.5; p = 0.007) and frequent use (≥5 visits per year) (PR = 1.5; 95% CI: 1.2–1.8; p < 0.001) in the last year. Conclusion: among users of emergency services, the prevalence of multimorbidity and previous use of this type of service is high. These findings reinforce the idea that disease burden is a key factor in understanding how people use health services.
Introduction: Guided Bone Regeneration (GBR) is a technique that uses membranes as physical barriers to promote new bone formation in defect areas, preventing soft tissue invasion. The G21 dental regenerative membrane, composed of non-resorbable polyamide, presents promising characteristics, such as biocompatibility, impermeability, and structural stability. Objective: to evaluate the clinical efficacy of the G21 membrane in alveolar preservation after extraction for dental implant placement. Method: this is a prospective clinical case report involving a 43-year-old male patient who underwent extraction of the upper right first molar with extensive periradicular lesion. The G21 membrane was installed immediately after extraction and removed after 15 days. Clinical and radiographic follow-up was performed in three phases: preoperative, immediate postoperative (15 days), and late postoperative (80 days), focusing on bone formation and viability for dental implant placement. Results: the G21 membrane demonstrated excellent clinical integration, with no signs of inflammation or rejection. Granulation tissue formation was evident at 15 days, and new bone formation was confirmed by imaging after 80 days. Clinical application proved straightforward, without the need for further surgery to remove the membrane. Conclusion: the G21 polyamide membrane demonstrated satisfactory results in guided bone regeneration, demonstrating a viable, safe, and effective alternative for clinical use in alveolar preservation without the use of grafts.
Introduction: epigenetic alterations in glucocorticoid receptor gene (NR3C1) have been associated with psychosocial stress, however, their potential role in obesity remains unclear. Objective: given the complex interplay between psychosocial stress, HPA axis dysregulation, and obesity, the aim of this study was to investigate the association between overweight status and NR3C1 DNA methylation in adults. Methods: this study was characterized as a cross-sectional analysis. Two hundred and eighty-two Brazilian adults aged between 20 and 59 years were recruited from a public primary health care service. Participants underwent an anthropometric assessment. Venous blood samples were collected and NR3C1 DNA methylation was quantified using pyrosequencing. The association between overweight and NR3C1 DNA methylation was assessed using Mann-Whitney U test, Spearman correlation test and multivariable Poisson regression with robust variance (p<0,05). Results: the overweight group had lower DNA methylation levels than the non-overweight group for both total and CpG site-specific methylation (p <0.05 and p corrected= 0.037). Through factor analysis, two bins of CpGs were extracted, which were intercorrelated. The low methylation in these bins and in the total segment was explained by overweight status, controlled by confounding variables. Conclusion: this is one of the first studies to suggest an involvement between weight accumulation and methylation changes in NR3C1, a complex gene that encodes the glucocorticoid receptor and regulates stress responsiveness.
